Gilbert KE, et al. - Researchers investigated if an observed performance monitoring in preschool age is associated with later onset of obsessive-compulsive disorder (OCD) and altered dorsal anterior cingulate cortex (dACC) volume through adolescence. Findings from this observational cohort study of 292 preschool children demonstrate a significant correlation between heightened performance monitoring and onset of obsessive-compulsive disorder during the next 12 years and smaller right dorsal anterior cingulate cortex volume across 3 neuroimaging scans. Hence early childhood observed performance monitoring constitutes a readily observed risk factor of OCD that can be distinguished in preschool-aged children.

Methods

• As part of the Preschool Depression Study, researchers conducted a longitudinal observational cohort study at an academic medical center.
• From September 22, 2003, through May 12, 2005, a sample of 292 children oversampled for depression, completed a performance-based observational task during which they received persistent negative evaluation.
• Behavioral coding of child performance monitoring was done by blind raters.
• Annual diagnostic assessments were completed by children during the next 12 years; 133 completed the final behavioral follow-up and 152 contributed 1 to 3 magnetic resonance imaging scans.
• They completed follow-up on August 14, 2017.
• Main outcomes and measures included onset of DSM-5 diagnosis of OCD from baseline to the final behavioral assessment and whole-brain–adjusted dACC volume at the 3 waves of scanning.

Results

• The baseline evaluation was completed by 292 preschool children (51.4% boys; mean [SD] age, 4.5 [0.8] years), when controlling for demographic and clinical indicators.
• Among these, children exhibiting observed heightened performance monitoring had 2 times higher tendency to develop OCD (n = 35) during the next 12 years (odds ratio, 2.00; 95% CI, 1.06-3.78; P=.03).
• Multilevel modeling of dACC volume across the 3 scan waves (n = 152) demonstrated an association of heightened performance monitoring with smaller right dACC volume (intercept estimate, -0.14; SE, 0.07; t = -2.17; P=.03).