Task Control Circuit Targets for Obsessive Compulsive Behaviors in Children

Study Overview
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Brief Summary
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This study will use magnetic resonance imaging (MRI) to assess the function and structure of overlapping task control circuits in children with a range of Obsessive-Compulsive symptoms (OCS). The functioning of task control circuits will be assessed using the well-validated Multisource interference task (MSIT). This study will also assess functional and anatomical connectivity within task control circuits in the same children, and determine whether disturbances in these overlapping circuits are associated with Obsessive-Compulsive Disorder (OCD) symptom severity. Behavioral measures will be administered to further assess regulatory, learning and memory functions. Children with OCD will then be offered a standard course of up to 12 cognitive behavioral therapy (CBT), either via remote video conference sessions or in person visits when clinically indicated, before scanning (along with age-and gender-matched control participants) in order to assess how these circuits may change with treatment. Children with subclinical OC symptoms will be offered referral for treatment on an as-needed basis. In addition, de-identified data may be used in the future to conduct secondary data analyses. As more about OC symptoms and neurobiological mechanisms of interest in the current study are understood, data may be used to answer questions beyond those described in this protocol. All study procedures will be conducted on-site at Columbia University/the New York State Psychiatric Institute (New York, NY) and the University of Michigan's outpatient Child and Adolescent Psychiatry (Ann Arbor, Michigan).

Detailed Description
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Recruitment is complete.

Official Title
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Task Control Circuit Targets for Obsessive Compulsive Behaviors in Children

Conditions
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Obsessive-compulsive Disorders and Symptoms in Children

Intervention / Treatment
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* Behavioral: Cognitive Behavioral Therapy
* Other: Community Referral as appropriate


Participation Criteria
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Eligibility Criteria
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Obsessive-Compulsive Disorder (OCD) patient group INCLUSION: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Diagnosis of OCD as the principal problem Not on psychotropic medication and not receiving current psychotherapy for OCD Written informed assent by the participants and consent by the parent Participants and a parent/guardian must be able to read and understand English EXCLUSION DSM-5 current diagnosis of major depressive disorder, or substance/alcohol abuse DSM-5 lifetime diagnosis of psychotic disorder, bipolar disorder, eating disorder, pervasive developmental disorder, or substance/alcohol abuse Individuals who are currently receiving CBT, other forms of psychotherapy, or psychotropic medications (stable doses of stimulants or other types of ADHD medications - e.g. Guanfacine - are allowable for OCD subjects with comorbid attention deficit hyperactivity disorder following investigator review of medication; on day of study scan, subjects must be willing to refrain from taking medication until after scan is completed) Active suicidal ideation Females who are pregnant or nursing Major medical or neurological problems Presence of metallic device or dental braces Intelligence Quotient (IQ)<80 A current or past diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) Individuals who are currently receiving CBT, other forms of psychotherapy, or psychotropic medications Individuals who have received a full course of CBT in the past A positive pregnancy test Positive urine screen for illicit drugs Healthy controls INCLUSION: Written informed assent by the participants and consent by the parent Participants and a parent/guardian must be able to read and understand English EXCLUSION: Any current or lifetime psychiatric diagnosis Active suicidal ideation Females who are pregnant or nursing Major medical or neurological problems Presence of metallic device or dental braces IQ <80 A current or past diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) A positive pregnancy test Positive urine screen for illicit drugs Obsessive Compulsive Symptoms INCLUSION: Presence of obsession(s) and/or compulsion(s) but no current diagnosis of OCD (i.e.,<1 hour/day, no more than mild interference or distress) Not on psychotropic medication and not receiving current psychotherapy for OCD Written informed assent by the participants and consent by the parent Participants and a parent/guardian must be able to read and understand English EXCLUSION: DSM-5 current diagnosis of major depressive disorder, attention-deficit hyperactivity disorder, Tourette's/Tic Disorder, or substance/alcohol abuse DSM-5 lifetime diagnosis of psychotic disorder, bipolar disorder, eating disorder, pervasive developmental disorder, or substance/alcohol abuse Active suicidal ideation Females who are pregnant or nursing Major medical or neurological problems Presence of metallic device or dental braces IQ<80 A current or past diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) Individuals who are currently receiving CBT, other forms of psychotherapy, or psychotropic medications Individuals who have received a full course of CBT in the past Positive urine screen for illicit drugs

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 14 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Children ages 6-14 with OCD, obsessive compulsive symptoms, or healthy controls
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Obsessive Compulsive Disorder<br> | Behavioral: Cognitive Behavioral Therapy<br>* The treatment team will offer a course of up to 12 cognitive behavioral therapy (CBT) (45 minute sessions for 12 to 16 weeks), augmented by medication treatment when clinically indicated based on the clinical treatment standards. Due to Covid, therapy sessions are offered via remote video conference (in clinic sessions made available if clinically indicated). Cognitive-behavioral therapy (CBT) is a treatment based on learning and cognitive theories. CBT for Obsessive-Compulsive Disorder (OCD) involves gradually exposing patients to anxiety provoking stimuli while having patients refrain from engaging in compulsive rituals and/or avoidance behaviors. There are three major components of CBT treatment for OCD, specifically: (1) exposure to anxiety provoking stimuli, (2) response prevention, and (3) cognitive techniques intended to decrease anxiety during the exposure and response prevention processes.<br>|
| Other: Subclinical Obsessive-Compulsive symptoms (OCS)<br> | Other: Community Referral as appropriate<br>* Participants with Obsessive Compulsive Symptoms will be referred to the community for treatment<br>|
| No Intervention: Healthy Control<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood oxygen-level dependent (BOLD) functional MRI signal during a cognitive conflict task |  | up to 16 weeks after baseline (following 12 weeks of therapy for intervention groups); approximately 15-20 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood oxygen-level dependent (BOLD) functional connectivity MRI of task control circuits |  | up to 16 weeks after baseline (following 12 weeks of therapy for intervention groups);approximately 10 minutes | 
| Child Yale-Brown Obsessive Compulsive Scale | Child Yale-Brown Obsessive Compulsive Scale (CYBOCS) is scored on a scale of 0 to 40, with 40 being the most severe. | up to 16 weeks after baseline (following 12 weeks of therapy for intervention groups);approximately 1 hour | 
| Obsessive Compulsive Inventory - Child Version (OCI-CV) | Self-report assessment of obsessive compulsive symptoms, non-clinical to clinical range. | baseline assessment of all participants (OCD, subclinical OCS and HC) |