How Does Obsessive-Compulsive Disorder Affect Thinking and Decision-Making in Children and Teens?

What you need to know

• Children and teens with OCD showed differences in cognitive skills like decision-making, memory, and processing speed compared to those without OCD.
• These cognitive differences were not related to how severe a child’s OCD symptoms were.
• The cognitive differences remained even when accounting for differences in overall intelligence between the groups.

How OCD Affects Thinking in Young People

Obsessive-compulsive disorder (OCD) is a mental health condition that affects 1-3% of children and teens worldwide. People with OCD experience unwanted, intrusive thoughts (obsessions) and feel compelled to perform repetitive behaviors or mental acts (compulsions) to relieve anxiety.

While much research has looked at how OCD affects thinking and cognition in adults, less is known about its impact on children and teenagers. This study aimed to shed light on how OCD may influence various cognitive skills in young people.

The Study Design

Researchers compared 119 children and teens newly diagnosed with OCD to 90 peers without any psychiatric disorders. All participants completed tests measuring different aspects of thinking and cognition:

• Cognitive flexibility: The ability to switch between different tasks or thought processes
• Planning and decision-making
• Working memory: The ability to hold and manipulate information in mind for short periods
• Verbal and non-verbal fluency: The ability to generate ideas and solutions quickly
• Processing speed: How quickly the brain can take in and respond to information

The study was careful to include OCD patients who had not recently received medication or therapy for their condition. This helped ensure any cognitive differences were related to OCD itself rather than treatment effects.

Key Findings

Overall, the young people with OCD performed significantly worse on the cognitive tests compared to the control group without OCD. Specific areas where differences were seen included:

Cognitive Flexibility

Children with OCD had more difficulty on tests requiring them to switch between different tasks or rules. This suggests they may struggle more with adapting to changing situations or shifting their attention between different activities.

Decision-Making

The OCD group showed poorer quality of decision-making on a gambling task. This indicates potential difficulties weighing risks and rewards or making choices under uncertainty.

Working Memory

Participants with OCD scored lower on working memory tasks. Working memory is important for temporarily holding and manipulating information, which is crucial for many everyday activities and learning.

Processing Speed

The OCD group was slower on tasks measuring how quickly they could process information and respond. Slower processing speed can impact various areas of functioning in daily life.

Interestingly, the study did not find significant differences between the groups in planning ability or verbal/non-verbal fluency.

Important Considerations

There are a few key points to keep in mind when interpreting these results:

Not Tied to Symptom Severity

The researchers found no significant relationship between how severe a child’s OCD symptoms were and their performance on the cognitive tests. This suggests the cognitive differences may be a general feature associated with OCD rather than directly causing or resulting from symptom severity.

Independent of Overall Intelligence

While the OCD group had slightly lower overall intelligence scores than the control group, the cognitive differences remained even after accounting for this factor. This indicates the findings reflect specific cognitive differences related to OCD rather than just lower general intelligence.

Not Explained by Other Conditions

Many of the OCD patients also had other co-occurring mental health conditions. However, the cognitive differences were seen in OCD patients both with and without these additional diagnoses. This suggests the cognitive patterns are specifically related to OCD rather than other conditions.

What This Means for Families and Treatment

These findings have several important implications:

1. Cognitive challenges may be an under-recognized aspect of OCD in children and teens. Parents and clinicians should be aware that young people with OCD may struggle with certain thinking skills even if it’s not obvious from their symptoms.

2. Cognitive difficulties could impact a child’s functioning at school or in other areas of life. Accommodations or support may be helpful in some cases.

3. Existing OCD treatments primarily target reducing obsessions and compulsions. Future research should explore whether addressing cognitive skills could also be beneficial as part of treatment.

4. The cognitive differences don’t appear to directly cause OCD symptoms. However, they may contribute to ongoing difficulties or potentially interfere with the effectiveness of some treatments.

Conclusions

• Children and teens with OCD show differences in several areas of cognitive functioning compared to peers without OCD.
• These cognitive patterns appear to be a general feature associated with OCD rather than being directly related to symptom severity.
• More research is needed to understand how these cognitive differences develop and whether they should be specifically targeted in OCD treatment for young people.

While this study provides valuable insights, it’s important to remember that every child is unique. Not all young people with OCD will experience significant cognitive challenges, and many can still excel academically and in other areas of life with proper support and treatment.