Psychology Essay Help
An individual paper is required in this course.
It should be around 10 pages including the abstract and title page( The references not included). and must address literature review
about a topic focusing on attention in schizophrenia.
I uploaded an example below.
Neuropsychology of OCD 1
Running Head: Neuropsychology of OCD
Neuropsychological Profile of Childhood-Onset Obsessive-Compulsive Disorder
Metehan Irak & Martine M. Flament
University of Ottawa Institute Mental Health Research
September 16th , 2006
Neuropsychology of OCD 2
In this review paper, studies focusing on the neuropsychological characteristics of childhood-onset obsessive-
compulsive disorder (OCD) were evaluated. Systematic electronic searches were undertaken using MEDLINE
and Psycinfo databases (until June 2006). The presented results are of those that focus on the processes of
attention, memory, and executive functions related to the aspects of the measured instruments used. The aim of
this review was to provide a general neuropsychological profile of childhood-onset OCD based on the reviewed
studies. In general, results showed that there is no clear evidence that the neuropsychological aspects of
childhood-onset OCD differ from those of adult-onset OCD. In parallel with this, the processes of attention and
memory in childhood-onset OCD are observed to be selective and biased, and this bias is directed towards
threat-relevant stimuli related to obsessions and compulsions. In addition, dysfunction in memory and
visuospatial processes in OCD patients do not result from memory impairment per se, but rather from an
impaired ability to apply efficiently elaborated memory strategies. In childhood-onset OCD, the various lines of
evidence consistently include impairment of response suppression and motor inhibition abilities; there is less
consistent evidence for reduced set shifting, fluency, conceptual thinking, and planning ability. Whereas clinical
observation suggests that a central problem in OCD is at the meta-memory level and that people with OCD have
less meta-cognitive ability, processing of meta-cognition in childhood-onset OCD has not yet been investigated
adequately. Finally, the results of the reviewed studies were evaluated in terms of the effects of basic co-
morbidity, such as depression, Tourette’s disorder, tic disorder, and other confounding variables.
Key words: childhood-onset obsessive-compulsive disorder, attention, memory, executive functions
Neuropsychology of OCD 3
Clinical Characteristics of Childhood-Onset OCD
Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by repetitive obsessions
and compulsions. It is chronic, but can be cyclic, significantly affecting an individual’s social and daily
functioning. Although OCD has been recognized as a disorder commonly observed in adulthood, studies have
shown that the prevalence rate of OCD is 1%-4 % among adolescents (Douglass et al., 1995; Flament et al.,
1988), with more than 80% of OCD patients reporting relevant symptoms starting before the age of 18 years
(Pauls et al., 1995). OCD is often comorbid with other psychiatric disorders, namely depression, tic disorder,
and other anxiety disorders. The onset of OCD has been observed earlier in boys than in girls, with behaviors
reaching their peak approximately around pre-adolescence, and then again in early adulthood (Pauls et al., 1995;
Rasmussen and Eisen, 1992; Zohar, 1999). Adult- and childhood-onset OCD differ from each other in terms of
certain clinical characteristics. Childhood-onset OCD, as opposed to adult-onset OCD, starts as early as
adolescence and progresses rapidly. These differences lead to neurobiological and other related consequences
(Sobin et al., 2000).
There have been numerous theoretical approaches about the etiological factors and treatment of OCD,
including psychological and neurobiological explanations. , Recently, cognitive-behavioral therapy (CBT) and
pharmacological treatment approaches have been commonly used for the treatment of OCD. Although both of
these treatment approaches are used for childhood-onset OCD, it is a common opinion that there is a need for
more research on the effectiveness and reliability of these treatment modalities (Flament and Cohen, 2002). On
the other hand, research focusing on OCD suggests that neuropsychological approach/evaluation is becoming
more common. Based on this, in the following paragraphs theoretical approaches and research findings focusing
on the neuropsychological characteristics of OCD are discussed.
Neuropsychology of OCD 4
Neuropsychological Test Results in Childhood-Onset OCD
Today, the existence of many neuropsychological tests with advanced psychometric characteristics,
which are sensitive to detailed brain functioning, makes it possible for neuropsychological tests to be taken by
patient groups, to be performed on one dimension, and to be score-based. With these particular characteristics,
neuropsychological testing and evaluation, like in other psychiatric disorder groups, are part of the research
approach focusing on cognitive processes in OCD. We reviewed studies on the neuropsychological performance
of childhood-onset OCD patients and present an evaluation of the results. With this purpose in mind, a literature
search was performed using both MedLine and PsycInfo databases encompassing studies dated until June 2006.
This study included research investigating the neuropsychological performance of 0 to 19 year-old OCD
patients, and did not directly investigate the effects of any treatment methods (pharmacotherapy and/or
psychotherapy) on their effects on cognitive performance. The keywords used in the literature search were as
follows: OCD, neuropsychology, cognition, attention, memory, executive functions, information processing,
meta-cognition, and meta-memory. As a result of the literature search, 6 studies focusing on the relevant issues
were found and are presented in Table 1. Among these studies, only the study by Gladstone et al. (1993) was
published as a summary in a conference, and details of this study were taken from the review article by Cox
(1997). Findings are presented under attention, memory, and executive function subheadings, respectively.
Insert Table 1 here
In one of the first studies in this area, Foa and McNally (1986) found that in a dichotic listening task,
adult OCD patients understood or noticed threat-related words better than they did neutral words. The
difficulties experienced during cognitive performance are suggested to be closely related to anxiety, leading to
disruptive effects and interfering thoughts prohibiting fluency during cognitive processing, and occupying
consciousness (Eysenck, 1997; Gotlib et al., 1996). When cognitive functioning in OCD is in question, OCD
patients are said to not display any problems with attention performance. Cnsequently, the more commonly
accepted approach suggests that these patients have selective attention tendencies; defined as paying attention to
Neuropsychology of OCD 5
selective characteristics of stimuli in the environment and not paying attention to or ignoring the remainder of
the stimuli (Diniz et al., 2004; Kuelz et al., 2004; Moritz et al., 2004).
Many of the studies which have studied various aspects of attention performance in childhood-onset
OCD, have reported that it is less of a factor in adult OCD patients. In a study by Cox et al. (1989), the
neuropsychological performance of 8 to 18 year-old OCD patients was compared to that of a healthy control
group matched in terms of age, sex, and hand preference (Table 1). In terms of attention performance, the only
difference found between the two groups was in their dichotic listening task total linear scores; the total linear
percentage of the OCD group was lower than the healthy control group. Similarly, in a study by Gladstone et al.
(1993) 8 to 13 year-old children with Tourette’s disorder (TD) were matched for age, sex, and intelligence
quotient (IQ) with children diagnosed with OCD, and their neuropsychological performances were compared.
Results showed that the sustained attention performance in both groups was lower than normative values (Cox,
1997). The authors interpreted the results as attention being disrupted in OCD and TD (Gladstone et al., 1993).
In a study by Behar et al. (1984) the neuropsychological test performance of OCD patients (mean age:
13.7 years) who were receiving a 10-week clomipramine treatment were compared to a healthy control group
matched for age, gender, and IQ. Additionally, the sizes of their cerebral ventricles were measured with CT
(computer tomography). According to the CT results, cerebral ventricles of the OCD patients were significantly
larger than those of the healthy control group. Although in some memory tests the OCD group scored
significantly lower (Table 1) than controls, there was no significant difference between the scores of attention
and perception tests between the two groups. More specifically, although the scores of the Dihaptic (Tactual)
Testing, Reaction Time, and Two-Flash Threshold Test were in favor of the healthy control group, the
differences between the two groups were not found to be statistically significant. As the reaction time and
reaction threshold scores were not significantly different, the authors suggested that the lower scores of the
OCD patients on some neuropsychological tests could not be explained by an attention problem or by obsessive
style. In summary, the findings on attention indicate that in childhood-onset OCD, as in the adult group, there is
Neuropsychology of OCD 6
a bias in attention processing. However, as there are only a few studies on attention and the variation of the
basic characteristics measured by the applied tests, it was not possible to create a general profile on this topic.
Aspects of the behaviour seen in people with OCD (e.g., checking) are certainly suggestive of memory
problems (e.g., failure to appropriately encode memories for self-actions). For example, a problem such as
checking might indicate that the individual is either unable to code his or her behavior in memory in a suitable
way or that he or she cannot remember it. Although there are approaches suggesting a malfunction in the reality
checking and memory performance of OCD patients (Constans et al., 1995; Hermans et al. 2003), the results of
some studies do not support this. In a larger number of studies (Ceschi et al., 2003; MacDonald et al., 1997;
Tolin et al., 2001) no difference was found between various memory performances of OCD patients and the
healthy control group. Consequently, some studies have found that the memory performance of OCD patients
is diminished when compared to a healthy control group (Savage et al., 2000; Tallis et al., 1999; Tuna et al.,
2005; Zitterl et al., 2001), and that the memory performance related to threat-relevant stimuli is higher in OCD
patients than in a healthy control group (Constans et al., 1995; Randomsky and Rachman, 1999; Randomsky et
In a study performed by Flament et al. (1990), the neuropsychological performance of 10 to 18 year-old
OCD patients who received a 5-week clomipramine treatment was measured before and after the treatment (2-7
years) and was then compared to a healthy control group. The OCD group was observed to have made
numerous mistakes in The Money Road Map Test of Directional Sense, especially in tasks in which the position
was expected to be turned towards the right direction or the opposite direction. In the Stylus Maze learning task,
OCD patients were found to have elevated error rates during the task, and tended to brake more rules when
compared to the healthy control group. Although, in a follow-up study, an increase in the performance of OCD
patients on both tests were found, and the previously-mentioned error rates were in favor of the control group.
Additionally, the low performance scores in the neuropsychological tests were not related to symptom severity
in either of the measurements. The Money Road Map Test of Directional Sense is a test that measures basic
Neuropsychology of OCD 7
visual-spatial perception ability, such as mentally representing objects and their respective positions in space,
and transforming them if necessary (Zacks et al., 2000). The Stylus Maze learning task on the other hand, is a
test sensitive to right temporal lobe functioning, and measures learning and visual-spatial perception ability.
Results of this study, taking what both of the tests measure into account, suggest a problem in visual-spatial
perception/memory functioning in OCD.
These results obtained from the Flament et al. (1990) study are similar to the results obtained from
Behar et al. (1984). As mentioned before, the clinical group was found to have larger ventricles, and no
difference was found between the the groups on both their attention and perception test results. However, in
both of the studies, the OCD group performed lower than the control group in some memory scores. The results
showed that the away, toward, and combined scores on The Money’s Road Map Test of Directional Sense, the
error rate and rule breaking on the Stylus Maze Learning Task , and copying scores on the Rey-Osterrieth
Complex Design Test were all significantly different and favored the healthy control group. The authors suggest
that there is not enough evidence yet to explain this difference and noted a high level of depression in the OCD
group as a confounding variable. The negative effect depression severity, especially on the memory and
learning process of information processing (Eysenck, 1997; Gotlib, et al., 1996), supports this explanation. On
the other hand, clinical-level depression is a comorbid diagnosis often reported by OCD patients. Nonetheless,
in the studies summarized above, the significantly low cognitive performance levels in the OCD group were not
associated with OCD symptom severity or with other clinical measures, such as depression.
In contrast, in a study by Gladstone et al. (1993), although the subjects in the OCD group had no
problem in learning and recall performance with the vocabulary list task, their performance scores on drawing
both simple geometric designs and a complex figure was significantly lower than the normative scores. This
low level of performance was observed more in remembering complex figures. In spite of these results, the
authors argued that the OCD patients’ normal performance on the vocabulary learning and recall task, and their
low performance on the drawing simple and complex figure test are not sufficient enough to be able to
differentiate if these results are due to a memory deficit or if there is a disability in visual-spatial processing
Neuropsychology of OCD 8
during copying (Cox, 1997). However, the authors interpreted these results as a disability in
visuospatial/constructional deficit in OCD and TD (Gladstone et al., 1993). This interpretation is consistent with
the findings of Flament et al. (1990), which suggest a problem in visual-spatial memory/perception ability in
In summary, the findings regarding memory do not suggest a memory malfunction in OCD. The
findings do, however, indicate a different functioning in memory performance and visual-spatial perception
ability, which is not as functional, when compared to a healthy control group. Studies in support of and those
that do not support a memory problem in OCD are relatively balanced and this dilemma in memory
performance might be explained by a process prior to memory, such as attention. Thus, selective and biased
functioning during the attention process seems to lead to related memory bias functioning and visual-spatial
The idea that there is little evidence that supports either memory or attention problems in OCD, and that
OCD patients have a memory and attention bias, leads one to think that the source of this bias might be a meta-
cognitive system problem. As a matter of fact, there are many studies (Cox 1997; Kuelz, et al., 2004; Moritz, et
al., 2002; Otto, 1992) suggesting a problem in executive functions in OCD patients. Executive functions are
used to define high-level cognitive functioning. More specifically, executive functions refer to ‘higher-order
cognitive functions’, such as volition, planning, self-regulation, maintenance of cognitive set and set-shifting
ability, goal directed behaviours, sustained attention, impulse control, motor inhibition, and working memory
(Lezak, 1995; Spreen and Strauss, 1998). These high level functions enable the coordination and integration of
basic lower level cognitive functioning. In general, executive functions are associated with the frontal lobe.
Set shifting, planning, and perseveration are the most commonly studied executive function defecits in
OCD. Studies done in this area (Abbruzzese et al., 1997; Bohne et al., 2005; Cavedini et al., 1998; Morritz et
al., 2001; Rowe et al., 2001; Spitznagel and Suhr, 2002) found that adult OCD patients’ executive function
scores were lower than in healthy controls. On the other hand, different studies investigating the same executive
Neuropsychology of OCD 9
functions found that the performances of the OCD patient and control group were not always the same. Kuelz et
al. (2004), noting these differences in the results, suggested that insufficient matching, in terms of education
level, co-morbidity, and medication use, might cause these differences.
In a study performed by Bornstein (1991), the neuropsychological test performance of 100 OCD and TD
patients aged 6 to 18 years, including low and high symptom severity OCD groups, were compared using the
Wisconsin Card Sorting Test (WCST) and Halstead-Reitan Test Battery. Results indicated that the only
significant differences were for the number of categories completed and perseverative error scores, with the
differences in favor of the OCD group with low symptom severity. On the other hand, no significant group
differences were found in any of the Halstead-Reitan Test Battery scores (Broshek and Jaffrey, 2000) measuring
various executive functions, such as memory, abstract thinking, language, sensorimotor integration,
imperceptions, and motor abilities. In spite of the fact that the high symptom severity OCD group had a higher
rate of medication use, no significant effect was found on the neuropsychological scores. Additionally, the
results of the variance analysis showed a significant effect of both duration of illness and symptom severity on
the number of completed categories and the perseverative error scores on the WCST. This suggested that the
low WCST scores could be explained by the OCD symptoms being more severe in this group. Conversely, there
were significant negative correlations between the degree of OCD severity, Wechsler Total IQ, number of
completed categories, and perseverative error scores of the WCST. These correlations did not change when the
results of partial correlation analyses were obtained, controlling for total IQ and symptom severity (according to
the TD Symptom List). These results also support the view that the low WCST scores could be explained by
OCD symptom severity. Finally, focusing on the increased number of perseverative errors, it was hypothesized
that the obsessive characteristics (alone or observed with TD) could be related to weak frontal lobe functioning,
especially in the orbitofrontal and dorsolateral frontal areas which contain the caudate nucleus (Bornstein,
1991). As a criticism of this interpretation, the only difference between the groups was in the perseveration
scores of the WCST, a result that weakens the interpretation. The neurophysiology of OCD corresponds to the
neural network, including the orbital cortex, caudate, and thalamus; however, in the relevant paper it is noted
Neuropsychology of OCD 10
that the TD-related primary brain areas are the basal ganglia. Although there are neuroanatomical studies
pointing to an association between the basal ganglia and frontal lobe (Delong et al., 1983; Schel and Strick,
1984), there is a need for brain observation studies and neuropsychological test results supporting a functional
relationship between these areas.
Beers et al. (1999) studied the neuropsychological test performance of 21 childhood-onset OCD patients
(mean age: 12.3 years) that did not receive any pharmacological treatment, and compared the results to those of
a healthy control group matched for age, gender, intelligence, and socioeconomic status (SES). Results
suggested that there were significant differences in Stroop’s word and color naming, Controlled Oral World
Association Test total score, and Go/No-Go Task B subtest scores, with those differences being in favor of the
OCD group. For all other tests, no significant group differences were found. These results were the opposite of
the expected results and they were explained by the patient group not being clinically depressed and not having
used any medication until the time of the study. In other words, in the Beers et al. (1999) study, no cognitive
dysfunction was observed in childhood-onset OCD patients who were not depressive, who were diagnosed
early, and who did not receive any medication treatment. Subsequently, some of the neuropsychological test
performance scores of this group were found to be higher than in the healthy control group. The results of this
study suggest the importance of co-morbidity as a major confounding variable in studies investigating cognitive
functioning in OCD. The fact that depression commonly accompanies OCD and, as mentioned previously,
depression affects cognitive processes negatively (Eysenck, 1997; Gotlib et al., 1996), we can conclude that
these notions support this approach. Additionally in both studies (Cox et al., 1989; Flament et al., 1990) there
was no significant association between neuropsychological measures and the severity of OCD symptoms.
Moreover, there was no mentioning of a relationship with other clinical observations. Yet, the relationship
between the level of depression and neuropsychological and cognitive measures was not investigated in any of
the reviewed studies. This fact is considered to be a common weakness of studies investigating cognitive
performance in childhood-onset OCD. Some authors, based on results with the adult group, considered that the
neuropsychological tests used might not have been sensitive enough to measure the functioning of the fronto-
Neuropsychology of OCD 11
striatal loop, which is the main structure involved in OCD, and suggested that the problems in cognitive
functioning observed in OCD might develop at later stages of the disorder. This situation leads to a new
research question. A longitudinal or cross-sectional study investigating how the cognitive processes in OCD are
affected would answer many significant questions in this area.
In a study by Gladstone et al. (1994), the WCST scores of the TD and OCD groups did not differ from
normative values. On the other hand both groups performed significantly lower in the continuous performance
test regarding eliminating the incorrect responses (Cox, 1997). In relevant studies it was unclear through which
test or task this performance was measured: however, the mentioned performance, the elimination of irrelevant
stimuli, is among the executive functions discussed in previous sections. As a matter of fact, although no
difference was found in WCST scores, the authors interpreted the significant decrease in eliminating incorrect
responses performance as a malfunction of the executive functioning in OCD and TD (Gladstone et al., 1993).
In conclusion, in spite of the fact that results of the studies investigating executive functioning in childhood-
onset OCD are inconsistent, the OCD patients demonstrated a lower performance in some executive functioning
tasks (i.e., response suppression and motor inhibition) and research findings on other executive functions are
In this paper, studies investigating the neuropsychological characteristics of childhood-onset OCD were
evaluated. Relevant evaluations were presented under the subheadings of cognitive processes, such as attention,
memory, and executive functions. Accordingly, results of studies of childhood-onset OCD support that memory
and attention are not dysfunctional in OCD, but that there is biased or selective memory and attention
functioning in OCD. The mentioned bias of memory and attention was observed to be directed at anxiety
provoking or threat-relevant stimuli related to obsessions and/or compulsions. Taking this into consideration,
childhood-onset OCD patients differed from healthy control groups in terms of selective memory and attention
bias related to these stimuli. The present findings did not demonstrate that these biases were different in
Neuropsychology of OCD 12
childhood-onset OCD than in adult-onset OCD or that specifically related with this age group. Basic factors,
such as the various neuropsychological tests being used or the variety of the sampling groups, limit the validity
of such an interpretation. Also, as mentioned in previous sections, attention plays a major role in memory when
it is a matter of information processing. When we consider attention and memory functioning together in OCD,
we can say that biased attention leads to biased memory. Nevertheless, the question of how the mentioned bias
changes according to the kind of memory and attention, still remains to be answered. Clinical observations
show that the memory bias is a working memory problem; however, this needs to be supported with additional
studies. With this in mind, a detailed analysis of the relationship between attention and memory processes in
childhood-onset OCD, focusing on various attention and memory tasks, would help answer many questions on
General results of the studies investigating executive functions demonstrated that childhood-onset OCD
patients, in comparison to healthy controls, performed significantly lower in the executive functions of response
suppression and motor inhibition. However, there are conflicting results in the studies of other executive
functioning, such as perseveration, set shifting, and fluency. These conflicts are also observed in the results of
adult-onset OCD patients, as well. As presented in previous sections, a general finding is that OCD groups, as
compared to the healthy controls, performed lower on tests (e.g. OAT, DAT) measuring the functioning of the
orbitofrontal area and executive functions, such as set shifting and fluency. However, these findings do not
contribute to create a general profile, as there are basic confounding variables, such as the variance in the study
groups. Additionally, these executive function tests which were used in the studies of childhood-onset and
adult-onset OCD are different. As a result, it is not possible to compare adult- and childhood-onset OCD based
on these findings. Studies using neuropsychological tests, which include OAT and DAT, and that measure
different aspects of executive functioning would be significantly helpful in enlightening many questions
regarding executive functioning in childhood-onset OCD.
Clinical observations of OCD indicate that the basic problem is at the meta-cognitive level. For
example, the fact that the trust on memory performance, which is a type of meta-cognitive function, is lower in
Neuropsychology of OCD 13
the OCD group than in the control group is a common finding in these type of studies. On the other hand,
studies on meta-cognition in childhood-onset OCD are almost non-existent. When the information processing
models in normal groups are considered, we see that meta-cognition (as a high-level system), in addition to
controlling, organizing, and managing information processing also plays a role in the transition among
subsystems (Nelson and Narens, 1990). In contemporary information-processing models on memory and
executive functioning, meta-cognition is seen to play a complementary and integrative role. Moreover, it is
suggested that using various experimental tasks that measure different aspects of meta-cognition will play a key
role in understanding information processes in OCD. There is a need for new findings and sub-models for
investigating the transitions among attention, memory, and executive functioning in childhood-onset OCD.
Along with this, the models developed for investigating cognitive and neuropsychological processes in
childhood-onset OCD need to be tested with new research designs that include meta-cognitive processes.
Neuropsychology of OCD 14
Abbruzzese M, Ferri S, Scarone S (1997) The selective breakdown of frontal functions in patients with
obsessive-compulsive disorder and in patients with schizophrenia: a double dissociation experimental finding.
Neuropsychologia, 35: 907-912.
Beers SR, Rosenberg DR, Dick EL, et al. (1999) Neuropsychological study of frontal lobe function in
psychotropic-naive children with obsessive-compulsive disorder. Am J Psychiatry, 156: 777-779.
Behar D, Rapoport JL, Berg CJ, et al. (1984) Computerized tomography and neuropsychological test measures
in adolescents with obsessive-compulsive disorder. Am J Psychiatry, 141: 363-369.
Bohne A, Savage CR, Deckersbach T, et al. (2005) Visuospatial abilities, memory, and executive functioning in
trichotillomania and obsessive-compulsive disorder. J Clin Exp Neuropsychol, 27: 385-399.
Bornstein RA (1991) Neuropsychological correlates of obsessive characteristics in Tourette syndrome. J
Neuropsychiatry Clin Neurosci, 3: 157-162.
Broshek DK, Jaffrey TB (2000) The Halstead-Reitan Neuropsychological Test Battery. Neuropsychological
Assessment in Clinical Practice: A Guide to Test Interpretation and Integration, G Groth-Marnat (Ed), New
York. John Wiley and Sons, s. 116-135.
Cavedini P, Ferri S, Scarone S, Bellodi L (1998) Frontal lobe dysfunction in obsessive-compulsive disorder and
major depression: a clinical-neuropsychological study. Psychiatry Res, 78: 21-28.
Ceschi G, Van der LM, Dunker D, et al. (2003) Further exploration memory bias in compulsive washers. Behav
Res Ther, 41: 737-748.
Constans JI, Foa EB, Franklin ME, et al. (1995) Memory for actual and imagined events in OC checkers. Behav
Res Ther, 33: 665-671.
Neuropsychology of OCD 15
Cox C, Fedio P, Rapoport JL (1989) Neuropsyhological testing of obsessive-compulsive adolescents. Obsessive
Compulsive Disorder in Children and Adolescents, JL Rapoport (Ed), Washington. American Psychiatric Press,
Cox C (1997) Neuropsychological abnormalities in obsessive-compulsive disorder and their assessments. Int
Rev Psychiatry, 9: 45-59.
Delong MR, Georgoppoulos AP, Crutcher AP (1983) Cortico-basal ganglia relationa and coding of motor
perfromance. Experimental Brain Research, 7: 30-40.
Diniz JB, Rosario-Campos MC, Shavitt RG, et al. (2004) Impact of age at onset and duration of illness on the
expression of comorbidities in obsessive-compulsive disorder. J Clin Psychiatry, 65: 22-27.
Douglass HM, Moffitt TE, Dar R, et al. (1995) Obsessive-compulsive disorder in a birth cohort of 18-year-olds:
prevalence and predictors. J Am Acad Child Adolesc Psychiatry, 34: 1424-1431.
Eysenck MV (1997) Anxiety and Cognition: A Unified Theory. Hove. Psychology Press, s. 53-88.
Flament MF, Whitaker A, Rapoport JL (1988) Obsessive compulsive disorder in adolescence: an
epidemiological study. J Am Acad Child Adolesc Psychiatry. 27: 764-771.
Flament MF, Koby E, Rapoport JL, et al. (1990) Childhood obsessive-compulsive disorder: a prospective
follow-up study. J Child Psychol Psychiatry, 31: 363-380.
Flament MF, Cohen D (2002) Emotional regulation and affective disorders in children and adolescents with
obsessive compulsive disorder. Emotional Development, J Nadel, D Muir (Ed), New York. Oxford University
Press, s. 383-408.
Foa EB, McNally RJ (1986) Sensitivity to feared stimuli in obsessive-compulsives: A dichotic listening
analysis. Cognitive Therapy and Research, 10: 477-485.
Neuropsychology of OCD 16
Gladstone M, Carter AS, Schultz RT, et al. (1993) Neuropsychological functioning of children affected with
Tourette syndrome and obsessive-compulsive disorder. J Clin Exp.Neuropsychol, 15: 70.
Gotlib IH, Roberts JE, Gilboa E (1996) Cognitive interference in depression. Cognitive interference: Theories,
methods, and findings. IG Sarason, GR Pierce, BR Sarason (Ed), New Jersey. Lawrence Erlbaum, s. 347-377.
Hermans D, Martens K, De Cort K, et al. (2003) Reality monitoring and metacognitive beliefs related to
cognitive confidence in obsessive-compulsive disorder. Behav Res Ther, 41: 383-401.
Kuelz AK, Hohagen F, Voderholzer U (2004) Neuropsychological performance in obsessive-compulsive
disorder: a critical review. Biol Psychol, 65: 185-236.
Lezak K (1995) Neuropsychological Assessment. 3. baskı, Oxford. Oxford University Press, s. 650-685.
MacDonald PA, Antony MM, Macleod CM, et al. (1997) Memory and confidence in memory judgements
among individuals with obsessive compulsive disorder and non-clinical controls. Behav Res Ther, 35: 497-505.
Moritz S, Fricke S, Wagner M, et al. (2001) Further evidence for delayed alternation deficits in obsessive-
compulsive disorder. J Nerv Ment Dis, 189: 562-564.
Moritz S, Birkner C, Kloss M, et al. (2002) Executive functioning in obsessive-compulsive disorder, unipolar
depression, and schizophrenia. Arch Clin Neuropsychol, 17: 477-483.
Moritz S, Jacobsen D, Kloss M, et al. (2004) Examination of emotional Stroop interference in obsessive-
compulsive disorder. Behav Res Ther, 42: 671-682.
Nelson TO, Narens L (1990) Metamemory: Theoretical framework and new findings. The Psychology of
Learning and Motivation, 26: 125-141.
Otto MW (1992) Normal and abnormal information processing. A neuropsychological perspective on obsessive
compulsive disorder. Psychiatr Clin North Am, 15: 825-848.
Neuropsychology of OCD 17
Pauls DL, Alsobrook JP, Goodman W, et al. (1995) A family study of obsessive-compulsive disorder. Am J
Psychiatry, 152: 76-84.
Radomsky AS, Rachman S, Hammond D (2001) Memory bias, confidence and responsibility in compulsive
checking. Behav Res Ther, 39: 813-822.
Randomsky AS, Rachman S (1999) Memory bias in obsessive-compulsive disorder (OCD). Behav Res Ther,
Rasmussen SA, Eisen JL (1992) The epidemiology and clinical features of obsessive compulsive disorder.
Psychiatr Clin North Am, 15: 743-758.
Rowe JB, Owen AM, Johnsrude IS, et al. (2001) Imaging the mental components of a planning task.
Neuropsychologia, 39: 315-327.
Savage CR, Deckersbach T, Wilhelm S, et al. (2000) Strategic processing and episodic memory impairment in
obsessive compulsive disorder. Neuropsychology, 14: 141-151.
Schell GR, Strick FR (1984) The origin of thalamus inputs to the acurate premotor and supplementary motor
areas. J Neurosci, 4: 539-560.
Sobin C, Blundell ML, Karayiorgou M (2000) Phenotypic differences in early- and late-onset Obsessive-
Compulsive Disorder. Compr Psychiatry, 41: 373-379.
Spitznagel MB, Suhr JA (2002) Executive function deficits associated with symptoms of schizotypy and
obsessive-compulsive disorder. Psychiatry Res, 110: 151-163.
Spreen O, Strauss E (1998) A Compendium of Neuropsychological Tests: Administration, Norms and
Commentary, 2. baskı, New York. Oxford University Press, s. 171-173.
Neuropsychology of OCD 18
Tallis F, Pratt P, Jamani N (1999) Obsessive compulsive disorder, checking, and non-verbal memory: a
neuropsychological investigation. Behav Res Ther, 37: 161-166.
Tolin DF, Abramowitz JS, Brigidi BD, et al. (2001) Memory and memory confidence in obsessive-compulsive
disorder. Behav Res Ther, 39: 913-927.
Tuna S, Tekcan AI, Topcuoglu V (2005) Memory and metamemory in obsessive-compulsive disorder. Behav
Res Ther, 43: 15-27.
Zacks JM, Mires J, Tiversky B, et al. (2000) Mental spatial transformations of objects and perspective. Spatial
Cognition and Computation, 2: 315-332.
Zitterl W, Urban C, Linzmayer L, et al. (2001) Memory deficits in patients with DSM-IV obsessive-compulsive
disorder. Psychopathology, 34: 113-117.
Zohar AH (1999) The epidemiology of obsessive-compulsive disorder in children and adolescents. Child
Adolesc Psychiatr Clin N Am, 8: 445-460.
Neuropsychology of OCD 19
Table 1. General characteristics and results of studies that investigated the neuropsychological characteristics of childhood-onset OCD.
Participants Matching & Exclusion Criteria Tests Used Significant Differences
Behar et al.
n = 17 (14M, 3F)
Age = 13.7 ± 1.6
AO: 2-14 years
n = 16 (13M, 3F)
Age = 13.9 ± 2.2
Age ( ± 1 year), sex, race, hand
Total IQ > 85 ( ± 15)
Behavior or learning difficulty, family
history of psychiatric disorders,
significant head injury
Money Direction Sense Road
Away and toward errors scores – Significant differences are in
favor of the control group.
– Clinical group received a 10-
week clomipramine treatment
– There was no significant
relation between the low
neuropsychological test results
and the obsession type.
Stylus Maze Learning High eeror rates, more
frequent rule breaking
Rey Vocabulary List Learning –
Touch Sense Test
Reaction Time and
Two-Flash Threshold Task
Cox et al.
n = 42 (30M, 12F)
Age = 8-18 (14 ± 2.7)
Gender, age, hand preference, verbal
and performance IQ > 85
Psychotic symptoms, primary
depression, neurological problem
Stylus Maze Learning Route and Rule-breaking
– Significant differences are in
favor of the control group.
– Patient group’s medication
usage was not specified.
– There is a significant
difference between the
Performance and Verbal IQ
WCST Consecutive correct sorting
Money Direction Sense Road
Correct moves, setting
directions by groups
Visual recognition threshold for
words and patterns
Neuropsychology of OCD 20
n = 35 (26M, 9F)
Age = 8-18 (14 ± 2.6)
(OCD > Control)
– Scores of both groups are
close to each other except
WCST, Maze learning and
– Group differences were not
found to be associated with the
OCD symptoms’s severity.
Rey Audiovisual Learning Test Total over 5 trials, Trials by
Listening task: monolithic and
Total correct scores for
Diphatic encoding task Correct response
-Flament et al.
n = 27 (18M, 9F)
Age = 10-18
AO: 10.3 ± 3.7
n = 29 (21M, 8F)
Age = 10-17
Age, gender, IQ > 80+, symptom
duration > 1 year
Physical illness, organic mental
disorder, psychotic disorder or primary
Money Direction Sense Road
Away and toward, and total
– Significant differences are in
favor of the control group.
– In the follow-up study the
test performance of the OCD
group increased significantly.
– 19 of the patients in the
follow-up study received
clomipramine treatment for
– Low performance scores in
neuropsychological tests were
not associated with symptom
severity in both measures.
Stylus Maze Learning Errors, crossovers, combined
Study Participants Matching & Tests Used Significant Differences Evaluation
Neuropsychology of OCD 21
(Year) Exclusion Criteria between Groups
n = 62
Age = 6-18 (12.21 ±
AO: 5.7 ± 2.5
n = 38
Age = 6-18 (12.71 ±
AO: 5.7 ± 2.5
– There are no significant group
differences in age, gender, education
level, and symptoms duration.
– Lower OCD group has significantly
lower age of onset.
– High OCD group has significantly
lower Total IQ.
WCST Number of completed
categories and perseverative
– Significant group differences
are in favor of low OCD
– Almost 50% of all patients
received pharmacotherapy and
this percentage is significantly
higher in high OCD group.
– Groups are determined by
taking 70 as cut off point in
TD Control List.
Halstead-Reitan Test Battery –
Gladstone et al.
n = 12
Age = 8-13
n = 12
Age, gender, and IQ WCST –
Rey Audiovisual Learning Test Low performance in drawing
simple and complex designs
Vocabulary list learning task –
Neuropsychology of OCD 22
Age = 8-13
Beers et al.
n = 21 (12M, 9F)
Age = 12.3 ± 2.9
n = 21 (12M, 9F) Age =
12.2 ± 2.9
Age, gender, SES and IQ
Psychiatric or neurological disorder
except OCD; for the CG psychotic or
affective disorder in first degree
Stroop Vocabulary reading and color
– Significant differences are in
favor of the OCD group.
– There were no group
differences in age, gender,
SES, WISC-3 Vocabulary and
– There were no significant
clinical test scores, age of
onset, and duration of illness.
– There is no medication
history in the patient group.
Controlled Oral Word
Hanoi Tower –
Go/No-go Test B subtest
California Verbal Learning Test –
Grooved Pegboard Test –
CG: Control group; AO: Age of Onset; WCST: Wisconsin Card Sorting Test; ROCFT: Rey-Osterrieth Complex Figure Test; TD: Tourette’s Disorder; IQ: Intelligence Quotient