Atypical action updating in a dynamic environment associated with adolescent obsessive–compulsive disorder

Marzuki, Aleya A., Vaghi, Matilde M. ORCID:, Conway-Morris, Anna, Kaser, Muzaffer, Sule, Akeem, Apergis-Schoute, Annemieke, Sahakian, Barbara J. and Robbins, Trevor W. (2022) Atypical action updating in a dynamic environment associated with adolescent obsessive–compulsive disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines, 63 (12). pp. 1591-1601. ISSN 0021-9630

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Background: Computational research had determined that adults with obsessive–compulsive disorder (OCD) display heightened action updating in response to noise in the environment and neglect metacognitive information (such as confidence) when making decisions. These features are proposed to underlie patients’ compulsions despite the knowledge they are irrational. Nonetheless, it is unclear whether this extends to adolescents with OCD as research in this population is lacking. Thus, this study aimed to investigate the interplay between action and confidence in adolescents with OCD. Methods: Twenty-seven adolescents with OCD and 46 controls completed a predictive-inference task, designed to probe how subjects’ actions and confidence ratings fluctuate in response to unexpected outcomes. We investigated how subjects update actions in response to prediction errors (indexing mismatches between expectations and outcomes) and used parameters from a Bayesian model to predict how confidence and action evolve over time. Confidence–action association strength was assessed using a regression model. We also investigated the effects of serotonergic medication. Results: Adolescents with OCD showed significantly increased learning rates, particularly following small prediction errors. Results were driven primarily by unmedicated patients. Confidence ratings appeared equivalent between groups, although model-based analysis revealed that patients’ confidence was less affected by prediction errors compared to controls. Patients and controls did not differ in the extent to which they updated actions and confidence in tandem. Conclusions: Adolescents with OCD showed enhanced action adjustments, especially in the face of small prediction errors, consistent with previous research establishing ‘just-right’ compulsions, enhanced error-related negativity, and greater decision uncertainty in paediatric-OCD. These tendencies were ameliorated in patients receiving serotonergic medication, emphasising the importance of early intervention in preventing disorder-related cognitive deficits. Confidence ratings were equivalent between young patients and controls, mirroring findings in adult OCD research.

Item Type: Article
Additional Information: Funding Information: This research was funded by the Wellcome Trust (Grant 104631/Z/14/Z/ to T.W.R.). For open access purposes, the author has applied a CC‐BY public copyright licence to any Author Accepted Manuscript version arising from this submission. M.K. reported receiving Clinical Lectureship funding from the National Institute of Health Research during the conduct of the study. B.J.S. reported consulting for Cambridge Cognition and for Greenfield Bioventures outside the submitted work. T.W.R. reported receiving grants from Wellcome Trust that supported this research during the conduct of the study; and receiving personal fees from Cambridge Cognition outside the submitted work. The remaining authors have declared that they have no competing or potential conflicts of interest.
Uncontrolled Keywords: adolescence,cognition,obsessive–compulsive disorder,pediatrics, perinatology, and child health,developmental and educational psychology,psychiatry and mental health,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2735
Faculty \ School: Faculty of Social Sciences > School of Psychology
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Depositing User: LivePure Connector
Date Deposited: 05 Oct 2022 11:31
Last Modified: 07 Mar 2024 02:40
DOI: 10.1111/jcpp.13628


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