MICHR Pilot Grant Recipient Envisions Faster, More Accessible Treatment for Pediatric OCD


Pediatric anxiety disorders affect about one in three children by the time they reach adolescence, and one of them, obsessive compulsive disorder (OCD), tends to emerge around age 9-12, says Kate Fitzgerald, MD, who is an assistant professor in the University of Michigan’s Department of Psychiatry. OCD is characterized by intrusive, anxiety-provoking thoughts or obsessions along with repetitious behavior, or compulsions, that a child uses to alleviate the distress caused by these thoughts. These anxiety-provoking thoughts are generally the result of what the brain perceives as a cognitive error, often in the realms of harm and safety, health and cleanliness, or order and symmetry.

Medication works to relieve OCD symptoms about half the time, but cognitive behavioral therapy (CBT) is usually the first line of treatment. CBT involves teaching patients to dismiss the first error signals as irrelevant, Fitzgerald says, to think “it’s just a little mistake, it doesn’t matter. It shouldn’t affect my ongoing behavior.” It exercises regions of the brain that encourage cognitive responses rather than emotional responses. One element of CBT is teaching coping mechanisms, and another element is exposure to the trigger, a sort of “feel the fear and do it anyway” approach, Fitzgerald says. “If you do that over and over again, the brain kind of gets bored of it and produces less anxiety.”

Treatment is Slow and Sometimes Inaccessible
CBT takes several months, however, and may be only partly successful. “That’s a lot of time if you’re really suffering,” she says. There are also long waiting lists to get into treatment in addition to other barriers such as poor insurance coverage for mental health and stigmas associated with mental health treatment. Fitzgerald would like to see the treatment become shorter and more accessible.

“Does it have to be a master’s-level therapist or higher who’s delivering the treatment? Or could you train teachers, parents, other people that kids interact with?”

MICHR Pilot Grant to Help Determine How Brain Response Relates to OCD Symptoms
First, Fitzgerald says, we must determine how and why CBT works and we must develop better treatments.

Fitzgerald’s research is a step in that direction. She says that the psychiatry field is becoming more interdisciplinary, combining geneticists, imaging experts, and clinicians. Fitzgerald specializes in imaging but also has clinical time every week. Her research has already demonstrated that the more hyperactive the response to error is in particular regions of the brain, the less the OCD symptoms are. “This suggests that that ability to engage cognitive areas of the brain to mediate your response to error may help you push down symptoms of OCD,” Fitzgerald says.

Now, she wants to find out how that brain response relates to child development and the early course of OCD, and she is investigating that with the help of a $50,000 MICHR pilot grant. The hypothesis of the pilot grant study is that children with OCD, over the course of cognitive behavioral therapy – if they respond to CBT, with lesser symptoms by the end of treatment – should further engage these regions of the brain in response to making a simple cognitive mistake, and that this will associate with a decrease in OCD symptoms over the course of the treatment.  

"We will need to study a large number of children, at each age, to really look at the development question, and data coming from the MICHR-funded study will help us begin to address that question," Fitzgerald says. The study looks at three age groups during which she says the brain response to errors develops dramatically – pre-pubertal (8-10 years), peri-pubertal (11-14 years), and adolescent (15-18 years). Study participants undergo an MRI at the beginning of the study and then again at the end, after receiving three months of cognitive behavioral therapy. Each time, the MRI will measure the activity in certain parts of the brain in response to perceived cognitive errors.

MRI Simulator Helps Patients Prepare for the Real Thing
Fitzgerald’s study involves two MRI procedures for participants and sometimes, she says, children experience anxiety about or during the procedure, or withdraw during it. In order to help the children practice and get used to the procedure before having an actual MRI, she has an MRI simulator located in a room near her office at the Rachel Upjohn Building. Once a child is inside the MRI simulator, they interact with a computer to practice not just the MRI procedure but also the type of activity that will be used to elicit simple cognitive mistakes. For example, the child might be shown a series of words and be asked to press a button to indicate the color of the font. “(They see) the word ‘red’ printed in blue, and the automatic response is to say ‘red,’” Fitzgerald says.

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