Self-Regulation and Other Executive Functions Relationship to Pediatric OCD Severity and Treatment Outcome

  • Joseph P. H. McNamara
  • Adam M. Reid
  • Amanda M. Balkhi
  • Regina Bussing
  • Eric A. Storch
  • Tanya K. Murphy
  • Paulo A. Graziano
  • Andrew G. Guzick
  • Gary R. Geffken


The intersection of obsessive-compulsive disorder (OCD) and executive functioning (EF) in children and adolescents is an emerging topic in the current literature. Spurred by the consistent association between increased EF deficits and higher adult obsessive-compulsive severity, a few initial studies have replicated this relationship in pediatric OCD samples and also have found preliminary evidence that EF deficits are associated with worse response to first-line psychotherapeutic or psychopharmacological treatments for pediatric OCD. This study aimed to extend the literature by providing the first comprehensive investigation of how multiple EF domains, measured repeatedly over the course of treatment, impact pediatric obsessive-compulsive severity and response to multimodal treatment. Multi-level modeling results found that deficits in shifting, inhibition, emotional control, planning/organizing, monitoring and initiating all predicted higher average obsessive compulsive severity across treatment. Interestingly, out of the eight domains of EF investigated, only emotional control moderated treatment outcome such that those with worse emotional control experienced less of a reduction in obsessive-compulsive severity during treatment. The findings generally align with previous theories for the link between EF and OCD and indicate that emotional control has important implications in the treatment of pediatric OCD. In fact, emotional control may provide one explanation for why factors such as disgust sensitivity, oppositional behavior, and third-wave behavioral treatment techniques have all been linked to pediatric OCD treatment outcome. Future research should investigate augmentation strategies that target emotional control in children and adolescents.


Obsessive-compulsive disorder Children BRIEF Cognitive behavioral therapy Serotonin reuptake inhibitors Treatment outcome 



This research was supported by grant 5UO1 MH078594 from the National Institute of Mental Health. The authors thank the study coordinators, all staff members who contributed to data collection, the families for their participation, and Drs. Ayesha Lall, Jane Mutch and Omar Rahman for their contribution to the study interventions.

Conflict of Interest

Dr. Regina Bussing has received research support from Pfizer Inc. and Otsuka Pharmaceuticals. She also has served as a consultant for Pfizer Inc. and Shire Pharmaceuticals and has received travel support and honorarium to present original research findings at meetings in Germany. Dr. Tanya Murphy reports research support from the AstraZeneca Neuroscience iMED, Otsuka Pharmaceuticals, Shire Pharmaceuticals, National Institute of Health/National Institute of Mental Health, Center for Disease Control, International Obsessive-Compulsive Disorder Foundation, Ortho-McNeil Janssen Pharmaceuticals, Pfizer Inc., and Massachusetts General Hospital. She also reports travel support from the Tourette Syndrome Association. Finally, Dr. Eric Storch reports research support from the National Institute of Health, Center for Disease Control, Agency for Healthcare Research and Quality, International Obsessive-Compulsive Disorder Foundation, and Ortho-McNeil Janssen Pharmaceuticals. All other authors of this paper have no conflicts of interest to report.

Experiment Participants

This study was approved by the university Internal Review Board and all study procedures, including informed consent, were conducted in adherence to this review board and the standards of the National Institute of Mental Health.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Joseph P. H. McNamara
    • 1
  • Adam M. Reid
    • 1
    • 2
  • Amanda M. Balkhi
    • 1
    • 2
  • Regina Bussing
    • 1
    • 2
    • 5
  • Eric A. Storch
    • 4
    • 6
  • Tanya K. Murphy
    • 4
    • 6
  • Paulo A. Graziano
    • 3
  • Andrew G. Guzick
    • 1
  • Gary R. Geffken
    • 1
    • 2
  1. 1.Division of Medical Psychology, Department of PsychiatryUniversity of FloridaGainesvilleUSA
  2. 2.Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleUSA
  3. 3.Center for Children and Families & Department of PsychologyFlorida International UniversityMiamiUSA
  4. 4.Department of PediatricsUniversity of South FloridaPetersburgUSA
  5. 5.Department of PediatricsUniversity of FloridaGainesvilleUSA
  6. 6.Department of Psychiatry & Behavioral NeurosciencesUniversity of South FloridaTampaUSA

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