The Association between Performance Monitoring, Anterior Cingulate Volume and Obsessive-Compulsive Disorder in Early Development

What's the science?

Obsessive-compulsive disorder (OCD) has been associated with heightened performance monitoring. Although monitoring one's performance on tasks can be beneficial, too much performance monitoring may affect daily function. The anterior cingulate cortex is a brain region known to be involved in performance monitoring. It is unknown whether elevated performance monitoring in early childhood predicts later development of OCD, and whether this is associated with structural changes in anterior cingulate cortex. Identifying early markers of OCD has important implications for public health. This week in JAMA Psychiatry Gilbert and colleagues investigate the association between performance monitoring, OCD risk and anterior cingulate volume in a longitudinal cohort of preschool-aged children.

How did they do it?

292 preschool-aged children who were part of a longitudinal depression study completed an observational task where they received negative evaluation (i.e. performance based). The child’s performance monitoring behavior was rated by blinded observers. Performance monitoring was scored as the average of a number of measures representative of performance monitoring, including frustration, deliberateness and care while drawing circles and observed self-criticism and intensity. The participants were then followed up annually for 12 years with clinical assessments and received 1-3 MRI scans throughout the follow-up. 133 completed the final behavioral follow-up and 152 completed MRI scans. The development of OCD was recorded over the 12-year period (using the DSM-V criteria). The authors used logistic regression to test whether performance monitoring was associated with increased risk of OCD. They also measured anterior cingulate cortex volume using MRI and used multi-level modeling (this method can model changes over time) to test whether performance monitoring was associated with anterior cingulate volume over time.

What did they find?

35 children in total developed OCD over the course of the follow-up. High performance monitoring of pre-school aged children (at initial assessment) was associated with a greater risk (2 times higher) of developing OCD later on after controlling for medication, clinical and demographic variables. This association was specific to OCD, meaning there was no association with performance monitoring and the development of other psychiatric disorders. High performance monitoring at baseline was also associated with reduced right dorsal anterior cingulate volume over time. Baseline anxiety was also associated with reduced right anterior cingulate volume. A follow-up exploratory analysis showed that high performance monitoring was also associated with larger left thalamus volume.

                                      Brain,  S  ervier Medical Art,  image by BrainPost,  CC BY-SA 3.0

                                      Brain, Servier Medical Art, image by BrainPost, CC BY-SA 3.0

What's the impact?

This is the first study to demonstrate that performance monitoring in preschool-aged children is associated with later development of OCD. Further, heightened performance monitoring is also associated with reductions in anterior cingulate volume as children age. This study could help in the identification of children at high risk of developing OCD and furthers our understanding of the brain mechanisms involved.


Gilbert et al. Associations of Observed Performance Monitoring During Preschool With Obsessive-Compulsive Disorder and Anterior Cingulate Cortex Volume Over 12 Years. JAMA Psychiatry 2018.  Access the original scientific publication here.