A new study has found that adolescents with obsessive-compulsive disorder (OCD) have widespread learning and memory problems.
Researchers at the University of Cambridge say their findings have already been used to assist adolescents with OCD obtain the help they needed at school to realize their potential — including helping one go on to university.
Almost 90 percent of adolescent patients with OCD have problems at school, home, or socially, according to researchers, who note that difficulties doing homework and concentrating at school are the two most common problems.
And if an adolescent is not doing well in school, they are likely to become stressed and anxious, the researchers add.
The University of Cambridge researchers previously showed that there are problems of cognitive inflexibility in adults with OCD. Since flexibility in problem-solving is an important skill for performance in school, they wanted to study whether adolescents with OCD had difficulty in this area.
Cognitive flexibility becomes important when trying to find the correct solutions to a problem, particularly when your first attempt at solving that problem does not work. To reach the correct solution, you have to switch to a new approach from the one you were previously using.
In healthy individuals, there is a balance between goal-directed control and habit control, and this balance is crucial for daily functioning, the researchers noted.
For example, when learning to drive, we focus on specific goals, such as traveling at the right speed, staying within the traffic lines, and following safety rules. We often have strategies to perform these tasks optimally. However, once we are an experienced driver, we frequently find that driving becomes habitual.
In new situations, healthy people tend to use goal-directed control. However, under conditions of stress, they frequently select habitual learning.
In the new study, published in the journal Psychological Medicine, researchers looked at whether cognitive flexibility for learning tasks and goal-directed control was impaired early in the development of OCD.
For the study, researchers had 36 adolescents with OCD and 36 healthy young people complete learning and memory tasks. The computerized tests included recognition memory — remembering which of two objects they had seen before — and episodic memory — where in space they remember seeing an object.
A subset of 30 participants in each group also carried out a task designed to assess the balance of goal-directed and habitual behavioral control.
The researchers found that adolescent patients with OCD had impairments in all learning and memory tasks.
The study also demonstrated for the first time impaired goal-directed control and lack of cognitive plasticity early in the development of OCD, the researchers report.
“While many studies have focused on adult OCD, we actually know very little about the condition in teenagers,” said Dr. Julia Gottwald, the study’s first author. “Our study suggests that teens with OCD have problems with memory and the ability to flexibly adjust their actions when the environment changes.”
“I was surprised and concerned to see such broad problems of learning and memory in these young people so early in the course of OCD,” added Professor Barbara Sahakian, senior author. “It will be important to follow this study up to examine these cognitive problems further and in particular to determine how they impact on clinical symptoms and school performance.”
Experiencing learning and memory problems at school could affect self-esteem, the researchers said. They added that some symptoms seen in people with OCD, such as compulsive checking, may result from them having reduced confidence in their memory ability. The stress of having difficulty in learning may also start a negative influence and promote inflexible habit learning.
“This study has been very useful in assisting adolescents with OCD with the help they needed at school in terms of structuring the environment to ensure that there was a level playing field,” said Dr. Anna Conway Morris. “This allowed them to receive the help they needed to realize their potential.”
“One person with OCD was able to obtain good A Levels and to be accepted by a good university where she could get the support that she needed in order to do well in that environment,” she continued.
Future studies will examine in more detail the nature of these impairments and how they might affect clinical symptoms and school performance, the researchers said.
Source: University of Cambridge