4 - (SYM 106) Developing Patient-centered Extinction Learning Profiles to Guide the Treatment of Pediatric OCD

Obsessive-Compulsive Disorder (OCD) predominantly onsets in childhood, affects ~3% of the population, and represents a leading cause of disability worldwide. Exposure-based cognitive behavioral therapy (CBT) is the recommended as the frontline for youth with OCD. However, not all youth exhibit a treatment response to this therapeutic approach. While several factors may influence treatment outcomes, initial evidence has found that extinction learning impairments predict therapeutic response to CBT. While representing a promising marker of treatment response to exposure-based CBT, current approaches to measure extinction learning are resource-intensive and challenging to implement in everyday clinical practice. In response, we investigated latent patient-centered extinction learning profiles to develop proxy clinical profiles using common clinical rating scales.

 98 youth with OCD completed a clinical battery to characterize psychiatric diagnoses, OCD severity, anxiety severity, and general psychopathology. Afterward, youth completed a differential fear conditioning/extinction task with skin conductance response (SCR) serving as the primary outcome. Parallel-process growth mixture modeling (i.e., within-person trends in concurrent change in SCR to differential stimuli over time) illuminated person-centered trends in fear conditioning and extinction learning processes. The BCH method compared latent classes on clinical rating scales to identify a composite of observable clinical correlates that signal impaired extinction learning.

 Results from the class enumeration process indicated that a 2-class solution had optimal fit and was retained. This was evidenced by high entropy values indicating clear separation between the latent classes. Class 1 was comprised of 85% of the sample and characterized by typical patterns of fear conditioning and extinction learning. Meanwhile, Class 2 was comprised of 15% of the sample, who exhibited elevated levels of SCR throughout the task and impairments in threat discrimination during extinction learning. Patient-centered profiles were identified using clinical rating scales that differentiated the two classes.

 A 2-class solution identified differences between extinction learning processes in youth with OCD. As physiological measurement is resource-intensive in clinical practice, these identified patient-centered clinical profiles can be meaningful prognostic indicators of impaired extinction learning, and used to guide treatment recommendations.