Figure 2. Interference-processing in left anterior insula/frontal operculum (aI/fO) and posterior medial frontal cortex (pMFC): Effects of symptom severity in unmedicated patients with pediatric obsessive-compulsive disorder (OCD).

Note: Interference-processing activated posterior medial frontal cortex (pMFC) and bilateral anterior insula (aI/fO) (A). ROI analyses showed associations of greater pMFC activation with better performance (faster response time, RT; higher accuracy, Acc) in HC, but worse performance in OCD (B–C) and greater left aI/fO activation with lower OCD severity (C-YBOCS, Child Yale Brown Obsessive Compulsive Scale) in patients (D). Exploratory wholebrain analyses showed altered associations of pMFC activation with age (E), RT (F) and Acc (G) in unmedicated patients (uOCD) compared to HC. In patients, there was a CY-BOCs-by-age interaction driven by the association of greater left aI/fO activation with lower OCD severity at older ages across uOCD and medicated (mOCD) patients (H). Color bars show t-scores, reflecting relative strength of brain activation. Montreal Neurologic Institute coordinates shown (x, y, z).

Acc = accuracy, C-YBOCS = Child Yale-Brown Obsessive Compulsive Scale, FWE = familywise error, HC = healthy controls, MFC = medial frontal cortex, mOCD = medicated obsessive-compulsive disorder, ROIs = regions of interest, RT = response time, uOCD = unmedicated obsessive-compulsive disorder