Error-related brain activity in adolescents with obsessive-compulsive disorder and major depressive disorder
Open accessAbstract
BACKGROUND: The error-related negativity (ERN) is a negative deflection in the event-related potential following a mistake that is often increased in patients with obsessive-compulsive disorder (OCD). The relationship of the ERN to comorbid major depressive disorder (MDD) has not been examined in adolescents with OCD. This study compared ERN amplitudes in OCD patients with MDD (OCD + MDD), OCD patients without MDD (OCD - MDD), MDD patients, and healthy controls (HC). METHOD: The ERN, correct response negativity, and accuracy were measured during a flanker task to assess performance monitoring in 53 adolescents with a lifetime diagnosis of OCD, 36 adolescents with a lifetime diagnosis of MDD, and 89 age-matched HC of 13-18 years. Fourteen OCD patients had a history of MDD. RESULTS: ERN amplitude was significantly increased in OCD patients compared to HC and significantly correlated in OCD patients with age at OCD symptom onset, particularly in the OCD - MDD patients. The ERN was significantly enlarged in OCD + MDD patients compared to HC, but not in MDD patients compared to HC. There was a trend for an increased ERN amplitude in OCD - MDD patients compared to HC. OCD patients were significantly less accurate than either MDD patients or HC. CONCLUSIONS: An enlarged ERN is a neural correlate of adolescent OCD that is associated with age at OCD symptom onset. Adolescents with OCD may have impaired cognitive control on a flanker task. Follow-up studies with larger samples may determine whether an enlarged ERN in adolescents with OCD is associated with a higher risk for MDD.
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In paediatric OCD, larger ERN amplitudes were sometimes associated with better task accuracy or fewer errors.
“In paediatric OCD, larger ERN amplitudes were sometimes associated with better task accuracy or fewer errors [38,39,40,50].”
From Electrophysiological Correlates of Cognitive Dysfunction in Obsessive-Compulsive Disorder (OCD): A Systematic and Mechanistic Review of EEG, ERP, and QEEG Evidence (2026) · cites this paper as [39]
Results §3.2 reports that greater accuracy was associated with a larger (more negative) ERN across all participants, but does not establish that association specifically within the adolescent OCD group. The Conclusion instead notes that the OCD group was less accurate than the comparison groups despite having an enlarged ERN. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn pediatric patients, ERN amplitude is negatively correlated with the age of disease onset, meaning that ERN amplitude increased with the duration of the pathology.
“Interestingly, in pediatric patients, ERN amplitude is negatively correlated with the age of disease onset, meaning that ERN amplitude increased with the duration of the pathology [34, 36].”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [36]
Results §3.4 reports that, among adolescents with OCD, larger (more negative) ERN amplitudes were associated with earlier OCD symptom onset; the association was significant in those without comorbid MDD but not those with it. The reported correlation for signed amplitude is positive (r = .29), so the claimed negative relationship applies to amplitude magnitude, not the signed measure. The paper does not show that ERN amplitude increases as the pathology persists or establish a relationship with disease duration. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn most pediatric studies reviewed, only the amplitude of the ERN/CRN component was measured and statistically analyzed, but close examination of Pe/Pc tracings revealed that in most of them, the amplitude of the Pe component appeared substantially smaller in children with OCD than in control children or adolescents.
“In most cases, only the amplitude of the ERN/CRN component was measured and statistically analyzed. However, close examination of the Pe/Pc tracings obtained in these studies revealed that in most of them, the amplitude of the Pe component appeared to be substantially smaller in children with OCD than in control children or adolescents [25, 33–36, 64, 65].”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [36]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe results support the hypothesis that an enlarged ERN may serve as a transdiagnostic biomarker for OCD and tic disorders as well as some anxiety disorders.
“The results support the hypothesis that an enlarged ERN may serve as a transdiagnostic biomarker for OCD and tic disorders as well as some anxiety disorders [8, 17–22].”
From Altered Error Monitoring and Decreased Flanker Task Accuracy in Pediatric Obsessive–Compulsive Disorder (2026) · cites this paper as [21]
The Discussion (page unavailable) reports an enlarged ERN in adolescents with OCD and an association with anxiety symptoms within the OCD group. The Introduction suggests the ERN may be a biomarker for OCD. Our copy does not establish it as a biomarker for tic disorders or for anxiety disorders as distinct diagnoses, so the broader transdiagnostic claim is only partly supported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn paediatric samples, youths with OCD repeatedly showed enlarged ERN amplitudes relative to healthy controls during modified Eriksen flanker tasks.
“In paediatric samples, youths with OCD repeatedly showed enlarged ERN amplitudes relative to healthy controls during modified Eriksen flanker tasks [33,34,37,38,39,40,45,50].”
Major depressive disorder without OCD did not show comparable ERN enhancement.
“At the same time, major depressive disorder without OCD did not show comparable ERN enhancement [39].”
Adolescents with OCD plus major depressive disorder showed the strongest ERN enlargement, whereas OCD without depression showed a weaker or trend-level effect.
“Comorbid depression also appeared relevant: adolescents with OCD plus major depressive disorder showed the strongest ERN enlargement, whereas OCD without depression showed a weaker or trend-level effect [39].”
Our studies of older children and adolescents have shown decreased flanker task accuracy in youth with OCD compared to healthy controls.
“However, our studies of older children and adolescents have shown increased ERN amplitudes but decreased flanker task accuracy in youth with OCD compared to HC [20, 21].”
From Altered Error Monitoring and Decreased Flanker Task Accuracy in Pediatric Obsessive–Compulsive Disorder (2026) · cites this paper as [21]
We found no differences between youth with major depressive disorder and healthy controls in flanker task accuracy.
“In contrast, we found augmented ERN amplitudes but normal flanker task accuracy in youth with anxiety disorders compared to HC [22] and no differences between youth with major depressive disorder and HC in either ERN amplitudes or flanker task accuracy [21].”
From Altered Error Monitoring and Decreased Flanker Task Accuracy in Pediatric Obsessive–Compulsive Disorder (2026) · cites this paper as [21]
We found no differences between youth with major depressive disorder and healthy controls in ERN amplitudes.
“In contrast, we found augmented ERN amplitudes but normal flanker task accuracy in youth with anxiety disorders compared to HC [22] and no differences between youth with major depressive disorder and HC in either ERN amplitudes or flanker task accuracy [21].”
From Altered Error Monitoring and Decreased Flanker Task Accuracy in Pediatric Obsessive–Compulsive Disorder (2026) · cites this paper as [21]
Our studies of older children and adolescents have shown increased ERN amplitudes in youth with OCD compared to healthy controls.
“However, our studies of older children and adolescents have shown increased ERN amplitudes but decreased flanker task accuracy in youth with OCD compared to HC [20, 21].”
From Altered Error Monitoring and Decreased Flanker Task Accuracy in Pediatric Obsessive–Compulsive Disorder (2026) · cites this paper as [21]
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“Interestingly, in pediatric patients, ERN amplitude is negatively correlated with the age of disease onset, meaning that ERN amplitude increased with the duration of the pathology [34, 36].”
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- Authors
- Hanna, G. L., Liu, Y., Isaacs, Y. E., Ayoub, A. M., Brosius, A., Salander, Z., Arnold, P. D., & Gehring, W. J.
- Affiliations
- University of Michigan (US)
- University of Massachusetts Amherst (US)
- University of Calgary (CA)
- Corresponding author
- Hanna, Gregory L.
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2018-05-07
- Volume
- 35
- Issue
- 8
- Pages
- 752-760
- ISSN
- 1091-4269 (ISSN-L)
- PMC
- PMC6105517
- OpenAlex
- W2801424204
- Cited by
- 29
- References
- 34
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 8 · 2019: 4 · 2018: 1
- FWCI
- 4.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH101493)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- error-related negativity, obsessive-compulsive disorder, major depressive disorder, comorbidities, adolescents, performance monitoring, flanker task, cognitive control, age at symptom onset, correct response negativity, response accuracy
- MeSH terms
- Adolescent, Major Depressive Disorder, Electroencephalography, Evoked Potentials, Female, Humans, Male, Obsessive-Compulsive Disorder, Comorbidity, Executive Function
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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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