Cognitive inflexibility and frontal–cortical activation in pediatric obsessive–compulsive disorder
Open accessAbstract
Objective Deficits in cognitive flexibility and response inhibition have been linked to perturbations in cortico-striatal-thalamic circuitry in adult obsessive-compulsive disorder (OCD). Although similar cognitive deficits have been identified in pediatric OCD, few neuroimaging studies have been conducted to examine its neural correlates in the developing brain. In this study, we tested hypotheses regarding group differences in the behavioral and neural correlates of cognitive flexibility in a pediatric OCD and a healthy comparison (HC) sample. Method In this functional magnetic resonance imaging (fMRI) study, a pediatric sample of 10- to 17-year-old subjects, 15 with OCD and 20 HC, completed a set-shifting task. The task, requiring an extradimensional shift to identify a target, examines cognitive flexibility. Within each block, the dimension (color or shape) that identified the target either alternated (i.e., mixed) or remained unchanged (i.e., repeated). Results Compared with the HC group, the OCD group tended to be slower to respond to trials within mixed blocks. Compared with the HC group, the OCD group exhibited less left inferior frontal gyrus/BA47 activation in the set-shifting contrast (i.e., HC > OCD, mixed versus repeated); only the HC group exhibited significant activation in this region. The correlation between set shifting-induced right caudate activation and shift cost (i.e., reaction time differential in response to mixed versus repeated trials) was significantly different between HC and OCD groups, in that we found a positive correlation in HC and a negative correlation in OCD. Conclusions In pediatric OCD, less fronto-striatal activation may explain previously identified deficits in shifting cognitive sets.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 66 cited sources checked · 0 supported · 0 flagged
- Findingown data
Age did not correlate with switch cost in either group or the group as a whole.
“Age did not correlate with switch cost in either group (p > .7) or the group as a whole (p > .9).”
Quote in the paperNot a substantial claim - Findingown data
Accuracy rates for the first block of shape and color, but not mixed blocks, were significantly lower than for subsequent blocks.
“The accuracy rates for the first block of the shape and color, but not the mixed blocks [block × condition effect: F(6, 198) = 3.0, p < .03] were significantly lower than the accuracy rates for subsequent blocks [block effect: [F(3, 99) = 22.2, p < .001].”
Quote in the paperNot a substantial claim - Findingown data
The accuracy rates during the color block were lower than during the shape and mixed blocks.
“The accuracy rates during the color block (OCD: 88.7% ± 9.4%, HC: 89.8% ± 9.6%) were lower than the shape (OCD: 91.8% ± 6.1%, HC: 92.9% ± 7.9%) and mixed blocks (OCD: 93.7% ± 5.3%, HC: 93.9% ± 5.9%) [condition effect: F(2, 66) = 12.1, p < .001].”
Quote in the paperSubstantial claim - Findingown data
There were no group or group × condition interactions for accuracy.
“No group or group × condition interactions were noted (all p > .7).”
Quote in the paperNot a substantial claim - Findingown data
In the OCD group, total CY-BOCS score was not significantly correlated with mixed versus repeated activation in the inferior frontal gyrus or caudate.
“In the OCD group, the total CY-BOCS score was not significantly correlated with mixed versus repeated activation in the inferior frontal gyrus or caudate, two regions showing between-group differences.”
Quote in the paperNot a substantial claim
- Findingown data
None of the structural indexes correlated with symptoms in the OCD group.
“In addition, none of these structural indexes correlated with symptoms in the OCD group.”
Quote in the paperNot a substantial claim - Findingown data
Percent signal change in the inferior frontal gyrus and caudate ROIs were positively correlated in the HC group only.
“Extracted values of percent signal change in the inferior frontal gyrus and caudate ROIs, identified by the group differences in activation and correlation with shift cost respectively, were positively correlated in the HC group only (HC: Pearson's r = 0.50, p < .03; OCD: p > .28).”
Quote in the paperNot a substantial claim - Findingown data
Compared with HC, the OCD group tended to have greater gray matter density in the inferior frontal gyrus at an uncorrected threshold.
“Of particular interest, compared with the HC group, the OCD group tended to have greater gray matter density in the inferior frontal gyrus [(−34, 28, −10), Z = 3.00, k = 25] at an uncorrected threshold of p < .005.”
Quote in the paperNot a substantial claim - Findingown data
No significant between-group differences in striatal or hippocampal activation were detected.
“Of note, no significant between-group differences in striatal or hippocampal activation (e.g., mixed versus repeated) were detected using either whole-brain analysis or anatomically defined ROI analysis (p > .6).”
Quote in the paperNot a substantial claim - Findingown data
In pediatric OCD, compared with healthy controls, the OCD group exhibited less left inferior frontal gyrus/BA47 activation in the set-shifting contrast (mixed vs repeated).
“Compared with the HC group, the OCD group exhibited less left inferior frontal gyrus/BA47 activation in the set-shifting contrast (i.e., HC > OCD, mixed versus repeated); only the HC group exhibited significant activation in this region.”
- Also stated in: § Imaging Data · plain
“Compared with the HC group, the OCD group exhibited less left inferior frontal gyrus/BA47 [(−38, 32, −4), Z = 4.05, k = 31)] activation in the set-shifting contrast (i.e., HC > OCD, mixed versus repeated)”
- Also stated in: § Discussion · plain
“The left inferior frontal gyrus/BA47 activation during set-shifting (i.e., mixed versus repeated) was greater in the healthy comparison group compared with the OCD group.”
Quote in the paperSubstantial claim - Also stated in: § Imaging Data · plain
- Findingown data
In the OCD group, the left inferior frontal gyrus showed a deactivation (repeated > mixed) at a lower threshold.
“whereas for the OCD group, at a lower threshold (uncorrected p < .005), a deactivation (i.e., repeated > mixed [−40, 30, −6), Z = 2.96, k = 13]) was noted”
- Also stated in: § Discussion · hedged
“In the OCD group, the left inferior frontal gyrus region tends to be more activated in the reverse contrast (i.e., repeated > mixed).”
Quote in the paperSubstantial claim - Also stated in: § Discussion · hedged
- Findingown data
Only the healthy comparison group showed significant activation in the left inferior frontal gyrus during set-shifting.
“only the HC group exhibited significant activation in this region.”
- Also stated in: § Imaging Data · plain
“an activation was found in the HC group [(−36, 32, −4), Z = 3.40, k = 8]”
Quote in the paperSubstantial claim - Also stated in: § Imaging Data · plain
- Findingnone given
In this set-shifting task, the only group difference found was in the left inferior frontal gyrus.
“Finding a group difference only in left inferior frontal gyrus in this set-shifting task”
Quote in the paperSubstantial claim - Findingown data
The correlation between set-shifting-induced right caudate activation and shift cost differed significantly between HC and OCD groups.
“The correlation between set shifting-induced right caudate activation and shift cost (i.e., reaction time differential in response to mixed versus repeated trials) was significantly different between HC and OCD groups”
- Also stated in: § Imaging Data · plain
“A significant group difference in correlation between shift cost and activation in response to mixed versus repeated conditions was detected in the right caudate [(8, 8, 2), Z = 3.58, k = 46].”
Quote in the paperSubstantial claim - Also stated in: § Imaging Data · plain
- Findingown data
Reaction times during repeated trials were similar between the OCD and HC groups.
“The reaction times during repeated trials were similar between the groups (OCD: 622.4 ± 143.6 ms, HC: 622.3 ± 149.0 ms)”
Quote in the paperNot a substantial claim - Findingown data
In pediatric OCD, compared with healthy controls, the OCD group tended to have slower reaction times during mixed set-shifting trials (greater shift cost).
“Compared with the HC group, the OCD group tended to be slower to respond to trials within mixed blocks.”
- Also stated in: § Behavioral Data · hedged
“compared with the HC group, the OCD group tended to have slower reaction times during mixed trials (OCD: 638.1 ± 162.1 ms, HC: 616.6 ± 152.0 ms) [condition × group effect: F(1, 33) = 3.6, p < .07], indicating a greater shift cost in the OCD group.”
- Also stated in: § Discussion · hedged
“The OCD group showed behavioral deficits in set-shifting, evidenced by the tendency to have a greater shift cost (i.e., slower reaction time to mixed trials versus repeated trials).”
Quote in the paperSubstantial claim - Also stated in: § Behavioral Data · hedged
- Findingown data
Group differences in striatal activation were not detected in either whole-brain or anatomical ROI analyses.
“Group differences in striatal activation were not detected in either whole-brain or anatomical ROI analyses”
Quote in the paperSubstantial claim - Findingown data
Group differences in correlation between caudate activation and shift cost were noted.
“however, group differences in correlation between caudate activation and shift cost were noted.”
Quote in the paperSubstantial claim - Findingown data
Using this block design paradigm, a group difference was detected in the inferior frontal gyrus in set-shifting ability.
“Indeed, using this paradigm, a group difference was detected in the inferior frontal gyrus in set-shifting ability.”
Quote in the paperSubstantial claim - Findingown data
A positive correlation between caudate activation and shift cost was found in the HC group.
“a positive correlation between caudate activation and shift cost was found in the HC group”
Quote in the paperSubstantial claim - Findingown data
The functional connectivity analysis using extracted values indicates that the inferior frontal gyrus and caudate regions are positively correlated in the HC group only.
“the functional connectivity analysis using extracted values indicate that the inferior frontal gyrus and caudate regions are positively correlated in the HC group only.”
Quote in the paperSubstantial claim - Findingown data
No group differences were noted in caudate activation in response to mixed versus repeated conditions.
“Although no group differences were noted in caudate activation in response to mixed versus repeated conditions”
Quote in the paperSubstantial claim - Findingown data
No relationships between activation and symptom severity scores measured by the CY-BOCS were noted in the OCD group.
“No relationships between activation and symptom severity scores measured by the CY-BOCS were noted in the OCD group”
Quote in the paperSubstantial claim - Findingown data
The present OCD group did have higher depression scores than the HC group, as measured by the CDI.
“The present OCD group did have higher depression scores than the HC group, as measured by the CDI”
Quote in the paperSubstantial claim - Findingown data
In the OCD group, the relationship between shift cost and caudate activation is reversed.
“In the OCD group, the relationship between shift cost and caudate activation is reversed.”
Quote in the paperSubstantial claim - Findingown data
The HC group, compared with the OCD group, showed greater putamen activation in both mixed versus fixation and repeated versus fixation contrasts.
“the HC group, compared with the OCD group, showed greater putamen activation in both mixed versus fixation and repeated versus fixation contrasts.”
Quote in the paperSubstantial claim - Findingown data
As shift cost increased, caudate activation increased in the HC group.
“As the shift cost (i.e., the reaction time differential between mixed and repeated trials) increased, the caudate activation increased in the HC group.”
Quote in the paperSubstantial claim - Findingown data
Individuals with OCD who had a lower shift cost (higher shift benefit) showed greater caudate activation.
“The individuals with OCD who had a lower shift cost (i.e., higher shift benefit) showed greater caudate activation.”
Quote in the paperSubstantial claim - Findingown data
A negative correlation between caudate activation and shift cost was observed in the OCD group.
“whereas a negative correlation between caudate activation and shift cost was observed in the OCD group.”
Quote in the paperSubstantial claim - Findingown data
There were no significant group differences in striatum activation during set-shifting (mixed > repeated).
“There were no significant group differences in the striatum activation during set-shifting (i.e., mixed > repeated).”
Quote in the paperSubstantial claim - Premisecitation
In adult OCD, cognitive flexibility deficits have been linked to less frontal-striatal activity.
“Although these deficits in cognitive flexibility have been linked to less frontal-striatal activity in adult OCD,5,6,13,14”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [5] Remijnse, 2006, Reduced orbitofrontal-striatal activity on a reversal learning task in obsessive-compulsive disorder, Arch Gen Psychiatry source
Not checked in the free run.
- cites [6] Gu, 2008, Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder, Brain source
Not checked in the free run.
- cites [13] Roth, 2007, Event-related functional magnetic resonance imaging of response inhibition in obsessive-compulsive disorder, Biol Psychiatry source
Not checked in the free run.
- cites [14] Page, 2009, A functional magnetic resonance imaging study of inhibitory control in obsessive-compulsive disorder, Psychiatry Res source
Not checked in the free run.
- Study design and conductown data
When CDI depression scores were included as a covariate, the reported behavioral results remained significant.
“When CDI depression scores were included as a covariate, the reported results remained significant.”
Quote in the paperSubstantial claim - Premisecitation
Few behavioral and imaging studies have been conducted in pediatric OCD samples.
“few behavioral and imaging studies have been conducted in pediatric OCD samples.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [15] Shin, 2008, A study of neuropsychological deficit in children with obsessive-compulsive disorder, Eur Psychiatry source
Not checked in the free run.
- cites [16] Rosenberg, 1997, Oculomotor response inhibition abnormalities in pediatric obsessive-compulsive disorder, Arch Gen Psychiatry source
Not checked in the free run.
- cites [17] Rubia, 2010, Disorder-specific dysfunction in right inferior prefrontal cortex during two inhibition tasks in boys with attention-deficit hyperactivity disorder compared to boys with obsessive-compulsive disorder, Hum Brain Mapp source
Not checked in the free run.
- Premisecitation
In behavioral studies, children and adolescents with OCD had more response inhibition errors during an antisaccade task than healthy pediatric controls.
“and more response inhibition errors during an antisaccade task.16”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [16] Rosenberg, 1997, Oculomotor response inhibition abnormalities in pediatric obsessive-compulsive disorder, Arch Gen Psychiatry source
Not checked in the free run.
- Interpretationreasoning
The pattern of greater gray matter density and blunted fMRI response may suggest a higher density of inhibitory interneurons in the inferior frontal gyrus in the OCD group.
“This pattern may suggest a higher density of inhibitory interneurons in the inferior frontal gyrus in the OCD group, which might lead to higher voxel-based morphometry values and blunted fMRI response.”
Quote in the paperNot a substantial claim - Premisecitation
The few extant reports in pediatric OCD are consistent with findings in studies of adult OCD.
“The few extant reports in pediatric OCD are consistent with findings in studies of adult OCD.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [15] Shin, 2008, A study of neuropsychological deficit in children with obsessive-compulsive disorder, Eur Psychiatry source
Not checked in the free run.
- cites [16] Rosenberg, 1997, Oculomotor response inhibition abnormalities in pediatric obsessive-compulsive disorder, Arch Gen Psychiatry source
Not checked in the free run.
- cites [17] Rubia, 2010, Disorder-specific dysfunction in right inferior prefrontal cortex during two inhibition tasks in boys with attention-deficit hyperactivity disorder compared to boys with obsessive-compulsive disorder, Hum Brain Mapp source
Not checked in the free run.
- Premisecitation
In behavioral studies, children and adolescents with OCD had more perseverative errors on the WCST than healthy pediatric controls.
“In behavioral studies, compared with healthy pediatric controls, children and adolescents with OCD had more perseverative errors on the WCST15”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Shin, 2008, A study of neuropsychological deficit in children with obsessive-compulsive disorder, Eur Psychiatry source
Not checked in the free run.
- Interpretationown data
In pediatric OCD, reduced fronto-striatal activation could account for previously reported difficulties in shifting cognitive sets.
“In pediatric OCD, less fronto-striatal activation may explain previously identified deficits in shifting cognitive sets.”
Quote in the paperSubstantial claim - Interpretationcitation
The finding of less left inferior frontal activation in pediatric OCD is consistent with recent evidence of less bilateral ventrolateral prefrontal cortical activation during task-switching in adult OCD.
“This result is consistent with recent evidence of less bilateral ventrolateral prefrontal cortical activation during task-switching in adult OCD6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Gu, 2008, Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder, Brain source
Not checked in the free run.
- Study design and conductown data
The significant group difference in left inferior frontal gyrus activation remained after covarying out shift cost, age, and CDI depression scores.
“This significant group difference remained after covarying out the effects of shift cost, age and CDI depression scores.”
Quote in the paperSubstantial claim - Premisecitation
In neuroimaging studies, boys with OCD showed less inferior frontal cortex activation during task switching than healthy boys.
“In neuroimaging studies, compared with healthy boys, boys with OCD showed less inferior frontal cortex activation during task switching17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Rubia, 2010, Disorder-specific dysfunction in right inferior prefrontal cortex during two inhibition tasks in boys with attention-deficit hyperactivity disorder compared to boys with obsessive-compulsive disorder, Hum Brain Mapp source
Not checked in the free run.
- Interpretationreasoning
The OCD group may lag behind in this developmental shift.
“and the OCD group may lag behind in this developmental shift.”
Quote in the paperNot a substantial claim - Interpretationown data
The lack of relationship between activation and CY-BOCS possibly indicates that the findings in the inferior frontal gyrus represent stable trait effects of OCD rather than symptom-driven effects.
“possibly indicating that the findings in the inferior frontal gyrus represent stable trait effects of OCD rather than symptom-driven effects.”
Quote in the paperSubstantial claim - Study design and conductown data
The significant group × condition interaction in left inferior frontal gyrus survived analysis that statistically accounted for depressive symptoms.
“however, our significant group × condition interaction in left inferior frontal gyrus survived analysis that statistically accounted for depressive symptoms.”
Quote in the paperSubstantial claim - Study design and conductown data
It is unlikely that the activation differences were a result of behavioral differences.
“therefore, it is unlikely that the activation differences were a result of behavioral differences.”
Quote in the paperSubstantial claim - Premisecitation
As the attentional system matures, the early reliance on the frontal-parietal system may shift to a frontal-striatal system.
“As the attentional system matures, the early reliance on the frontal-parietal system may shift to a frontal-striatal system,45”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [45] Sohn, 2000, Inaugural article: the role of prefrontal cortex and posterior parietal cortex in task switching, Proc Natl Acad Sci U S A source
Not checked in the free run.
- Premisecitation
This finding is consistent with resting state data showing the HC group has greater connectivity between the inferior frontal gyrus and striatal regions (putamen).
“This finding is consistent with resting state data showing the HC group has greater connectivity between the inferior frontal gyrus and striatal regions (i.e., the putamen).46”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [46] Harrison, 2009, Altered corticostriatal functional connectivity in obsessive-compulsive disorder, Arch Gen Psychiatry source
Not checked in the free run.
- Study design and conductnone given
The pediatric OCD sample consisted mostly of medicated individuals.
“Our pediatric OCD sample consisted mostly of medicated individuals.”
Quote in the paperSubstantial claim - Interpretationcitation
No feedback is provided during the task that would elicit a striatal response to change behavior.
“Moreover, no feedback is provided to the subject during the task that would elicit a striatal response to change behavior.36”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [36] Monchi, 2001, Wisconsin Card Sorting revisited: distinct neural circuits participating in different stages of the task identified by event-related functional magnetic resonance imaging, J Neurosci source
Not checked in the free run.
- Premisecitation
During successful motor inhibition, healthy comparison subjects activated the right inferior frontal gyrus more than OCD subjects.
“During successful motor inhibition, healthy comparison subjects activated the right inferior frontal gyrus more than OCD subjects.13,18”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [13] Roth, 2007, Event-related functional magnetic resonance imaging of response inhibition in obsessive-compulsive disorder, Biol Psychiatry source
Not checked in the free run.
- cites [18] Woolley, 2008, Brain activation in paediatric obsessive compulsive disorder during tasks of inhibitory control, Br J Psychiatry source
Not checked in the free run.
- Interpretationcitation
The fixed block order and resulting predictability could reduce striatal activation, because the striatum is particularly responsive to novelty.
“In other words, the block order is fixed, and this predictability could reduce striatal activation, as the striatum is particularly responsive to novelty.29”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] Rauch, 1997, Probing striatal function in obsessive-compulsive disorder: a PET study of implicit sequence learning, J Neuropsychiatry Clin Neurosci source
Not checked in the free run.
- Premisecitation
Gray matter abnormalities associated with the orbitofrontal cortex and reductions in right inferior frontal gyrus activation in response inhibition tasks and reversal learning tasks have also been detected in unaffected relatives.
“In addition, gray matter abnormalities associated with the orbitofrontal cortex and reductions in right inferior frontal gyrus activation in response inhibition tasks and reversal learning tasks have also been detected in unaffected relatives.48,49”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [48] Menzies, 2007, Neurocognitive endophenotypes of obsessive-compulsive disorder, Brain source
Not checked in the free run.
- cites [49] Chamberlain, 2008, Orbitofrontal dysfunction in patients with obsessive-compulsive disorder and their unaffected relatives, Science source
Not checked in the free run.
- Study design and conductnone given
This study does not have sufficient power to examine activation in different age groups.
“however, this study does not have sufficient power to examine activation in different age groups.”
Quote in the paperSubstantial claim - Premisecitation
This finding is consistent with prior results indicating that depressive symptoms were not correlated with WCST performance in OCD patients.
“This finding is consistent with prior results indicating that depressive symptoms were not correlated with WCST performance in OCD patients.3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Lawrence, 2006, Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder, Neuropsychology source
Not checked in the free run.
- Interpretationreasoning
The negative correlation between caudate activation and shift cost in the OCD group could be explained by failure to activate the caudate with higher difficulty (greater shift cost).
“This negative correlation between caudate activation and shift cost in the OCD group could be explained by failure to activate the caudate with higher difficulty (i.e., greater shift cost).”
Quote in the paperSubstantial claim - Interpretationown data
Caudate activation seems to increase with increased difficulty to shift cognitive sets.
“Caudate activation seems to increase with increased difficulty to shift cognitive sets.”
Quote in the paperSubstantial claim - Study design and conductcitation
In this study, analyses were conducted on a heterogeneous sample with symptoms representative of most OCD symptom factors.
“however, in this study, analyses were conducted on a heterogeneous sample with symptoms representative of most OCD symptom factors, as previously defined.26,27”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [26] Leckman, 1997, Symptoms of obsessive-compulsive disorder, Am J Psychiatry source
Not checked in the free run.
- cites [27] Stewart, 2008, Four-factor structure of obsessive-compulsive disorder symptoms in children, adolescents, and adults, J Am Acad Child Adolesc Psychiatry source
Not checked in the free run.
- Interpretationcitation
Depressive symptoms may have greater effects on affective switching (reversal learning) tasks than the cognitive set-shifting tasks used in this study.
“In addition, the depressive symptoms may have greater effects on affective switching (i.e., reversal learning) tasks54 than the cognitive set-shifting tasks, such as the one used in this study.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [54] Remijnse, 2009, Differential frontal-striatal and paralimbic activity during reversal learning in major depressive disorder and obsessive-compulsive disorder, Psychol Med source
Not checked in the free run.
- Interpretationcitation
Given medication effects on brain activation, it would be more difficult to detect significant group differences in the inferior prefrontal cortex.
“Given these medication effects on brain activation, it would be more difficult to detect significant group differences in the inferior prefrontal cortex”
Quote in the paperSubstantial claim - Interpretationcitation
Current results are consistent with a study that combined healthy adults and children and found a negative correlation between caudate activation during mixed trials and reaction time to mixed trials.
“These current results are consistent with a study that combined healthy adults and children and found a negative correlation between caudate activation during mixed trials and reaction time to mixed trials.19”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Casey, 2004, Early development of subcortical regions involved in non-cued attention switching, Dev Sci source
Not checked in the free run.
- Interpretationreasoning
The lack of caudate and/or inferior frontal gyrus activation or the connectivity between these regions in the OCD group may reflect increased difficulty in shifting between cognitive sets.
“The lack of caudate and/or inferior frontal gyrus activation or the connectivity between these regions in the OCD group, may reflect increased difficulty in shifting between cognitive sets.”
Quote in the paperSubstantial claim - Premisecitation
Previous research in adult OCD has shown that set-shifting deficits on the WCST remain unchanged even after symptom remission.
“Previous research in adult OCD has shown that set-shifting deficits on the WCST remain unchanged even after symptom remission.4”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4] Bannon, 2006, Executive functions in obsessive-compulsive disorder: state or trait deficits?, Aust N Z J Psychiatry
Not checked in the free run.
- Interpretationcitation
Findings extend results from a recent study of task-switching in adult OCD6 by replicating them in a pediatric sample.
“Findings also extend results from a recent study of task-switching in adult OCD6 by replicating them in a pediatric sample.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] Gu, 2008, Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder, Brain source
Not checked in the free run.
- Premisenone given
The block design was selected because it has greater statistical power than event-related designs to detect differences.
“In a first attempt to examine group differences in the neural correlates of set-shifting in pediatric OCD, we opted to use a block design paradigm. Indeed, using this paradigm, a group difference was detected in the inferior frontal gyrus in set-shifting ability. Compared with event-related designs, block designs have increased statistical power to detect differences.”
Quote in the paperSubstantial claim- Rests on an assumption: Block designs have greater statistical power than event-related designs to detect differences.
- Study design and conductown data
Including age as a covariate did not alter the results.
“Even though including age as a covariate did not alter the results”
Quote in the paperNot a substantial claim
- May combine two claims. 16
- Classified as probably not a substantial claim. 31
- The quote only partly states this claim. 1
May combine two claims.
Findingown dataAfter accounting for intracranial volume, no significant group differences in overall gray matter, white matter, or CSF were found.
“After accounting for intracranial volume in regression analyses, no significant group differences in overall gray matter, white matter, or CSF were found (all p > .15).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataCompared with HC, the OCD group showed greater gray matter density in medial frontal gyrus/BA10, OFC, and rACC.
“Compared with the HC group, the OCD group showed greater gray matter density in medial frontal gyrus/BA10 [(−18, 58, −10), Z = 3.68, k = 34], OFC [(−8, 42, −14), Z = 3.34, k = 10], and rACC [(−8, 56, 10), Z = 3.25, k = 10].”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataNo significant correlations or group differences in correlation between shift cost and activation in the left or right inferior frontal gyrus were found.
“No significant correlations in either group and no significant group differences in correlation between shift cost and activation in either the left or right inferior frontal gyrus were found.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataNo group differences were detected in the dorsolateral prefrontal cortex and anterior cingulate cortex at the a priori threshold or any additional region at the FWE-corrected threshold.
“Group differences were not detected in the dorsolateral prefrontal cortex and ACC at our a priori significance threshold or any additional region at the FWE-corrected threshold.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn the HC group, right caudate activation during set-shifting was positively correlated with shift cost; in the OCD group, it was negatively correlated.
“in that we found a positive correlation in HC and a negative correlation in OCD.”
- Also stated in: § Imaging Data · plain
“The HC group showed a positive correlation (Pearson's r = 0.53, p < .02) and the OCD group showed a negative correlation (Pearson's r = 0.61, p < .02) between shift cost and percent signal change values in this region.”
- Also stated in: § Imaging Data · plain
“In other words, as the shift cost increased, the right caudate activation increased in the HC group and decreased in the OCD group”
Quote in the paperSubstantial claim- Also stated in: § Imaging Data · plain
May combine two claims.
Findingown dataThere were no significant main effects or group × condition interactions for reaction time on correct trials.
“No significant main effects or group × condition interactions for reaction time on correct trials were noted (all p > .2).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataIn the current study, accuracy rates in both groups were quite high, and most errors occurred within the first trials of the block.
“In the current study, accuracy rates in both groups were quite high, and most errors occurred within the first trials of the block”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe HC group activated both the putamen and caudate in these contrasts, but the OCD group did not activate these regions in either contrast.
“Specifically, the HC group activated both the putamen and caudate in these contrasts, but the OCD group did not activate these regions in either contrast.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataThe final study sample included 15 individuals with OCD and 20 healthy comparison subjects, matched for age, gender, and handedness.
“The final study sample included 15 individuals with OCD and 20 HC subjects, matched for age, gender, and handedness.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductown dataStatistical significance was based on both a peak threshold and a spatial extent threshold that corrects for multiple comparisons to p < .05.
“Statistical significance was based on both a peak threshold and a spatial extent threshold that corrects for multiple comparisons to a level of p < .05.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe left inferior frontal gyrus may maintain cognitive sets.
“The left inferior frontal gyrus may maintain the cognitive sets,38-41”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [38] Aron, 2004, A componential analysis of task-switching deficits associated with lesions of left and right frontal cortex, Brain source
Not checked in the free run.
- cites [39] Aron, 2004, Inhibition and the right inferior frontal cortex, Trends Cogn Sci source
Not checked in the free run.
- cites [40] Garavan, 2002, Dissociable executive functions in the dynamic control of behavior: inhibition, error detection, and correction, Neuroimage source
Not checked in the free run.
- cites [41] MacDonald, 2000, Dissociating the role of the dorsolateral prefrontal and anterior cingulate cortex in cognitive control, Science source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductcitationThe study used a priori regions of interest (OFC, inferior frontal gyrus, striatal, hippocampal) based on previous literature.
“Based on previous literature on task-switching, set-shifting, and implicit learning tasks,6,19,29,30 we examined group interaction effects in the frontal cortical (OFC, inferior frontal gyrus), striatal, and hippocampal regions, as a priori regions of interest (ROIs).”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [6] Gu, 2008, Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder, Brain source
Not checked in the free run.
- cites [19] Casey, 2004, Early development of subcortical regions involved in non-cued attention switching, Dev Sci source
Not checked in the free run.
- cites [29] Rauch, 1997, Probing striatal function in obsessive-compulsive disorder: a PET study of implicit sequence learning, J Neuropsychiatry Clin Neurosci source
Not checked in the free run.
- cites [30] Rauch, 2007, Functional magnetic resonance imaging study of regional brain activation during implicit sequence learning in obsessive-compulsive disorder, Biol Psychiatry source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductcitationThe set-shifting task used examines cognitive flexibility.
“The task, requiring an extradimensional shift to identify a target, examines cognitive flexibility.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Casey, 2004, Early development of subcortical regions involved in non-cued attention switching, Dev Sci source
Not checked in the free run.
The quote only partly states this claim.
PremisecitationIn neuroimaging studies, boys with OCD showed less caudate and orbitofrontal cortex activation in response to successful inhibition during a stop/signal task than healthy boys.
“as well as less caudate and orbitofrontal cortex (OFC) activation in response to successful inhibition during a stop/signal task.18”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [18] Woolley, 2008, Brain activation in paediatric obsessive compulsive disorder during tasks of inhibitory control, Br J Psychiatry source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataNo subjects were excluded for excessive head movement.
“None of the subjects were excluded for excessive head movement (3-mm translational movement or 1.5° rotation in any direction).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationAdults with OCD have deficits in cognitive flexibility and response inhibition.
“Numerous studies demonstrate that adults with OCD have deficits in cognitive flexibility and response inhibition.”
Quote in the paperSubstantial claim0 of 7 sources checked- cites [2] Kuelz, 2004, Neuropsychological performance in obsessive-compulsive disorder: a critical review, Biol Psychol source
Not checked in the free run.
- cites [3] Lawrence, 2006, Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder, Neuropsychology source
Not checked in the free run.
- cites [4] Bannon, 2006, Executive functions in obsessive-compulsive disorder: state or trait deficits?, Aust N Z J Psychiatry
Not checked in the free run.
- cites [5] Remijnse, 2006, Reduced orbitofrontal-striatal activity on a reversal learning task in obsessive-compulsive disorder, Arch Gen Psychiatry source
Not checked in the free run.
- cites [10] Penades, 2007, Impaired response inhibition in obsessive compulsive disorder, Eur Psychiatry source
Not checked in the free run.
- cites [11] Bannon, 2002, Response inhibition deficits in obsessive-compulsive disorder, Psychiatry Res source
Not checked in the free run.
- cites [12] Rosenberg, 1997, Response-inhibition deficits in obsessive-compulsive disorder: an indicator of dysfunction in frontostriatal circuits, J Psychiatry Neurosci
Not checked in the free run.
May combine two claims.
Interpretationown dataThe lack of left inferior frontal activation in the OCD group during mixed blocks, together with their tendency toward greater shift costs, suggests that the OCD group may have difficulty shifting cognitive sets because of a failure to activate the left inferior frontal gyrus.
“The lack of left inferior frontal activation in the OCD group during mixed blocks, coupled with the patients' tendency toward greater shift costs, suggest that the OCD group may have difficulty shifting cognitive sets because of a failure to activate the left inferior frontal gyrus.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationBilateral inferior frontal gyrus activations have been reported during set-shifting.
“Bilateral inferior frontal gyrus activations have been reported during set-shifting.35-37”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [35] Dove, 2000, Prefrontal cortex activation in task switching: an event-related fMRI study, Brain Res Cogn Brain Res source
Not checked in the free run.
- cites [36] Monchi, 2001, Wisconsin Card Sorting revisited: distinct neural circuits participating in different stages of the task identified by event-related functional magnetic resonance imaging, J Neurosci source
Not checked in the free run.
- cites [37] Nakahara, 2002, Functional MRI of macaque monkeys performing a cognitive set-shifting task, Science source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisenone givenThe left inferior frontal gyrus may be recruited to successfully shift cognitive sets.
“Generally, the left inferior frontal gyrus may be recruited to successfully shift cognitive sets.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe final sample was obtained after excluding data from four OCD and one HC participant for poor behavioral response and one HC participant for technical problems.
“This final sample was obtained after data from participants were excluded for poor behavioral response (four OCD, one HC) and technical problems (one HC).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationFronto-striatal circuitry hyperactivity has been detected in Tourette's disorder patients, which is contrary to our finding.
“Fronto-striatal circuitry hyperactivity has been detected in Tourette's disorder patients,55,56 which is contrary to our finding”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [55] Baym, 2008, Neural correlates of tic severity and cognitive control in children with Tourette syndrome, Brain source
Not checked in the free run.
- cites [56] Marsh, 2007, A developmental fMRI study of self-regulatory control in Tourette's syndrome, Am J Psychiatry source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationOther studies suggest that medication effects from SSRIs may reduce frontal and striatal activation during OCD symptom provocation.
“However, other studies suggest that medication effects from SSRIs may reduce frontal and striatal activation during OCD symptom provocation.51”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [51] Nakao, 2005, Brain activation of patients with obsessive-compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: a functional magnetic resonance imaging study, Biol Psychiatry source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSeveral studies have suggested the importance of examining the different OCD symptom profiles separately.
“Several studies have suggested the importance of examining the different OCD symptom profiles separately3,30”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [3] Lawrence, 2006, Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder, Neuropsychology source
Not checked in the free run.
- cites [30] Rauch, 2007, Functional magnetic resonance imaging study of regional brain activation during implicit sequence learning in obsessive-compulsive disorder, Biol Psychiatry source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSome studies have reported that the neuropsychological deficits in executive functioning are attributable to comorbid depressive symptoms.
“Some studies have reported that the neuropsychological deficits in executive functioning are attributable to comorbid depressive symptoms.53”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [53] Purcell, 1998, Neuropsychological deficits in obsessive-compulsive disorder: a comparison with unipolar depression, panic disorder, and normal controls, Arch Gen Psychiatry source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningThe group difference in correlation may be explained by the activation of different neuronal populations within the caudate.
“The group difference in correlation may be explained by the activation of different neuronal populations within the caudate.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe left inferior frontal gyrus may resolve interference from previous trials in working memory tasks.
“resolve interference from previous trials in working memory tasks.44”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [44] D'Esposito, 1999, The neural substrate and temporal dynamics of interference effects in working memory as revealed by event-related functional MRI, Proc Natl Acad Sci U S A source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationContemporary neurocircuitry models of OCD emphasize a potential imbalance between the mutually antagonistic direct and indirect cortico-striatal-thalamic pathways.
“Contemporary neurocircuitry models of OCD emphasize a potential imbalance between the mutually antagonistic direct and indirect cortico-striatal-thalamic pathways.47”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [47] Saxena, 1998, Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder, Br J Psychiatry Suppl source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenThe group difference in correlation may be explained by the multiple discrete cell types in the striatum that cannot be readily discriminated using fMRI imaging methods.
“The group difference in correlation also may be explained by the multiple discrete cell types in the striatum that cannot be readily discriminated using fMRI imaging methods.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe left inferior frontal gyrus may mediate cognitive shift.
“mediate the cognitive shift,42,43”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [42] Derrfuss, 2005, Involvement of the inferior frontal junction in cognitive control: meta-analyses of switching and Stroop studies, Hum Brain Mapp source
Not checked in the free run.
- cites [43] Konishi, 2002, Hemispheric asymmetry in human lateral prefrontal cortex during cognitive set shifting, Proc Natl Acad Sci U S A source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationSome studies have suggested that medication may not influence cognitive function or group differences in activation.
“Some studies have suggested that medication may not influence cognitive function or group differences in activation.6,50”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [6] Gu, 2008, Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder, Brain source
Not checked in the free run.
- cites [50] Mataix-Cols, 2002, Neuropsychological performance in medicated versus unmedicated patients with obsessive-compulsive disorder, Psychiatry Res source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningDevelopmental effects may explain the lack of striatal group differences.
“Alternatively, developmental effects may explain the lack of striatal group differences.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe right inferior frontal gyrus may facilitate successful response inhibition.
“On the other hand, the right inferior frontal gyrus may facilitate successful response inhibition.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationThe right inferior frontal gyrus has been implicated in tasks requiring response inhibition or task-switching when stimulus-response mappings change.
“The right inferior frontal gyrus has been implicated in tasks that require responses inhibition (e.g., during go/no go tasks) or taskswitching when stimulus–response mappings change.38”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [38] Aron, 2004, A componential analysis of task-switching deficits associated with lesions of left and right frontal cortex, Brain source
Not checked in the free run.
May combine two claims.
PremisecitationExtradimensional shift deficits may represent a possible endophenotype, as first-degree relatives of females with OCD who have contamination symptoms have demonstrated similar deficits.
“Extradimensional shift deficits may represent a possible endophenotype, as first-degree relatives of females with OCD who have contamination symptoms have demonstrated similar deficits.7”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] Chamberlain, 2006, Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania, Am J Psychiatry source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationWork in ADHD has found reductions in frontal regions during response inhibition tasks.
“however, work in ADHD has found reductions in frontal regions during response inhibition tasks.57”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [57] Smith, 2006, Task-specific hypoactivation in prefrontal and temporoparietal brain regions during motor inhibition and task switching in medication-naive children and adolescents with attention deficit hyperactivity disorder, Am J Psychiatry source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThere is some evidence that antidepressants enhance right inferior prefrontal activation during inhibitory tasks.
“In addition, there is some evidence that antidepressants enhance right inferior prefrontal activation during inhibitory tasks.52”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [52] Vollm, 2006, Serotonergic modulation of neuronal responses to behavioural inhibition and reinforcing stimuli: an fMRI study in healthy volunteers, Eur J Neurosci source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningIt is expected that the group differences found in this study with a medicated OCD sample would be more pronounced in drug-naive patients.
“and it is expected that the group differences found in this study with a medicated OCD sample would be more pronounced in drug-naive patients.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
InterpretationreasoningGroup differences between HC and OCD groups in set-shifting may emerge at a later time point along the brain's developmental trajectory.
“Group differences between HC and OCD groups in set-shifting may emerge at a later time point along the brain's developmental trajectory”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe sample did contain individuals with comorbid diagnoses of Tourette's disorder and attention-deficit/hyperactivity disorder (ADHD).
“Finally, our sample did contain individuals with comorbid diagnoses of Tourette's disorder and attention-deficit/hyperactivity disorder (ADHD).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationGu et al. reported less inferior frontal gyrus activation during task-switching in adults with OCD and show that this effect is independent of medication status.
“In particular, Gu et al. reported less inferior frontal gyrus activation during task-switching in adults with OCD and show that this effect is independent of medication status.6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Gu, 2008, Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder, Brain source
Not checked in the free run.
May combine two claims.
InterpretationreasoningBoth the behavioral and functional activation group differences are highly relevant to the disorder's symptoms, suggesting that deficits in shifting cognitive sets are linked to less inferior frontal gyrus and striatal activation.
“Both the behavioral and functional activation group differences are highly relevant to the disorder's symptoms, suggesting that deficits in shifting cognitive sets are linked to less inferior frontal gyrus and striatal activation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenThe functional activation patterns may be dependent on developmental stage.
“Finally, the functional activation patterns may be dependent on developmental stage.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataAs IQ measures were not obtained from this sample, we cannot address whether IQ differences affected the group differences in functional activation.
“As IQ measures were not obtained from this sample, we cannot address whether IQ differences affected the group differences in functional activation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationown dataResults from this study provide new insight into the neural correlates of cognitive flexibility deficits in pediatric OCD.
“In summary, results from this study provide new insight into the neural correlates of cognitive flexibility deficits in pediatric OCD.”
Quote in the paperNot a substantial claim- Rests on an assumption: No prior study has examined set-shifting in pediatric OCD.
The paper relies on this without support.
OCD symptoms may arise from an inability to shift cognitive sets or inhibit repetitive behaviors.
“symptoms that may arise from the inability to shift cognitive sets or to inhibit repetitive behaviors.”
The paper relies on this without support.
Task-switching paradigms involve shifting both cognitive tasks and motor response mappings.
“The task-switching paradigms involve shifting both cognitive tasks and motor response mappings”
The paper relies on this without support.
The set-shifting task isolates cognitive shifting deficits from motor response shifts.
“additional neuroimaging studies in pediatric OCD are needed to investigate neural correlates of cognitive flexibility isolating deficits during cognitive from motor shifts.”
The paper relies on this without support.
No prior study has examined set-shifting in pediatric OCD.
“To the authors' knowledge, this study represents the first attempt to study set-shifting in pediatric OCD.”
The paper relies on this without support.
Block designs have greater statistical power than event-related designs to detect differences.
“Compared with event-related designs, block designs have increased statistical power to detect differences.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Probabilistic reversal learning tasks have often been used to test cognitive flexibility.
“To test cognitive flexibility, probabilistic reversal learning tasks have often been used (e.g., Adleman et al., 2011; Britton et al., 2010; Clarke et al., 2004; Klanker et al., 2013; van der Plasse and Feenstra, 2008; Xue et al., 2013).”
From Cognitive flexibility in adolescence: Neural and behavioral mechanisms of reward prediction error processing in adaptive decision making during development (2015) · cites this paper as Britton et al., 2010
Children with OCD, compared with controls, have reduced orbitofrontal cortex activation during set shifting, with no differences in the striatum, dorsomedial prefrontal cortex, or dorsolateral prefrontal cortex.
“Children with OCD, relative to controls, had decreased OFC activation during set shifting, but there were no differences in the striatum, dmPFC, or dlPFC.”
From Neural Substrates of Childhood Anxiety Disorders (2012) · cites this paper as [162]
Caudate activation is positively correlated with a behavioral measure of cognitive flexibility in healthy controls, but negatively correlated in children with OCD.
“Caudate activation was positively correlated with a behavioral measure cognitive flexibility in healthy controls, but negatively correlated in OCD.”
From Neural Substrates of Childhood Anxiety Disorders (2012) · cites this paper as [162]
Children with OCD have larger gray-matter volume in the orbitofrontal cortex.
“Larger gray-matter volume has also been reported in the OFC162,166”
From Neural Substrates of Childhood Anxiety Disorders (2012) · cites this paper as [162]
Children with OCD show differences in the inferior frontal gyrus.
“Other PFC areas that show differences in OCD include the medial frontal gyrus162,167 and inferior frontal gyrus.162”
From Neural Substrates of Childhood Anxiety Disorders (2012) · cites this paper as [162]
Children with OCD show differences in the medial frontal gyrus.
“Other PFC areas that show differences in OCD include the medial frontal gyrus162,167 and inferior frontal gyrus.162”
From Neural Substrates of Childhood Anxiety Disorders (2012) · cites this paper as [162]
Childhood OCD is associated with larger gray-matter volume in the anterior cingulate cortex, replicated in multiple samples using manual tracing and voxel-based morphometry.
“In the PFC, the most consistent structural finding to date is that childhood OCD is associated with larger gray-matter volume in the ACC, a finding that has been replicated in multiple samples using both manual tracing152,166,170 and voxel-based morphometry162 methods.”
From Neural Substrates of Childhood Anxiety Disorders (2012) · cites this paper as [162]
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- ConsistentF(2, 66) = 12.1reported p < .001 · recomputed p < .001
“F(2, 66) = 12.1, p < .001”
- ConsistentF(6, 198) = 3reported p < .03 · recomputed p = .008
“F(6, 198) = 3.0, p < .03”
- ConsistentF(3, 99) = 22.2reported p < .001 · recomputed p < .001
“F(3, 99) = 22.2, p < .001”
- ConsistentF(1, 33) = 3.6reported p < .07 · recomputed p = .067
“F(1, 33) = 3.6, p < .07”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Self-check results appear here once an independent check has confirmed them.
Cites
Co-Planar Stereotaxic Atlas of the Human Brain
Talairach, J., & Tournoux, P. (1988) · Medical Entomology and Zoology · Cited by 11,798 · see citing works
Cortical Surface-Based Analysis
Dale, A. M., Fischl, B., & Sereno, M. I. (1999) · NeuroImage · doi:10.1006/nimg.1998.0395 · Cited by 10,910 · see citing works
KAUFMAN, J., BIRMAHER, B., BRENT, D., RAO, U., FLYNN, C., MORECI, P., WILLIAMSON, D., & RYAN, N. (1997) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199707000-00021 · Cited by 10,148 · see citing works
The Yale-Brown Obsessive Compulsive Scale: I. Development, Use, and Reliability
Goodman, W. K. (1989) · Archives of General Psychiatry · doi:10.1001/archpsyc.1989.01810110048007 · Cited by 7,712 · see citing works
J Neuropsychiatry Clin Neurosci
Yudofsky, S. C., & Hales, R. E. (1992) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.4.4.359 · Cited by 3,818 · see citing works
MacDonald, A. W., Cohen, J. D., Stenger, V. A., & Carter, C. S. (2000) · Science · doi:10.1126/science.288.5472.1835 · Cited by 3,666 · see citing works
Inhibition and the right inferior frontal cortex
Aron, A. R., Robbins, T. W., & Poldrack, R. A. (2004) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2004.02.010 · Cited by 3,197 · see citing works
The Yale-Brown Obsessive Compulsive Scale: II. Validity
Goodman, W. K. (1989) · Archives of General Psychiatry · doi:10.1001/archpsyc.1989.01810110054008 · Cited by 2,799 · see citing works
The Yale-Brown Obsessive-Compulsive Scale: Measures of internal consistency
Kim, S. W., Dysken, M. W., Pheley, A. M., & Hoover, K. M. (1994) · Psychiatry Research · doi:10.1016/0165-1781(94)90039-6 · Cited by 2,361 · see citing works
Region of interest analysis using an SPM toolbox
Brett, M. (2002) · NeuroImage · Cited by 2,273 · see citing works
The yale global tic severity scale: initial testing of a clinician-rated scale of tic severity
LECKMAN, J. F., RIDDLE, M. A., HARDIN, M. T., ORT, S. I., SWARTZ, K. L., STEVENSON, J., & COHEN, D. J. (1989) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-198907000-00015 · Cited by 2,146 · see citing works
Garavan, H. (2002) · NeuroImage · doi:10.1006/nimg.2002.1326 · Cited by 988 · see citing works
Monchi, O., Petrides, M., Petre, V., Worsley, K., & Dagher, A. (2001) · The Journal of Neuroscience · doi:10.1523/jneurosci.21-19-07733.2001 · Cited by 961 · see citing works
Neuroimaging and frontal–subcortical circuitry in obsessive–compulsive disorder
Saxena, S., Brody, A. L., Schwartz, J. M., & Baxter, L. R. (1998) · British Journal of Psychiatry · doi:10.1192/s0007125000297870 · Cited by 831 · see citing works
Symptoms of obsessive-compulsive disorder
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.7.911 · Cited by 766 · see citing works
Prefrontal cortex activation in task switching: an event-related fMRI study
Dove, A., Pollmann, S., Schubert, T., Wiggins, C. J., & Yves von Cramon, D. (2000) · Cognitive Brain Research · doi:10.1016/s0926-6410(99)00029-4 · Cited by 714 · see citing works
Statistical Parametric Mapping
Friston, K. J. (2003) · Springer eBooks · doi:10.1007/978-1-4615-1079-6_16 · Cited by 690 · see citing works
Motor Inhibition and Cognitive Flexibility in Obsessive-Compulsive Disorder and Trichotillomania
Chamberlain, S. R., Fineberg, N. A., Blackwell, A. D., Robbins, T. W., & Sahakian, B. J. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.7.1282 · Cited by 627 · see citing works
Derrfuss, J., Brass, M., Neumann, J., & von Cramon, D. Y. (2005) · Human Brain Mapping · doi:10.1002/hbm.20127 · Cited by 606 · see citing works
Altered corticostriatal functional connectivity in obsessive-compulsive disorder
Harrison, B. J., Soriano-Mas, C., Pujol, J., Ortiz, H., López-Solà, M., Hernández-Ribas, R., Deus, J., Alonso, P., Yücel, M., Pantelis, C., et al. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.152 · Cited by 571 · see citing works
The role of prefrontal cortex and posterior parietal cortex in task switching
Sohn, M.-H., Ursu, S., Anderson, J. R., Stenger, V. A., & Carter, C. S. (2000) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.240460497 · Cited by 552 · see citing works
Chamberlain, S. R., Menzies, L., Hampshire, A., Suckling, J., Fineberg, N. A., del Campo, N., Aitken, M., Craig, K., Owen, A. M., Bullmore, E. T., et al. (2008) · Science · doi:10.1126/science.1154433 · Cited by 550 · see citing works
Neurocognitive endophenotypes of obsessive-compulsive disorder
Menzies, L., Achard, S., Chamberlain, S. R., Fineberg, N., Chen, C.-H., del Campo, N., Sahakian, B. J., Robbins, T. W., & Bullmore, E. (2007) · Brain · doi:10.1093/brain/awm205 · Cited by 443 · see citing works
Neuropsychological performance in obsessive-compulsive disorder: a critical review
Kuelz, A. K., Hohagen, F., & Voderholzer, U. (2004) · Biological Psychology · doi:10.1016/j.biopsycho.2003.07.007 · Cited by 436 · see citing works
Reduced orbitofrontal-striatal activity on a reversal learning task in obsessive-compulsive disorder
Remijnse, P. L., Nielen, M. M. A., van Balkom, A. J. L. M., Cath, D. C., van Oppen, P., Uylings, H. B. M., & Veltman, D. J. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.11.1225 · Cited by 408 · see citing works
Aron, A. R., Monsell, S., Sahakian, B. J., & Robbins, T. W. (2004) · Brain · doi:10.1093/brain/awh169 · Cited by 372 · see citing works
Purcell, R., Maruff, P., Kyrios, M., & Pantelis, C. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.5.415 · Cited by 330 · see citing works
D’Esposito, M., Postle, B. R., Jonides, J., & Smith, E. E. (1999) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.96.13.7514 · Cited by 329 · see citing works
Impaired response inhibition in obsessive compulsive disorder
Penadés, R., Catalán, R., Rubia, K., Andrés, S., Salamero, M., & Gastó, C. (2007) · European Psychiatry · doi:10.1016/j.eurpsy.2006.05.001 · Cited by 308 · see citing works
Nakao, T., Nakagawa, A., Yoshiura, T., Nakatani, E., Nabeyama, M., Yoshizato, C., Kudoh, A., Tada, K., Yoshioka, K., Kawamoto, M., et al. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.12.039 · Cited by 307 · see citing works
(1997) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.9.4.568 · Cited by 301 · see citing works
Self-citationSmith, A. B., Taylor, E., Brammer, M., Toone, B., & Rubia, K. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.6.1044 · Cited by 300 · see citing works
Lawrence, N. S., Wooderson, S., Mataix-Cols, D., David, R., Speckens, A., & Phillips, M. L. (2006) · Neuropsychology · doi:10.1037/0894-4105.20.4.409 · Cited by 291 · see citing works
Functional MRI of macaque monkeys performing a cognitive set-shifting task
Nakahara, K., Hayashi, T., Konishi, S., & Miyashita, Y. (2002) · Science · doi:10.1126/science.1067653 · Cited by 286 · see citing works
Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder
Gu, B.-M., Park, J.-Y., Kang, D.-H., Lee, S. J., Yoo, S. Y., Jo, H. J., Choi, C.-H., Lee, J.-M., & Kwon, J. S. (2007) · Brain · doi:10.1093/brain/awm277 · Cited by 284 · see citing works
Response inhibition deficits in obsessive–compulsive disorder
Bannon, S., Gonsalvez, C. J., Croft, R. J., & Boyce, P. M. (2002) · Psychiatry Research · doi:10.1016/s0165-1781(02)00104-x · Cited by 246 · see citing works
Veale, D. M., Sahakian, B. J., Owen, A. M., & Marks, I. M. (1996) · Psychological Medicine · doi:10.1017/s0033291700035984 · Cited by 239 · see citing works
Executive function in Tourette’s syndrome and obsessive–compulsive disorder
WATKINS, L. H., SAHAKIAN, B. J., ROBERTSON, M. M., VEALE, D. M., ROGERS, R. D., PICKARD, K. M., AITKEN, M. R. F., & ROBBINS, T. W. (2005) · Psychological Medicine · doi:10.1017/s0033291704003691 · Cited by 210 · see citing works
Rubia, K., Cubillo, A., Smith, A. B., Woolley, J., Heyman, I., & Brammer, M. J. (2010) · Human Brain Mapping · doi:10.1002/hbm.20864 · Cited by 192 · see citing works
Neural correlates of tic severity and cognitive control in children with Tourette syndrome
Baym, C. L., Corbett, B. A., Wright, S. B., & Bunge, S. A. (2008) · Brain · doi:10.1093/brain/awm278 · Cited by 186 · see citing works
Roth, R. M., Saykin, A. J., Flashman, L. A., Pixley, H. S., West, J. D., & Mamourian, A. C. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.12.007 · Cited by 181 · see citing works
Rauch, S. L., Wedig, M. M., Wright, C. I., Martis, B., McMullin, K. G., Shin, L. M., Cannistraro, P. A., & Wilhelm, S. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.12.012 · Cited by 167 · see citing works
Self-citationBrain activation in paediatric obsessive-compulsive disorder during tasks of inhibitory control
Woolley, J., Heyman, I., Brammer, M., Frampton, I., McGuire, P. K., & Rubia, K. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.036558 · Cited by 162 · see citing works
Hemispheric asymmetry in human lateral prefrontal cortex during cognitive set shifting
Konishi, S., Hayashi, T., Uchida, I., Kikyo, H., Takahashi, E., & Miyashita, Y. (2002) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.122644899 · Cited by 161 · see citing works
Rubia, K., Halari, R., Cubillo, A., Mohammad, A., Scott, S., & Brammer, M. (2010) · Human Brain Mapping · doi:10.1002/hbm.20975 · Cited by 153 · see citing works
A functional magnetic resonance imaging study of inhibitory control in obsessive-compulsive disorder
Page, L. A., Rubia, K., Deeley, Q., Daly, E., Toal, F., Mataix-Cols, D., Giampietro, V., Schmitz, N., & Murphy, D. G. M. (2009) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2009.05.002 · Cited by 147 · see citing works
A Developmental fMRI Study of Self-Regulatory Control in Tourette’s Syndrome
Marsh, R., Zhu, H., Wang, Z., Skudlarski, P., & Peterson, B. S. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.6.955 · Cited by 132 · see citing works
Executive functions in obsessive–compulsive disorder: state or trait deficits?
Bannon, S., Gonsalvez, C. J., Croft, R. J., & Boyce, P. M. (2006) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2006.01928.x · Cited by 131 · see citing works
Remijnse, P. L., Nielen, M. M. A., van Balkom, A. J. L. M., Hendriks, G.-J., Hoogendijk, W. J., Uylings, H. B. M., & Veltman, D. J. (2009) · Psychological Medicine · doi:10.1017/s0033291708005072 · Cited by 127 · see citing works
Mataix-Cols, D., Alonso, P., Pifarré, J., Menchón, J. M., & Vallejo, J. (2002) · Psychiatry Research · doi:10.1016/s0165-1781(02)00024-0 · Cited by 116 · see citing works
Oculomotor Response Inhibition Abnormalities in Pediatric Obsessive-Compulsive Disorder
Rosenberg, D. R. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830210075008 · Cited by 114 · see citing works
Rosenberg, D. R., Dick, E. L., O’Hearn, K. M., & Sweeney, J. A. (1997) · PubMed Central · Cited by 111 · see citing works
Four-factor structure of obsessive-compulsive disorder symptoms in children, adolescents, and adults
Stewart, S. E., Rosario, M. C., Baer, L., Carter, A. S., Brown, T. A., Scharf, J. M., Illmann, C., Leckman, J. F., Sukhodolsky, D., Katsovich, L., et al. (2008) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e318172ef1e · Cited by 110 · see citing works
Self-citationVöllm, B., Richardson, P., McKie, S., Elliott, R., Deakin, J. F. W., & Anderson, I. M. (2006) · European Journal of Neuroscience · doi:10.1111/j.1460-9568.2005.04571.x · Cited by 106 · see citing works
A study of neuropsychological deficit in children with obsessive-compulsive disorder
Shin, M.-S., Choi, H., Kim, H., Hwang, J.-W., Kim, B.-N., & Cho, S.-C. (2008) · European Psychiatry · doi:10.1016/j.eurpsy.2008.03.010 · Cited by 81 · see citing works
Early development of subcortical regions involved in non-cued attention switching
Casey, B. J., Davidson, M. C., Hara, Y., Thomas, K. M., Martinez, A., Galvan, A., Halperin, J. M., Rodríguez‐Aranda, C. E., & Tottenham, N. (2004) · Developmental Science · doi:10.1111/j.1467-7687.2004.00377.x · Cited by 80 · see citing works
Executive functions in obsessive?compulsive disorder: state or trait deficits?
Bannon, S., Gonsalvez, C. J., Croft, R. J., et al. (2006) · Australian & New Zealand Journal of Psychiatry · doi:10.1111/j.1440-1614.2006.01928.x · Cited by 49 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Snyder, H. R., Kaiser, R. H., Warren, S. L., & Heller, W. (2015) · Clinical Psychological Science · doi:10.1177/2167702614534210 · Cited by 325 · see citing works
Hauser, T. U., Iannaccone, R., Walitza, S., Brandeis, D., & Brem, S. (2015) · NeuroImage · doi:10.1016/j.neuroimage.2014.09.018 · Cited by 203 · see citing works
Carlisi, C. O., Norman, L. J., Lukito, S. S., Radua, J., Mataix-Cols, D., & Rubia, K. (2017) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.10.006 · Cited by 176 · see citing works
Eng, G. K., Sim, K., & Chen, S.-H. A. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.03.002 · Cited by 148 · see citing works
Neural Substrates of Childhood Anxiety Disorders
Blackford, J. U., & Pine, D. S. (2012) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2012.05.002 · Cited by 138 · see citing works
Self-citationAbramovitch, A., Abramowitz, J. S., Mittelman, A., Stark, A., Ramsey, K., & Geller, D. A. (2015) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12414 · Cited by 88 · see citing works
Brem, S., Hauser, T. U., Iannaccone, R., Brandeis, D., Drechsler, R., & Walitza, S. (2012) · Journal of Neural Transmission · doi:10.1007/s00702-012-0813-z · Cited by 79 · see citing works
Neural correlates of behavior therapy for Tourette׳s disorder
Deckersbach, T., Chou, T., Britton, J. C., Carlson, L. E., Reese, H. E., Siev, J., Scahill, L., Piacentini, J. C., Woods, D. W., Walkup, J. T., et al. (2014) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2014.09.003 · Cited by 78 · see citing works
Self-citationBurrows, C. A., Timpano, K. R., & Uddin, L. Q. (2017) · Clinical Psychological Science · doi:10.1177/2167702616683506 · Cited by 43 · see citing works
Marzuki, A. A., Pereira de Souza, A. M. F. L., Sahakian, B. J., & Robbins, T. W. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.12.010 · Cited by 39 · see citing works
Funch Uhre, V., Melissa Larsen, K., Marc Herz, D., Baaré, W., Katrine Pagsberg, A., & Roman Siebner, H. (2022) · NeuroImage: Clinical · doi:10.1016/j.nicl.2022.103268 · Cited by 18 · see citing works
Defining repetitive behaviours in frontotemporal dementia
Restrepo-Martínez, M., Ramirez-Bermudez, J., Chacon-Gonzalez, J., Ruiz-Garcia, R., Malik, R., & Finger, E. (2024) · Brain · doi:10.1093/brain/awad431 · Cited by 15 · see citing works
Nishat, E., Dockstader, C., Wheeler, A. L., Tan, T., Anderson, J. A. E., Mendlowitz, S., Mabbott, D. J., Arnold, P. D., & Ameis, S. H. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.632736 · Cited by 3 · see citing works
Li, Z., Tong, G., Wang, Y., Ruan, H., Zheng, Z., Cheng, J., & Wang, Z. (2024) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2023.2251057 · Cited by 4 · see citing works
- Authors
- Britton, J. C., Rauch, S. L., Rosso, I. M., Killgore, W. D. S., Price, L. M., Ragan, J., Chosak, A., Hezel, D. M., Pine, D. S., Leibenluft, E., Pauls, D. L., Jenike, M. A., & Stewart, S. E.
- Affiliations
- National Institute of Mental Health (US)
- McLean Hospital (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Stewart, S. Evelyn
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 49
- Issue
- 9
- Pages
- 944-953
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC4196669
- OpenAlex
- W2147831701
- Semantic Scholar
- e9e087f420e0254ba132a4389f83fb45900a3970
- Cited by
- 92
- References
- 57
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 3 · 2017: 9 · 2016: 8 · 2015: 13 · 2014: 5 · 2013: 1 · 2012: 9
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Defense
- Massachusetts General Hospital
- McLean Hospital
- National Institutes of Health
- National Institute of Mental Health
- National Institute of Neurological Disorders and Stroke (R01NS016648)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- pediatric obsessive-compulsive disorder, cognitive flexibility, set-shifting, response inhibition, frontostriatal circuits, inferior frontal gyrus, neural correlates, developing brain
- MeSH terms
- Adolescent, Attention, Brain Mapping, Caudate Nucleus, Child, Cognition, Color Perception, Corpus Striatum, Dominance, Cerebral, Female, Frontal Lobe, Humans, Magnetic Resonance Imaging, Male, Obsessive-Compulsive Disorder, Orientation, Pattern Recognition, Visual, Psychomotor Performance, Reaction Time, Reference Values, Reversal Learning
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.
Statistics and arithmetic are recomputed, not judged.
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 ›
Are you an author, or do you see a problem with this page? Request a review
