Error-related negativity and tic history in pediatric obsessive-compulsive disorder
Open accessAbstract
Objective The error-related negativity (ERN) is a negative deflection in the event-related potential after an incorrect response, which is often increased in patients with obsessive-compulsive disorder (OCD). However, the relation of the ERN to comorbid tic disorders has not been examined in patients with OCD. This study compared ERN amplitudes in patients with tic-related OCD, patients with non-tic-related OCD, and healthy controls.Method The ERN, correct response negativity, and error number were measured during an Eriksen flanker task to assess performance monitoring in 44 youth with a lifetime diagnosis of OCD and 44 matched healthy controls ranging in age from 10 to 19 years. Nine youth with OCD had a lifetime history of tics.Results ERN amplitude was significantly increased in patients with OCD compared with healthy controls. ERN amplitude was significantly larger in patients with non-tic-related OCD than in patients with tic-related OCD or controls. ERN amplitude had a significant negative correlation with age in healthy controls but not in patients with OCD. Instead, in patients with non-tic-related OCD, ERN amplitude had a significant positive correlation with age at onset of OCD symptoms. ERN amplitude in patients was unrelated to OCD symptom severity, current diagnostic status, or treatment effects.Conclusions The results provide further evidence of increased error-related brain activity in pediatric OCD. The difference in the ERN between patients with tic-related and those with non-tic-related OCD provides preliminary evidence of a neurobiological difference between these two OCD subtypes. The results indicate the ERN is a trait-like measurement that may serve as a biomarker for non-tic-related OCD.
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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.
“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 [34]
The Results section (Clinical Correlations and Comparisons) reports no significant correlation with age at onset across all pediatric OCD patients. In the non-tic-related subgroup, the correlation with age at onset was positive, not negative. The paper does report a larger ERN with longer symptom duration, but only in that subgroup. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredERN amplitude increases progressively with age in both pediatric OCD patients and age-matched controls.
“Furthermore, ERN amplitude increases progressively with age in both pediatric OCD patients and age‐matched controls [34, 35].”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [34]
The Results (Event-Related Brain Potential Data) found that ERN amplitude at Cz became larger with age in healthy controls, but the age correlation was not significant in the OCD group. The Discussion likewise says the age correlation occurred in controls, not patients with OCD. Thus the source contradicts the claim that ERN amplitude increases with age in both groups. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThis increase is also seen in siblings not expressing the disease.
“This increase is also seen in siblings not expressing the disease [25, 33–35]”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [34]
The Introduction reports increased ERN amplitude in unaffected first-degree relatives of people with OCD, supporting the claim that the increase can occur without symptoms. It does not identify those relatives specifically as siblings, and this study did not test siblings. No page number is available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIncreased ERN amplitude is an endophenotype of a predisposition to develop the pathology.
“confirming that increased ERN amplitude is an endophenotype of a predisposition to develop the pathology.”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [34]
The Abstract Results and Discussion report increased ERN amplitude in OCD and describe it as a trait-like measure. But the Discussion says its status as an endophenotype is only proposed: further research is needed to establish its relationship to genetic risk, and the authors suggest ‘biomarker’ may better describe its current status. The source therefore does not confirm the endophenotype claim. (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 [34]
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 measured
In 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].”
The enlarged ERN effect in paediatric OCD was generally specific to error processing, because the correct-response negativity was often unchanged.
“This effect was generally specific to error processing, because the correct-response negativity was often unchanged, suggesting that the abnormality did not simply reflect a general increase in response-related activity [34,37,38,40,42].”
Paediatric studies suggested that enlarged ERN may be especially pronounced in non-tic-related OCD, whereas youths with tic-related OCD sometimes resembled healthy controls.
“Paediatric studies suggested that enlarged ERN may be especially pronounced in non-tic-related OCD, whereas youths with tic-related OCD sometimes resembled healthy controls [37].”
As in adult OCD patients, children and adolescents with OCD show an increase in ERN amplitude compared to age-matched control participants.
“As in adult OCD patients, children and adolescents with OCD show an increase in ERN amplitude compared to age‐matched control participants.”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [34]
Several studies, including the present study, reported no association between an altered ERN and OCD symptom severity.
“Furthermore, several studies (Endrass, Riesel, Kathmann, & Buhlmann, 2014; Hanna et al., 2012; Nawani et al., 2017; Riesel, Kathmann, & Endrass, 2014; Ruchsow et al., 2005), including the present study reported no association between an altered ERN and OCD symptom severity.”
From Obsessive–compulsive disorder (OCD) is associated with increased engagement of frontal brain regions across multiple event-related potentials (2023) · cites this paper as Hanna et al., 2012
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Hanna, G., Liu, Y., Rentschler, L., Hanna, B., Arnold, P., & Gehring, W. (2024) · doi:10.21203/rs.3.rs-3943784/v1 · Cited by 4 · see citing works
Self-citationChmiel, J., & Kładna, A. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15155994
Wassouf, I., Vibert, N., Dampuré, J., Doolub, D., Harika-Germaneau, G., Langbour, N., & Jaafari, N. (2026) · Depression and Anxiety · doi:10.1155/da/9694689
“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].”
- Authors
- Hanna, G. L., Carrasco, M., Harbin, S. M., Nienhuis, J. K., LaRosa, C. E., Chen, P., Fitzgerald, K. D., & Gehring, W. J.
- Affiliations
- University of Michigan (US)
- National Chung Cheng University (TW)
- Corresponding author
- Hanna, Gregory L.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 51
- Issue
- 9
- Pages
- 902-910
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC3427894
- OpenAlex
- W2065898394
- Cited by
- 80
- References
- 54
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 5 · 2019: 5 · 2018: 11 · 2017: 10 · 2016: 5 · 2015: 5 · 2014: 10 · 2013: 4 · 2012: 1
- FWCI
- 7.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- International OCD Foundation
- Ministry of Education
- National Institute of Mental Health (F31 MH086273, K23 MH 082176, R01 MH086321)
- Dana Foundation
- 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, performance monitoring, flanker task, event-related potentials, tic disorders, age of onset, biomarkers, pediatric OCD
- MeSH terms
- Adolescent, Anxiety Disorders, Attention, Brain, Brain Mapping, Cerebral Cortex, Child, Conflict, Psychological, Contingent Negative Variation, Decision Making, Electroencephalography, Female, Frontal Lobe, Humans, Male, Nerve Net, Neuropsychological Tests, Obsessive-Compulsive Disorder, Orientation, Pattern Recognition, Visual, Reaction Time, Reference Values, Signal Processing, Computer-Assisted, Tic Disorders, Comorbidity, Age of Onset, Young Adult
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