Frontostriatal functional connectivity correlates with repetitive behaviour across autism spectrum disorder and obsessive–compulsive disorder
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Background: Autism spectrum disorder (ASD) and obsessive–compulsive disorder (OCD) are neurodevelopmental disorders with considerable overlap in terms of their defining symptoms of compulsivity/repetitive behaviour. Little is known about the extent to which ASD and OCD have common versus distinct neural correlates of compulsivity. Previous research points to potentially common dysfunction in frontostriatal connectivity, but direct comparisons in one study are lacking. Here, we assessed frontostriatal resting-state functional connectivity in youth with ASD or OCD, and healthy controls. In addition, we applied a cross-disorder approach to examine whether repetitive behaviour across ASD and OCD has common neural substrates. Methods: A sample of 78 children and adolescents aged 8–16 years was used (ASD n = 24; OCD n = 25; healthy controls n = 29), originating from the multicentre study COMPULS. We tested whether diagnostic group, repetitive behaviour (measured with the Repetitive Behavior Scale-Revised) or their interaction was associated with resting-state functional connectivity of striatal seed regions. Results: No diagnosis-specific differences were detected. The cross-disorder analysis, on the other hand, showed that increased functional connectivity between the left nucleus accumbens (NAcc) and a cluster in the right premotor cortex/middle frontal gyrus was related to more severe symptoms of repetitive behaviour. Conclusions: We demonstrate the fruitfulness of applying a cross-disorder approach to investigate the neural underpinnings of compulsivity/repetitive behaviour, by revealing a shared alteration in functional connectivity in ASD and OCD. We argue that this alteration might reflect aberrant reward or motivational processing of the NAcc with excessive connectivity to the premotor cortex implementing learned action patterns.
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Neuroimaging across OCD and ASD shows that increased functional connectivity within frontostriatal circuitry relates to more severe repetitive behaviour symptoms.
“Neuroimaging investigations across OCD and ASD provide evidence that increased functional connectivity within frontostriatal circuitry relates to more severe symptoms of repetitive behaviour91.”
From Cognitive and behavioural flexibility: Neural mechanisms and clinical considerations (2021) · cites this paper as [91]
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“Seven child studies incorporated a brain imaging component (Akkermans et al., 2019; Gooskens et al., 2019, 2021; Hollestein et al., 2021; Jacobs et al., 2021; Kushki et al., 2019; Naaijen et al., 2017 ), with only three reporting differences in repetitive behavior based on neurological markers.”
InfluentialChoi, E. J., Vandewouw, M. M., Taylor, M. J., Arnold, P. D., Brian, J. A., Crosbie, J., Kelley, E. A., Lai, M., Liu, X., Schachar, R. J., et al. (2020) · NeuroImage Clinical · doi:10.1016/j.nicl.2020.102476 · Cited by 25 · see citing works
“, 2018), while a third study, assessed frontostriatal rs-fc in children with ASD and OCD, and found no diagnosis-specific differences but an association between increased nucleus accumbens connectivity with the frontal region and symptom severity in repetitive behaviours (Akkermans et al., 2018).”
BackgroundBieneck, V., Bletsch, A., Mann, C., Schäfer, T., Seelemeyer, H., Herøy, N., Zimmermann, J., Pretzsch, C. M., Hattingen, E., & Ecker, C. (2021) · Genes · doi:10.3390/genes12122024 · Cited by 24 · see citing works
“Additionally, an increased functional connectivity between the left nucleus accumbens and a cluster in the right premotor cortex/middle frontal gyrus was related to more severe symptoms of repetitive behavior in children and adolescents with ASD [65].”
Mogadam, A., Keller, A. E., Arnold, P. D., Schachar, R. J., Lerch, J. P., Anagnostou, E. A., & Pang, E. W. (2019) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-019-9280-2 · Cited by 17 · see citing works
“A recent fMRI study in children with ASD and OCD found a relation between increased functional connectivity across frontostriatal regions during resting state and increased morbidity on their measure of repetitive behaviours [77], although this may reverse in adulthood [78].”
Structural and functional whole brain changes in autism spectrum disorder at different age stages
Wang, Z., Zheng, L., Yang, L., Yin, S., Yu, S., Chen, K., ZHANG, T., Wang, H., Zhang, T., & Zhang, Y. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02585-6 · Cited by 13 · see citing works
Jin, J., Wang, X., Yang, X., Zhao, N., Feng, Z., Zang, Y., & Yuan, L. (2023) · Human Brain Mapping · doi:10.1002/hbm.26455 · Cited by 13 · see citing works
“Dysfunction of the right DLPFC and FC between right DLPFC – NAc has been detected in ASD before, for example, decreased regional homogeneity (Paakki et al., 2010) in the right DLPFC/MFG and increased FC between right DLPFC/MFG with NAc (Delmonte et al., 2013) in RS-fMRI studies.”
Obsessive–Compulsive Disorder in Autism Spectrum Disorder Across the Lifespan
Pazuniak, M., & Pekrul, S. R. (2020) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2020.08.010 · Cited by 13 · see citing works
Koithan, E. M., Demeter, D. V., Ali, S. A., Feigelis, M., & Greene, D. J. (2024) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2024.101429 · Cited by 10 · see citing works
Niemeyer, L., Mechler, K., Dittmann, R., Banaschewski, T., Buitelaar, J. K., Durston, S., & Häge, A. (2022) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2022.100982 · Cited by 8 · see citing works
Self-citationZhu, J.-S., Jiao, Y., Chen, R., Wang, X., & Han, Y. (2023) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2023.111749 · Cited by 7 · see citing works
Dissecting Psychiatric Heterogeneity and Comorbidity with Core Region-Based Machine Learning
Lv, Q., Zeljic, K., Zhao, S., Zhang, J., Zhang, J., & Wang, Z. (2023) · Neuroscience Bulletin · doi:10.1007/s12264-023-01057-2 · Cited by 5 · see citing works
“[139] reported that higher functional connectivity between the left NAc and right premotor/middle frontal gyrus is associated with more compulsivity measured by repetitive behaviors.”
BackgroundChoi, E. J., Vandewouw, M. M., Taylor, M. J., Stevenson, R. A., Arnold, P. D., Brian, J. A., Crosbie, J., Kelley, E. A., Liu, X., Jones, J., et al. (2023) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2023.10.014 · Cited by 4 · see citing works
Autistic traits in obsessive compulsive disorder: A systematic review and meta-analysis
DERİN, S., Tetik, M., & Bora, E. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.05.006 · Cited by 4 · see citing works
Chien, Y., Chen, Y.-J., Tseng, W., Hsu, Y., Wu, C., Tseng, W. I., & Gau, S. S. (2022) · Autism · doi:10.1177/13623613221125620 · Cited by 4 · see citing works
“…contained these impaired segments are consistent with previous reports on the ILF and SLF, cingulum, TR, and CC (Barnea-Goraly et al., 2010; Di et al., 2018; Jou et al., 2016) that echo frontostriatal dysfunction in autism (Akkermans et al., 2018), particularly in males (Zeestraten et al., 2017).”
BackgroundResultThalamic regulation of reinforcement learning strategies across prefrontal-striatal networks
Wang, B., Wang, M. B., Lam, N. H., Liu, M., Li, S., Wimmer, R. D., Paz‐Alonso, P. M., Halassa, M. M., & Pleger, B. (2025) · Nature Communications · doi:10.1038/s41467-025-63995-x · Cited by 4 · see citing works
“Disruptions in the prefrontal-striatal circuits are associated with recurring pathological behaviors, such as those seen in obsessive-compulsive disorders 14 , and with the behavioral rigidity observed in schizophrenia 15 .”
Xu, S., Li, M., Yang, C., Fang, X., Ye, M., Wu, Y., Yang, B., Huang, W., Li, P., Ma, X., et al. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s367104 · Cited by 3 · see citing works
“Moreover, the MFG is a key region involved in the formation of dorsolateral prefrontal cortical (dlPFC) circuits.(62,63) Specific dlPFC circuits have been shown to support selfregulation and habit learning,(62) which are associated with goal-oriented planning.”
BackgroundHorne, K., Chen, T., & Irish, M. (2024) · British Journal of Clinical Psychology · doi:10.1111/bjc.12505 · Cited by 4 · see citing works
“…et al., 2017), neurodegenerative disease (e.g. frontotemporal dementia [FTD], Parkinson's disease, Alzheimer's disease; Bozeat et al., 2000; Horne et al., 2023; Robbins & Cools, 2014; Townley et al., 2020), and obsessive-compulsive disorder (OCD; Akkermans et al., 2019; Gruner & Pittenger, 2017).”
Pereira, J. A., Veenstra-VanderWeele, J. M., & Jutla, A. (2025) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2025.06.017 · Cited by 2 · see citing works
Behavioural rigidity as a transdiagnostic marker of nucleus accumbens dysfunction in dementia
Chen, T., Ahmed, R. M., Piguet, O., & Irish, M. (2026) · Brain · doi:10.1093/brain/awag095 · Cited by 1 · see citing works
“29 Moreover, regions supporting self-referential processing within the default mode network, 30 such as the medial prefrontal cortex and medial temporal lobe (e.g. hippocampus), have been shown to interact with the NAc in the context of behavioural rigidity in OCD.”
Yang, C., Sun, A., Ma, S., Dong, W., Chen, X., Chen, S., You, Y., Zang, Y.-F., & Yuan, L. (2026) · Autism Research · doi:10.1002/aur.70241
Meng, W., Yin, F., Ma, C., & Yang, Y. (2026) · Journal of Neuroscience · doi:10.1523/jneurosci.0313-26.2026
The social behavioral phenotype of Kabuki syndrome
Ng, R., Fanara, P., Meier, L. M., & Harris, J. R. (2026) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acag069
- Authors
- Akkermans, S. E. A., Rheinheimer, N., Bruchhage, M. M. K., Durston, S., Brandeis, D., Banaschewski, T., Boecker-Schlier, R., Wolf, I., Williams, S. C. R., Buitelaar, J. K., van Rooij, D., Oldehinkel, M., & the TACTICS consortium
- Affiliations
- Radboud University Nijmegen (NL)
- King's College London (GB)
- University Medical Center Utrecht (NL)
- Heidelberg University (DE)
- Corresponding author
- Akkermans, Sophie E.A.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2018-10-26
- Volume
- 49
- Issue
- 13
- Pages
- 2247-2255
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2898157569
- Cited by
- 33
- References
- 70
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 6 · 2021: 5 · 2020: 3 · 2019: 2
- FWCI
- 2.93
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0617-10150)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Keywords
- autism spectrum disorder, obsessive-compulsive disorder, repetitive behavior, compulsivity, resting-state functional connectivity, nucleus accumbens, premotor cortex, middle frontal gyrus, cross-disorder analysis, reward processing
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Brain Mapping, Child, Europe, Female, Frontal Lobe, Humans, Male, Obsessive-Compulsive Disorder
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