The link between ADHD-like inattention and obsessions and compulsions during treatment of youth with OCD

Abstract

Attention-deficit/hyperactivity disorder (ADHD) has been found to be highly comorbid in children and adolescents with obsessive-compulsive disorder (OCD). Some have proposed, however, that obsessive anxiety may cause inattention and executive dysfunction, leading to inappropriate ADHD diagnoses in those with OCD. If this were the case, these symptoms would be expected to decrease following successful OCD treatment. The present study tested this hypothesis and evaluated whether ADHD symptoms at baseline predicted OCD treatment response. Obsessive-compulsive and ADHD symptoms were assessed in 50 youth enrolled in a randomized controlled trial investigating selective serotonin reuptake inhibitor and cognitive behavioral treatment. Repeated-measures analysis of variance (RMANOVA) revealed that ADHD symptoms at baseline do not significantly predict treatment outcome. A multivariate RMANOVA found that OCD treatment response moderated change in inattention; participants who showed greater reduction in OCD severity experienced greater reduction in ADHD-inattentive symptoms, while those with less substantial reduction in obsessions and compulsions showed less change. These findings suggest that children and adolescents with OCD and inattention may experience meaningful improvements in attention problems following OCD treatment. Thus, in many youth with OCD, inattention may be inherently tied to obsessions and compulsions. Clinicians may consider addressing OCD in treatment before targeting inattentive-type ADHD.

Dissociative absorption, mind‐wandering, and attention‐deficit symptoms: Associations with obsessive‐compulsive symptoms

“…Indeed, Abramovitch, Dar, Hermesh, and Schweiger () have suggested an ‘executive overload’ model for OCD, according to which obsessions represent attempts to control automatic processes, consequently consuming valuable cognitive resources and resulting in neuropsychological impairments. This model, suggesting that ADHD‐like symptoms are actually an epiphenomenon of OCD symptoms, is supported by the finding that treatment for OCD is related to a reduction in inattention symptoms (Guzick et al ., ). The executive overload model represents one possible explanation for the findings of the current study: Specifically, individuals characterized by OC symptoms probably score highly on absorption because they tend to immerse in obsessions or engage their full attention in compulsive mental rituals.…”

“…Indeed, one study on a treatment‐seeking sample of patients with OCD demonstrated that dissociative absorption at the beginning of treatment was predictive of treatment non‐response (Rufer et al ., ). Interestingly, in a different study, baseline inattention symptoms were unsuccessful in predicting treatment response for youth with OCD (Guzick et al ., ). Thus, therapeutic implications should be considered.…”

“…Thus, it has been questioned whether the ‘inattention, distractibility and restlessness’ in comorbid individuals represents internal distraction from obsessional ideation or anxiety or rather, ‘true’ ADHD (Geller et al ., , p. 83). Some (e.g., Geller et al ., ; Masi et al ., ; Ruscio et al ., ) have maintained that the OCD‐ADHD comorbidity represents a genuine dual‐diagnosis reality, yet others have debated this, contending that OCD manifests in ADHD‐like symptoms that do not represent the true disorder (Abramovitch, Dar, Mittelman, & Schweiger, ; Abramovitch et al ., ; Guzick et al ., ). Thus, it remains to be determined whether the deficient attentional capacities characterizing people with OCD (Abramovitch, Abramowitz, et al ., ; Shin et al ., ) reflect (and stem from) the subjectively reported difficulty in controlling and regulating obsessional thoughts, or rather, if they may pose a risk factor for the development of OCD.…”

Diagnostic Issues in Early-Onset Obsessive-Compulsive Disorder and their Treatment Implications

“…Previous research has also found that comorbid ADHD may interfere with success in OCD treatment, with poorer treatment outcomes in cognitive behavioral therapy (CBT) [33]. However, a recent study [34] has found that when treating a child or adolescent with co-occurring OCD and clinically significant attention problems when OCD-onset clearly precedes ADHD-like inattention, clinicians may wish to target obsessive-compulsive symptoms first to have also inattention improved.…”

Co-Morbid Obsessive–Compulsive Disorder and Attention Deficit Hyperactivity Disorder: Neurobiological Commonalities and Treatment Implications

“…In terms of co-morbid OCD–ADHD, there is evidence to support that treating OCD with SSRIs and cognitive behaviour therapy with exposure response prevention (CBT+ERP) improves attentional symptoms (38). This may be mediated through SSRI activation of BDNF and other neurotrophic factors that lead to neuronal growth in networks responsible for working memory and processing speed (39–41).…”