How Do Performance Monitoring Abilities Differ in OCD, Tourette's, ADHD, and Autism?

What you need to know

• Performance monitoring, the ability to detect errors and adjust behavior, was compared across OCD, Tourette’s syndrome, ADHD and autism using EEG measures.

• OCD and Tourette’s syndrome showed increased error detection, while ADHD and autism showed decreased error detection.

• OCD had the most widespread alterations, with increases in multiple performance monitoring processes.

• ADHD showed reductions in internal but not external performance monitoring.

• Findings suggest some shared neurocognitive alterations between OCD/Tourette’s and ADHD/autism, which may help explain why these conditions often co-occur.

Performance Monitoring Across Neurodevelopmental Conditions

Performance monitoring refers to our ability to continuously monitor our thoughts and actions to ensure they align with our current goals and adapt them when needed. For example, when driving to work, we might notice and change our route if a road is closed. This process involves detecting any errors we make and processing feedback about our performance.

Brain imaging studies show that a region called the anterior cingulate cortex (ACC) plays a key role in performance monitoring. The ACC receives signals from other brain areas indicating whether an action had better or worse outcomes than expected. Changes in ACC activity flag when there’s a mismatch between the predicted and actual outcome of an action. This allows us to make adaptive changes in our behavior.

Researchers can measure brain activity related to performance monitoring using electroencephalography (EEG). EEG records electrical activity from the scalp with very precise timing. This allows scientists to examine brain responses that happen within milliseconds after an error is made or feedback is received.

Several common neurodevelopmental conditions involve difficulties with behavioral control and flexibility, including obsessive-compulsive disorder (OCD), Tourette’s syndrome, attention-deficit/hyperactivity disorder (ADHD), and autism. Researchers have proposed that alterations in performance monitoring may contribute to symptoms in these conditions. However, it’s been unclear whether they show similar or distinct patterns of performance monitoring changes.

This meta-analysis aimed to systematically compare performance monitoring abilities across OCD, Tourette’s syndrome, ADHD and autism by synthesizing findings from EEG studies. The researchers examined specific EEG markers of performance monitoring, including:

• Error-related negativity (ERN): A brain response occurring 0-100 milliseconds after an error is made
• Error positivity (Pe): A response occurring 150-500 milliseconds after an error
• Feedback-related negativity (FRN): A response to external performance feedback
• Feedback P3: Another marker of feedback processing

By comparing these EEG measures across conditions, the researchers sought to identify shared and distinct alterations in performance monitoring. This could provide insights into the neurocognitive mechanisms involved in different neurodevelopmental conditions.

Increased Performance Monitoring in OCD

The meta-analysis found the most extensive alterations in performance monitoring in OCD. Individuals with OCD showed significantly increased amplitude of the ERN, Pe, and FRN compared to control participants without OCD.

The increased ERN suggests that people with OCD have heightened error detection capabilities. Their brains show an amplified response when they make a mistake. This aligns with the excessive doubting and checking behaviors often seen in OCD - their brains may be overly sensitive to potential errors.

The increased Pe indicates that individuals with OCD also show alterations in how they evaluate and process errors after detecting them. This component is thought to reflect conscious error awareness and initiation of adaptive behaviors. The amplified Pe could relate to the prolonged rumination on mistakes that many people with OCD experience.

Interestingly, OCD was also associated with an increased FRN, suggesting heightened sensitivity to external feedback about performance. This pattern of results indicates that individuals with OCD show hyperactive performance monitoring across multiple processes - both internal error detection/evaluation and external feedback processing.

These widespread increases in performance monitoring markers are consistent with the idea that OCD involves an overactive error detection system. This may contribute to the persistent doubts and repetitive checking behaviors that characterize the condition. For example, even after washing their hands, a person with OCD may doubt whether they did it correctly, leading to repeated hand-washing.

Increased Error Detection in Tourette’s Syndrome

The meta-analysis found that individuals with Tourette’s syndrome, like those with OCD, showed significantly increased amplitude of the ERN compared to controls. This suggests heightened error detection capabilities.

However, there were fewer studies on Tourette’s syndrome compared to the other conditions, so these results should be interpreted cautiously. It’s also unclear whether the increased ERN reflects a contributing factor to tic symptoms or a compensatory mechanism to help control tics.

Some researchers have proposed that enhanced performance monitoring in Tourette’s syndrome may help individuals detect when tics are about to occur and exert control over them. Further research is needed to clarify the relationship between altered error detection and tic symptoms.

Reduced Internal Monitoring in ADHD

In contrast to OCD and Tourette’s syndrome, individuals with ADHD showed significantly reduced amplitude of both the ERN and Pe compared to controls. This suggests difficulties with internal error detection (ERN) and error evaluation/awareness (Pe).

Interestingly, there were no significant differences in the FRN or feedback P3 between ADHD and control groups. This indicates that external performance monitoring based on feedback may be relatively intact in ADHD.

These findings align with the idea that ADHD involves deficits in self-monitoring and self-regulation. Individuals with ADHD may have more difficulty internally detecting when they’ve made an error and adapting their behavior accordingly. This could contribute to symptoms like careless mistakes and difficulty sustaining attention on tasks.

The intact feedback processing suggests that providing frequent external feedback may be beneficial for individuals with ADHD. This could help compensate for difficulties with internal performance monitoring.

Reduced Error Detection in Autism

The meta-analysis found that autistic individuals showed significantly reduced ERN amplitude compared to non-autistic controls, indicating decreased error detection capabilities. There were no significant differences in Pe amplitude.

There were fewer studies examining feedback-related components in autism, but the available evidence suggested some alterations in feedback processing as well. However, more research is needed to clarify the nature of feedback-related changes in autism.

The reduced ERN in autism is consistent with the idea that difficulties detecting errors may contribute to inflexible and repetitive behaviors. If errors in behavior are not efficiently detected, it may be harder to flexibly adjust to changing situations.

Shared and Distinct Alterations Across Conditions

By comparing performance monitoring markers across conditions, this meta-analysis revealed some interesting patterns of shared and distinct alterations:

• OCD and Tourette’s syndrome both showed increased ERN, suggesting shared enhancement of error detection mechanisms.

• ADHD and autism both showed decreased ERN, indicating shared reductions in error detection.

• OCD showed the most widespread alterations, with increases across multiple performance monitoring processes.

• ADHD showed specific reductions in markers of internal monitoring (ERN, Pe) but not external feedback processing.

These findings suggest that OCD and Tourette’s syndrome may involve some common neurocognitive alterations related to heightened performance monitoring. Meanwhile, ADHD and autism may share reductions in error detection capabilities.

The opposing patterns between OCD/Tourette’s and ADHD/autism are intriguing, given that these conditions frequently co-occur in the same individuals. Further research is needed to understand how these contrasting alterations may manifest in people with multiple co-occurring conditions.

Conclusions

• Performance monitoring alterations differ across OCD, Tourette’s syndrome, ADHD and autism, with some shared patterns between certain conditions.

• OCD shows the most extensive changes, with increased activity across multiple performance monitoring processes. This may contribute to excessive doubt and repetitive behaviors.

• Both OCD and Tourette’s syndrome involve enhanced error detection, though more research is needed on Tourette’s.

• ADHD is associated with reduced internal performance monitoring but relatively intact external monitoring. This suggests external feedback may be beneficial.

• Autism shows decreased error detection capabilities, which may relate to behavioral inflexibility.

• Understanding shared and distinct alterations may provide insights into why these conditions frequently co-occur and inform more targeted interventions.