Abstract
BACKGROUND: While exposure with response prevention (ERP) is the frontline treatment for pediatric obsessive-compulsive disorder (OCD), not all patients benefit. Impairments in extinction learning are implicated in pediatric OCD's etiology and treatment, with impaired pre-treatment extinction learning associated with worse ERP outcomes. However, available methods for assessing patients' difficulties with fear extinction are costly and underdeveloped. In response, we used person-centered profiles to characterize latent fear extinction patterns among youth with OCD, and investigated the degree to which scores on common rating scales correspond to profile membership. METHODS: Youth with OCD (n=98) completed a diagnostic clinical battery followed by a differential fear conditioning/extinction task, in which skin conductance response (SCR) to stimuli served as the primary outcome. Parallel process growth mixture modeling (i.e., person-centered trends in concurrent change over time SCR to differential stimuli) was used to illuminate latent profiles of fear conditioning/extinction processes. The Bose-Chaudhuri-Hocquenghem method compared latent classes to identify clinical correlates of impaired extinction. RESULTS: A 2-profile solution was retained. Profile 1 (85%) was characterized by typical patterns of fear acquisition and extinction learning. Profile 2 (15%) exhibited elevated levels of SCR and impairments in threat discrimination during extinction. Several items on anxiety and OCD rating scales were significantly different between profiles. CONCLUSIONS: Findings identified two distinct profiles in how youth with OCD responded to a fear extinction task, with one demonstrating substantial difficulty. Future directions should examine the extent to which impaired fear extinction ability inhibits ERP effectiveness, and consider utilizing patient-centered profiles as an initial prognostic indicator of ERP appropriateness.