The ERN as a neural index of changes in performance monitoring following attention training in pediatric obsessive-compulsive disorder

Evidence of associations between obsessive compulsive disorder (OCD) and alterations in neural indices of performance monitoring, i.e., elevated neural activity following errors, have accelerated interest in the error-related negativity (ERN) as a biomarker for pediatric OCD. The study investigates the degree to which attention bias training is linked to changes in neural measures of performance monitoring (ERN, correct response negativity or CRN) and whether pre-to-post training changes in these neural indices are associated with symptom changes in youth with OCD. The sample included 36 youth (8–17 years) diagnosed with OCD who completed a 12-session attention training program and pre- and post-training EEG assessment of performance monitoring using cognitive and emotional flanker tasks. The emotional flanker task was individualized to each participant’s negative ratings of stimuli at pre-treatment to enhance salience of threat-related stimuli across youth. Results indicated that unlike participants who received attentional control protocol (CON), those who received attentional bias modification protocol (ABM) showed significant attenuations in neural activity following erroneous and correct responses in the emotional flanker task. The ERN amplitude during the cognitive flanker task was unchanged in both ABM and CON groups. Attenuations in the ERN were also linked to decreases in social anxiety and depressive symptoms. Findings highlight the relevance of including emotionally-salient tasks when investigating potential neural mechanisms of treatments and suggest that alterations in neural processes underlying performance monitoring can be targeted via attention training programs in pediatric OCD. •Youth with OCD who received attention bias modification training showed attenuated ERN/CRN.•Youth with OCD who received attentional control training did not show attenuations in ERN/CRN.•Attenuations in ERN/CRN observed only on a flanker task requiring cognitive control of emotionally salient stimuli.•Training-related changes in the ERN were also linked to decreases in social anxiety in youth with OCD.•Findings suggest that ERN/CRN might serve as treatment engagement markers that inform neural mechanisms of cognitive training.