Functional Magnetic Resonance Imaging During Planning Before and After Cognitive- Behavioral Therapy in Pediatric Obsessive-Compulsive Disorder  Chaim Huyser, M.D., Dick J. Veltman, M.D., Ph.D., Lidewij H. Wolters, M.Sc., Else de Haan, M.Sc., Ph.D., Frits Boer, M.D., Ph.D.  Journal of the American Academy of Child & Adolescent Psychiatry  Volume 49, Issue 12, Pages 1238-1248.e5 (December 2010) DOI: 10.1016/j.jaac.2010.08.007 Copyright © 2010 American Academy of Child and Adolescent Psychiatry Terms and Conditions

FIGURE 1 Brain regions showing significant blood oxygenation level-dependent (BOLD) signal increase during planning compared with control task in healthy controls (HC) versus patients with obsessive compulsive disorder (OCD) patients at p < .001 uncorrected before treatment. Note: (A) Frontal lobe, posterior dorsolateral prefrontal cortex/premotor region. (B) BOLD signal before and after treatment in patients with OCD (red, T0 = first column, T1 = second column) and HC (blue, T0 = third column, T1 = fourth column) in the dorsolateral prefrontal cortex (Montreal Neurological Institute space [MNI] −54, 6, 42). (C) Parietal lobe, post central gyrus. (D) BOLD signal before and after treatment in patients with OCD and HCs in the parietal lobe (MNI space 45, −27, 45). EOI = effect of interest; T0 = before treatment; T1 = after treatment. Journal of the American Academy of Child & Adolescent Psychiatry 2010 49, 1238-1248.e5DOI: (10.1016/j.jaac.2010.08.007) Copyright © 2010 American Academy of Child and Adolescent Psychiatry Terms and Conditions

FIGURE 2 Brain regions showing significant blood oxygenation level-dependent signal increase during planning task compared with control task in patients with obsessive-compulsive disorder (A) and controls (B) before treatment. Note: p < .05 corrected (false discovery rate). Journal of the American Academy of Child & Adolescent Psychiatry 2010 49, 1238-1248.e5DOI: (10.1016/j.jaac.2010.08.007) Copyright © 2010 American Academy of Child and Adolescent Psychiatry Terms and Conditions

FIGURE 3 Changes in Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS) scores before and after treatment (DeltaCYBOCS) were significantly correlated with blood oxygenation level-dependent (BOLD)- changes before and after treatment in patients with obsessive compulsive disorder during planning versus control task within the left parietal cortex (r 0.656, p < .001, Z 3.48). A) Haircross at Montreal Neurological Institute space xyz 60 6 18. B) Scatterplot of correlation of change in BOLD signal in parietal cortex and change in CYBOCS score. Journal of the American Academy of Child & Adolescent Psychiatry 2010 49, 1238-1248.e5DOI: (10.1016/j.jaac.2010.08.007) Copyright © 2010 American Academy of Child and Adolescent Psychiatry Terms and Conditions

FIGURE 4 (A) Increased blood oxygenation level-dependent (BOLD) signal at increased task load in the insular cortex (cross-hairs), medial dorsal prefrontal lobe, and left dorsal anterior cingulate cortex in patients with obsessive compulsive disorder (OCD) compared with HCs before treatment. (B) BOLD signal in left insula (Montreal Neurological Institute space −42, 12, −12) before and after treatment for patients with OCD (red) and HCs (blue). Note: EOI = effect of interest. Journal of the American Academy of Child & Adolescent Psychiatry 2010 49, 1238-1248.e5DOI: (10.1016/j.jaac.2010.08.007) Copyright © 2010 American Academy of Child and Adolescent Psychiatry Terms and Conditions

FIGURE 5 Brain regions showing significant blood oxygenation level-dependent signal increase during increased task load in patients with obsessive-compulsive disorder (A) and controls (B) before treatment. Note: p < .05 corrected (false discovery rate). Journal of the American Academy of Child & Adolescent Psychiatry 2010 49, 1238-1248.e5DOI: (10.1016/j.jaac.2010.08.007) Copyright © 2010 American Academy of Child and Adolescent Psychiatry Terms and Conditions

FIGURE S1 Reaction times Tower of London task patients and controls before and after treatment. Note: General Linear Model repeated measure Reaction Time at T0 Mean all moves versus Reaction Time at T1 Mean all moves for patients and controls show significant (p < 0.01) time × group effect for overall mean reaction time (F = 7,034, p 0.01), indicating a greater decrease in patients (T1: 5.96 s (SD 1.00) than control subjects (T1: 5.76 s (SD 1.22)). Journal of the American Academy of Child & Adolescent Psychiatry 2010 49, 1238-1248.e5DOI: (10.1016/j.jaac.2010.08.007) Copyright © 2010 American Academy of Child and Adolescent Psychiatry Terms and Conditions