LAUSR

Child and adolescent psychiatry trainees are traditionally offered "pearls of wisdom" emphasizing, among other things, the value of collegial peer networks such as that found within the American Academy of Child and Adolescent Psychiatry (AACAP). The article in this issue by Cervin et al.1 demonstrates the value of an admittedly different type of network. They report on the application of Network Theory and related analytic methods to examine for "universal" obsessive-compulsive symptomatology (OCS) patterns, as expressed within normative and pathological samples. Specifically, they use Obsessive-Compulsive Inventory-Child Version (OCI-CV)2 data from an impressive sample of 6,991 unselected school children and 704 obsessive-compulsive disorder (OCD)-affected children, collected across 18 international sites. OCD is one of the most debilitating and heterogeneous childhood-onset psychiatric illnesses with notable treatment potential.3 Yet, it remains unclear whether the OCD phenotype represents: (1) an "extreme end" of human cognition and behavior within a normative continuum, or (2) a distinct symptom pattern that is a harbinger of significant dysfunction and distress.4 This question has historically been difficult to address, given limited available samples and analytic strategies. Although the pediatric OCD phenotype was traditionally described according to symptom categories5 and dimensions,6 their interrelationships were not fully examined. Nor was the individual symptom of "doubt" within or across dimensions. The networking analyses of Cervin et al. highlights the doubt/checking OCS dimension as a central node, especially within clinical populations. This supports a long-standing lay definition of OCD as the "doubting disease." The study also demonstrates observable cross-population differences-with less robust interconnections ("edges") between nodes among OCD-affected children versus unselected students-raising the question of whether this paucity contributes to the dysfunction and distress characterizing this illness. Akin to peer networks, which are optimally dense with close, strong interconnections, it would appear that the presence of fewer connections within pediatric OCS networks may contribute to poorer function. Longitudinal studies examining OCS networks in unaffected, at-risk siblings both pre- and post-OCD onset would help to substantiate this.