Neuroimaging and neuropsychological findings in pediatric obsessive–compulsive disorder: a review and developmental considerations Practice points „ Pediatric obsessive–compulsive disorder (OCD) appears to be distinct from its adult counterpart, especially in preadolescent patients. „ In contrast to the majority of adult imaging studies, a volumetric increase has been identified in the frontal and, in particular, striatal regions in pediatric OCD. „ Imaging research indicates increased frontostriatal metabolism in the pediatric OCD population, but decreased activation in preadolescent young children. „ The decreased activationcorrelates with OCD symptomatology in young children and increased activation correlates with symptom severity in adolescents. „ Abnormalities in frontostriatal activity tend to normalize following successful treatment. „ Maturational reorganization, including neuronal pruning and myelination, further complicates the isolation of specific neurobiological underpinnings of OCD. „ Even more so than in the adult population, research is inconsistent with regard to the executive function deficits of children with OCD, in part because of hypothesized abnormal maturation processes in this population. „ Studies of executive functioning may be complicated by heterogeneous sample bases that span large developmental ranges. „ More neuropsychological and neurobiological pediatric OCD studies are needed and future studies are advised to incorporate a developmental perspective.