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REFERENCES. Monogr Soc Res Child Dev 2016. [DOI: 10.1111/mono.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Duerden EG, Lee M, Chow S, Sato J, Mak-Fan K, Taylor MJ. Neural Correlates of Reward Processing in Typical and Atypical Development. Child Neurol Open 2016; 3:2329048X16667350. [PMID: 28503615 PMCID: PMC5417348 DOI: 10.1177/2329048x16667350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/19/2016] [Accepted: 07/29/2016] [Indexed: 12/22/2022] Open
Abstract
Atypically developing children including those born preterm or who have autism spectrum disorder can display difficulties with evaluating rewarding stimuli, which may result from impaired maturation of reward and cognitive control brain regions. During functional magnetic resonance imaging, 58 typically and atypically developing children (6-12 years) participated in a set-shifting task that included the presentation of monetary reward stimuli. In typically developing children, reward stimuli were associated with age-related increases in activation in cognitive control centers, with weaker changes in reward regions. In atypically developing children, no age-related changes were evident. Maturational disturbances in the frontostriatal regions during atypical development may underlie task-based differences in activation.
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Affiliation(s)
- Emma G Duerden
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Neurology, University of Toronto, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Minha Lee
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Chow
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julie Sato
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Mak-Fan
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Neurology, University of Toronto, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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153
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Breukelaar IA, Antees C, Grieve SM, Foster SL, Gomes L, Williams LM, Korgaonkar MS. Cognitive control network anatomy correlates with neurocognitive behavior: A longitudinal study. Hum Brain Mapp 2016; 38:631-643. [PMID: 27623046 PMCID: PMC5347905 DOI: 10.1002/hbm.23401] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/05/2016] [Accepted: 08/30/2016] [Indexed: 01/31/2023] Open
Abstract
Cognitive control is the process of employing executive functions, such as attention, planning or working memory, to guide appropriate behaviors in order to achieve a specific goal. Functional magnetic resonance imaging studies suggest a superordinate cognitive control network, comprising the dorsal regions of the lateral prefrontal cortex (DLPFC), anterior cingulate cortex (dACC) and parietal cortex (DPC). How gray matter structure changes across this network throughout neurodevelopment and how these changes impact cognitive control are not yet fully understood. Here we investigate changes in gray matter volume of the key nodes of the cognitive control network using structural MRI scans from 176 participants aged 8-38 years. One hundred and eleven of these also completed a longitudinal follow-up at two years. We compare these with performance on a cognitive battery also measured at these two time points. We found that volume decreases in the cognitive control network were associated with improved performance in executive function (in left DLPFC and bilateral DPC), information processing (in bilateral dACC and right DPC) and emotion identification tasks (left DLPFC). These results were significant after controlling for age. Furthermore, gray matter changes were coordinated across the network. These findings imply age-independent synaptic pruning in the cognitive control network may have a role in improving performance in cognitive domains. This study provides insight into the direct impact of structural changes on behavior within this network during neurodevelopment and provides a normative evidence base to better understand development of cognitive dysfunction in brain disorders. Hum Brain Mapp 38:631-643, 2017. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Isabella A Breukelaar
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia
| | - Cassandra Antees
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia
| | - Stuart M Grieve
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia.,Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre and Sydney Medical School, University of Sydney, NSW, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sheryl L Foster
- Department of Radiology, Westmead Hospital, Westmead, NSW, Australia.,The Discipline of Medical Radiation Sciences, Faculty of Health Science, The University of Sydney, NSW, Australia
| | - Lavier Gomes
- Department of Radiology, Westmead Hospital, Westmead, NSW, Australia
| | - Leanne M Williams
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia.,Psychiatry and Behavioral Sciences, Stanford University, Stanford, California.,MIRECC, Palo Alto VA, Palo Alto, California
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia.,Discipline of Psychiatry, Sydney Medical School, Westmead, Sydney, Australia
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154
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Neural processing of negative emotional stimuli and the influence of age, sex and task-related characteristics. Neurosci Biobehav Rev 2016; 68:773-793. [DOI: 10.1016/j.neubiorev.2016.04.020] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 11/22/2022]
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155
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Oron Semper JV, Murillo JI, Bernacer J. Adolescent Emotional Maturation through Divergent Models of Brain Organization. Front Psychol 2016; 7:1263. [PMID: 27602012 PMCID: PMC4993867 DOI: 10.3389/fpsyg.2016.01263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
In this article we introduce the hypothesis that neuropsychological adolescent maturation, and in particular emotional management, may have opposing explanations depending on the interpretation of the assumed brain architecture, that is, whether a componential computational account (CCA) or a dynamic systems perspective (DSP) is used. According to CCA, cognitive functions are associated with the action of restricted brain regions, and this association is temporally stable; by contrast, DSP argues that cognitive functions are better explained by interactions between several brain areas, whose engagement in specific functions is temporal and context-dependent and based on neural reuse. We outline the main neurobiological facts about adolescent maturation, focusing on the neuroanatomical and neurofunctional processes associated with adolescence. We then explain the importance of emotional management in adolescent maturation. We explain the interplay between emotion and cognition under the scope of CCA and DSP, both at neural and behavioral levels. Finally, we justify why, according to CCA, emotional management is understood as regulation, specifically because the cognitive aspects of the brain are in charge of regulating emotion-related modules. However, the key word in DSP is integration, since neural information from different brain areas is integrated from the beginning of the process. Consequently, although the terms should not be conceptually confused, there is no cognition without emotion, and vice versa. Thus, emotional integration is not an independent process that just happens to the subject, but a crucial part of personal growth. Considering the importance of neuropsychological research in the development of educational and legal policies concerning adolescents, we intend to expose that the holistic view of adolescents is dependent on whether one holds the implicit or explicit interpretation of brain functioning.
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Affiliation(s)
- Jose V Oron Semper
- Mind-Brain Group, Institute for Culture and Society, University of Navarra Pamplona, Spain
| | - Jose I Murillo
- Mind-Brain Group, Institute for Culture and Society, University of Navarra Pamplona, Spain
| | - Javier Bernacer
- Mind-Brain Group, Institute for Culture and Society, University of Navarra Pamplona, Spain
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156
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The development of social cognition in adolescence: An integrated perspective. Neurosci Biobehav Rev 2016; 70:106-120. [PMID: 27545755 DOI: 10.1016/j.neubiorev.2016.08.016] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 01/13/2023]
Abstract
Social cognitive processes are critical in navigating complex social interactions and are associated with a network of brain areas termed the 'social brain'. Here, we describe the development of social cognition, and the structural and functional changes in the social brain during adolescence, a period of life characterised by extensive changes in social behaviour and environments. Neuroimaging and behavioural studies have demonstrated that the social brain and social cognition undergo significant development in human adolescence. Development of social cognition and the social brain are discussed in the context of developments in other neural systems, such as those implicated in motivational-affective and cognitive control processes. Successful transition to adulthood requires the rapid refinement and integration of these processes and many adolescent-typical behaviours, such as peer influence and sensitivity to social exclusion, involve dynamic interactions between these systems. Considering these interactions, and how they vary between individuals and across development, could increase our understanding of adolescent brain and behavioural development.
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157
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Abstract
Purpose of review This review examines emerging neuroimaging research in pediatric obsessive compulsive disorder (OCD) and explores the possibility that developmentally sensitive mechanisms may underlie OCD across the lifespan. Recent findings Diffusion tensor imaging (DTI) studies of pediatric OCD reveal abnormal structural connectivity within frontal-striato-thalamic circuity (FSTC). Resting-state functional magnetic resonance imaging (fMRI) studies further support atypical FSTC connectivity in young patients, but also suggest altered connectivity within cortical networks for task-control. Task-based fMRI studies show that hyper- and hypo-activation of task control networks may depend on task difficulty in pediatric patients similar to recent findings in adults. Summary This review suggests that atypical neurodevelopmental trajectories may underlie the emergence and early course of OCD. Abnormalities of structural and functional connectivity may vary with age, while functional engagement during task may vary with age and task complexity. Future research should combine DTI, resting-state fMRI and task-based fMRI methods and incorporate longitudinal designs to reveal developmentally sensitive targets for intervention.
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158
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Behavioral and neurophysiological evidence for increased cognitive flexibility in late childhood. Sci Rep 2016; 6:28954. [PMID: 27349808 PMCID: PMC4923946 DOI: 10.1038/srep28954] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/07/2016] [Indexed: 11/08/2022] Open
Abstract
Executive functions, like the capacity to control and organize thoughts and behavior, develop from childhood to young adulthood. Although task switching and working memory processes are known to undergo strong developmental changes from childhood to adulthood, it is currently unknown how task switching processes are modulated between childhood and adulthood given that working memory processes are central to task switching. The aim of the current study is therefore to examine this question using a combined cue- and memory-based task switching paradigm in children (N = 25) and young adults (N = 25) in combination with neurophysiological (EEG) methods. We obtained an unexpected paradoxical effect suggesting that memory-based task switching is better in late childhood than in young adulthood. No group differences were observed in cue-based task switching. The neurophysiological data suggest that this effect is not due to altered attentional selection (P1, N1) or processes related to the updating, organization, and implementation of the new task-set (P3). Instead, alterations were found in the resolution of task-set conflict and the selection of an appropriate response (N2) when a task has to be switched. Our observation contrasts findings showing that cognitive control mechanisms reach their optimal functioning in early adulthood.
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159
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Demystifying cognitive flexibility: Implications for clinical and developmental neuroscience. Trends Neurosci 2016; 38:571-8. [PMID: 26343956 DOI: 10.1016/j.tins.2015.07.003] [Citation(s) in RCA: 461] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/01/2015] [Accepted: 07/13/2015] [Indexed: 01/21/2023]
Abstract
Cognitive flexibility, the readiness with which one can selectively switch between mental processes to generate appropriate behavioral responses, develops in a protracted manner and is compromised in several prevalent neurodevelopmental disorders. It is unclear whether cognitive flexibility arises from neural substrates distinct from the executive control network (ECN) or from the interplay of nodes within this and other networks. Here we review neuroimaging studies of cognitive flexibility, focusing on set shifting and task switching. We propose that more consistent operationalization and study of cognitive flexibility is required in clinical and developmental neuroscience. We suggest that an important avenue for future research is the characterization of the relationship between neural flexibility and cognitive flexibility in typical and atypical development.
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160
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161
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Hwang K, Ghuman AS, Manoach DS, Jones SR, Luna B. Frontal preparatory neural oscillations associated with cognitive control: A developmental study comparing young adults and adolescents. Neuroimage 2016; 136:139-48. [PMID: 27173759 DOI: 10.1016/j.neuroimage.2016.05.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/24/2016] [Accepted: 05/05/2016] [Indexed: 01/22/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) studies suggest that age-related changes in the frontal cortex may underlie developmental improvements in cognitive control. In the present study we used magnetoencephalography (MEG) to identify frontal oscillatory neurodynamics that support age-related improvements in cognitive control during adolescence. We characterized the differences in neural oscillations in adolescents and adults during the preparation to suppress a prepotent saccade (antisaccade trials-AS) compared to preparing to generate a more automatic saccade (prosaccade trials-PS). We found that for adults, AS were associated with increased beta-band (16-38Hz) power in the dorsal lateral prefrontal cortex (DLPFC), enhanced alpha- to low beta-band (10-18Hz) power in the frontal eye field (FEF) that predicted performance, and increased cross-frequency alpha-beta (10-26Hz) amplitude coupling between the DLPFC and the FEF. Developmental comparisons between adults and adolescents revealed similar engagement of DLPFC beta-band power but weaker FEF alpha-band power, and lower cross-frequency coupling between the DLPFC and the FEF in adolescents. These results suggest that lateral prefrontal neural activity associated with cognitive control is adult-like by adolescence; the development of cognitive control from adolescence to adulthood is instead associated with increases in frontal connectivity and strengthening of inhibition signaling for suppressing task-incompatible processes.
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Affiliation(s)
- Kai Hwang
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, United States; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, PA, United States.
| | - Avniel S Ghuman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, PA, United States; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States
| | - Stephanie R Jones
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, PA, United States
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162
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Liu Y, Angstadt M, Taylor SF, Fitzgerald KD. The typical development of posterior medial frontal cortex function and connectivity during task control demands in youth 8-19years old. Neuroimage 2016; 137:97-106. [PMID: 27173761 DOI: 10.1016/j.neuroimage.2016.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/15/2016] [Accepted: 05/03/2016] [Indexed: 01/23/2023] Open
Abstract
To characterize the development of neural substrate for interference processing and task control, this study examined both linear and non-linear effects of age on activation and connectivity during an interference task designed to engage the posterior medial frontal cortex (pMFC). Seventy-two youth, ages 8-19years, performed the Multi-Source Interference Task (MSIT) during functional magnetic resonance imaging (fMRI). With increasing age, overall performance across high-interference incongruent and low-interference congruent trials became faster and more accurate. Effects of age on activation to interference- (incongruent versus congruent conditions), error- (errors versus correct trials during the incongruent condition) and overall task-processing (incongruent plus congruent conditions, relative to implicit baseline) were tested in whole-brain voxel-wise analyses. Age differentially impacted activation to overall task processing in discrete sub-regions of the pMFC: activation in the pre-supplementary motor area (pre-SMA) decreased with age, whereas activation in the dorsal anterior cingulate cortex (dACC) followed a non-linear (i.e., U-shaped) pattern in relation to age. In addition, connectivity of pre-SMA with anterior insula/frontal operculum (AI/FO) increased with age. These findings suggest differential development of pre-SMA and dACC sub-regions within the pMFC. Moreover, as children age, decreases in pre-SMA activation may couple with increases in pre-SMA-AI/FO connectivity to support gains in processing speed in response to demands for task control.
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Affiliation(s)
- Yanni Liu
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor 48109, United States
| | - Mike Angstadt
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor 48109, United States
| | - Stephan F Taylor
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor 48109, United States
| | - Kate D Fitzgerald
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor 48109, United States
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163
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Kim C, Shin G, Hur M. An Integrative View of Conflict Adaptation and Active Maintenance. JAPANESE PSYCHOLOGICAL RESEARCH 2016. [DOI: 10.1111/jpr.12113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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164
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Longitudinal development of frontoparietal activity during feedback learning: Contributions of age, performance, working memory and cortical thickness. Dev Cogn Neurosci 2016; 19:211-22. [PMID: 27104668 PMCID: PMC4913556 DOI: 10.1016/j.dcn.2016.04.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/16/2016] [Accepted: 04/10/2016] [Indexed: 01/25/2023] Open
Abstract
We performed a longitudinal study on feedback learning (N = 208, age 8–27 years). We tested linear and nonlinear patterns in frontoparietal activity during learning. DLPFC and parietal cortex showed a late-adolescent peak in activity. SMA showed a linear increase, and ACC a linear decrease in brain activity with age. Performance predicted DLPFC and parietal activity, thickness predicted SMA activity.
Feedback learning is a crucial skill for cognitive flexibility that continues to develop into adolescence, and is linked to neural activity within a frontoparietal network. Although it is well conceptualized that activity in the frontoparietal network changes during development, there is surprisingly little consensus about the direction of change. Using a longitudinal design (N = 208, 8–27 years, two measurements in two years), we investigated developmental trajectories in frontoparietal activity during feedback learning. Our first aim was to test for linear and nonlinear developmental trajectories in dorsolateral prefrontal cortex (DLPFC), superior parietal cortex (SPC), supplementary motor area (SMA) and anterior cingulate cortex (ACC). Second, we tested which factors (task performance, working memory, cortical thickness) explained additional variance in time-related changes in activity besides age. Developmental patterns for activity in DLPFC and SPC were best characterized by a quadratic age function leveling off/peaking in late adolescence. There was a linear increase in SMA and a linear decrease with age in ACC activity. In addition to age, task performance explained variance in DLPFC and SPC activity, whereas cortical thickness explained variance in SMA activity. Together, these findings provide a novel perspective of linear and nonlinear developmental changes in the frontoparietal network during feedback learning.
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165
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Jankowski KF, Bruce J, Beauchamp KG, Roos LE, Moore WE, Fisher PA. Preliminary evidence of the impact of early childhood maltreatment and a preventive intervention on neural patterns of response inhibition in early adolescence. Dev Sci 2016; 20. [PMID: 27061609 DOI: 10.1111/desc.12413] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Abstract
Maltreated youths in foster care often experience negative developmental and psychological outcomes, which have been linked with poor response inhibition. Recent evidence suggests that childhood maltreatment is also associated with alterations in the neural circuitry underlying response inhibition. However, a burgeoning line of research has begun to explore the mitigating effects of preventive interventions on neural functioning. The current study used event-related functional magnetic resonance imaging to explore the impact of early childhood maltreatment and a preventive intervention on response inhibition in early adolescence. Thirty-six demographically similar adolescents (ages 9-14 years) completed a Go/NoGo task. The sample included nonmaltreated adolescents (n = 14) and maltreated adolescents who were in foster care as preschoolers and randomly assigned to receive services as usual (n = 11) or a preventive intervention, Multidimensional Treatment Foster Care for Preschoolers (n = 11). The groups demonstrated similar behavioral performance but significantly different neural patterns. The maltreated adolescents who received services as usual demonstrated subcortical hypoactivity during successful response inhibition and subcortical hyperactivity during unsuccessful response inhibition. In contrast, the nonmaltreated adolescents and maltreated adolescents who received the intervention exhibited strikingly similar neural patterns during successful response inhibition, but the maltreated adolescents who received the intervention demonstrated prefrontal hypoactivity during unsuccessful response inhibition. These findings offer preliminary evidence that early childhood maltreatment alters the neural patterns underlying response inhibition in early adolescence and that participating in a preventive intervention could mitigate maltreatment-related effects on these neural systems.
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166
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Neural Dysfunction in Cognitive Control Circuits in Persons at Clinical High-Risk for Psychosis. Neuropsychopharmacology 2016; 41:1241-50. [PMID: 26354046 PMCID: PMC4793108 DOI: 10.1038/npp.2015.273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 08/22/2015] [Accepted: 08/23/2015] [Indexed: 11/08/2022]
Abstract
Cognitive control, a set of functions that develop throughout adolescence, is important in the pathogenesis of psychotic disorders. Whether cognitive control has a role in conferring vulnerability for the development of psychotic illness is still unknown. The aim of this study was to investigate the neural systems supporting cognitive control in individuals deemed to be potentially prodromal for psychotic illness. We recruited 56 participants at clinical high-risk (CHR) for psychosis based on the Structured Interview for Psychosis-Risk Syndromes (SIPS) and 49 healthy controls. Twelve of the CHR participants eventually developed psychosis. We compared functional magnetic resonance imaging (fMRI) BOLD signal during the performance of the Simon task. We tested for differences between CHR individuals and controls in conflict-related functional activity. In the CHR group when compared with controls, we detected smaller conflict-related activations in several cortical areas, including the Dorsolateral Prefrontal Cortex (DLPFC). Furthermore, conflict-related activations in the DLPFC of those CHR individuals who ultimately developed psychosis (CHR converters) were smaller than in non-converters (CHR non-converters). Higher levels of conflict-related activation were associated with better social and role outcome. Risk for psychosis was associated at the neural level with reduced conflict-related brain activity. This neural phenotype appears correlated within the DLPFC with the development of psychosis and with functional outcome.
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167
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Silk TJ, Genc S, Anderson V, Efron D, Hazell P, Nicholson JM, Kean M, Malpas CB, Sciberras E. Developmental brain trajectories in children with ADHD and controls: a longitudinal neuroimaging study. BMC Psychiatry 2016; 16:59. [PMID: 26969310 PMCID: PMC4787204 DOI: 10.1186/s12888-016-0770-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/03/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The symptom profile and neuropsychological functioning of individuals with Attention Deficit/Hyperactivity Disorder (ADHD), change as they enter adolescence. It is unclear whether variation in brain structure and function parallels these changes, and also whether deviations from typical brain development trajectories are associated with differential outcomes. This paper describes the Neuroimaging of the Children's Attention Project (NICAP), a comprehensive longitudinal multimodal neuroimaging study. Primary aims are to determine how brain structure and function change with age in ADHD, and whether different trajectories of brain development are associated with variations in outcomes including diagnostic persistence, and academic, cognitive, social and mental health outcomes. METHODS/DESIGN NICAP is a multimodal neuroimaging study in a community-based cohort of children with and without ADHD. Approximately 100 children with ADHD and 100 typically developing controls will be scanned at a mean age of 10 years (range; 9-11years) and will be re-scanned at two 18-month intervals (ages 11.5 and 13 years respectively). Assessments include a structured diagnostic interview, parent and teacher questionnaires, direct child cognitive/executive functioning assessment and magnetic resonance imaging (MRI). MRI acquisition techniques, collected at a single site, have been selected to provide optimized information concerning structural and functional brain development. DISCUSSION This study will allow us to address the primary aims by describing the neurobiological development of ADHD and elucidating brain features associated with differential clinical/behavioral outcomes. NICAP data will also be explored to assess the impact of sex, ADHD presentation, ADHD severity, comorbidities and medication use on brain development trajectories. Establishing which brain regions are associated with differential clinical outcomes, may allow us to improve predictions about the course of ADHD.
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Affiliation(s)
- Timothy J. Silk
- Murdoch Childrens Research Institute, Melbourne, Australia ,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sila Genc
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia ,The Royal Children’s Hospital, Melbourne, Australia
| | - Daryl Efron
- Murdoch Childrens Research Institute, Melbourne, Australia ,The Royal Children’s Hospital, Melbourne, Australia ,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Discipline of Psychiatry, University of Sydney, Sydney, Australia
| | - Jan M. Nicholson
- Murdoch Childrens Research Institute, Melbourne, Australia ,Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Michael Kean
- Murdoch Childrens Research Institute, Melbourne, Australia ,The Royal Children’s Hospital, Melbourne, Australia
| | | | - Emma Sciberras
- Murdoch Childrens Research Institute, Melbourne, Australia ,The Royal Children’s Hospital, Melbourne, Australia ,Department of Paediatrics, University of Melbourne, Melbourne, Australia ,School of Psychology, Deakin University, Melbourne, Australia
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168
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Experiential reward learning outweighs instruction prior to adulthood. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2016; 15:310-20. [PMID: 25582607 DOI: 10.3758/s13415-014-0332-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Throughout our lives, we face the important task of distinguishing rewarding actions from those that are best avoided. Importantly, there are multiple means by which we acquire this information. Through trial and error, we use experiential feedback to evaluate our actions. We also learn which actions are advantageous through explicit instruction from others. Here, we examined whether the influence of these two forms of learning on choice changes across development by placing instruction and experience in competition in a probabilistic-learning task. Whereas inaccurate instruction markedly biased adults' estimations of a stimulus's value, children and adolescents were better able to objectively estimate stimulus values through experience. Instructional control of learning is thought to recruit prefrontal-striatal brain circuitry, which continues to mature into adulthood. Our behavioral data suggest that this protracted neurocognitive maturation may cause the motivated actions of children and adolescents to be less influenced by explicit instruction than are those of adults. This absence of a confirmation bias in children and adolescents represents a paradoxical developmental advantage of youth over adults in the unbiased evaluation of actions through positive and negative experience.
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Shulman EP, Smith AR, Silva K, Icenogle G, Duell N, Chein J, Steinberg L. The dual systems model: Review, reappraisal, and reaffirmation. Dev Cogn Neurosci 2016; 17:103-17. [PMID: 26774291 PMCID: PMC6990093 DOI: 10.1016/j.dcn.2015.12.010] [Citation(s) in RCA: 435] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/17/2015] [Accepted: 12/19/2015] [Indexed: 01/06/2023] Open
Abstract
According to the dual systems perspective, risk taking peaks during adolescence because activation of an early-maturing socioemotional-incentive processing system amplifies adolescents' affinity for exciting, pleasurable, and novel activities at a time when a still immature cognitive control system is not yet strong enough to consistently restrain potentially hazardous impulses. We review evidence from both the psychological and neuroimaging literatures that has emerged since 2008, when this perspective was originally articulated. Although there are occasional exceptions to the general trends, studies show that, as predicted, psychological and neural manifestations of reward sensitivity increase between childhood and adolescence, peak sometime during the late teen years, and decline thereafter, whereas psychological and neural reflections of better cognitive control increase gradually and linearly throughout adolescence and into the early 20s. While some forms of real-world risky behavior peak at a later age than predicted, this likely reflects differential opportunities for risk-taking in late adolescence and young adulthood, rather than neurobiological differences that make this age group more reckless. Although it is admittedly an oversimplification, as a heuristic device, the dual systems model provides a far more accurate account of adolescent risk taking than prior models that have attributed adolescent recklessness to cognitive deficiencies.
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Affiliation(s)
- Elizabeth P Shulman
- Brock University, Psychology Department, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1, Canada.
| | - Ashley R Smith
- Temple University, Department of Psychology, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
| | - Karol Silva
- Temple University, Department of Psychology, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
| | - Grace Icenogle
- Temple University, Department of Psychology, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
| | - Natasha Duell
- Temple University, Department of Psychology, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
| | - Jason Chein
- Temple University, Department of Psychology, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
| | - Laurence Steinberg
- Temple University, Department of Psychology, 1701 N. 13th Street, Philadelphia, PA 19122, USA; King Abdulaziz University, Abdullah Sulayman, Jeddah 22254, Saudi Arabia.
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170
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Cooray G, Garrido M, Brismar T, Hyllienmark L. The maturation of mismatch negativity networks in normal adolescence. Clin Neurophysiol 2016; 127:520-529. [DOI: 10.1016/j.clinph.2015.06.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 06/04/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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171
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Chorlian DB, Rangaswamy M, Manz N, Kamarajan C, Pandey AK, Edenberg H, Kuperman S, Porjesz B. Gender modulates the development of theta event related oscillations in adolescents and young adults. Behav Brain Res 2015; 292:342-52. [PMID: 26102560 PMCID: PMC4705839 DOI: 10.1016/j.bbr.2015.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 12/16/2022]
Abstract
The developmental trajectories of theta band (4-7 Hz) event-related oscillations (EROs), a key neurophysiological constituent of the P3 response, were assessed in 2170 adolescents and young adults ages 12 to 25. The theta EROs occurring in the P3 response, important indicators of neurocognitive function, were elicited during the evaluation of task-relevant target stimuli in visual and auditory oddball tasks. These tasks call upon attentional and working memory resources. Large differences in developmental rates between males and females were found; scalp location and task modality (visual or auditory) differences within males and females were small compared to gender differences. Trajectories of interregional and intermodal correlations between ERO power values exhibited increases with age in both genders, but showed a divergence in development between auditory and visual systems during ages 16 to 21. These results are consistent with previous electrophysiological and imaging studies and provide additional temporal detail about the development of neurophysiological indices of cognitive activity. Since measures of the P3 response has been found to be a useful endophenotypes for the study of a number of clinical and behavioral disorders, studies of its development in adolescents and young adults may illuminate neurophysiological factors contributing to the onset of these conditions.
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Affiliation(s)
- David B Chorlian
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | | | - Niklas Manz
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Chella Kamarajan
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Ashwini K Pandey
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Howard Edenberg
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Bernice Porjesz
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
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172
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) and conditions involving excessive eating (eg, obesity, binge/loss of control eating) are increasingly prevalent within pediatric populations, and correlational and some longitudinal studies have suggested inter-relationships between these disorders. In addition, a number of common neural correlates are emerging across conditions, eg, functional abnormalities within circuits subserving reward processing and executive functioning. To explore this potential cross-condition overlap in neurobehavioral underpinnings, we selectively review relevant functional neuroimaging literature, specifically focusing on studies probing (i) reward processing, (ii) response inhibition, and (iii) emotional processing and regulation, and we outline 3 specific shared neurobehavioral circuits. Based on our review, we also identify gaps within the literature that would benefit from further research.
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173
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Leonard HC, Bernardi M, Hill EL, Henry LA. Executive Functioning, Motor Difficulties, and Developmental Coordination Disorder. Dev Neuropsychol 2015; 40:201-15. [DOI: 10.1080/87565641.2014.997933] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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174
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Cservenka A, Stroup ML, Etkin A, Nagel BJ. The effects of age, sex, and hormones on emotional conflict-related brain response during adolescence. Brain Cogn 2015; 99:135-50. [PMID: 26175008 DOI: 10.1016/j.bandc.2015.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 02/04/2023]
Abstract
While cognitive and emotional systems both undergo development during adolescence, few studies have explored top-down inhibitory control brain activity in the context of affective processing, critical to informing adolescent psychopathology. In this study, we used functional magnetic resonance imaging to examine brain response during an Emotional Conflict (EmC) Task across 10-15-year-old youth. During the EmC Task, participants indicated the emotion of facial expressions, while disregarding emotion-congruent and incongruent words printed across the faces. We examined the relationships of age, sex, and gonadal hormones with brain activity on Incongruent vs. Congruent trials. Age was negatively associated with middle frontal gyrus activity, controlling for performance and movement confounds. Sex differences were present in occipital and parietal cortices, and were driven by activation in females, and deactivation in males to Congruent trials. Testosterone was negatively related with frontal and striatal brain response in males, and cerebellar and precuneus response in females. Estradiol was negatively related with fronto-cerebellar, cingulate, and precuneus brain activity in males, and positively related with occipital response in females. To our knowledge, this is the first study reporting the effects of age, sex, and sex steroids during an emotion-cognition task in adolescents. Further research is needed to examine longitudinal development of emotion-cognition interactions and deviations in psychiatric disorders in adolescence.
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Affiliation(s)
- Anita Cservenka
- Department of Psychiatry, Oregon Health & Science University, United States
| | | | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States
| | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, United States; Department of Behavioral Neuroscience, Oregon Health & Science University, United States.
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175
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Janssen RJ, Jylänki P, Kessels RPC, van Gerven MAJ. Probabilistic model-based functional parcellation reveals a robust, fine-grained subdivision of the striatum. Neuroimage 2015; 119:398-405. [PMID: 26163800 DOI: 10.1016/j.neuroimage.2015.06.084] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 06/16/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022] Open
Abstract
The striatum is involved in many different aspects of behaviour, reflected by the variety of cortical areas that provide input to this structure. This input is topographically organized and is likely to result in functionally specific signals. Such specificity can be examined using functional clustering approaches. Here, we propose a Bayesian model-based functional clustering approach applied solely to resting state striatal functional MRI timecourses to identify intrinsic striatal functional modules. Data from two sets of ten participants were used to obtain parcellations and examine their robustness. This stable clustering was used to initialize a more constrained model in order to obtain individualized parcellations in 57 additional participants. Resulting cluster time courses were used to examine functional connectivity between clusters and related to the rest of the brain in a GLM analysis. We find six distinct clusters in each hemisphere, with clear inter-hemispheric correspondence and functional relevance. These clusters exhibit functional connectivity profiles that further underscore their homologous nature and are consistent with existing notions on segregation and integration in parallel cortico-basal ganglia loops. Our findings suggest that multiple territories within both the affective and motor regions can be distinguished solely using resting state functional MRI from these regions.
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Affiliation(s)
- R J Janssen
- Radboud University Nijmegen, Donders Centre for Brain Cognition and Behaviour, Nijmegen, The Netherlands.
| | - P Jylänki
- Radboud University Nijmegen, Donders Centre for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - R P C Kessels
- Radboud University Nijmegen, Donders Centre for Brain Cognition and Behaviour, Nijmegen, The Netherlands; Radboud University Medical Centre, Department of Medical Psychology, Nijmegen, The Netherlands
| | - M A J van Gerven
- Radboud University Nijmegen, Donders Centre for Brain Cognition and Behaviour, Nijmegen, The Netherlands
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176
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Abstract
Brains systems undergo unique and specific dynamic changes at the cellular, circuit, and systems level that underlie the transition to adult-level cognitive control. We integrate literature from these different levels of analyses to propose a novel model of the brain basis of the development of cognitive control. The ability to consistently exert cognitive control improves into adulthood as the flexible integration of component processes, including inhibitory control, performance monitoring, and working memory, increases. Unique maturational changes in brain structure, supported by interactions between dopaminergic and GABAergic systems, contribute to enhanced network synchronization and an improved signal-to-noise ratio. In turn, these factors facilitate the specialization and strengthening of connectivity in networks supporting the transition to adult levels of cognitive control. This model provides a novel understanding of the adolescent period as an adaptive period of heightened experience-seeking necessary for the specialization of brain systems supporting cognitive control.
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177
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Chantiluke K, Barrett N, Giampietro V, Brammer M, Simmons A, Murphy DG, Rubia K. Inverse Effect of Fluoxetine on Medial Prefrontal Cortex Activation During Reward Reversal in ADHD and Autism. Cereb Cortex 2015; 25:1757-70. [PMID: 24451919 PMCID: PMC4459282 DOI: 10.1093/cercor/bht365] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) share brain function abnormalities during cognitive flexibility. Serotonin is involved in both disorders, and selective serotonin reuptake inhibitors (SSRIs) can modulate cognitive flexibility and improve behavior in both disorders. Thus, this study investigates shared and disorder-specific brain dysfunctions in these 2 disorders during reward reversal, and the acute effects of an SSRI on these. Age-matched boys with ADHD (15), ASD (18), and controls (21) were compared with functional magnetic resonance imaging (fMRI) during a reversal task. Patients were scanned twice, under either an acute dose of Fluoxetine or placebo in a double-blind, placebo-controlled randomized design. Repeated-measures analyses within patients assessed drug effects. Patients under each drug condition were compared with controls to assess normalization effects. fMRI data showed that, under placebo, ASD boys underactivated medial prefrontal cortex (mPFC), compared with control and ADHD boys. Both patient groups shared decreased precuneus activation. Under Fluoxetine, mPFC activation was up-regulated and normalized in ASD boys relative to controls, but down-regulated in ADHD boys relative to placebo, which was concomitant with worse task performance in ADHD. Fluoxetine therefore has inverse effects on mPFC activation in ASD and ADHD during reversal learning, suggesting dissociated underlying serotonin abnormalities.
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Affiliation(s)
| | | | | | | | - Andrew Simmons
- Department of Neuroimaging, Institute of Psychiatry
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Trust
| | - Declan G. Murphy
- Department of Forensic and Developmental Sciences, King's College London, London, UK
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry
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178
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Jarcho JM, Romer AL, Shechner T, Galvan A, Guyer AE, Leibenluft E, Pine DS, Nelson EE. Forgetting the best when predicting the worst: Preliminary observations on neural circuit function in adolescent social anxiety. Dev Cogn Neurosci 2015; 13:21-31. [PMID: 25933410 PMCID: PMC4466042 DOI: 10.1016/j.dcn.2015.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/19/2015] [Accepted: 03/16/2015] [Indexed: 11/20/2022] Open
Abstract
Social anxiety disorder typically begins in adolescence, a sensitive period for brain development, when increased complexity and salience of peer relationships requires novel forms of social learning. Disordered social learning in adolescence may explain how brain dysfunction promotes social anxiety. Socially anxious adolescents (n = 15) and adults (n = 19) and non-anxious adolescents (n = 24) and adults (n = 32) predicted, then received, social feedback from high and low-value peers while undergoing functional magnetic resonance imaging (fMRI). A surprise recall task assessed memory biases for feedback. Neural correlates of social evaluation prediction errors (PEs) were assessed by comparing engagement to expected and unexpected positive and negative feedback. For socially anxious adolescents, but not adults or healthy participants of either age group, PEs elicited heightened striatal activity and negative fronto-striatal functional connectivity. This occurred selectively to unexpected positive feedback from high-value peers and corresponded with impaired memory for social feedback. While impaired memory also occurred in socially-anxious adults, this impairment was unrelated to brain-based PE activity. Thus, social anxiety in adolescence may relate to altered neural correlates of PEs that contribute to impaired learning about social feedback. Small samples necessitate replication. Nevertheless, results suggest that the relationship between learning and fronto-striatal function may attenuate as development progresses.
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Affiliation(s)
- Johanna M Jarcho
- Section on Development and Affective Neuroscience, National Institute of Mental Health, United States.
| | - Adrienne L Romer
- Department of Psychology and Neuroscience, Duke University, United States
| | | | - Adriana Galvan
- Department of Psychology, University of Los Angeles, CA, United States
| | - Amanda E Guyer
- Department of Human Ecology, Center for Mind and Brain, University of Davis, CA, United States
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, National Institute of Mental Health, United States
| | - Daniel S Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health, United States
| | - Eric E Nelson
- Section on Development and Affective Neuroscience, National Institute of Mental Health, United States
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179
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Abstract
Major unipolar depression is a significant global health problem, with the highest incident risk being during adolescence. A depressive illness during this period is associated with negative long-term consequences including suicide, additional psychiatric comorbidity, interpersonal relationship problems, poor educational performance and poor employment attainment well into adult life. Despite previous safety concerns, selective serotonin reuptake inhibitors (SSRIs) remain a key component of the treatment of moderate to severe depression episodes in adolescents. The impact of SSRIs on the developing adolescent brain, however, remains unclear. In this review we first consider what is currently known about the developing brain during adolescence and how these development processes may be affected by a depressive illness. We then review our understanding of the action of SSRIs, their effects on the brain and how these may differ between adults and adolescents. We conclude that there is currently little evidence to indicate that the human adolescent brain is at developmental risk from SSRIs. Furthermore, there is no clear-cut evidence to support the concerns of marked suicidal adverse side effects accruing in depressed adolescents being treated with SSRIs. Neither, however, is there irrefutable evidence to dismiss all such concerns. This makes SSRI prescribing a matter of medical judgement, ensuring the benefits outweigh the risks for the individual patients, as with so much in therapeutics. Overall, SSRIs show clinical benefits that we judge to outweigh the risks to neurodevelopment and are an important therapeutic choice in the treatment of moderate to severe adolescent depression.
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Affiliation(s)
- Lesley Cousins
- Developmental Psychiatry Section, Department of Psychiatry, University of Cambridge, Cambridge, UK Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ian M Goodyer
- Developmental Psychiatry Section, Department of Psychiatry, University of Cambridge, Cambridge, UK Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
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180
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Cohen-Gilbert JE, Sneider JT, Crowley DJ, Rosso IM, Jensen JE, Silveri MM. Impact of family history of alcoholism on glutamine/glutamate ratio in anterior cingulate cortex in substance-naïve adolescents. Dev Cogn Neurosci 2015; 16:147-154. [PMID: 26025607 PMCID: PMC4618784 DOI: 10.1016/j.dcn.2015.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022] Open
Abstract
Neuroimaging studies of individuals with family histories of alcoholism provide evidence suggesting neurobiological risk factors for alcoholism. Youth family history positive (FH+) for alcoholism exhibit increased impulsivity compared to family history negative (FH-) peers in conjunction with altered functional activation in prefrontal cortex, including anterior cingulate cortex (ACC). This study examined glutamate (Glu) and glutamine (Gln), amino acids vital to protein synthesis, cellular metabolism and neurotransmission, acquired from ACC and parieto-occipital cortex (POC) using magnetic resonance spectroscopy (MRS) at 4T. Participants were 28 adolescents (13 male, 12-14 yrs) and 31 emerging adults (16 male, 18-25 yrs), stratified into FH- and FH+ groups. Significantly higher ACC Gln/Glu was observed in emerging adults versus adolescents in FH- but not FH+ groups. In FH- adolescents, higher impulsivity was significantly associated with higher ACC Gln/Glu. In FH+ emerging adults, higher impulsivity was negatively associated with ACC Gln/Glu. No differences or associations were observed for POC. These findings provide preliminary evidence that family history of alcoholism is associated with a neurochemical profile that may influence normative age differences in glutamatergic metabolites and their association with impulse control, which together could confer greater genetic risk of addiction later in life.
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Affiliation(s)
- Julia E Cohen-Gilbert
- McLean Imaging Center, McLean Hospital, 115 Mill Street, Mail Stop 204, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2-West, Boston, MA 02215, USA.
| | - Jennifer T Sneider
- McLean Imaging Center, McLean Hospital, 115 Mill Street, Mail Stop 204, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2-West, Boston, MA 02215, USA.
| | - David J Crowley
- McLean Imaging Center, McLean Hospital, 115 Mill Street, Mail Stop 204, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2-West, Boston, MA 02215, USA.
| | - Isabelle M Rosso
- McLean Imaging Center, McLean Hospital, 115 Mill Street, Mail Stop 204, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2-West, Boston, MA 02215, USA.
| | - J Eric Jensen
- McLean Imaging Center, McLean Hospital, 115 Mill Street, Mail Stop 204, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2-West, Boston, MA 02215, USA.
| | - Marisa M Silveri
- McLean Imaging Center, McLean Hospital, 115 Mill Street, Mail Stop 204, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2-West, Boston, MA 02215, USA.
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181
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Heitzeg MM, Cope LM, Martz ME, Hardee JE. Neuroimaging Risk Markers for Substance Abuse: Recent Findings on Inhibitory Control and Reward System Functioning. CURRENT ADDICTION REPORTS 2015; 2:91-103. [PMID: 26236575 DOI: 10.1007/s40429-015-0048-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Rates of alcohol and other drug use rise sharply throughout adolescence and peak in the early 20s. Likewise, prevalence of first-time substance use disorder (SUD) and past-year SUD both peak between ages 18-23. SUD is associated with a host of negative outcomes and is a serious health concern. Understanding the mechanisms that precede the onset and escalation of substance use is crucial in order to develop more effective prevention and intervention strategies for children and adolescents at risk for SUD. In this review, we discuss recent findings from functional neuroimaging studies in children, adolescents, and emerging adults that focus on uncovering the neural underpinnings of SUD risk. The focus is on inhibitory control and reward circuitry due to their involvement in risk-taking behaviors, which are heightened in adolescence and may facilitate substance use. We discuss convergences in the literature and highlight findings suggesting that the association between SUD risk and neurofunctioning may be moderated by age, gender, and history of substance use. Recommendations for future directions are also discussed.
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Affiliation(s)
- Mary M Heitzeg
- Department of Psychiatry and Addiction Research Center, The University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA
| | - Lora M Cope
- Department of Psychiatry and Addiction Research Center, The University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA
| | - Meghan E Martz
- Department of Psychiatry and Addiction Research Center, The University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA ; Department of Psychology, The University of Michigan, 2044 East Hall, 530 Church St., Ann Arbor, MI 48108, USA
| | - Jillian E Hardee
- Department of Psychiatry and Addiction Research Center, The University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA
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182
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Heightened graft failure risk during emerging adulthood and transition to adult care. Pediatr Nephrol 2015; 30:567-76. [PMID: 24890339 DOI: 10.1007/s00467-014-2859-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
Emerging adulthood, defined as the interval between 18 and 25 years of age, is a socially-defined developmental stage. Although people in this age group appear physically mature, brain maturation is not complete until the end of this period. Perhaps due to this immaturity and a resulting inferior ability to manage chronic illness emerging adults with a variety of chronic health conditions are at a high risk for adverse outcomes. In this review I will summarize evidence that emerging adulthood constitutes a high-risk period for kidney transplant recipients, and consider the possible reasons for the spike in graft failure risk during this age interval-including age-related adherence behaviour and the changes in care organization, processes and structures associated with transfer from pediatric to adult-oriented care. I will also discuss evidence showing transfer from pediatric to adult-oriented care contributes to this elevated risk, and highlight the limitations and challenges of studies examining this question. Finally, I will direct readers to resources providing guidance on the best practices for care of patients transitioning to adult care.
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183
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Ensink K, Biberdzic M, Normandin L, Clarkin J. A Developmental Psychopathology and Neurobiological Model of Borderline Personality Disorder in Adolescence. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15289168.2015.1007715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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184
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Mechanisms of motivation-cognition interaction: challenges and opportunities. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2015; 14:443-72. [PMID: 24920442 DOI: 10.3758/s13415-014-0300-0] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Recent years have seen a rejuvenation of interest in studies of motivation-cognition interactions arising from many different areas of psychology and neuroscience. The present issue of Cognitive, Affective, & Behavioral Neuroscience provides a sampling of some of the latest research from a number of these different areas. In this introductory article, we provide an overview of the current state of the field, in terms of key research developments and candidate neural mechanisms receiving focused investigation as potential sources of motivation-cognition interaction. However, our primary goal is conceptual: to highlight the distinct perspectives taken by different research areas, in terms of how motivation is defined, the relevant dimensions and dissociations that are emphasized, and the theoretical questions being targeted. Together, these distinctions present both challenges and opportunities for efforts aiming toward a more unified and cross-disciplinary approach. We identify a set of pressing research questions calling for this sort of cross-disciplinary approach, with the explicit goal of encouraging integrative and collaborative investigations directed toward them.
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185
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Yerys BE, Antezana L, Weinblatt R, Jankowski KF, Strang J, Vaidya CJ, Schultz RT, Gaillard WD, Kenworthy L. Neural Correlates of Set-Shifting in Children With Autism. Autism Res 2015; 8:386-97. [PMID: 25599972 DOI: 10.1002/aur.1454] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/18/2014] [Accepted: 11/25/2014] [Indexed: 11/11/2022]
Abstract
Autism spectrum disorder (ASD) is often associated with high levels of inflexible thinking and rigid behavior. The neural correlates of these behaviors have been investigated in adults and older adolescents, but not children. Prior studies utilized set-shifting tasks that engaged multiple levels of shifting, and depended on learning abstract rules and establishing a strong prepotent bias. These additional demands complicate simple interpretations of the results. We used functional magnetic resonance imaging (fMRI) to investigate the neural correlates of set-shifting in 20 children (ages 7-14) with ASD and 19 typically developing, matched, control children. Participants completed a set-shifting task that minimized nonshifting task demands through the use of concrete instructions that provide spatial mapping of stimuli-responses. The shift/stay sets were given an equal number of trials to limit the prepotent bias. Both groups showed an equivalent "switch cost," responding less accurately and slower to Switch stimuli than Stay stimuli, although the ASD group was less accurate overall. Both groups showed activation in prefrontal, striatal, parietal, and cerebellum regions known to govern effective set-shifts. Compared to controls, children with ASD demonstrated decreased activation of the right middle temporal gyrus across all trials, but increased activation in the mid-dorsal cingulate cortex/superior frontal gyrus, left middle frontal, and right inferior frontal gyri during the Switch vs. Stay contrast. The successful behavioral switching performance of children with ASD comes at the cost of requiring greater engagement of frontal regions, suggesting less efficiency at this lowest level of shifting.
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Affiliation(s)
- Benjamin E Yerys
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Autism Spectrum Disorders, Children's National Medical Center, Washington, DC.,Children's Research Institute, Children's National Medical Center, Washington, DC.,Department of Psychology, University of Oregon, Eugene, Oregon
| | - Ligia Antezana
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Weinblatt
- Center for Autism Spectrum Disorders, Children's National Medical Center, Washington, DC.,Children's Research Institute, Children's National Medical Center, Washington, DC
| | - Kathryn F Jankowski
- Center for Autism Spectrum Disorders, Children's National Medical Center, Washington, DC.,Children's Research Institute, Children's National Medical Center, Washington, DC.,Department of Psychology, University of Oregon, Eugene, Oregon.,Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - John Strang
- Center for Autism Spectrum Disorders, Children's National Medical Center, Washington, DC.,Children's Research Institute, Children's National Medical Center, Washington, DC
| | - Chandan J Vaidya
- Children's Research Institute, Children's National Medical Center, Washington, DC.,Department of Psychology, Georgetown University, Washington, DC
| | - Robert T Schultz
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D Gaillard
- Children's Research Institute, Children's National Medical Center, Washington, DC.,Neurology, School of Medicine and Health Sciences, George Washington University, Washington, DC.,Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children's National Medical Center, Washington, DC.,Children's Research Institute, Children's National Medical Center, Washington, DC.,Department of Psychology, University of Oregon, Eugene, Oregon.,Department of Psychology, Georgetown University, Washington, DC.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania.,Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
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186
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Peng X, Li Y, Wang P, Mo L, Chen Q. The ugly truth: negative gossip about celebrities and positive gossip about self entertain people in different ways. Soc Neurosci 2015; 10:320-36. [DOI: 10.1080/17470919.2014.999162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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187
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Applications and adaptations of Acceptance and Commitment Therapy (ACT) for adolescents. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2015. [DOI: 10.1016/j.jcbs.2015.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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188
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Cservenka A, Gillespie AJ, Michael PG, Nagel BJ. Family history density of alcoholism relates to left nucleus accumbens volume in adolescent girls. J Stud Alcohol Drugs 2015; 76:47-56. [PMID: 25486393 PMCID: PMC4263780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/25/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE A family history of alcoholism is a significant risk factor for the development of alcohol use disorders (AUDs). Because common structural abnormalities are present in reward and affective brain regions in alcoholics and those with familial alcoholism, the current study examined the relationship between familial loading of AUDs and volumes of the amygdala and nucleus accumbens (NAcc) in largely alcohol-naive adolescents, ages 12-16 years (N = 140). METHOD The amygdala and NAcc were delineated on each participant's T1-weighted anatomical scan, using FMRIB Software Library's FMRIB Integrated Registration & Segmentation Tool, and visually inspected for accuracy and volume outliers. In the 140 participants with accurate segmentation (75 male/65 female), subcortical volumes were represented as a ratio to intracranial volume (ICV). A family history density (FHD) score was calculated for each adolescent based on the presence of AUDs in first- and second-degree relatives (range: 0.03-1.50; higher scores represent a greater prevalence of familial AUDs). Multiple regressions, with age and sex controlled for, examined the association between FHD and left and right amygdala and NAcc volume/ICV. RESULTS There was a significant positive relationship between FHD and left NAcc volume/ICV (ΔR² = .04, p = .02). Post hoc regressions indicated that this effect was only significant in females (ΔR² = .11, p = .006). CONCLUSIONS This finding suggests that the degree of familial alcoholism, genetic or otherwise, is associated with alterations in reward-related brain structure. Further work will be necessary to examine whether FHD is related to future alcohol-related problems and reward-related behaviors.
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Affiliation(s)
- Anita Cservenka
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Alicia J Gillespie
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Paul G Michael
- School of Professional Psychology, Pacific University, Hillsboro, Oregon
| | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon
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189
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Potvin S, Tikàsz A, Dinh-Williams LLA, Bourque J, Mendrek A. Cigarette Cravings, Impulsivity, and the Brain. Front Psychiatry 2015; 6:125. [PMID: 26441686 PMCID: PMC4562259 DOI: 10.3389/fpsyt.2015.00125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 08/26/2015] [Indexed: 12/28/2022] Open
Abstract
Craving is a core feature of tobacco use disorder as well as a significant predictor of smoking relapse. Studies have shown that appetitive smoking-related stimuli (e.g., someone smoking) trigger significant cravings in smokers impede their self-control capacities and promote drug seeking behavior. In this review, we begin by an overview of functional magnetic resonance imaging (fMRI) studies investigating the neural correlates of smokers to appetitive smoking cues. The literature reveals a complex and vastly distributed neuronal network underlying smokers' craving response that recruits regions involved in self-referential processing, planning/regulatory processes, emotional responding, attentional biases, and automatic conducts. We then selectively review important factors contributing to the heterogeneity of results that significantly limit the implications of these findings, namely between- (abstinence, smoking expectancies, and self-regulation) and within-studies factors (severity of smoking dependence, sex-differences, motivation to quit, and genetic factors). Remarkably, we found that little to no attention has been devoted to examine the influence of personality traits on the neural correlates of cigarette cravings in fMRI studies. Impulsivity has been linked with craving and relapse in substance and tobacco use, which prompted our research team to examine the influence of impulsivity on cigarette cravings in an fMRI study. We found that the influence of impulsivity on cigarette cravings was mediated by fronto-cingulate mechanisms. Given the high prevalence of cigarette smoking in several psychiatric disorders that are characterized by significant levels of impulsivity, we conclude by identifying psychiatric patients as a target population whose tobacco-smoking habits deserve further behavioral and neuro-imaging investigation.
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Affiliation(s)
- Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada
| | - Andràs Tikàsz
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada
| | | | - Josiane Bourque
- Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada ; Centre de Recherche de l'Hôpital Sainte-Justine , Montreal, QC , Canada
| | - Adrianna Mendrek
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychology, Bishop's University , Lennoxville, QC , Canada
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190
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Keshavan MS, Giedd J, Lau JYF, Lewis DA, Paus T. Changes in the adolescent brain and the pathophysiology of psychotic disorders. Lancet Psychiatry 2014; 1:549-58. [PMID: 26361314 DOI: 10.1016/s2215-0366(14)00081-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/23/2014] [Indexed: 10/24/2022]
Abstract
Adolescence is a time of extensive neuroanatomical, functional, and chemical reorganisation of the brain which parallels substantial maturational changes in cognition and affect regulation. This period is characterised by stabilisation of synapses to diminish redundancy and increase efficiency of neural function, fine-tuning of excitatory and inhibitory neurotransmitter systems, beginning of integration between late maturing and early maturing brain structures, and development of effective connections. In effect, these so-called moving parts create a state of dynamic change that might underlie adolescent behaviours. Imbalances or changes in timing of these developmental processes clearly increase the risk for psychiatric disorders. Genetic, environmental, and epigenetic factors that shape brain development and hormonal changes that affect stress reactivity could be reasons why some, but not all, adolescents are at a heightened risk of developing a psychopathological disorder. In this Series paper, we assess the neurobiology of the changing adolescent brain, implications of this knowledge, and future research in major psychiatric disorders, particularly for psychotic disorders.
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Affiliation(s)
- Matcheri S Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA.
| | - Jay Giedd
- Brain Imaging Section, Child Psychiatry Branch, NIMH, Bethesda, MD, USA
| | | | - David A Lewis
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Tomáš Paus
- Rotman Research Institute and Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
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191
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Kalpakidou AK, Allin MPG, Walshe M, Giampietro V, McGuire PK, Rifkin L, Murray RM, Nosarti C. Functional neuroanatomy of executive function after neonatal brain injury in adults who were born very preterm. PLoS One 2014; 9:e113975. [PMID: 25438043 PMCID: PMC4250191 DOI: 10.1371/journal.pone.0113975] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/01/2014] [Indexed: 02/01/2023] Open
Abstract
Individuals who were born very preterm (VPT; <33 gestational weeks) are at risk of experiencing deficits in tasks involving executive function in childhood and beyond. In addition, the type and severity of neonatal brain injury associated with very preterm birth may exert differential effects on executive functioning by altering its neuroanatomical substrates. Here we addressed this question by investigating with functional magnetic resonance imaging (fMRI) the haemodynamic response during executive-type processing using a phonological verbal fluency and a working memory task in VPT-born young adults who had experienced differing degrees of neonatal brain injury. 12 VPT individuals with a history of periventricular haemorrhage and ventricular dilatation (PVH+VD), 17 VPT individuals with a history of uncomplicated periventricular haemorrhage (UPVH), 13 VPT individuals with no history of neonatal brain injury and 17 controls received an MRI scan whilst completing a verbal fluency task with two cognitive loads (‘easy’ and ‘hard’ letters). Two groups of VPT individuals (PVH+VD; n = 10, UPVH; n = 8) performed an n-back task with three cognitive loads (1-, 2-, 3-back). Results demonstrated that VPT individuals displayed hyperactivation in frontal, temporal, and parietal cortices and in caudate nucleus, insula and thalamus compared to controls, as demands of the verbal fluency task increased, regardless of type of neonatal brain injury. On the other hand, during the n-back task and as working memory load increased, the PVH+VD group showed less engagement of the frontal cortex than the UPVH group. In conclusion, this study suggests that the functional neuroanatomy of different executive-type processes is altered following VPT birth and that neural activation associated with specific aspects of executive function (i.e., working memory) may be particularly sensitive to the extent of neonatal brain injury.
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Affiliation(s)
- Anastasia K. Kalpakidou
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
- * E-mail:
| | - Matthew P. G. Allin
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Muriel Walshe
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Philip K. McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Larry Rifkin
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Chiara Nosarti
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
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192
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Berner LA, Marsh R. Frontostriatal circuits and the development of bulimia nervosa. Front Behav Neurosci 2014; 8:395. [PMID: 25452718 PMCID: PMC4233924 DOI: 10.3389/fnbeh.2014.00395] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/27/2014] [Indexed: 11/23/2022] Open
Abstract
Bulimia nervosa (BN) is characterized by both recurrent episodes of binge eating that are, in part, defined by a sense of loss of control and compensatory behaviors to avoid weight gain. Impulsive behaviors are also common in individuals with BN, indicating more pervasive difficulties in behavioral self-regulation. Findings from functional and anatomical neuroimaging studies of individuals with BN suggest dysfunction in the dorsal frontostriatal circuits that support self-regulatory capacities and habit learning and in overlapping ventral circuits that support reward processing and reward-based learning. In this review, we describe the normal development of frontostriatal circuits and then present behavioral and neuroimaging data from adolescents and adults with BN. These data suggest that the abnormal maturation of frontostriatal circuits may contribute to the habitual binge-eating and purging behaviors of BN. Future longitudinal imaging studies will improve understanding of how these circuits contribute to the developmental trajectory of BN and will inform novel interventions that could target or prevent the impulsive and habit-like features of this disorder.
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Affiliation(s)
- Laura A Berner
- Department of Psychology, Drexel University , Philadelphia, PA , USA
| | - Rachel Marsh
- MRI Unit, Department of Psychiatry, Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University , New York, NY , USA
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193
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Cieslik EC, Mueller VI, Eickhoff CR, Langner R, Eickhoff SB. Three key regions for supervisory attentional control: evidence from neuroimaging meta-analyses. Neurosci Biobehav Rev 2014; 48:22-34. [PMID: 25446951 DOI: 10.1016/j.neubiorev.2014.11.003] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/08/2014] [Accepted: 11/02/2014] [Indexed: 12/20/2022]
Abstract
The supervisory attentional system has been proposed to mediate non-routine, goal-oriented behaviour by guiding the selection and maintenance of the goal-relevant task schema. Here, we aimed to delineate the brain regions that mediate these high-level control processes via neuroimaging meta-analysis. In particular, we investigated the core neural correlates of a wide range of tasks requiring supervisory control for the suppression of a routine action in favour of another, non-routine one. Our sample comprised n=173 experiments employing go/no-go, stop-signal, Stroop or spatial interference tasks. Consistent convergence across all four paradigm classes was restricted to right anterior insula and inferior frontal junction, with anterior midcingulate cortex and pre-supplementary motor area being consistently involved in all but the go/no-go task. Taken together with lesion studies in patients, our findings suggest that the controlled activation and maintenance of adequate task schemata relies, across paradigms, on a right-dominant midcingulo-insular-inferior frontal core network. This also implies that the role of other prefrontal and parietal regions may be less domain-general than previously thought.
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Affiliation(s)
- Edna C Cieslik
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Universitätsstraße 1, 40225 Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1) Research Centre Jülich, Leo-Brandt-Straße, 52428 Jülich, Germany.
| | - Veronika I Mueller
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Universitätsstraße 1, 40225 Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1) Research Centre Jülich, Leo-Brandt-Straße, 52428 Jülich, Germany
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine (INM-1) Research Centre Jülich, Leo-Brandt-Straße, 52428 Jülich, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen, University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Robert Langner
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Universitätsstraße 1, 40225 Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1) Research Centre Jülich, Leo-Brandt-Straße, 52428 Jülich, Germany
| | - Simon B Eickhoff
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Universitätsstraße 1, 40225 Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1) Research Centre Jülich, Leo-Brandt-Straße, 52428 Jülich, Germany
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194
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Singh MK, Chang KD, Kelley RG, Saggar M, Reiss A, Gotlib IH. Early signs of anomalous neural functional connectivity in healthy offspring of parents with bipolar disorder. Bipolar Disord 2014; 16:678-89. [PMID: 24938878 PMCID: PMC4213354 DOI: 10.1111/bdi.12221] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/12/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Bipolar disorder (BD) has been associated with dysfunctional brain connectivity and with family chaos. It is not known whether aberrant connectivity occurs before illness onset, representing vulnerability for developing BD amidst family chaos. We used resting-state functional magnetic resonance imaging (fMRI) to examine neural network dysfunction in healthy offspring living with parents with BD and healthy comparison youth. METHODS Using two complementary methodologies [data-driven independent component analysis (ICA) and hypothesis-driven region-of-interest (ROI)-based intrinsic connectivity], we examined resting-state fMRI data in 8-17-year-old healthy offspring of a parent with BD (n = 24; high risk) and age-matched healthy youth without any personal or family psychopathology (n = 25; low risk). RESULTS ICA revealed that, relative to low-risk youth, high-risk youth showed increased connectivity in the ventrolateral prefrontal cortex (VLPFC) subregion of the left executive control network (ECN), which includes frontoparietal regions important for emotion regulation. ROI-based analyses revealed that high-risk versus low-risk youth had decreased connectivities between the left amygdala and pregenual cingulate, between the subgenual cingulate and supplementary motor cortex, and between the left VLPFC and left caudate. High-risk youth showed stronger connections in the VLPFC with age and higher functioning, which may be neuroprotective, and weaker connections between the left VLPFC and caudate with more family chaos, suggesting an environmental influence on frontostriatal connectivity. CONCLUSIONS Healthy offspring of parents with BD show atypical patterns of prefrontal and subcortical intrinsic connectivity that may be early markers of resilience to or vulnerability for developing BD. Longitudinal studies are needed to determine whether these patterns predict outcomes.
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Affiliation(s)
- Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Kiki D Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Ryan G Kelley
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Manish Saggar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Allan Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
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195
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Hardee JE, Weiland BJ, Nichols TE, Welsh RC, Soules ME, Steinberg DB, Zubieta JK, Zucker RA, Heitzeg MM. Development of impulse control circuitry in children of alcoholics. Biol Psychiatry 2014; 76:708-16. [PMID: 24742620 PMCID: PMC4163541 DOI: 10.1016/j.biopsych.2014.03.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Difficulty with impulse control is heightened in children with a family history of alcohol use disorders and is a risk factor for later substance problems. Cross-sectional functional magnetic resonance imaging studies have shown altered impulse control processing in adolescents with a positive family history, yet developmental trajectories have yet to be examined. METHODS Longitudinal functional magnetic resonance imaging was conducted in children of alcoholic families (family history positive [FH+]; n = 43) and children of control families (family history negative [FH-]; n = 30) starting at ages 7-12 years. Participants performed a go/no-go task during functional magnetic resonance imaging at intervals of 1-2 years, with two to four scans performed per subject. We implemented a repeated-measures linear model fit across all subjects to conduct a whole-brain search for developmental differences between groups. RESULTS Performance improved with age in both groups, and there were no performance differences between groups. Significant between-group differences in linear age-related activation changes were found in the right caudate, middle cingulate, and middle frontal gyrus. Post hoc analyses revealed significant activation decreases with age in the caudate and middle frontal gyrus for FH- subjects and a significant increase with age in middle cingulate activation for FH+ subjects. Group differences were evident at age 7-12 years, even in alcohol- and drug-naïve participants, with FH+ subjects showing significantly blunted activation at baseline compared with FH- subjects. CONCLUSIONS Differences in response inhibition circuitry are visible in FH+ individuals during childhood; these differences continue into adolescence, displaying trajectories that are inconsistent with development of normal response inhibition. These patterns precede problem drinking and may be a contributing factor for subsequent substance use problems.
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Affiliation(s)
- Jillian E. Hardee
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
,Addiction Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Barbara J. Weiland
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
,Addiction Research Center, University of Michigan, Ann Arbor, MI, USA
,Department of Psychology and Neuroscience, University of Colorado, Boulder, USA
| | - Thomas E. Nichols
- Department of Statistics & Warwick Manufacturing Group, University of Warwick, Conventry, UK
| | - Robert C. Welsh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Mary E. Soules
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
,Addiction Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Davia B. Steinberg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
,Addiction Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
,Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - Robert A. Zucker
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
,Addiction Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
,Addiction Research Center, University of Michigan, Ann Arbor, MI, USA
,Corresponding author at: Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109.
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196
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Bhattacharyya S, Iyegbe C, Atakan Z, Martin-Santos R, Crippa JA, Xu X, Williams S, Brammer M, Rubia K, Prata D, Collier DA, McGuire PK. Protein kinase B (AKT1) genotype mediates sensitivity to cannabis-induced impairments in psychomotor control. Psychol Med 2014; 44:3315-3328. [PMID: 25065544 DOI: 10.1017/s0033291714000920] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND What determines inter-individual variability to impairments in behavioural control that may underlie road-traffic accidents, and impulsive and violent behaviours occurring under the influence of cannabis, the most widely used illicit drug worldwide? METHOD Employing a double-blind, repeated-measures design, we investigated the genetic and neural basis of variable sensitivity to cannabis-induced behavioural dyscontrol in healthy occasional cannabis users. Acute oral challenge with placebo or Δ9-tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis, was combined with functional magnetic resonance imaging, while participants performed a response inhibition task that involved inhibiting a pre-potent motor response. They were genotyped for rs1130233 single nucleotide polymorphisms (SNPs) of the protein kinase B (AKT1) gene. RESULTS Errors of inhibition were significantly (p = 0.008) increased following administration of THC in carriers of the A allele, but not in G allele homozygotes of the AKT1 rs1130233 SNP. The A allele carriers also displayed attenuation of left inferior frontal response with THC evident in the sample as a whole, while there was a modest enhancement of inferior frontal activation in the G homozygotes. There was a direct relationship (r = -0.327, p = 0.045) between the behavioural effect of THC and its physiological effect in the inferior frontal gyrus, where AKT1 genotype modulated the effect of THC. CONCLUSIONS These results require independent replication and show that differing vulnerability to acute psychomotor impairments induced by cannabis depends on variation in a gene that influences dopamine function, and is mediated through modulation of the effect of cannabis on the inferior frontal cortex, that is rich in dopaminergic innervation and critical for psychomotor control.
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Affiliation(s)
- S Bhattacharyya
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - C Iyegbe
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - Z Atakan
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - R Martin-Santos
- Pharmacology Research Unit, IMIM-Hospital del Mar and Psychiatric Department,ICN,Hospital Clinico, Barcelona,Spain
| | - J A Crippa
- Department of Neurology, Psychiatry and Medical Psychology, Faculty of Medicine of Ribeirão Preto,University of São Paulo,Brazil
| | - X Xu
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - S Williams
- Department of Neuroimaging, Centre for Neuroimaging Sciences,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - M Brammer
- Department of Neuroimaging, Centre for Neuroimaging Sciences,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - K Rubia
- Department of Child and Adolescent Psychiatry,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - D Prata
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - D A Collier
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - P K McGuire
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
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197
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Hämmerer D, Müller V, Li SC. Performance monitoring across the lifespan: Still maturing post-conflict regulation in children and declining task-set monitoring in older adults. Neurosci Biobehav Rev 2014; 46 Pt 1:105-23. [DOI: 10.1016/j.neubiorev.2014.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 05/30/2014] [Accepted: 06/17/2014] [Indexed: 02/04/2023]
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198
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Cognitive flexibility in adolescence: neural and behavioral mechanisms of reward prediction error processing in adaptive decision making during development. Neuroimage 2014; 104:347-54. [PMID: 25234119 PMCID: PMC4330550 DOI: 10.1016/j.neuroimage.2014.09.018] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/05/2014] [Accepted: 09/06/2014] [Indexed: 01/24/2023] Open
Abstract
Adolescence is associated with quickly changing environmental demands which require excellent adaptive skills and high cognitive flexibility. Feedback-guided adaptive learning and cognitive flexibility are driven by reward prediction error (RPE) signals, which indicate the accuracy of expectations and can be estimated using computational models. Despite the importance of cognitive flexibility during adolescence, only little is known about how RPE processing in cognitive flexibility deviates between adolescence and adulthood. In this study, we investigated the developmental aspects of cognitive flexibility by means of computational models and functional magnetic resonance imaging (fMRI). We compared the neural and behavioral correlates of cognitive flexibility in healthy adolescents (12–16 years) to adults performing a probabilistic reversal learning task. Using a modified risk-sensitive reinforcement learning model, we found that adolescents learned faster from negative RPEs than adults. The fMRI analysis revealed that within the RPE network, the adolescents had a significantly altered RPE-response in the anterior insula. This effect seemed to be mainly driven by increased responses to negative prediction errors. In summary, our findings indicate that decision making in adolescence goes beyond merely increased reward-seeking behavior and provides a developmental perspective to the behavioral and neural mechanisms underlying cognitive flexibility in the context of reinforcement learning. Adolescents and adults show differences in processing RPEs. Adolescents learn faster from negative prediction errors. The anterior insula activation may cause altered sensitivity to RPEs.
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199
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Altered prefrontal connectivity after acute heroin administration during cognitive control. Int J Neuropsychopharmacol 2014; 17:1375-85. [PMID: 24641978 DOI: 10.1017/s1461145714000297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neuroimaging studies have reported reduced activity in a broad network of brain regions during response inhibition in heroin-dependent patients. However, how heroin in an acute dose modulates the neural correlates of response inhibition and the underlying brain connectivity has not yet been investigated. In this double-blind placebo-controlled study, we used functional magnetic resonance imaging to examine whether acute heroin administration changed whole brain activity during response inhibition in 26 heroin-dependent patients. We then applied dynamic causal modelling to investigate the effect of an acute dose of heroin on the functional interactions between the dorsal anterior cingulate cortex (dACC) and the bilateral inferior frontal gyri (IFG). Heroin acutely reduced dACC activity, as well as the inhibition-induced modulation of connectivity from the dACC to the right IFG compared with placebo. Furthermore, dACC activity was positively related to false alarm rates after placebo but not heroin administration. These results suggest that acute heroin administration impairs cognitive control in dependent patients by reducing the activity in the dACC activity and the functional connectivity from the dACC to the right IFG.
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200
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Vara AS, Pang EW, Vidal J, Anagnostou E, Taylor MJ. Neural mechanisms of inhibitory control continue to mature in adolescence. Dev Cogn Neurosci 2014; 10:129-39. [PMID: 25212682 PMCID: PMC6987894 DOI: 10.1016/j.dcn.2014.08.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/22/2014] [Accepted: 08/24/2014] [Indexed: 11/12/2022] Open
Abstract
Brain mechanisms involved in inhibitory control were examined in adults and teens. No differences were seen on reaction time and accuracy for the Go/No-go tasks. Adults showed the expected activation in right inferior frontal gyrus. Teens showed a delayed and left dominant activation of inferior frontal gyri. Teens also recruited temporal and parietal regions to support inhibitory processing.
Inhibition is a fundamental executive function necessary for self-management of behaviour. The ability to withhold prepotent responses shows protracted development, extending through childhood and into adulthood. Using magnetoencephalography (MEG) with co-registered MRI, the spatiotemporal neural processes involved in inhibitory control were examined in 15 adolescents and 15 adults during a Go/No-go task. Two tasks were run that contained inverse ratios of Go to No-go trials for the experimental (2:1) and control conditions (1:2). Using vector beamforming, images of neural activation between No-go and Go trials were compared for both age-groups and revealed recruitment of the right inferior frontal gyrus in adults (BA 45; 200–250 ms), but delayed recruitment of the left inferior frontal gyri in adolescents (BA 45; 250–300 ms). Left anticipatory-related activity near the hand motor region (BA 6) was present in both adolescents and adults, but for a longer duration in adults. Adolescents additionally recruited the right middle and superior temporal gyri (BA21, BA22), while adults engaged the right temporal gyrus (BA41) but for a much briefer duration. These findings of delayed recruitment of canonical inhibitory control areas with supplementary and prolonged involvement of temporal areas in adolescents compared to adults indicate an immature inhibitory network even in adolescence.
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Affiliation(s)
- Anjili S Vara
- Diagnostic Imaging, The Hospital for Sick Children, Canada; Holland Bloorview Kids Rehabilitation Centre, Canada; University of Toronto, Toronto, Canada
| | - Elizabeth W Pang
- Neurology, The Hospital for Sick Children, Canada; University of Toronto, Toronto, Canada
| | - Julie Vidal
- Diagnostic Imaging, The Hospital for Sick Children, Canada; Unité CNRS 3521, Université Paris Descartes, France
| | - Evdokia Anagnostou
- Neurology, The Hospital for Sick Children, Canada; Holland Bloorview Kids Rehabilitation Centre, Canada; University of Toronto, Toronto, Canada
| | - Margot J Taylor
- Diagnostic Imaging, The Hospital for Sick Children, Canada; Neurology, The Hospital for Sick Children, Canada; University of Toronto, Toronto, Canada.
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