Dual neurocircuitry dysfunctions in disruptive behavior disorders: emotional responding and response inhibition

Losing Control: Prefrontal Emotion Regulation Is Related to Symptom Severity and Predicts Treatment-Related Symptom Change in Adolescent Girls With Conduct Disorder

BACKGROUND

Emotion regulation skills are linked to corticolimbic brain activity (e.g., dorsolateral prefrontal cortex [dlPFC] and limbic regions) and enable an individual to control their emotional experiences, thus allowing healthy social functioning. Disruptions in emotion regulation skills are reported in neuropsychiatric disorders, including conduct disorder or oppositional defiant disorder (CD/ODD). Clinically recognized means to ameliorate emotion regulation deficits observed in CD/ODD include cognitive or dialectical behavioral skills therapy as implemented in the START NOW program. However, the role of emotion regulation and its neural substrates in symptom severity and prognosis following treatment of adolescent CD/ODD has not been investigated.

METHODS

Cross-sectional data including functional magnetic resonance imaging responses during emotion regulation (N = 114; average age = 15 years), repeated-measures assessments of symptom severity (pretreatment, posttreatment, long-term follow-up), and functional magnetic resonance imaging data collected prior to and following the START NOW randomized controlled trial (n = 44) for female adolescents with CD/ODD were analyzed using group comparisons and multiple regression.

RESULTS

First, behavioral and neural correlates of emotion regulation were disrupted in female adolescents with CD/ODD. Second, ODD symptom severity was negatively associated with dlPFC/precentral gyrus activity during regulation. Third, treatment-related symptom changes were predicted by pretreatment ODD symptom severity and regulatory dlPFC/precentral activity. Additionally, pretreatment dlPFC/precentral activity and ODD symptom severity predicted long-term reductions in symptom severity following treatment for participants who received the START NOW treatment.

CONCLUSIONS

Our findings demonstrate the important role that emotion regulation skills play in the characteristics of CD/ODD and show that regulatory dlPFC/precentral activity is positively associated with treatment response in female adolescents with CD/ODD.

Involving Parents in Cognitive Behavioral Therapy for Children and Adolescents with Conduct Problems: Goals, Outcome Expectations, and Normative Beliefs About Aggression are Targeted in Sessions with Parents and Their Child

Children and adolescents with conduct problems participate in Cognitive Behavioral Therapy (CBT), either in individual or group format, in view of learning social problem-solving skills that enable them to behave in more independent and situation-appropriate ways. Parents must support their child's learning processes in everyday life and therefore these processes need attention in CBT sessions in which parents and their child participate. The social problem-solving model of CBT previously described (Matthys & Schutter, Clin Child Fam Psychol Rev 25:552-572, 2022; Matthys & Schutter, Clin Child Fam Psychol Rev 26:401-415, 2023) consists of nine psychological skills. In this narrative review we propose that instead of addressing each skill separately in sessions with both parents and their child, therapists work on three schemas (latent mental structures): (1) goals, (2) outcome expectations, and (3) normative beliefs about aggression. Based on social-cognitive and cognitive neuroscience studies we argue that these three schemas affect five core social problem-solving skills: (1) interpretation, (2) clarification of goals, (3) generations of solutions, (4) evaluation of solutions, and (5) decision-making. In view of tailoring CBT to the individual child's characteristic schemas and associated social problem-solving skills, we suggest that children and adolescents participate in individual sessions with their parents. The therapist uses Socratic questioning in order to find out characteristic schemas of the child, encourage reflection on these schemas, and explore alternative schemas that had previously been outside the child's attention. The therapist functions as a model for parents to ask their child questions about the relevant schemas with a view of achieving changes in the schemas.

Executive functioning in antisocial behavior: A multi-level systematic meta-analysis

Neurobiological information - including executive functioning - is increasingly relevant for forensic clinical practice, as well as for the criminal justice system. Previous meta-analyses report that antisocial populations show impaired performance on executive functioning tasks, but these meta-analyses are outdated, have limitations in their methodological approach, and are therefore in need of an update. The current multi-level meta-analysis including 133 studies (2008-2023) confirms impaired performance in executive functioning (d=.42), but studies are heterogeneous. Several moderator analyses showed that neuropsychological test used, type of executive function component, and control group characteristics moderated the overall effect. Specifically, matching psychiatric problems in the non-antisocial control group eliminated any differences in executive functioning between groups. No moderation effects were found for assessment quality, hot or cold executive functions, and various population characteristics. These results could indicate that the assessment of executive functioning in antisocial populations may be less relevant for recidivism risk assessment than thought, although this should first be assessed in prospective longitudinal studies. Executive functioning could potentially be used to identify or screen for individuals with certain treatment needs or be used as a responsivity factor, especially in disorders which are often underdiagnosed in criminal justice settings.

Associations between disordered eating, internalizing symptoms, and behavioral and neural correlates of response inhibition in preadolescence

Response inhibition difficulties are reported in individuals with eating disorders (EDs), anxiety, and depression. Although ED symptoms and internalizing symptoms co-occur in preadolescence, there is limited research examining associations between these symptoms and response inhibition in this age group. This study is the first to investigate the associations between behavioral and neural markers of response inhibition, disordered eating (DE), and internalizing symptoms in a community sample of preadolescents. Forty-eight children (M age = 10.95 years, 56.3% male) completed a Go/NoGo task, whereas electroencephalography was recorded. Self-report measures of DE and internalizing symptoms were collected. Higher levels of anxiety and depression were associated with neural markers of suboptimal response inhibition (attenuated P3NoGo amplitudes) in preadolescence. In contrast, higher levels of depression were associated with greater response inhibition at a behavioral level. These findings suggest internalizing symptoms in preadolescence are associated with P3-indexed difficulties in evaluation and monitoring, but these are not sufficient to disrupt behavioral performance on a response inhibition task. This pattern may reflect engagement of compensatory processes to support task performance. DE was not significantly associated with response inhibition, suggesting that difficulties in response inhibition may only be reliably observed in more chronic and severe DE and ED presentations.

Neural correlates of automatic emotion regulation and their association with suicidal ideation in adolescents during the first 90-days of residential care

BACKGROUND

Suicide is the second leading cause of death for adolescents in the United States. However, relatively little is known about the forms of atypical neuro-cognitive function that are correlates of suicidal ideation (SI). One form of cognitive/affective function that, when dysfunctional, is associated with SI is emotion regulation. However, very little work has investigated the neural correlates of emotion dysregulation in adolescents with SI.

METHODS

Participants (N = 111 aged 12-18, 32 females, 31 [27.9%] reporting SI) were recruited shortly after their arrival at a residential care facility where they had been referred for behavioral and mental health problems. Daily reports of SI were collected during the participants' first 90-days in residential care. Participants were presented with a task-fMRI measure of emotion regulation - the Affective Number Stroop task shortly after recruitment. Participants were divided into two groups matched for age, sex and IQ based on whether they demonstrated SI.

RESULTS

Participants who demonstrated SI showed increased recruitment of regions including dorsomedial prefrontal cortex/supplemental motor area and parietal cortex during task (congruent and incongruent) relative to view trials in the context of emotional relative to neutral distracters.

CONCLUSIONS

Participants with SI showed increased recruitment of regions implicated in executive control during the performance of a task indexing automatic emotion regulation. Such data might suggest a relative inefficiency in the recruitment of these regions in individuals with SI.

Reduced recruitment of inhibitory control regions in very young children with ADHD during a modified Kiddie Continuous Performance Task: a fMRI study

Attention-Deficit/Hyperactivity Disorder (ADHD) symptom profiles are known to undergo changes throughout development, rendering the neurobiological assessment of ADHD challenging across different developmental stages. Particularly in young children (ages 4 to 7 years), measuring inhibitory control network activity in the brain has been a formidable task due to the lack of child-friendly functional Magnetic Resonance Imaging (fMRI) paradigms. This study aims to address these difficulties by focusing on measuring inhibitory control in very young children within the MRI environment. A total of 56 children diagnosed with ADHD and 78 typically developing (TD) 4-7-year-old children were examined using a modified version of the Kiddie-Continuous Performance Test (K-CPT) during BOLD fMRI to assess inhibitory control. We concurrently evaluated their performance on the established and standardized K-CPT outside the MRI scanner. Our findings suggest that the modified K-CPT effectively elicited robust and expected brain activity related to inhibitory control in both groups. Comparisons between the two groups revealed subtle differences in brain activity, primarily observed in regions associated with inhibitory control, such as the inferior frontal gyrus, anterior insula, dorsal striatum, medial pre-supplementary motor area (pre-SMA), and cingulate cortex. Notably, increased activity in the right anterior insula was associated with improved response time (RT) and reduced RT variability on the K-CPT administered outside the MRI environment, although this did not survive statistical correction for multiple comparisons. In conclusion, our study successfully overcame the challenges of measuring inhibitory control in very young children within the MRI environment by utilizing a modified K-CPT during BOLD fMRI. These findings shed light on the neurobiological correlates of inhibitory control in ADHD and TD children, provide valuable insights for understanding ADHD across development, and potentially inform ADHD diagnosis and intervention strategies. The research also highlights remaining challenges with task fMRI in very young clinical samples.

Reduced grey matter volume in adolescents with conduct disorder: a region-of-interest analysis using multivariate generalized linear modeling

BACKGROUND

Conduct disorder (CD) involves a group of behavioral and emotional problems that usually begins during childhood or adolescence. Structural brain alterations have been observed in CD, including the amygdala, insula, ventrolateral and medial prefrontal cortex, anterior cingulate cortex, and fusiform gyrus. The current study developed a multivariate generalized linear model (GLM) to differentiate adolescents with CD from typically developing (TD) adolescents in terms of grey matter volume (GMV).

METHODS

The whole-brain structural MRI data were collected from 96 adolescents with CD (mean age = [Formula: see text] years; mean IQ = [Formula: see text]; 63 males) and 90 TD individuals (mean age = [Formula: see text] years; mean IQ = [Formula: see text]; 59 males) matched on age, IQ, and sex. Region-wise GMV was extracted following whole-brain parcellation into 68 cortical and 14 subcortical regions for each participant. A multivariate GLM was developed to predict the GMV of the pre-hypothesized regions-of-interest (ROIs) based on CD diagnosis, with intracranial volume, age, sex, and IQ serving as the covariate.

RESULTS

A diagnosis of CD was a significant predictor for GMV in the right pars orbitalis, right insula, right superior temporal gyrus, left fusiform gyrus, and left amygdala (F(1, 180) = 5.460-10.317, p < 0.05, partial eta squared = 0.029-0.054). The CD participants had smaller GMV in these regions than the TD participants (MCD-MTD = [- 614.898] mm3-[- 53.461] mm3).

CONCLUSIONS

Altered GMV within specific regions may serve as a biomarker for the development of CD in adolescents. Clinical work can potentially target these biomarkers to treat adolescents with CD.

Reduced Grey Matter Volume in Adolescents with Conduct Disorder: A Region-of-Interest Analysis Using Multivariate Generalized Linear Modeling

Background

Conduct disorder (CD) involves a group of behavioral and emotional problems that usually begins during childhood or adolescence. Structural brain alterations have been observed in CD, including the amygdala, insula, ventrolateral and medial prefrontal cortex, anterior cingulate cortex, and fusiform gyrus. The current study developed a multivariate generalized linear model (GLM) to differentiate adolescents with CD from typically developing (TD) adolescents in terms of grey matter volume (GMV).

Methods

The whole-brain structural MRI data were collected from 96 adolescents with CD (mean age = years; mean IQ = ; 63 males) and 90 TD individuals (mean age = years; mean IQ = ; 59 males) matched on age, IQ, and sex. Region-wise GMV was extracted following whole-brain parcellation into 68 cortical and 14 subcortical regions for each participant. A multivariate GLM was developed to predict the GMV of the pre-hypothesized regions-of-interest (ROIs) based on CD diagnosis, with intracranial volume, age, sex, and IQ serving as the covariate.

Results

A diagnosis of CD was a significant predictor for GMV in the right pars orbitalis, right insula, right superior temporal gyrus, left fusiform gyrus, and left amygdala (F(1, 180) = 5.460 - 10.317, p < 0.05, partial eta squared = 0.029 - 0.054). The CD participants had smaller GMV in these regions than the TD participants (MCD - MTD = [-614.898] mm3 - [-53.461] mm3).

Conclusions

Altered GMV within specific regions may serve as a biomarker for the development of CD in adolescents. Clinical work can potentially target these biomarkers to treat adolescents with CD.

Association Between Aggression and Differential Functional Activity of Neural Regions Implicated in Retaliation

OBJECTIVE

The goal of the current study was to determine the extent to which atypical neural responsiveness during retaliation is associated with observed aggression in youth in residential care.

METHOD

This functional magnetic resonance imaging study involved 83 adolescents (56 male and 27 female; mean age, 16.18 years) in residential care performing a retaliation task. Of the 83 adolescents, 42 displayed aggressive behavior within the first 3 months of residential care, whereas 41 did not. During the retaliation task, participants were offered either fair or unfair divisions of $20 pots (allocation phase) and could either accept the offer or reject it, and, by spending $1, $2, or $3, punish the partner (retaliation phase).

RESULTS

The study's main findings were that aggressive adolescent showed the following: reduced down-regulation of activity within regions involved in representing the expected value of choice options (left ventromedial prefrontal cortex and left posterior cingulate cortex) as a function of offer unfairness and retaliation level; and reduced recruitment of regions implicated in response control (right inferior frontal gyrus and bilateral anterior insular cortex) and associated fronto-parietal regions as a function of retaliation level. The aggressive adolescents were also significantly more likely to have been aggressive prior to residential care and showed a strong trend for increased retaliation on the task.

CONCLUSION

We suggest that individuals with a greater propensity for aggression show reduced representation of the negative consequences of retaliation and associated reduced recruitment of regions potentially involved in over-ruling these negative consequences to engage in retaliation.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex balance in the selection of non-human subjects. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

More than a feeling? An expanded investigation of emotional responsiveness in young children with conduct problems and callous-unemotional traits

Children with conduct problems and high callous-unemotional (CP+CU) traits are characterized by dampened emotional responding, limiting their ability for affective empathy and impacting the development of prosocial behaviors. However, research documenting this dampening in young children is sparse and findings vary, with attachment-related stimuli hypothesized to ameliorate deficits in emotional responding. Here we test emotional responsiveness across various emotion-eliciting stimuli using multiple measures of emotional responsiveness (behavioral, physiological, self-reported) and attention, in young children aged 2-8 years (M age = 5.37), with CP+CU traits (CP+CU; n = 36), CPs and low CU traits (CP-CU; n = 82) and a community control sample (CC; n = 27). We found no evidence that attachment-related stimulus ameliorated deficits in emotional responding. Rather, at a group level we found a consistent pattern of reduced responding across all independent measures of responsiveness for children with CP+CU compared to the CC group. Few differences were found between CP+CU and CP-CU groups. When independent measures were standardized and included in a regression model predicting to CU trait score, higher CU traits were associated with reduced emotional responding, demonstrating the importance of multimodal measurement of emotional responsiveness when investigating the impact of CU traits in young children.

Psychopharmacological treatment of disruptive behavior in youths: systematic review and network meta-analysis

To conduct a systematic review of the comparative efficacy of various psychotropic medications for the treatment of disruptive behavior (DBs) in youths. To this aim, we systematically reviewed randomized clinical trials (RCTs) of various psychotropic medications targeting symptoms of DBs and applied network meta-analysis to investigate their relative efficacy. Fifty-five RCTs meeting the inclusion criteria were selected. To predict and interpret relative treatment efficacy, we compared the efficacy of various psychotropic medications prescribed for DB symptoms based on their mechanism of action. Network meta-analysis revealed that for reducing DBs, second-generation antipsychotics, stimulants, and non-stimulant ADHD medications were more efficacious than placebo, and second-generation antipsychotics were the most efficacious. The dopaminergic modulation of top-down inhibitory process by these medications is discussed in this review. This study offers information on the relative efficacy of various psychotropic medications for the treatment of DB, and insight into a potential neurobiological underpinning for those symptoms. It also illustrates the potential utility of these neurobiological mechanisms as a target for future treatment studies.

Dysfunction in differential reward-punishment responsiveness in conduct disorder relates to severity of callous-unemotional traits but not irritability

BACKGROUND

Conduct disorder (CD) has been associated with dysfunction in reinforcement-based decision-making. Two forms of affective traits that reflect the components of CD severity are callous-unemotional (CU; reduced guilt/empathy) traits and irritability. The form of the reinforcement-based decision-making dysfunction with respect to CD and CU traits remains debated and has not been examined with respect to irritability in cases with CD. The goals of the current study were to determine the extent of dysfunction in differential (reward v. punishment) responsiveness in CD, and CU traits and irritability in participants with CD.

METHODS

The study involved 178 adolescents [typically developing (TD; N = 77) and cases with CD (N = 101)]. Participants were scanned with fMRI during a passive avoidance task that required participants to learn to respond to (i.e. approach) stimuli that engender reward and refrain from responding to (i.e. passively avoid) stimuli that engender punishment.

RESULTS

Adolescents with CD showed reduced differential reward-punishment responsiveness within the striatum relative to TD adolescents. CU traits, but not irritability, were associated with reduced differential reward-punishment responsiveness within the striatum, rostromedial, and lateral frontal cortices.

CONCLUSIONS

The results suggest CD is associated with reduced differential reward-punishment responsiveness and the extent of this dysfunction in participants with CD is associated with the severity of CU traits but not irritability.

Emotion processing in youths with conduct problems: an fMRI meta-analysis

Functional magnetic resonance imaging (fMRI) studies consistently indicate differences in emotion processing in youth with conduct problems. However, no prior meta-analysis has investigated emotion-specific responses associated with conduct problems. This meta-analysis aimed to generate an up-to-date assessment of socio-affective neural responding among youths with conduct problems. A systematic literature search was conducted in youths (ages 10-21) with conduct problems. Task-specific seed-based d mapping analyses examined responses to threatening images, fearful and angry facial expressions, and empathic pain stimuli from 23 fMRI studies, which included 606 youths with conduct problems and 459 comparison youths. Whole-brain analyses revealed youths with conduct problems relative to typically developing youths, when viewing angry facial expressions, had reduced activity in left supplementary motor area and superior frontal gyrus. Additional region of interest analyses of responses to negative images and fearful facial expressions showed reduced activation in right amygdala across youths with conduct problems. Youths with callous-unemotional traits also exhibited reduced activation in left fusiform gyrus, superior parietal gyrus, and middle temporal gyrus when viewing fearful facial expressions. Consistent with the behavioral profile of conduct problems, these findings suggest the most consistent dysfunction is found in regions associated with empathic responding and social learning, including the amygdala and temporal cortex. Youth with callous-unemotional traits also show reduced activation in the fusiform gyrus, consistent with reduced attention or facial processing. These findings highlight the potential role of empathic responding, social learning, and facial processing along with the associated brain regions as potential targets for interventions.

Dissociation of behavioral and neural responses to provocation during reactive aggression in healthy adults with high versus low externalization

The externalizing spectrum describes a range of heterogeneous personality traits and behavioral patterns, primarily characterized by antisocial behavior, disinhibition, and substance (mis)use. In psychopathology, abnormalities in neural threat, reward responses and the impulse-control system may be responsible for these externalizing symptoms. Within the non-clinical range, mechanisms remain still unclear. In this fMRI-study, 61 healthy participants (31 men) from the higher versus lower range of the non-clinical variation in externalization (31 participants with high externalization) as assessed by the subscales disinhibition and meanness of the Triarchic-Psychopathy-Measure (TriPM) performed a monetary modified Taylor-Aggression-Paradigm (mTAP). This paradigm consisted of a mock competitive-reaction-time-task played against a fictional opponent with preprogrammed win- and lose-trials. In lose-trials, participants were provoked by subtraction of an amount of money between 0 and 90 cents. As a manipulation check, provocation induced a significant rise in behavioral aggression levels linked with an increased activation in the anterior cingulate cortex (ACC). High externalization predicted reduced ACC responses to provocation. However, high externalizing participants did not behave more aggressively than the low externalization group. Additionally, the high externalizing group showed a significantly lower positive affect while no group differences emerged for negative affect. In conclusion, high externalization in the non-clinical range was related to neural alterations in regions involved in affective decision-making as well as to changes in affect but did not lead to higher behavioral aggression levels in response to the mTAP. This is in line with previous findings suggesting that aberrations at multiple levels are essential for developing externalizing disorders.

How reliable are amygdala findings in psychopathy? A systematic review of MRI studies

The amygdala is a key component in predominant neural circuitry models of psychopathy. Yet, after two decades of neuroimaging research on psychopathy, the reproducibility of amygdala findings is questionable. We systematically reviewed MRI studies (81 of adults, 53 of juveniles) to determine the consistency of amygdala findings across studies, as well as within specific types of experimental tasks, community versus forensic populations, and the lowest- versus highest-powered studies. Three primary findings emerged. First, the majority of studies found null relationships between psychopathy and amygdala structure and function, even in the context of theoretically relevant tasks. Second, findings of reduced amygdala activity were more common in studies with low compared to high statistical power. Third, the majority of peak coordinates of reduced amygdala activity did not fall primarily within the anatomical bounds of the amygdala. Collectively, these findings demonstrate significant gaps in the empirical support for the theorized role of the amygdala in psychopathy and indicate the need for novel research perspectives and approaches in this field.

Orbitofrontal control of conduct problems? Evidence from healthy adolescents processing negative facial affect

Conduct problems (CP) in patients with disruptive behavior disorders have been linked to impaired prefrontal processing of negative facial affect compared to controls. However, it is unknown whether associations with prefrontal activity during affective face processing hold along the CP dimension in a healthy population sample, and how subcortical processing is affected. We measured functional brain responses during negative affective face processing in 1444 healthy adolescents [M = 14.39 years (SD = 0.40), 51.5% female] from the European IMAGEN multicenter study. To determine the effects of CP, we applied a two-step approach: (a) testing matched subgroups of low versus high CP, extending into the clinical range [N = 182 per group, M = 14.44 years, (SD = 0.41), 47.3% female] using analysis of variance, and (b) considering (non)linear effects along the CP dimension in the full sample and in the high CP group using multiple regression. We observed no significant cortical or subcortical effect of CP group on brain responses to negative facial affect. In the full sample, regression analyses revealed a significant linear increase of left orbitofrontal cortex (OFC) activity with increasing CP up to the clinical range. In the high CP group, a significant inverted u-shaped effect indicated that left OFC responses decreased again in individuals with high CP. Left OFC activity during negative affective processing which is increasing with CP and decreasing in the highest CP range may reflect on the importance of frontal control mechanisms that counteract the consequences of severe CP by facilitating higher social engagement and better evaluation of social content in adolescents.

Neuroanatomical changes associated with conduct disorder in boys: influence of childhood maltreatment

Childhood maltreatment (CM) poses a serious risk to the physical, emotional and psychological well-being of children, and can advance the development of maladaptive behaviors, including conduct disorder (CD). CD involves repetitive, persistent violations of others' basic rights and societal norms. Little is known about whether and how CM influences the neural mechanisms underlying CD, and CD-characteristic neuroanatomical changes have not yet been defined in a structural magnetic resonance imaging (sMRI) study. Here, we used voxel-based morphometry (VBM) and surface-based morphometry (SBM) to investigate the influence of the CD diagnosis and CM on the brain in 96 boys diagnosed with CD (62 with CM) and 86 typically developing (TD) boys (46 with CM). The participants were 12-17 years of age. Compared to the CM- CD group, the CM+ CD group had structural gray matter (GM) alterations in the fronto-limbic regions, including the left amygdala, right posterior cingulate cortex (PCC), right putamen, right dorsolateral prefrontal cortex (dlPFC) and right anterior cingulate cortex (ACC). We also found boys with CD exhibited increased GM volume in bilateral dorsomedial prefrontal cortex (dmPFC), as well as decreased GM volume and decreased gyrification in the left superior temporal gyrus (STG) relative to TD boys. Regional GM volume correlated with aggression and conduct problem severity in the CD group, suggesting that the GM changes may contribute to increased aggression and conduct problems in boys with CD who have suffered CM. In conclusion, these results demonstrate previously unreported CM-associated distinct brain structural changes among CD-diagnosed boys.

Sensitization-based risk for substance abuse in vulnerable individuals with ADHD: Review and re-examination of evidence

Evidence of sensitization following stimulants administration in humans is just emerging, which prevents reaching more definitive conclusions in favor or against a purported protective role of stimulant treatments for ADHD for the development of substance use disorders. Existing evidence from both animal and human research suggest that stimulants produce neurophysiological changes in the brain reward system, some of which could be persistent. This could be relevant in choosing optimal treatments for young patients with ADHD who have additional clinical risk factors for substance abuse (e.g. conduct disorder (CD) and/or familial addictions). Here we stipulate that, while the majority of youth with ADHD greatly benefit from treatments with stimulants, there might be a subpopulation of individuals whose neurobiological profiles may confer risk for heightened vulnerability to the effects of stimulants on the responsiveness of the brain reward system. We propose that focused human research is needed to elucidate the unknown effects of prolonged stimulant exposure on the neurophysiology of the brain reward system in young patients with ADHD.

Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy

In cognitive behavioral therapy (CBT) children and adolescents with conduct problems learn social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Empirical studies on psychological functions show that the effectiveness of CBT may be further improved by putting more emphasis on (1) recognition of the type of social situations that are problematic, (2) recognition of facial expressions in view of initiating social problem-solving, (3) effortful emotion regulation and emotion awareness, (4) behavioral inhibition and working memory, (5) interpretation of the social problem, (6) affective empathy, (7) generation of appropriate solutions, (8) outcome expectations and moral beliefs, and (9) decision-making. To improve effectiveness, CBT could be tailored to the individual child's or adolescent's impairments of these psychological functions which may depend on the type of conduct problems and their associated problems.

Common functional brain networks between attention deficit and disruptive behaviors in youth

Attention deficits (AD) and disruptive behavior (DB) are highly comorbid youth externalizing behaviors. This study aimed to study reliable functional brain networks shared by AD and DB in youth aged from 8 to 21 years from the Philadelphia Neurodevelopmental Cohort (PNC). The PNC study assessed AD and DB behaviors via Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS). This study employed sparse canonical correlation analysis (SCCA) to examine the correlation of AD and DB behaviors with resting-state functional connectivity maps of the brain regions identified via activation likelihood estimation (ALE) meta-analyses on attention deficit/hyperactivity disorder (ADHD) and DB disorder (DBD). Our meta-analyses identified that the middle cingulate cortex, pre-supplementary motor area (pre-SMA), and striatum had a great consensus in existing ADHD studies and the amygdala and inferior parietal lobule were consistently found in existing DBD studies. Our SCCA analysis revealed that the AD and DB behavioral items relevant to inattention and delinquency were correlated with the functional connectivity of the pre-SMA with the ventral attentional and frontoparietal networks (FPN), and the striatum with the default mode (DMN) and dorsal attentional networks. The AD and DB behavioral items relevant to inattention and irritability were associated with the functional connectivity between the amygdala and the DMN and FPN. Our findings suggest that the functional organization of the ADHD- and DBD-related brain regions provides insights on the shared neural basis in AD and DB.

Interaction of irritability and anxiety on emotional responding and emotion regulation: a functional MRI study

BACKGROUND

Irritability and anxiety frequently co-occur in pediatric populations. Studies separately looking at the neural correlates of these symptoms have identified engagement of similar neural systems - particularly those implicated in emotional processing. Both irritability and anxiety can be considered negative valence emotional states that might relate to emotion dysregulation. However, previous work has not examined the neural responding during the performance of an emotion regulation task as a function of interaction between irritability and anxiety simultaneously.

METHODS

This fMRI study involved 155 participants (90 with significant psychopathologies and 92 male) who performed the Affective Stroop Task, designed to engage emotion regulation as a function of task demands. The Affective Reactivity Index (ARI) was used to index irritability and the Screen for Child Anxiety Related Emotional Disorders (SCARED) was used to index anxiety.

RESULTS

Levels of irritability, but not anxiety, was positively correlated with responses to visual images within the right rostro-medial prefrontal cortex and left anterior cingulate cortex during view trials. The second region of ventral anterior cingulate cortex showed a condition-by-emotion-by-ARI score-by-SCARED score interaction. Specifically, anxiety level was significantly correlated with a decreased differential BOLD response to negative relative to neutral view trials but only in the presence of relatively high irritability.

CONCLUSIONS

Atypical maintenance of emotional stimuli within the rostro-medial prefrontal cortex may exacerbate the difficulties faced by adolescents with irritability. Moreover, increased anxiety combined with significant irritability may disrupt an automatic emotional conflict-based form of emotion regulation that is particularly associated with the ventral anterior cingulate cortex.

Conduct problems among children in low-income, urban neighborhoods: A developmental psychopathology- and RDoC-informed approach

Conduct problems are associated with numerous negative long-term psychosocial sequelae and are among the most frequent referrals for children's mental health services. Youth residing in low-income, urban communities are at increased risk for conduct problems, but not all youth in these environments develop conduct problems, suggesting heterogeneity in risk and resilience processes and developmental pathways. The present study used a developmental psychopathology- and Research Domain Criteria (RDoC)-informed approach for conceptualizing risk and resilience for conduct problems among children from low-income, urban neighborhoods. Participants were 104 children (M = 9.93 ± 1.22 years; 50% male; 96% African American, 4% Latinx). We assessed four constructs reflecting cognitive and neurobiological processes associated with conduct problems using multiple levels of analysis and informants: autonomic nervous system reactivity, limbic system/orbitofrontal cortical functioning, dorsolateral prefrontal cortical functioning, and conduct problems. Latent profile analysis identified four profiles: typically developing (TD, n = 34); teacher-reported conduct problems (TCP, n = 14); emotion processing (EP, n = 27); and emotion expression recognition (EER, n = 29). External validation analyses demonstrated that profiles differed on various indices of conduct problems in expected ways. The EP profile exhibited lower levels of emotional lability and callous–unemotional behaviors, and higher levels of prosocial behavior. The TD profile demonstrated elevated emotional lability. Implications for etiological and intervention models are presented.

Resting-state EEG Connectivity in Young Children with ADHD

Objective: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent and impairing neurodevelopmental disorder. While early childhood is a crucial time for early intervention, it is characterized by instability of ADHD diagnosis. Neural correlates of ADHD have potential to improve diagnostic accuracy; however, minimal research has focused on early childhood. Research indicates that disrupted neural connectivity is associated with ADHD in older children. Here, we explore network connectivity as a potential neural correlate of ADHD diagnosis in early childhood.Method: We collected EEG data in 52 medication-naïve children with ADHD and in 77 typically developing controls (3-7 years). Data was collected with the EGI 128 HydroCel Sensor Net System, but to optimize the ICA, the data was down sampled to the 10-10 system. Connectivity was measured as the synchronization of the time series of each pair of electrodes. Subsequent analyses utilized graph theoretical methods to further characterize network connectivity.Results: Increased global efficiency, which measures the efficiency of information transfer across the entire brain, was associated with increased inattentive symptom severity. Further, this association was robust to controls for age, IQ, SES, and internalizing psychopathology.Conclusions: Overall, our findings indicate that increased global efficiency, which suggests a hyper-connected neural network, is associated with elevated ADHD symptom severity. These findings extend previous work reporting disruption of neural network connectivity in older children with ADHD into early childhood.

Neural Responses to Fluoxetine in Youths with Disruptive Behavior and Trauma Exposure: A Pilot Study

Objective: A preliminary investigation of the impact of a serotonergic agent (fluoxetine) on symptom profile and neural response in youths with disruptive behavior disorders (DBDs) and a history of trauma exposure. Methods: There were three participant groups: (i) Youths with DBDs and trauma exposure who received fluoxetine treatment for 8 weeks (n = 11); (ii) A matched group of youths with DBDs and trauma exposure who received routine regular follow-up in an outpatient clinic (n = 10); and (iii) Typically developing youths (n = 18). All participants conducted an expression processing functional magnetic resonance imaging task twice, 8 weeks apart: (pretreatment and post-treatment for youths with DBDs). Results: Youths with DBDs and trauma exposure who received fluoxetine treatment compared to the other two groups showed: (i) significant improvement in externalizing, oppositional defiant disorder, irritability, anxiety-depression, and trauma-related symptoms; (ii) as a function of fearful expression intensity, significantly decreased amygdala response and increased recruitment of regions implicated in top-down attention control (insula cortex, inferior parietal lobule, and postcentral gyrus) and emotional regulation (ventromedial prefrontal cortex [vmPFC]); and (iii) correlation between DBD/irritability symptom improvement and increased activation of top-down attention control areas (inferior parietal lobule, insula cortex, and postcentral gyrus) and an emotion regulation area (vmPFC). Conclusions: This study provides preliminary evidence that a serotonergic agent (fluoxetine) can reduce disruptive behavior and mood symptoms in youths with DBDs and trauma exposure and that this may be mediated by enhanced activation of top-down attention control and emotion regulation areas (inferior parietal lobule, insula cortex, and vmPFC).

Reduced neural responsiveness to looming stimuli is associated with increased aggression

While neuro-cognitive work examining aggression has examined patients with conditions at increased risk for aggression or individuals self-reporting past aggression, little work has attempted to identify neuro-cognitive markers associated with observed/recorded aggression. The goal of the current study was to determine the extent to which aggression by youth in the first three months of residential care was associated with atypical responsiveness to threat stimuli. This functional MRI study involved 98 (68 male; mean age = 15.96 [sd = 1.52]) adolescents in residential care performing a looming threat task involving images of threatening and neutral human faces or animals that appeared to be either loom or recede. Level of aggression was negatively associated with responding to looming stimuli (irrespective of whether these were threatening or neutral) within regions including bilateral inferior frontal gyrus, right inferior parietal lobule, right superior/middle temporal gyrus and a region of right uncus proximal to the amygdala. These data indicate that aggression level is associated with a decrease in responsiveness to a basic threat cue-looming stimuli. Reduced threat responsiveness likely results in the individual being less able to represent the negative consequences that may result from engaging in aggression, thereby increasing the risk for aggressive episodes.

Alcohol and Cannabis Use Disorder Symptom Severity, Conduct Disorder, and Callous-Unemotional Traits and Impairment in Expression Recognition

Background: Alcohol and cannabis are commonly used by adolescents in the United States. Both alcohol use disorder (AUD) and cannabis use disorder (CUD) have been associated with reduced emotion expression recognition ability. However, this work has primarily occurred in adults and has not considered neuro-cognitive risk factors associated with conduct problems that commonly co-occur with, and precede, substance use. Yet, conduct problems are also associated with reduced emotion expression recognition ability. The current study investigated the extent of negative association between AUD and CUD symptom severity and expression recognition ability over and above any association of expression recognition ability with conduct problems [conduct disorder (CD) diagnostic status]. Methods: In this study, 152 youths aged 12.5-18 years (56 female; 60 diagnosed with CD) completed a rapid presentation morphed intensity facial expression task to investigate the association between relative severity of AUD/CUD and expression recognition ability. Results: Cannabis use disorder identification test (CUDIT) scores were negatively associated with recognition accuracy for higher intensity (particularly sad and fearful) expressions while CD diagnostic status was independently negatively associated with recognition of sad expressions. Alcohol use disorder identification test (AUDIT) scores were not significantly associated with expression recognition ability. Conclusions: These data indicate that relative severity of CUD and CD diagnostic status are statistically independently associated with reduced expression recognition ability. On the basis of these data, we speculate that increased cannabis use during adolescence may exacerbate a neuro-cognitive risk factor for the emergence of aggression and antisocial behavior.

Modulation of Amygdala Response by Cognitive Conflict in Adolescents with Conduct Problems and Varying Levels of CU Traits

Adolescents with conduct problems and low callous-unemotional traits are characterised by high levels of reactive aggression. Prior studies suggest that they can have exaggerated neural and behavioural responses to negative emotional stimuli, accompanied by compromised affect regulation and atypical engagement of prefrontal areas during cognitive control. This pattern may in part explain their symptoms. Clarifying how neurocognitive responses to negative emotional stimuli can be modulated in this group has potential translational relevance. We present fMRI data from a cognitive conflict task in which the requirement to visually scan emotional (vs. calm) faces was held constant across low and high levels of cognitive conflict. Participants were 17 adolescent males with conduct problems and low levels of callous-unemotional traits (CP/LCU); 17 adolescents with conduct problems and high levels of callous-unemotional traits (CP/HCU, who typically show blunted reactivity to fear), and 18 typically developing controls (age range 10-16). Control participants showed typical attenuation of amygdala response to fear relative to calm faces under high (relative to low) conflict, replicating previous findings in a healthy adult sample. In contrast, children with CP/LCU showed a reduced (left amygdala) or reversed (right amygdala) attenuation effect under high cognitive conflict conditions. Children with CP/HCU did not differ from controls. Findings suggest atypical modulation of amygdala response as a function of task demands, and raise the possibility that those with CP/LCU are unable to implement typical regulation of amygdala response when cognitive task demands are high.

Cognitive control and emotional response in attention-deficit/ hyperactivity disorder comorbidity with disruptive, impulse-control, and conduct disorders

BACKGROUND

This study investigated cognitive and emotional functioning in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and disruptive, impulse-control, and conduct disorders (DICCD).

METHODS

Thirty patients with ADHD, 26 with DICCD, 22 with ADHD+DICCD were recruited from the outpatient department of Shanghai Changning Mental Health Center, plus 20 healthy controls (HC). Differences between the groups in cognitive and emotional functioning were examined using Golden's Stroop and Emotional Stroop tests. For Emotional Stroop Mean reaction time (RT) of positive word (POS) and negative word (NEG) with color congruence (C) or incongruence (I) were recorded as POS-C, POS-I, NEG-C and NEG-I, respectively.

RESULTS

For Golden's interference scores (IGs), both errors and RTs in the ADHD group were higher than in the other groups. Longer mean RTs of POS-C, POS-I, NEG-C and neural word (NEU) of the ADHD group, and NEG-I of ADHD+DICCD and DICCD groups were observed compared to HC. After 12 weeks of methylphenidate treatment, differences between ADHD subgroups and HC on Golden's Stroop RT disappeared, but differences in Golden's Stroop errors and Emotional Stroop mean RTs remained. The ADHD+DICCD group showed longer mean RTs in NEG-C, NEG-I and NEU of the Emotional Stroop test than the ADHD group.

CONCLUSIONS

Our study shows that regardless of emotional responding, deficit in cognitive control is the core symptom of ADHD. However, emotionally biased stimuli may cause response inhibitory dysfunction among DICCD with callous-unemotional traits, and the comorbidity of ADHD and DICCD tends to account for the negative emotional response characteristic of DICCD. These deficits may be eliminated by medication treatment in ADHD, but not the ADHD with comorbid DICCD. Our results support the notion that ADHD with comorbid DICCD is more closely related to DICCD than to ADHD.

Increasing Effectiveness of Cognitive Behavioral Therapy for Conduct Problems in Children and Adolescents: What Can We Learn from Neuroimaging Studies?

Cognitive behavioral therapy (CBT) is particularly relevant for children from 7 years on and adolescents with clinical levels of conduct problems. CBT provides these children and adolescents with anger regulation and social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Typically, CBT is combined with another psychological treatment such as behavioral parent training in childhood or an intervention targeting multiple systems in adolescence. The effectiveness of CBT, however, is in the small to medium range. The aim of this review is to describe how the effectiveness of CBT may be improved by paying more attention to a series of psychological functions that have been shown to be impaired in neuroimaging studies: (1) anger recognition, (2) the ability to generate situation appropriate solutions to social problems, (3) reinforcement-based decision making, (4) response inhibition, and (5) affective empathy. It is suggested that children and adolescents first become familiar with these psychological functions during group CBT sessions. In individual sessions in which the parents (and/or child care workers in day treatment and residential treatment) and the child or adolescent participate, parents then learn to elicit, support, and reinforce their child’s use of these psychological functions in everyday life (in vivo practice). In these individual sessions, working on the psychological functions is tailored to the individual child’s characteristic impairments of these functions. CBT therapists may also share crucial social-learning topics with teachers with a view to creating learning opportunities for children and adolescents at school.

Neural processing of socioemotional content in conduct-disordered juvenile offenders with limited prosocial emotions

BACKGROUND

Reflecting evidence on Callous-Unemotional (CU) traits (e.g., lack of empathy and guilt, shallow affect), the DSM-5 added a categorical CU-based specifier for Conduct Disorder (CD), labeled 'with Limited Prosocial Emotions' (LPE). Theory and prior work suggest that CD youths with and without LPE will likely differ in neural processing of negative socioemotional content. This proposition, however, is mainly derived from studies employing related, yet distinct, operationalizations of CU traits (e.g., dimensional measure/median split/top quartile), thus precluding direct examination of LPE-specific neurocognitive deficits.

METHODS

Employing a DSM-5 informed LPE proxy, neural processing of recognizing and resonating negative socioemotional content (angry and fearful faces) was therefore examined here among CD offenders with LPE (CD/LPE+; N = 19), relative to CD offenders without LPE (CD/LPE-; N = 31) and healthy controls (HC; N = 31).

RESULTS

Relative to HC and CD/LPE- youths and according to a linearly increasing trend (CD/LPE- < HC < CD/LPE+), CD/LPE+ youths exhibited hyperactivity within dorsolateral, dorsomedial, and ventromedial prefrontal regions during both emotion recognition and resonance. During emotion resonance, CD/LPE+ youths additionally showed increased activity within the posterior cingulate and precuneal cortices in comparison to HC and CD/LPE- youths, which again followed a linearly increasing trend (CD/LPE- < HC < CD/LPE+). These effects moreover seemed specific to the LPE specifier, when compared to a commonly employed method for CU-based grouping in CD (i.e., median split on CU scores).

CONCLUSIONS

These data cautiously suggest that CD/LPE+ youths may exhibit an over-reliance on cortical neurocognitive systems when explicitly processing negative socioemotional information, which could have adverse downstream effects on relevant socioemotional functions. The findings thus seem to provide novel, yet preliminary, clues on the neurocognitive profile of CD/LPE+, and additionally highlight the potential scientific utility of the LPE specifier.

Reduced top-down attentional control in adolescents with generalized anxiety disorder

BACKGROUND

Generalized anxiety disorder (GAD) can significantly impair quality of life and is associated with a relatively poor long-term prognosis. Anxiety disorders are often associated with hyper-responsiveness to threat, perhaps coupled with impaired executive functioning. However, GAD, particularly adolescent GAD, has been the focus of little functional neuroimaging work compared to other anxiety disorders. Here, we examine the neural association of adolescent GAD with responsiveness to threat and response control.

METHODS

The study involved 35 adolescents with GAD and 34 healthy comparison individuals (N = 69) matched on age, gender, and IQ. Participants were scanned during an affective number Stroop task.

RESULTS

We found significant Group-by-Task Condition interactions in regions involved in response control/motor responding (bilateral precentral gyri and cerebellum) and/or cognitive control/attention (dorsomedial and lateral frontal cortex, posterior cingulate cortex, cuneus, and precuneus). In line with predictions, the youth with GAD showed significantly less recruitment during task trials than the healthy comparison individuals. However, no indications of specific heightened responses to threat were seen.

CONCLUSIONS

GAD involves reduced capacity for engaging regions involved in response control/motor responding and/or cognitive control/attention. This might reflect either a secondary consequence of the patient's worry or an early risk factor for the development of worry.

Callous-Unemotional Traits Moderate the Relationship Between Irritability and Threatening Responding

Background: Irritability and callous-unemotional (CU; reduced guilt/empathy) traits vary dimensionally in the typically developing population but may be particularly marked in youth with conduct disorder (CD). While these dimensional traits are positively correlated, they have been associated with divergent forms of dysfunction, particularly with respect to threat processing (i.e., irritability with increased, and CU traits with decreased, threat responsiveness). This suggests that interactions between these two dimensions may be complex at the neurobiological level. However, this issue has received minimal empirical attention. Methods: The study included 105 adolescents (typically developing and cases with CD; N = 59). They were scanned with fMRI during a looming threat task that involved images of threatening and neutral human faces or animals that appeared to be either looming or receding. Results: Significant irritability-by-CU traits-by-Direction-by-Emotion interactions were seen within right thalamus/PAG, left lingual gyrus and right fusiform gyrus; irritability was positively associated with the BOLD response for Looming Threatening vs. Receding Threatening trials, particularly for youth with low CU traits. In contrast, CU traits were negatively associated with the same differential BOLD response but particularly for youth showing higher levels of irritability. Similar findings were seen within left ventral anterior and posterior cingulate cortices, though the addition of the interaction with CU traits was only seen at slightly more lenient thresholds. Conclusions: The results support previous work linking irritability to increased, and CU traits to reduced, threat responsiveness. However, for adolescents with high irritability, if CU traits are also high, the underlying neuropathology appears to relate to reduced, rather than increased, threat responsiveness.

Alcohol Use Disorder and Cannabis Use Disorder Symptomatology in Adolescents and Aggression: Associations With Recruitment of Neural Regions Implicated in Retaliation

BACKGROUND

Alcohol and cannabis are commonly used by adolescents in the United States. Both alcohol use disorder (AUD) and cannabis use disorder (CUD) have been associated with an increased risk of aggression. One form of aggression seen during retaliation is reactive aggression to social provocation. This study investigated the association between AUD and CUD symptom severity and recruitment of neural regions implicated in retaliation.

METHODS

In this study, 102 youths aged 13-18 years (67 male; 84 in residential care) completed self-report measures of aggression-related constructs and participated in a retaliation task during functional magnetic resonance imaging to investigate the association between relative severity of AUD/CUD and atypical recruitment of regions implicated in retaliation.

RESULTS

AUD Identification Test scores were positively associated with irritability and reactive aggression scores. CUD Identification Test scores were positively associated with callous-unemotional traits and both proactive and reactive aggression scores. In functional magnetic resonance imaging analyses, only AUD Identification Test (not CUD Identification Test) scores were associated with an exaggerated recruitment of regions implicated in retaliation (dorsomedial frontal, anterior insula cortices, caudate, and, to a lesser extent, periaqueductal gray).

CONCLUSIONS

These data suggest that relative severity of AUD is associated with a disinhibited, exaggerated retaliation response that relates to an increased risk for reactive aggression. Similar findings were not related to severity of CUD.

Neurofunctional abnormalities in antisocial spectrum: A meta-analysis of fMRI studies on Five distinct neurocognitive research domains

Past functional magnetic resonance imaging on antisocial subjects have shown important inconsistencies and methodological problems (e.g. heterogeneity in fMRI tasks domain, small sample sizes, analyses on regions-of-interest). We aimed to conduct a meta-analysis of whole-brain fMRI studies on antisocial individuals based on distinct neurocognitive domains. A voxel-based meta-analysis via permutation of subject images (SDM-PSI) was performed on studies using fMRI tasks in the domains of acute threat response, cognitive control, social cognition, punishment and reward processing. Overall, 83 studies were retrieved. Using a liberal statistical threshold, several key regions were identified in the meta-analysis, principally during acute threat response, social cognition and cognitive control tasks. Additionally, we observed that the right amygdala was negatively associated with both callous-unemotional traits and severity of antisocial behaviors, in meta-analyses on region-of-interest and on dimensional studies, respectively. The findings show that the most prominent functional brain deficits arise during acute threat response, social cognitions and cognitive control neurocognitive domains. These results provide substantial insights for our understanding of aberrant neural processing across specific contexts.

Relations between Reactive and Proactive Aggression and Daily Emotions in Adolescents

The current study examined whether individual differences in reactive and proactive aggression: 1) relate to level of daily emotion, including happiness, sadness, anger, and fear, 2) predict across-day variability in these emotions, and 3) moderate reactivity of these emotions to positive and negative events. Participants were a racially/ethnically diverse sample of 144 adolescents (80 girls, 64 boys; M age = 13.55 years; SD = 1.34). Adolescents self-reported on reactive and proactive aggression in a home visit prior to the collection of daily data. Using daily dairy procedures, adolescents then reported on their daily emotions and positive/negative events over 12 consecutive days. Higher reactive aggression was associated with greater levels of daily anger, more variability in anger across days, and heightened angry reactivity to negative events. Additionally, higher reactive aggression predicted lower levels of daily happiness but greater happy reactivity to positive events. Finally, higher reactive aggression was linked to increased variability in daily fear. In contrast, proactive aggression was largely unrelated to adolescents' daily emotions, with the exception that higher proactive aggression predicted less variability in happiness across days. Results indicate that reactive aggression is characterized by significant emotionality at the daily level, and proactive aggression is characterized by lack of emotionality.

Inhibitory Control Deficits in Children with Oppositional Defiant Disorder and Conduct Disorder Compared to Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis

Inhibitory control deficits are known to be characteristic of Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and Attention-Deficit/Hyperactivity Disorder (ADHD); but it is unclear whether children with ODD/CD have inhibitory control problems independent of ADHD comorbidity. Previous reviews of inhibitory control and ODD/CD have only focused on one type of measure of inhibitory control or used non-clinical samples. The current meta-analysis explored inhibitory control problems of children with ODD/CD by systematically reviewing studies where children have a diagnosis of ODD and/or CD. Comparisons were made across 25 studies between children with ODD/CD, ODD/CD + ADHD, ADHD, and healthy controls (HC) on various measures of inhibitory control and ADHD symptomatology to explore impacts of ADHD comorbidity. A small significant effect (g = -0.58, p < .001) suggested children with ODD/CD are likely to have more difficulties with inhibitory control than healthy children. However, comparisons between clinical groups suggested this effect may be due to ADHD symptomatology present in each group. As difficulties with inhibitory control are similar, across clinical groups, a dimensional approach to understanding ODD/CD and ADHD may be more useful to consider in future diagnostic criteria. Similarities across clinical groups highlight that therapeutic approaches that assist children with disruptive behaviours could benefit from teaching children and their families how to cope with inhibitory control deficits.

Effectiveness of Stimulant Medications on Disruptive Behavior and Mood Problems in Young Children

Objective

There are very few studies on the effectiveness of stimulant medications for the treatment of disruptive mood and behavior problems in young children (less than 7 years) with Disruptive Behavior Disorders (DBD). The current study aims to determine whether young children (ages 4−7) in a long-term, intensive outpatient behavioral treatment program who are receiving stimulant medications show greater improvement in mood and behavior problems compared to peers who did not.

Methods

A retrospective chart review was conducted for 97 participants diagnosed with DBD, aged 4−7 years old who were enrolled in an intensive outpatient behavioral intervention program. Pre- and post-intervention Child Behavior Checklist (CBCL) scores for disruptive behavior and mood problems were compared between the children who received stimulant medications and those who did not.

Results

Paired t tests showed a statistically significant improvement in CBCL outcomes between pre- and post-intervention scores of disruptive behavior and mood problems. ANCOVA analysis, however, showed no clear further improvement in those same CBCL scores in the participants who received stimulant medications compared to the participants who did not. CBCL scores for Conduct Disorder were marginally significant for less improvement for the participants who received stimulant medications.

Conclusion

This retrospective review suggests a possibility that stimulant medications may not provide additional benefit for the long-term treatment of disruptive behavior and mood problems in young children under age 7. Future study is warranted to evaluate the efficacy/effectiveness of stimulant medications in the treatment of disruptive behavior and mood problems in this population.

Trait impulsivity and callous-unemotional traits as predictors of inhibitory control and risky choices among high-risk adolescents

Trait impulsivity and callous-unemotional traits are associated with behavioural problems among high-risk adolescents. While both are known to influence behaviour, the nature of their expression in high-risk behaviours, particularly those related to inhibitory control, is not well understood. In the current, preliminary study, we examined whether and how these traits predicted deficits in behaviour driven by bottom-up, automatic versus deliberate, top-down inhibitory processes among high-risk adolescents. Two go/no-go task variants, emotional and non-emotional, were used to assess reactive response inhibition, and the Balloon Analogue Risk Task was used to assess the ability to resist deliberate risky choices. The results showed that the two types of self-reported trait measures were differentially associated with performance on the two types of behavioural inhibition tasks. Trait impulsivity predicted non-emotional inhibitory control whereas callous-unemotional traits predicted risky choices. The results also showed that the emotions task elicited slower reaction times and higher false alarm rates than did the letters task, and that participants had greater difficulty inhibiting responses to negatively than to positively valenced no-go stimuli. While preliminary, the results suggest that the interplay between trait impulsivity and callous-unemotional traits is an important determinant of inhibitory behaviour in this high-risk adolescents.

Clarifying the Link Between Amygdala Functioning During Emotion Processing and Antisocial Behaviors Versus Callous-Unemotional Traits Within a Population-Based Community Sample

Prominent theories suggest that disruptions in amygdala reactivity and connectivity when processing emotional cues are key to the etiology of youth antisocial behavior (AB) and that these associations may be dependent on co-occurring levels of callous-unemotional (CU) traits. We examined the associations among AB, CU traits, and amygdala reactivity and functional connectivity while viewing emotional faces (fearful, angry, sad, happy) in 165 adolescents (46% male; 73.3% African American) from a representative, predominantly low-income community sample. AB was associated with increased amygdala activation in response to all emotions and was associated with greater amygdala reactivity to emotion only at low levels of CU traits. AB and CU traits were also associated with distinct patterns of amygdala connectivity. These findings demonstrate that AB-related deficits in amygdala functioning may extend across all emotions and highlight the need for further research on amygdala connectivity during emotion processing in relation to AB and CU traits within community populations.

Dysfunctional neurocognition in individuals with clinically significant psychopathic traits

The main goal of this review is to consider the main forms of dysfunctional neurocognition seen in individuals with clinically significant psychopathic traits (ie, reduced guilt/empathy and increased impulsive/antisocial behavior). A secondary goal is to examine the extent to which these forms of dysfunction are seen in both adults with psychopathic traits and adolescents with clinically significant antisocial behavior that may also involve callous-unemotional traits (reduced guilt/empathy). The two main forms of neurocognition considered are emotional responding (to distress/pain cues and emotional stimuli more generally) and reward-related processing. Highly related forms of neurocognition, the response to drug cues and moral judgments, are also discussed. It is concluded that dysfunction in emotional responsiveness and moral judgments confers risk for aggression across adolescence and into adulthood. However, reduced reward-related processing, including to drug cues, is only consistently found in adolescents with clinically significant antisocial behavior, not adults with psychopathy.


Investigating Sex Differences in Emotion Recognition, Learning, and Regulation Among Youths With Conduct Disorder

OBJECTIVE

Conduct disorder (CD) is a serious neurodevelopmental disorder marked by notably higher prevalence rates for boys than girls. Converging evidence suggests that CD is associated with impairments in emotion recognition, learning, and regulation. However, it is not known whether there are sex differences in the relationship between CD and emotion dysfunction. Prior studies on emotion functioning in CD have so far been underpowered for investigating sex differences. Therefore, our primary aim was to characterize emotion processing skills in a large sample of girls and boys with CD compared to typically developing controls (TDCs) using a comprehensive neuropsychological test battery.

METHOD

We included 542 youths with CD (317 girls) and 710 TDCs (479 girls), 9 to 18 years of age, from a European multisite study (FemNAT-CD). Participants completed three experimental tasks assessing emotion recognition, learning, and regulation, respectively. Data were analyzed to test for effects of group and sex, and group-by-sex interactions, while controlling for potentially confounding factors.

RESULTS

Relative to TDCs, youths with CD showed impaired emotion recognition (that was related to more physical and proactive aggression, and higher CU traits), emotional learning (specifically from punishment), and emotion regulation. Boys and girls with CD, however, displayed similar impairments in emotion processing.

CONCLUSION

This study provides compelling evidence for a relationship between CD and deficient neurocognitive functioning across three emotional domains that have previously been linked to CD etiology. However, there was no support for sex-specific profiles of emotion dysfunction, suggesting that current neurocognitive models of CD apply equally to both sexes.

Is Callous Always Cold? A Critical Review of the Literature on Emotion and the Development of Callous-Unemotional Traits in Children

Low emotional responsiveness is considered a core feature of callous-unemotional (CU) traits in childhood and, in the context of antisocial behavior, a precursor of psychopathic traits in adulthood. However, recent findings suggest that CU traits are not always characterized by low emotional responsiveness and the evidence base requires review. This review asks a fundamental question- 'Is callous always cold?'-with a specific focus on emotional responsiveness and CU traits in children with conduct problems (CPs). PRISMA review protocols were followed to identify literature reporting on emotional responsiveness for children 3-18 years with CPs and varying (high and low) CU traits. Results from eligible studies were contrasted by age (children 3-11 years, adolescents 12-18 years), emotional responsive measurement type (physiological, behavioral, self-report), emotion-eliciting stimuli type (interactive activities, static imagery, film) and socio-emotional context of the stimuli (other-orientated, self-orientated, neutral). This review highlights considerable variation in results across studies: reduced emotional responsiveness was not synonymous with participants demonstrating high CU traits. A more consistent picture of reduced emotional responsiveness in participants with high CU traits was found when studies used physiological measures, when stimuli were other-orientated in socio-emotional context, and in older, adolescent samples. In conclusion, this paper advocates for a more nuanced understanding of the relationship between high CU traits and the specific factors involved in emotional responsiveness, ultimately suggesting that callous is not always cold. Given that emotional responsiveness is central to theories of moral development, these findings may suggest innovative approaches to early intervention.

Modeling the Comorbidity of Cannabis Abuse and Conduct Disorder/Conduct Problems from a Cognitive Neuroscience Perspective

Objective: A cognitive neuroscience perspective seeks to understand behavior, in this case the comorbidity of cannabis abuse and conduct disorder/conduct problems, in terms of dysfunction in cognitive processes underpinned by neural processes. The goal of this review is to articulate a cognitive neuroscience account of this comorbidity. Methods: Literature on the following issues will be reviewed: (i) the longitudinal relationship between cannabis abuse and conduct disorder/conduct problems (CD/CP); (ii) the extent to which there are genetic and environmental (specifically maltreatment) factors that underpin this relationship; (iii) forms of neurocognitive function that are reported dysfunctional in CD/CP and also, when dysfunctional, appear to be risk factors for future cannabis abuse; and (iv) the extent to which cannabis abuse may further compromise these systems leading to increased future abuse and greater conduct problems. Results: CD/CP typically predate cannabis abuse. There appear to be shared genetic factors that contribute to the relationship between CD/CP and cannabis abuse. Moreover, trauma exposure increases risk for both cannabis abuse and CP/CD. One form of neurocognitive dysfunction, response disinhibition, that likely exacerbates the symptomatology of many individuals with CD also appears to increase the risk for cannabis abuse. The literature with respect to other forms of neurocognitive dysfunction remains inconclusive. Conclusions: Based on the literature, a causal model of the comorbidity of cannabis abuse and CD/CP is developed.

Threat Responsiveness as a Function of Cannabis and Alcohol Use Disorder Severity

Objective: Two of the most commonly abused substances by adolescents in the United States are alcohol and cannabis, both of which are associated with adverse medical and psychiatric outcomes throughout the lifespan. Both are assumed to impact the development of emotional processing although findings on the direction of this impact have been mixed. Preclinical animal work and some functional magnetic resonance imaging (fMRI) work with humans have suggested cannabis use disorder (CUD) and alcohol use disorder (AUD) are associated with increased threat responsiveness. However, other fMRI work has indicated CUD/AUD are associated with diminished threat responsiveness. In this study, we report on a study examining the relationship of severity of CUD/AUD and threat responsiveness in an adolescent population. Methods: The study involved 87 (43 male) adolescents with varying levels of CUD/AUD symptomatology (N = 45 above clinical cutoffs for CUD or AUD). They were scanned with fMRI during a looming threat task that involved images of threatening and neutral human faces or animals that appeared to be either looming or receding. Results: Increasing levels of CUD symptomatology were associated with decreased responding to looming stimuli within regions, including rostral frontal and fusiform gyrus as well as the amygdala. There were no relationships with AUD symptomatology. Conclusions: These data indicate that CUD in particular is associated with a decrease in responsiveness to the looming threat cue possibly relating to the putative neurotoxic impact of cannabis abuse.

Conduct disorder

Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects ~3% of school-aged children and is twice as prevalent in males than in females. This disorder can be subtyped according to age at onset (childhood-onset versus adolescent-onset) and the presence or absence of callous-unemotional traits (deficits in empathy and guilt). The aetiology of CD is complex, with contributions of both genetic and environmental risk factors and different forms of interplay among the two (gene-environment interaction and correlation). In addition, CD is associated with neurocognitive impairments; smaller grey matter volume in limbic regions such as the amygdala, insula and orbitofrontal cortex, and functional abnormalities in overlapping brain circuits responsible for emotion processing, emotion regulation and reinforcement-based decision-making have been reported. Lower hypothalamic-pituitary-adrenal axis and autonomic reactivity to stress has also been reported. Management of CD primarily involves parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used, especially in individuals with comorbid ADHD.

Atypical Dorsolateral Prefrontal Activity in Female Adolescents With Conduct Disorder During Effortful Emotion Regulation

Background

Conduct disorder (CD), which is characterized by severe aggressive and antisocial behavior, is linked to emotion processing and regulation deficits. However, the neural correlates of emotion regulation are yet to be investigated in adolescents with CD. Furthermore, it remains unclear whether CD is associated with deficits in emotional reactivity, emotion regulation, or both.

Methods

We used functional magnetic resonance imaging to study effortful emotion regulation by cognitive reappraisal in 59 female adolescents 15 to 18 years of age (30 with a CD diagnosis and 29 typically developing (TD) control adolescents).

Results

Behaviorally, in-scanner self-report ratings confirmed successful emotion regulation within each group individually but significant group differences in emotional reactivity and reappraisal success when comparing the groups (CD < TD). Functional magnetic resonance imaging results revealed significantly lower activation in left dorsolateral prefrontal cortex and angular gyrus in CD compared with TD adolescents during emotion regulation, but no group differences for emotional reactivity. Furthermore, connectivity between left dorsolateral prefrontal cortex and the bilateral putamen, right prefrontal cortex, and amygdala was reduced in CD compared with TD adolescents during reappraisal. Callous-unemotional traits were unrelated to neural activation, but these traits correlated negatively with behavioral reports of emotional reactivity.

Conclusions

Our results demonstrate reduced prefrontal brain activity and functional connectivity during effortful emotion regulation in female adolescents with CD. This sheds light on the neural basis of the behavioral deficits that have been reported previously. Future studies should investigate whether cognitive interventions are effective in enhancing emotion-regulation abilities and/or normalizing prefrontal and temporoparietal activity in female adolescents with CD.

Association of Different Types of Childhood Maltreatment With Emotional Responding and Response Control Among Youths

Importance

Childhood maltreatment is associated with serious developmental consequences that may be different depending on the form of maltreatment. However, relatively little research has investigated this issue despite implications for understanding the development of psychiatric disorders after maltreatment.

Objective

To determine the association of childhood maltreatment and potential differential associations of childhood abuse or neglect with neural responsiveness within regions of the brain implicated in emotional responding and response control.

Design, Setting, and Participants

In this cross-sectional study, participants aged 10 to 18 years with varying levels of prior maltreatment as indexed by the Childhood Trauma Questionnaire (CTQ) were recruited from a residential care facility and the surrounding community. Blood oxygen level-dependent response data were analyzed via 2 analyses of covariance that examined 2 (sex) × 3 (task condition [view, congruent, incongruent]) × 3 (valence [negative, neutral, positive]) with Blom-transformed covariates: (1) total CTQ score; and (2) abuse and neglect subscores. Data were collected from April 1, 2016, to June 30, 2018. Data analyses occurred from June 10, 2018, to October 31, 2018.

Main Outcomes and Measures

Blood oxygenation level-dependent signals in response to an Affective Stroop task were measured via functional magnetic resonance imaging.

Results

The sample included 116 youths (mean [SD] age, 15.0 [2.2] years; 70 [60.3%] male). Fifteen participants reported no prior maltreatment. The remaining 101 participants (87.1%) reported at least some prior maltreatment, and 55 (54.5%) reported significant maltreatment, ie, total CTQ scores were greater than the validated CTQ score threshold of 40. There were significant total CTQ score × task condition associations within the bilateral postcentral gyrus, left precentral gyrus, midcingulate cortex, middle temporal gyrus, and superior temporal gyrus (left postcentral gyrus: F = 11.73; partial η2 = 0.14; right postcentral and precentral gyrus: F = 9.81; partial η2 = 0.10; midcingulate cortex: F = 12.76; partial η2 = 0.12; middle temporal gyrus: F = 13.24; partial η2 = 0.10; superior temporal gyrus: F = 10.33; partial η2 = 0.11). In all examined regions of the brain, increased maltreatment was associated with decreased differential responsiveness to incongruent task trials compared with view trials (left postcentral gyrus: r = -0.34; 95% CI, -0.17 to -0.51; right postcentral and precentral gyrus: r = -0.31; 95% CI, -0.14 to -0.49; midcingulate cortex: r = -0.36; 95% CI, -0.18 to -0.53; middle temporal gyrus: r = -0.35; 95% CI, -0.17 to -0.52; superior temporal gyrus: r = -0.37; 95% CI, -0.20 to -0.55). These interactions were particularly associated with level of abuse rather than neglect. A second analysis of covariance revealed significant abuse × task condition (but not neglect × task) interactions within the midcingulate cortex (F = 13.96; partial η2 = 0.11), right postcentral gyrus and inferior parietal lobule (F = 15.21; partial η2 = 0.12), left postcentral and precentral gyri (F = 11.16; partial η2 = 0.12), and rostromedial frontal cortex (F = 10.36; partial η2 = 0.08)). In all examined regions of the brain, increased abuse was associated with decreased differential responsiveness to incongruent task trials compared with view trials (midcingulate cortex: partial r = -0.33; P < .001; right postcentral gyrus and inferior parietal lobule: partial r = -0.41; P < .001; left postcentral and precentral gyri: partial r = -0.40; P < .001; and rostromedial frontal cortex: partial r = -0.40; P < .001).

Conclusions and Relevance

These data document associations of different forms of childhood maltreatment with atypical neural response. This suggests that forms of maltreatment may differentially influence the development of psychiatric pathology.

[Response inhibition and emotional responding in attention-deficit/hyperactivity disorder with comorbid disruptive, impulse-control, and conduct disorders]

OBJECTIVE

To characterize the traits of neuropsychological functioning deficits in patients with attention-deficit/ hyperactivity disorder (ADHD) with comorbid disruptive, impulse-control, and conduct disorders (DICCD).

METHODS

Twenty out-patients with ADHD, 20 with ADHD with comorbid DICCD, and 20 with DICCD, all aged 6-16 years, were enrolled in this study, with 20 healthy subjects matched for age, gender and IQ serving as the healthy controls. The patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5). All the subjects were assessed with Golden Stroop test and emotional Stroop test to evaluate their response inhibition and emotional responding.

RESULTS

In Golden Stroop test, the interference scores (IGs) of errors and reaction time both differed significantly among the groups (P &lt; 0.05), and were the highest in patients with ADHD only. In emotional Stroop test, the mean reaction time (MRT) showed significant differences among the groups (P &lt; 0.05); the MRT of positive- congruent trials in ADHD with comorbid DICCD group was shorter than that in ADHD group but longer than that in group DICCD; the MRT in the 3 case groups were all longer than that in the control group. The MRT of both positive-incongruent trials and negative-congruent trials in ADHD with comorbid DICCD group and DICCD group was shorter than that in ADHD group but longer than that in the control group. The MRT of negative- incongruent trials in DICCD group was shorter than that in ADHD group and ADHD with comorbid DICCD group but longer than that in the control group.

CONCLUSIONS

The response inhibition deficit and abnormal emotional responding are the core symptoms of ADHD. Bias emotional stimuli may render response inhibitory dysfunction in patients with DICCD with callous-unemotional traits of emotional responding disorder, especially in dealing with negative emotional trials, while the comorbidity of ADHD and DICCD tends to have the emotional response trait of DICCD.

Applying a Cognitive Neuroscience Perspective to Disruptive Behavior Disorders: Implications for Schools

A cognitive neuroscience perspective seeks to understand behavior, in this case disruptive behavior disorders (DBD), in terms of dysfunction in cognitive processes underpinned by neural processes. While this type of approach has clear implications for clinical mental health practice, it also has implications for school-based assessment and intervention with children and adolescents who have disruptive behavior and aggression. This review articulates a cognitive neuroscience account of DBD by discussing the neurocognitive dysfunction related to emotional empathy, threat sensitivity, reinforcement-based decision-making, and response inhibition. The potential implications for current and future classroom-based assessments and interventions for students with these deficits are discussed.