Longitudinal structural brain development and externalizing behavior in adolescence

The Dynamic Interplay Between Puberty and Structural Brain Development as a Predictor of Mental Health Difficulties in Adolescence: A Systematic Review

Puberty is a time of intense reorganization of brain structure and a high-risk period for the onset of mental health problems, with variations in pubertal timing and tempo intensifying this risk. We conducted 2 systematic reviews of articles published up to February 1, 2024, focusing on 1) the role of brain structure in the relationship between puberty and mental health, and 2) precision psychiatry research evaluating the utility of puberty in making individualized predictions of mental health outcomes in young people. The first review provides inconsistent evidence about whether and how pubertal and psychopathological processes may interact in relation to brain development. While most studies found an association between early puberty and mental health difficulties in adolescents, evidence on whether brain structure mediates this relationship is mixed. The pituitary gland was found to be associated with mental health status during this time, possibly through its central role in regulating puberty and its function in the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-adrenal axes. In the second review, the design of studies that have explored puberty in predictive models did not allow for a quantification of its predictive power. However, when puberty was evaluated through physically observable characteristics rather than hormonal measures, it was more commonly identified as a predictor of depression, anxiety, and suicidality in adolescence. Social processes may be more relevant than biological ones to the link between puberty and mental health problems and represent an important target for educational strategies.

Association between gestational weight gain and behavioral problems of the offspring aged 6-7 years: A population-based study in Japan

OBJECTIVE

To identify the optimal gestational weight gain (GWG) thresholds for behavioral problems and prosocial behavior in 6- to 7-year-old children.

METHODS

A retrospective cohort study was conducted using data from the Adachi Child Health Impact of Living Difficulty study, including all first-graders in public schools in Adachi, Tokyo, in 2017, 2019, and 2021 (n = 11 048, response rate = 80.1%). GWG was based on clinical records in the Mother and Child Health Handbook. Total difficulties and prosocial behavior were assessed using the Strength and Difficulties Questionnaire. Logistic regression models with restricted cubic splines, and quintile categories were employed to examine the association of GWG with the clinical range of total difficulties and prosocial behavior, controlling for covariates.

RESULTS

The association between GWG and total difficulties exhibited a reverse J-shaped pattern, with low GWG, but not high GWG, increasing the risk (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01-1.42, P = 0.039 for GWG < 7 kg; OR 1.03, 95% CI 0.85-1.24, P = 0.786 for GWG > 14 kg), referencing the median (10 kg). High GWG was associated with a lower risk of problems in prosocial behavior (OR = 0.77, 95% CI 0.62-0.95, P = 0.017 for GWG > 14 kg; OR 1.06, 95% CI 0.88-1.27, P = 0.532 for GWG <7 kg).

CONCLUSION

GWG less than 7 kg may increase the risk of total difficulties, whereas GWG over 14 kg may serve as a protective factor for prosocial behavior in 6- to 7-year-old children.

An epidemiological study of season of birth, mental health, and neuroimaging in the UK Biobank

Environmental exposures during the perinatal period are known to have a long-term effect on adult physical and mental health. One such influential environmental exposure is the time of year of birth which affects the amount of daylight, nutrients, and viral load that an individual is exposed to within this key developmental period. Here, we investigate associations between season of birth (seasonality), four mental health traits (n = 137,588) and multi-modal neuroimaging measures (n = 33,212) within the UK Biobank. Summer births were associated with probable recurrent Major Depressive Disorder (β = 0.026, pcorr = 0.028) and greater mean cortical thickness in temporal and occipital lobes (β = 0.013 to 0.014, pcorr<0.05). Winter births were associated with greater white matter integrity globally, in the association fibers, thalamic radiations, and six individual tracts (β = -0.013 to -0.022, pcorr<0.05). Results of sensitivity analyses adjusting for birth weight were similar, with an additional association between winter birth and white matter microstructure in the forceps minor and between summer births, greater cingulate thickness and amygdala volume. Further analyses revealed associations between probable depressive phenotypes and a range of neuroimaging measures but a paucity of interactions with seasonality. Our results suggest that seasonality of birth may affect later-life brain structure and play a role in lifetime recurrent Major Depressive Disorder. Due to the small effect sizes observed, and the lack of associations with other mental health traits, further research is required to validate birth season effects in the context of different latitudes, and by co-examining genetic and epigenetic measures to reveal informative biological pathways.

Exploring Emotional Dysregulation and Avoidance with Caregivers as the Mechanisms Linking Social Communication Understanding and Aggressive Behaviours

Many autistic adolescents and young adults present with aggressive behaviours, which can be challenging for caregivers. The present study aimed to explore the underlying mechanisms between social communication understanding and aggressive behaviours in autistic and non-autistic adolescents, specifically the role of emotional dysregulation and its impact on avoidance with caregivers. Caregivers of autistic (n = 275) and non-autistic adolescents (n = 123) completed standardised caregiver-report questionnaires measuring social communication understanding, emotional dysregulation, avoidance between the adolescent and caregiver and aggressive behaviours. A serial mediation analysis indicated that levels of social communication understanding were indirectly associated with aggressive behaviours. This occurred through increased emotional dysregulation, which may have led to increased avoidance between the autistic and non-autistic adolescents and their caregivers. These findings support a sequential process by which adolescents with low social communication understanding are more likely to behave aggressively through being emotionally dysregulated and the impact of this on the increased avoidance within the caregiver-adolescent dyad. This process was found within autistic and non-autistic adolescents, suggesting a mechanism across individuals with aggression. These findings indicate that interventions based on improving emotion regulation ability and responses between adolescents and their caregivers may aid in reducing aggressive behaviours in adolescents and young adults with lower social communication understanding.

The default mode network is associated with changes in internalizing and externalizing problems differently in adolescent boys and girls

Internalizing and externalizing problems that emerge during adolescence differentially increase boys' and girls' risk for developing psychiatric disorders. It is not clear, however, whether there are sex differences in the intrinsic functional architecture of the brain that underlie changes in the severity of internalizing and externalizing problems in adolescents. Using resting-state fMRI data and self-reports of behavioral problems obtained from 128 adolescents (73 females; 9-14 years old) at two timepoints, we conducted multivoxel pattern analysis to identify resting-state functional connectivity markers at baseline that predict changes in the severity of internalizing and externalizing problems in boys and girls 2 years later. We found sex-differentiated involvement of the default mode network in changes in internalizing and externalizing problems. Whereas changes in internalizing problems were associated with the dorsal medial subsystem in boys and with the medial temporal subsystem in girls, changes in externalizing problems were predicted by hyperconnectivity between core nodes of the DMN and frontoparietal network in boys and hypoconnectivity between the DMN and affective networks in girls. Our results suggest that different neural mechanisms predict changes in internalizing and externalizing problems in adolescent boys and girls and offer insights concerning mechanisms that underlie sex differences in the expression of psychopathology in adolescence.

Mood variability during adolescent development and its relation to sleep and brain development

Mood swings, or mood variability, are associated with negative mental health outcomes. Since adolescence is a time when mood disorder onset peaks, mood variability during this time is of significant interest. Understanding biological factors that might be associated with mood variability, such as sleep and structural brain development, could elucidate the mechanisms underlying mood and anxiety disorders. Data from the longitudinal Leiden self-concept study (N = 191) over 5 yearly timepoints was used to study the association between sleep, brain structure, and mood variability in healthy adolescents aged 11-21 at baseline in this pre-registered study. Sleep was measured both objectively, using actigraphy, as well as subjectively, using a daily diary self-report. Negative mood variability was defined as day-to-day negative mood swings over a period of 5 days after an MRI scan. It was found that negative mood variability peaked in mid-adolescence in females while it linearly increased in males, and average negative mood showed a similar pattern. Sleep duration (subjective and objective) generally decreased throughout adolescence, with a larger decrease in males. Mood variability was not associated with sleep, but average negative mood was associated with lower self-reported energy. In addition, higher thickness in the dorsolateral prefrontal cortex (dlPFC) compared to same-age peers, suggesting a delayed thinning process, was associated with higher negative mood variability in early and mid-adolescence. Together, this study provides an insight into the development of mood variability and its association with brain structure.

Parental Deprivation- and Threat-Based Factors Associated with Youth Emotion-Based Neurocircuitry and Externalizing Behavior: A Systematic Review

Parental factors, including negative parenting practices (e.g., family conflict, low monitoring), parental depression, and parental substance use, are associated with externalizing behaviors among youth. However, the ways in which these parental factors are associated with youth brain function and consequent externalizing behavior has been less studied. Both the dimensional and stress acceleration models provide frameworks for understanding how parental factors may be associated with frontolimbic and frontoparietal networks implicated in emotional attention and regulation processes. The current review builds upon this work by examining how deprivation- and threat-based parental factors are associated with youth neurocircuitry involved in emotional functioning and externalizing behaviors. A systematic review using PRISMA guidelines was completed and included five studies assessing parenting behaviors, six studies assessing parental depressive symptoms and/or diagnosis, and 12 studies assessing parental history of substance use. Synthesis of reviewed studies discusses support for the dimensional and stress acceleration models within the context of deprivation and threat. Further, a limited number of studies tested (i.e., six studies) and supported (i.e., three studies) youth neural structure and function as a mediator of the association between parental factors and youth externalizing behavior. Specific recommendations for future work include more deliberate planning related to sample composition, improved clarity related to parental constructs, consistency in methodology, and longitudinal study design in order to better understand associations between contextual parental influences and youth neural and behavioral functioning.

Longitudinal Associations Between White Matter Microstructure and Psychiatric Symptoms in Youth

OBJECTIVE

Associations between psychiatric problems and white matter (WM) microstructure have been reported in youth. Yet, a deeper understanding of this relation has been hampered by a dearth of well-powered longitudinal studies and a lack of explicit examination of the bidirectional associations between brain and behavior. We investigated the temporal directionality of WM microstructure and psychiatric symptom associations in youth.

METHOD

In this observational study, we leveraged the world's largest single- and multi-site cohorts of neurodevelopment: the Generation R (GenR) and Adolescent Brain Cognitive Development Studies (ABCD) (total n scans = 11,400; total N = 5,700). We assessed psychiatric symptoms with the Child Behavioral Checklist as broad-band internalizing and externalizing scales, and as syndrome scales (eg, Anxious/Depressed). We quantified WM with diffusion tensor imaging (DTI), globally and at a tract level. We used cross-lagged panel models to test bidirectional associations of global and specific measures of psychopathology and WM microstructure, meta-analyzed results across cohorts, and used linear mixed-effects models for validation.

RESULTS

We did not identify any longitudinal associations of global WM microstructure with internalizing or externalizing problems across cohorts (confirmatory analyses) before, and after multiple testing corrections. We observed similar findings for longitudinal associations between tract-based microstructure with internalizing and externalizing symptoms, and for global WM microstructure with specific syndromes (exploratory analyses). Some cross-sectional associations surpassed multiple testing corrections in ABCD, but not in GenR.

CONCLUSION

Uni- or bi-directionality of longitudinal associations between WM and psychiatric symptoms were not robustly identified. We have proposed several explanations for these findings, including interindividual differences, the use of longitudinal approaches, and smaller effects than expected.

STUDY REGISTRATION INFORMATION

Bidirectionality Brain Function and Psychiatric Symptoms; https://doi.org/10.17605/OSF.IO/PNY92.

Socioemotional functioning across the transition to lower secondary school: The role of temperament and relationships with mothers and teachers

This Finnish longitudinal study investigated the role of relationships with mothers (n = 631) and teachers (n = 56), and adolescents' (n = 848; 53.9% girls, 46.1% boys) temperament in the development of the adolescents' socioemotional functioning during the transition to lower secondary school (Grade 6 to Grade 7; age in Grade 6: M = 12.32, SD = 0.36). The results showed that mother-adolescent closeness predicted a higher level and teacher-adolescent closeness predicted a smaller decrease in prosocial behavior. Teacher-adolescent conflict predicted a higher level, and mother-adolescent conflict predicted an increase in externalizing problems. Only temperament predicted internalizing problems. In addition, relationship quality both mediated and moderated some of the associations between temperament and socioemotional functioning.

Stage 2 Registered Report: The Bidirectional Relationship Between Brain Features and the Dysregulation Profile: A Longitudinal, Multimodal Approach

OBJECTIVE

Youth with symptoms of emotion dysregulation are at risk for a multitude of psychiatric diagnoses later in life. However, few studies have focused on the underlying neurobiology of emotion dysregulation. This study assessed the bidirectional relationship between emotion dysregulation symptoms and brain morphology throughout childhood and adolescence.

METHOD

A combined total of 8,235 children and adolescents drawn from 2 large population-based cohorts, the Generation R Study and Adolescent Brain Cognitive Development (ABCD) Study, were included. Data were acquired in 3 waves in Generation R (mean [SD] age = 7.8 [1.0] wave 1 [W1]; 10.1 [0.6] W2; 13.9 [0.5] W3) and in 2 waves in ABCD (mean [SD] age = 9.9 [0.6] W1; 11.9 [0.6] W2). Cross-lagged panel models were used to determine the bidirectional relationships between emotion dysregulation symptoms and brain morphology. The study was preregistered before performing analyses.

RESULTS

In the Generation R sample, emotion dysregulation symptoms at W1 preceded lower hippocampal (β = -.07, SE = 0.03, p = .017) and temporal pole (β = -.19, SE = 0.07, p = .006) volumes at W2. Emotion dysregulation symptoms at W2 preceded lower fractional anisotropy in the uncinate fasciculus (β = -.11, SE = 0.05, p = .017) and corticospinal tract (β = -.12, SE = 0.05, p = .012). In the ABCD sample, emotion dysregulation symptoms preceded posterior cingulate (β = .01, SE = 0.003, p = .014) and nucleus accumbens volumes (left hemisphere: β = -.02, SE = 0.01, p = .014; right hemisphere: β = -.02, SE = 0.01, p = .003).

CONCLUSION

In population-based samples, with relatively low psychopathology symptoms in the majority of children, symptoms of emotion dysregulation can precede differential development of brain morphology. This provides the foundation for future work to assess to what extent optimal brain development can be promoted through early intervention.

STUDY REGISTRATION INFORMATION

The Bidirectional Relationship Between Brain Features and the Dysregulation Profile: A Longitudinal, Multimodal Approach; https://doi.org/10.1016/j.jaac.2022.03.008.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure that the study questionnaires were prepared in an inclusive way. 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.

Neurodevelopmental risk and adaptation as a model for comorbidity among internalizing and externalizing disorders: genomics and cell-specific expression enriched morphometric study

BACKGROUND

Comorbidity is the rule rather than the exception for childhood and adolescent onset mental disorders, but we cannot predict its occurrence and do not know the neural mechanisms underlying comorbidity. We investigate if the effects of comorbid internalizing and externalizing disorders on anatomical differences represent a simple aggregate of the effects on each disorder and if these comorbidity-associated cortical surface differences relate to a distinct genetic underpinning.

METHODS

We studied the cortical surface area (SA) and thickness (CT) of 11,878 preadolescents (9-10 years) from the Adolescent Brain and Cognitive Development Study. Linear mixed models were implemented in comparative and association analyses among internalizing (dysthymia, major depressive disorder, disruptive mood dysregulation disorder, agoraphobia, panic disorder, specific phobia, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder), externalizing (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder) diagnostic groups, a group with comorbidity of the two and a healthy control group. Genome-wide association analysis (GWAS) and cell type specificity analysis were performed on 4468 unrelated European participants from this cohort.

RESULTS

Smaller cortical surface area but higher thickness was noted across patient groups when compared to controls. Children with comorbid internalizing and externalizing disorders had more pronounced areal reduction than those without comorbidity, indicating an additive burden. In contrast, cortical thickness had a non-linear effect with comorbidity: the comorbid group had no significant CT differences, while those patient groups without comorbidity had significantly higher thickness compare to healthy controls. Distinct biological pathways were implicated in regional SA and CT differences. Specifically, CT differences were associated with immune-related processes implicating astrocytes and oligodendrocytes, while SA-related differences related mainly to inhibitory neurons.

CONCLUSION

The emergence of comorbidity across distinct clusters of psychopathology is unlikely to be due to a simple additive neurobiological effect alone. Distinct developmental risk moderated by immune-related adaptation processes, with unique genetic and cell-specific factors, may contribute to underlying SA and CT differences. Children with the highest risk but lowest resilience, both captured in their developmental morphometry, may develop a comorbid illness pattern.

Brain Structure Relations With Psychopathology Trajectories in the ABCD Study

OBJECTIVE

A general psychopathology (p) factor captures shared variation across mental disorders. Structural neural alterations have been associated with the p factor concurrently, but less is known about whether these alterations relate to within-person change in the p factor over time, especially during preadolescence, a period of neurodevelopmental changes.

METHOD

This study examined whether baseline brain structure was prospectively related to the trajectory of the p factor and specific forms of psychopathology over 2 years in 9,220 preadolescents (aged 9-10 at baseline) from the Adolescent Brain Cognitive Development Study (ABCD). Longitudinal multilevel models were conducted to determine whether baseline brain structure (volume, surface area, thickness) was associated with between-person differences and within-person change in the p factor (from a higher-order confirmatory factor model) and internalizing, externalizing, neurodevelopmental, somatization, and detachment factor scores (from a correlated factors model) over 3 study waves.

RESULTS

Smaller global volume and surface area, but not thickness, were associated with higher between-person levels of the p factor scores, which persisted over time. None of the brain structure measures were related to within-person change in the p factor scores. Lower baseline cortical thickness was associated with steeper decreases in internalizing psychopathology, which was driven by lower thickness within sensorimotor and temporal regions.

CONCLUSION

These novel results identify specific brain structure features that might contribute to transdiagnostic psychopathology development in preadolescence. Children with smaller total brain volume and surface area may be vulnerable to persistent general psychopathology during preadolescence. Cortical thinning reflective of pruning and myelination in sensorimotor and temporal brain regions specifically may protect against increases in internalizing, but not general psychopathology, during preadolescence.

Associations Between Adolescent Pain and Psychopathology in the Adolescent Brain Cognitive Development (ABCD) Study

Pain and psychopathology co-occur in adolescence, but the directionality and etiology of these associations are unclear. Using the pain questionnaire and the Child Behavior Checklist from the Adolescent Brain Cognitive Development study (n = 10,414 children [770 twin pairs] aged 12-13), we estimated longitudinal, co-twin control, and twin models to evaluate the nature of these associations. In two-wave cross-lag panel models, there were small cross-lag effects that suggested bidirectional associations. However, the co-twin control models suggested that most associations were familial. Pain at age 12 and 13 was mostly environmental (A = 0-12%, C = 15-30%, E = 70-73%) and the twin models suggested that associations with psychopathology were primarily due to shared environmental correlations. The exception was externalizing, which had a phenotypic prospective effect on pain, a significant within-family component, and a non-shared environmental correlation at age 12. Environmental risk factors may play a role in pain-psychopathology co-occurrence. Future studies can examine risk factors such as stressful life events.

Adolescent Distress: Is There a Vaccine? Social and Cultural Considerations during the COVID-19 Pandemic

The COVID-19 pandemic had an unprecedented impact on mental health. In particular, the impact on adolescents was likely significant due to vulnerability factors linked to this developmental stage and pre-existing conditions of hardship. The present work aimed at grasping the particular effects of the pandemic on social and cultural aspects of adolescence, providing a cross-sectional picture of this historical moment of contemporary youth culture. Further research is needed to verify the findings.

Juvenile confinement exacerbates adversity burden: A neurobiological impetus for decarceration

Every year, about 700,000 youth arrests occur in the United States, creating significant neurodevelopmental strain; this is especially concerning as most of these youth have early life adversity exposures that may alter brain development. Males, Black, and Latinx youth, and individuals from low socioeconomic status households have disproportionate contact with the juvenile justice system (JJS). Youth confined in the JJS are frequently exposed to threat and abuse, in addition to separation from family and other social supports. Youths’ educational and exploratory behaviors and activities are substantially restricted, and youth are confined to sterile environments that often lack sufficient enrichment resources. In addition to their demonstrated ineffectiveness in preventing future delinquent behaviors, high recidivism rates, and costs, juvenile conditions of confinement likely exacerbate youths’ adversity burden and neurodevelopmentally harm youth during the temporally sensitive window of adolescence. Developmentally appropriate methods that capitalize on adolescents’ unique rehabilitative potential should be instated through interventions that minimize confinement. Such changes would require joint advocacy from the pediatric and behavioral health care communities. “The distinct nature of children, their initial dependent, and developmental state, their unique human potential as well as their vulnerability, all demand the need for more, rather than less, legal and other protection from all forms of violence (United Nations Committee on the Rights of the Child, 2007).”

The relationship between adolescents' externalizing and internalizing symptoms and brain development over a period of three years

BACKGROUND

Adolescence is a crucial period for both brain maturation and the emergence of mental health disorders. Associations between brain morphology and internalizing/externalizing symptomatology have been identified in clinical or at-risk samples, but age-related developmental differences were rarely considered. The current study investigated the longitudinal relationship between internalizing/externalizing symptoms and brain development in the absence of psychiatric disorders during early and late adolescence.

METHODS

98 healthy adolescents within two cohorts (younger: 9 years, older: 12 years) participated in annual assessments for three years; a clinical assessment measuring their externalizing and internalizing symptoms (SDQ) and an MRI assessment measuring their brain volume and white matter microstructure, including fractional anisotropy (FA), mean diffusivity (MD) and average path length.

RESULTS

Linear mixed effect models and cross-lagged panel models showed that larger subcortical gray matter volume predicted more externalizing symptoms in older adolescents whereas decreases of subcortical gray matter volume predicted more externalizing symptoms for younger adolescents. Additionally, longer average white matter path length predicted more externalizing symptoms for older adolescents, while decreases in cerebral white matter volume were predictive of more externalizing symptoms for younger adolescents. There were no predictive effects for internalizing symptoms, FA or MD.

CONCLUSIONS

Delays in subcortical brain maturation, in both early and late adolescence, are associated with increases in externalizing behavior which indicates a higher risk for psychopathology and warrants further investigations.

Time Dimension of Childhood Adversities and Externalizing Behavior Among Children of Teen Mothers: Sensitive Period Hypothesis vs. Accumulation Hypothesis

Childhood adversities are associated with compromised behavioral health later in life. However, less attention has been paid to how time contributes to the damaging effects of adversity exposure. In addition, the differential impact of childhood maltreatment and household dysfunction has been understudied. The current study tested (a) the sensitive period hypothesis regarding timing of childhood adversity on externalizing behavior, (b) the accumulation hypothesis regarding the associations between the duration of childhood adversity and externalizing behavior, and (c) the domain-specific impact of childhood adversity on externalizing behavior. Data came from the Young Women and Child Development Study (N = 240). Childhood adversity was measured at seven periods (age range: 5.5-16), which were used to test the sensitive period hypothesis. Childhood adversity at each time period was summed across seven time periods to test the accumulation measure representing the duration of childhood adversity. Least angle and multiple regression analyses were conducted. Results supported the sensitive period hypothesis-the effect of childhood adversity was the most prominent at age 11.5, whereas the accumulation of childhood adversity time periods was not a significant predictor of later externalizing behavior. Probing childhood adversity by subdomains revealed maltreatment primarily accounted for externalizing behavior (p < .05). Findings suggest intervention efforts for children of teen mothers during early adolescence to prevent externalizing behavior in later adolescence. Unpacking childhood adversity may illuminate key areas of vulnerability to externalizing behavior.

Stronger brain activation for own baby but similar activation toward babies of own and different ethnicities in parents living in a multicultural environment

Specific facial features in infants automatically elicit attention, affection, and nurturing behaviour of adults, known as the baby schema effect. There is also an innate tendency to categorize people into in-group and out-group members based on salient features such as ethnicity. Societies are becoming increasingly multi-cultural and multi-ethnic, and there are limited investigations into the underlying neural mechanism of the baby schema effect in a multi-ethnic context. Functional magnetic resonance imaging (fMRI) was used to examine parents' (N = 27) neural responses to (a) non-own ethnic in-group and out-group infants, (b) non-own in-group and own infants, and (c) non-own out-group and own infants. Parents showed similar brain activations, regardless of ethnicity and kinship, in regions associated with attention, reward processing, empathy, memory, goal-directed action planning, and social cognition. The same regions were activated to a higher degree when viewing the parents' own infant. These findings contribute further understanding to the dynamics of baby schema effect in an increasingly interconnected social world.

Cortico-amygdalar connectivity and externalizing/internalizing behavior in children with neurodevelopmental disorders

Background

Externalizing and internalizing behaviors contribute to clinical impairment in children with neurodevelopmental disorders (NDDs). Although associations between externalizing or internalizing behaviors and cortico-amygdalar connectivity have been found in clinical and non-clinical pediatric samples, no previous study has examined whether similar shared associations are present across children with different NDDs.

Methods

Multi-modal neuroimaging and behavioral data from the Province of Ontario Neurodevelopmental Disorders (POND) Network were used. POND participants aged 6–18 years with a primary diagnosis of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) or obsessive–compulsive disorder (OCD), as well as typically developing children (TDC) with T1-weighted, resting-state fMRI or diffusion weighted imaging (DWI) and parent-report Child Behavioral Checklist (CBCL) data available, were analyzed (total n = 346). Associations between externalizing or internalizing behavior and cortico-amygdalar structural and functional connectivity indices were examined using linear regressions, controlling for age, gender, and image-modality specific covariates. Behavior-by-diagnosis interaction effects were also examined.

Results

No significant linear associations (or diagnosis-by-behavior interaction effects) were found between CBCL-measured externalizing or internalizing behaviors and any of the connectivity indices examined. Post-hoc bootstrapping analyses indicated stability and reliability of these null results.

Conclusions

The current study provides evidence towards an absence of a shared linear relationship between internalizing or externalizing behaviors and cortico-amygdalar connectivity properties across a transdiagnostic sample of children with different primary NDD diagnoses and TDC. Different methodological approaches, including incorporation of multi-dimensional behavioral data (e.g., task-based fMRI) or clustering approaches may be needed to clarify complex brain-behavior relationships relevant to externalizing/internalizing behaviors in heterogeneous clinical NDD populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00429-022-02483-0.

Growth charts of brain morphometry for preschool children

Brain development from 1 to 6 years of age anchors a wide range of functional capabilities and carries early signs of neurodevelopmental disorders. However, quantitative models for depicting brain morphology changes and making individualized inferences are lacking, preventing the identification of early brain atypicality during this period. With a total sample size of 285, we characterized the age-dependence of the cortical thickness and subcortical volume in neurologically normal children and constructed quantitative growth charts of all brain regions for preschool children. While the cortical thickness of most brain regions decreased with age, the entorhinal and parahippocampal regions displayed an inverted-U shape of age-dependence. Compared to the cortical thickness, the normalized volume of subcortical regions exhibited more divergent trends, with some regions increasing, some decreasing, and some displaying inverted-U-shaped trends. The growth curve models for all brain regions demonstrated utilities in identifying brain atypicality. The percentile measures derived from the growth curves facilitate the identification of children with developmental speech and language disorders with an accuracy of 0.875 (area under the receiver operating characteristic curve: 0.943). Our results fill the knowledge gap in brain morphometrics in a critical development period and provide an avenue for individualized brain developmental status evaluation with demonstrated sensitivity.

Multivariate Genetic Structure of Externalizing Behavior and Structural Brain Development in a Longitudinal Adolescent Twin Sample

Externalizing behavior in its more extreme form is often considered a problem to the individual, their families, teachers, and society as a whole. Several brain structures have been linked to externalizing behavior and such associations may arise if the (co)development of externalizing behavior and brain structures share the same genetic and/or environmental factor(s). We assessed externalizing behavior with the Child Behavior Checklist and Youth Self Report, and the brain volumes and white matter integrity (fractional anisotropy [FA] and mean diffusivity [MD]) with magnetic resonance imaging in the BrainSCALE cohort, which consisted of twins and their older siblings from 112 families measured longitudinally at ages 10, 13, and 18 years for the twins. Genetic covariance modeling based on the classical twin design, extended to also include siblings of twins, showed that genes influence externalizing behavior and changes therein (h² up to 88%). More pronounced externalizing behavior was associated with higher FA (observed correlation r_ph up to +0.20) and lower MD (r_ph up to −0.20), with sizeable genetic correlations (FA r_a up to +0.42; MD r_a up to −0.33). The cortical gray matter (CGM; r_ph up to −0.20) and cerebral white matter (CWM; r_ph up to +0.20) volume were phenotypically but not genetically associated with externalizing behavior. These results suggest a potential mediating role for global brain structures in the display of externalizing behavior during adolescence that are both partially explained by the influence of the same genetic factor.

Understanding the Dynamics of the Developing Adolescent Brain Through Team Science

One of the major goals for research on adolescent development is to identify the optimal conditions for adolescents to grow up in a complex social world and to understand individual differences in these trajectories. Based on influential theoretical and empirical work in this field, achieving this goal requires a detailed understanding of the social context in which neural and behavioral development takes place, along with longitudinal measurements at multiple levels (e.g., genetic, hormonal, neural, behavioral). In this perspectives article, we highlight the promising role of team science in achieving this goal. To illustrate our point, we describe meso (peer relations) and micro (social learning) approaches to understand social development in adolescence as crucial aspects of adolescent mental health. Finally, we provide an overview of how our team has extended our collaborations beyond scientific partners to multiple societal partners for the purpose of informing and including policymakers, education and health professionals, as well as adolescents themselves when conducting and communicating research.

Neurodevelopmental Trajectories in Children With Internalizing, Externalizing and Emotion Dysregulation Symptoms

INTRODUCTION

Childhood and adolescence are crucial periods for brain and behavioral development. However, it is not yet clear how and when deviations from typical brain development are related to broad domains of psychopathology.

METHODS

Using three waves of neuroimaging data within the population-based Generation R Study sample, spanning a total age range of 6-16 years, we applied normative modeling to establish typical development curves for (sub-)cortical volume in 37 brain regions, and cortical thickness in 32 brain regions. Z-scores representing deviations from typical development were extracted and related to internalizing, externalizing and dysregulation profile (DP) symptoms.

RESULTS

Normative modeling showed regional differences in developmental trajectories. Psychopathology symptoms were related to negative deviations from typical development for cortical volume in widespread regions of the cortex and subcortex, and to positive deviations from typical development for cortical thickness in the orbitofrontal, frontal pole, pericalcarine and posterior cingulate regions of the cortex.

DISCUSSION

Taken together, this study charts developmental curves across the cerebrum for (sub-)cortical volume and cortical thickness. Our findings show that psychopathology symptoms, are associated with widespread differences in brain development, in which those with DP symptoms are most heavily affected.

The Development of Externalizing and Internalizing Behaviors Among Youth With or Without a Family History of Substance Use Disorder: The Indirect Effects of Early-Life Stress and Impulsivity

Youth with a family history of substance use disorder (FH+) are more prone to have externalizing and internalizing problems compared to youth without a family history of substance use disorder (FH-), increasing the likelihood of later maladjustment. However, mechanisms for this association remain understudied. In this longitudinal study, we examined if FH+ youth are more likely to experience early-life stressors (ELS), which in turn would increase impulsivity and the expression of externalizing and internalizing behaviors. Data were collected from youth and a parent (n = 386) during a baseline assessment (age 10-12 years) and every six months when the youth was 13-16 years old. In support of the primary hypothesis, FH+ youth reported higher levels of externalizing and internalizing behaviors through ELS to impulsivity providing a developmental pathway through which FH+ youth are more prone to externalizing and internalizing problems.

Identifying profiles of brain structure and associations with current and future psychopathology in youth

Brain structure is often studied as a marker of youth psychopathology by examining associations between volume or thickness of individual regions and specific diagnoses. However, these univariate approaches do not address whether the effect of a particular region may depend on the structure of other regions. Here, we identified subgroups of individuals with distinct profiles of brain structure and examined how these profiles were associated with concurrent and future youth psychopathology. We used latent profile analysis to identify distinct neuroanatomical profiles of subcortical region volume and orbitofrontal cortical thickness in the ABCD study (N = 9376, mean age = 9.91, SD = 0.62). We identified a five-profile solution consisting of a reduced subcortical volume profile, a reduced orbitofrontal thickness profile, a reduced limbic and elevated striatal volume profile, an elevated orbitofrontal thickness and reduced striatal volume profile, and an elevated orbitofrontal thickness and subcortical volume profile. While controlling for age, sex, and intracranial volume, profiles exhibited differences in concurrent psychopathology measured dimensionally and categorically and in psychopathology at 1-year follow-up measured dimensionally. Results show that profiles of brain structure have incremental validity for associations with youth psychopathology beyond intracranial volume.

Contextualizing adolescent structural brain development: Environmental determinants and mental health outcomes

The spatiotemporal group-level patterns of brain macrostructural development are relatively well-documented. Current research emphasizes individual variability in brain development, including its causes and consequences. Although genetic factors and prenatal and perinatal events play critical roles, calls are now made to also study brain development in transactional interplay with the different aspects of an individual's physical and social environment. Such focus is highly relevant for research on adolescence, a period involving a multitude of contextual changes paralleled by continued refinement of complex cognitive and affective neural systems. Here, we discuss associations between selected aspects of an individual's physical and social environment and adolescent brain structural development and possible links to mental health. We also touch on methodological considerations for future research.

Mapping Pathways by Which Genetic Risk Influences Adolescent Externalizing Behavior: The Interplay Between Externalizing Polygenic Risk Scores, Parental Knowledge, and Peer Substance Use

Genetic predispositions and environmental influences both play an important role in adolescent externalizing behavior; however, they are not always independent. To elucidate gene-environment interplay, we examined the interrelationships between externalizing polygenic risk scores, parental knowledge, and peer substance use in impacting adolescent externalizing behavior across two time-points in a high-risk longitudinal sample of 1,200 adolescents (764 European and 436 African ancestry; Mage = 12.99) from the Collaborative Study on the Genetics of Alcoholism. Results from multivariate path analysis indicated that externalizing polygenic scores were directly associated with adolescent externalizing behavior but also indirectly via peer substance use, in the European ancestry sample. No significant polygenic association nor indirect effects of genetic risk were observed in the African ancestry group, likely due to more limited power. Our findings underscore the importance of gene-environment interplay and suggest peer substance use may be a mechanism through which genetic risk influences adolescent externalizing behavior.

Inter-individual variability in structural brain development from late childhood to young adulthood

A fundamental task in neuroscience is to characterize the brain’s developmental course. While replicable group-level models of structural brain development from childhood to adulthood have recently been identified, we have yet to quantify and understand individual differences in structural brain development. The present study examined inter-individual variability and sex differences in changes in brain structure, as assessed by anatomical MRI, across ages 8.0–26.0 years in 269 participants (149 females) with three time points of data (807 scans), drawn from three longitudinal datasets collected in the Netherlands, Norway, and USA. We further investigated the relationship between overall brain size and developmental changes, as well as how females and males differed in change variability across development. There was considerable inter-individual variability in the magnitude of changes observed for all examined brain measures. The majority of individuals demonstrated decreases in total gray matter volume, cortex volume, mean cortical thickness, and white matter surface area in mid-adolescence, with more variability present during the transition into adolescence and the transition into early adulthood. While most individuals demonstrated increases in white matter volume in early adolescence, this shifted to a majority demonstrating stability starting in mid-to-late adolescence. We observed sex differences in these patterns, and also an association between the size of an individual’s brain structure and the overall rate of change for the structure. The present study provides new insight as to the amount of individual variance in changes in structural morphometrics from late childhood to early adulthood in order to obtain a more nuanced picture of brain development. The observed individual- and sex-differences in brain changes also highlight the importance of further studying individual variation in developmental patterns in healthy, at-risk, and clinical populations.

Cortical Correlates of Impulsive Aggressive Behavior in Pediatric Bipolar Disorder

Background: Impulsive aggression represents a frequent characteristic of pediatric bipolar disorder (PBD). Cortical alterations associated with impulsive aggression and its multiple facets have not been investigated yet in youth with bipolar disorder. Aim: To investigate the relationship between cortical thickness and facets of impulsive aggression in youth with PBD. Materials and Methods: Twenty-three youth with PBD and 23 healthy controls (HC) were administered the aggression questionnaire (AQ) and underwent 3T magnetic resonance imaging scan. Cortical thickness was assessed with FreeSurfer. Canonical correlation analyses were used to investigate the relationship between AQ total and subscale scores and cortical thickness in youth with PBD. Results: Youth with PBD had increased scores in the subscales of AQ-anger and AQ-hostility and cortical thinning in in areas belonging to the affective network (AN), frontoparietal network (FPN) and cingulo-opercular network (CON), i.e., right rostral anterior cingulate, right caudal anterior cingulate, right lateral orbitofrontal, right medial orbitofrontal, left and right inferior parietal, left posterior cingulate, left and right supramarginal left lingual cortices. Greater thickness in these networks positively correlated with the AQ-hostility subscale and negatively correlated with AQ-anger subscale. Conclusions: The opposite patterns observed between areas belonging to AN, FPN, CON, and the two facets of IA, namely anger and hostility, corroborate clinical findings supporting the different nature of these two constructs.

The longitudinal association between externalizing behavior and frontoamygdalar resting-state functional connectivity in late adolescence and young adulthood

BACKGROUND

Externalizing behavior has been attributed, in part, to decreased frontolimbic control over amygdala activation. However, little is known about developmental trajectories of frontoamygdalar functional connectivity and its relation to externalizing behavior. The present study addresses this gap by examining longitudinal associations between adolescent and adult externalizing behavior and amygdala-anterior cingulate cortex (ACC) and amygdala-orbitofrontal cortex (OFC) resting-state functional connectivity in a sample of 111 typically developing participants aged 11-23 at baseline.

METHODS

Participants completed two-to-four data waves spaced approximately two years apart, resulting in a total of 309 data points. At each data wave, externalizing behavior was measured using the Externalizing Behavior Broadband Scale from the Achenbach Youth/Adult Self-Report questionnaire. Resting-state fMRI preprocessing was performed using FSL. Amygdala functional connectivity was examined using AFNI. The longitudinal association between externalizing behavior and amygdala-ACC/OFC functional connectivity was examined using linear mixed effect models in R.

RESULTS

Externalizing behavior was associated with increased amygdala-ACC and amygdala-OFC resting-state functional connectivity across adolescence and young adulthood. For amygdala-ACC connectivity, externalizing behavior at baseline primarily drove this association, whereas for amygdala-OFC functional connectivity, change in externalizing behavior relative to baseline drove the main effect of externalizing behavior on amygdala-OFC functional connectivity. No evidence was found for differential developmental trajectories of frontoamygdalar connectivity for different levels of externalizing behavior (i.e., age-by-externalizing behavior interaction effect).

CONCLUSIONS

Higher externalizing behavior is associated with increased resting-state attunement between the amygdala and ACC/OFC, perhaps indicating a generally more vigilant state for neural networks important for emotional processing and control.

Motor Vehicle Collisions during Adolescence: The Role of Alexithymic Traits and Defense Strategies

International literature has shown that adolescents represent the population most at risk of fatal and nonfatal motor vehicle collisions (MVCs). Adolescents’ alexithymic traits and significant use of immature defense strategies have been seen to play a key role. This study aimed to investigate the possible mediation role played by defense strategies use in the relationship between alexithymia and MVCs. Our sample consisted of 297 adolescents divided into four subgroups, based on the number of visits to the emergency department due to an MVC. We assessed adolescents’ alexithymic traits and defense strategies use through self-report instruments. Results showed that males reported a higher rate of MVCs than females. Higher rates of MVCs are associated with more alexithymic traits and maladaptive defense strategies use. Adolescents’ Acting Out and Omnipotence use significantly mediated the relationship between alexithymia and MVCs. Our findings suggest the recidivism of MVCs as an attempt to cope with emotional difficulties, with important clinical implications.

Structural Brain Development and Aggression: A Longitudinal Study in Late Childhood

This longitudinal study examined the neurodevelopmental correlates of aggression in children, focusing on structural brain properties. A community sample of 110 (60 females) children participated at age 8 years and again at age 10 years. Brain structure was assessed by using magnetic resonance imaging (MRI), and parents reported on child aggression using the Child Behavior Checklist. Analyses examined the relationship between aggression and development of volume of subcortical regions, cortical thickness, and subcortical-cortical structural coupling. Females with relatively high aggression exhibited reduced right hippocampal growth over time. Across males and females, aggression was associated with amygdala- and hippocampal-cortical developmental coupling, with findings for amygdala-cortical coupling potentially indicating reduced top-down prefrontal control of the amygdala in those with increasing aggression over time. Findings suggest that aggressive behaviors may be associated with alterations in normative brain development; however, results were not corrected for multiple comparisons and should be interpreted with caution.

Sex differences in medial prefrontal and parietal cortex structure in children with disruptive behavior

Sex differences in brain structure in children with disruptive behavior disorders (DBD) remain poorly understood. This study examined sex differences in gray matter volume in children with DBD in a priori regions-of-interest implicated in the pathophysiology of disruptive behavior. We then conducted a whole-brain analysis of cortical thickness to examine sex differences in regions not included in our hypothesis. Exploratory analyses investigated unique associations between structure, and dimensional measures of severity of disruptive behavior and callous-unemotional traits. This cross-sectional study included 88 children with DBD (30 females) aged 8-16 years and 50 healthy controls (20 females). Structural MRI data were analyzed using surface-based morphometry to test for interactions between sex and group. Multiple-regression analyses tested for sex-specific associations between structure, callous-unemotional traits, and disruptive behavior severity. Boys with DBD showed reduced gray matter volume in the left ventromedial prefrontal cortex (vmPFC) and reduced cortical thickness in the supramarginal gyrus, but not girls compared to respective controls. Dimensional analyses revealed associations between sex, callous-unemotional traits, and disruptive behavior for amygdala and vmPFC volume, and ventrolateral prefrontal cortex cortical thickness. Sex-specific differences in prefrontal structures involved in emotion regulation may support identification of neural biomarkers of disruptive behavior to inform target-based treatments.

Cognitive reappraisal and expressive suppression relate differentially to longitudinal structural brain development across adolescence

Emotional disorders commonly emerge in adolescence, a period characterized by changes in emotion-related processes. Thus, the ability to regulate emotions is crucial for well-being and adaptive social functioning during this period. Concurrently, the brain undergoes large structural and functional changes. We investigated relations between tendencies to use two emotion regulation strategies, cognitive reappraisal and expressive suppression, and structural development of the cerebral cortex and subcortical structures (specifically amygdala and nucleus accumbens given these structures are frequently associated with emotion regulation). A total of 112 participants (59 females) aged 8-26 were followed for up to 3 times over a 7-year period, providing 272 observations. Participants completed the Emotion Regulation Questionnaire (ERQ), yielding a measure of tendencies to use cognitive reappraisal and expressive suppression at the final time point. Linear mixed model analyses were performed to account for the longitudinal nature of the data. Contrary to expectations, volumetric growth of the amygdala and nucleus accumbens was not associated with either emotion regulation strategy. However, frequent use of expressive suppression was linked to greater regionally-specific apparent cortical thinning in both sexes, while tendency to use cognitive reappraisal was associated with greater regionally-specific apparent thinning in females and less thinning in males. Although cognitive reappraisal is traditionally associated with cognitive control regions of the brain, our results suggest it is also associated with regions involved in social cognition and semantics. The continued changes in cortical morphology and their associations with habitual use of different emotion regulation strategies indicate continued plasticity during this period, and represent an opportunity for interventions targeting emotion regulation for adolescents at risk.

The Effect of Smoking during Pregnancy on Severity and Directionality of Externalizing and Internalizing Symptoms: A Genetically Informed Approach

The objective was to examine the association between maternal smoking during pregnancy (SDP) and (I) severity and (II) directionality of externalizing and internalizing symptoms in a sample of sibling pairs while rigorously controlling for familial confounds. The Missouri Mothers and Their Children Study is a family study (N = 173 families) with sibling pairs (aged 7 to 16 years) who are discordant for exposure to SDP. This sibling comparison study is designed to disentangle the effects of SDP from familial confounds. An SDP severity score was created for each child using a combination of SDP indicators (timing, duration, and amount). Principal component analysis of externalizing and internalizing behavior, assessed with the Child Behavior Checklist and Teacher Report Form, was used to create symptom severity and directionality scores. The variance in severity and directionality scores was primarily a function of differences between siblings (71% and 85%, respectively) rather than differences across families (29% and 15%, respectively). The severity score that combines externalizing and internalizing symptom severity was not associated with SDP. However, a significant within-family effect of SDP on symptom directionality (b = 0.07, p = 0.04) was observed in the sibling comparison model. The positive directionality score indicates that SDP is associated with differentiation of symptoms towards externalizing rather than internalizing symptoms after controlling for familial confounds with a sibling comparison model. This supports a potentially causal relationship between SDP and externalizing behavior.

Transactional relations between developmental trajectories of executive functioning and internalizing and externalizing symptomatology in adolescence

Adolescence is a period of social, physical, and neurobiological transitions that may leave individuals more vulnerable to the development of internalizing and externalizing symptomatology. Extant research demonstrates that executive functioning (EF) is associated with psychopathology outcomes in adolescence; however, it has yet to be examined how EF and psychopathology develop transactionally over time. Data were collected from 167 adolescents (47% female, 13-14 years old at Time 1) and their primary caregiver over 4 years. At each time point, adolescents completed three behavioral tasks that capture the underlying dimensions of EF, and both adolescents and their primary caregiver completed measures of adolescent psychopathology. Latent growth curve modeling was used to test the associations between initial levels and trajectories of EF and psychopathology. Results indicated that higher initial levels of internalizing and externalizing symptomatology were associated with lower EF at Time 4 (controlling for Time 1 EF). Initial levels of EF did not predict changes in internalizing and externalizing symptomatology. These findings suggest that early psychopathology may be a risk factor for maladaptive EF development in adolescence.

Cortical thickness of the insula and prefrontal cortex relates to externalizing behavior: Cross-sectional and prospective findings

Externalizing behaviors (EBs) pertain to a diverse set of aggressive, antisocial, and potentially destructive behaviors directed toward the external environment. They range from nonclinical to clinical in severity, associated with opposition, aggression, hyperactivity, or impulsivity, and are considered a risk factor for the emergence of psychopathology later in adulthood. Focusing on community adolescents (N = 102; 49 female and 53 male adolescents; age range 12-19 years), this study aimed to explore the relations between EBs and the cortical thickness of regions of interest as well as to identify possible risk markers that could improve understanding of the EB construct. Using a mixed cross-sectional and prospective design (1-year follow-up), we report specific associations with cortical thickness of the left insular, right orbitofrontal, and left anterior cingulate cortex. Specifically, thinner left insular and right orbitofrontal cortex was associated with higher EBs, and thinner left anterior cingulate cortex predicted less reduction in EBs 1 year later. In addition, further examination of the aggression and rule-breaking subscales of the Youth/Adult Self-Report, used to assess EBs, revealed specific associations with insular subregions. Findings suggest that cortical structure morphology may significantly relate to the expression and maintenance of EBs within the general population of adolescents.

Genetic and environmental influences on structure of the social brain in childhood

Prosocial behavior and empathy are important aspects of developing social relations in childhood. Prior studies showed protracted structural development of social brain regions associated with prosocial behavior. However, it remains unknown how structure of the social brain is influenced by genetic or environmental factors, and whether overlapping heritability factors explain covariance in structure of the social brain and behavior. The current study examined this hypothesis in a twin sample (aged 7–9-year; N = 512). Bilateral measures of surface area and cortical thickness of the medial prefrontal cortex (mPFC), temporo-parietal junction (TPJ), posterior superior temporal sulcus (pSTS), and precuneus were analyzed. Results showed genetic contributions to surface area and cortical thickness for all brain regions. We found additional shared environmental influences for TPJ, suggesting that this region might be relatively more sensitive to social experiences. Genetic factors also influenced parent-reported prosocial behavior (A = 45%) and empathy (A = 59%). We provided initial evidence that the precuneus shares genetically determined variance with empathy, suggesting a possible small genetic overlap (9%) in brain structure and empathy. These findings show that structure of the social brain and empathy are driven by a combination of genetic and environmental factors, with some factors overlapping for brain structure and behavior.

Internalizing and Externalizing Symptoms Are Associated With Different Trajectories of Cortical Development During Late Childhood

OBJECTIVE

Investigation of neurobiological differences between internalizing and externalizing symptoms in children is needed to better understand the unique pathophysiology of each, which may ultimately better target treatments and interventions. Longitudinal studies are critical, given the marked brain development that occurs in childhood; however, few such studies exist, and results are inconsistent. The aim of this study was to longitudinally investigate associations between internalizing and externalizing symptoms, and cortical thinning during late childhood.

METHOD

Participants were 105 children (49 male) from the community, who underwent magnetic resonance imaging (MRI) brain scans, and completed questionnaire measures of depressive and anxiety symptoms at two time points (mean age: 8.4 years at baseline, 10.0 years at follow-up); and, mothers, who reported on child internalizing and externalizing symptoms at both time points. Whole-brain vertex-wise regression analyses were performed to assess associations between change in cortical thickness and symptoms between baseline and follow-up.

RESULTS

Increases in internalizing symptoms over time were associated with reduced thinning in the orbitofrontal cortex, whereas increases in externalizing symptoms were associated with reduced thinning in the postcentral gyrus. The interaction between internalizing and externalizing symptom change was not associated with cortical thinning.

CONCLUSION

Results suggest that the development of internalizing and externalizing symptoms are associated with unique neurodevelopmental patterns in late childhood, potentially implicating differential deficits in affective reactivity, emotion regulation, and social cognition. Further research is required to elucidate the implications of these patterns for ongoing brain development, psychopathology, and behavior.