Adolescents' Neural Processing of Risky Decisions: Effects of Sex and Behavioral Disinhibition

Sex differences in Cingulo-Opercular activation during risky decision-making in youth with externalizing disorders

BACKGROUND

Risky decision-making deficits predict unsafe behaviors, but sex differences in decision-making are underexplored in high-risk youth with externalizing disorders. While boys with externalizing pathology are more likely to make risky decisions, it remains unclear how these patterns manifest in girls, whose brains may process risks differently. Our study investigates sex differences in risky decision-making neurobiological activation among at-risk adolescents to identify sex-specific vulnerabilities for risky behaviors.

METHOD

168 adolescents divided into four groups of 81 externalizing males, 39 externalizing females, 33 control males, and 15 control females completed a risky decision-making task, the Balloon Analog Risk Task, during functional magnetic resonance imaging.

RESULTS

Our primary finding was that externalizing males showed greater activation in the right dorsomedial prefrontal cortex/dorsal anterior cingulate cortex as the chance of a balloon explosion increased while making riskier choices over safer choices, compared to all other groups.

CONCLUSIONS

These findings highlight key sex differences in the neurobiology of risky decision-making in youth with externalizing psychopathology within the cingulo-opercular network. With this network's involvement in cognitive control and impulse inhibition-functions critical for managing risky behaviors-understanding its role in the interaction between sex and externalizing disorders is crucial for targeted, sex-specific interventions preventing risky behaviors.

Interplay Among Self-Regulation Processes Over Time for Adolescents in the Context of Chronic Stress

Developmental changes in self-regulation are theorized to underlie adolescents' engagement in risky behaviors, physical health, mental health, and transition to adulthood. Two central processes involved in self-regulation, self-management (i.e., planning, concentration, and problem-solving) and disinhibition (e.g., distractibility and impulsivity) appear to develop asynchronously and may be differentially activated based on contextual factors. Using a sample identified based on exposure to chronic stressors, we investigated how changes in self-management and disinhibition affect each other over time and whether these changes occur differently for boys and girls. Youth aged 8-16 (N = 708) who attended a U.S. summer camp self-reported on components of disinhibition and self-management. Cross-lagged structural equation modeling revealed a reciprocal relationship between self-management and disinhibition, with anger coping and distractibility emerging as critical factors in shaping this relationship. Changes in concentration, planning, and problem-solving were components of self-management that drove subsequent changes in boys' disinhibition (for girls, however, planning did not). Autocorrelations for both broad processes remained strong from year to year, indicating a high degree of stability in rank order despite the myriad of physical, cognitive and socioemotional changes that occur during adolescence. We discuss implications of the reciprocal model with a focus on the relative pliability of components from each process and strategies for shaping them. Planning, concentration and distractibility are highlighted as potential targets for intervention.

Associations Between Adolescents' Social Re-orientation Toward Peers Over Caregivers and Neural Response to Teenage Faces

Adolescence is a period of intensive development in body, brain, and behavior. Potentiated by changes in hormones and neural response to social stimuli, teenagers undergo a process of social re-orientation away from their caregivers and toward expanding peer networks. The current study examines how relative relational closeness to peers (compared to parents) during adolescence is linked to neural response to the facial emotional expressions of other teenagers. Self-reported closeness with friends (same- and opposite-sex) and parents (mother and father), and neural response to facial stimuli during fMRI, were assessed in 8- to 19-year-old typically developing youth (n = 40, mean age = 13.90 years old, SD = 3.36; 25 female). Youth who reported greater relative closeness with peers than with parents showed decreased activation in the dorsolateral prefrontal cortex (dlPFC) during stimulus presentation, which may reflect lessened inhibitory control or regulatory response to peer-aged faces. Functional connectivity between the dlPFC and dorsal striatum was greatest in older youth who were closer to peers; in contrast, negative coupling between these regions was noted for both younger participants who were closer to peers and older participants who were closer to their parents. In addition, the association between relative closeness to peers and neural activation in regions of the social brain varied by emotion type and age. Results suggest that the re-orientation toward peers that occurs during adolescence is accompanied by changes in neural response to peer-aged social signals in social cognitive, prefrontal, and subcortical networks.

Neural Correlates of Risk Processing Among Adolescents: Influences of Parental Monitoring and Household Chaos

Adolescent risky behavior is related to developmental changes in decision-making processes and their neural correlates. Yet, research investigating how the family environment relates to risk processing in the adolescent brain is limited. In this study, longitudinal data were collected from 167 adolescents (13-15 years, 53% male) who self-reported household chaos and their parent's monitoring practices, and completed a decision-making task during functional MRI at Time 1 and Time 2 (1 year apart). Parental knowledge was positively related to insular risk processing only among adolescents in low-chaos environments at both time points. Results highlight environmental correlates of insular risk processing in the developing brain.

Sex differences in animal models of decision making

The ability to weigh the costs and benefits of various options to make an adaptive decision is critical to an organism's survival and wellbeing. Many psychiatric diseases are characterized by maladaptive decision making, indicating a need for better understanding of the mechanisms underlying this process and the ways in which it is altered under pathological conditions. Great strides have been made in uncovering these mechanisms, but the majority of what is known comes from studies conducted solely in male subjects. In recent years, decision-making research has begun to include female subjects to determine whether sex differences exist and to identify the mechanisms that contribute to such differences. This Mini-Review begins by describing studies that have examined sex differences in animal (largely rodent) models of decision making. Possible explanations, both theoretical and biological, for such differences in decision making are then considered. The Mini-Review concludes with a discussion of the implications of sex differences in decision making for understanding psychiatric conditions. © 2016 Wiley Periodicals, Inc.

Brain circuitry associated with the development of substance use in bipolar disorder and preliminary evidence for sexual dimorphism in adolescents

Substance use disorders and mood disorders are highly comorbid and confer a high risk for adverse outcomes. However, data are limited on the neurodevelopmental basis of this comorbidity. Substance use initiation typically occurs during adolescence, and sex-specific developmental mechanisms are implicated. In this preliminary study, we review the literature and investigate regional gray matter volume (GMV) associated with subsequent substance use problems in adolescents with bipolar disorder (BD) and explore these associations for females and males. Thirty adolescents with DSM-IV-diagnosed BD and minimal alcohol/substance exposure completed baseline structural magnetic resonance imaging scans. At follow-up (on average 6 years post baseline), subjects were administered the CRAFFT interview and categorized into those scoring at high ( ≥ 2: CRAFFT_HIGH ) vs. low ( < 2: CRAFFT_LOW ) risk for alcohol/substance problems. Lower GMV in prefrontal, insular, and temporopolar cortices were observed at baseline among adolescents with BD reporting subsequent alcohol and cannabis use compared to adolescents with BD who did not (P < 0.005, clusters ≥ 20 voxels). Lower dorsolateral prefrontal GMV was associated with future substance use in both females and males. In females, lower orbitofrontal and insula GMV was associated with future substance use, while in males, lower rostral prefrontal GMV was associated with future use. Lower orbitofrontal, insular, and temporopolar GMV was observed in those who transitioned to smoking tobacco. Findings indicate that GMV development is associated with risk for future substance use problems in adolescents with BD, with results implicating GMV development in regions subserving emotional regulation in females and regions subserving executive processes and attention in males. © 2016 Wiley Periodicals, Inc.

Heightened activity in social reward networks is associated with adolescents' risky sexual behaviors

Adolescent sexual risk behavior can lead to serious health consequences, yet few investigations have addressed its neurodevelopmental mechanisms. Social neurocircuitry is postulated to underlie the development of risky sexual behavior, and response to social reward may be especially relevant. Typically developing adolescents (N=47; 18M, 29F; 16.3±1.4years; 42.5% sexual intercourse experience) completed a social reward fMRI task and reported their sexual risk behaviors (e.g., lifetime sexual partners) on the Youth Risk Behavior Survey (YRBS). Neural response and functional connectivity to social reward were compared for adolescents with higher- and lower-risk sexual behavior. Adolescents with higher-risk sexual behaviors demonstrated increased activation in the right precuneus and the right temporoparietal junction during receipt of social reward. Adolescents with higher-risk sexual behaviors also demonstrated greater functional connectivity between the precuneus and the temporoparietal junction bilaterally, dorsal medial prefrontal cortex, and left anterior insula/ventrolateral prefrontal cortex. The greater activation and functional connectivity in self-referential, social reward, and affective processing regions among higher sexual risk adolescents underscores the importance of social influence underlying sexual risk behaviors. Furthermore, results suggest an orientation towards and sensitivity to social rewards among youth engaging in higher-risk sexual behavior, perhaps as a consequence of or vulnerability to such behavior.

Children's brain activation during risky decision-making: A contributor to substance problems?

OBJECTIVE

Among young children excessive externalizing behaviors often predict adolescent conduct and substance use disorders. Adolescents with those disorders show aberrant brain function when choosing between risky or cautious options. We therefore asked whether similarly aberrant brain function during risky decision-making accompanies excessive externalizing behaviors among children, hypothesizing an association between externalizing severity and regional intensity of brain activation during risky decision-making.

METHOD

Fifty-eight (58) 9-11 year-old children (both sexes), half community-recruited, half with substance-treated relatives, had parent-rated Child Behavior Checklist Externalizing scores. During fMRI, children repeatedly chose between doing a cautious behavior earning 1 point or a risky behavior that won 5 or lost 10 points. Conservative permutation-based whole-brain regression analyses sought brain regions where, during decision-making, activation significantly associated with externalizing score, with sex, and with their interaction.

RESULTS

Before risky responses higher externalizing scores were significantly, negatively associated with neural activation (t's: 2.91-4.76) in regions including medial prefrontal cortex (monitors environmental reward-punishment schedules), insula (monitors internal motivating states, e.g., hunger, anxiety), dopaminergic striatal and midbrain structures (anticipate and mediate reward), and cerebellum (where injuries actually induce externalizing behaviors). Before cautious responses there were no significant externalizing:activation associations (except in post hoc exploratory analyses), no significant sex differences in activation, and no significant sex-by-externalizing interactions.

CONCLUSIONS

Among children displaying more externalizing behaviors extensive decision-critical brain regions were hypoactive before risky behaviors. Such neural hypoactivity may contribute to the excessive real-life risky decisions that often produce externalizing behaviors. Substance exposure, minimal here, was a very unlikely cause.

Risk-Taking Propensity in Older Adolescents: Internalizing Symptoms, Gender, and Negative Reinforcement

OBJECTIVE

Engagement in risk behaviors, including substance use, risky sex, and violence, tends to increase throughout adolescence into young adulthood. One motivational process that may underlie risk behaviors during adolescence is negative reinforcement. Moreover, gender and internalizing symptoms (e.g., depression and anxiety) may both convey risk for negative reinforcement-based risk taking. Along these lines, the aims of the current study were to (a) examine gender differences in negative reinforcement-based risk-taking propensity and (b) examine internalizing symptoms as a moderator of the relationship between gender and negative reinforcement-based risk-taking propensity.

METHOD

Participants included 103 youth between the ages of 18 and 21 (50.49% female, age M(SD) = 19.41(1.06)) who were recruited from a large Mid-Atlantic university between September 2013 and November 2014. Participants completed self-report assessments of internalizing symptomatology and a computerized behavioral analog assessment of negative reinforcement-based risk-taking propensity.

RESULTS

Results indicated that, overall, female older adolescents were riskier under conditions of negative reinforcement than male older adolescents. In addition, internalizing symptoms significantly moderated the relationship between gender and negative reinforcement-based risk-taking propensity such that the relationship between gender and negative reinforcement-based risk-taking propensity was nonsignificant at high levels of internalizing symptoms, and female gender was significantly positively predictive of heightened negative reinforcement-based risk-taking propensity at low levels of internalizing symptoms.

CONCLUSIONS

Thus, although female youth overall were riskier, the predictive utility of gender for negative reinforcement-based risk taking may be most relevant at low levels of internalizing symptoms. Results are discussed in terms of implications for future prevention and intervention.

Human Papillomavirus Vaccination and Sexual Disinhibition in Females: A Systematic Review

CONTEXT

Some parents believe human papillomavirus (HPV) vaccination increases the chance of risky sexual behaviors among adolescents. This review summarizes the evidence available on adolescent girls and women engaging in risky sexual activity following HPV vaccination.

EVIDENCE ACQUISITION

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in 2014 and updated in 2015. Literature was searched for articles published between 2004 and 2015 in MEDLINE, PsycInfo, CINAHL, Cochrane Database, Web of Science, and EMBASE without language limits. Studies were screened according to predefined inclusion and exclusion criteria. Methodologic quality of the included articles was assessed.

EVIDENCE SYNTHESIS

The search resulted in 21 articles to be included in the review, with 527,475 participants. Included studies were conducted in 12 different countries using experimental and observational study designs. The review included data on girls aged as young as 11 years to women aged 40 years. Studies measured changes in sexual behaviors using a variety of outcomes, including age at sexual debut; risky sexual behaviors; use of condoms and contraception; and clinical indicators such as rates of sexually transmitted infections, HIV, and pregnancy terminations. Available data showed either no association between vaccination status and the outcomes of interest or a positive association between safer sexual behaviors, such as condom use and receipt of HPV vaccination. Methodologic quality of all but one study was moderate or weak.

CONCLUSIONS

This review did not find sufficient evidence to support compensatory sexual risk behaviors following HPV vaccination among adolescent girls or women.

Brain Cortical Thickness Differences in Adolescent Females with Substance Use Disorders

Some youths develop multiple substance use disorders early in adolescence and have severe, persistent courses. Such youths often exhibit impulsivity, risk-taking, and problems of inhibition. However, relatively little is known about the possible brain bases of these behavioral traits, especially among females.

A Behavioral Measure of Costly Helping: Replicating and Extending the Association with Callous Unemotional Traits in Male Adolescents

BACKGROUND

Some conduct-disordered youths have high levels of callous unemotional traits and meet the DSM-5's "with limited prosocial emotions" (LPE) specifier. These youths often do aggressive, self-benefitting acts that cost others. We previously developed a task, the AlAn's game, which asks participants to repeatedly decide whether to accept or reject offers in which they will receive money but a planned charity donation will be reduced. In our prior work, more "costly helping" (i.e., rejecting the offered money and protecting the donation) was associated with lower callous unemotional traits. Here we extend that prior work in a larger sample of adolescent male patients with serious conduct problems and controls, and test whether this association is mediated specifically by a Moral Elevation response (i.e., a positive emotional response to another's act of virtue).

METHODS

The adolescent male participants were: 45 patients (23 with LPE) and 26 controls, who underwent an extensive phenotypic assessment including a measure of Moral Elevation. About 1 week later participants played the AlAn's game.

RESULTS

All AlAn's game outcomes demonstrated significant group effects: (1) money taken for self (p = 0.02); (2) money left in the charitable donation (p = 0.03); and, (3) costly helping (p = 0.047). Controls took the least money and did the most costly helping, while patients with LPE took the most money and did the least costly helping. Groups also significantly differed in post-stimulus Moral Elevation scores (p = 0.005). Exploratory analyses supported that the relationship between callous unemotional traits and costly helping on the AlAn's game may be mediated in part by differences in Moral Elevation.

CONCLUSIONS

The AlAn's game provides a standardized behavioral measure associated with callous unemotional traits. Adolescents with high levels of callous unemotional traits engage in fewer costly helping behaviors, and those differences may be related to blunting of positive emotional responses.