Reciprocal Effects Between Negative Parenting and Children's Callous-Unemotional Traits From Mid to Late Childhood

OBJECTIVE

The role of negative parenting in the development of callous-unemotional (CU) traits remains unclear. Both negative parenting and CU traits are influenced by genetic and environmental factors. The authors used genetically informed longitudinal cross-lagged models to examine the extent to which reciprocal effects between negative parenting and children's CU traits in mid-to-late childhood are genetic versus environmental in origin.

METHODS

In 9,260 twin pairs from the Twins Early Development Study, the authors estimated cross-lagged effects between negative parenting (discipline and feelings) and children's CU traits in mid (ages 7-9) and late (ages 9-12) childhood.

RESULTS

CU traits were strongly heritable and stable. Stability was explained largely by genetic factors. The influence of negative parenting on the development of CU traits was small and driven mostly by genetic and shared environmental factors. In mid childhood, the influence of children's CU traits on subsequent negative parenting (i.e., evoked by children's CU traits) was also small and mostly genetic in origin. In late childhood, CU traits showed no effects on negative parental discipline and small effects on negative parental feelings, which reflected mostly shared environmental factors.

CONCLUSIONS

In mid-to-late childhood, genetic factors strongly influenced the development of CU traits, whereas environmental effects of negative parenting were small. Negative parenting was also relatively unaffected by CU traits. The small reciprocal effects originated mostly from genetic and shared environmental factors. Therefore, repeated intensive interventions addressing multiple risk factors rather than negative parenting alone may be best positioned to support families of children with CU traits across development.

An 'embedded brain' approach to understanding antisocial behaviour

Antisocial behaviour (ASB) incurs substantial costs to the individual and society. Cognitive neuroscience has the potential to shed light on developmental risk for ASB, but it cannot achieve this potential in an 'essentialist' framework that focuses on the brain and cognition isolated from the environment. Here, we present the case for studying the social transactional and iterative unfolding of brain and cognitive development in a relational context. This approach, which we call the study of the 'embedded brain', is needed to fully understand how risk for ASB arises during development. Concentrated efforts are required to develop and unify methods to achieve this approach and reap the benefits for improved prevention and intervention of ASB.

Parenting boys with conduct problems and callous-unemotional traits: parent and child perspectives

Parenting children with conduct problems (CP) is challenging, yet very little research has examined parenting using both quantitative and qualitative methods, from the perspective of the child and their parent/caregiver, and separately for those with high vs. low levels of callous-unemotional traits (HCU vs. LCU). One hundred and forty-six boys aged 11-16 [Typically developing (TD) n = 31; CP/HCU n = 35; CP/LCU n = 35] and their parents/caregivers completed the Alabama Parenting Questionnaire and provided a written qualitative statement describing their respective experiences of parenting/being parented. Parents/caregivers of CP/HCU boys reported more difficulty with child monitoring and supervision than parents of TD boys. This was echoed in qualitative reports of parents of CP/HCU boys reporting concerns regarding their child's safety. Parents/caregivers of both groups of CP boys reported more inconsistent discipline than parents of TD boys. Parental qualitative descriptions of challenging behavior in CP/HCU boys, and difficulties with setting boundaries and motivating CP/LCU boys, provided further insight to the potential triggers for inconsistent discipline. Qualitative reports from boys with CP indicated that they understood the parenting challenges their parents/caregivers faced. These findings replicate and extend previous work on the associations between parenting and CP. Children with CP/HCU and CP/LCU show some commonalities and differences in their parenting experiences and CP children and their parents/caregivers do not necessarily share all the same perceptions or concerns. CP interventions often involve parent/family engagement and this research highlights the continued importance of examining both parent and child perspectives.

Child Maltreatment, Peer Victimization, and Mental Health: Neurocognitive Perspectives on the Cycle of Victimization

Children who experience maltreatment are at increased risk of revictimization across the life span. In childhood, this risk often manifests as peer victimization. Understanding the nature of this risk, and its impact on mental health, is critical if we are to provide effective support for those children who are most vulnerable. A systematic scoping review was conducted using Google Scholar and PsycINFO. Studies on adults, psychiatric, and/or inpatient populations were excluded. Included studies concerned all forms of child maltreatment and peer victimization. We found 28 studies about the association between maltreatment experience and peer victimization as well as peer rejection. We review the evidence documenting the relation between these adverse childhood experiences and mental health. The evidence suggests that maltreatment and peer victimization have additive effects on mental health outcomes. A number of theoretical developmental frameworks that delineate putative mechanisms that might account for an association are considered. Building on prior research, we then discuss the role of recent neurocognitive findings in providing a multilevel framework for conceptualizing mental health vulnerability following maltreatment. In addition, we consider how altered neurocognitive functioning following maltreatment may shed light on why affected children are more likely to be victimized by their peers. Specifically, we consider the threat, reward, and autobiographical memory systems and their role in relation to stress generation, stress susceptibility, and social thinning. Such a mechanistic understanding is necessary if we are to reduce the likelihood of peer victimization in children exposed to maltreatment, and move to a preventative model of mental health care.

A genetically informed Registered Report on adverse childhood experiences and mental health

Children who experience adversities have an elevated risk of mental health problems. However, the extent to which adverse childhood experiences (ACEs) cause mental health problems remains unclear, as previous associations may partly reflect genetic confounding. In this Registered Report, we used DNA from 11,407 children from the United Kingdom and the United States to investigate gene-environment correlations and genetic confounding of the associations between ACEs and mental health. Regarding gene-environment correlations, children with higher polygenic scores for mental health problems had a small increase in odds of ACEs. Regarding genetic confounding, elevated risk of mental health problems in children exposed to ACEs was at least partially due to pre-existing genetic risk. However, some ACEs (such as childhood maltreatment and parental mental illness) remained associated with mental health problems independent of genetic confounding. These findings suggest that interventions addressing heritable psychiatric vulnerabilities in children exposed to ACEs may help reduce their risk of mental health problems.

Trust and childhood maltreatment: evidence of bias in appraisal of unfamiliar faces

BACKGROUND

Child maltreatment is associated with poorer social functioning and increased risk of mental health problems in adolescence and adulthood, but the processes underlying these associations remain unclear. Although crucial for establishing and maintaining relationships, trust judgements have not been experimentally investigated in children who have experienced abuse and neglect.

METHODS

A community-based sample of 75 children aged 8-16 years with maltreatment documented on the basis of social services records, and a group of 70 peers matched on age, gender, cognitive ability, socioeconomic status, and ethnicity took part in the study. Children completed a trustworthiness face-judgement task in which they appraised the trustworthiness of unfamiliar facial stimuli varying along a computationally modelled trustworthiness dimension.

RESULTS

In line with clinical observations that childhood maltreatment is associated with an atypical pattern of trust processing, children with maltreatment experience were significantly less likely than their peers to rate unfamiliar faces as trustworthy. Moreover, they were more variable in their trust attributions than their peers.

CONCLUSIONS

The study provides compelling experimental evidence that children with documented maltreatment perceive others as less trustworthy than their peers and are less consistent in their estimates of trustworthiness in others. Over time, alterations in trust processing may disrupt the development of social bonds and contribute to 'social thinning' (a reduction in the extent and quality of social relationships), leaving children more vulnerable to environmental stressors, increasing risk of mental health difficulties.

Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database

OBJECTIVES

To investigate the extent of antipsychotic prescribing to people with recorded personality disorder (PD) in UK primary care and factors associated with such prescribing.

DESIGN

Retrospective cohort study.

SETTING

General practices contributing to The Health Improvement Network UK-wide primary care database, 1 January 2000-31 December 2016.

PARTICIPANTS

46 210 people registered with participating general practices who had a record of PD in their general practice notes. 1358 (2.9%) people with missing deprivation information were excluded from regression analyses; no other missing data.

MAIN OUTCOME MEASURES

Prescriptions for antipsychotics in general practice records and length of time in receipt of antipsychotic prescriptions.

RESULTS

Of 46 210 people with recorded PD, 15 562 (34%) were ever prescribed antipsychotics. Among the subgroup of 36 875 people with recorded PD, but no recorded severe mental illness (SMI), 9208 (25%) were prescribed antipsychotics; prescribing was lower in less deprived areas (adjusted rate ratio (aRR) comparing least to most deprived quintile: 0.56, 95% CI 0.48 to 0.66, p<0.001), was higher in females (aRR:1.25, 95% CI 1.16 to 1.34, p<0.001) and with a history of adverse childhood experiences (aRR:1.44, 95% CI 1.28 to 1.56, p<0.001). Median time prescribed antipsychotics was 605 days (IQR 197-1639 days). Prescribing frequency has increased over time.

CONCLUSIONS

Contrary to current UK guidelines, antipsychotics are frequently and increasingly prescribed for extended periods to people with recorded PD, but with no history of SMI. An urgent review of clinical practice is warranted, including the effectiveness of such prescribing and the need to monitor for adverse effects, including metabolic complications.

Disruptive Behavior Disorders: The Challenge of Delineating Mechanisms in the Face of Heterogeneity

Causal pathways to disruptive behavior disorders, even within the same diagnostic category, are varied. Both equifinality and multifinality pose considerable challenges to uncovering underlying mechanisms and understanding varied developmental trajectories associated with disruptive behavior disorders. Uncovering genetic causes requires improved granularity in how we operationalize presentation and developmental trajectories associated with disruptive behavior disorders. If we want to integrate the study of genetic, environmental, and neurocognitive factors within a longitudinal framework, we need to improve measurement. Furthermore, brain changes associated with disruptive behavior disorders should not simply be understood as outcomes of genetic and environmental influences, but also as factors that reciprocally influence future social environments over time in ways that are important in contributing to risk and resilience. Advancing the field with regard to these challenges will result in more truly integrated investigation of disruptive behavior disorders, which holds the promise of improving our ability to develop more effective preventive and intervention approaches.

Thinking about Others' Minds: Mental State Inference in Boys with Conduct Problems and Callous-Unemotional Traits

Children with conduct problems (CP) and high levels of callous-unemotional traits (CP/HCU) have been found to have an intact ability to represent other minds, however, they behave in ways that indicate a reduced propensity to consider other people’s thoughts and feelings. Here we report findings from three tasks assessing different aspects of mentalising in 81 boys aged 11–16 [Typically developing (TD) n = 27; CP/HCU n = 28; CP and low levels of callous-unemotional traits (CP/LCU) n = 26]. Participants completed the Movie Assessment of Social Cognition (MASC), a task assessing ability/propensity to incorporate judgements concerning an individual’s mind into mental state inference; provided a written description of a good friend to assess mind-mindedness; and completed the Social Judgement Task (SJT), a new measure assessing mentalising about antisocial actions. Boys with CP/HCU had more difficulty in accurately inferring others’ mental states in the MASC than TD and CP/LCU boys. There were no group differences in the number of mind-related comments as assessed by the mind-mindedness protocol or in responses to the SJT task. These findings suggest that although the ability to represent mental states is intact, CP/HCU boys are less likely to update mental state inferences as a function of different minds.

Investigating patterns of neural response associated with childhood abuse v. childhood neglect

BACKGROUND

Childhood maltreatment is robustly associated with increased risk of poor mental health outcome and changes in brain function. The authors investigated whether childhood experience of abuse (e.g. physical, emotional and sexual abuse) and neglect (physical and emotional deprivation) was differentially associated with neural reactivity to threat.

METHODS

Participants were drawn from an existing study and allocated to one of four groups based on self-report of childhood maltreatment experience: individuals with childhood abuse experiences (n = 70); individuals with childhood neglect experiences (n = 87); individuals with combined experience of childhood abuse and neglect (n = 50); and non-maltreated individuals (n = 207) propensity score matched (PSM) on gender, age, IQ, psychopathology and SES. Neural reactivity to facial cues signalling threat was compared across groups, allowing the differential effects associated with particular forms of maltreatment experience to be isolated.

RESULTS

Brain imaging analyses indicated that while childhood abuse was associated with heightened localised threat reactivity in ventral amygdala, experiences of neglect were associated with heightened reactivity in a distributed cortical fronto-parietal network supporting complex social and cognitive processing as well as in the dorsal amygdala. Unexpectedly, combined experiences of abuse and neglect were associated with hypo-activation in several higher-order cortical regions as well as the amygdala.

CONCLUSIONS

Different forms of childhood maltreatment exert differential effects in neural threat reactivity: while the effects of abuse are more focal, the effects of neglect and combined experiences of abuse are more distributed. These findings are relevant for understanding the range of psychiatric outcomes following childhood maltreatment and have implications for intervention.

Neurocognitive Adaptation and Mental Health Vulnerability Following Maltreatment: The Role of Social Functioning

Childhood maltreatment is associated with a lifetime increase in risk of mental health disorder. We propose that such vulnerability may stem in large part from altered patterns of social functioning. Here, we highlight key findings from the psychological and epidemiological literature indicating that early maltreatment experience compromises social functioning and attenuates social support in ways that increase mental health vulnerability. We then review the extant neuroimaging studies of children and adolescents, focusing on three domains implicated in social functioning: threat processing, reward processing, and emotion regulation. We discuss how adaptations in these domains may increase latent vulnerability to mental health problems by impacting on social functioning via increased stress susceptibility as well as increased stress generation. Finally, we explore how computational psychiatry approaches, alongside systematically reported measures of social functioning, can complement studies of neural function in the creation of a mechanistic framework aimed at informing approaches to prevention and intervention.

Multi-Polygenic Score Approach to Identifying Individual Vulnerabilities Associated With the Risk of Exposure to Bullying

Importance

Exposure to bullying is a prevalent experience with adverse consequences throughout the life span. Individual vulnerabilities and traits, such as preexisting mental health problems, may be associated with increased likelihood of experiencing bullying. Identifying such individual vulnerabilities and traits is essential for a better understanding of the etiology of exposure to bullying and for tailoring effective prevention.

Objective

To identify individual vulnerabilities and traits associated with exposure to bullying in childhood and adolescence.

Design, Setting, and Participants

For this study, data were drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort study. The initial ALSPAC sample consisted of 14 062 children born to women residing in Avon, United Kingdom, with an expected date of delivery between April 1, 1991, and December 31, 1992. Collection of the ALSPAC data began in September 6, 1990, and the last follow-up assessment of exposure to bullying was conducted when participants were 13 years of age. Data analysis was conducted from November 1, 2017, to January 1, 2019.

Exposures

The polygenic score approach was used to derive genetic proxies that indexed vulnerabilities and traits. A total of 35 polygenic scores were computed for a range of mental health vulnerabilities (eg, depression) and traits related to cognition (eg, intelligence), personality (eg, neuroticism), and physical measures (eg, body mass index), as well as negative controls (eg, osteoporosis).

Main Outcomes and Measures

Single and multi-polygenic score regression models were fitted to test the association between indexed traits and exposure to bullying. Children completed the Bullying and Friendship Interview Schedule at the ages of 8, 10, and 13 years. A mean score of exposure to bullying across ages was used as the main outcome.

Results

A total of 5028 genotyped individuals (2481 boys and 2547 girls) with data on exposure to bullying were included. Among the 35 initially included polygenic scores, 11 were independently associated with exposure to bullying; no significant association was detected for the 24 remaining scores. In multivariable analyses, 5 polygenic scores were associated with exposure to bullying; the largest associations were present for genetic risk relating to mental health vulnerabilities, including diagnosis of depression (standardized b = 0.065; 95% CI, 0.035-0.095) and attention-deficit/hyperactivity disorder (standardized b = 0.063; 95% CI, 0.035-0.091), followed by risk taking (standardized b = 0.041; 95% CI, 0.013-0.069), body mass index (standardized b = 0.036; 95% CI, 0.008-0.064), and intelligence (standardized b = -0.031; 95% CI, -0.059 to 0.003).

Conclusion and Relevance

Using the multi-polygenic score approach, the findings implicate preexisting mental health vulnerabilities as risk factors for exposure to bullying. A mechanistic understanding of how these vulnerabilities link to exposure of bullying is important to inform prevention strategies.

Evidence of concurrent and prospective associations between early maltreatment and ADHD through childhood and adolescence

PURPOSE

An emerging body of work suggests a link between childhood maltreatment and attention-deficit hyperactivity disorder (ADHD). However, research examining the role of maltreatment in the early course of the disorder lacks robust evidence from longitudinal studies. Our aim was to examine concurrent and prospective associations between maltreatment experiences and ADHD diagnosis and sex differences, and to estimate the association between repetitive maltreatment exposure and ADHD through childhood and adolescence.

METHODS

Data were obtained from the Boricua Youth Study, a longitudinal study of 2480 children and adolescents of Puerto Rican background. Neglect, physical, emotional and sexual abuse, and foster placement were regressed on ADHD diagnosis measured at each of three waves using the Diagnostic Interview Schedule for Children-IV. Multilevel regressions estimated the effects of exposure on ADHD, adjusted by age, sex, income, household education, parental psychopathology, comorbidity and ADHD medication status.

RESULTS

Emotional abuse and foster placement had robust associations with ADHD diagnosis. For girls, physical abuse had a threefold increase in the odds of having ADHD diagnosis; for boys, associations were observed only for emotional abuse. Prospective models examining the risk of ADHD following maltreatment provided initial evidence for the effects of physical abuse on ADHD, and a linear trend for repetitive exposure suggested increased probability for disorder persistence.

CONCLUSIONS

Associations between early maltreatment and ADHD were robust. Different categories of maltreatment increase the likelihood of ADHD for girls and boys. Increased exposure to maltreatment may predict symptom persistence. Interventions addressing ADHD must consider the effects of both sex and family environment.

Towards understanding atypical social affiliation in psychopathy

One distinctive feature of individuals with psychopathy is their reduced motivation and capacity to develop authentic social relationships, which are founded on an enjoyment of prosocial interactions or concern for others. Surprisingly, potential neurocognitive vulnerabilities contributing to atypical social affiliation, and lack of prosocial behaviours in psychopathy, have yet to be systematically investigated. Research efforts have largely focused on how individuals with psychopathy process negative emotions, and how this might affect their capacity to feel guilt or empathise with others' distress. Here, we propose a framework for understanding the development of atypical social affiliation and attachment in psychopathy, and outline several key processes and neural systems speculated to underpin them. We then describe present neurocognitive findings that suggest that these processes and neural systems are compromised in individuals with, or at risk of developing, psychopathy. Finally, we consider several research directions that would help with the understanding of the origin and development of social affiliation in individuals with psychopathy. This work has the potential to inform and enhance prevention and treatment strategies.

Developmental trajectories associated with juvenile sexually abusive behaviour and emerging severe personality disorder in childhood: 3-year study

Background

Little is known about the developmental trajectories of juveniles presenting with sexually abusive behaviour or emerging severe personality disorder traits.

Aims

To investigate whether ‘age at onset’ of sexually abusive behaviour and whether emerging severe personality disorder traits are associated with specific developmental profiles.

Method

A retrospective file review of 280 juveniles presenting with sexually abusive behaviour was conducted and follow-up Offenders Index data were analysed.

Results

Juveniles with early onset (<11 years) of sexually abusive behaviour had higher levels of psychosocial adversity and early childhood antisocial behaviour compared with those with late onset. Emerging severe personality disorder traits were associated with higher levels of psychosocial adversity, antisocial behaviour, convictions and predatory sexually abusive behaviour.

Conclusions

Preliminary evidence supports the existence of distinct developmental trajectories within this population and points to a key role for traits of emerging severe personality disorder.

Living with conduct problem youth: family functioning and parental perceptions of their child

Parenting children with conduct problems (CP) is challenging, yet very little is known about the impact of the child's behaviour on family functioning or how parents of children with CP perceive their child. The aim of this research was to examine whether families with children with CP and high vs. low levels of callous-unemotional traits (HCU vs. LCU) experience differences in family functioning and parental perceptions. One hundred and one parents/caregivers of boys aged 11-16 [Typically developing (TD) n = 31; CP/HCU n = 35; CP/LCU n = 35] completed the McMaster Family Assessment Device, measuring multiple domains of family functioning. Parents/caregivers also completed a written statement describing their child, used for qualitative analysis. Families with CP/HCU children had poorer affective involvement than TD (p = 0.00; d = - 1.17) and CP/LCU (p = 0.03; d = - 0.62) families. Families with CP/HCU children showed significantly poorer general family functioning (p = 0.04; d = - 0.63) and more poorly defined family roles (p = 0.005; d = - 0.82) than families with TD children. Qualitative analyses indicated that parents/caregivers of CP/HCU children characterised them as having a dichotomous personality and being superficially charming. CP/LCU children were characterised as cheeky and endearing, with parents reporting good rapport. Families with CP/HCU children presented with specific difficulties in affective involvement and parents described challenges which were in line with the child's specific presentation of lack of empathy and shallow affect. These findings may be used to help clinicians identify targets for family interventions.

Concurrent and Longitudinal Contribution of Exposure to Bullying in Childhood to Mental Health: The Role of Vulnerability and Resilience

IMPORTANCE

Exposure to bullying is associated with poor mental health. However, the degree to which observed associations reflect direct detrimental contributions of exposure to bullying to mental health remains uncertain, as noncausal relationships may arise from genetic and environmental confounding (eg, preexisting vulnerabilities). Determining to what extent exposure to bullying contributes to mental health is an important concern, with implications for primary and secondary interventions.

OBJECTIVE

To characterize the concurrent and longitudinal contribution of exposure to bullying to mental health in childhood and adolescence using a twin differences design to strengthen causal inference.

DESIGN, SETTING, AND PARTICIPANTS

Participants were drawn from the Twins Early Development Study, a population-based cohort recruited from population records of births in England and Wales between January 1, 1994, and December 31, 1996. Data collection took place when the participants were between 11 and 16 years of age from December 1, 2005, to January 31, 2013. Data analysis was conducted from January 1, 2016, to June 20, 2017.

EXPOSURES

Participants completed the Multidimensional Peer-Victimization Scale at 11 and 14 years of age.

MAIN OUTCOMES AND MEASURES

Mental health assessments at 11 and 16 years of age included anxiety, depression, hyperactivity and impulsivity, inattention, conduct problems, and psychotic-like experiences (eg, paranoid thoughts or cognitive disorganization).

RESULTS

The 11 108 twins included in the final sample (5894 girls and 5214 boys) were a mean age of 11.3 years at the first assessment and 16.3 years at the last assessment. The most stringent twin differences estimates (monozygotic) were consistent with causal contribution of exposure to bullying at 11 years to concurrent anxiety, depression, hyperactivity and impulsivity, inattention, and conduct problems. Effects decreased over time; that is, substantial concurrent contributions to anxiety (β = 0.27; 95% CI, 0.22-0.33) persisted for 2 years (β = 0.12; 95% CI, 0.04-0.20) but not 5 years. Direct contributions to paranoid thoughts and cognitive disorganization persisted for 5 years.

CONCLUSIONS AND RELEVANCE

This study is the largest to date to characterize the contribution of exposure to bullying in childhood to mental health using a twin differences design and multi-informant, multiscale data. Stringent evidence of the direct detrimental contribution of exposure to bullying in childhood to mental health is provided. Findings also suggest that childhood exposure to bullying may partly be viewed as a symptom of preexisting vulnerabilities. Finally, the dissipation of effects over time for many outcomes highlights the potential for resilience in children who were bullied. In addition to programs that aim to reduce exposure to bullying, interventions may benefit from addressing preexisting vulnerabilities and focus on resilience.

Social Reward Questionnaire-Adolescent Version and its association with callous-unemotional traits

During adolescence, social interactions are a potent source of reward. However, no measure of social reward value exists for this age group. In this study, we adapted the adult Social Reward Questionnaire, which we had previously developed and validated, for use with adolescents. Participants aged 11-16 (n = 568; 50% male) completed the Social Reward Questionnaire-Adolescent Version (SRQ-A), alongside measures of personality traits-five-factor model (FFM) and callous-unemotional (CU) traits-for construct validity purposes. A confirmatory factor analysis of the SRQ-A supported a five-factor structure (Comparative Fit Index = 0.90; Root Mean Square Error of Approximation = 0.07), equating to five questionnaire subscales: enjoyment of Admiration, Negative Social Potency, Passivity, Prosocial Interactions and Sociability. Associations with FFM and CU traits were in line with what is seen for adult samples, providing support for the meaning of SRQ-A subscales in adolescents. In particular, adolescents with high levels of CU traits showed an 'inverted' pattern of social reward, in which being cruel is enjoyable and being kind is not. Gender invariance was also assessed and was partially supported. The SRQ-A is a valid, reliable measure of individual differences in social reward in adolescents.

Anticipation of guilt for everyday moral transgressions: The role of the anterior insula and the influence of interpersonal psychopathic traits

Psychopathy is a personality disorder characterised by atypical moral behaviour likely rooted in atypical affective/motivational processing, as opposed to an inability to judge the wrongness of an action. Guilt is a moral emotion believed to play a crucial role in adherence to moral and social norms, but the mechanisms by which guilt (or lack thereof) may influence behaviour in individuals with high levels of psychopathic traits are unclear. We measured neural responses during the anticipation of guilt about committing potential everyday moral transgressions, and tested the extent to which these varied with psychopathic traits. We found a significant interaction between the degree to which anticipated guilt was modulated in the anterior insula and interpersonal psychopathic traits: anterior insula modulation of anticipated guilt was weaker in individuals with higher levels of these traits. Data from a second sample confirmed that this pattern of findings was specific to the modulation of anticipated guilt and not related to the perceived wrongness of the transgression. These results suggest a central role for the anterior insula in coding the anticipation of guilt regarding potential moral transgressions and advance our understanding of the neurocognitive mechanisms that may underlie propensity to antisocial behaviour.

Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study

BACKGROUND

Childhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding.

METHOD

Data from 18 168 adult twins, aged 20-46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins.

RESULTS

CM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37-0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21-0.36) and MZ (0.18, 95% CI 0.10-0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results.

CONCLUSIONS

CM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.

Regional grey matter volume and concentration in at-risk adolescents: Untangling associations with callous-unemotional traits and conduct disorder symptoms

Structural Magnetic Resonance Imaging studies have reported volume reductions in several brain regions implicated in social cognition and emotion recognition in juvenile antisocial populations. However, it is unclear whether these structural abnormalities are specifically related to antisocial features, or to co-occurring callous-unemotional (CU) traits. The present study employed voxel-based morphometry to assess both grey matter volume (GMV) and grey matter concentration (GMC) in a large representative at-risk sample of adolescents (n=134; mean age 17.7yr), characterized by a broad range of CU trait and conduct disorder (CD) symptom scores. There was a significant interaction between CD symptom and CU trait scores in the prediction of GMV in the anterior insula, with a significant positive association between CU traits and GMV in youth low on CD symptoms only. In addition, we found a significant unique positive association between CD symptoms and GMC in the amygdala, and unique negative associations between CU traits and GMC in the amygdala and insula. These findings are in line with accumulating evidence of distinct associations of CD symptoms and CU traits with amygdala and insula GMC in juvenile antisocial populations.

Exploring the Relationship Between Childhood Maltreatment and Addiction: A Review of the Neurocognitive Evidence

Childhood maltreatment has been shown to increase the risk of a range of psychiatric disorders including substance use disorders (SUDs) and is associated with the onset, course and severity of illness. We review the evidence for alterations in brain structure and neurocognitive processing in individuals who have experienced childhood maltreatment, focusing specifically on changes related to reward processing, executive functioning and affect processing. Changes in these neurocognitive systems have been documented in adults presenting with SUDs, who are typically characterized by heightened subcortico-striatal responses to salient stimuli and impairments in fronto-cingulate regulation. Maltreatment-specific effects in these processing domains may account for the particularly severe clinical presentation of SUDs in adults with histories of maltreatment in childhood. The findings are considered in relation to the theory of latent vulnerability, which contends that alterations in these neurocognitive systems may reflect calibration to early risk environments that in turn increases the risk of developing of SUDs later in life.

Psychopathy

Psychopathy is a condition that has long captured the public imagination. Newspaper column inches are devoted to murderers with psychopathic features and movies such as No Country for Old Men and We Need to Talk About Kevin focus on characters who are exceptionally cold and callous. Psychopathy is in fact a personality disorder characterised by lack of empathy and guilt, shallow affect, manipulation of other people and severe, premeditated and violent antisocial behaviour. Individuals with psychopathy generate substantial societal costs both as a direct financial consequence of their offending behaviour and lack of normal participation in working life, but also in terms of the emotional and psychological costs to their victims.

Common and distinct impacts of autistic traits and alexithymia on social reward

According to the social motivation hypothesis of autism, individuals with high levels of autistic traits experience reduced levels of reward from social interactions. However, empirical evidence to date has been mixed, with some studies reporting lower levels of social reward in individuals with Autism Spectrum Disorder (ASD), and others finding no difference when compared to typically developing controls. Alexithymia, a subclinical condition associated with the reduced ability to identify and describe one’s own emotions, has been found to account for other affective difficulties observed inconsistently in individuals with ASD. The current study used a nonclinical sample (N = 472) to explore the associations between autistic traits and the value of six types of social reward, as measured by the Social Reward Questionnaire. In addition, we measured alexithymia to assess if this accounted for associations between autistic traits and social reward. There were three main findings. Firstly, higher levels of autistic traits were associated with significantly less enjoyment of admiration and sociability, and adding alexithymia to these models did not account for any additional variance. Secondly, both autistic traits and alexithymia were uniquely associated with reduced levels of enjoyment of prosocial interactions and sexual relationships. Thirdly, autistic traits were associated with higher levels of enjoyment of passivity and negative social potency, but these associations were no longer significant once alexithymia was taken into account, suggesting that co-occurring alexithymia accounted for these apparent associations. Overall, the current findings provide a novel and more nuanced picture of the relationship between autistic traits and social reward.

I can't take my eyes off of you: attentional allocation to infant, child, adolescent and adult faces in mothers and non-mothers

It has been reported previously that infant faces elicit enhanced attentional allocation compared to adult faces in adult women, particularly when these faces are emotional and when the participants are mothers, as compared to non-mothers [1]. However, it remains unclear whether this increased salience of infant faces as compared to adult faces extends to children older than infant age, or whether infant faces have a unique capacity to elicit preferential attentional allocation compared to juvenile or adult faces. Therefore, this study investigated attentional allocation to a variety of different aged faces (infants, pre-adolescent children, adolescents, and adults) in 84 adult women, 39 of whom were mothers. Consistent with previous findings, infant faces were found to elicit greater attentional engagement compared to pre-adolescent, adolescent, or adult faces, particularly when the infants displayed distress; again, this effect was more pronounced in mothers compared to non-mothers. Pre-adolescent child faces were also found to elicit greater attentional engagement compared to adolescent and adult faces, but only when they displayed distress. No preferential attentional allocation was observed for adolescent compared to adult faces. These findings indicate that cues potentially signalling vulnerability, specifically age and sad affect, interact to engage attention. They point to a potentially important mechanism, which helps facilitate caregiving behaviour.

Neural bases of Theory of Mind in children with autism spectrum disorders and children with conduct problems and callous-unemotional traits

Individuals with autism spectrum disorders (ASD) have difficulty understanding other minds (Theory of Mind; ToM), with atypical processing evident at both behavioural and neural levels. Individuals with conduct problems and high levels of callous-unemotional (CU) traits (CP/HCU) exhibit reduced responsiveness to others' emotions and difficulties interacting with others, but nonetheless perform normally in experimental tests of ToM. The present study aimed to examine the neural underpinnings of ToM in children (aged 10–16) with ASD (N = 16), CP/HCU (N = 16) and typically developing (TD) controls (N = 16) using a non-verbal cartoon vignette task. Whilst individuals with ASD were predicted to show reduced fMRI responses across regions involved in ToM processing, CP/HCU individuals were predicted to show no differences compared with TD controls. The analyses indicated that neural responses did not differ between TD and CP/HCU groups during ToM. TD and CP/HCU children exhibited significantly greater medial prefrontal cortex responses during ToM than did the ASD group. Within the ASD group, responses in medial prefrontal cortex and right temporoparietal junction (TPJ) correlated with symptom severity as measured by the Autism Diagnostic Observation Schedule (ADOS). Findings suggest that although both ASD and CP/HCU are characterized by social difficulties, only children with ASD display atypical neural processing associated with ToM.

Social Reward Questionnaire (SRQ): development and validation

Human beings seek out social interactions as a source of reward. To date, there have been limited attempts to identify different forms of social reward, and little is known about how the value of social rewards might vary between individuals. This study aimed to address both these issues by developing the Social Reward Questionnaire (SRQ), a measure of individual differences in the value of different social rewards. Exploratory factor analysis (EFA) was run on an initial set of 75 items (N = 305). Based on this analysis, confirmatory factor analysis (CFA) was then conducted on a second sample (N = 505) with a refined 23-item scale. This analysis was used to test a six-factor structure, which resulted in good model fit (CFI = 0.96, RSMEA = 0.07). The factors represent six subscales of social reward defined as follows: Admiration; Negative Social Potency; Passivity; Prosocial Interactions; Sexual Reward; and Sociability. All subscales demonstrated good test-retest reliability and internal consistency. Each subscale also showed a distinct pattern of associations with external correlates measuring personality traits, attitudes, and goals, thus demonstrating construct validity. Taken together, the findings suggest that the SRQ is a reliable, valid measure that can be used to assess individual differences in the value experienced from different social rewards.

The link between child abuse and psychopathology: a review of neurobiological and genetic research

Childhood abuse is associated with later psychopathology, including conduct disorder, antisocial personality disorder, anxiety and depression as well as a heightened risk of health and social problems. However, the neurobiological mechanisms by which childhood adversity increases vulnerability to psychopathology remain poorly understood. There is likely to be a complex interaction between environmental experiences (such as abuse) and individual differences in risk versus protective genes, which influences the neurobiological circuitry underpinning psychological and emotional development. Neuroendocrine studies indicate an association between early adversity and atypical development of the hypothalamic-pituitary-adrenal (HPA) axis stress response, which may predispose to psychiatric vulnerability in adulthood. Brain imaging research in children and adults is providing evidence of several structural and functional brain differences associated with early adversity. Structural differences have been reported in the corpus callosum, cerebellum and prefrontal cortex. Functional differences have been reported in regions implicated in emotional and behavioural regulation, including the amygdala and anterior cingulate cortex. These differences at the neurobiological level may represent adaptations to early experiences of heightened stress that lead to an increased risk of psychopathology. We also consider the clinical implications of future neurobiological and genetic research.

Attachment style, affective loss and gray matter volume: a voxel-based morphometry study

Early patterns of infant attachment have been shown to be an important influence on adult social behavior. Animal studies suggest that patterns of early attachment influence brain development, contributing to permanent alterations in neural structure; however, there are no previous studies investigating whether differences in attachment style are associated with differences in brain structure in humans. In this study, we used Magnetic Resonance Imaging (MRI) and voxel-based morphometry (VBM) to examine for the first time the association between attachment style, affective loss (for example, death of a loved one) and gray matter volume in a healthy sample of adults (n = 32). Attachment style was assessed on two dimensions (anxious and avoidant) using the ECR-Revised questionnaire. High attachment-related anxiety was associated with decreased gray matter in the anterior temporal pole and increased gray matter in the left lateral orbital gyrus. A greater number of affective losses was associated with increased gray matter volume in the cerebellum; in this region, however, the impact of affective losses was significantly moderated by the level of attachment-related avoidance. These findings indicate that differences in attachment style are associated with differences in the neural structure of regions implicated in emotion regulation. It is hypothesized that early attachment experience may contribute to structural brain differences associated with attachment style in adulthood; furthermore, these findings point to a neuronal mechanism through which attachment style may mediate individual differences in responses to affective loss.

Effects of stressful life events on human brain structure: a longitudinal voxel-based morphometry study

Although stressful life events (SLEs) have been associated with an increased risk of illness and mental disorder, their impact on brain anatomy remains poorly understood. Using a longitudinal design, we tested the hypothesis that SLEs are significantly associated with changes in gray matter volume (GMV) in brain regions previously implicated in post-traumatic stress disorder (PTSD) in a group of clinically healthy adults. Magnetic resonance imaging was used to acquire an anatomical scan from 26 subjects (13 males and 13 females; mean age ± SD: 25.2 ± 4.3 years), with no psychiatric diagnosis, at two time points with a 3-month interval. Voxel-based morphometry was used to examine an association between SLEs and gray matter changes during this period. The number of SLEs was associated with a decrease in GMV in the anterior cingulate, hippocampus, and parahippocampal gyrus (p < 0.001). In contrast, there were no areas where the number of SLEs was associated with an increase in GMV. These results provide evidence that, in adults with no formal psychiatric diagnosis, SLEs are associated with GMV decreases in a subset of regions implicated in PTSD, and that these alterations can be observed within a period as short as 3 months.

The impact of childhood maltreatment: a review of neurobiological and genetic factors

Childhood maltreatment represents a significant risk factor for psychopathology. Recent research has begun to examine both the functional and structural neurobiological correlates of adverse care-giving experiences, including maltreatment, and how these might impact on a child's psychological and emotional development. The relationship between such experiences and risk for psychopathology has been shown to vary as a function of genetic factors. In this review we begin by providing a brief overview of neuroendocrine findings, which indicate an association between maltreatment and atypical development of the hypothalamic-pituitary-adrenal axis stress response, which may predispose to psychiatric vulnerability in adulthood. We then selectively review the magnetic resonance imaging (MRI) studies that have investigated possible structural and functional brain differences in children and adults who have experienced childhood maltreatment. Differences in the corpus callosum identified by structural MRI have now been reliably reported in children who have experienced abuse, while differences in the hippocampus have been reported in adults with childhood histories of maltreatment. In addition, there is preliminary evidence from functional MRI studies of adults who have experienced childhood maltreatment of amygdala hyperactivity and atypical activation of frontal regions. These functional differences can be partly understood in the context of the information biases observed in event-related potential and behavioral studies of physically abused children. Finally we consider research that has indicated that the effect of environmental adversity may be moderated by genotype, reviewing pertinent studies pointing to gene by environment interactions. We conclude by exploring the extent to which the growing evidence base in relation to neurobiological and genetic research may be relevant to clinical practice and intervention.

Research review: the neurobiology and genetics of maltreatment and adversity

The neurobiological mechanisms by which childhood maltreatment heightens vulnerability to psychopathology remain poorly understood. It is likely that a complex interaction between environmental experiences (including poor caregiving) and an individual's genetic make-up influence neurobiological development across infancy and childhood, which in turn sets the stage for a child's psychological and emotional development. This review provides a concise synopsis of those studies investigating the neurobiological and genetic factors associated with childhood maltreatment and adversity. We first provide an overview of the neuroendocrine findings, drawing from animal and human studies. These studies indicate an association between early adversity and atypical development of the hypothalamic-pituitary-adrenal (HPA) axis stress response, which can predispose to psychiatric vulnerability in adulthood. We then review the neuroimaging findings of structural and functional brain differences in children and adults who have experienced childhood maltreatment. These studies offer evidence of several structural differences associated with early stress, most notably in the corpus callosum in children and the hippocampus in adults; functional studies have reported atypical activation of several brain regions, including decreased activity of the prefrontal cortex. Next we consider studies that suggest that the effect of environmental adversity may be conditional on an individual's genotype. We also briefly consider the possible role that epigenetic mechanisms might play in mediating the impact of early adversity. Finally we consider several ways in which the neurobiological and genetic research may be relevant to clinical practice and intervention.

Heritable variations in gray matter concentration as a potential endophenotype for psychopathic traits

CONTEXT

Genetic vulnerability to psychopathic traits is likely to also manifest at the neural level. We have recently reported increased gray matter concentration in several brain areas in boys with psychopathic traits.

OBJECTIVE

To explore whether these gray matter concentration differences can be regarded as endophenotypes for psychopathic traits by (1) assessing their heritability and (2) examining the etiology of the co-occurrence of psychopathic traits and increased gray matter concentration.

DESIGN

Community twin sample.

SETTING

On-campus neuroimaging facility.

PATIENTS OR OTHER PARTICIPANTS

One hundred twenty-three male twins (56 monozygotic and 67 dizygotic individuals; mean age 11.55 years; range, 10-13 years).

MAIN OUTCOME MEASURES

We analyzed structural magnetic resonance imaging scans. Voxel-based morphometry analyses were used to obtain gray matter concentration values that were analyzed in a biometrical genetic twin model.

RESULTS

Left posterior cingulate and right dorsal anterior cingulate gray matter concentrations were found to be the strongest endophenotype markers, with heritability estimates of 46% and 37%, respectively, and common genes explaining the phenotypic relationship between these regions and psychopathic traits. No significant heritabilities were found for several regions, including the right orbitofrontal cortex and insula.

CONCLUSIONS

These findings suggest that structural endophenotypes, in the form of variations in gray matter concentration, reflect genetic vulnerability for psychopathic traits. Specifically, gray matter concentration in the left posterior cingulate and right dorsal anterior cingulate, brain areas implicated in empathy, moral processing, and introspection, are potential candidate endophenotypes for psychopathic traits.

Eye-witness memory and suggestibility in children with Asperger syndrome

BACKGROUND

Individuals with autism spectrum disorders (ASD) present with a particular profile of memory deficits, executive dysfunction and impaired social interaction that may raise concerns about their recall and reliability in forensic and legal contexts. Extant studies of memory shed limited light on this issue as they involved either laboratory-based tasks or protocols that varied between participants.

METHOD

The current study used a live classroom event to investigate eye-witness recall and suggestibility in children with Asperger syndrome (AS group; N = 24) and typically developing children (TD group; N = 27). All participants were aged between 11 and 14 years and were interviewed using a structured protocol. Two measures of executive functioning were also administered.

RESULTS

The AS group were found to be no more suggestible and no less accurate than their peers. However, free recall elicited less information, including gist, in the AS group. TD, but not AS, participants tended to focus on the socially salient aspects of the scene in their free recall. Both general and specific questioning elicited similar numbers of new details in both groups. Significant correlations were found between memory recall and executive functioning performance in the AS group only.

CONCLUSIONS

The present study indicates that children with AS can act as reliable witnesses but they may be more reliant on questioning to facilitate recall. Our findings also provide evidence for poor gist memory. It is speculated that such differences stem from weak central coherence and lead to a reliance on generic cognitive processes, such as executive functions, during recall. Future studies are required to investigate possible differences in compliance, rates of forgetting and false memory.

How reading differs from object naming at the neuronal level

This paper uses whole brain functional neuroimaging in neurologically normal participants to explore how reading aloud differs from object naming in terms of neuronal implementation. In the first experiment, we directly compared brain activation during reading aloud and object naming. This revealed greater activation for reading in bilateral premotor, left posterior superior temporal and precuneus regions. In a second experiment, we segregated the object-naming system into object recognition and speech production areas by factorially manipulating the presence or absence of objects (pictures of objects or their meaningless scrambled counterparts) with the presence or absence of speech production (vocal vs. finger press responses). This demonstrated that the areas associated with speech production (object naming and repetitively saying "OK" to meaningless scrambled pictures) corresponded exactly to the areas where responses were higher for reading aloud than object naming in Experiment 1. Collectively the results suggest that, relative to object naming, reading increases the demands on shared speech production processes. At a cognitive level, enhanced activation for reading in speech production areas may reflect the multiple and competing phonological codes that are generated from the sublexical parts of written words. At a neuronal level, it may reflect differences in the speed with which different areas are activated and integrate with one another.

Dyslexia: cultural diversity and biological unity

The recognition of dyslexia as a neurodevelopmental disorder has been hampered by the belief that it is not a specific diagnostic entity because it has variable and culture-specific manifestations. In line with this belief, we found that Italian dyslexics, using a shallow orthography which facilitates reading, performed better on reading tasks than did English and French dyslexics. However, all dyslexics were equally impaired relative to their controls on reading and phonological tasks. Positron emission tomography scans during explicit and implicit reading showed the same reduced activity in a region of the left hemisphere in dyslexics from all three countries, with the maximum peak in the middle temporal gyrus and additional peaks in the inferior and superior temporal gyri and middle occipital gyrus. We conclude that there is a universal neurocognitive basis for dyslexia and that differences in reading performance among dyslexics of different countries are due to different orthographies.

Voice therapy outcomes in vocal fold nodules: a retrospective audit

Twenty-six speech and language therapy (SLT) clinical files, in which patients presented with a medical diagnosis of bilateral or unilateral vocal fold nodule(s), were audited retrospectively over a six year period (1992-1998). The objective of the study was to evaluate current practice within our trust in the management of patients with vocal fold nodules against what was considered 'best practice' and to take action for improvements where deficits were identified. Multidimensional outcome measurements were employed. This study lends support to experimental findings of treatment effectiveness. Results demonstrated elimination and/or reduction of vocal fold nodules in over 70% of clinical files audited. Post-therapy over 80% of patients presented with either a normal voice quality or a mild degree of dysphonia.

Abnormal functional activation during a simple word repetition task: A PET study of adult dyslexics

Eight dyslexic subjects, impaired on a range of tasks requiring phonological processing, were matched for age and general ability with six control subjects. Participants were scanned using positron emission tomography (PET) during three conditions: repeating real words, repeating pseudowords, and rest. In both groups, speech repetition relative to rest elicited widespread bilateral activation in areas associated with auditory processing of speech; there were no significant differences between words and pseudowords. However, irrespective of word type, the dyslexic group showed less activation than the control group in the right superior temporal and right post-central gyri and also in the left cerebellum. Notably, the right anterior superior temporal cortex (Brodmann's area 22 [BA 22]) was less activated in each of the eight dyslexic subjects, compared to each of the six control subjects. This deficit appears to be specific to auditory repetition as it was not detected in a previous study of reading which used the same sets of stimuli (Brunswick, N., McCrory, E., Price, C., Frith, C.D., & Frith, U. [1999]. Explicit and implicit processing of words and pseudowords by adult developmental dyslexics: A search for Wernicke's Wortschatz? Brain, 122, 1901-1917). This implies that the observed neural manifestation of developmental dyslexia is task-specific (i.e., functional rather than structural). Other studies of normal subjects indicate that attending to the phonetic structure of speech leads to a decrease in right-hemisphere processing. Lower right hemisphere activation in the dyslexic group may therefore indicate less processing of non-phonetic aspects of speech, allowing greater salience to be accorded to phonological aspects of attended speech.

A cultural effect on brain function

We present behavioral and anatomical evidence for a multi-component reading system in which different components are differentially weighted depending on culture-specific demands of orthography. Italian orthography is consistent, enabling reliable conversion of graphemes to phonemes to yield correct pronunciation of the word. English orthography is inconsistent, complicating mapping of letters to word sounds. In behavioral studies, Italian students showed faster word and non-word reading than English students. In two PET studies, Italians showed greater activation in left superior temporal regions associated with phoneme processing. In contrast, English readers showed greater activations, particularly for non-words, in left posterior inferior temporal gyrus and anterior inferior frontal gyrus, areas associated with word retrieval during both reading and naming tasks.

Explicit and implicit processing of words and pseudowords by adult developmental dyslexics: A search for Wernicke's Wortschatz?

Two groups of male university students who had been diagnosed as dyslexic when younger, and two groups of control subjects of similar age and IQ to the dyslexics, were scanned whilst reading aloud and during a task where reading was implicit. The dyslexics performed less well than their peers on a range of literacy tasks and were strikingly impaired on phonological tasks. In the reading aloud experiment, simple words and pseudowords were presented at a slow pace so that reading accuracy was equal for dyslexics and controls. Relative to rest, both normal and dyslexic groups activated the same peri- and extra-sylvian regions of the left hemisphere that are known to be involved in reading. However, the dyslexic readers showed less activation than controls in the left posterior inferior temporal cortex [Brodmann area (BA) 37, or Wernicke's Wortschatz], left cerebellum, left thalamus and medial extrastriate cortex. In the implicit reading experiment, word and pseudoword processing was contrasted to visually matched false fonts while subjects performed a feature detection paradigm. The dyslexic readers showed reduced activation in BA 37 relative to normals suggesting that this group difference, seen in both experiments, resides in highly automated aspects of the reading process. Since BA 37 has been implicated previously in modality-independent naming, the reduced activation may indicate a specific impairment in lexical retrieval. Interestingly, during the reading aloud experiment only, there was increased activation for the dyslexics relative to the controls in a pre-motor region of Broca's area (BA 6/44). We attribute this result to the enforced use of an effortful compensatory strategy involving sublexical assembly of articulatory routines. The results confirm previous findings that dyslexic readers process written stimuli atypically, based on abnormal functioning of the left hemisphere reading system. More specifically, we localize this deficit to the neural system underlying lexical retrieval.