Neuroimaging findings in disruptive behavior disorders

Abstract

Decades of research have shown that youths with disruptive behavior disorders (DBD) are a heterogeneous population. Over the past 20 years, researchers have distinguished youths with DBD as those displaying high (DBD/HCU) versus low (DBD/LCU) callous-unemotional (CU) traits. These traits include flat affect and reduced empathy and remorse, and are associated with more severe, varied, and persistent patterns of antisocial behavior and aggression. Conduct problems in youths with HCU and LCU are thought to reflect distinct causal vulnerabilities, with antisocial behavior in youths with DBD/HCU reflecting a predominantly genetic etiology, while antisocial behavior in youths with DBD/LCU is associated primarily with environmental influences. Here we selectively review recent functional (fMRI) and structural (sMRI) magnetic resonance imaging research on DBD, focusing particularly on the role of CU traits. First, fMRI studies examining the neural correlates of affective stimuli, emotional face processing, empathy, theory of mind, morality, and decision-making in DBD are discussed. This is followed by a review of the studies investigating brain structure and structural connectivity in DBD. Next, we highlight the need to further investigate females and the role of sex differences in this population. We conclude the review by identifying potential clinical implications of this research.

Brain structural correlates of irritability: Findings in a large healthy cohort

“…The positive correlation of ACC volume and aggression in our samples of healthy adult nonclinical subjects contrasts with the mostly negative correlation in (mostly clinical) child and adolescent samples [Baker et al, 2015;Boes et al, 2008]. An explanation for these divergent findings might be that these structures see considerable structural changes across development in adolescence in early adulthood and therefore associations in children or adults might reflect delayed cortical maturation [De Brito et al, 2009], while this association changes in adulthood.…”

Neural correlates of reactive aggression in children with attention‐deficit/hyperactivity disorder and comorbid disruptive behaviour disorders

“…Findings concerning disinhibited behaviour in children with DBD also refer to decreased inhibitory influences of prefrontal areas on lower brain structures as a crucial factor, but also atypical responses of subcortical regions (e.g. hypo‐ as well as hyper‐responsiveness of the amygdala) were identified in this patient cohort and were associated with aggressive behaviour in patients with DBD . Regarding those findings, it seems reasonable to hypothesize decreased activation of prefrontal areas during aggressive responses in children with ADHD and comorbid DBD during impulsive aggressive acts.…”

“…When interpreting these findings in the context of our data, the dysfunction of brain areas that are involved in social cognition may reflect deficient processing of social interaction and reduced empathy, which results in higher reactive aggressive responses during the aggression phase. Furthermore, reduced empathy has been reliably documented in relation to DBD symptomatology .…”

Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders – differentiating decision making in attention‐deficit/hyperactivity disorder, conduct disorder, depression, and anxiety

“…Disruptions in brain regions such as the amygdala and anterior insula that are involved in the processing of valence and emotional and motivational salience are implicated in CD. Structural and functional changes in frontal and temporal regions have also been reported (Baker, Clanton, Rogers, & De Brito, 2015;Fairchild et al, 2011Fairchild et al, , 2013Fairchild et al, , 2015Hyatt, Haney-Caron, & Stevens, 2012;Rubia, 2011). Treatment options include parenting interventions and multisystemic therapy (NICE 2013).…”