Adolescent disruptive behavior disorders linked to brain’s anticipation of reward

Children with disruptive behavior disorders and callous-unemotional traits may have reduced neural activation in reward and cognitive-control regions, according to study results published in American Journal of Psychiatry.

“Youths with disruptive behavior disorders [DBDs] exhibit difficulties linking outcomes with antecedent events, consistent with their reported deficits in cognitive flexibility and behavioral adaptation,” Samuel W. Hawes, PhD, of the department of psychology and Center for Children and Families at Florida International University, and colleagues wrote. “Some of this inflexibility could arise because these youths show robust behavioral responses to receiving various rewards, prefer large, immediate rewards, and demonstrate more aggression in response to frustrative nonreward. Concomitantly, youths with DBDs show impairments in the use of changing expected value information to optimize behavior, as well as reduced anticipatory recruitment of motivational neurocircuitry.”

Results of previous studies suggested the neural response of youths with DBDs may be exaggerated during the emotional component of reward receipt. Further, this appeared coupled with minimal recruitment of neurocircuitry required for the effort to obtain the reward. Despite these research efforts, functional MRI data are sparse regarding examination of a divergence in the motivational neurocircuitry related to DBDs.

Hawes and colleagues aimed to examine neural sensitivity associated with reward anticipation and receipt among youths with DBDs, some of whom had callous-unemotional traits. They obtained data of adolescents with a mean age of 9.51 years who were included in the Adolescent Brain and Cognitive Development Study and examined reward-related activation during a monetary incentive delay task across 16 brain regions, including the anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), amygdala and nucleus accumbens (NAcc). Further, they used latent variable modeling to examine network-level coactivation.

The investigators compared several diagnostic groups, including 693 typically developing youths and 995 youths with DBDs, the latter of whom were subdivided into 198 with a DBD and callous-unemotional traits (DBD+CU) and 276 with a DBD only.

Those in the overall DBD group exhibited decreased dorsal ACC activation during reward anticipation compared with typically developing youths. The investigators observed reduced ventral and dorsal striatal activity among the DBD-only group compared with the DBD+CU and typically developing groups. Moreover, those with DBDs exhibited increased cortical (i.e., OFC) and subcortical (i.e., NAcc) regional activation during reward receipt compared with typically developing youths. The researchers observed greater activation in several regions, including the amygdala and dorsal ACC, among the DBU+CU group compared with the typically developing and DBD-only groups, respectively. The DBD-only group exhibited reduced anticipatory reward activation at the network level compared with the DBU+CU and typically developing groups; however, those in the DBU+CU group exhibited increased activation during reward receipt vs. those in the typically developing group.

“Future studies conducted within a prospective longitudinal design can establish whether differences in neural sensitivity to reward represent a predictive biomarker of youths at risk for DBDs, including those with callous-unemotional traits, which could inform personalized interventions,” Hawes and colleagues wrote.