Inhibitory Control Deficits in Children with Oppositional Defiant Disorder and Conduct Disorder Compared to Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis

The High Rates of Comorbidity among Neurodevelopmental Disorders: Reconsidering the Clinical Utility of Distinct Diagnostic Categories

The boundaries between neurodevelopmental disorders are often indistinct, even among specialists. But do these boundaries exist, or do experts struggle to distinguish and categorize symptoms in order to arrive at a dominant diagnosis while comorbidity continually leaves questions about where each disorder ends and begins? What should be reconsidered? The introduction of the term 'spectrum of neurodevelopmental disorders' could pave the way for a re-appraisal of the clinical continuum of neurodevelopmental disorders. This study aims to highlight the problems that emerge in the field of the differential diagnosis of neurodevelopmental disorders and propose a renegotiation of the distinctiveness criteria.

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.

100 days of Adolescence: Elucidating Externalizing Behaviors Through the Daily Assessment of Inhibitory Control

Inhibitory control is a transdiagnostic risk factor for externalizing behaviors, particularly during adolescence. Despite advances in understanding links between inhibitory control and externalizing behaviors across youth on average, significant questions remain about how these links play out in the day-to-day lives of individual adolescents. The goals of the current study were to: (1) validate a novel 100-occasion measure of inhibitory control; (2) assess links between day-to-day fluctuations in inhibitory control and individual differences in externalizing behaviors; and (3) illustrate the potential of intensive longitudinal studies for person-specific analyses of adolescent externalizing behaviors. Participants were 106 youth (57.5% female, Mage = 13.34 years; SDage = 1.92) who completed a virtual baseline session followed by 100 daily surveys, including an adapted Stroop Color Word task designed to assess inhibitory control. Results suggested that the novel task was generally reliable and valid, and that inhibitory control fluctuated across days in ways that were meaningfully associated with individual differences in baseline impulsive behaviors. Results of illustrative personalized analyses suggested that inhibitory control had more influence in the daily networks of adolescents who used substances during the 100 days than in a matched set of adolescents who did not. This work marks a path forward in intensive longitudinal research by validating a novel inhibitory control measure, revealing that daily fluctuations in inhibitory control may be a unique construct broadly relevant to adolescent externalizing problems, and at the same time, highlighting that links between daily inhibitory control and impulsive behaviors are adolescent-specific.

Physiological Dysregulation in Children With and Without Externalizing Difficulties: Novel Insights From Intensive Longitudinal Data

Extant research on physiological dysregulation in children has focused on point-in-time measures and absolute mean levels of physiology. However, these methods do not capture dynamic fluctuations in physiology that characterize dysregulation. In the present work, we aimed to assess whether physiological dysregulation as captured by fluctuations rather than mean levels would differentiate between children with and without clinically elevated levels of externalizing behavior. As an exploratory approach, we examined fluctuations in children's physiological responses (i.e., root mean square of successive differences [RMSSD] in beat-to-beat heart rate intervals) to social transgression scenarios across 15 short-term measurement occasions (5-second bins). Controlling for mean RMSSD, as well as emotional and cognitive correlates of externalizing behavior (i.e., sympathy and inhibitory control), children with externalizing difficulties exhibited greater within-person fluctuations in RMSSD (i.e., physiological dysregulation) compared to children without externalizing difficulties. The present findings provide preliminary support for using intensive longitudinal data comprised of short-term physiological measurements and point to the centrality of within-child physiological variability as a marker of dysregulation, particularly amongst children with externalizing disorders for whom self-regulation is a core challenge.

Longitudinal relationship between oppositional defiant disorder symptoms and attention-deficit/hyperactivity disorder symptoms in Chinese children: insights from cross-lagged panel network analyses

Oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common childhood mental disorders, and they have substantial comorbidity. The developmental precursor model has long been widely used to explain the mechanisms of comorbidity between ODD and ADHD, however whether it is equally effective at the symptomatic level is unclear. Therefore, this study aimed to (a) examine the stability of the ODD and ADHD comorbidity network in a longitudinal sample of high-risk children in China; and (b) examine the longitudinal relationship between the ODD and ADHD symptom networks based on a developmental precursor model. Two hundred sixty-three Chinese children aged 6 to 13 years with ODD and/or ADHD were assessed for symptoms of ODD and ADHD in two surveys conducted 1 year apart. We used data from these two time points to construct two cross-sectional networks and a cross-lagged panel network (CLPN) to explore the symptom network for comorbidity of ODD and ADHD. The analysis shows that: (1) the two cross-sectional networks are highly similar in terms of structure, existence of edges, centrality estimates, and the invariance test shows that there is no significant difference between them. The symptoms "follow through", "interrupts/intrudes", "difficulty playing quietly" and "concentration" had the highest expected influence centrality at both time points. (2) Combined with the results of the cross-sectional and cross-lagged networks, we found that "annoy" and "blame" are potential bridge symptoms between the ODD and ADHD symptom networks. The symptom "annoy" forms a reciprocal predictive relationship with "interrupts/intrudes", while "blame" unidirectionally predicts "close attention". In addition, we found that "vindictive" predicted numerous ADHD symptoms, whereas "angry" was predicted by numerous ADHD symptoms. The findings emphasize the broad predictive relationship between ODD and ADHD symptoms with each other, and that ODD symptoms may lead to activation of the ADHD symptom network and vice versa. These findings suggest that the developmental precursor model at the symptom level may partially explain the comorbidity mechanisms of ODD and ADHD, and future studies should further investigate the underlying multiple mechanisms.

How Self-Regulation and Executive Functions Deficits Affect Quality of Life of Children/Adolescents with Emotional Regulation Disorders

BACKGROUND

Deficits in self-regulation and executive functions (EFs) frequently characterize children/adolescents with emotional regulation disorders and restrict their daily function and quality of life (QOL). These deficits are mainly manifested by neuropsychological measures in laboratory settings. This study aimed to compare self-regulation and EFs by ecological measures to reflect the implications in daily life between children with emotional regulation disorders and healthy controls and examine the relations between self-regulation, EFs and QOL in the study group.

METHODS

the participants were 49 children aged 8-18: 25 children/adolescents with emotional regulation disorders and 24 healthy children. The parents completed a socio-demographic questionnaire, the Child Behavior Checklist (CBCL), the Behavior Rating Inventory of Executive Functions (BRIEF) and the Pediatric Quality of Life Inventory (Peds-QL).

RESULTS

The study group had greater self-regulation difficulties (internalization and externalization problems), executive dysfunctions (EFdys) (including metacognition difficulties) and a lower QOL. Their internalization and externalization problems correlated with reduced EFs and QOL. Internalization predicted the physical and emotional QOLs, while metacognition predicted social and school-related QOLs.

CONCLUSIONS

Deficits in self-regulation and EFs are prevalent in children/adolescents with emotional disorders and restrict their daily function and QOL. Therefore, they should be routinely evaluated by ecological instruments to reflect daily restrictions.

Differential effects of mindfulness meditation and cognitive training on cool and hot inhibitory control in children and adolescents

Inhibitory control (IC) can occur either in a neutral context (cool) or in social contexts involving emotions (hot). Cool and hot IC have specific developmental trajectories; cool IC develops linearly from childhood to adulthood, whereas hot IC follows a quadratic trajectory. Some activities can improve the IC, such as cognitive training (CT) and mindfulness meditation (MM). The aim of our study was to compare the effects of 5 weeks of computerized MM versus CT on IC performance in 66 children (9-10 years old) and 63 adolescents (16-17 years old) by specifically analyzing cool and hot dimensions in the same participants and from a developmental perspective. We fit a linear mixed-effect model on the Stroop interference score with time (pretest vs. posttest) and type of conflict (cool vs. hot) as within-participant factors and intervention group (CT vs. MM) and age group (child vs. adolescent) as between-participant factors. The findings revealed that children but not adolescents benefitted from interventions. More specifically, CT improved cool IC but not hot IC, whereas MM practice improved hot IC but not cool IC. This study supports the benefits of MM at a young age. Theoretical issues linking MM programs to emotional competence grounded in hot IC skills are considered in academic settings.

Conceptualizing the Role of Parent and Child Emotion Regulation in the Treatment of Early-Onset Behavior Disorders: Theory, Research, and Future Directions

Behavior disorders (BDs) are common and costly, making prevention and early-intervention a clinical and public health imperative. Behavioral Parent Training (BPT) is the standard of care for early-onset (3-8 years old) BDs, yet effect sizes vary and wane with time suggesting the role of underlying factors accounting for variability in outcomes. The literature on emotion regulation (ER), which has been proposed as one such underlying factor, is reviewed here, including a brief overview of ER, theory and research linking ER, externalizing symptoms, and/or BDs, and still largely preliminary work exploring the role of parent and child ER in BPT outcomes. Research to date provides clues regarding the interrelationship of ER, BDs, and BPT; yet, determining whether adaptations to BPT targeting ER are necessary or useful, for whom such adaptations would be most important, and how those adaptations would be implemented requires addressing mixed findings and methodological limitations. To guide such work, we propose a conceptual model elucidating how standard BPT may impact ER and processes linked to ER, which we believe will be useful in organizing and advancing both basic and applied research in future work.

Identifying and removing ableism from Tier 1 school-wide positive behaviour support practices

Across Australia, almost one third of schools have been trained to implement school-wide positive behaviour support (SWPBS). As part of a Tier 1 approach, students are expected to demonstrate expected behaviours. By defining these behaviours in conjunction with students and families, and explicitly teaching these to students, schools implementing SWPBS can create climates where students can thrive both academically and behaviourally. However, many students with disability continue to be over-represented in discipline data in all schools, including those implementing SWPBS. We argue this is because defining the behaviours we want to see and celebrate is only part of the solution. Implementation is destined to fail if we do not, in tandem, address the conditions we created that act as barriers for students with disability. Further, through an analysis of Australian SWPBS matrices, we show that structural ableism exists in the way some expected behaviours are framed by requiring a greater response effort from students with disability if they are to meet the standard expected. We offer suggestions for schools to both recognise and remove ableism from Tier 1 SWPBS practices.

Neural and functional validation of fMRI-informed EEG model of right inferior frontal gyrus activity

The right inferior frontal gyrus (rIFG) is a region involved in the neural underpinning of cognitive control across several domains such as inhibitory control and attentional allocation process. Therefore, it constitutes a desirable neural target for brain-guided interventions such as neurofeedback (NF). To date, rIFG-NF has shown beneficial ability to rehabilitate or enhance cognitive functions using functional Magnetic Resonance Imaging (fMRI-NF). However, the utilization of fMRI-NF for clinical purposes is severely limited, due to its poor scalability. The present study aimed to overcome the limited applicability of fMRI-NF by developing and validating an EEG model of fMRI-defined rIFG activity (hereby termed "Electrical FingerPrint of rIFG"; rIFG-EFP). To validate the computational model, we employed two experiments in healthy individuals. The first study (n = 14) aimed to test the target engagement of the model by employing rIFG-EFP-NF training while simultaneously acquiring fMRI. The second study (n = 41) aimed to test the functional outcome of two sessions of rIFG-EFP-NF using a risk preference task (known to depict cognitive control processes), employed before and after the training. Results from the first study demonstrated neural target engagement as expected, showing associated rIFG-BOLD signal changing during simultaneous rIFG-EFP-NF training. Target anatomical specificity was verified by showing a more precise prediction of the rIFG-BOLD by the rIFG-EFP model compared to other EFP models. Results of the second study suggested that successful learning to up-regulate the rIFG-EFP signal through NF can reduce one's tendency for risk taking, indicating improved cognitive control after two sessions of rIFG-EFP-NF. Overall, our results confirm the validity of a scalable NF method for targeting rIFG activity by using an EEG probe.

Early Risk of Tobacco Smoke Exposure and Preschoolers' Hot and Cool Inhibitory Control: Promotive and Protective Roles of Maternal Positivity in Early Mother-child Interaction

Early tobacco smoke exposure (TSE) in utero and/or during the first years after birth poses threats to the development of child executive functioning and self-regulation skills, including inhibitory control. Efforts are still needed to examine under what conditions such effects may occur and thus identify modifiable intervention targets. In addition, a distinction between cool and hot inhibitory control is also important to obtain greater nuance in such links. The cool inhibitory control refers to children's suppression of prepotent automatic responses to a distracting stimulus in solving arbitrary and decontextualized problems, whereas the hot inhibitory control refers to children's control of impulse in motivationally and emotionally high-stake situations. Using data derived from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, we examined the links between early risk of TSE and preschoolers' hot and cool inhibitory control and tested the potential promotive/protective roles of maternal positivity in early mother-child interactions. Results indicate that early risk of TSE was negatively linked to child cool inhibitory control when maternal positivity was low, but this link was nonsignificant when maternal positivity was high (i.e., the protective role of maternal positivity). The link between early risk of TSE and child later hot inhibitory control was not moderated by maternal positivity; instead, early risk of TSE and maternal positivity were negatively and positively associated with child hot inhibitory control above and beyond each other, respectively (i.e., the promotive role of maternal positivity). Accordingly, building a tobacco-free environment during pregnancy and infancy likely yields long-term benefits for child self-regulation development. Improving early mothering may offset the negative link between early TSE and child cool inhibitory control and also facilitate child hot inhibitory control even in the face of early TSE.

Mechanism-based groups of children with ADHD are associated with distinct domains of impairment

Person-oriented analyses are commonly used to identify subgroups of children with mental health conditions in the hopes that they will meaningfully inform the taxonomy, assessment, and treatment of psychological disorder. However, whether these data-driven groups are demonstrably better at predicting important aspects of adaptive functioning than standard DSM taxonomy has not been established. Using Attention-Deficit-Hyperactivity-Disorder (ADHD) as a model condition, we utilized dimensions of personality and cognitive ability to identify person-centered profiles of school-aged children (N=246) and evaluated the association of these profiles with critical areas of adaptive functioning. A single profile ("Conscientious") represented non-ADHD controls and was characterized by faster drift rate and higher executive functioning scores. Three profiles ("Disagreeable," "Negative Emotionality," and "Extraverted") were identified for children with ADHD. Drift rate, but not executive functioning, distinguished among ADHD profiles, which were also distinctly associated with comorbid externalizing and internalizing psychopathology, social skills, and academic achievement. In contrast, the Diagnostic and Statistical Manual (DSM) presentations were not informative and showed similar patterns of impairment across domains. Person-centered profiles of children with ADHD are associated with distinct adaptive functioning deficits and may be useful in informing clinical practice.

Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy

In cognitive behavioral therapy (CBT) children and adolescents with conduct problems learn social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Empirical studies on psychological functions show that the effectiveness of CBT may be further improved by putting more emphasis on (1) recognition of the type of social situations that are problematic, (2) recognition of facial expressions in view of initiating social problem-solving, (3) effortful emotion regulation and emotion awareness, (4) behavioral inhibition and working memory, (5) interpretation of the social problem, (6) affective empathy, (7) generation of appropriate solutions, (8) outcome expectations and moral beliefs, and (9) decision-making. To improve effectiveness, CBT could be tailored to the individual child's or adolescent's impairments of these psychological functions which may depend on the type of conduct problems and their associated problems.

Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach

BACKGROUND

Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD).

OBJECTIVE

To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD.

METHOD

Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians.

RESULTS

A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X² (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X²(3) = 84.66, p < .001).

CONCLUSION

Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.

Childhood Antisocial Behavior: A Neurodevelopmental Problem

Early-onset disruptive, aggressive, and antisocial behavior is persistent, can become increasingly serious as children grow older, and is difficult to change. In 2007, our group proposed a theoretical model highlighting the interplay between neurobiological deficits and cognitive and emotional functioning as mediators of the link between genetic influences and early social adversity, on the one hand, and antisocial behavioral problems in childhood, on the other. In this article, we review the post-2007 evidence relevant to this model. We discuss research on genetics/epigenetics, stress/arousal regulation, and emotion and executive functioning in support of the argument that antisocial children, especially those who persist in engaging in antisocial behavior as they grow older, have a range of neuropsychological characteristics that are important in explaining individual differences in the severity and persistence of antisocial behavior. Current clinical practice tends not to acknowledge these individual neuropsychological risks factors or to target them for intervention. We argue that aggressive and disruptive behavior in childhood should be regarded as a neurodevelopmental problem and that intervening at the level of mediating neuropsychological processes represents a promising way forward in tackling these serious behavioral problems. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Structural atrophy of the right superior frontal gyrus in adolescents with severe irritability

Severe irritability is common in youths with psychiatric disorders and results in significant dysfunction across domains (academic, social, and familial). Prior structural MRI studies in the pediatric population demonstrated that aberrations of cortical thickness (CT) and gray matter volume (GMV) in the fronto‐striatal‐temporal regions which have been associated with irritability. However, the directions of the correlations between structural alteration and irritability in the individual indices were not consistent. Thus, we aim to address this by implementing comprehensive assessments of CT, GMV, and local gyrification index (LGI) simultaneously in youths with severe levels of irritability by voxel‐based morphometry and surface‐based morphometry. One hundred and eight adolescents (46 youths with severe irritability and 62 healthy youths, average age = 14.08 years, standard deviation = 2.36) were scanned with a T1‐weighted MRI sequence. The severity of irritability was measured using the affective reactivity index. In youths with severe irritability, there was decreased CT, GMV, and LGI in the right superior frontal gyrus (SFG) compared to healthy youths, and negative correlations between these indices of the SFG and irritability. Our findings suggest that structural deficits in the SFG, potentially related to its role in inhibitory control, may be critical for the neurobiology of irritability.

Increasing Effectiveness of Cognitive Behavioral Therapy for Conduct Problems in Children and Adolescents: What Can We Learn from Neuroimaging Studies?

Cognitive behavioral therapy (CBT) is particularly relevant for children from 7 years on and adolescents with clinical levels of conduct problems. CBT provides these children and adolescents with anger regulation and social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Typically, CBT is combined with another psychological treatment such as behavioral parent training in childhood or an intervention targeting multiple systems in adolescence. The effectiveness of CBT, however, is in the small to medium range. The aim of this review is to describe how the effectiveness of CBT may be improved by paying more attention to a series of psychological functions that have been shown to be impaired in neuroimaging studies: (1) anger recognition, (2) the ability to generate situation appropriate solutions to social problems, (3) reinforcement-based decision making, (4) response inhibition, and (5) affective empathy. It is suggested that children and adolescents first become familiar with these psychological functions during group CBT sessions. In individual sessions in which the parents (and/or child care workers in day treatment and residential treatment) and the child or adolescent participate, parents then learn to elicit, support, and reinforce their child’s use of these psychological functions in everyday life (in vivo practice). In these individual sessions, working on the psychological functions is tailored to the individual child’s characteristic impairments of these functions. CBT therapists may also share crucial social-learning topics with teachers with a view to creating learning opportunities for children and adolescents at school.