Magnitude and chronometry of neural mechanisms of emotion regulation in subtypes of aggressive children

Annual Research Review: What processes are dysregulated among emotionally dysregulated youth? - a systematic review

Proliferation of the term "emotion dysregulation" in child psychopathology parallels the growing interest in processes that influence negative emotional reactivity. While it commonly refers to a clinical phenotype where intense anger leads to behavioral dyscontrol, the term implies etiology because anything that is dysregulated requires an impaired regulatory mechanism. Many cognitive, affective, behavioral, neural, and social processes have been studied to improve understanding of emotion dysregulation. Nevertheless, the defective regulatory mechanism that might underlie it remains unclear. This systematic review of research on processes that affect emotion dysregulation endeavors to develop an integrative framework for the wide variety of factors investigated. It seeks to ascertain which, if any, constitutes an impaired regulatory mechanism. Based on this review, we propose a framework organizing emotion-relevant processes into categories pertaining to stimulus processing, response selection and control, emotion generation, closed- or open-loop feedback-based regulation, and experiential influences. Our review finds scant evidence for closed-loop (automatic) mechanisms to downregulate anger arousal rapidly. Open-loop (deliberate) regulatory strategies seem effective for low-to-moderate arousal. More extensive evidence supports roles for aspects of stimulus processing (sensory sensitivity, salience, appraisal, threat processing, and reward expectancy). Response control functions, such as inhibitory control, show robust associations with emotion dysregulation. Processes relating to emotion generation highlight aberrant features in autonomic, endocrine, reward functioning, and tonic mood states. A large literature on adverse childhood experiences and family interactions shows the unique and joint effects of interpersonal with child-level risks. We conclude that the defective closed-loop regulatory mechanisms that emotion dysregulation implies require further specification. Integrating research on emotion-relevant mechanisms along an axis from input factors through emotion generation to corrective feedback may promote research on (a) heterogeneity in pathogenesis, (b) interrelationships between these factors, and (c) the derivation of better-targeted treatments that address specific pathogenic processes of affected youth.

Impact of emotionally-charged images and trial order on downstream cognitive processing: An ERP study

Theories of emotion-cognition interactions suggest that emotional valence can both facilitate or limit cognitive performance. One cause for the mixed findings may be the order (random versus non-random presentation) in which emotional stimuli are presented. To investigate the impact of stimuli order on cognitive control processing, EEG data were recorded as 130 undergraduate students (M age = 22.2, SD = 5.4; 79 female) completed a modified version of the AX-Continuous Performance Task in which the cue was followed by an emotionally-valenced image (positive, negative, and neutral). Specifically, the task was designed so that valenced images were presented in either a block or random order, prior to probe presentation. We examined two event-related potentials (ERPs), the N2, which reflects aspects of cognitive control, and the late positive potential (LPP), which reflects attention allocation to emotional stimuli. We assessed the impact of emotionally oriented attention (LPP) on downstream cognitive control (N2) and how this relationship might differ for a block versus random (order of emotional image) task design. Consistent with the LPP literature, we found a main effect of image valence with the negative trials showing larger LPPs than the positive and neutral trials. For N2s, we found that the negative trials were associated with smaller N2s than both the positive and neutral trials. We observed that as LPP amplitude increased, subsequent N2 amplitude was reduced, specifically for negative trials in the random design. These results suggest an emotion-related depletion of neural cognitive resources. Lastly, we found larger N2s for the block design versus the random design. Together, these results indicate the importance of paying attention to both trial order (block versus random) and within trial stimulus sequence when designing emotion induction tasks.

Attention-Deficit Hyperactivity Disorder and the Dysregulation of Emotion Generation and Emotional Expression

Individuals with attention-deficit/hyperactivity disorder (ADHD) frequently experience strong reactions to emotionally evocative situations. Difficulties modulating anger and other upsets have clinically significant behavioral consequences. Those with ADHD may have anomalies in emotion generation, emotion expression, or both that predispose to these problems. The association between ADHD and emotion dysregulation raises Important clinical and research issues, including possible heterogeneity in the mechanisms by which they are related. Although first-line treatments for ADHD often help to resolve emotional dysregulation symptoms as well, the evidence base for widespread practice of combination pharmacotherapy remains sparse. Psychosocial treatments that engage processes underlying emotional dysregulation are in development.

Investigation of a developmental pathway from infant anger reactivity to childhood inhibitory control and ADHD symptoms: interactive effects of early maternal caregiving

BACKGROUND

ADHD is a neurodevelopmental disorder with a complex pathogenesis. Individual differences in temperamental reactivity - in particular, anger reactivity - are predictive of ADHD. The goal of this study was to examine the moderating (maternal caregiving behaviors; MCB) and mediating (inhibitory control) variables of reactivity using a 9-year multimethod prospective longitudinal design.

METHODS

Participants included 291 children (135 male; 156 female) who participated in a larger study of temperament and social-emotional development. Anger reactivity was assessed by observation of facial anger during an arm restraint task, and MCB were observed during a series of semi-structured mother-infant tasks, both at 9 months of age. Inhibitory control was assessed by performance on a go/no-go task at 5 years of age. ADHD symptoms were assessed by parent and teacher report questionnaires at 7 and 9 years, respectively.

RESULTS

Anger reactivity and poor inhibitory control were predictive of later ADHD symptoms. Results supported a moderated mediation model, in which the indirect effects of anger reactivity on ADHD symptoms through inhibitory control were conditional on quality of early MCB. Inhibitory control mediated the effect of anger reactivity on ADHD symptoms, but only among children exposed to lower-quality MCB.

CONCLUSIONS

Infant anger reactivity exerts a direct effect on later ADHD from infancy, suggesting anger reactivity as a very early indicator of ADHD risk. Higher-quality caregiving did not buffer against the direct risk of anger reactivity on ADHD but did buffer against the indirect risk by reducing the negative effect of anger reactivity on inhibitory control. Thus, in the developmental pathway from anger reactivity to ADHD, more sensitive, less intrusive parenting supports the development of protective mechanisms (i.e. inhibitory control) to remediate ADHD risk.

Implicit Emotion Regulation Deficits in Trait Anxiety: An ERP Study

According to the framework of emotion regulation (ER), both explicit and implicit forms are essential to our well-being. It is the interaction between these two processes that ensures adaptive emotional responses. Although many studies have focused on explicit ER deficits in anxiety, there is still a lack of awareness about the implicit form and its role in anxiety. To address this issue, we explored the time course of implicit ER processes in individuals with high and low trait anxiety (LTA). To do this, we employed the newly developed Priming-Identify (PI) paradigm, which includes a word-matching task (externally-generated implicit goals) and a facial expression identification task (emotion processing). We aimed to modulate the implicit ER goals of individuals through the application of different priming conditions (ER-related and -unrelated words). In addition to their behavioral effects, we recorded the influence of these priming conditions through event-related potentials (ERPs) during the facial expression identification task. Three ERP components were chosen as indexes of three stages of implicit ER processing: N170, early posterior negativity (EPN) and late positive potential (LPP). In individuals with LTA, the early N170 and the middle EPN were enlarged under the ER-related priming condition, while the LPP was not influenced. However, in individuals with high trait anxiety (HTA), we observed an absence of any significant differences between the ER-related and -unrelated priming conditions across all three ERP components. Furthermore, enlargements of N170 and EPN amplitudes were significantly correlated with a decrease in negative emotion experience scores. Our results suggest that HTA individuals experience implicit ER deficits during the early and middle stages of ER.

Impact of early institutionalization on attention mechanisms underlying the inhibition of a planned action

Institutional rearing is associated with deficits in executive functions, such as inhibitory control, and may contribute to later externalizing behavior problems. In the current study, we explored the impact of institutional rearing on attention in the context of inhibiting a planned action. As part of the Bucharest Early Intervention Project (BEIP), children were randomized to either remain in the institutions in which they lived (Care as Usual Group) or be placed into foster family homes (Foster Care Group). We also recruited age and gender matched never-institutionalized (NIG) children from the Bucharest community. We examined differences in behavioral and Event Related Potentials (ERPs) during a go-no-go task when children were 12 years old. Results revealed that the ever-institutionalized group (CAUG and FCG combined) showed slower reaction times, worse performance accuracy, larger P2 activation, and smaller (less negative) N2 activation than the NIG group. Results of a moderation analysis revealed that children who spent more time in institutions and had small N2s showed more externalizing symptoms. These results have implications for the design of treatment approaches for previously institutionalized children with externalizing behavior problems.

The detrimental effect of acute stress on response inhibition when exposed to acute stress: an event-related potential analysis

Response inhibition as a core cognitive function plays a critical role in our daily activities. However, response inhibition can be easily altered when exposed to acute stress. The current study investigated how and whether or not acute stress impacted response inhibition and the underlying neural mechanism with behavioral and event-related potential methods. Healthy participants were assigned randomly to a modified Trier Social Stress Test as a stressor and a control condition. Then, event-related potentials were measured when participants performed a modified Go/No-Go task. In this task, participants were informed to make or withhold a response according to the colored frame of three different emotional pictures: negative, neutral, and positive. Increased negative effect in the stress condition compared with the control condition indicated a successful acute stress induction. The stress group showed significantly smaller frontal and central N2 mean difference waves, relatively less positive parietal P3 mean difference waves, and prolonged N2 and Nogo-P3 latency compared with the control group. In addition, the reaction time in 'Go' trials was correlated negatively with N2 and P3 difference waves in the stress group. Behaviorally, acute stress did not influence response times and miss rates of 'Go' trials as well as the rate of false alarms in 'No-Go' trials. These findings suggested that acute stress impaired conflict detection, monitoring processes, and response inhibition processes on the neural level without a behavioral performance deficit. These findings provide neural evidence for understanding how the dynamic processes of acute stress influence response inhibition.

Disrupted Executive Function and Aggression in Individuals With a History of Adverse Childhood Experiences: An Event-Related Potential Study

Here, we explored the functional and neural mechanisms underlying aggression related to adverse childhood experiences. We assessed behavioral performance and event-related potentials during a go/no-go and N-back paradigm. The participants were 15 individuals with adverse childhood experiences and high aggression (ACE + HA), 13 individuals with high aggression (HA), and 14 individuals with low aggression and no adverse childhood experiences (control group). The P2 latency (initial perceptual processing) was longer in the ACE + HA group for the go trials. The HA group had a larger N2 (response inhibition) than controls for the no-go trials. Error-related negativity (error processing) in the ACE + HA and HA groups was smaller than that of controls for false alarm go trials. Lastly, the ACE + HA group had shorter error-related negativity latencies than controls for false alarm trials. Overall, our results reveal the neural correlates of executive function in aggressive individuals with ACEs.

Pediatric Irritability: A Systems Neuroscience Approach

Irritability, defined as an increased propensity to exhibit increased anger relative to one's peers, is a common clinical problem in youth. Irritability can be conceptualized as aberrant responses to frustration (where frustration is the emotional response to blocked goal attainment) and/or aberrant 'approach' responses to threat. Irritable youth show hyper-reactivity to threat mediated by dysfunction in amygdala, medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, and association cortex. Irritable youth also show abnormalities in reward learning, cognitive control, and responses to frustration. These abnormalities are mediated by circuitry that includes the inferior frontal gyrus (iFG), striatum, ACC, and parietal cortex. Effective treatments for irritability are lacking, but pathophysiological research could lead to more precisely targeted interventions.

Relationship between brain stem volume and aggression in children diagnosed with autism spectrum disorder

BACKGROUND

Aggressive behaviors are common in individuals diagnosed with autism spectrum disorder (ASD) and may be phenotypic indicators of different subtypes within ASD. In current research literature for non-ASD samples, aggression has been linked to several brain structures associated with emotion and behavioral control. However, few if any studies exist investigating brain volume differences in individuals with ASD who have comorbid aggression as indicated by standardized diagnostic and behavioral measures.

METHOD

We examined neuroimaging data from individuals rigorously diagnosed with ASD versus typically developing (TD) controls. We began with data from brain volume regions of interest (ROI) taken from previous literature on aggression including the brainstem, amygdala, orbitofrontal cortex, anterior cingulate cortex, and dorsolateral prefrontal cortex. We defined aggression status using the Irritability subscale of the Aberrant Behavior Checklist and used lasso logistic regression to select among these predictor variables. Brainstem volume was the only variable shown to be a predictor of aggression status.

RESULTS

We found that smaller brainstem volumes are associated with higher odds of being in the high aggression group.

CONCLUSIONS

Understanding brain differences in individuals with ASD who engage in aggressive behavior from those with ASD who do not can inform treatment approaches. Future research should investigate brainstem structure and function in ASD to identify possible mechanisms related to arousal and aggression.

Executive function in children with externalizing and comorbid internalizing behavior problems

BACKGROUND

The goal of this study is to investigate differences in executive function (EF) in children with different levels of disruptive behavior problems (DBP).

METHODS

Ninety-three children between 7 and 12 years old with DBP were compared to 63 normally developing peers on a battery of EF tasks that varied in the amount of required emotion regulation ('hot' EF).

RESULTS

Differences in EF were found between DBP and comparison groups as indexed by hot EF tasks. Self-reported emotion scales, in conjunction with physiological recordings of heart rate, confirmed that emotions were elicited during hot EF.

CONCLUSIONS

Results suggest that difficulties in hot EF underlie externalizing problem behaviors in middle childhood.

The role of anxiety in the development, maintenance, and treatment of childhood aggression

The majority of aggressive children exhibit symptoms of anxiety, yet none of our developmental models of aggression incorporate the role of anxiety, and our treatments ignore this comorbidity. This article outlines a novel theoretical model that specifies three hypotheses about comorbid anxious and aggressive children: (a) unpredictable parenting induces anxiety in children that in turn triggers aggressive behavior; (b) prolonged periods of anxiety deplete children's capacity to inhibit impulses and trigger bouts of aggression, and aggression in turn functions to regulate levels of anxiety; and (c) minor daily stressors give rise to anxiety while cognitive perseveration maintains anxious moods, increasingly disposing children to aggress. Little or no research has directly tested these hypotheses. Extant research and theory consistent with these claims are herein reviewed, and future research designs that can test them specifically are suggested. The clinical implications most relevant to the hypotheses are discussed, and to improve the efficacy of treatments for childhood aggression, it is proposed that anxiety may need to be the primary target of treatment.

Neural Rhythms of Change: Long-Term Improvement after Successful Treatment in Children with Disruptive Behavior Problems

Neural changes were investigated for children with disruptive behavior problems one year after a treatment program ended. Thirty-nine children and their parents visited the research lab before, after, and a year after treatment ended. During those lab visits, electroencephalography (EEG) was recorded during a challenging Go/No-go task. Treatment consisted of intensive 14-week combined cognitive behavioral therapy and parent management training sessions. For the analysis, participants were divided into long-term improvers (IMPs) and long-term nonimprovers (NIMPs) based on changes in their externalizing problem scores. The results showed early no-go theta power (4–8 Hz, 100–250 ms) decreased for long-term IMPs compared to NIMPs. When participants were divided based on changes in their comorbid internalizing symptoms, effects were stronger and reductions in theta power were found for early as well as later phases (250–650 ms). We provided preliminary evidence that theta power is a useful neural measure to trace behavioral change linked to improved self-regulation even up to a year after treatment ended. Results may have implications for the characterization of children with disruptive behavior problems and may lead to the development of novel markers of treatment success.

Cognitive control moderates early childhood temperament in predicting social behavior in 7-year-old children: an ERP study

Behavioral inhibition (BI) is a temperament associated with heightened vigilance and fear of novelty in early childhood, and social reticence and increased risk for anxiety problems later in development. However, not all behaviorally inhibited children develop signs of anxiety. One mechanism that might contribute to the variability in developmental trajectories is the recruitment of cognitive-control resources. The current study measured N2 activation, an ERP (event-related potential) associated with cognitive control, and modeled source-space activation (LORETA; Low Resolution Brain Electromagnetic Tomography) at 7 years of age while children performed a go/no-go task. Activation was estimated for the entire cortex and then exported for four regions of interest: ventromedial prefrontal cortex (VMPFC), ventrolateral prefrontal cortex (VLPFC), dorsal anterior cingulate cortex (dorsal ACC), and dorsal lateral prefrontal cortex (DLPFC). BI was measured in early childhood (ages 2 and 3 years). Anxiety problems and social reticence were measured at 7 years of age to ascertain stability of temperamental style. Results revealed that BI was associated with increased performance accuracy, longer reaction times, greater (more negative) N2 activation, and higher estimated dorsal ACC and DLPFC activation. Furthermore, early BI was only associated with social reticence at age 7 at higher (more negative) levels of N2 activation or higher estimated dorsal ACC or DLPFC activation. Results are discussed in the context of overcontrolled behavior contributing to social reticence and signs of anxiety in middle childhood.

The developmental psychopathology of irritability

Chronic, severe irritability is common in childhood and is very impairing. Furthermore, childhood irritability predicts suicidality, social impairment, and depressive and anxiety disorders in adulthood. Focusing on both normative and pathologic development, we review the construct of irritability from its origins in aggression and disruptive behavior research to its contemporary relevance for affective psychopathology. We then describe two broad neurocognitive systems that show promise in differentiating irritable from nonirritable youths: aberrant processing of emotional stimuli and impaired context-sensitive regulation. We suggest behavioral, neurocognitive, and physiologic measures that may aid in studying severe irritability and assessing its therapeutics. Finally, we argue for therapeutic trials targeting severe irritability that address emotional aspects of irritability in addition to the associated disruptive behavior.

Impact of negative affectively charged stimuli and response style on cognitive-control-related neural activation: an ERP study

The canonical AX-CPT task measures two forms of cognitive control: sustained goal-oriented control ("proactive" control) and transient changes in cognitive control following unexpected events ("reactive" control). We modified this task by adding negative and neutral International Affective Picture System (IAPS) pictures to assess the effects of negative emotion on these two forms of cognitive control. Proactive and reactive control styles were assessed based on measures of behavior and electrophysiology, including the N2 event-related potential component and source space activation (Low Resolution Tomography [LORETA]). We found slower reaction-times and greater DLPFC activation for negative relative to neutral stimuli. Additionally, we found that a proactive style of responding was related to less prefrontal activation (interpreted to reflect increased efficiency of processing) during actively maintained previously cued information and that a reactive style of responding was related to less prefrontal activation (interpreted to reflect increased efficiency of processing) during just-in-time environmentally triggered information. This pattern of results was evident in relatively neutral contexts, but in the face of negative emotion, these associations were not found, suggesting potential response style-by-emotion interaction effects on prefrontal neural activation.

Physical aggression, diagnostic presentation, and executive functioning in inpatient adolescents diagnosed with mood disorders

While a relationship has been identified between physical aggression and executive functioning within the adult population, this relationship has not yet been consistently examined in the adolescent population. This study examined the association between physical aggression towards others, self-reported depressive symptoms, and executive functioning within an adolescent inpatient sample diagnosed with a mood disorder. This study consisted of a retrospective chart review of 105 adolescent inpatients (ages 13-19) that received a diagnosis of a mood disorder (excluding Bipolar Disorder). Participants were grouped based on history of aggression towards others, resulting in a mood disorder with physically aggressive symptoms group (n = 49) and a mood disorder without physically aggressive symptoms group (n = 56). Ten scores on various measures of executive functioning were grouped into five executive functioning subdomains: Problem Solving/Planning, Cognitive Flexibility/Set Shifting, Response Inhibition/Interference Control, Fluency, and Working Memory/Simple Attention. Results from analyses of covariance indicated that there were no significant differences (p < .01) between aggression groups on any executive functioning subdomains. Correlation analyses (p < .01) indicated a negative correlation between disruptive behavior disorders and response inhibition/interference control, while anxiety disorders were negatively correlated with problem solving/planning. These findings provide important information regarding the presence of executive dysfunction in adolescent psychiatric conditions, and the specific executive subdomains that are implicated.

Neural activation underlying cognitive control in the context of neutral and affectively charged pictures in children

The neural correlates of cognitive control for typically developing 9-year-old children were examined using dense-array ERPs and estimates of cortical activation (LORETA) during a go/no-go task with two conditions: a neutral picture condition and an affectively charged picture condition. Activation was estimated for the entire cortex after which data were exported for four regions of interests (ROIs): ventrolateral prefrontal cortex (VLPFC), dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (DLPFC), and orbitofrontal/ventromedial prefrontal cortex (OFC/VMPFC). Results revealed faster reaction times, greater N2 activation, and greater prefrontal activation for the affectively charged picture condition than the neutral picture condition. The findings are discussed in reference to the impact of affective stimuli on recruitment of specific brain regions involved in cognitive control.

Emotion regulation in children with behavior problems: Linking behavioral and brain processes

Past studies have shown that aggressive children exhibit rigid (rather than flexible) parent–child interactions; these rigid repertoires may provide the context through which children fail to acquire emotion-regulation skills. Difficulties in regulating emotion are associated with minimal activity in dorsal systems in the cerebral cortex, for example, the anterior cingulate cortex. The current study aimed to integrate parent–child and neurocognitive indices of emotion regulation and examine their associations for the first time. Sixty children (8–12 years old) referred for treatment for aggression underwent two assessments. Brain processes related to emotion regulation were assessed using dense-array EEG with a computerized go/no-go task. The N2 amplitudes thought to tap inhibitory control were recorded, and a source analysis was conducted. In the second assessment, parents and children were videotaped while trying to solve a conflict topic. State space grids were used to derive two dynamic flexibility parameters from the coded videotapes: (a) the number of transitions between emotional states and (b) the dispersion of emotional states, based on proportional durations in each state. The regression results showed that flexibility measures were not related to N2 amplitudes. However, flexibility measures were significantly associated with the ratio of dorsal to ventral source activation: for transitions, ΔR2 = .27, F (1, 34) = 13.13, p = .001; for dispersion, ΔR2 = .29, F (1, 35) = 14.76, p < .001. Thus, in support of our main hypothesis, greater dyadic flexibility was associated with a higher ratio of dorsomedial to ventral activation, suggesting that children with more flexible parent–child interactions are able to recruit relatively more dorsomedial activity in challenging situations.

Performance monitoring and the medial prefrontal cortex: a review of individual differences and context effects as a window on self-regulation

The medial prefrontal cortex (MPFC) is central to self-regulation and has been implicated in generating a cluster of event-related potential components, collectively referred to as medial frontal negativities (MFNs). These MFNs are elicited while individuals monitor behavioral and environmental consequences, and include the error-related negativity, Nogo N2, and the feedback-related negativity. A growing cognitive and affective neuroscience literature indicates that the activation of the anterior cingulate cortex (ACC) and surrounding medial prefrontal regions during performance monitoring is not only influenced by task context, but that these patterns of activity also vary as a function of individual differences (e.g., personality, temperament, clinical and non-clinical symptomatology, socio-political orientation, and genetic polymorphisms), as well as interactions between individual differences and task context. In this review we survey the neuroscience literature on the relations between performance monitoring, personality, task context, and brain functioning with a focus on the MPFC. We relate these issues to the role of affect in the paradigms used to elicit performance-monitoring neural responses and highlight some of the theoretical and clinical implications of this research. We conclude with a discussion of the complexity of these issues and how some of the basic assumptions required for their interpretation may be clarified with future research.

Time course of automatic emotion regulation during a facial Go/Nogo task

Neuroimaging research has determined that the neural correlates of automatic emotion regulation (AER) include the anterior cingulate cortex. However, the corresponding time course remains unknown. In the current study, we collected event-related potentials (ERPs) from 20 healthy volunteers during a judgment of the gender of emotional faces in a cued Go/Nogo task. The results indicate that Go-N2 amplitudes and latencies following positive and negative faces decreased more than those following neutral faces; Nogo-N2 amplitudes and latencies did not vary with valence. Moreover, positive and negative faces prompted higher P3 amplitudes and shorter P3 latencies than neutral faces in both Go and Nogo trials. These observations suggest that in the executive processes, Go-N2 reflects top-down attention toward emotions, while Go-P3 reflects only motivated attention; in the inhibitory processes, Nogo-N2 reflects cognitive conflict monitoring, while Nogo-P3 overlaps with the automatic response inhibition of emotions. These observations imply that AER can modulate early ERP components, and both Go-N2 and Nogo-P3 can be used as electrophysiological indices of AER.