Meta-Analysis of fMRI Studies of Disruptive Behavior Disorders
Open accessAbstract
OBJECTIVE: Functional magnetic resonance imaging (fMRI) studies in conduct disorder and in oppositional defiant disorder have shown inconsistencies. The aim of this meta-analysis of fMRI studies in disruptive behavior disorders was to establish the most consistent brain dysfunctions and to address task- and subtype-related heterogeneity. METHOD: Web-based publication databases were searched to conduct a meta-analysis of all whole-brain fMRI studies of youths with disruptive behavior disorder or conduct problems up to August 2015. Sub-meta-analyses were conducted in functional subdomains of emotion processing; in cool and hot executive functions, which refer to goal-directed higher cognitive functions with and without motivational and affective significance; and in a subgroup of youths with additional psychopathic traits. The authors performed a meta-analysis of voxel-based group differences in functional activation using the anisotropic effect-size version of seed-based d mapping. RESULTS: Across 24 studies, 338 youths with disruptive behavior disorder or conduct problems relative to 298 typically developing youths had consistent underactivation in the rostral and dorsal anterior cingulate and in the medial prefrontal cortex and ventral caudate. Sub-meta-analyses of fMRI studies showed that medial fronto-cingulate dysfunction was driven by hot executive function. The sub-meta-analysis of emotion processing fMRI studies showed the most consistent underactivation in the dorsolateral prefrontal cortex and temporal pole, while cool executive functions were associated with temporal abnormalities. Youths with disruptive behavior disorder with psychopathic traits showed reduced ventromedial prefrontal-hypothalamic-limbic activation, but they also showed hyperactivation in cognitive control mediating dorsolateral prefrontal-dorsal and striatal regions. CONCLUSIONS: The findings show that the most consistent dysfunction in youths with disruptive behavior disorder is in the rostro-dorsomedial, fronto-cingulate, and ventral-striatal regions that mediate reward-based decision making, which is typically compromised in the disorder. Youths with psychopathic traits, on the other hand, have dysfunctions associated with the ventromedial prefrontal cortex and limbic system, together with dorsal and fronto-striatal hyperfunctioning, which may reflect poor affect reactivity and empathy in the presence of hyperactive executive control. These findings provide potential targets for neurotherapeutic and pharmacological interventions.
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These inconsistent findings are likely due to small sample sizes, confounds of previous medication history, and the presence of comorbidities, in particular CD and ODD which have been associated with ventromedial and dorsomedial-limbic dysfunctions during hot EF and emotion processing.
“These inconsistent findings are likely due to small sample sizes, confounds of previous medication history, and the presence of comorbidities, in particular CD and ODD which have been associated with ventromedial and dorsomedial-limbic dysfunctions during hot EF and emotion processing (Rubia, 2011; Alegria et al., 2016).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Alegria et al., 2016
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Experimental — accuracy not yet measuredCD children have problems with recruitment of hot vmPFC and OFC-limbic systems that mediate top-down control over motivation and affect.
“whereas CD children have problems with the recruitment of “hot” vmPFC and OFC-limbic systems that mediate top-down control over motivation and affect (Rubia, 2011; Alegria et al., 2016).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Alegria et al., 2016
The Discussion reports reduced activation in medial prefrontal regions involved in top-down regulation of motivation and affect, with dysfunction largely arising from hot executive-function studies. But the paper identifies rostro-dorsal fronto-cingulate regions as the most consistent finding; it associates ventromedial prefrontal–limbic dysfunction particularly with youth who have psychopathic traits and says further studies may reveal more orbitofrontal–limbic abnormalities. The claim presents those latter systems too broadly as an established finding for children with conduct disorder. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAffective childhood disorders appear to suffer from similar underactivations in ventromedial and/or dorsomedial prefrontal and limbic regions during cognitive control.
“These more “affective childhood disorders” appear to suffer from similar underactivations in ventromedial and/or dorsomedial prefrontal and limbic regions during cognitive control (Passarotti and Pavuluri, 2011; Sebastian et al., 2014; Alegria et al., 2016; Norman et al., 2016;”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Alegria et al., 2016
The Cognitive sub-domain meta-analyses report dorsomedial prefrontal underactivation during hot executive-function tasks in youth with disruptive or conduct problems, and ventromedial prefrontal and related subcortical underactivation in the subgroup with psychopathic traits. The same section reports mainly temporal, insular and putaminal underactivation during cool executive-function tasks. The claim therefore broadens findings from a specific disorder and task-dependent subgroups to affective childhood disorders generally during cognitive control. (LLM, conf=0.85)
Experimental — accuracy not yet measuredA recent meta-analysis of fMRI studies of cool and hot EF and emotion processing in CD/ODD showed that the most consistent underactivation was in ventral and dorsal medial prefrontal cortex, mostly triggered by hot EF tasks.
“A recent meta-analysis of fMRI studies of cool and hot EF as well as emotion processing in CD/ODD showed that the most consistent underactivation was in ventral and dorsal medial prefrontal cortex, which was mostly triggered by hot EF tasks (Alegria et al., 2016).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Alegria et al., 2016
There are disorder-specific and process-related dissociations in prefrontal functional deficits between ADHD and CD/ODD.
“In conclusion, it appears that there are disorder-specific and process-related dissociations in prefrontal functional deficits between both disorders”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Alegria et al., 2016
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References 103 · Cited by 174
Research works printed but not linked: 3
- American Psychiatric Association: Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA, American Psychiatric Publishing, 2013
- Zelazo P, Muller U: Executive function in typical and atypical development, in: Handbook of childhood cognitive development. Edited by Goswami U. Oxford, UK, Blackwell, 2004
- Stroup DF, Berlin JA, Morton SC, et al: Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283:2008-2012
- Authors
- Alegria, A. A., Radua, J., & Rubia, K.
- Affiliations
- From the Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London; the Department of Translational Neuroimaging, FIDMAG Sisters Hospitallers Research Foundation, and the Mental Health Network Biomedical Research Centre (CIBERSAM), Barcelona, Spain; and the Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
- King's College London (GB)
- Corresponding author
- Rubia, Katya
- ORCID
- Rubia, Katya
- Venue
- American Journal of Psychiatry
- Published
- 2016-11-01
- Volume
- 173
- Issue
- 11
- Pages
- 1119-1130
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2474713866
- Cited by
- 174
- References
- 103
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 16 · 2023: 22 · 2022: 15 · 2021: 20 · 2020: 18 · 2019: 18 · 2018: 20 · 2017: 12 · 2016: 1
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Eli Lilly and Company
- South London and Maudsley NHS Foundation Trust
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- Action Medical Research
- National Institute for Health and Care Research
- King's College London
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- disruptive behavior disorders, conduct disorder, oppositional defiant disorder, youth, brain dysfunction, anterior cingulate cortex, medial prefrontal cortex, executive function, emotional processing, psychopathic traits, reward-based decision-making, cognitive control, dorsolateral prefrontal cortex, temporal pole, ventromedial prefrontal cortex, limbic system, hyperactivation
- MeSH terms
- Adolescent, Brain, Brain Mapping, Child, Emotions, Female, Humans, Magnetic Resonance Imaging, Male, Case-Control Studies, Conduct Disorder, Attention Deficit and Disruptive Behavior Disorders, Executive Function, Functional Neuroimaging
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