Neurobiological, Neuroimaging, and Neuropsychological Studies of Children and Adolescents with Disruptive Behavior Disorders
| DOI | http://doi.org/10.1111/fare.12182 |
| Published date | 01 February 2016 |
| Author | Areti Smaragdi,Graeme Fairchild,Ignazio Puzzo,Karen Gonzalez,Nayra Martin‐Key |
| Date | 01 February 2016 |
I P, A S, K G,
N M-K, G F
University of Southampton
Neurobiological, Neuroimaging,
and Neuropsychological Studies of Children
and Adolescents with Disruptive Behavior Disorders
Special Issue Guest Editor’s Note: In this arti-
cle the authors highlight the importance of neu-
roscience research in characterizing biomark-
ers associated with antisocial and aggressive
behavior. Presenting a focus on the neurology
associated with common disruptive behavioral
disorders, the authors examine how neurobio-
logical, neuroimaging, and neuropsychological
ndings can inform interventions as well as how
they contribute to a biopsychosocial model of
early child disciplinary practices and children’s
later functioning. In the paired article, “Should
Parents’ Physical Punishment of Children Be
Considered a Source of Toxic Stress That Affects
Brain Development?” (this issue, pp. 151–162),
Gershoff extendsthe research to address whether
physical punishment is a source of toxic stress.
A
The aim of this article is to review ndings
from the neurobiological, neuroimaging, and
neuropsychological literature that have con-
tributed to our understanding of the etiology and
development of disruptive behavior disorders,
Developmental Brain-Behaviour Laboratory, Academic
Unit of Psychology, University of Southampton, High-
eld Campus, Southampton SO17 1BJ, United Kingdom
(ignaziopzz@gmail.com).
Key Words: antisocial behavior,callous–unemotional traits,
conduct disorder, disruptive behavior disorders, emotion,
neurobiology,neuroendocrinology, neuroimaging.
with particular reference to conduct disorder.
This review focuses on neurobiological systems
such as the hypothalamic–pituitary–adrenal
axis and neuroimaging evidence linking dis-
ruptive behavior disorders to changes in brain
functioning or structure. Overall, this research
suggests that brain areas involved in emotional
processing and regulation are particularly
compromised in children and adolescents with
disruptive behavior disorder, which ts with
evidence obtained from neuropsychological
studies. This review highlights the importance
of neuroscientic research in characterizing
reliable brain-based functional and structural
biomarkers that may contribute to an increased
understanding of, and the development of
new treatments for, antisocial and aggressive
behavior in children and adolescents.
A persistent and severe pattern of antisocial
behavior in children or adolescents can be diag-
nosed as a disruptive behavior disorder [DBD;
American Psychiatric Association (APA),
2013]. The DBD category includes oppositional
deant disorder (ODD), which is characterized
by deance of authority and severe temper
outbursts, as well as conduct disorder (CD),
which is a pervasive and persistent form of
disruptive behavior resulting in the violation
of other people’s rights or of age-appropriate
societal norms (APA, 2013).
Typical antisocial behaviors include deance
of authority, deceitfulness, theft, and acts that
134 Family Relations 65 (February 2016): 134–150
DOI:10.1111/fare.12182
Neurobiology of Child Disruptive Behaviors 135
show a reckless disregard for the well-being
of others. CD is diagnosed on the basis of the
presence of at least three symptoms out of a list
of 15 (APA, 2013). These symptoms fall into
four distinct categories: (a) aggression to people
and animals, (b) destruction of property, (c)
deceitfulness or theft, and (d) serious violations
of rules. It is important to note that in order for
an individual to be diagnosed with CD, these
symptoms must result in social, academic, or
occupational impairment (APA, 2013). Given
the number and variety of symptoms that could
lead to a diagnosis (Nock, Kazdin, Hiripi, &
Kessler, 2006), the CD population is highly
heterogeneous. Researchers have tried to iden-
tify meaningful subtypes within the broader
construct of CD in an attempt to examine
whether these subtypes have distinct etiologies,
developmental courses, or prognoses. The three
most inuential subtyping approaches have
classied CD on the basis of (a) its age of onset,
(b) whether the individual displays aggressive
versus nonaggressive symptoms of CD, or (c)
the presence or absence of callous–unemotional
(CU) personality traits. In the fourth and fth
editions of the Diagnostic and Statistical
Manual of Mental Disorders, age-of-onset dif-
ferentiates between individuals who display
symptoms of CD prior to the age of 10 (termed
childhood-onset CD) and those whose antisocial
behavior rst becomes apparent in the teenage
years, referred to as adolescence-onset CD
(APA, 1994, 2013). Childhood-onset CD is
associated with a more severe and persistent
manifestation of antisocial behavior (including
higher levels of aggression), and is strongly
correlated with individual and family risk fac-
tors (McCabe, Hough, Wood, & Yeh, 2001).
Conversely,adolescence-onset CD is considered
to reect the imitation of antisocial peers and is
viewed as an extreme form of adolescent rebel-
lion (Moftt, 2001). The distinction between
aggressive and nonaggressive (rule-breaking)
forms of CD overlaps to some extent with the
age-of-onset approach to subtyping CD, as
aggressive behavior tends to be displayed at
an early age and remains fairly stable across
development, whereas rule-breaking behavior
increases dramatically in adolescence but is less
stable (Broidy et al., 2003; Eley, Lichtenstein,
& Moftt, 2003; Verhulst & van der Ende,
1995). Another common way of subtyping CD
is through the assessment of CU traits, which
include personality features such as diminished
empathy or guilt (Frick & White, 2008). Individ-
uals with CD and high levels of CU traits have
been found to display a more severe, violent, and
chronic pattern of antisocial behavior relative
to those with low levels of CU traits (Frick &
White, 2008). CD is associated with a range of
negative outcomes such as criminality in adult-
hood, poor physical and mental health, a higher
incidence of sexually transmitted diseases, and
poor academic and occupational achievement
(Fazel, Doll, & Långström, 2008; Forrest, Tam-
bor, Riley, Ensminger, & Stareld, 2000; Teich-
ner & Golden, 2000; Teplin et al., 2005; Teplin,
Abram, McClelland, Dulcan, & Mericle, 2002).
In terms of associated psychiatric disorders,
ODD is often diagnosed when a child does
not meet the criteria for CD but shows dif-
cult or challenging behavior for a period of at
least 6 months (Davidson, O’Connell, Tondora,
Lawless, & Evans, 2005). Children with ODD
often lose their temper, deliberately annoy
others, and refuse to obey adult requests, as
well as argue with their caregivers and teachers
(APA, 2013). ODD has often been regarded
as a developmental precursor of CD, although
there is evidence that it is an independent pre-
dictor of mood disorders (Stringaris, Maughan,
Copeland, Costello, & Angold, 2013).
Epidemiological studies conducted in the
United States suggest that approximately 4.6%
of school-age children would meet criteria for
either ODD or CD, with overall prevalence
increasing with age (Perou et al., 2013). Sim-
ilarly, it is estimated that around 5% of all
school-age children in the United Kingdom
would fulll diagnostic criteria for CD, making
it the most common psychiatric disorder in
children and adolescents (National Institute for
Health and Clinical Excellence, Social Care
Institute for Excellence, 2006). The economic
cost of CD to society is considerable. Scott
(2012) estimated that the cumulative costs of
services to 10-year-old individuals diagnosed
with CD over a period of 18 years are 10 times
higher than children without conduct problems,
and Foster and Jones (2005) estimated that
preventing antisocial behavior from a young
age could save society $70,000 per adolescent
over a period of 7 years. These gures explain
why there has been an intense research focus on
the development of DBDs since the mid-1990s,
and an increased emphasis on neurobiology
and emotional dysfunction in individuals with
antisocial behavior, although this is probably
To continue reading
Request your trial