Abstract
Oppositional defiant disorder (ODD) and conduct disorder (CD) are common behavioural disorders in childhood and adolescence and are associated with brain abnormalities. This systematic review and meta-analysis investigates structural (sMRI) and functional MRI (fMRI) findings in individuals with ODD/CD with and without attention-deficit hyperactivity disorder (ADHD). Online databases were searched for controlled studies, resulting in 12 sMRI and 17 fMRI studies. In line with current models on ODD/CD, studies were classified in hot and cool executive functioning (EF). Both the meta-analytic and narrative reviews showed evidence of smaller brain structures and lower brain activity in individuals with ODD/CD in mainly hot EF-related areas: bilateral amygdala, bilateral insula, right striatum, left medial/superior frontal gyrus, and left precuneus. Evidence was present in both structural and functional studies, and irrespective of the presence of ADHD comorbidity. There is strong evidence that abnormalities in the amygdala are specific for ODD/CD as compared to ADHD, and correlational studies further support the association between abnormalities in the amygdala and ODD/CD symptoms. Besides the left precuneus, there was no evidence for abnormalities in typical cool EF related structures, such as the cerebellum and dorsolateral prefrontal cortex. Resulting areas are associated with emotion-processing, error-monitoring, problem-solving and self-control; areas associated with neurocognitive and behavioural deficits implicated in ODD/CD. Our findings confirm the involvement of hot, and to a smaller extent cool, EF associated brain areas in ODD/CD, and support an integrated model for ODD/CD (e.g. Blair, Development and Psychopathology, 17(3), 865-891, 2005).
Highlights
In recent years, magnetic resonance imaging (MRI) studies have provided insight into the underlying brain mechanisms of disruptive behaviour disorders, including oppositional defiant disorder (ODD) and conduct disorder (CD)
The narrative parts contain a summary of the main findings for ODD/CD-only groups first since those are not biased by comorbid attention-deficit hyperactivity disorder (ADHD), followed by the main findings in ODD/CD-mixed and ODD/CD+ ADHD groups, and ends with the correlational findings and the specificity of findings regarding ODD/CD
Further support for involvement of abnormalities of some of these structures in ODD/CD was established by comparing the results from studies using ODD/CD-only samples with the results from studies using ODD/CD-mixed and ODD/CD+ ADHD samples to see if results were mainly driven by ODD/CD, and reviewing the correlational and specificity findings
Summary
Magnetic resonance imaging (MRI) studies have provided insight into the underlying brain mechanisms of disruptive behaviour disorders, including oppositional defiant disorder (ODD) and conduct disorder (CD). Community samples show a prevalence rate for ODD ranging between 2 and 14 % and for CD ranging between 2 and 16 % (Boylan et al 2007; Loeber et al 2000). Both disorders are more prevalent in boys than in girls with ratio’s ranging from 3:1 to 9:1 (Loeber et al 2000). ODD is defined by a frequent and persistent pattern of irritable and angry mood, vindictiveness and developmentally inappropriate, negativistic, defiant, and disobedient behaviour toward authority figures (American Psychiatric Association 2013). Depending on whether the individual was younger or older than 10 years at the time of symptom onset, there is a Neuropsychol Rev (2016) 26:44–72 differentiation between childhood-onset CD and adolescentonset CD (American Psychiatric Association 2013)
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