Risky Decisions and Their Consequences: Neural Processing by Boys with Antisocial Substance Disorder

Substance Dependence Division, Psychiatry Department, University of Colorado Denver, Denver, Colorado, USA.
PLoS ONE (Impact Factor: 3.23). 09/2010; 5(9):e12835. DOI: 10.1371/journal.pone.0012835
Source: PubMed


Adolescents with conduct and substance problems ("Antisocial Substance Disorder" (ASD)) repeatedly engage in risky antisocial and drug-using behaviors. We hypothesized that, during processing of risky decisions and resulting rewards and punishments, brain activation would differ between abstinent ASD boys and comparison boys.
We compared 20 abstinent adolescent male patients in treatment for ASD with 20 community controls, examining rapid event-related blood-oxygen-level-dependent (BOLD) responses during functional magnetic resonance imaging. In 90 decision trials participants chose to make either a cautious response that earned one cent, or a risky response that would either gain 5 cents or lose 10 cents; odds of losing increased as the game progressed. We also examined those times when subjects experienced wins, or separately losses, from their risky choices. We contrasted decision trials against very similar comparison trials requiring no decisions, using whole-brain BOLD-response analyses of group differences, corrected for multiple comparisons. During decision-making ASD boys showed hypoactivation in numerous brain regions robustly activated by controls, including orbitofrontal and dorsolateral prefrontal cortices, anterior cingulate, basal ganglia, insula, amygdala, hippocampus, and cerebellum. While experiencing wins, ASD boys had significantly less activity than controls in anterior cingulate, temporal regions, and cerebellum, with more activity nowhere. During losses ASD boys had significantly more activity than controls in orbitofrontal cortex, dorsolateral prefrontal cortex, brain stem, and cerebellum, with less activity nowhere.
Adolescent boys with ASD had extensive neural hypoactivity during risky decision-making, coupled with decreased activity during reward and increased activity during loss. These neural patterns may underlie the dangerous, excessive, sustained risk-taking of such boys. The findings suggest that the dysphoria, reward insensitivity, and suppressed neural activity observed among older addicted persons also characterize youths early in the development of substance use disorders.

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    • "There is evidence not just that the maturational sequences in brain development relate to adolescent vulnerability to problem behaviors but also that individual differences in such development relate to levels of these behaviors. A brain imaging study involving a cautious versus risky decision-making task found that boys with conduct disorders show extensive neural hypoactivity in the regions of the brain responsible for impulse control during risky decision making, as well as both decreased activity during reward outcomes and increased activity during loss outcomes (Crowley et al. 2010). These neural patterns may underlie the excessive and dangerous risk taking of such boys. "
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    • "In other clinical cohorts such as in those with anxiety and attention disorders, behavioral and conduct disorders have been linked with abnormal structure and activity of subcortical regions such as the caudate , striatum, amygdala, and the hippocampus. Lower functional activity of the amygdala, hippocampus, and the striatum has been seen in youth with conduct disorders [Crowley et al., 2010; Fairchild et al., 2013; Marsh et al., 2013], while smaller thalamus are found in children with ADHD [Xia et al., 2012]. In contrast, negative or nonsignificant relationships in brain-behavior relationships have been reported previously both in typical children [Lebel et al., 2010] and in typical older populations [Gautam et al., 2011]. "
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