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Elizabeth C. Finger, MD; Abigail A. Marsh, PhD; Derek G. Mitchell, PhD; Marguerite E. Reid, BA; Courtney Sims, BA; Salima Budhani, PhD; David S. Kosson, PhD; Gang Chen, PhD; Kenneth E. Towbin, MD; Ellen Leibenluft, MD; Daniel S. Pine, MD; James R. Blair, PhD

Arch Gen Psychiatry. 2008;65(5):586-594.

Context  Children and adults with psychopathic traits and conduct or oppositional defiant disorder demonstrate poor decision making and are impaired in reversal learning. However, the neural basis of this impairment has not previously been investigated. Furthermore, despite high comorbidity of psychopathic traits and attention-deficit/hyperactivity disorder, to our knowledge, no research has attempted to distinguish neural correlates of childhood psychopathic traits and attention-deficit/hyperactivity disorder.

Objective  To determine the neural regions that underlie the reversal learning impairments in children with psychopathic traits plus conduct or oppositional defiant disorder.

Design  Case-control study.

Setting  Government clinical research institute.

Participants  Forty-two adolescents aged 10 to 17 years: 14 with psychopathic traits and oppositional defiant disorder or conduct disorder, 14 with attention-deficit/hyperactivity disorder only, and 14 healthy controls.

Main Outcome Measure  Blood oxygenation level–dependent signal as measured via functional magnetic resonance imaging during a probabilistic reversal task.

Results  Children with psychopathic traits showed abnormal responses within the ventromedial prefrontal cortex (Brodmann area 10) during punished reversal errors compared with children with attention-deficit/hyperactivity disorder and healthy children (P < .05 corrected for multiple comparisons).

Conclusions  To our knowledge, this study provides the first evidence of abnormal ventromedial prefrontal cortex responsiveness in children with psychopathic traits and demonstrates this dysfunction was not attributable to comorbid attention-deficit/hyperactivity disorder. These findings suggest that reversal learning impairments in patients with developmental psychopathic traits relate to abnormal processing of reinforcement information.

Author Affiliations: National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Drs Finger, Marsh, Budhani, Chen, Towbin, Leibenluft, Pine, and Blair and Mss Reid and Sims); Departments of Clinical Neurological Sciences (Dr Finger) and Psychiatry and Anatomy and Cell Biology (Dr Mitchell), University of Western Ontario, London, Ontario, Canada; and Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (Dr Kosson).

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