Neuronal basis of emotion processing and regulation in conduct disorder

Emotion regulation, a key component of healthy development, has been shown to be deficient in several psychiatric conditions, including conduct disorder. Conduct disorder is a neuropsychiatric disorder of childhood and adolescence characterized by severe aggressive behavior and violation of societal norms. It is highly prevalent and results in substantial economic costs and negative social consequences. Neuroimaging evidence has revealed brain activity alterations in several regions, including prefrontal, temporal, and limbic cortex (amygdala, insula, and cingulate gyrus). While the neuronal basis of emotion processing in conduct disorder has been intensely investigated, the brain correlates of implicit and explicit emotion regulation remain unclear.
The main aim of this dissertation was to extend current knowledge by investigating the neuronal mechanisms of emotion regulation in children and adolescents with conduct disorder. First, we conducted a meta-analysis in order to identify the neuronal correlates of emotion processing in adolescents with aggressive behavior. We then developed an affective Stroop task designed to investigate the interplay between emotion and cognition in a paediatric population, and validated it in healthy young adults. We then employed the task to study the neuronal characteristics of implicit emotion-cognition interaction in children and adolescents with conduct disorder. Finally, we investigated explicit emotion regulation by cognitive reappraisal (i.e., reinterpretation of the meaning of an emotional stimulus) in conduct disorder.
We here present findings on altered brain function during tasks assessing implicit and explicit emotion regulation in adolescents with conduct disorder that are in agreement with behaviorally observed deficits. Our meta-analysis on emotion processing in conduct disorder summarized previous literature indicating prefrontal and limbic brain structure and function alterations. The results from our study employing the affective Stroop task in healthy adults validated the usefulness of our task design and replicated previous findings suggesting that emotion significantly impacts cognition on a behavioral and neuronal level. Using the affective Stroop and cognitive reappraisal tasks in adolescents with conduct disorder revealed neuronal alterations within prefrontal and limbic regions, brain areas implicated in both emotion and cognition. Overall, the results of this dissertation provide novel evidence on the neuronal basis of emotion regulation deficits in conduct disorder. Future studies shall further investigate emotion regulation in specific subgroups of conduct disorder, for example those with psychopathic traits or high levels of anxiety with the ultimate goal of influencing the child’s immediate environment and society as a whole.