Elsevier

Biological Psychiatry

Volume 70, Issue 9, 1 November 2011, Pages 873-879
Biological Psychiatry

Archival Report
Neural Changes Associated with Treatment Outcome in Children with Externalizing Problems

https://doi.org/10.1016/j.biopsych.2011.05.029Get rights and content

Background

The current study directly investigated whether changes in the neural correlates of self-regulation (SR) are associated with the effectiveness of treatment for the externalizing problems of children.

Methods

Seventy-one children 8–12 years of age with clinical levels of externalizing behavior and their families completed a 3-month cognitive behavioral therapy program with a parent management training component. Electroencephalogram correlates of SR were evaluated before and after treatment with a go/no-go task requiring inhibitory control.

Results

Results showed that neural markers of SR, such as the N2 and frontal P3 event-related potential magnitudes, differed between the clinical sample and a matched comparison group before treatment: the clinical sample had larger N2 magnitudes and smaller frontal P3 magnitudes. Children who improved with treatment demonstrated a marked decrease in the magnitude of the N2 in comparison with children who did not improve. For improvers only, source analyses during the time period of the N2 estimated activation decreases in medial and ventral prefrontal cortex as well as the anterior medial temporal lobe.

Conclusions

A decrease in N2 magnitudes and corresponding source activation in children who improved with treatment might reflect improved efficiency in the neural mechanisms of SR.

Section snippets

Participants

The EEG data were collected from 140 children (107 boys), 8–12 years of age, with externalizing behavior problems, over a span of 5 years (2005–2010). Children were recruited in collaboration with two treatment agencies. Participants were referred to these agencies by mental health professionals, teachers, and/or parents. Inclusion criteria for the study consisted of scores within the clinical or borderline-clinical range on the externalizing subscale of the Child Behavior Checklist (CBCL) (43

Behavioral Results

A 2(Session: pre vs. post) × 2(Group: improvers vs. nonimprovers) × 3(Block: A vs. B vs. C) mixed-model analysis of variance (ANOVA) was conducted for go/no-go performance accuracy and for go response time. A Session × Group interaction was found, whereby improvers showed greater increases in accuracy from pre- to post-treatment than nonimprovers [F(1,65) = 5.53, p = .02, partial η2 = .08]. Collapsing across block, improvers had lower accuracy scores than nonimprovers before treatment (p =

Discussion

The present study found that the neural correlates of SR differed between children with clinically significant externalizing behavior problems and an age-matched comparison group, but both behavioral and neural indices of SR changed when clinical children improved with treatment.

We first confirmed that larger N2 magnitudes and smaller frontal P3 magnitudes characterized the clinical children. Larger N2 amplitudes suggested, consistent with other reports on medial frontal negativities, less

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