Association Study On Executive Function And Brain Imaging In Children With Disruptive Behavior Disorders

ObjectivesBy means of neuropsychological tests and brain imaging,to investigate the characteristics of executive function,neuroimaging and risk factors such as IQ,co-morbidity and development in children with Disruptive Behavior Disorders(DBD).Methods1.Executive function profile of children with DBD(7-14 years old)diagnosed by DSM-IV,was investigated by a set of measurement tools,including Wechsler Intelligence Scale-the fourth edition(WISC-IV),Stroop color-word test,Wisconsin Card Sorting Test(WCST)and Cambridge Neuropsychological Test Automated Battery(CANTAB),the results of which were compared with normal developed children,matched by gender,age and educational level.Behavioral feature was also collected by parents reported questionnaires.2.Structural brain image data of DBD patients(11-15 years old)was collected,and was compared with which collected from normal developed children.The relationship between abnormal brain regions and impaired executive function in DBD patients was also explored.3.Resting state MRI data from DBD patients were also collected,which was also compared with those of normal developed children.Results Part One1.Compared with control group,the study group had significantly higher scores in PSQ,including conduct problems,learning problems,impulsivity hyperactivity,somatic factor,anxiety and hyperactivity index(t=3.535~19.115,P<0.05)Meanwhile,study group had significantly higher scores in emotional symptom,conduct problem,hyperactivity/inattention,peer relationship and total difficulty(Z=-2.501~-4.0418.295,P<0.05)and significantly lower score in pre-social behavior(Z=-2.478,P=0.013)in SDQ than control group;compared with control group,the study group got significantly lower scores in total score of WISC-IV,general capability index,processing speed index,four subscale and many subtests of WISC-IV(t=-1.624~-6.013,P<0.05)than control group;2.There were significant differences in multiple environmental factors including development,parenting style and family environment between the study group and control group.Logistic regression analysis showed:maternal abnormality,difficulty in raising-up and parenting styles in family(‘brutal beating’,‘severe constraints’,‘too much care’)were risk factors for DBD(χ~2=108.090,P=0.000);3.Independent of IQ level(general capability index in WISC-IV as covariate),study group were significant different from control group in several executive function tests,including working memory subscale(WISC-IV),processing speed subscale(WISC-IV),correct number in test B of stroop test,sustained error number(WCST),sustained response number(WCST),SOC Problems solved in minimum moves(CANTAB),SWMS(CANTAB),SOC2 and SOC4(t=4.105~18.446,P<0.05);4.Logistic regression showed some factors in executive function tests were related to DBD,they were:correct number in test B of stroop test,sustained error response(WCST)and digit span backward(WISC-IV)(χ2=132.702,P=0.000);5.By paired t test,pure DBD sub-group got significant higher score in SOC4(t=-2.385,P=0.033)than that of control group;while the scores of DBD/ADHD subgroup in working memory subscale(WISC-IV),processing speed subscale(WISC-IV),correct number in test A and test B of stroop test,sustained error number(WCST),sorting number(WCST),conceptual level(WCST),sustained response number(WCST),SOC Problems solved in minimum moves(CANTAB)and SWMS(CANTAB)(t=2.407~4.858,P﹤0.05)were significant different from paired control group.Part Two1.The study group had higher scores in PSQ,including conduct problems,learning problems,impulsivity hyperactivity,somatic factor and hyperactivity index(t=2.049~6.685,P<0.05);and study group showed higher score in attention/impulsiveness in Barrate II(t=2.498,P=0.020)than that of control group;at the same time,study group showed significantly lower scores in correct number in Part A(Z=-2.365,P=0.018)and Part B(t=-2.595,P=0.014)of stroop test,SOC Problems solved in minimum moves(CANTAB)(Z=-2.842,P=0.004)than that of control group,and significantly higher scores in SOC3(CANTAB)(t=3.736,P=0.002)than control group;2.The study group showed significant lower grey matter density than control group in several regions,including left superior parietal lobule,left cuneus,left superior temporal gyrus and pole of superior temporal,middle temporal gyrus and pole of middle temporal gyrus,right inferior temporal gyrus,left cerebellum anterior lobe and posterior lobe;and study group showed significant lower FA value in right cingulated gyrus than control group;3.The study group showed several significant differences in adolescent daily emotional regulation questionnaire and adolescent emotional regulation capability questionnaire,including negative emotional expression suppression,negative emotional expression catharsis(t=2.276~2.492,P<0.05)in adolescent daily emotional regulation questionnaire,emotional reflect ability,emotional evaluation ability,strategy in emotion regulation,emotional self-efficacy(t/Z=3.117~5.729,P<0.005)in adolescent emotional regulation capability questionnaire.The score in conduct problem of PSQ was positive correlated with negative emotion immersion and emotional expression catharsis(r=0.504~0.582,P<0.05),and negative correlated with negative emotion cognitive reappraisal,emotional evaluation ability,strategy in emotion regulation,emotional self-efficacy(r=0.387~0.581,P<0.05);4.In adolescent daily emotional regulation questionnaire,negative emotion immersion was correlated with SOC Problems solved in minimum moves(CANTAB)(r=-0.479,P=0.012),negative emotion cognitive reappraisal was correlated with SWMS(CANTAB)(r=-0.506,P=0.006),negative emotional expression suppression was correlated with sustained error number(WCST)(r=-0.375,P=0.045)(WCST),SSP(r=0.410,P=0.026)and SOC3(r=-0.451,P=0.018);negative emotional expression catharsis was correlated with sustained error number(WCST)(r=0.386,P=0.042)(WCST);in adolescent emotional regulation capability questionnaire,emotional evaluation ability was correlated with correct number in test A of stroop test(r=0.526,P=0.003),sustained error number(r=-0.405,P=0.029)(WCST),SSP(r=0.434,P=0.019)and SOC3(r=-0.406,P=0.032);strategy in emotion regulation was correlated with correct number in Part A in stroop test(r=-0.381,P=0.038),SWMS(r==-0.392,P=0.035);emotional self-efficacy was correlated with correct number in Part A in stroop test,(r=-0.380,P=0.038),SOC Problems solved in minimum moves(CANTAB)(r=0.387,P=0.042);5.In study group,the density of left superior parietal lobule was positive correlated with SOC Problems solved in minimum moves(CANTAB)(r=0.609,P=0.012),SSP(CANTAB)(r=0.633,P=0.003)and negative correlated with SWMS(CANTAB)(r=-0.488,P=0.040);the density of middle temporal gyrus was positive correlated with SSP(CANTAB)(r=0.642,P=0.004),the density of left cuneus was correlated to SOC(total)(CANTAB)(r=-0.530,P=0.035);the density of left cerebellum was correlated to negative emotion cognitive reappraisal(r=0.672,P=0.017).Part Three1.Compared with control group,study group demonstrated higher Reho value in right cerebellum anterior lobe and lower Reho value in frontal lobe(pre-central gyrus);2.Compared with control group,study group demonstrated higher ALFF value in frontal lobe and caudate;3.Compared with study group,control group showed greater functional connectivity between left amygdale and left frontal lobe(pre-central gyrus);and greater functional connectivity between right amygdale and frontal lobe,anterior cingulate.4.Regions with decreased grey matter density in left superior parietal lobule and left middle temporal gyrus in VBM were selected as ROI region,which showed weaker functional connectivity between left middle temporal gyrus and left cerebellum posterior lobe,right middle temporal gyrus and left pre-cuneus lobe in study group;and weaker functional connectivity between left superior parietal lobule and left parietal lobe,parahippocampal gyrus,right frontal lobe,occipital lobe,cingulated gyrus,limbic lobe.Conclusions1.Several dimensions of executive function were found to be impaired in children with DBD,including response inhibition,working memory and planning/monitor capability,which was independent of IQ level.Compared with pure DBD patients,DBD patients co-morbid with ADHD suffered from more executive function impairment.2.Several brain structure,such as left superior parietal lobule and left middle temporal gyrus,were different between children with DBD and normal developed children,and the function of several regions,such as caudate nucleus,were different between DBD children and normal developed children,which might explain their impaired executive function in DBD.3.Children with DBD had more problems in emotional regulation.The functional connectivity between amygdale and prefrontal cortex in children with DBD was weaker than which in normal developed children,which might explain the biological basis of emotional dysregulation in DBD children.