Disrupted expected value signaling in youth with disruptive behavior disorders to environmental reinforcers.

Objective: Youth with disruptive behavior disorders (DBD), including conduct disorder (CD) and oppositional defiant disorder (ODD), have difficulties in reinforcement-based decision making, the neural basis of which is poorly understood. Studies examining decision making in youth with DBD have revealed reduced reward responses within the ventromedial prefrontal cortex/orbitofrontal cortex (vmPFC/OFC), increased responses to unexpected punishment within the vmPFC and striatum, and reduced use of expected value information in the anterior insula cortex and dorsal anterior cingulate cortex during the avoidance of suboptimal choices. Previous work has used only monetary reinforcement. The current study examined whether dysfunction in youth with DBD during decision making extended to environmental reinforcers.

Method: A total of 30 youth (15 healthy youth and 15 youth with DBD) completed a novel reinforcement-learning paradigm using environmental reinforcers (physical threat images, e.g., striking snake image; contamination threat images, e.g., rotting food; appetitive images, e.g., puppies) while undergoing functional magnetic resonance imaging (fMRI).

Results: Behaviorally, healthy youth were significantly more likely to avoid physical threat, but not contamination threat, stimuli than youth with DBD. Imaging results revealed that youth with DBD showed significantly reduced use of expected value information in the bilateral caudate, thalamus, and posterior cingulate cortex during the avoidance of suboptimal responses.

Conclusions: The current data suggest that youth with DBD show deficits to environmental reinforcers similar to the deficits seen to monetary reinforcers. Importantly, this deficit was unrelated to callous-unemotional (CU) traits, suggesting that caudate impairment may be a common deficit across youth with DBD.