A Systematic Review and Meta-analysis of Neuroimaging in Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) Taking Attention-Deficit Hyperactivity Disorder (ADHD) Into Account

Abstract

Oppositional defiant disorder (ODD) and conduct disorder (CD) are common behavioural disorders in childhood and adolescence and are associated with brain abnormalities. This systematic review and meta-analysis investigates structural (sMRI) and functional MRI (fMRI) findings in individuals with ODD/CD with and without attention-deficit hyperactivity disorder (ADHD). Online databases were searched for controlled studies, resulting in 12 sMRI and 17 fMRI studies. In line with current models on ODD/CD, studies were classified in hot and cool executive functioning (EF). Both the meta-analytic and narrative reviews showed evidence of smaller brain structures and lower brain activity in individuals with ODD/CD in mainly hot EF-related areas: bilateral amygdala, bilateral insula, right striatum, left medial/superior frontal gyrus, and left precuneus. Evidence was present in both structural and functional studies, and irrespective of the presence of ADHD comorbidity. There is strong evidence that abnormalities in the amygdala are specific for ODD/CD as compared to ADHD, and correlational studies further support the association between abnormalities in the amygdala and ODD/CD symptoms. Besides the left precuneus, there was no evidence for abnormalities in typical cool EF related structures, such as the cerebellum and dorsolateral prefrontal cortex. Resulting areas are associated with emotion-processing, error-monitoring, problem-solving and self-control; areas associated with neurocognitive and behavioural deficits implicated in ODD/CD. Our findings confirm the involvement of hot, and to a smaller extent cool, EF associated brain areas in ODD/CD, and support an integrated model for ODD/CD (e.g. Blair, Development and Psychopathology, 17(3), 865-891, 2005).

Keywords: ADHD; ALE meta-analysis; CD; Functional MRI; ODD; Structural MRI.

Fig. 1

PRISMA flow diagram showing the process of study selection

Fig. 2

Results of the structural ALE meta-analysis showing the clusters in left amygdala, insula, and left medial/superior frontal gyrus (p _corrected < 0.05) superimposed on a structural scan in Talairach space. Top row: coronal view, bottom row: axial view. L Left, R Right

Fig. 3

Results of the functional ALE meta-analysis of hot EF showing the clusters in right globus pallidus, bilateral amygdala, left caudate, and left fusiform gyrus (p _corrected < 0.05) superimposed on a structural scan in Talairach space. Top row: coronal view, bottom row: axial view. L Left, R Right

Fig. 4

Overview of the connectivity of areas involved in ODD/CD described in this review, based on connectivity studies in typically developing individuals (see main text). Green arrows indicate excitatory connectivity, red arrows indicate inhibitory connectivity, and arrows in both green and red indicate both excitatory and inhibitor connectivity. Red boxed areas exhibit mainly hot EF, blue boxed areas exhibit mainly cool EF, and areas boxed in both red and blue exhibit a combination of hot and cool EF