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•The mother-child dyads of ODD children exhibit lower neural synchrony across of parent-child interactions (positive, negative, and neutral).•The neural synchrony between mother and child was negatively associated ODD symptoms in children.•Various neural synchronies (positive, negative, and neutral) between mother and child all play a role in the network of ODD symptoms in children. Interpersonal neural synchrony (INS) between mothers and children responds to the temporal similarity of brain signals in joint behavior between dyadic partners and is considered an important neural indicator of the formation of adaptive social interaction bonds. Parent-child interactions are particularly important for the development and maintenance of oppositional defiant disorder (ODD) in children, but the underlying neurocognitive mechanisms are unknown. Therefore, in the current study we measured INS between mothers and children in interactions by using simultaneous functional Near-infrared Spectroscopy (fNIRS), and explored its association with ODD symptoms in children. Seventy-two mother-child dyads were recruited to participate in the study, including 35 children with ODD and 37 healthy children to be used as a control. Each mother-child dyad was measured for neural activity in frontal, parietal, and temporal lobe regions while completing free-play as well as positive, and negative topic discussion tasks. We used Phase-locked value to calculate the synchrony strength and then used the K-means algorithm and k-space based alignment tests to confirm the specific patterns of parent-child synchrony in different brain areas. The results showed that, in free-play (right MFG and bilateral SFG), positive (left TPJ and bilateral SFGdor), and negative (bilateral SFGmed, right ANG, and left MFG) topic discussions, the mother-child pairs showed different patterns of INS. These specific INS patterns were significantly lower in the ODD group compared to the control group and were negatively associated with ODD symptoms in children. Network analyses showed that these INS patterns were connected to different nodes in the ODD symptom network. Our findings suggest that ODD mother-child dyads exhibit lower neural synchrony across a wide range of parent-child interactions. Neural synchrony in the context of interpersonal interactions provides new insights into understanding the neural mechanisms of ODD and can be used as an indicator of neural and socio-environmental factors in the network of psychological disorder symptoms.

Background Attention Deficit Hyperactivity Disorder (ADHD) often coexists with Oppositional Defiant Disorder (ODD), exacerbating impairment. The distinct neurological and biological patterns that differentiate this comorbidity from ADHD alone remain unclear. Method We conducted systematic review of multi model correlates differentiating ODD+ADHD from ADHD alone following PRISMA 2020 with databases like MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Sciences until August 2025. 144 full texts were reviewed and 26 studies were selected for final inclusion after 1457 records with 37 other sources. Designs included cross-sectional case-control studies, longitudinal studies, and imaging based on the ABCD framework, while measures covered structural and functional MRI, diffusion MRI, resting and task fNIRS, EEG and ERP, HPA-axis and immune-metabolic biomarkers, and executive and cognitive indices. The evaluation of bias employed RoB 2, ROBINS-I, and JBI, while synthesis utilised Braun-Clarke thematic analysis. Results Oppositionality involved limbic–striatal and cerebello-cortical differences, with ODD+ADHD showing greater executive and emotion-processing deficits than ADHD alone. ODD was linked to lower cortisol and reduced sympathetic reactivity, while ADHD showed higher cortisol and tryptophan–kynurenine shifts, with cytokines decreasing after methylphenidate. Conclusion ODD along with ADHD showed a distinct neurobiological and physiological pattern from ADHD alone. Such pattern is marked by greater executive and emotional regulation deficits with unique stress-response patterns, highlighting the need for tailored assessments and intervention approaches.

Objectives The current study aimed to investigate the structural and functional connectivity of the subregions of the amygdala in children with Attention Deficit/Hyperactivity Disorder (ADHD) only or comorbid with Oppositional Defiant Disorder (ODD). Methods A total of 354 children with ADHD-only, 161 children with ADHD and ODD (ADHD + ODD), and 100 healthy controls were enrolled. The Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) were filled out by caregivers. Analysis of covariance (ANCOVA) was performed to test group-wise differences in these behavioral measures. A subsample comprising 209 participants underwent a resting-state functional MRI scan and a diffusion-weighted imaging (DWI) scan. Functional connectivity and structural connectivity were calculated using bilateral subregions of the Amygdala as seeds. Between-group voxel-wise comparisons were conducted. Results The ADHD + ODD group had more anxious/depressed moods, more delinquent and aggressive behaviors, more emotional control problems, and more inhibition deficits than the ADHD-only group (all P Bonferroni−corrected < 0.05). Compared with the control and ADHD + ODD groups, the ADHD-only group displayed increased FC strength between the amygdala subregions and the left caudate, left putamen, and frontal cortex. Regarding structural connectivity (SC), the ADHD-only group demonstrated higher streamline density in the left internal capsule, corpus callosum, and the right superior corona radiata. The altered SC was associated with emotional problems in children with ADHD, while the altered FC was associated with other ADHD-related clinical features. Conclusions Altered structural and functional connectivity of the subregions of the amygdala in children with ADHD compared with their healthy counterparts were respectively associated with ADHD-related behavioral and emotional problems. Clinical trial number : not applicable.

While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal. Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging. Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation. These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.

Brain imaging studies have shown altered amygdala activity during emotion processing in children and adolescents with oppositional defiant disorder (ODD) and conduct disorder (CD) compared to typically developing children and adolescents (TD). Here we aimed to assess whether aggression-related subtypes (reactive and proactive aggression) and callous-unemotional (CU) traits predicted variation in amygdala activity and skin conductance (SC) response during emotion processing. We included 177 participants (n = 108 cases with disruptive behaviour and/or ODD/CD and n = 69 TD), aged 8-18 years, across nine sites in Europe, as part of the EU Aggressotype and MATRICS projects. All participants performed an emotional face-matching functional magnetic resonance imaging task. Differences between cases and TD in affective processing, as well as specificity of activation patterns for aggression subtypes and CU traits, were assessed. Simultaneous SC recordings were acquired in a subsample (n = 63). Cases compared to TDs showed higher amygdala activity in response to negative faces (fearful and angry) v. shapes. Subtyping cases according to aggression-related subtypes did not significantly influence on amygdala activity; while stratification based on CU traits was more sensitive and revealed decreased amygdala activity in the high CU group. SC responses were significantly lower in cases and negatively correlated with CU traits, reactive and proactive aggression. Our results showed differences in amygdala activity and SC responses to emotional faces between cases with ODD/CD and TD, while CU traits moderate both central (amygdala) and peripheral (SC) responses. Our insights regarding subtypes and trait-specific aggression could be used for improved diagnostics and personalized treatment.

Background Diffuse low-grade gliomas (dLGG) are rare slow growing brain tumors. Symptoms associated with dLGG typically include seizures, hemiparesis, ataxia, behavioral changes, headaches, and tremors. In this study, we present the case of a thirteen-year-old male admitted to the National Institutes of Health (NIH) Undiagnosed Diseases Program (UDP). To the best of our knowledge, this is one of the only documented cases of an adult-type dLGG diagnosed in a pediatric patient with monitoring of tumor progression for nearly a decade prior to diagnosis. Case presentation The patient presented with a history of progressive signal abnormalities on brain magnetic resonance imaging (MRI), refractory to treatment attention deficit hyperactivity disorder (ADHD) and Oppositional Defiant Disorder (ODD), headaches, irritability, and difficulties sleeping. His detailed neurological exam was normal. Following six years of repeated MRI demonstrating increasing infiltrative tumor mass effect throughout gray and white matter, a brain biopsy was performed. The brain biopsy showed white and gray matter with mildly hypercellular areas, and tumor DNA sequencing showed the presence of a canonical IDH1 mutation. A “watch and wait” approach was adopted resulting from discussions between the patient and his family alongside the medical team with repeated quarterly brain MRI to monitor symptoms and tumor growth. Conclusion While behavioral and psychiatric changes are common in brain tumor patients, they typically present alongside neurological symptoms which emphasizes the difficulty in diagnosing cases like this patient’s. Low-grade malignancies should be part of the differential diagnosis in cases with progressive multifocal white matter lesions, despite the absence of the typical neurological focal signs.

Abstract Affective symptoms and behavioural symptoms are two important dimensions of oppositional defiant disorder (ODD) symptoms. These two dimensions of symptoms are closely associated with emotion process deficits in children with ODD. This study utilized functional near-infrared spectroscopy (fNIRS) to investigate the brain activation during the emotion process in children with ODD and its relationship with ODD symptoms. A total of 72 participants, comprising 35 children with ODD and 37 typically developing (TD) children were recruited to perform experiment tasks of emotion recognition (ERC) and emotion regulation (ERG). Their brain activation in the prefrontal lobes and behavioural responses were recorded and analysed. Significant brain activation was observed in the right MFG, right SFGdor, and the bilateral SFGmed for ERC, and the right SFGdor for ERG among the TD children, but not among the children with ODD. Meanwhile, no significant difference was observed in behavioural outcomes between TD and ODD. Path analysis results showed that ERC neural deficits (SFGmed) predicted affective symptoms, while ERG neural deficits (SFGdor) predicted behavioural symptoms. These findings elucidate the distinct influence pathways of different emotion process deficits. A potential dual-processing framework was proposed to understand the characteristics and role of emotion process deficits in ODD.

There is increasing evidence for altered brain resting state functional connectivity in adolescents with disruptive behavior. While a considerable body of behavioral research points to differences between reactive and proactive aggression, it remains unknown whether these two subtypes have dissociable effects on connectivity. Additionally, callous-unemotional traits are important specifiers in subtyping aggressive behavior along the affective dimension. Accordingly, we examined associations between two aggression subtypes along with callous-unemotional traits using a seed-to-voxel approach. Six functionally relevant seeds were selected to probe the salience and the default mode network, based on their presumed role in aggression. The resting state sequence was acquired from 207 children and adolescents of both sexes [mean age (standard deviation) = 13.30 (2.60); range = 8.02–18.35] as part of a Europe-based multi-center study. One hundred eighteen individuals exhibiting disruptive behavior (conduct disorder/oppositional defiant disorder) with varying comorbid attention-deficit/hyperactivity disorder (ADHD) symptoms were studied, together with 89 healthy controls. Proactive aggression was associated with increased left amygdala–precuneus coupling, while reactive aggression related to hyper-connectivities of the posterior cingulate cortex (PCC) to the parahippocampus, the left amygdala to the precuneus and to hypo-connectivity between the right anterior insula and the nucleus caudate. Callous-unemotional traits were linked to distinct hyper-connectivities to frontal, parietal, and cingulate areas. Additionally, compared to controls, cases demonstrated reduced connectivity of the PCC and left anterior insula to left frontal areas, the latter only when controlling for ADHD scores. Taken together, this study revealed aggression-subtype-specific patterns involving areas associated with emotion, empathy, morality, and cognitive control.

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are highly comorbid disorders. ADHD has been associated with altered white matter (WM) microstructure, though the literature is inconsistent, which may be due to differences in the in- or exclusion of participants with comorbid ODD. WM abnormalities in ODD are still poorly understood, and it is unclear whether comorbid ODD in ADHD may have confounded the current ADHD literature. Diffusion Tensor Imaging (DTI) was used to compare fractional anisotropy (FA) and mean diffusivity (MD) between ADHD patients with ( n  = 42) and without ( n  = 117) comorbid ODD. All participants were between 8–25 years and groups did not differ in mean age or gender. Follow-up analyses were conducted to examine the role of antisocial behaviour (conduct problems) on FA and MD values in both groups. Comorbid ODD in ADHD was associated with lower FA in left frontotemporal WM, which appeared independent of ADHD symptoms. FA was negatively associated with antisocial behaviour in ADHD + ODD, but not in ADHD-only. Comorbid ODD is associated with WM abnormalities in individuals with ADHD, which appears to be independent of ADHD symptoms. Altered WM microstructure in comorbid ODD may play a role in inconsistencies in the current DTI literature in ADHD. Altered development of these tracts may contribute to social-emotional and cognitive problems in children with oppositional and antisocial behaviour.

Understanding atypicalities in ADHD brain correlates is a step towards better understanding ADHD etiology. Efforts to map atypicalities at the level of brain structure have been hindered by the absence of normative reference standards. Recent publication of brain charts allows for assessment of individual variation relative to age- and sex-adjusted reference standards and thus estimation not only of case-control differences but also of intraindividual prediction. Methods. Aim was to examine, whether brain charts can be applied in a sample of adolescents ( N  = 140, 38% female) to determine whether atypical brain subcortical and total volumes are associated with ADHD at-risk status and severity of parent-rated symptoms, accounting for self-rated anxiety and depression, and parent-rated oppositional defiant disorder (ODD) as well as motion. Results. Smaller bilateral amygdala volume was associated with ADHD at-risk status, beyond effects of comorbidities and motion, and smaller bilateral amygdala volume was associated with inattention and hyperactivity/impulsivity, beyond effects of comorbidities except for ODD symptoms, and motion. Conclusions. Individual differences in amygdala volume meaningfully add to estimating ADHD risk and severity. Conceptually, amygdalar involvement is consistent with behavioral and functional imaging data on atypical reinforcement sensitivity as a marker of ADHD-related risk. Methodologically, results show that brain chart reference standards can be applied to address clinically informative, focused and specific questions.