Successful Evidence-Based Parenting Programs are Associated With Brain Changes and Improved Reward Processing in Boys With Conduct Problems.

Background: Early parenting interventions are the gold standard treatment for reducing antisocial behaviour (ASB) in children with conduct problems (CP), but the neurocognitive mechanisms underpinning treatment response are unknown.

Methods: We assessed fMRI and performance data from a reward learning task in boys with CP (aged 5-10 years old) before and after gold-standard group parenting intervention. Matched controls were assessed concurrently at two equally spaced time points. The CP group was subdivided into those whose ASB improved or persisted over the course of treatment. Longitudinal group (Control, Improving CP, Persistent CP]) by time (Pre, Post) analyses were then conducted on task-based fMRI and reinforcement learning data.

Results: Following intervention, a comparison of the Improving CP group with persistent CP and control groups showed: a) increased neural activity, in the direction of typically developing children, within the ventromedial prefrontal cortex (VMPFC), insula, posterior cingulate cortex and hippocampus in Improving CP, but not in the Persistent CP group; and, b) distinct changes in learning rate, action bias and reward/punishment sensitivity. Further, changes in insula activity and punishment/reward sensitivity correlated with changes in parenting behaviour.

Conclusions: Improved ASB after early intervention is associated with changes in reward processing regions and specific reinforcement learning parameters. These changes are not observed in those with persistent CP and correlate with changes in parenting behaviour. These findings highlight the importance of early interventions for CP and reveal potential mechanisms underpinning successful treatment.