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 behavior (ASB) in children with conduct problems (CPs), but the neurocognitive mechanisms that underpin treatment response are unknown. METHODS:We assessed functional magnetic resonance imaging (fMRI) and performance data from a reward learning task in boys with CPs (ages 5-10 years) before and after a gold-standard group parenting intervention. Matched control boys were assessed concurrently at 2 equally spaced time points. The CP group was subdivided into boys whose ASB improved or persisted over the course of treatment. Longitudinal group (control, improving CP, persistent CP) × time (pre-, postintervention) analyses were then conducted on task-based fMRI and reinforcement learning data. RESULTS:Following the intervention, a comparison of the improving CP group with the persistent CP and control groups showed 1) increased neural activity in the direction of typically developing children within the ventromedial prefrontal cortex, insula, posterior cingulate cortex, and hippocampus in the improving CP, but not the persistent CP, group and 2) distinct changes in learning rate, action bias, and reward/punishment sensitivity. Furthermore, changes in insula activity and punishment/reward sensitivity correlated with changes in parenting behavior. CONCLUSIONS:Improved ASB after early intervention was associated with changes in reward-processing regions and specific reinforcement learning parameters. These changes were not observed in boys with persistent CPs and correlated with changes in parenting behavior. These findings highlight the importance of early interventions for CPs and reveal potential mechanisms that underpin successful treatment.