Differentiating brain function of punishment versus reward processing in conduct disorder with and without attention deficit hyperactivity disorder

Sarah Baumann, Arne Hartz, Wolfgang Scharke, Stephane A. De Brito, Graeme Fairchild, Beate Herpertz-Dahlmann, Kerstin Konrad, Gregor Kohls

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)


Objectives: Conduct disorder (CD) and attention-deficit/hyperactivity disorder (ADHD) are reported to co-occur in about 30–50% of affected individuals. Research suggests that poor reinforcement-based decision-making may contribute to impaired social functioning in both youths with CD and ADHD. Considering its frequent co-occurrence this raises the question whether decision-making deficits in both disorders have a disorder-specific and/or shared neurobiological basis. Methods: 138 participants with CD, ADHD, or CD + ADHD, and typically developing controls (TDCs) aged 9–18 years (48% girls) were included in the study. Participants completed a reinforcement-based decision-making task in the fMRI scanner, investigating decision-making capabilities under different reinforcement contingencies (i.e. punishment vs. reward). Whole-brain and ROI analyses were used to test for potential group differences. Results: For punishment versus reward contingencies, relative to TDCs, youths with CD + ADHD displayed lower brain activity in dorsal striatum (incl. caudate), middle temporal gyrus (MTG), inferior frontal gyrus (IFG) and lateral occipital cortex, and they showed lower activity in dorsal striatum (incl. putamen), orbitofrontal cortex (OFC) and IFG relative to participants with ADHD. All other group comparisons were found to be non-significant. Conclusions: Participants with comorbid CD + ADHD are neurobiologically the most severely impaired group regarding reinforcement-based decision-making, particularly in response to punishment.

Original languageEnglish
Pages (from-to)349-360
Number of pages12
JournalWorld Journal of Biological Psychiatry
Issue number5
Early online date15 Nov 2021
Publication statusPublished - 31 Dec 2022


  • attention-deficit/hyperactivity disorder
  • Conduct disorder
  • fMRI
  • punishment
  • reinforcement learning

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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