Abstract
Background: Conduct disorder (CD) is characterized by severe aggressive and antisocial behavior. Initial evidence
suggests neural deficits and aberrant eye gaze pattern during emotion processing in CD; both concepts, however,
have not yet been studied simultaneously. The present study assessed the functional brain correlates of emotional
face processing with and without consideration of concurrent eye gaze behavior in adolescents with CD
compared to typically developing (TD) adolescents.
Methods: 58 adolescents (23CD/35TD; average age = 16 years/range = 14–19 years) underwent an implicit
emotional face processing task. Neuroimaging analyses were conducted for a priori-defined regions of interest
(insula, amygdala, and medial orbitofrontal cortex) and using a full-factorial design assessing the main effects of
emotion (neutral, anger, fear), group and the interaction thereof (cluster-level, p < .05 FWE-corrected) with and
without consideration of concurrent eye gaze behavior (i.e., time spent on the eye region).
Results: Adolescents with CD showed significant hypo-activations during emotional face processing in right
anterior insula compared to TD adolescents, independent of the emotion presented. In-scanner eye-tracking data
revealed that adolescents with CD spent significantly less time on the eye, but not mouth region. Correcting for
eye gaze behavior during emotional face processing reduced group differences previously observed for right
insula.
Conclusions: Atypical insula activation during emotional face processing in adolescents with CD may partly be
explained by attentional mechanisms (i.e., reduced gaze allocation to the eyes, independent of the emotion
presented). An increased understanding of the mechanism causal for emotion processing deficits observed in CD
may ultimately aid the development of personalized intervention programs
