Violence and threat exposure is associated with frontostriatal alterations during risky decision-making in children with co-morbid ADHD and disruptive behavior disorders

Front Psychiatry. 2026 May 8;17:1799471. doi: 10.3389/fpsyt.2026.1799471. eCollection 2026.

ABSTRACT

INTRODUCTION: Early life adversity (ELA) is prevalent in the US and is associated with a number of risky behaviors, including substance use. Recent work has shown that specific forms of ELA, including violence exposure and threat exposure, is associated with alterations in reward and attentional neuro-circuitries implicated in risky decision-making. Although a couple of studies have examined the relationship between ELA and neural alterations in youths at high risk for substance use disorders (SUDs), none of these studies have examined neural functioning during risky decision-making.

METHODS: One-hundred twenty-three participants aged 11-12 recruited within a US community completed the Balloon Analogue Risk Task (BART) during functional magnetic resonance imaging (fMRI). We specifically defined ELA as exposure to violence and trauma (VTE), which was measured using the Screen for Adolescent Violence Exposure (SAVE) and the UCLA PTSD reaction index. Additionally, substance use outcomes, such as problematic substance use, were collected every 6 months following fMRI. All data preprocessing, individual-level analyses, and group analyses were performed using Analysis of Functional NeuroImages.

RESULTS: Individuals with high levels of VTE showed reduced BOLD response when making safe choices within the anterior insula, inferior frontal gyrus, and caudate nucleus. VTE was also associated with problematic substance use at follow-up. Logistic regression analyses showed that BOLD responses when making risky choices in these regions also predicted problematic substance use at follow-up.

DISCUSSION: The current findings provide evidence of neural alteration during risky decision-making in children with greater VTE, specifically in neural responses differentiating between safer and riskier options. These findings may suggest that children with VTE have alterations in generating neural signals that help differentiate between safer and riskier options, resulting in impairments in goal-directed behaviors and potentially predisposing them to risky substance use in adolescence.

PMID:42179986 | PMC:PMC13194102 | DOI:10.3389/fpsyt.2026.1799471