Altered Neural Processing of Threat-Related Information in Children and Adolescents Exposed to Violence: A Transdiagnostic Mechanism Contributing to the Emergence of Psychopathology.

Exposure to violence in childhood is associated with increased risk for multiple forms of internalizing and externalizing psychopathology. We evaluated how exposure to violence in early life influences neural responses to neutral and threat-related stimuli in childhood and adolescence, developmental variation in these associations, and whether these neural response patterns convey transdiagnostic risk for psychopathology over time.Participants were 149 youth (75 female youth), ages 8 to 17 (M =12.8, SD=2.63), who experienced either physical abuse, sexual abuse, or domestic violence (n=76) or had never experienced violence (n=73). Participants underwent fMRI scanning while passively viewing fearful, neutral, and scrambled faces presented rapidly in a block design without specific attentional demands. Internalizing and externalizing psychopathology were assessed concurrently with the scan and two years later and used to compute a transdiagnostic general psychopathology factor (p-factor).Exposure to violence was associated with reduced activation in dorsal anterior cingulate cortex (dACC) and frontal pole (1985 voxels, Peak x,y,z=6,4,40) when viewing fearful (versus scrambled) faces, and reduced activation in dorsomedial prefrontal cortex and superior frontal gyrus (1970 voxels, Peak x,y,z=16,64,10) when viewing neutral faces, but not amygdala activation or connectivity. Lower dACC response to fearful faces predicted increases in the p-factor two years later (B=-0.186, p=.031) and mediated the association of violence exposure with longitudinal increases in the p-factor.Reduced recruitment of the dACC-a region involved in salience processing, conflict monitoring, and cognitive control-in response to threat-related cues may convey increased transdiagnostic psychopathology risk in youth exposed to violence.