Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study.

OBJECTIVES: The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. METHODS: National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24-48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King-Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale. RESULTS: Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24-48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5-70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6-49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1-2.9; male athletes, mean = 4.1, 95% CI 1.5-10.9). CONCLUSIONS: Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.

Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium.

Mild traumatic brain injury (mTBI) has been described in the United States (US) military service academy cadet population, but female-specific characteristics and recovery outcomes are poorly characterized despite sex being a confounder. Our objective was to describe female cadets' initial characteristics, assessment performance, and return-to-activity outcomes post-mTBI. Female cadets (n = 472) from the four US military service academies who experienced a mTBI completed standardized mTBI assessments from pre-injury to acute initial injury and unrestricted return-to-duty (uRTD). Initial injury presentation characteristics (e.g., delayed symptoms, retrograde amnesia) and return-to-activity outcomes [i.e., return-to-learn, initiate return-to-duty protocol (iRTD), uRTD] were documented. Descriptive statistics summarized female cadets' injury characteristics, return-to-activity outcomes, and post-mTBI assessment performance change categorization (worsened, unchanged, improved) relative to pre-injury baseline using established change score confidence rank criteria for each assessment score. The median (interquartile range) days to return-to-learn (n = 157) was 7.0 (3.0-14.0), to iRTD (n = 412) was 14.7 (8.6-25.8), and to uRTD (n = 431) was 26.0 (17.7-41.8). The majority experienced worse SCAT total symptom severity (77.8%) and ImPACT reaction time (97.0%) acutely < 24-h versus baseline, but unchanged BESS total errors (75.2%), SAC total score (72%), BSI-18 total score (69.6%), and ImPACT verbal memory (62.3%), visual memory (58.4%), and visual motor speed (52.5%). We observed similar return-to-activity times in the present female cadet cohort relative to the existing female-specific literature. Confidence ranks categorizing post-mTBI performance were heterogenous and indicate multimodal assessments are necessary. Our findings provide clinically relevant insights to female cadets experiencing mTBI across the US service academies for stakeholders providing healthcare.

Female Collegiate Athletes' Concussion Characteristics and Recovery Patterns: A Report from the NCAA-DoD CARE Consortium.

Concussion has been described in the United States (US) collegiate student-athlete population, but female-specific findings are often underrepresented and underreported. Our study aimed to describe female collegiate student-athletes' initial injury characteristics and return to activity outcomes following concussion. Female collegiate student-athletes (n = 1393) from 30-US institutions experienced a concussion and completed standardized, multimodal concussion assessments from pre-injury through unrestricted return to play (uRTP) in this prospective, longitudinal cohort study. Initial injury presentation characteristics, assessment, and return to activity outcomes [<48-h (acute), return to learn, initiate return to play (iRTP), uRTP] were collected. We used descriptive statistics to report injury characteristics, return to activity outcomes, and post-injury assessment performance change categorization (worsened, unchanged, improved) based on change score confidence rank criteria across sport contact classifications [contact (n = 661), limited (n = 446), non-contact (n = 286)]. The median (25th to 75th percentile) days to return to learn was 6.0 (3.0-10.0), iRTP was 8.1 (4.8-13.8), and uRTP was 14.8 (9.9-24.0), but varied by contact classification. Across contact levels, the majority experienced worse SCAT total symptom severity (72.8-82.6%), ImPACT reaction time (91.2-92.6%), and BSI-18 total score (45.2-51.8%) acutely relative to baseline, but unchanged BESS total errors (58.0-60.9%), SAC total score (71.5-76.1%), and remaining ImPACT domains (50.6-66.5%). Our findings provide robust estimates of the typical female collegiate student-athlete presentation and recovery trajectory following concussion, with overall similar findings to the limited female collegiate student-athlete literature. Overall varying confidence rank classification was observed acutely. Our findings provide clinically-relevant insights for athletes, clinicians, researchers, and policymakers to inform efforts specific to females experiencing concussion.

Baseline Predictors of Response to Repetitive Task Practice in Chronic Stroke.

BACKGROUND: Repetitive task practice reduces mean upper extremity motor impairment in populations of patients with chronic stroke, but individual response is highly variable. A method to predict meaningful reduction in impairment in response to training based on biomarkers and other data collected prior to an intervention is needed to establish realistic rehabilitation goals and to effectively allocate resources. OBJECTIVES: To identify prognostic factors and better understand the biological substrate for reductions in arm impairment in response to repetitive task practice among patients with chronic (≥6 months) post-stroke hemiparesis. METHODS: The intervention is a form of repetitive task practice using a combination of robot-assisted therapy and functional arm use in real-world tasks. Baseline measures include the Fugl-Meyer Assessment, Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, MRI, transcranial magnetic stimulation, kinematics, accelerometry, and genomic testing. RESULTS: Mean increase in FM-UE was 4.6 ± 1.0 SE, median 2.5. Approximately one-third of participants had a clinically meaningful response to the intervention, defined as an increase in FM ≥ 5. The selected logistic regression model had a receiver operating curve with AUC = .988 (Std Error = .011, 95% Wald confidence limits: .967-1) showed little evidence of overfitting. Six variables that predicted response represented impairment, functional, and genomic measures. CONCLUSION: A simple weighted sum of 6 baseline factors can accurately predict clinically meaningful impairment reduction after outpatient intensive practice intervention in chronic stroke. Reduction of impairment may be a critical first step to functional improvement. Further validation and generalization of this model will increase its utility in clinical decision-making.

The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain-behavior relationships after stroke.

The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta- and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world, comprising the largest multisite retrospective stroke data collaboration to date. This article outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multisite stroke brain magnetic resonance imaging, behavioral and demographics data. Specifically, the processes for scalable data intake and preprocessing, multisite data harmonization, and large-scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided.

Contraction Phase and Force Differentially Change Motor Evoked Potential Recruitment Slope and Interhemispheric Inhibition in Young Versus Old.

Interhemispheric interactions are important for arm coordination and hemispheric specialization. Unilateral voluntary static contraction is known to increase bilateral corticospinal motor evoked potential (MEP) amplitude. It is unknown how increasing and decreasing contraction affect the opposite limb. Since dynamic muscle contraction is more ecologically relevant to daily activities, we studied MEP recruitment using a novel method and short interval interhemispheric inhibition (IHI) from active to resting hemisphere at 4 phases of contralateral ECR contraction: Rest, Ramp Up [increasing at 25% of maximum voluntary contraction (MVC)], Execution (tonic at 50% MVC), and Ramp Down (relaxation at 25% MVC) in 42 healthy adults. We analyzed the linear portion of resting extensor carpi radialis (ECR) MEP recruitment by stimulating at multiple intensities and comparing slopes, expressed as mV per TMS stimulation level, via linear mixed modeling. In younger participants (age ≤ 30), resting ECR MEP recruitment slopes were significantly and equally larger both at Ramp Up (slope increase = 0.047, p < 0.001) and Ramp Down (slope increase = 0.031, p < 0.001) compared to rest, despite opposite directions of force change. In contrast, Active ECR MEP recruitment slopes were larger in Ramp Down than all other phases (Rest:0.184, p < 0.001; Ramp Up:0.128, p = 0.001; Execution: p = 0.003). Older (age ≥ 60) participants' resting MEP recruitment slope was higher than younger participants across all phases. IHI did not reduce MEP recruitment slope equally in old compared to young. In conclusion, our data indicate that MEP recruitment slope in the resting limb is affected by the homologous active limb contraction force, irrespective of the direction of force change. The active arm MEP recruitment slope, in contrast, remains relatively unaffected. Older participants had steeper MEP recruitment slopes and less interhemispheric inhibition compared to younger participants.

Emotional Intelligence in Incarcerated Female Offenders With Psychopathic Traits.

Emotional impairment is a core feature of psychopathy, and the disorder has been linked to an inability to recognize and regulate emotion, leading to deficiencies in empathy and difficulties in social functioning. This study investigated associations among psychopathic traits and ability-based emotional intelligence (EI) in female offenders and integrated data with previously published male offender data (Ermer, Kahn, Salovey, & Kiehl, 2012) to examine gender differences in relationships. Results showed that female offenders were impaired in the understanding and management of emotion relative to the general population, and that female offenders scored higher than male offenders in EI. Affective psychopathic traits (e.g., callousness) yielded a small relationship with difficulties in managing emotion in female offenders, and few gender differences in relationships between psychopathy and EI were found. Findings contribute to literature on emotional functioning in females with psychopathic traits and further understanding of gender differences in emotional abilities among offenders.

Methods for an Investigation of Neurophysiological and Kinematic Predictors of Response to Upper Extremity Repetitive Task Practice in Chronic Stroke.

OBJECTIVE: To demonstrate the feasibility of algorithmic prediction using a model of baseline arm movement, genetic factors, demographic characteristics, and multimodal assessment of the structure and function of motor pathways. To identify prognostic factors and the biological substrate for reductions in arm impairment in response to repetitive task practice. DESIGN: This prospective single-group interventional study seeks to predict response to a repetitive task practice program using an intent-to-treat paradigm. Response is measured as a change of ≥5 points on the Upper Extremity Fugl-Meyer from baseline to final evaluation (at the end of training). SETTING: General community. PARTICIPANTS: Anticipated enrollment of community-dwelling adults with chronic stroke (N = 96; onset≥6mo) and moderate to severe residual hemiparesis of the upper limb as defined by a score of 10-45 points on the Upper Extremity Fugl-Meyer. INTERVENTION: The intervention is a form of repetitive task practice using a combination of robot-assisted therapy coupled with functional arm use in real-world tasks administered over 12 weeks. MAIN OUTCOME MEASURES: Upper Extremity Fugl-Meyer Assessment (primary outcome), Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, magnetic resonance imaging, transcranial magnetic stimulation, arm kinematics, accelerometry, and a saliva sample for genetic testing. RESULTS: Methods for this trial are outlined, and an illustration of interindividual variability is provided by example of 2 participants who present similarly at baseline but achieve markedly different outcomes. CONCLUSION: This article presents the design, methodology, and rationale of an ongoing study to develop a predictive model of response to a standardized therapy for stroke survivors with chronic hemiparesis. Applying concepts from precision medicine to neurorehabilitation is practicable and needed to establish realistic rehabilitation goals and to effectively allocate resources.

Why do people think that others should earn this or that?

Some questions, such as when a statistical distribution of incomes becomes too unequal, seem highly attention-grabbing, inferentially productive, and morally vexing. Yet many other questions that are crucial to the functioning of a modern economy seem uninteresting non-issues. An evolutionary-psychological framework to study folk-economic beliefs has the potential to illuminate this puzzle.

Conditional Reasoning in Schizophrenic Patients.

Conditional reasoning (if p then q) is used very frequently in everyday situations. Conditional reasoning is impaired in brain-lesion patients, psychopathy, alcoholism, and polydrug dependence. Many neurocognitive deficits have also been described in schizophrenia. We assessed conditional reasoning in 25 patients with schizophrenia, 25 depressive patients, and 25 controls, using the Wason selection task in three different domains: social contracts, precautionary rules, and descriptive rules. Control measures included depression, anxiety, and severity of schizophrenia measures as a Verbal Intelligence Scale. Patients with schizophrenia were significantly impaired on all conditional reasoning tasks compared to depressives and controls. However, the social contract and precautions tasks yielded better results than the descriptive tasks. Differences between groups disappeared for social contract but remained for precautions and descriptive tasks when verbal intelligence was used as a covariate. These results suggest that domain-specific reasoning mechanisms, proposed by evolutionary psychologists, are relatively resilient in the face of brain network disruptions that impair more general reasoning abilities. Nevertheless, patients with schizophrenia could encounter difficulties understanding precaution rules and social contracts in real-life situations resulting in unwise risk-taking and misunderstandings in the social world.

Cross-cultural regularities in the cognitive architecture of pride.

Pride occurs in every known culture, appears early in development, is reliably triggered by achievements and formidability, and causes a characteristic display that is recognized everywhere. Here, we evaluate the theory that pride evolved to guide decisions relevant to pursuing actions that enhance valuation and respect for a person in the minds of others. By hypothesis, pride is a neurocomputational program tailored by selection to orchestrate cognition and behavior in the service of: (i) motivating the cost-effective pursuit of courses of action that would increase others' valuations and respect of the individual, (ii) motivating the advertisement of acts or characteristics whose recognition by others would lead them to enhance their evaluations of the individual, and (iii) mobilizing the individual to take advantage of the resulting enhanced social landscape. To modulate how much to invest in actions that might lead to enhanced evaluations by others, the pride system must forecast the magnitude of the evaluations the action would evoke in the audience and calibrate its activation proportionally. We tested this prediction in 16 countries across 4 continents (n = 2,085), for 25 acts and traits. As predicted, the pride intensity for a given act or trait closely tracks the valuations of audiences, local (mean r = +0.82) and foreign (mean r = +0.75). This relationship is specific to pride and does not generalize to other positive emotions that coactivate with pride but lack its audience-recalibrating function.

Decoding of nonverbal language in alcoholism: A perception or a labeling problem?

Alcohol-dependent patients have difficulty recognizing social cues such as emotional facial expressions, prosody, and postures. However, most researchers describing these difficulties rely on labeling tasks. It therefore remains difficult to disentangle genuine emotion-decoding problems from emotion-labeling impairments. In the present study, 35 recently detoxified alcohol-dependent patients were compared with 35 matched controls on four emotion-pairing tasks to explore the distinction between labeling and perceptual abilities. First, 2 tasks were used to assess emotion-labeling ability (labeling task) and working memory (necessary to process emotional stimuli; control matching task). Next, 2 experimental pairing tasks were used to explore unimodal, Face-face or voice-voice) and cross-modal, Face-voice or voice-face) matching abilities in the absence of any labeling requirement. Patients had difficulty accurately processing voices in unimodal tasks and correctly matching emotional stimuli in cross-modal tasks. Specifically, they did not correctly identify neutral stimuli in unimodal or cross-modal tasks and did not correctly identify fear in cross-modal tasks. Reaction times were also slower in these patients. However, accuracy and reaction time (RT) differences between patients and controls were accounted for by including anxiety and depression scores as covariates in the model. These results suggest that emotion-decoding difficulties observed in recently detoxified alcohol-dependent patients are not due to a specific emotion-labeling impairment, but rather involve perceptual difficulties or later integrative processing steps in the brain. Future studies should directly compare depressed or nondepressed alcohol-dependent patients with depressive patients to disentangle the influences of these highly comorbid disorders on nonverbal language perception.

Impaired non-verbal emotion processing in Pathological Gamblers.

Impaired perception of emotion in others has been described and confirmed in addictions with substances, but no such data exists regarding addictions without substances. As it has been hypothesized that toxic effect of substances on the brain was responsible for the impairments described, studying addictions without substances could be of interest to confirm this hypothesis. Twenty-two male pathological gamblers were compared to 22 male healthy controls matched for age and education level on non-verbal emotion perception tasks including faces, voices, and musical excerpts. Depression and anxiety levels were controlled for. Pathological gamblers significantly underestimated the intensity of peacefulness in music, and overall they were less accurate when reading emotion in voices and faces. They also overestimated emotional intensity in neutral voices and faces. Although anxiety levels did account for accuracy problems when detecting fear in voices and for overestimating emotions in neutral faces, anxiety levels did not explain the range of deficits observed. This is the first study showing non-verbal perception deficits in a purely behavioural addiction. These findings show that deficits in decoding non-verbal signals are associated with addictive behaviours per se, and are not due solely to toxic effects of substances on the brain.

Emotional Intelligence and Callous-Unemotional Traits in Incarcerated Adolescents.

Emotional intelligence (EI) is the ability to perceive, manage, and reason about emotions and to use this information to guide thinking and behavior adaptively. Youth with callous-unemotional (CU) traits demonstrate a variety of affective deficits, including impairment in recognition of emotion and reduced emotional responsiveness to distress or pain in others. We examined the association between ability EI and CU traits in a sample of incarcerated adolescents (n = 141) using an expert-rater device (Psychopathy Checklist Youth Version (PCL-YV; Manual for the Hare psychopathy checklist: Youth version. Multi-Health Systems, Toronto, 2003) and self-report assessments of CU traits. EI was assessed using the Mayer-Salovey-Caruso Emotional Intelligence Test-Youth Version, Research Version (MSCEIT-YV-R; MSCEIT YV: Mayer-Salovey-Caruso emotional intelligence test: Youth version, research version 1.0. Multi-Health Systems, Toronto, Ontario, 2005). Similar to findings in adult forensic populations, high levels of CU traits in incarcerated adolescents were associated with lower EI, particularly higher order EI skills. Identifying impairment on EI abilities may have important implications for emerging treatment and intervention developments for youth with high levels of CU traits.

Paralimbic biomarkers in taxometric analyses of psychopathy: does changing the indicators change the conclusion?

Although psychopathy has consistently been shown to distribute as a dimension, all prior studies have examined behavioral indicators that may be phenotypically distant from core biological correlates of the syndrome. The current studies attempted to determine whether biomarkers from a high-resolution structural MRI scan of selected limbic and paralimbic structures identified the latent structure of psychopathy as continuous. Participants were 254 adult male medium/maximum security inmates (Study 1) and 191 adolescent male maximum security inmates (Study 2) who volunteered to undergo research MRI scans. Indicators of gray matter concentration (GMC) in the adult sample and of gray matter volume (GMV) in the adolescent sample were subjected to taxometric analysis using three nonredundant taxometric procedures: mean above minus below a cut (MAMBAC), maximum covariance (MAXCOV), and latent-mode factor analysis (L-Mode). Evidence of continuous latent structure was found across samples (adults, adolescents), measures (GMV, GMC, Psychopathy Checklist-Revised [PCL-R], Psychopathy Checklist: Youth Version [PCL:YV]), and procedures (MAMBAC, MAXCOV, L-Mode). Continuous latent structure was also noted when biomarker (GMV, GMC) and behavioral (PCL) indicators were included in the same analysis. The current results support the view that psychopathy is a quantitative construct on which people differ in degree ("more of" or "less of") rather than a qualitative construct that assigns people to distinct categories ("either/or"). Continued development of the psychopathy construct may depend on our ability to identify, understand, and make effective use of its apparent continuous latent structure.

Paralimbic gray matter reductions in incarcerated adolescent females with psychopathic traits.

Psychopathy-related paralimbic and limbic structural brain abnormalities have been implicated in incarcerated adult and adolescent male samples. However, there have been few neuroimaging studies of psychopathic traits in females in general and no studies from incarcerated female youth in particular. Here we present the first study to examine the relationship between brain gray matter volumes and psychopathic traits (assessed using the Psychopathy Checklist-Youth Version [PCL-YV]) in a sample of maximum-security incarcerated female adolescents (N = 39; mean age = 17.6 years). Consistent with male samples, regional gray matter volumes were negatively related to psychopathic traits in female youth offenders in limbic and paralimbic areas, including orbitofrontal cortex, parahippocampal cortex, temporal poles, and left hippocampus. These results provide evidence that psychopathic traits manifest similar neural abnormalities across sex and age.

Unfairness sensitivity and social decision-making in individuals with alcohol dependence: a preliminary study.

BACKGROUND: Altruistic punishment is an evolutionary-based mechanism aimed at maximizing the probability of reciprocity in cooperative exchanges, through the deterrence of non-cooperators. In economic games, humans will often punish others for non-cooperation, even if this punishment is costly to the self. For instance, in the Ultimatum Game paradigm, people refuse offers considered as unfair even though they are disadvantaged financially by doing so. Here, we hypothesize that, due to an impulsive decision making style, individuals with alcoholism will display an heightened unfairness sensitivity that leads them to reject advantageous offers more frequently on the Ultimatum Game. METHODS: Thirty recently detoxified alcohol-dependent individuals and 30 matched healthy control participants performed the Ultimatum Game task, in which participants had to respond to take-it-or-leave-it offers ranging from fair to unfair and made by a fictive proposer. RESULTS: Alcohol-dependent participants decided to reject unfair offers more frequently during the Ultimatum Game, as compared to controls. CONCLUSIONS: In situations of social frustration or irritation, such as unfair Ultimatum Game offers, alcohol-dependent individuals may have more difficulty than controls regulating their emotional impulses, and respond aggressively or retributively (i.e., by rejecting the unfair offer).

Polysubstance dependent patients display a more utilitarian profile in moral decision-making than alcohol-dependent patients, depressive patients and controls.

BACKGROUND: Addiction has been shown to be associated with the endorsement of utilitarian moral judgments. Ventro-medial prefrontal cortex (VMPFC) dysfunction may explain these findings. METHODS: 100 subjects were recruited: 25 polysubstance dependent patients, 25 alcohol dependent patients, 25 patients with major depressive disorders, and 25 normal controls. Subjects were assessed with a battery of 24 moral dilemmas: 8 impersonal dilemmas (no physical contact involved); 8 personal pareto (direct action that does not make the harmed individual worse off) and 8 personal non-pareto (direct action that does make the harmed individual worse off). The Iowa Gambling Task was used to document a possible connection between VMPFC dysfunction and responses to the moral dilemmas. RESULTS: Polysubstance dependent patients endorsed more utilitarian choices than controls on all types of dilemmas and more than depressed patients on impersonal and personal pareto dilemmas. Alcohol dependent patients had intermediate results between polysubstance dependent patients and controls but these differences were not significant. All patients showed significantly poorer performance compared to controls on the Iowa Gambling Task, but there was no significant association between Iowa Gambling Tasks scores and moral dilemma choices. CONCLUSION: Polysubstance dependent patients made more utilitarian choices when responding to moral dilemmas than depressed patients and normal controls, while alcoholic patients showed intermediate results. The absence of correlation between performance on the Iowa Gambling Task and the number of more utilitarian choices indicates that moral dilemma and decision making under uncertainty tap into separate mechanisms.

Aberrant paralimbic gray matter in incarcerated male adolescents with psychopathic traits.

OBJECTIVE: To investigate the relationship between brain structure and psychopathic traits in maximum-security incarcerated male adolescents, and to examine whether the associations between brain volumes in paralimbic and limbic regions and psychopathic traits observed in incarcerated adult men extend to an independent sample of incarcerated male adolescents. METHOD: A structural magnetic resonance imaging (MRI) study of regional gray matter volumes by using voxel-based morphometry in maximum-security incarcerated male adolescents (N = 218) assessed for psychopathic traits using the Hare Psychopathy Checklist-Youth Version (PCL-YV). All analyses controlled for effects of age, substance use, and brain size. RESULTS: Consistent with hypotheses and the adult literature, psychopathic traits were associated with decreased regional gray matter volumes in diffuse paralimbic regions, including orbitofrontal cortex, bilateral temporal poles, and posterior cingulate cortex. CONCLUSIONS: These results strengthen the interpretation that paralimbic regions are central for understanding neural dysfunction associated with psychopathic traits and that psychopathy is best conceptualized as a neurodevelopmental disorder.