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Reduced cortical surface area and amygdala volume are associated with youth internalizing and externalizing disordersBrain Imaging Shows Shared Patterns in Youth Mental Disorders

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Key Takeaway
Note that reduced amygdala volume and cortical surface area are associated with several youth psychiatric disorders.

This meta-analysis synthesizes 3D T1-weighted magnetic resonance imaging data to examine structural brain differences in youth with anxiety disorders (n = 1044), depression (n = 504), ADHD (n = 1317), and conduct disorder (n = 1172) compared to healthy controls. The analysis focuses on regional cortical thickness, surface area (SA), and subcortical volume.

Key findings indicate lower SA in the insula, entorhinal cortex, and middle temporal gyrus for both internalizing and externalizing disorders (Cohen's ds = -0.07 to -0.24). Additionally, a reduction in amygdala volume was observed across these groups (Cohen's ds = -0.07 to -0.24). Lower total SA and intracranial volume were also reported (ds = -0.11 to -0.25). Specific reductions in frontoparietal regions were noted only for externalizing disorders (ds = -0.08 to -0.13).

The authors note that no internalizing-specific associations were identified, and disorder-specific alterations were not found for depression. These findings may help identify common biological processes across youth psychiatric disorders while highlighting specific features of externalizing conditions. Clinical application is currently limited to guiding future research into shared versus unique neurobiological pathways.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the neurobiological markers of youth psychiatric disorders by identifying common structural differences in both internalizing and externalizing conditions. While previous coverage has focused on behavioral interventions for depression and anxiety in adults, this study provides evidence regarding the underlying brain structure associated with these conditions in children and adolescents.

Researchers analyzed 3D magnetic resonance imaging from a large group of youth aged 4 to 21. The study included thousands of participants with anxiety disorders, depression, attention-deficit/hyperactivity disorder (ADHD), and conduct disorder, as well as a healthy control group. This large analysis aimed to identify physical differences in brain structure related to these conditions.

The findings showed that youth with both internalizing and externalizing disorders had lower surface area in specific regions, including the insula and entorhinal cortex. Additionally, these groups showed smaller amygdala volumes and lower total intracranial volume compared to healthy peers. Some specific reductions in frontoparietal areas were noted specifically for those with externalizing disorders.

Because this is a large observational analysis of brain scans, it shows links between brain structure and mental health rather than causing the conditions. The results suggest that while some traits are shared across different diagnoses, others are unique to specific conditions like ADHD or conduct disorder. These findings may help researchers identify common biological processes in youth psychiatric disorders.

What this means for you:
Brain scans show shared structural differences in certain areas for several youth mental health conditions.

Common questions

What specific parts of the brain were affected?

The study found lower surface area in the insula, entorhinal cortex, and middle temporal gyrus for both internalizing and externalizing disorders. It also showed smaller amygdala volumes and lower total intracranial volume across these groups.

Who was included in this research?

The study included a large group of youth between the ages of 4 and 21. This included participants with anxiety disorders, depression, ADHD, and conduct disorder, along with a healthy control group.

Are these findings specific to every condition?

While many differences were shared across groups, some results were unique. For example, reductions in frontoparietal regions were specifically linked to externalizing disorders, while certain changes were only found in ADHD and conduct disorder.

Study Details

Study typeMeta analysis
Sample sizen = 1,044
EvidenceLevel 1
Follow-up252.0 mo
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: Externalizing and internalizing disorders are common in youth but are often studied separately, preventing researchers from identifying shared (i.e., transdiagnostic) alterations in brain structure. Using data from the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium, we conducted a mega-analysis to identify shared and distinct cortical and subcortical brain alterations across internalizing (anxiety disorders and depression) and externalizing (attention-deficit/hyperactivity disorder [ADHD] and conduct disorder [CD]) disorders in youth. METHODS: 3D T1-weighted magnetic resonance imaging data from youths (age range 4-21 years) with anxiety disorders (n = 1044), depression (n = 504), ADHD (n = 1317), and CD (n = 1172) along with healthy control participants (n = 4743) were analyzed. We assessed group differences in regional cortical thickness, surface area (SA), and subcortical volume using linear models, adjusted for site, age, and sex, as well as total intracranial volume in the SA and subcortical volume models. RESULTS: We observed transdiagnostic associations, with both internalizing and externalizing disorders characterized by lower SA in the insula, entorhinal cortex, and middle temporal gyrus and lower amygdala volume (Cohen's ds = -0.07 to -0.24) as well as total SA and intracranial volume (ds = -0.11 to -0.25). Externalizing-specific reductions in SA were observed in frontoparietal regions (ds = -0.08 to -0.13), but no internalizing-specific associations were identified. Disorder-specific alterations were identified for ADHD, CD, and anxiety disorders but not depression. CONCLUSIONS: Both common and disorder-specific alterations were identified, with regions involved in salience attribution and emotion processing implicated across internalizing and externalizing disorders. These novel findings can guide future research targeting common biological processes across youth psychiatric disorders as well as features unique to individual disorders.
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