B ainSci.2021,11,387.h ps://doi.o g/10.3390/b ainsci11030387www.mdpi.com/jou nal/b ainsci
A icle
Dis inc i eF on alandOccipi o empo alSu aceFea u es
inNeglec ulPa en ing
InmaculadaLeón
1,2,
*,Ma íaJoséRod igo
1,2
,IleanaQuiñones
3
,JuanAnd ésHe nández‐Cab e a
1,2
andLo naGa cía‐Pen ón
4
1
Ins i u oUni e si a iodeNeu ociencia,Uni e sidaddeLaLaguna,38200LaLaguna,Spain;
mj od [email protected](M.J.R.);jhe [email protected](J.A.H.‐C.)
2
Facul addePsicología,Uni e sidaddeLaLaguna,38200LaLaguna,Spain
3
BasqueCen e onCogni ion,B ain,andLanguage;20009Donos ia‐SanSebas ián,Spain;i.quin[email p o ec ed]
4
MRCCogni ion&B ainSciencesUni ,Uni e si yo Camb idge,Camb idgeCB27EF,UK;[email protected]
*Co espondence:[email protected]
Abs ac :Al hough heb ainsigna u eso adap i ehumanpa en inga ewelldocumen ed, he
co ical ea u esassocia edwi hmaladap i eca egi inga eunde explo ed.
Wein es iga ed
whe he co ical hicknessandsu acea ea a yinasmallg oupo mo he swhohadneglec ed
hei child en(24in heneglec g oup,NG)compa ed oacon olg oupo mo he swi hnon‐ne‐
glec ulca egi ing(21in hecon olg oup,CG).Wealso es edwhe he heco icaldi e ences
we e ela ed odyadicmo he ‐childemo ionala ailabili y(EA)inaplay askwi h hei child en
andwhe he alexi hymiain ol inglowemo ionalawa eness ha cha ac e izes heNGcouldplay
a olein heco ical‐EAassocia ions.Whole‐b ainanalysiso heco icalman leiden i ied educed
co ical hicknessin he igh os almiddle on algy usandaninc easedsu acea eain he igh
lingualandla e aloccipi alco ices o heNGwi h espec o heCG.Follow‐uppa hanalysis
showeddi ec e ec so he igh os almiddle on algy us(RMFG)on heemo ionala ailabili y
(EA)andon hedi icul y oiden i y eelings(alexi hymia ac o ),wi hama ginalindi ec RMFG‐
EAe ec h ough his ac o .Thesep elimina y indingsex endexis ingwo kbyimplica ingdi ‐
e encesinco ical ea u esassocia edwi hneglec ulpa en ingand ele an omo he ‐childin e ‐
ac i ebonding.
Keywo ds:neglec ulpa en ing;co ical hickness;su acea ea;alexi hymia;mo he ‐childin e ac ion
1.In oduc ion
Al houghmos pa en scan espondapp op ia ely o hei child’sneeds,ex emecases
o insensi i eca egi ingdoexis .In ac ,neglec is hemos common o mo childmal‐
ea men ,whichin ol esad as ic ailu e op o ide hechildwi h ood,clo hing,shel e ,
medicalca e,supe ision,o emo ionalsuppo ha places hechild’ssa e ya isk[1,2].
Beingse e elyneglec eden ailsnega i ebeha io al,neu obiological,andclinicalconse‐
quences o hechild[3,4].Al hough heb ainsigna u eso adap i epa en inga ewell
documen ed(e.g.,[5]), heneu almechanismsassocia edwi hneglec ulca egi inga e
compa a i elylesss udied.Ne e heless,iden i ying heco ical ea u eslinked oneglec ‐
ulbeha io couldbe ele an obe e unde s anding hecycleo maladap i epa en ing.
To hisend, hiss udyseeks oad ancewo k onmaladap i epa en ingbyin es i‐
ga ingwhe he co ical ea u es a yinmo he swhoneglec hei child en. Speci ically,
weadd essgapsinknowledgein wodi ec ions.Fi s ,weiden i ydi e encesinco ical
hicknessandsu acea eabe weenag oupo hosemo he swhohadneglec ed hei
child en,aneglec g oup(NG),andacon olg oupo mo he s(CG)wi hnon‐neglec ul
ca egi ing.Second,weexamine owha ex en hoseco ical ea u espo en iallyassoci‐
Ci a ion:León,I.;
Rod igo,M.J.;Quiñones,I.;
He nández‐Cab e a,J.A.;
Ga cía‐Pen ón,L.Dis inc i eF on al
andOccipi o empo alSu ace
Fea u esinNeglec ulPa en ing.
B ainSci.2021,11,387.
h ps://doi.o g/10.3390/
b
ainsci11030387
AcademicEdi o :PaolaVenu i
Recei ed:4Feb ua y2021
Accep ed:13Ma ch2021
Published:18Ma ch2021
Publishe ’sNo e:MDPIs aysneu‐
alwi h ega d oju isdic ional
claimsinpublishedmapsandins i‐
u ionala ilia ions.
Copy igh :©2021by heau ho s.Li‐
censeeMDPI,Basel,Swi ze land.
Thisa icleisanopenaccessa icle
dis ibu edunde he e msandcon‐
di ionso heC ea i eCommonsA ‐
ibu ion(CCBY)license(h p://c ea‐
i ecommons.o g/licenses/by/4.0/).
B ainSci.2021,11,3872o 15
a edwi h heNGwe e ela ed o hequali yo amo he ‐childin e ac i eplay ask(co ‐
ical–emo ionala ailabili yassocia ions),andwede e minewhe he alexi hymiacould
playa olein heseassocia ions.
1.1.Neu oana omicalCo ela eso Neglec ulCa egi ing
P e iousneu oimaging esea chonmo he sshowingneglec ulca egi inghasiden‐
i ied unc ionalands uc u al a ia ionsmos lyin on al,cingula e,andoccipi o em‐
po ala eas.Ina unc ionalmagne ic esonanceimage( MRI)s udy[6],mo he swhone‐
glec ed hei child en e suscon olmo he sshowed educedac i a ionsin esponse o
in an andadul c ying aces,bo hina on alco icala ea(in e io on algy us)aswell
asoccipi o empo alco icala eas(lingualand usi o m).In hesames udy,mo he swi h
neglec ulbeha io alsoshowedana enua edac i a ion oin an c ying acesinle mid‐
dle on alandan e io cingula ea eas,unde sco ing hei speci icdi icul ieswi h e‐
sponding o hein an ’semo ionalcues. Ina oxel‐basedmo phome ics udy[7],g ey
ma e olume educ ionsin he igh insula,an e io /middlecingula e,andin e io /mid‐
dle on algy us,andg ea e olumein he igh usi o mandce ebellum,we eob ained
o mo he swi hneglec ulbeha io ascompa ed ocon olmo he s.
Neu oimaging esea chhasalsodocumen ed hec i ical oleo egionssuchas he
medialandla e alp e on alco ex(PFC)andan e io cingula eco ex(ACC)inemo ion
egula ion[8,9].Emo ion egula o ycapaci iesa e i al o suppo ingpa en s’abili y o
bepe cep i e, esponsi e,and lexiblein he aceo challengingchildbeha io [10,11].
Likewise,occipi o empo al isuala easspecializedin hep ocessingo acesa ec ucially
in ol edinsensi i epa en ing[5,12]. Mo eo e , hesea easha eshown hei in ol e‐
men in heal e edp ocessingo achild’sc yinginmo he swhoneglec hei child en,
a ec ing heca egi e ’sabili y obea uned o hein an ’sneeds[6,13].Howe e ,lessis
knownabou hepo en ial oleo co ical hinningandsu acea eain hespeci icneu al
unde pinningso bo hemo ion egula ionand ace‐ esponsi ea easin hecon ex o ne‐
glec ulca egi ing.
Co ical hickness(CT)andco icalsu acea ea(SA)a emo phological ea u eso
hece eb alco ex ha ollowdi e en gene ic,phylogene ic,andde elopmen al ou es,
cap u ing heana omicaland unc ional a iabili yin heb ain[14].S udiesinno mal
mo he ingha eshown ha heb ainunde goeschangesinco ical hickness,wi hdi ‐
e encesobse edbe o eanda e p egnancy[15,16]andinp imipa ousmo he s e sus
non‐mo he s[17]. The eisalsoe idenceo co ical a ia ionsin hema e nalb ainina
g oupo i s ‐ imemo he s,showing ha ala e pos pa ummon hwasassocia edwi h
inc easedco ical hicknessin hep e on alco ex, hela e aloccipi ala eas,and he u‐
si o mgy i[18],sugges ingb ains uc u aladap a ions o hechild’se ol ingneeds.
F omacomplemen a ype spec i e ha compa esex eme a ia ionsinma e nalca e‐
gi ing, hecu en s udyexaminedpossibledi e encesinco ical ea u es(CTandSA)
in hosemo he swhohadneglec ed hei child e suscon olmo he s,andwhe he hese
co icaldi e encesa e ela ed oobse edmo he ‐childin e ac i ebeha io .
1.2.Rela ionsbe weenB ainFea u es,Pe sonali yT ai sandQuali yo Mo he ‐Child
In e ac ion
As o heseconddi ec ion akenin hiss udy,we a o edusinganobse a ional
mo he ‐child egula o y asko e sel ‐ epo ins umen sin o medby hemo he s.We
usedemo ionala ailabili y(EA),measu ed h oughamo he ‐child eeplay ask,asa
p oxy o hequali yo mo he ‐childin e ac ions[19,20].Thismeasu eisp edic i eo he
mo he ’s epo edchilda achmen [21].EA e e s osensi i eand esponsi edyadicex‐
changesand hecogni i eo ganiza iono coo dina edmo he ‐childac ions owa ds
achie ingjoin goals.Mo he ‐childsynch onyindailyexchangesisac ucial ea u ein
his ask ha is ela ed o hein an ’sa achmen quali y[22,23].Mo eo e , esul son his
askdisc imina ed helowpe o mancein heemo ionala ailabili yo neglec ul e sus
non‐neglec uldyads e ywell[7].Lowpe o manceinEAwasalso ela ed o educ ions
B ainSci.2021,11,3873o 15
in hes uc u alconnec i i yo whi ema e ac sin e connec ing he ace‐ esponsi e
co exwi h helimbicand on ala easinmo he swi hneglec ulbeha io [24].
Somedi e encesin ai alexi hymia oundinneglec ul e susnon‐neglec ulca e‐
gi ing[25]couldplaya olein heco icaldi e ences–EAassocia ions. Alexi hymiais
de inedasme acogni i eimpai men sinemo ionalawa eness ha in ol edi icul iesin
iden i yinganddesc ibingone’semo ionsandminimizingemo ionalexpe ienceby o‐
cusinga en ionex e nally[26–28],whichmaya ec hemo he ‐childexchanges. B ain
egionshypo hesizedas ea u ingNGandCGdi e encesha ebeendesc ibedaspa o
alexi hymianeu alco ela es.Highcompa ed olowalexi hymicwomenshowed e‐
ducedac i a ionsin heo bi o on alco ex(OFC)andACCwhileempa hizingwi han
imaginedyoungchild[29].Mo eo e , ecen e idencehasshownassocia ionsbe ween
co ical hickness ea u esandpe sonali y ai s[30,31]. Taking hise idencein oaccoun ,
weha es a ed omamodel ha conside s a ia ionsinco ical ea u esasan eceden s,
p esumably ela ed odi e encesinalexi hymiaand hepe o mancein hemo he ‐child
play ask. Finally,sincemo he swi hneglec ulbeha io ha eshownahis o yo child‐
hoodmal ea men andli es ess ha usuallyen ailsea lyb ainal e a ions[1,4],i isim‐
po an oconside i spossiblee ec onco ical ea u es.
Insum, hiss udyadd esses helacko e idenceinneu oimaging esea chonpossi‐
bledi e encesin heco ical ea u esin egionsassocia edwi hneglec ul e susnon‐
neglec ulca egi ing. Thiss udyalso ies o inde idenceo he ela ionshipso hose
di e en ialco ical ea u eswi h hequali yo mo he ‐childin e ac ions.Following e‐
sul sob ainedwi ho he neu oimagingmeasu esinmo he swi hneglec ulca egi ing
epo edhe e,weexpec edco icaldi e encesinbo h on alandoccipi o empo ala eas.
Wealso en a i elyexpec ed ha alexi hymiaasanemo ionalpe sonali y ai wouldcon‐
ibu e o heassocia ionbe ween hoseco ical ea u esandobse eddyadicemo ional
a ailabili y.
2.Ma e ialsandMe hods
2.1.Pa icipan s
Fo y‐ i emo he s(24NGand21CG)o he o y‐se enscannedsamplespa ici‐
pa edin heexpe imen .Theywe eall ec ui ed h ough hesameP ima yHeal hCen e .
Allsubjec sga e hei w i enin o medconsen o inclusionbe o e heypa icipa edin
hes udy.Thes udywasconduc ed ollowing heDecla a iono Helsinki,and hep o o‐
colwasapp o edby heE hicsCommi eeo heUni e si yo LaLaguna(code:
CEIBA2017‐0254;da eo app o al:25July2017). Gene alinclusionc i e iawe ebeing he
biologicalmo he o achildunde h eeyea soldwhohadno beenplacedin os e ca e
a anypoin in hei his o y,no beenbo np ema u elyo su e edpe ina alo pos na al
medicalcomplica ions,acco ding o hepedia icians’ epo s.Speci icinclusionc i e ia
o amo he in heneglec g oupwe easubs an ia edcaseo neglec egis e edin helas
12mon hsbyChildP o ec i eSe ices(CPS)andcomplyingwi h heindica o so he
Mal ea men Classi ica ionSys em(MCS) o se e eneglec [32].Thecon olg oup’sin‐
clusionc i e iawe eha ingnega i esco esinall heMCSneglec indica o sand heab‐
senceo CPSo P e en i eSe ices eco ds o he amily.
As o hemo he s’sociodemog aphicp o ile, heywe eallin hei ea ly30s,had
mo echild enandasimila meanageo he a ge child,li edin u ala eas,andsha ed
asimila lowle elo educa ion;mo he sin heNGwe emo elikely han hosein heCG
oli einsingle‐pa en amiliesand o ecei e inancialassis ance(Table1).Acco ding o
heneglec iskp o ile a edby hesocialwo ke s,mos mo he sin heneglec g ouphad
ahis o yo childhoodabuseo neglec andsco edposi i elyinneglec ulca egi ingin‐
dica o s(seeSupplemen a yS1:Pa icipan ec ui men s a egyandp ocedu e;Supple‐
men a yS2:Riskp o ilemeasu es).
B ainSci.2021,11,3874o 15
Table1.Sociodemog aphicandneglec iskp o ileinNeglec andCon olG oups.G oupcom‐
pa isonswi hmeansco eswe epe o medwi h s a is ic,while hosewi hpe cen age alues
we epe o medwi hchi‐squa e(χ2)s a is ic.
Neglec G oup
n=24
Con olG oup
n=21
Compa isons
χ2/
Sociodemog aphic
p o ile
Meanageo he
mo he 29.1(7.1)33.6(3.2)−2.82**
Numbe o child en2.08(0.8)1.57(0.6)2.24*
Meanageo a ge
child2.7(1.5)2.3(1.9)0.82
Ru ala eas(%)87.580.90.04
Le elo educa ion
(%):
2.53
P ima y7047.6
Seconda y16.628.5
>Seconda y12.523.8
Single‐pa en amily50144.92*
Financialhelp om
ins i u ions831418.7***
Neglec iskp o ile
His o yabuse/neglec
(%)671410.5**
In ima epa ne con‐
lic (%)501.22
Ch onicphysicalill‐
ness(%)1650.22
Poo householdman‐
agemen (%)88024.4***
Dis ega dheal h/edu‐
ca ionneeds(%)61012.4***
Dis ega demo‐
ion/cogni i eneeds
(%)
89520.9***
Rigid/inconsis en
no ms(%)67511.4***
Psychia icDiso de s
ac o 0.67(0.99)−0.69(0.23)6.35***
*p<0.05;**p<0.01;***p<0.001.
2.2.MRIDa aAcquisi ion
High‐ esolu ionT1‐weigh edMagne isa ionP epa edRapidG adien Echoo
MPRAGEana omical olumeswe eacqui edonaGene alElec ic3Tscanne loca eda he
Uni e si yHospi al’sMagne icResonanceSe ice o BiomedicalResea cha heUni e ‐
si yo LaLaguna.A o alo 196con iguous1mmsagi alsliceswe eacqui edwi h he
ollowingpa ame e s: epe i ion ime=8.716ms,echo ime=1.736ms, ieldo iew=256×
256mm2,in‐plane esolu ion=1mm×1mm, lipangle=12.
Du ing heongoingda aacquisi ion, heT1‐MRIwassc eened o clea a i ac sby
heMRI echnician.Pa icipan swe e escannedon hewayi anob iousa i ac was
de ec ed.I he echnician(o he ainedexpe imen e )de ec sanypo en ialal e a ion
B ainSci.2021,11,3875o 15
clinically ele an , heimageswe epassed o heneu o adiologis o u he examina‐
ion.All hepa icipan ssignedin heconsen o m oag ee o ecei ein o ma ioni any
al e a ionwasde ec ed.Noda awe e ejec eda hiss age.
2.3.Co icalThicknessandSu aceA ea
A e da acon e sionin oNi i o ma , he ainedexpe imen e isuallychecked
hequali yo eachT1‐MRIimageusing heMRIc onso wa e.Theexpe imen e ho ‐
oughlyinspec ed heimages, akingin oaccoun hesemainc i e ia:mo iona i ac s
(ghos ingo blu inge ec sin heimagesdue omainlypa icipan ’sg ossmo emen s,
b ea hing,ca diace ec s,e c.), inginga i ac s( unca ion/Gibbsa i ac s)andsuscep i‐
bili ya i ac s(imagedis o ionsdue oinhomogenei ieso hemagne ic ield).Noda a
we e ejec ed, ollowed isualinspec ion,andallpassedin oF eesu e ’sau oma edp e‐
p ocessingpipeline( econ‐all).Howe e ,da a om wocon olpa icipan shad obe
excludeddue oF eeSu e co ical econs uc ionp ocess( econ‐all) ailu es.F eesu e ’s
ou pu s omallpa icipan swe ealso isuallyinspec ed,asexplainedbelow.Nos a is‐
icalex emeou lie swe eiden i iedbelowo abo e2.5SD o heex ac edclus e b ain
measu es ha mayha ed i en he esul sob ained.
Co ical hickness(CT)andsu acea ea(SA)measu eswe eob ainedusingF ee‐
Su e ( e sion5.1)(h p://su e .nm .mgh.ha a d.edu/,accessedon10Feb ua y2020).
Su aceco ical econs uc ionincluded:mo ionco ec ion,skull ipped,au oma ed
ans o ma ionin oTalai achspace,subco icalwhi ema e ,deepg ayma e olume ‐
ics uc u esegmen a ion, iangula essella iono hewhi esu ace(co esponding o
heg ey/whi ema e bounda y),andpialsu ace(co esponding o hepiama e ),and
au oma ed opologyco ec ionandsu acede o ma ion ha op imallyplace he(inne )
whi esu aceand he(ou e )pialsu ace[33,34].Somede o ma ionsincludedsu ace
in la ionandahigh‐dimensionalnonlinea egis a ion oasphe icala las.Thesegmen‐
a ionandde o ma ionalgo i hmsp oduce ep esen a ionso heCT ha is hea e age
o hecloses dis ance om hewhi e o hepialsu aceand om hepial o hewhi e
su acea each e exon he essella edsu aces.TheSAiscompu eda hewhi esu ace,
whichislesssensi i e oco ical hickness a ia ions,andmeasu eda each e exasone‐
hi do hea eao each iangle ha mee s he e ex;ino he wo ds,i is hesumo he
a eao all he iangles ha mee he e exdi idedby h ee[14].TheCTandSAmaps
we esmoo hedusinga15mmwi ha ull‐wid ha hal maximum(FWHM)Gaussian
il e .
Fo hequali ychecko F eeSu e ’sou pu s, heindi idualwhi eandpialsu aces
we edisplayedinF ee iew oinspec isuallyi heyaccu a ely ollowed heg eyand
whi ema e bounda ies.Noe o swe eobse ed.F eeSu e alsop o idedana e aged
b ain( sa e age)inMon ealNeu ologicalIns i u e(MNI)s anda dspace ha wasused
ocompa eand isualize esul s.
2.4.Beha io alandPe sonali yMeasu es
TheMini‐In e na ionalNeu opsychia icIn e iew(M.I.N.I.6.0),in heSpanish e ‐
sion[35],including15majo psychia icdiso de s,wasadminis e ed(seeSupplemen a y
TableS1Psychopa hologicalcondi ionss a i iedbyG oup).Thesco eob ained o each
diso de co esponds oacumula i esco ingo symp omsandno oaca ego icalcu ‐o
classi ica ion.The wog oupsmainlydi e edin i epsychopa hological a iables,ma ked
ini alics,whichsu i ed heBon e onico ec ionandwe esubmi ed oaP incipalCom‐
ponen Analysis.Resul sga eone‐ ac o solu ion:“Psychia icDiso de s”(PD),wi hmod‐
e a ein e ‐co ela ionsamong he i e a iables,Kaise ‐Meye ‐Olkin(KMO) es =0.65,Ei‐
gen alue=2.53,wi hanexplained a ianceo 51%,wi h hecoe icien sco esinPDbeing
highe in heNG(seeTable1).Noneo hemo he sinei he g oupwe ebeingmedica ed
o psychia icdiso de sa he imeo es ing.Thecoe icien sco einPDwasusedasa
eg esso in heF eeSu e model ocon olasmuchaspossible o i se ec onco ical
di e ences.
B ainSci.2021,11,3876o 15
DyadicEmo ionalA ailabili ywasmeasu edin hecon ex o mo he ‐child eeplay
using heEmo ionalA ailabili yScale(EA):In ancy oEa lyChildhoodVe sion[36].EA
signi ies hequali yo emo ionalexchanges, ocusingonpa ne s’accessibili y oeacho he
and hei abili y o eadand espondapp op ia ely oeacho he ’scommunica ions.Two
ex e nalobse e sblind o hemo he s’g oupingsmade he ideos’ a ings,and hein e ‐
a e eliabili yo he a ingsineachscale(Kappasco e,0 o1)wascalcula ed.Thescale
ope a ionalizes ou aspec so pa en albeha io :Sensi i i y( hepa en showscon ingen
esponsi eness ochildsignalsanddemands,K=0.94);S uc u ing( hepa en app op ia ely
acili a es hechild’splay,K=0.90);Non‐in usi eness( hepa en cansuppo hechild’s
playwi hou beingo e di ec i eand/o in e e ing,K=0.87);Non‐hos ili y( hepa en can
beha ewi h hechildinaway ha isno ejec ingo an agonis ic,K=0.92).Thescalealso
measu es woaspec so childbeha io :Responsi eness( hechild’sabili yandin e es in
explo ingonhiso he ownandin esponding o hepa en ’sbids,K=0.92),andIn ol emen
( hechild’sabili yandwillingness oengage hepa en inin e ac ion,K=0.86).Toob aina
simple s uc u eo hesixs anda dizedscales,aP incipalComponen Analysiswas
pe o med(seeSupplemen a yTableS2:In e ‐ a e eliabili iesandone‐ ac o componen
loadingso heEmo ionalA ailabili yScales).The esul yieldedasingle‐ ac o s uc u e
gi en heexis enceo highin e ‐co ela ionsbe ween he a iablesin hemo he ‐child
dyad:KMO=0.84,Eigen alue=4.49,wi hanexplained a ianceo 75%.Thecoe icien sco e
in hissingle ac o wasusedasameasu eo dyadicemo ionala ailabili y.
Finally, heTo on oAlexi hymiaScale(TAS‐20)[37,38]measu es hedi icul yin
iden i yingandexp essingone’semo ions.The20i emsa esco edona5‐poin scale om
s onglydisag ee os onglyag ee.TheTAS‐20hasa h ee‐ ac o s uc u e:Fac o 1,Di ‐
icul yinDesc ibingFeelings(DDF;α=0.73);Fac o 2,Di icul yinIden i yingFeelings
(DIF;α=0.90);andFac o 3,Ex e nallyO ien edThinking(EOT;α=0.50).Theo e all
sco ea e aging he h ee‐ ac o sco eswasalsocalcula ed.
S a is icalanalysescompa ingmeasu esbe ween he wog oupsshowedsigni i‐
can lyhighe alexi hymiaandlowe dyadicemo ionala ailabili yin heNG hanin he
CG(seeTable2).
Table2.Pa hanalysispsychological a iables.Alexi hymiaandEmo ionalA ailabili ycompa i‐
sonsbe weenNeglec andCon olG oups.
Neglec G oup
n=24
Con olG oup
n=21Compa isons
M(SD)M(SD)T(43)δ
Alexi hymia(a e aged
sco e)3.10(0.88)2.45(0.79)2.56*0.77
Di icul yinDesc ibing3.35(1.30)2.59(1.18)2.03*0.60
Feelings
Di icul yinIden i ying2.98(1.31)2.18(1.07)2.21*0.66
Feelings
Ex e nallyO ien ed
Thinking3.05(0.61)2.59(0.56)2.63**0.78
Emo ionalA ailabili y
( ac o Sco e)
−0.62(0.92)0.71(0.48)−6.18***1.78
*p<0.05;**p<0.01;***p<0.001.
2.5.S a is icalAnalyses o B ainMeasu es
Asnop io esea chhasexamineddi e en ialco ical ea u esinneglec ulca egi ‐
ing,wep obed heen i eco icalman lewi hanexplo a o ywhole‐b ainanaly icap‐
p oach oallow hedisco e yo a ull angeo co icaldi e encesassocia edwi hne‐
glec ul e susnon‐neglec ulca egi ing.Ananalysiso co a iance(ANCOVA)waspe ‐
o medinF eeSu e oexplo e egionaldi e encesinCTandSAbe ween heNGand
B ainSci.2021,11,3877o 15
CG,adjus ed o age.Themodelalsoincludedone eg esso desc ibedabo easPsychi‐
a icDiso de s,once hepo en ialcollinea i yo hispsychia iccondi ionwi h heg oup
was uledou (seeSupplemen a yTableS3:Collinea i yindexesbe ween heG oupand
hepsychopa hologicalcondi ions).To alin ac anial olume(TIV)wasalsoincludedas
anuisanceco a ia ein heSAanalysis.
Smoo hedGaussianMon eCa lo(MCZ)simula ion(10,000i e a ions)wasused o
pe o mclus e ‐wise(CW)co ec iono mul iplecompa isons,wi hanini ial e exwise
clus e ‐ o ma ion h eshold(CFT)≤0.001[39].Howe e ,acco ding o heseau ho s,i no
clus e is ound,alesss ic CFT(≤0.005)canbeused o co ical hickness(CT)analyses.
A his h eshold,CTislessa ec edby alse‐posi i e a es(FPR) hanSu aceA ea(SA)anal‐
ysesi heFWHM>10mmis ul illed,asisou case(FWHM=15mm).To u he minimize
FPR,wecheckedwhe he heclus e ssu i ing he o me c i e iaa ealsohypo hesis‐d i en,
co esponding o he egions(e.g., on alandoccipi o empo al)mos ly oundin he epo ed
s udies.Clus e o ma ionwaspe o medineachhemisphe esepa a elyand henco ec ed
o bo hhemisphe esusingBon e onico ec iona p‐ alue<0.05.Regionaldi e encesa e
desc ibedbasedon heF eeSu e Desikan/Killianypa cella iona las[40].
2.6.S a is icalAnalyses o Co ical–EAAssocia ions
Pa hanalyseswe eplanned o es hepo en ial ela ionbe weenco ical ea u es
(CT/SA),alexi hymia(assuming ha i di e sbe weeng oups),andemo ionala ailabil‐
i y(EA)in hewholesample.Acco ding o hes a ingmodelexplainedabo e, heco ical
measu e/sac edas heexogenous a iable/s, healexi hymiao e all ac o sco eand/o
speci ic ac o sac edas he a iable/sbe weenb ainmeasu esandEA,andEAac edas
hecomple elyendogenousou come a iable.Theb ainmeasu es’ alueswe e hemean
hicknessandsu acea eaex ac ed o hedi e en ialclus e sin heabo eanalyses.The
alexi hymiasco esmos sui ed oen e in hepa hanalysiswe e hoseo hea e aged
ac o and/o he h eespeci ic ac o s,p o ided ha heyco ela edwi hbo h heclus e
aluesand heEAsco es.
Sincemos mo he sin heNG(16ou o 24)hadsu e edchildhoodmal ea men
(neglec o physicalabuse), hiscondi ionshouldalsobeconside ed.P e iouss udies
showed ha ahis o yo childabusewas ela ed oco ical olume ical e a ions[41]and
poo quali yo mo he ‐in an in e ac ions[42].Basedon hise idence,pa hanalyseswe e
alsoplannedwhe e hemo he ’sownchildhoodmal ea men ac edas heexogenous
a iable,gi eni scondi ionas empo alan eceden .Co icalmeasu esac edas he a i‐
ablesbe weenmal ea men condi ionandEA,andEAac edas hecomple elyendoge‐
nousou come a iable.All heanalyseswe epe o medwi hRCo e eam[43]and
La aanR[44]packages.
3.Resul s
3.1.Di e en ialCo icalFea u esinNeglec andCon olG oups
The esul sinCTwi haCFT=0.001showednoclus e o ma ion.Then,aCFT=0.005,
alsope mi ed o CTwi haFWHM>10mm,wasapplied, esul inginoneclus e wi ha
pa e no co icalg eyma e educ ioninmo he so heNGcompa ed o heCG(CG>
NG).Theclus e (p=0.014,Table3uppe andFigu e1)spannedse e alcon iguousana‐
omical egionsin he igh hemisphe e,in ol ing he igh os almiddle on algy us
(RMFG)and hela e alandmedialo bi o on alco ex(OFC),whichco esponds o he
on al egionsp e iouslyhypo hesized.Thes uc u alMRIda aand heco a ia essco es
ha suppo he indingso hiss udya ea ailableinaG‐NodeIn as uc u e(GIN) epos‐
i o y( o de ails,see heDa aA ailabili ys a emen a heendo hepape ).
B ainSci.2021,11,3878o 15
Table3.Di e en ialco ical ea u esinNeglec e susCon olg oups.Aclus e showing educed
co ical hickness o mo he so heneglec g oup(CG>NG)was oundcomp ising he os al
middle on alando bi o on al egions.Theg ea e su acea eawas oundin helingualand
la e aloccipi algy i o heneglec g oup(CG<NG).Age, o alin ac anial olume o su ace
analysesonly,andPsychia icDiso de swe eincludedasnuisanceco a ia es.
Clus e /RegionsTo alVe exClus e ‐Wise
p‐ValueMaxx,y,z(mm)Max
−log10(p‐Value)
Con olG oup>Neglec G oup(Co ical hickness)
R.Ros almiddle
on al,la e al
andmedialo ‐
bi o on al
14340.01421.1,51.5,−12.53.45
Con olG oup<Neglec G oup(Su acea ea)
R.Lingualand
la e aloccipi al11850.00027.4,−88.3,−11.3−3.35
Figu e1.Theco ical hickness educ ioninNeglec e susCon olg oups.Theclus e comp ises
he igh os almiddle on algy us,aspa o hedo sola e al on algy us,and hela e aland
medialo bi o on ala eas.Backg oundb ainimages ep esen hein e io (le image)andan e io
( igh image) iewso he igh in la edhemisphe eo (F eeSu e ) sa e ageb ain.No e:p<0.05
clus e ‐wiseco ec ed,10,000Mon eCa loi e a ions,age,andPsychia icDiso de swe eincluded
asnuisanceco a ia es o heco ical hicknessanalysis.
The esul sin heco icalsu acea ea,applyingaCFT=0.001, e ealedasigni ican
pa e no g ea e su acea eainmo he so heNGwi h espec o heCG(CG<NG)in
heoccipi o empo al egionp e iouslyhypo hesized.Theanalysisshowedala geclus e
(p=0.0002,seeTable3bo omandFigu e2)ex endingo e he igh lingualandla e al
occipi algy io he igh hemisphe e.
B ainSci.2021,11,3879o 15
Figu e2.Theinc easedco icalsu acea eainNeglec e susCon olg oups.Theclus e com‐
p iseslingualandla e aloccipi al egions.Backg oundb ainimages ep esen hein e io (le
image)andmedial( igh image) iewso he igh in la edhemisphe e(F eeSu e ) sa e age
b ain.No e:p<0.05clus e ‐wiseco ec ed,10,000Mon eCa loi e a ions,age, o alin ac anial
olume(TIV)andPsychia icDiso de swe eusedasnuisanceco a ia es o heco icalsu ace
a eaanalysis.
3.2.Roleo Alexi hymiainCo ical‐EAAssocia ions
Asp edic ed,bo h hea e agesco eo alexi hymiaandi s h ee ac o swe ehighe o
heNG han o heCG(seeTable2).Howe e ,only he ac o Di icul yinIden i yingFeel‐
ings(DIF)co ela edbo hwi h he igh os almiddle on algy us(RMFG)co ical hick‐
ness(posi i ely, =0.33,p=0.05)andwi hEmo ionalA ailabili y(nega i ely, =−0.30,p=
0.05).The e o e,DIFwasconside ed obeagoodcandida e o es ingi s oleinco ical‐EA
associa ions.Apa hanalysiswaspe o med o es he oleo DIFin he ela ionshipbe ween
heco ical hicknesssco esin hemiddle on algy us(RMFG)andEmo ionalA ailabili y
(EA)pe o mance.Alls anda de o sandhence he alueso hez‐s a is icha ebeenes i‐
ma ed om1000boo s apsamples.The esul sa edepic edinFigu e3,showing ha he
alexi hymia ac o Di icul yIden i yingFeelings(DIF)wasnega i ely ela ed oEAsco es(B
=−0.378,z=−2.829,p=0.005).Thepa hanalysisalso e ealedsigni ican di ec posi i ee ec s
o RMFG hicknessonalexi hymiaDIF(B=1.982,z=2.761,p=0.006),andonEAsco es(B=
1.795,z=2.846,p=0.004).Ama ginalindi ec nega i ee ec o RMFG hicknessonEA
h oughalexi hymiaDIFwasalso ound(B=−0.749,z=−1.850,p=0.064).Howe e , he o al
posi i ee ec o RMFG hicknessonEA,once heindi ec e ec h oughalexi hymiaDIFhad
beensub ac ed, emainedsigni ican (B=3.400,z=3.508,p=0.000).Gi en ha henumbe o
es ima edpa ame e sisequal o henumbe o di e en in o ma ionuni sin heco a iance
ma ix,nogoodnesso i wasob ained(X
2
anddeg eeso eedoma eequal oze o).
