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. Author manuscript; available in PMC: 2008 Jul 29.
Published in final edited form as: Dev Med Child Neurol. 2008 Jan 11;50(3):168–181. doi: 10.1111/j.1469-8749.2008.02026.x

Development of rostral prefrontal cortex and cognitive and behavioural disorders

Iroise Dumontheil 1, Paul W Burgess 2, Sarah-Jayne Blakemore 3
PMCID: PMC2488407  EMSID: UKMS1824  PMID: 18190537

Summary

Information on the development and functions of rostral prefrontal cortex (PFC), or Brodmann area 10, has been gathered from different fields, from anatomical development to functional neuroimaging in adults, and put in relation to three particular cognitive and behavioural disorders. Rostral PFC is larger and has a lower cell density in humans than in other primates. It also has a large number of dendritic spines per cells and numerous connections to the supramodal cortex. These characteristics suggest that rostral PFC is likely to support processes of integration or coordination of inputs particularly developed in humans. The development of rostral PFC is prolonged, with decreases in grey matter and synaptic density continuing into adolescence. Functions attributed to rostral PFC, such as prospective memory, appear to similarly follow a prolonged development until adulthood. Neuroimaging studies have generally found reduced recruitment of rostral PFC, e.g. in tasks requiring response inhibition, in adults compared with children or adolescents, which is consistent with grey matter maturation. The examples of autism, attention deficit and hyperactivity disorder and schizophrenia show that rostral PFC could be affected in several disorders due to the susceptibility of its prolonged maturation to developmental abnormalities.

1. Introduction

Rostral prefrontal cortex (PFC), which corresponds approximately to Brodmann area 10 (BA10, (1, 2), is the largest single architectonic region of the frontal lobes of the human brain (3). In humans, this region continues developing throughout childhood and adolescence. Evidence about the cognitive function of rostral PFC has been scarce until the last decade, partly because its position within the skull prevents successful use of techniques such as electroencephalography, animal lesions or single cells recording. Moreover, the proximity to facial nerves makes electrical stimulations of the scalp used in techniques such as transcranial magnetic stimulation painful. Therefore, the recent data that have been obtained on the function of rostral PFC tend to come from human lesion studies and functional imaging. Several theories of rostral PFC function have been proposed on the basis of these data, mostly attributing to this region a role in certain executive functions.

The purpose of this article is to integrate these findings with what is known about the structural development of rostral PFC and research on cognitive and behavioural disorders. We hope that this review will be a useful tool to inform psychological studies of children and adolescents, show the relevance of this field of research to a range of psychological disorders, and indicate possible future areas of investigation. First, the anatomy and anatomical development of rostral PFC will be presented, before describing evidence obtained in adults on the function of this region, and some theories that have been proposed. Second, experimental psychology and neuroimaging studies that shed light on rostral PFC development will be reviewed. Finally, it is proposed that due to the prolonged development of rostral PFC, extending to adolescence, impairments in the functions associated to this region should be observed in a large range of developmental disorders. Autism spectrum disorders (ASD), attention deficit and hyperactivity disorder (ADHD), and schizophrenia, three cognitive and behavioural disorders with different ages of onsets, were studied to test this hypothesis. The results suggest indeed that rostral PFC function might be affected by developmental anatomical abnormalities in a large spectrum of psychological disorders.

2. Anatomy of rostral PFC

Recent anatomical investigations have provided detailed data on the localisation of BA10, its size and connections with other areas, revealing an apparent distinction of sub-regions of rostral PFC.

2.1. Rostral PFC across species

A century ago Brodmann (2) suggested that a homology between the human and monkey frontal cortical regions was very unclear. However, recently Semendeferi et al. (4) demonstrated the presence of a homologous area 10 in the frontal pole of humans and other primates (see also (5)). Area 10 in the right hemisphere of humans was estimated by Semendeferi et al. (4) to contain 254.4 million neurons, whereas the estimate for great apes is less than one third of that number, and is for the gibbon of 8 million neurons only. The reverse relationship held true for the density of neurons: the human area 10 was found to have the lowest density and the gibbon’s the highest. Additionally, neuropil, which consists of the tangle of dendrites, axons and glial processes that remain when cell bodies of neurons and glia are removed from grey matter, was found to represent a higher fraction of grey matter in BA10 in humans than in the others apes. These findings are consistent with the description of the frontal pole of the human brain as being cell-sparse and pale in its overall appearance in comparison to the surrounding areas (5). Jacobs et al. (6) similarly observed that the number of dendritic spines per cell and the spine density are higher in human rostral PFC than in other comparable areas of the cortex, but that the density of cell bodies is markedly low. In terms of volume, area 10 was found to be larger in the human brain than in the other hominoids: even in relative terms it may be up to twice the size in the human brain than in any of the great apes ((4), see (7) for discussion on this result).

2.2 Subdivisions of rostral PFC

The large size of Brodmann area 10 suggests the possible differentiation of sub-regions. Semendeferi et al. (4) found no subdivisions of area 10 in the human brain. Öngür et al. (8), however, suggested that area 10 could be divided into different regions: caudally lie areas 10m and 10r, which form an area with relatively homogeneous granular structure, although axonal tracing experiments have suggested that the caudal and rostral portions have distinct connections (9-11); a large highly differentiated cortical area covers the frontal pole itself, and was named polar area 10 (10p) by the authors, to distinguish it from the monkeys area 10o, which occupies the rostral orbital region and the frontal pole (see (12)). Öngür et al. (8) found a marked difference between human and monkeys, with a striking expansion in the human brain of the granular cortex at the frontal pole, corresponding to area 10p (see Figure 1).

Figure 1.

Figure 1

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Architectonic subdivisions of the human area 10. On the left is shown the orbital surface, on the right the medial surface. Adapted from (8), with kind permission from the authors and the publishers of Journal of Comparative Neurology, © 2003 Wiley-Liss, Inc.

2.3 Connections between rostral PFC and other brain regions

Some subdivisions of rostral PFC are also apparent from connectivity data. Öngür et al. (8) proposed that a “medial” network involves areas on the medial wall including area 10 and projects to visceral control centres in the hypothalamus and periaqueductal grey. These regions receive auditory or polymodal input from the superior temporal sulcal region (13, 14). This network has been suggested to be a “viscero-motor” or “emoto-motor” system that could modulate visceral activity in response to affective stimuli (15). Rostral PFC does not seem to be interconnected with “downstream” areas in the way that other prefrontal areas are. It is the only prefrontal region that is predominantly interconnected with supramodal cortex in the PFC (e.g. (16)), anterior temporal cortex (e.g. (17)) and cingulate cortex (e.g. (18)). In addition, its projections are broadly reciprocal (19) (see (20) for review).

Anatomical studies of rostral PFC thus suggest this area is more extended and differentiated in humans than in other primates. It has a low cell density, which may indicate that rostral PFC in humans has more space available for extrinsic and intrinsic connections (4). Rostral PFC connections are mostly limited to interconnections with the supramodal cortex. Finally, Brodmann area 10 also has a particularly high number of dendritic spines per cell, which indicates that the computational properties of rostral PFC are more likely than those of comparable areas to involve the integration or coordination of inputs (20).

3. Anatomical development of rostral PFC

Anatomical development studies have focused on different age groups and employed a wide range of methods, from post-mortem to neuroimaging studies. Studies of neuroanatomical changes have shown that different brain structures mature at different rates. In particular, recent evidence from studies in humans suggests that frontal brain regions, including rostral PFC, develop more slowly than other regions, maturing into late adolescence and beyond.

3.1. Dendritic systems

Post-mortem studies of the development of the dendritic systems in rostral PFC suggest they mature later than primary sensory and motor regions, and continue maturing until late adolescence. Travis et al. (21) observed that total dendritic length and dendritic spine number of certain pyramidal neurons of neonatal human cortex were greater in BA4 than in BA10. According to the authors, these results show a roughly inverse regional pattern of dendritic complexity in the neonate than in adults, and indicate that the developmental time courses of these dendritic systems are more protracted for supramodal BA10 than for primary and unimodal regions (BA1, BA2, BA3, BA4 and BA18). This suggestion is supported by findings of prolonged decrease of synaptic density (22, 23), and increase of dendritic arborisation of pyramidal neurons (24) in the middle frontal gyrus-the rostral part of which corresponds to BA10- during late childhood and adolescence.

3.2. White matter

Developmental changes in white matter, which reflect differences in myelination and/or the direction or density of fibre tracts, have been investigated in MRI studies of the human brain, but only a few studies provide information regarding prefrontal cortex. Increased white matter volume in adults (mean age 27 years (y.)) compared with children (mean age 10 y.) was reported in the frontal lobes (25). Nagy and colleagues (26) observed a positive correlation of white matter density and age in relatively deep white fibre tracks of the left inferior frontal cortex. Finally, Barnea-Goraly and colleagues (27) observed that a measure of the direction of fibre tracts (fractional anisotropy1) correlated positively with age (range: 6-19 y.) in a number of prefrontal regions, including right lateral BA10 and medial area 10 (see also (29)).

3.3 Grey matter

MRI studies have also provided information on the development of grey matter in rostral PFC, which seems to follow a non-linear time course. Sowell et al. (30) scanned 45 children twice (2 y. apart) between the ages of 5 and 11. They showed that grey matter thickness of the right frontal cortex, including right rostral PFC, decreased significantly in absolute terms over the 2 year period between the scanning sessions, with 77.8% of points on this surface showing a significant loss. Konrad et al. (31) observed a reduction in grey matter during adolescence, with a smaller grey matter volume in adults (20-34 y.) compared to children (8-12 y.) bilaterally in rostral PFC. Giedd et al. (32) found that frontal grey matter volumes peaked at around 11-13 y. and then decreased during adolescence and early adulthood. In line with these findings, Sowell et al. (33) observed a reduction in grey matter density between adolescence (12-16 y.) and adulthood (23-30 y.) in rostral PFC and other regions. O’Donnell et al. (34) studied cortical thickness both in rostral PFC and dorsolateral PFC (DLPFC) in children and adolescents. Cortical thickness was found to decrease with age from 8 to 20 y., but there was no difference in the rate of change between the two frontal regions. A study by Gogtay et al. (35), however, suggests that grey matter maturation over rostral PFC ends earlier than over the DLPFC (Figure 2). In this longitudinal study, MRI scans of children were obtained repeatedly (minimum 3 times) at 2 year intervals, in the range 4 to 21 y.

Figure 2.

Figure 2

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Right lateral view of the dynamic sequence of grey matter maturation over the cortical surface in the age range 9-16 obtained by Gogtay et al. (35). The legend shows a shade representation of 4 categories of grey matter volume units. Rostral PFC appears to undergo earlier maturation than the nearby dorsolateral PFC. Adapted from (35), with kind permission from the authors and the publishers of Proceedings of the National Academy of Science of the USA, © 2004 The National Academy of Sciences of the USA.

Decreases in grey matter volume during adolescence have been attributed to synaptic pruning (e.g. (22)). However, it is important to note that developmental changes in grey matter volume could in addition be a consequence of the increase in cortical myelination (see (35-37)).

3.4 Brain growth

Sowell et al. (30) evaluated another measure of brain development: brain growth, assessed using an adapted “distance from the centre” method2. This measure does not indicate increases in grey or white matter but simply reflects radial expansion of the exterior cortical surface presumably caused by changes in the underlying grey and white matter. The results indicated that rostral PFC is one of the regions with the highest rate of brain growth in this age range (5-11 y.), with rates of growths between 0.5 and 1 mm per year in right lateral and medial rostral PFC.

Rostral PFC has thus been found to continue developing during childhood and adolescence (and beyond), with a reduction in synaptic density, reduction in grey matter density, and particularly fast brain growth. The protracted development of rostral PFC, as well as its anatomical characteristics (see section 2), are two reasons to suppose that rostral PFC may support cognitive processing that is especially important to humans (see (38)).

4. Cognitive functions supported by rostral PFC: studies in adults

The results of neuropsychological and neuroimaging studies of rostral PFC function will be summarised below and followed by a brief discussion of some of the theories of PFC function (for more details, see (39)).

4.1. Evidence from human lesion studies

Despite having profound problems in everyday life, patients with a lesion in rostral PFC often pass a wide range of cognitive tasks in the laboratory. A typical example is the case AP from Shallice & Burgess (40) (called “NM” in (41)). AP sustained a head injury that led to almost complete removal of the rostral PFC. However, on standard neuropsychological measures of intellectual functioning, memory, perception and even traditional tests of executive function, AP performed within the superior range (see (42)). This lack of general cognitive impairment has been replicated in several different patients (40, 42-46).

Some specific impairments, however, have been described: lesions in rostral PFC seem to lead to deficits when patients need to coordinate the performance of a number of tasks (multitasking), or in ill-structured situations. Multitasking typically involves maintaining super- or sub-ordinate goals whilst performing another task (see (44) for more details). Accordingly, one of AP’s most noticeable impairments in everyday life was a marked multitasking problem, which manifested itself as tardiness and disorganisation and which, despite his excellent intellect and social skills, ensured he never managed to return to work at the level he had enjoyed premorbidly (40-42). Shallice & Burgess (40) designed two new tests of multitasking to assess these problems, a real-life multitasking test based around a shopping exercise, the “Multiple Errands Test”, and a multitasking test for use in the laboratory: the “Six Element Test” (44). Despite excellent general cognitive skills, AP and the other cases reported by Shallice and Burgess (40) all performed these tasks below the 5% level compared with age- and IQ-matched controls (see (44) for a review of further cases reported in the literature). Additionally, rostral PFC lesions have also been found to impair disproportionately performance in “ill-structured” situations (e.g. (46, 47)), i.e. when the optimal way of behaving is not precisely signalled by the situation, so one has to impose one’s own structure.

To summarise, patients with rostral PFC lesions may have a generally preserved IQ, episodic memory and normal performance on standard tests of intelligence and executive functions. However, they are often impaired in multitasking, and in “ill-structured” situations (i.e. those where there are many possible ways of behaving, and the most advantageous is not immediately apparent).

4.2. Evidence from neuroimaging

Another approach which has been used to study rostral PFC function is neuroimaging. The studies mentioned here have used either positron emission topography (PET) or functional magnetic resonance imaging (fMRI). fMRI measures blood-oxygen dependent (BOLD) signal change, while positron emission topography usually measures cerebral blood flow differences (rCBF). These techniques have shown that BOLD signal or rCBF changes in rostral PFC occur during a wide range of cognitive tasks (48), from the simplest paradigms (e.g. conditioning paradigms (49)) to highly complex tests involving memory and judgment (e.g. (50-53) or problem-solving (e.g. (3)), but also during rest (e.g. (54)). Indeed, one can find recruitment of the rostral PFC in just about any kind of task (see (39)). However, there does seem to be some evidence for functional specialisation within rostral PFC. A recent meta-analysis of the changes in BOLD signal or rCBF observed in BA10 (55) showed that some paradigms show lateral or medial BA10 BOLD signal or rCBF differences depending on condition manipulations (e.g. working memory, episodic memory), while others tend to lead to the increase of BOLD signal or rCBF in a unique sub-region of rostral PFC.

In particular, two types of task seem to elicit BOLD signal or rCBF changes that occur both in the lateral and medial portions of BA10; further these changes appear to reveal a dissociation of these two regions depending on the conditions that are contrasted. (1) Gilbert et al. (55) defined a “Multitask” category which included studies involving the performance of more than one task within any given block of trials, e.g. tasks where one has to “bear something in mind” whilst doing something else (voluntary task switching after a delay (e.g. (53, 56)), prospective memory (PM; e.g. (51, 57, 58)). There is an increased recruitment of the lateral parts of BA10 in PM or multitasking conditions compared to a control task, while in medial BA10 the BOLD signal or rCBF are higher in the control task. (2) A similar dissociation of medial/lateral recruitment was observed in the different conditions of attention shifting (e.g. (59, 60)).

Some tasks appear to lead to changes in the recruitment of specific sub-regions of BA10, suggesting a functional specialisation of the underlying brain regions. Gilbert and colleagues (see (55) for full references) found that lateral changes in rCBF or BOLD signal were more likely in “working memory” tasks (86% of reported BOLD or rCBF signal changes in these tasks were lateral), defined in the manner of Cabeza & Nyberg (61) and including studies involving the phonological loop (verbal/numerical maintenance), the visuospatial sketchpad (maintenance of object or spatial information), and the central executive (problem solving) (e.g. (3, 62, 63)). The recruitment of lateral rostral PFC was also more likely in “episodic retrieval” tasks (86% of reported BOLD or rCBF signal changes in these tasks were lateral), i.e. those involving the search, access, and monitoring of stored information about personally experienced past events, as well as to the sustained mental set underlying these processes (e.g. (64, 65)). A reverse pattern was observed by Gilbert et al. (55) in “mentalising” tasks, i.e. tasks requiring reflection on one’s mental states and those of other agents, which tended to recruit medial rostral PFC rather than lateral PFC (88% of reported BOLD or rCBF signal changes in these tasks were medial) (e.g. (66-68) (see Figure 3).

Figure 3.

Figure 3

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Partitioning of rostral PFC according to a classification algorithm that predicted the task category from the absolute x coordinate and y coordinate of each peak of BOLD signal or rCBF change. The algorithm predicted Episodic Retrieval, Mentalising, or Multitask on 92% occasions, so only these three categories are presented (leaving out the categories Perception, Attention, Language, Working memory and Other memory). The algorithm used the absolute x coordinate to make predictions, thus left- and right-hemisphere shadings overlays are mirror images of one another. Results are plotted on an axial slice at z=0. Adapted from (55), with kind permission from the authors and the publishers of Journal of Cognitive Neuroscience, © 2006 Massachusetts Institute of Technology.

Gilbert et al. (55) also observed a further subdivision of rostral PFC: conditions requiring mentalising tended to be associated with increases in BOLD signal or rCBF in a medial region with a y coordinate lower (i.e. more posterior) than the mean of all studies, while multitasking tended to involve a rostral PFC region with a y coordinate higher (i.e. more anterior) than the mean of all studies. In other words, mentalising tasks recruit a medial rostral PFC region located posteriorly within area 10, whereas multitasking tests tend to involve a medial rostral PFC region that is relatively polar (i.e. anterior) (see Figure 3).

To summarise, neuroimaging studies have found rostral PFC BOLD signal or rCBF changes in a large variety of tasks. These activities tend to be independent of the precise characteristics of the response mode or stimuli. PM and attention paradigms reveal a dissociation of BOLD signal or rCBF changes in lateral and medial BA10. In other tasks only one sub-region tends to show increased BOLD signal or rCBF: episodic memory and working memory paradigms mostly lead to the recruitment of lateral rostral PFC, while mentalising tasks mostly recruit medial rostral PFC. Additionally, mentalising BOLD signal or rCBF changes have been found to be more caudal, and multitasking changes more rostral (see (69) for more details).

4.3. Theories of rostral PFC function

A number of theories of rostral PFC function have been put forward in recent years on the basis of the neuropsychological and neuroimaging results. These theories will be presented succinctly below. The aim of this section is to provide an overview of the possible functions of rostral PFC that will be used to approach the developmental and clinical data.

As presented in the section above, rostral PFC changes in rCBF or BOLD signal have been observed in a wide range of tasks. The recruitment of rostral PFC observed during episodic memory studies have led to the suggestion that rostral PFC is involved in aspects of memory retrieval (70), including retrieval mode (71-75), success monitoring (or retrieval verification) and source memory, i.e. remembering details of events that were not central to the event at the time, such the temporal order of them, or thoughts and feelings that were provoked by them ((65), see (20, 39) for reviews), or contextual recollection (50, 65, 76, 77). Independently, direct empirical studies of mentalising also suggest this region may be engaged when we attend to our own or others’ mental states ((52), see (78, 79) for reviews).

Other theories have focused on rostral PFC recruitment in multitasking situations, which are consistent with the impairments in multitasking observed in patients with lesions in this area (44). These theories concentrate on the different demands made by multitasking. (1) Burgess et al. (57) have proposed that rostral PFC is crucial for PM, which allows an intended act to be executed after a delay (51, 58, 80-82). (2) Pollman and colleagues proposed that rostral PFC is involved in controlling the reallocation of attention, which can be necessary when the most salient stimulus, or the most salient feature of a stimulus, is not the most relevant for a task, i.e. where intentional selection of perceptual information is required (83-85). (3) Another set of hypotheses of rostral PFC function focuses on the ability to manage more than one behavioural goal. Koechlin and colleagues (53, 86) proposed that the observation of selective bilateral activity in rostral PFC when volunteers were required to keep in mind a main goal (a working memory task) while performing concurrent sub-goals (dual-task performance) suggests this region mediates “cognitive branching”, or the ability to “hold in mind goals while exploring and processing secondary goals”. Braver & Bongiolatti (56) obtained similar data, but proposed that rostral PFC is involved in the integration of the results of the sub-goal processing with the main goal, rather than in the storage of information (see also (20)). (4) Finally, in a review of reasoning and episodic memory functional neuroimaging studies, Christoff and Gabrieli (87) proposed that rostral PFC is specifically involved in “self-referential evaluation”, a process that would be critical when non-routine cognitive strategies have to be generated and selected in the context of novel tasks or activities. This process would be particularly involved in multitasking, where strategies are used to perform goals and sub-goals, and could be related to impairments in ill-structured situations observed in patients with rostral PFC lesions.

Burgess and colleagues recently proposed a further theory of rostral PFC function (see (39, 69, 88, 89) for more details) which attempts to integrate the findings from human lesion studies with those from functional neuroimaging. The authors suggest that the impairments of patients with rostral PFC lesions in multitasking and ill-structured situations and the recruitment of rostral PFC during PM indicate that rostral PFC is involved in coordinating the allocation of attention either towards perceptually-derived information (the current stimuli) or towards stimulus-independent information that has been internally generated (e.g. the characteristics of the PM condition), or the overall goal. To perform PM tasks or to multitask subjects need regularly to switch between these two types of representation. This theory could account for the recruitment of rostral PFC in a wide range of studies, as it is proposed that any type of task that requires either regular reallocation of attention between perceptually-derived information and self-generated information (e.g. between cues and episodic memories) or forceful attending to a particular type of thoughts (e.g. attending to the less salient feature of a stimulus) would lead to the recruitment of rostral PFC.

To summarise this section, while lesion studies show only limited impairments associated with rostral PFC lesions, principally in multitasking and dealing with novel situations, neuroimaging data demonstrate the recruitment of this region in a wide range of tasks. On the basis of these data, a number of theories of rostral PFC function have been proposed, attributing to this region a role in: episodic memory, mentalising, PM, reallocation of attention, cognitive branching, self-referential evaluation or allocation of attention towards perceptually-derived or self-generated information. In the following two sections, psychological and neuroimaging data relating to the development of some of these functions will be presented.

5. Development of cognitive abilities supported by rostral PFC

This section will first present behavioural studies of development in children and adolescents, and then neuroimaging studies which provide some information regarding the recruitment of rostral PFC during development in different cognitive tasks.

5.1 Behavioural studies

The study of the development of executive functions, which is relatively recent (14, 90, 91), has provided evidence that the development of attentional and executive functions is a multistage process: different components have been found to develop at different times, beginning in infancy and continuing at least until adolescence (e.g. (92)). Because of the breadth of evidence obtained in this field, this section will focus on two particular cognitive functions which have been associated with rostral PFC: PM and mentalising. PM is an ability recruited during multitasking, or branching, and has been suggested to be supported by rostral PFC on the basis of neuroimaging and lesion studies (see above). Mentalising has been associated in imaging studies with changes in BOLD signal or rCBF in medial rostral PFC ((52), see (55) for a review).

5.1.2 Prospective memory (PM)

11- to 12-months-old infants are able to carry out an intention on the basis of stored information (93, 94). Performance on PM tasks continues to improve during childhood (95) and adolescence, with significant differences between late childhood and adolescence (96-98) and between adolescence and adulthood (99). Children become increasingly skilled at using external cues (95, 100) and time-checking strategies (97). Ward et al. (101) studied the performance of children (7-10 y.), adolescents (13-16) and young adults (18-21) on PM tasks. Children were worse at PM tasks than were adolescents and adults. However, despite their similar performances, adolescents and adults differed in the strategies they reported using. Adolescents reported keeping the intention in mind and looking out for the PM cues more often than adults, while most adults reported remembering an intention only when they saw the PM cues (see Table 1). This suggests that the use of cognitive resources vary between adolescence and adulthood in PM tasks.

Table 1.

Group frequencies of remembering strategies in a prospective memory task. Table from (101), with kind permission from the authors and the publishers of Child Neuropsychology, © 2005 Taylor & Francis Inc

Group Frequencies (%)
Strategy used Children (age 7-10) Adolescents (age 13-16) Adults (age 18-21)
Don’t know/can’t remember 3.3 0.0 0.0
Remembered only when saw the cues 73.3 37.9 73.3
Thought about all the time/looked out for the cues 23.3 48.9 20.0
Thought about at the start, but with all the other things to think about, switched to remembering only with the cues 0.0 10.3 3.3
Remembered only when saw the cues at the start but, with the reminders, began to think about all the time and looked out for the cues 0.0 3.4 3.3
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5.1.2 Theory of Mind and mentalising

Frith & Frith (52) reviewed behavioural studies of mentalising development, and proposed the existence of two developmental spurts in mentalising. First, children develop an understanding of desires, goals and intentions at around 18 months, which suggest that the understanding of many mental states such as wanting, knowing, pretending or believing is available in implicit form to 2-year-olds. The second developmental spurt is proposed to take place between the ages of 4 and 6 years. Typical tests of mentalising at these ages involve false belief paradigms such as those used by Wimmer & Perner (102), where children’s understanding of two sketches was tested: “in each sketch subjects observed how a protagonist put an object into a location x and then witnessed that in the absence of the protagonist the object was transferred from x to location y. Since this transfer came as a surprise they had to assume that the protagonist still believed that the object was in x. Subjects had to indicate where the protagonist will look for the object at his return.” (p. 103) Children of around 4 years old start to understand this scenario (102). At age 6 years all typically developing children understand the task (e.g. (103)), and also understand tasks involving more complex scenarios (104, 105).

Some studies have investigated the development of PM and mentalising, which have both been associated with rostral PFC. PM, although present in a rudimentary form very early on, continues to develop throughout childhood and adolescence, in particular in relation to the use of strategies (101). There have been very few studies investigating mentalising ability after age 6. However, it is logical to predict that, due to the development of the neural substrates of mentalising during late childhood and adolescence, subtle changes in mentalising ability might occur during this period of life.

5.2 Functional neuroimaging studies

In this section we review neuroimaging studies that provide information on developmental changes in the recruitment of rostral PFC in a range of tasks.

5.2.1. Response inhibition

Studies of inhibition-related BOLD or rCBF changes during development do not always observe variations in rostral PFC recruitment (e.g. (106, 107)), however when they do, they consistently report decreases of BOLD or rCBF signal in adulthood compared to younger ages. Indeed, in go-no go paradigms, Casey et al. (108) observed that the middle frontal gyrus (BA9/10/46) was less strongly recruited and over a smaller region in adults (21-24 y.) than in children (7-12 y.), and Booth et al. (109) observed reduced medial BA10 involvement in adults (20-30 y.) compared to children (9-12 y.). In a paradigm of emotional self-regulation, Levesque and colleagues (110, 111) found that voluntary suppression of emotion when shown sad film excerpts was associated with the recruitment of more prefrontal regions, including bilateral and medial BA10, in a children study (8-10 y.) than in an adult (20-30 y) study. Interestingly Casey et al. (112) focused on a young age group and observed that over this age range (9-11 year olds) BOLD signal was found to increase with age in the middle and inferior fontal gyri.

These results suggest a change in the recruitment of rostral PFC in situations of response inhibition during late childhood and adolescence. An initial increase of BOLD signal in this region (112) followed by a decrease in BOLD signal (108-111) appears consistent with the anatomical findings suggesting that grey matter volumes in the frontal cortex peak during early adolescence (32).

5.2.2. Response competition

Similarly to what has been observed for response inhibition, a study has shown evidence of decrease recruitment of rostral PFC during response competition during development. Konrad et al. (31) observed reduced BOLD signal in left lateral BA10 in adults (20-34 y.) compared to children (8-12 y.) when comparing incongruent targets to congruent targets in an Eriksen flanker task’s type of paradigm (113), where distractors can be congruent or incongruent with the target placed between them. Inferior frontal gyrus showed the reverse pattern. Two other contrasts: “reorienting”, comparing invalidly cued trials to validly cued trials, and “alerting”, comparing double cue trials (no direction) to no cue trials, did not show differences of BA10 BOLD signal between adults and children. However other studies did not find an effect of age on rostral PFC involvement when testing response competition with the Stroop task (114, 115) or in another study that employed the flanker task (116).

5.2.3. Working memory

Studies of working memory tasks do not appear to follow the same pattern of decrease recruitment in adults compared to children and adolescents, although only a few studies have investigated the involvement of PFC during development in these tasks. Kwon et al. (117) tested subjects from 7 to 22 years old in a 2-back spatial working memory task and found that the BOLD signal in bilateral rostral PFC increased with age during the working memory task compared with a control task. More specifically, both the size of these clusters, and the t-value of the contrast, increased with age, while accuracy and reaction times were not significantly different. Other studies did not find age effects on rostral PFC recruitment in tasks with a working memory component. Thomas et al. (118) found that when comparing an n-back task to a motor condition, a similar right lateral BA10/46 region showed increased BOLD signal both in adults (19-26 y.) and children (8-10 y.) (see also (119)). Crone et al. (120) observed a greater recruitment of right DLPFC during the delay period, when the working memory items had to be manipulated rather than only maintained, in adolescents (13-17 y.) and adults (18-25 y.) but not in children (8-12 y.), however no effect was found in rostral PFC.

5.2.4. Intelligent quotient (IQ)

Shaw et al. (121) obtained MRI scans of a large number of children in a longitudinal study and correlated cortical thickness and IQ, on the basis of Wechsler intelligence scales (122). The results showed that the relationship between cortical thickness and IQ changes during the development, and also differs across brain regions (see also (123, 124)). Of particular interest here was a comparison between the “superior” and “average intelligence” groups that showed that from around 10 years old there is a rapid increase in cortical thickness in the superior intelligence group compared to the average intelligence group, which peaks at age 13 and wanes in late adolescence. This effect is observed particularly strongly and over an extended period, over the rostral PFC.

5.2.5. Mentalising

A recent fMRI study investigated the development of communicative intent using an irony comprehension task and found that children (aged between 9 and 14) engaged frontal regions (medial PFC and left inferior frontal gyrus) more than did adults in this task (125). A similar result was revealed in a study in which we investigated the development during adolescence of the neural network underlying thinking about intentions (126). In this study, 19 adolescent participants (aged 12.1 - 18.1 years), and 11 adults (aged 22.4 - 37.8 years), were scanned using fMRI. In both adults and adolescents, answering questions about intentional causality versus physical causality activated the mentalising network, including medial PFC, superior temporal sulcus (STS) and temporal poles. In addition, there was a significant interaction between group and task in the medial PFC. During intentional relative to physical causality, adolescents activated part of the medial PFC more than did adults and adults activated part of the right STS more than did adolescents. These results suggest that the neural strategy for thinking about intentions changes between adolescence and adulthood. Although the same neural network is active, the relative roles of the different areas change, with activity moving from anterior (medial prefrontal) regions to posterior (temporal) regions with age.

To summarise, because of the novelty of the field of neuroimaging of brain development, there is only limited evidence regarding changes in rostral PFC recruitment. However when changes have been observed, they have quite consistently shown reduced recruitment of this region between late childhood-adolescence and adulthood. These results should be considered in relation to the anatomical findings of decrease grey matter volume in rostral PFC during adolescence presented above (31, 33, 34). Indeed, the progressive growth of the nervous system during development results in an overabundance of connections. Several mechanisms have been found to play a role in removing or modifying the exuberant connections to ensure that a functional organization of circuitry is established. These include cell death (127), synapses elimination (128) and the fine tuning of axon terminals and elimination of long axon collaterals, or “axon pruning” (129, 130). Maturation of the neural networks through such mechanisms during late childhood and adolescence could lead to an increase of the efficiency of the cerebral regions involved in particular tasks, and thus lead to a reduction of the observed increases in BOLD signal or rCBF during the performance of these tasks.

6. Role of rostral PFC in adult and childhood psychological disorders

As we have seen, rostral PFC is a region that undergoes protracted development that continues through adolescence in humans. Thus developmental abnormalities occurring at any point from conception through adolescence could affect rostral PFC function. It has been suggested that rostral PFC can be subdivided into regions based on both anatomical and functional differences (see also (69)). It is possible that these regions mature at different rates. Thus, abnormal development of early-developing and late-developing subregions might result in different disorders. In this section, we briefly present three developmental disorders that have different onsets and have been associated with abnormal functioning of BA10.

6.1. Autism spectrum disorders

Autism spectrum disorders (ASD) are characterised by impairments in reciprocal social interaction and communication, together with the presence of stereotyped or repetitive behaviours (DSM-IV (131)). ASDs are usually diagnosed in early childhood, but rarely before age 2, and are expressed throughout life (132). Neuro-anatomical differences between children with ASD and controls have been observed as early as 2-3 years of age (133). One recent finding is that people with autism have a greater total brain volume (e.g. (134)), which appears during the first few years of life and disappears from adolescence onwards (133, 135). One speculative theory is that brain enlargement might be due to a lack of early synaptic pruning (136). Some neuroanatomical and regional cerebral blood flow studies have pointed to abnormalities in rostral PFC, although the direction of the effects are inconsistent (e.g. (137-140)).

A number of cognitive abilities that have been associated with rostral PFC are impaired in ASD. These include multitasking (141, 142), episodic memory (143, 144, 145, 146-148), performance in novel situations (149, 150, 151) and mentalising (e.g. (103, 152, 153, 154, 155, 156, 157)). Hill & Bird (142) found that impairment of individuals with Asperger’s syndrome (a disorder at the high functioning end of the autism spectrum), on a multitasking paradigm correlated with the severity of their symptoms. PM does not appear to have been studied, but Farrant et al. (157) found that children with autism were not particularly impaired in reflecting on memory strategies, including PM ones.

6.2. Attention deficit and hyperactivity disorder

ADHD is a neuropsychiatric disorder with onset at preschool age, characterised by hyperactivity, inattentiveness and impulsivity, which can persist into adulthood ((158), DSM-IV (131)). Structural studies show that children with ADHD have reduced total brain volume compared with control children (159). Reduced volumes of grey and/or white matter in the PFC have been observed, although no study has found a specific abnormality in rostral PFC (see (158, 160, 161) for reviews). In relation to possible rostral PFC dysfunction, individuals with ADHD appear to be impaired in multitasking and PM (162-166). Further, one of these studies found a significant correlation between PM performance and a clinical measure of ADHD (166). Mentalising abilities have not been shown to be impaired in one study found (167), while evidence is mixed regarding episodic memory impairments (148, 168-170).

6.3 Schizophrenia

Schizophrenia is a disorder in which individuals experience positive symptoms such as auditory hallucinations and delusions as well as negative symptoms including loss of motivation, poverty of thought and emotional blunting (DSM-IV (131)). People with schizophrenia often have executive and memory deficits (171). Schizophrenia appears to have a significant developmental component, with abnormalities possibly taking place at different stages of development (172), including before birth (173, 174). Although the onset of psychosis tends to be during early adulthood, many children who go on to develop schizophrenia tend to display early neurological and cognitive problems (e.g. (175-178)). It has recently been suggested that schizophrenia may be associated with synaptic abnormalities that occur during cortex maturation in adolescence (179, 180). Structural imaging studies suggest some abnormalities in rostral medial PFC/orbito-frontal cortex, including a reduction in grey matter (181-183) and increased mean diffusivity (184). Harrison and colleagues (185) have suggested that the decreased cortical volume observed in schizophrenia is due to reduced neuropil and neuronal size, in particular in the prefrontal cortex (see also (186)). Reduced neuropil fraction has been observed in Brodmann area 10 (187), as well as reduced grey-level index (GLI), possibly associated to a reduced neuropil fraction (188).

A number of cognitive abilities associated with rostral PFC function have been observed to be impaired in schizophrenia, and one might speculate that there would be a relation with particular symptoms. For instance, mentalising impairments (see (189, 190) for reviews) may relate to delusions of persecution (e.g. (191-196)). Episodic memory impairment also seems to be associated with current symptoms (e.g. (197), see (198) for a review), and some have argued that source memory impairment could be associated with hallucination symptoms (199-202). PM impairment (203-207) is however mainly present in patients with other executive functions deficits (208). Finally, multitasking impairments have been observed in schizophrenic patients (209, 210), particularly in patients with a high level of negative symptoms ((211), see also (212, 213)).

The overview above suggests that ASDs, many of which are diagnosed in early development, are associated with widespread impairment of cognitive abilities associated with rostral PFC function. Thus it is possible that ASDs are associated with abnormal early development of rostral PFC. ADHD, which has a later onset, appears to be associated with less widespread impairment: for example, mentalising appears to be preserved and episodic memory has less consistently been found to be impaired. This would support the idea that mentalising abilities are well in place, and episodic memory possibly partly so, by the time ADHD-related developmental abnormalities occur. The case of schizophrenia appears to be more complicated, as developmental abnormalities at different stages overlap. Similarly to ASDs, a wide range of cognitive abilities are impaired in schizophrenia, although generally these impairments are associated with specific symptomatology. The different symptoms observed might be the consequences of different childhood and adolescent developmental abnormalities.

8. Conclusion

We have presented the current knowledge of the development of rostral PFC in relation to theories of the cognitive functions supported by this region. Anatomical studies show that rostral PFC is larger and more differentiated in humans than in other primates. This region has a low cell density and numerous connections to the supramodal cortex. Additionally, there is evidence for a sub-division of rostral PFC along a posterior-anterior axis. Anatomical and MRI studies reveal prolonged development of BA10, with rapid brain expansion during late childhood, decreases in grey matter and synaptic density and increases of dendritic arborisation during childhood and adolescence. In adults, lesion studies suggest a role of rostral PFC in multitasking and novel situations. Neuroimaging studies, on the other hand, show widespread involvement of this region in multiple tasks. A meta-analysis of these studies (55) suggests a subdivision of this region along the posterior-anterior axis, between the areas recruited preferentially in mentalising and multitasking paradigms respectively. An additional subdivision along a lateral-medial axis is suggested, which has not been observed anatomically, and which would differentiate between episodic and working memory tasks and mentalising tasks. On the basis of the neuropsychological and neuroimaging data, a number of theories have been proposed, attributing to rostral PFC a role in episodic and prospective memory, mentalising, allocation of attention, cognitive branching and self-referential evaluation.

In this review, we have attempted to link experimental psychology and neuroimaging findings of developmental studies to these proposed functions of rostral PFC. Psychological studies indicate that certain executive function capacities undergo extended development, with the presence early on of a certain level of ability and prolonged improvements in performance in the more complex tasks until late adolescence. This pattern thus follows the prolonged development, in particular reductions of grey matter volumes and densities, observed in rostral PFC during childhood and adolescence. Neuroimaging data of response inhibition, response competition and working memory, although limited, suggest that when a change during development is observed in rostral PFC, it tends to be in the direction of a reduction of the recruitment of this region between late childhood-adolescence and adulthood. Again these results are consistent with the anatomical findings of decrease grey matter volume in rostral PFC. Moreover, the study by Shaw and colleagues (121) suggests that processes of cortical extension and pruning might play an important role in the variations of intellectual abilities between individuals. Studying the development of functions attributed to rostral PFC, and their impairments, could help tease apart different components of this brain region. This would be particularly relevant for rostral PFC, as neuroimaging and anatomical studies already suggest subdivisions of this region.

Footnotes

1

Fractional anisotropy is a measure of the diffusion along fiber tracks (from 0 when diffusion is isotropic, i.e. equal in all directions, to 1 when there is maximum anisotropic diffusion, i.e. diffusion along one axis (see 28)).

2

In this “distance from the centre” method, a measure of radial expansion is calculated in millimetres from the centre of the brain to each point on the lateral surfaces, and from the centre of the hemispheres to each point on the medial surfaces.

Contributor Information

Iroise Dumontheil, Medical Research Council-Cognition and Brain Sciences Unit, Cambridge, UK.

Paul W. Burgess, Institute of Cognitive Neuroscience and Department of Psychology, University College London, UK.

Sarah-Jayne Blakemore, Institute of Cognitive Neuroscience and Department of Psychology, University College London, UK.

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