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Hypersensitivity to reward-relevant stimuli is theorized to be a core etiological factor in bipolar disorders (BDs). However, little is known about the role of cognitive control dysregulation within reward contexts in BDs, particularly during adolescence. Using electroencephalography (EEG), we explored alterations in cognitive control processes and approach motivation in 99 adolescents with (n=53) and without (n=46) BD during reward striving (target anticipation) and reward attainment (feedback) phases of a monetary incentive delay (MID) task. Time-frequency analysis yielded frontal theta and frontal alpha asymmetry as indices of cognitive control and approach motivation, respectively. Multilevel mixed models examined group differences, as well as age, sex, and other effects, on frontal theta and frontal alpha asymmetry during both phases of the task and on performance accuracy and reaction times. Healthy adolescent girls exhibited lower frontal theta than both adolescent girls with BD and adolescent boys with and without BD during reward anticipation and feedback. Across groups, adolescent boys displayed greater relative left frontal alpha activity than adolescent girls during reward anticipation and feedback. Behaviorally, adolescents with BD exhibited faster responses on both positively and negatively motivated trials versus neutral trials, whereas healthy adolescents had faster responses only on positively motivated trials; adolescents with BD were less accurate in responding to neutral trials compared to healthy controls. These findings shed light on normative and BD-specific involvement of approach motivation and cognitive control during different stages of reward processing in adolescence and, further, provide evidence of adolescent sex differences in these processes.

Neurophysiological correlates of cognitive control and approach motivation abnormalities in adolescent bipolar disorders