Diminished error-related negativity and error positivity in children and adults with externalizing problems and disorders: A meta-analysis on error processing

Miranda Lutz, Rianne Kok, Ilse Verveer, Marcelo Malbec De Vidts, Susanne Koot, Pol van Lier, Ingmar Franken*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

21 Citations (Scopus)
20 Downloads (Pure)


BACKGROUND: Deficits in error processing are reflected in an inability of people with externalizing problems to adjust their problem behaviour. The present study contains 2 meta-analyses, testing whether error processing - indexed by the event-related potentials error-related negativity (ERN) and error positivity (Pe) - is reduced in children and adults with externalizing problems and disorders compared to healthy controls.

METHODS: We conducted a systematic search in PubMed (1980 to December 2018), PsycInfo (1980 to December 2018) and Scopus (1970 to December 2018), identifying 328 studies. We included studies that measured error processing using the Eriksen flanker task, the go/no-go task or the stop-signal task in healthy controls and in adults or children with clearly described externalizing behavioural problems (e.g., aggression) or a clinical diagnosis on the externalizing spectrum (e.g., addiction).

RESULTS: Random-effect models (ERN: 23 studies, 1739 participants; Pe: 27 studies, 1456 participants) revealed a reduced ERN amplitude (Hedges' g = 0.44, 95% confidence interval [CI] 0.29 to 0.58) and a reduced Pe amplitude (Hedges' g = -0.27, 95% CI -0.44 to -0.09) during error processing in people with externalizing problems or disorders compared to healthy controls. Type of diagnosis, age and the presence of performance feedback or comorbidity did not moderate the results. The employed cognitive task was a moderator for Pe but not for ERN. The go/no-go task generated a greater amplitude difference in Pe than the Eriksen flanker task. Small-sample assessment revealed evidence of publication bias for both event-related potentials. However, a p curve analysis for ERN showed that evidential value was present; for Pe, the p curve analysis was inconclusive.

LIMITATIONS: The moderators did not explain the potential heterogeneity in most of the analysis, suggesting that other disorder- and patient-related factors affect error processing.

CONCLUSION: Our findings indicate the presence of compromised error processing in externalizing psychopathology, suggesting diminished activation of the prefrontal cortex during performance monitoring.

Original languageEnglish
Article number10.1503/jpn.200031
Pages (from-to)E615-E627
JournalJournal of Psychiatry & Neuroscience
Issue number6
Publication statusPublished - 9 Nov 2021

Bibliographical note

Funding Information:
This work was supported by the Erasmus Initiatives for Vital Cities and Citizens, Erasmus University Rotterdam, the Netherlands.

Publisher Copyright:
© 2021 CMA Joule Inc. or its licensors.

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