Altered brain substrates and neuroplastic potential in pediatric psychiatric disorders: A neuroimaging perspective

Introduction/Objective. Attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), mood disorders, anxiety disorders, and early-onset psychotic disorders could significantly impact child development by affecting emotional regulation, cognitive function, and social competence. This narrative review integrates neuroimaging evidence from large-scale consortia to delineate altered brain substrates and evaluate neuroplastic effects of interventions in these conditions. Methods. We analyzed findings from structural and functional magnetic resonance imaging, positron emission tomography, and electroencephalography studies published up to March 2025, focusing on key brain regions (prefrontal cortex, amygdala, basal ganglia, cerebellum, hippocampus) and brain networks (default mode network). Results. Structural anomalies, such as reduced subcortical/cortical volumes in ADHD and altered amygdala trajectories in ASD, coexist with functional disruptions, including hypoactivation and dysconnectivity. Pharmacological [stimulants and selective serotonin reuptake inhibitors (SSRIs)] and behavioral interventions induce neuroplastic changes, modulating regional activity and connectivity. Conclusion. These findings reveal shared and disorder-specific neurobiological mechanisms, offering pathways for early diagnosis and targeted treatments. We propose a multidisciplinary framework integrating neuroimaging with genetic, environmental, and clinical data to advance early diagnosis and treatment in precision psychiatry. Understanding brain alterations and their plasticity in childhood can guide strategies to reduce long-term morbidity.