“There were brain-imaging studies that suggested there was overactivity in the anterior cingulate gyrus in patients who had obsessive compulsive disorder (OCD). There was a SPECT study in 1991 reporting that Prozac decreased activity in the anterior cingulate gyrus in OCD patients. I saw hyperactivity in the anterior cingulate gyrus in many patients who did not have OCD. But I noticed a common thread with OCD. Patients had trouble shifting attention. Researcher Alan Mirsky wrote a book chapter highlighting the anterior cingulate area of the brain as being involved with shifting attention. In Robbin, Kaitlyn, and many of my patients who had too much activity in the anterior cingulate gyrus I saw this problem of shifting attention: there was a certain cognitive inflexibility that was evident in many of their symptoms. Could it be possible that oppositional children had a similar underlying brain mechanism found in OCD? I was intrigued. Over time the finding proved to be true. When there is increased activity in the anterior cingulate gyrus a certain cognitive inflexibility is present. This can present as many different symptoms, but the underlying mechanism, trouble shifting attention, remains. The symptom list at the beginning of the chapter is a compilation of what we have seen in these patients. The anterior cingulate area of the brain is heavily innervated with serotonin neurons. We have also found that serotonergic medications seem to be the most helpful in this disorder. The Anterior Cingulate Gyrus”