Inflections in adolescent cortical maturation signal psychopathology risk

Cerebral cortical maturation supports emotional, social, and cognitive development during adolescence ¹ . Neurodevelopmental theories of psychiatric illnesses, which peak in onset around age 18 ² , implicate subtle alterations in adolescent cortical development ³ . However, mechanistic links between cortical maturation and emergent psychopathology have remained elusive. This gap likely reflects a need for more nuanced understanding of cortical development ⁴ , larger, longitudinal samples powered to detect small effects, ⁵ and more uniform image quality control ⁶ . Using 29,482 structural MRI scans from 11,720 youth in the Adolescent Brain Cognitive Development (ABCD) study, we demonstrate reproducible differences in the contour and tempo of maturation across the cortical surface. Regional trajectories are robust to image quality variance and align with increasing functional specialization over time. Thicker cortex in early-maturing sensory regions predicts psychiatric symptoms as early as four years prior to their emergence, a pattern that subsequently spreads to association cortex. Overlap with spatially and temporally organized gene co-expression networks implicates prenatal patterning of this sequence of maturation and its links to psychopathology. These findings present a novel, versatile neurodevelopmental framework for cortical maturation during adolescence that sequentially implicates sensory and association cortex in risk for emergent psychiatric symptoms.