Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder

Abstract

Background: Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the 'gender paradox' and 'delayed-onset pathway' hypotheses of female CD. Methods: As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9-18 years), compared to 864 sex-and age-matched typically developing controls. Results: Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/ hyperactivity disorder. In line with the 'gender paradox' hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the 'delayed-onset pathway' hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology. Conclusions: Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the 'gender paradox' and 'delayed-onset pathway' hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.

Neuroendocrine Stress Response in Female and Male Youths With Conduct Disorder and Associations With Early Adversity

“…While this may be in line with recent findings showing girls with CD to be more clinically impaired than boys, 22 results need to be replicated. As earlier work did not investigate female and male youths with CD in response to a standardized stress task, our findings are the first to indicate blunted HPA-axis activity as a distinct characteristic of CD independent of sex.…”

“…As in earlier FemNAT-CD publications, [21][22][23] current and lifetime psychiatric disorders were assessed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL), IQ using the Wechsler Intelligence Scales, and pubertal status using the Pubertal Development Scale. This is a five-level categorical (pre-/early-/mid-/late-/post-pubertal) self-report measure on pubertal growth (e.g., changes in body hair, voice, or breast development; menarche) ranging from pre-pubertal (no changes) to post-pubertal status (all changes completed).…”

The roles of sex and gender in child and adolescent mental health

“…While authors have argued for further longitudinal research to identify biological and environmental risks associated with sex differences in symptoms and pathways in CD, they also recognised that findings may underline diverse socialisation experiences in males and females across different contexts. For example,Konrad et al (2021) raised the possibility that a later and more severe CD symptom profile in females may increase distress in school, leading to the greater likelihood of girls developing comorbid internalising difficulties.…”

Externalizing psychopathology from childhood to early adolescence: Psychometric evaluation using latent variable and network modeling.

“…Stability refers to whether the network structure remains the same while removing participants from the analyses (Epskamp et al, 2018). Given differences in risk and expression of externalizing psychopathology between male and female samples (King et al, 2018; Konrad et al, 2022; Lynch et al, 2021), we also examined whether there were sex differences across both latent variable and network approaches.…”