Investigating Sex Differences in Emotion Recognition, Learning, and Regulation Among Youths With Conduct Disorder

Abstract Objective Conduct disorder (CD) is a serious neurodevelopmental disorder marked by notable higher prevalence rates for boys than girls. Converging evidence suggests that CD is associated with impairments in emotion recognition, learning and regulation. However, it is not known whether there are sex differences in the relationship between CD and emotion dysfunction. Prior studies on emotion functioning in CD have so far been underpowered for investigating sex differences. Therefore, our primary aim was to characterize emotion processing skills in a large sample of girls and boys with CD compared to typically-developing controls (TDCs) using a comprehensive neuropsychological test battery. Method We included 542 youths with CD (317 female youths) and 710 TDCs (479 female youths), aged 9-18 years, from a European multisite study (FemNAT-CD). Participants completed three experimental tasks assessing emotion recognition, learning, and regulation, respectively. Data were analyzed to test for effects of group and sex, and group-by-sex interactions, while controlling for potentially confounding factors. Results Relative to TDCs, youths with CD showed impaired emotion recognition (that was related to more physical and proactive aggression, and higher CU traits), emotional learning (specifically from punishment), and emotion regulation. Boys and girls with CD, however, displayed similar impairments in emotion processing. Conclusion This study provides compelling evidence for a relationship between CD and deficient neurocognitive functioning across three emotional domains that have previously been linked to CD etiology. However, there was no support for sex-specific profiles of emotion dysfunction, suggesting that current neurocognitive models of CD apply equally to both sexes.