Investigating Sex Differences in Emotion Recognition, Learning, and Regulation among Youths with Conduct Disorder

Gregor Kohls, Sarah Baumann, Malou Gundlach, Wolfgang Scharke, Anka Bernhard, Anne Martinelli, Katharina Ackermann, Linda Kersten, Martin Prätzlich, Helena Oldenhof, Lucres Jansen, Lisette van den Boogaard, Areti Smaragdi, Karen Gonzalez-Madruga, Harriet Cornwell, Jack Rogers, Ruth Pauli, Roberta Clanton, Rosalind Baker, Aitana Bigorra GualbaBeate Herpertz-Dahlmann, Aranzazu Fernández-Rivas, Arne Popma, Christina Stadler, Stephane De Brito, James Blair, Christine M. Freitag, Graeme Fairchild, Kerstin Konrad

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Objective: Conduct disorder (CD) is a serious neurodevelopmental disorder marked by notably 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 girls) and 710 TDCs (479 girls), 9 to 18 years of age, 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.

Original languageEnglish
Pages (from-to)263-273
Number of pages12
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number2
Early online date23 Apr 2019
Publication statusPublished - 1 Feb 2020


  • FemNAT-CD
  • callous-unemotional traits
  • conduct disorder
  • emotion processing
  • sex differences

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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