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

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.

Psychophysiological responses to sadness in girls and boys with conduct disorder.

Reduced responsiveness to emotions is hypothesized to contribute to the development of conduct disorder (CD) in children and adolescents. Accordingly, blunted psychophysiological responses to emotions have been observed in boys with CD, but this has never been tested in girls. Therefore, this study compared psychophysiological responses to sadness in girls and boys with and without CD, and different clinical phenotypes of CD: with versus without limited prosocial emotions (LPE), and with versus without comorbid internalizing disorders (INT). Nine-hundred and 27 girls (427 CD, 500 controls) and 519 boys (266 CD, 253 controls) aged 9-18 years participated. Psychophysiological responses were measured while participants watched two validated sad film clips, specifically: heart rate (HR), respiratory sinus arrhythmia (RSA; indexing parasympathetic activity), preejection period (PEP; indexing sympathetic activity). Girls and boys with CD showed larger HR responses to sadness than controls. This effect was rendered nonsignificant, however, after controlling for covariates. We observed aberrant RSA responses to sadness in CD compared with controls. Similarly, we found a significant positive association between RSA responsivity and antisocial behavior when assessed dimensionally. The effects were very small, though. Results were similar for boys and girls. We found no evidence for emotional underresponsiveness in CD in the largest psychophysiological study to date in this field. More research is needed to explore whether this is specific to sadness or generalizes to other emotions. Furthermore, we recommend that studies on emotion processing in CD assess different physiological measures to help disentangle CD-related effects on sympathetic and parasympathetic activity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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

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.

Community Violence Exposure and Conduct Problems in Children and Adolescents with Conduct Disorder and Healthy Controls.

Exposure to community violence through witnessing or being directly victimized has been associated with conduct problems in a range of studies. However, the relationship between community violence exposure (CVE) and conduct problems has never been studied separately in healthy individuals and individuals with conduct disorder (CD). Therefore, it is not clear whether the association between CVE and conduct problems is due to confounding factors, because those with high conduct problems also tend to live in more violent neighborhoods, i.e., an ecological fallacy. Hence, the aim of the present study was: (1) to investigate whether the association between recent CVE and current conduct problems holds true for healthy controls as well as adolescents with a diagnosis of CD; (2) to examine whether the association is stable in both groups when including effects of aggression subtypes (proactive/reactive aggression), age, gender, site and socioeconomic status (SES); and (3) to test whether proactive or reactive aggression mediate the link between CVE and conduct problems. Data from 1178 children and adolescents (62% female; 44% CD) aged between 9 years and 18 years from seven European countries were analyzed. Conduct problems were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia diagnostic interview. Information about CVE and aggression subtypes was obtained using self-report questionnaires (Social and Health Assessment and Reactive-Proactive aggression Questionnaire (RPQ), respectively). The association between witnessing community violence and conduct problems was significant in both groups (adolescents with CD and healthy controls). The association was also stable after examining the mediating effects of aggression subtypes while including moderating effects of age, gender and SES and controlling for effects of site in both groups. There were no clear differences between the groups in the strength of the association between witnessing violence and conduct problems. However, we found evidence for a ceiling effect, i.e., individuals with very high levels of conduct problems could not show a further increase if exposed to CVE and vice versa. Results indicate that there was no evidence for an ecological fallacy being the primary cause of the association, i.e., CVE must be considered a valid risk factor in the etiology of CD.

De la incomunicación sensorial a la bienvenida al mundo: tratamiento con terapia de juego en un niño con sordera / From sensory isolation to welcome the world: play therapy treatment in a child with deafness

El juego es la vía natural de comunicación de los niños. A través del juego, el niño expresa ansiedades y resuelve conflictos. La terapia del juego se utiliza como herramienta para promover la expresión y la gestión de los conflictos internos y para entender las emociones de los niños. Caso Clínico: presentamos el caso de un niño de 10 años de edad, con diagnóstico de sordera y de síndrome de CHARGE (acrónimo en inglés de los signos de la enfermedad: C: coloboma ocular, H: cardiopatía, A: atresia de las coanas, R: retraso del crecimiento y/o desarrollo, G: hipoplasia genital, E: anomalías del pabellón auricular y/o sordera). Tiene dificultades de expresión y es complejo establecer una comunicación efectiva con él. Llevamos a cabo una intervención basada en la terapia de juego no directiva, centrada en el apoyo al desarrollo del ego y el reconocimiento emocional. Conclusiones: la terapia de juego puede servir de puente entre el conocimiento consciente y las experiencias emocionales. El trabajo con terapia de juego, ayudó a este niño a comprender y comunicar sus emociones. Creemos que es una buena técnica para ayudar a los niños con discapacidad auditiva a experimentar e identificar emociones

Play is the natural way of communication of children. Through play, the child expresses his anxieties and resolves his conflicts. Play therapy is used to promote the expression and management of internal conflicts and to understand children's emotions. Case report: We present the case of an 10-year-old boy diagnosed with CHARGE syndrome. He is deaf. His ability to communicate is markedly impaired and it is difficult to establish an effective communication channel with him. Our intervention focused on supporting development of ego and emotional recognition. To achieve this goal we started a non-directive play therapy. Conclusion: Play therapy bridges the gap between concrete experiences and abstract thought and emotional experiences. Working with play therapy has helped this child understand and communicate his emotions more effectively. We believe this constitutes an effective technique that helps deaf children experiment and identify emotions

Depresión perimenopáusica: una revisión / Perimenopausal depression: a review

A partir de la adolescencia, las mujeres presentan un riesgo 1’5 a 3 veces mayor que los hombres de padecer un trastorno depresivo. Este riesgo aumenta en el periodo de transición hacia la menopausia o perimenopausia, cuando la vulnerabilidad depresiva se hace especialmente intensa. Se han postulado mecanismos hormonales, psicológicos y socioculturales para entender la etiopatogenia de estos cuadros. El tratamiento de la depresión en la perimenopausia viene determinado por la gravedad clínica e incluye antidepresivos, psicoterapia y, en ocasiones, terapia hormonal sustitutiva mediante estrógenos. La depresión perimenopáusica constituye un problema infradiagnosticado e infratratado, que genera un alto nivel de sufrimiento y que merece una mayor atención por parte de los clínicos y el sistema sanitario (AU)

From adolescence, women have a 1.5 to 3 times higher risk than men of suffering from a depressive disorder. This risk increases in the transition period to menopause or perimenopause, when the depressive vulnerability becomes especially intense. Hormonal, psychological and sociocultural factors have been suggested to understand the etiopathogeny of these disorders. Treatment of depression in perimenopause is determined by clinical severity and includes antidepressants, psychotherapy, and sometimes, hormone replacement therapy with estrogens. Perimenopausal depression is an underdiagnosed and poorly treated problem, which generates a high level of suffering and deserves greater attention by clinicians and health systems (AU)