Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder – Gregor Kohls, PhD

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Watch this video abstract from Gregor Kohls, PhD, on his JCPP paper ‘Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder.’

Authors: Konrad K, Kohls G, Baumann S, Bernhard A, Martinelli A, Ackermann K, Smaragdi A, Gonzalez-Madruga K, Wells A, Rogers JC, Pauli R, Clanton R, Baker R, Kersten L, Prätzlich M, Oldenhof H, Jansen L, Kleeven A, Bigorra A, Hervas A, Kerexeta-Lizeaga I, Sesma-Pardo E, Angel Gonzalez-Torres M, Siklósi R, Dochnal R, Kalogerakis Z, Pirlympou M, Papadakos L, Cornwell H, Scharke W, Dikeos D, Fernández-Rivas A, Popma A, Stadler C, Herpertz-Dahlmann B, De Brito SA, Fairchild G, Freitag CM.J Child Psychol Psychiatry.

First published 19 May 2021.

doi: 10.1111/jcpp.13428


Gregor Kohls, PhD
Gregor Kohls, PhD

Currently works in the Department of Child and Adolescent Psychiatry, TU Dresden, Germany. Gregor does research in Cognitive Neuroscience, Clinical Developmental Psychology, Neuropsychology, and Biological Psychology.


[00:00:13.920] Gregor Kohls: Hi, my name is Gregor Kohls, and I’m a Private Lecturer at the University Hospital Aachen in Germany.  With other European colleagues, we recently published a study in the Journal of Child Psychology and Psychiatry, which is entitled “Sex Differences in Psychiatric Comorbidity and Clinical Presentation in Youth with Conduct Disorder.”  In this short video abstract, I’m going to tell you more about the aim of our study, the methods we used, the results and our thoughts on what the findings mean.

Conduct disorder, or in short, CD, is a term used to refer to children and adolescents who show a pattern of long-lasting symptoms that fall into four different categories: aggressive behaviours, destructive behaviours, deceitful behaviours, and violation of rules.

On average, CD affects boys three times more often than it affects girls.  So, it is hardly surprising that clinical research has so far, mainly focused on CD in boys.  Consequently, we still don’t know much about how CD looks in girls.  Is it different to CD in boys and if so, how?  This is an important question not only for research here, but also for those who work with these individuals.  For instance, it is unclear whether diagnostic protocols or prevention or interventions should be sex-specific, or whether non-specific ones would suffice.

We, therefore, addressed the lack of knowledge about girls with CD in the largest study of its kind to date, as part of the European multicentre study called FemNAT-CD.  Here, we focused on the clinical presentation of CD in girls compared to boys.  We specifically looked at the quality and severity of CD symptoms and associated traits and behaviours, the age of onset of the disorder and the co-occurrence of other psychiatric disorders.  To do so, we used semi-structural clinical interviews and rating scales to assess comprehensively about 750 girls and boys with CD, ages nine to 18-years-old, in comparison to a group of sex and age matched typically developing controls.

So, what are our three key findings?  First, compared to boys with CD, girls with CD had an overall higher rate of lifetime psychiatric comorbidities, and this higher rate was, in turn, associated with more CD symptoms.  Second, girls with CD showed higher rates of current depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, but had lower rates of current attention deficit hyperactivity disorder relative to boys with CD.  And third, girls with CD were more likely to have the adolescent onset form of CD, had fewer symptoms of physical aggression and destruction of property, but they showed more serious rule violations than boys with CD.

To conclude, our data provide compelling evidence for six specific clinical presentations of CD.  These findings are important when considering treatment approaches and long-term outcomes in youth with this disorder.  For example, sex-related differences in the clinical phenotype might suggest that there are sex differences in treatment responsiveness and that both prevention and treatment delivery may need to be tailored to the sex of the patient.

So, thank you for watching.  Please read the article if you would like to know more about our work, and please get in touch with us in case you have any questions or any thoughts.

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