Investigating sex differences in emotion recognition, learning, and regulation among youths with conduct disorder

Research output: Contribution to journalArticlepeer-review


  • 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
  • Roberta Clanton
  • Aitana Bigorra
  • Iñaki Kerexeta-Lizeaga
  • Eva Sesma-Pardo
  • Fernando Aguirregomoscorta-Menéndez
  • Réka Siklósi
  • Roberta Dochnal
  • Zacharias Kalogerakis
  • Mara Pirlympou
  • Leonidas Papadakos
  • Dimitris Dikeos
  • Amaia Hervas
  • Beate Herpertz-Dahlmann
  • Aranzazu Fernández-Rivas
  • Arne Popma
  • Christina Stadler
  • James R Blair
  • Christine M Freitag
  • Graeme Fairchild
  • Kerstin Konrad

External organisations

  • RWTH Aachen University
  • University Hospital RWTH Aachen
  • Senckenberg Institute of Pathology
  • University of Basel
  • Amsterdam University Medical Centre
  • Centre for Addiction and Mental Health, Toronto, Ontario, M5T1R8, Canada.
  • University of Southampton
  • Birmingham City University
  • University of Birmingham
  • Child and Adolescent Mental Health Unit, University Hospital Mutua Terrassa, Barcelona, Spain.
  • Psychiatric Service, Basurto University Hospital, Bilbao, Spain.
  • University of Szeged
  • National and Kapodistrian University of Athens
  • Boys Town National Research Hospital
  • University of Bath


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.

Bibliographic note

Copyright © 2019. Published by Elsevier Inc.


Original languageEnglish
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Early online date23 Apr 2019
Publication statusE-pub ahead of print - 23 Apr 2019


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

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