Brain Responses During Face Processing in Conduct Disorder: Considering Sex and Callous-Unemotional Traits

Abstract

Background: Functional magnetic resonance imaging studies of conduct disorder (CD) have mostly been limited to males. Here, we examined whether male and female youths with CD showed similar or distinct alterations in brain responses to emotional faces, using a large sample of male and female youths with CD. We also investigated the influence of callous-unemotional (CU) traits.

Methods: Brain responses to angry, fearful, and neutral faces were assessed in 161 youths with CD (74 female) and 241 typically developing (TD) youths (139 female) ages 9 to 18 years. Categorical analyses tested for diagnosis effects (CD vs. TD and CD with high levels of CU traits [CD/HCU] vs. low levels of CU traits [CD/LCU] vs. TD) and sex × diagnosis interactions.

Results: When processing faces in general (all faces vs. baseline), youths with CD exhibited lower amygdala responses compared with TD youths, which seemed to be driven by the CD/HCU subgroup. Sex × CU subgroup interactions were identified in the amygdala (CD/LCU females < TD females; CD/LCU males > TD males) and anterior insula (CD/HCU females > CD/LCU females; CD/HCU males < CD/LCU males).

Conclusions: The findings for males support an influential neurocognitive model of CD. However, the association between CU traits and brain response to facial expressions differed in females and males with CD, suggesting distinct pathophysiological processes.

Keywords: Callous-unemotional traits; Conduct disorder; Emotion processing; FemNAT-CD; Sex differences; fMRI.