(PS11-B45) Examining Clincal Diagnostic Differences Between Adolescent Males and Females Diagnosed with Conduct Disorder on a Psychiatric Inpatient Unit

Objective: Despite a recent shift towards understanding the divergent clinical presentations between males and females diagnosed with Conduct Disorder (CD), there has been a historic dearth of research on females with CD. While males have three times greater odds of developing conduct related behaviors compared to females, females with CD suffer comparable impairments in function, though may have different clinical presentations that warrant further investigation. Indeed, research demonstrates that females with CD endorse a greater number of comorbid internalizing disorders while males are expected to have higher comorbid externalizing/disruptive behaviors. Compared with community-based adolescents, adolescents in inpatient and acute care settings exhibit higher co-morbidity rates, regardless of sex. The current study aimed to explore sex differences among youth with CD in an acute, inpatient setting. Consistent with prior research, we expected females with CD to endorse a greater number of comorbid internalizing disorders while males are expected to have higher comorbid externalizing or disruptive behaviors. 

Method: This IRB-approved chart review study relied on data collected via a structured diagnostic interview that was administered as part of routine care on an adolescent inpatient unit. This resulted in a sample of 177 youth who met diagnostic criteria for CD; of these youth, 58% (N=102) were assigned female at birth.  An independent sample t-test was conducted to explore differential diagnoses and the number of comorbidities within the sample. Chi-square analyses were performed to determine sex differences in comorbid diagnoses for adolescents who met diagnostic criteria for CD. 

Results: Out of all adolescents who completed the diagnostic interview, prevalence of CD amongst adolescents assigned female at birth was 20% compared to 27% in adolescents assigned male at birth. Consistent with our hypothesis, female adolescents were observed to have a significantly greater number of comorbidities (p=0.012) when compared to males, as females demonstrated a mean of 4.6 diagnoses, while males demonstrate a mean of 3.6 diagnoses. Female adolescents who met diagnostic criteria for CD were more likely (p< 0.05) to be diagnosed with Major Depressive Disorder, manic episode(s), General Anxiety Disorder, Social Anxiety Disorder, and Post-Traumatic Stress Disorder. No significant differences were found between males and females when comparing Attention-Deficit/Hyperactivity Disorder (hyperactive, inattentive, and combined subtypes), Oppositional Defiant Disorder, or Obsessive-Compulsive Disorder.

Discussion: The present study adds to the current literature on sex differences in the clinical presentation of females and males with CD. Implications for treatment of females with CD will be discussed in light of heightened impairment in individuals with CD, particularly with elevated rates of co-morbidity.