Abstract
ObjectiveAttenuated activity of stress-regulating systems has consistently been reported in boys with conduct problems. Results in studies of girls are inconsistent, which may result from the high prevalence of comorbid post-trauma symptoms. Therefore, the aim of the present study is to investigate post-trauma symptoms as a potential mediator in the relation between stress-regulation systems functioning and conduct problems in female adolescents.MethodsThe sample consisted of 78 female adolescents (mean age 15.4; SD 1.1) admitted to a closed treatment institution. The diagnosis of disruptive behaviour disorder (DBD) was assessed by a structured interview—the diagnostic interview schedule for children version IV (DISC-IV). To assess post-trauma symptoms and externalizing behaviour problems, self-report questionnaires, youth self report (YSR) and the trauma symptom checklist for Children (TSCC) were used. The cortisol awakenings response (CAR) measured hypothalamic–pituitary–adrenal (HPA) axis activity, whereas autonomous nervous system (ANS) activity was assessed by heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA). Independent t-tests were used to compare girls with and without DBD, while path analyses tested for the mediating role of post- trauma symptoms in the relation between stress regulating systems and externalizing behaviour.ResultsFemales with DBD (n = 37) reported significantly higher rates of post-trauma symptoms and externalizing behaviour problems than girls without DBD (n = 39). Path analysis found no relation between CAR and externalizing behaviour problems. With regard to ANS activity, positive direct effects on externalizing behaviour problems were present for HR (standardized β = 0.306, p = 0.020) and PEP (standardized β = −0.323, p = 0.031), though not for RSA. Furthermore, no relation—whether direct or indirect—could be determined from post-trauma symptoms.ConclusionsPresent findings demonstrate that the neurobiological characteristics of female externalizing behaviour differ from males, since girls showed heightened instead of attenuated ANS activity. While the prevalence of post-trauma symptoms was high in girls with DBD, it did not mediate the relation between stress parameters and externalizing behaviour. Clinical implications and future directions are discussed.
Highlights
The long-term prognosis of girls with severe conduct problems treated in mandatory closed treatmentBabel et al Child Adolesc Psychiatry Ment Health (2016) 10:42 etiopathology of female disruptive behaviour disorder (DBD) may foster specific interventions for females.Disruptive behaviour disorder has been linked to attenuated activation of the main stress regulation systems: the Hypothalamic–pituitary–adrenal axis (HPA-axis) and the autonomic nervous system (ANS) [4]
Descriptive information for all variables distributed for disruptive behaviour disorder Subsequently, and as presented in Table 1, the sample was divided into two groups—one comprising those with a DBD diagnosis (DBD+) and those without DBD (DBD−)
No significance was noted between the DBD+ and the DBD− groups for the AUCi and AUCg, as correlates of the HPA-axis functioning, nor was there a difference for heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) as correlates of the ANS functioning
Summary
Disruptive behaviour disorder has been linked to attenuated activation of the main stress regulation systems: the Hypothalamic–pituitary–adrenal axis (HPA-axis) and the autonomic nervous system (ANS) [4]. The link between DBD and these systems is explained by the low arousal theory According to this theory, individuals expressing conduct problems are characterized by low arousal levels, due to the lack of a physiological stress response, which may lead to individuals not fearing the negative consequences of their behaviour [5]. Several studies in males demonstrate reduced levels of HPA-axis and ANS activity in samples with DBD or externalizing behaviour [4]. [8,9,10]) These studies provide support that low arousal, reflecting fearlessness or sensation seeking, may be a neurobiological correlate in adolescent males with externalizing behaviour
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