Sex Differences in Psychopathology in a Large Cohort of Nine and Ten-Year-Olds

Abstract

The current study quantified sex differences in psychopathology among 9 and 10-year-olds, examined sex differences among those with clinically elevated symptoms and investigated if puberty moderates the relationship between sex and psychopathology. Data were obtained from the Adolescent Brain and Cognitive Development (ABCD)® Study’s NDA data release 2.0. Results suggest that males have higher scores and greater frequency of clinically meaningful levels of psychopathology across several domains. Puberty did not interact with sex to affect psychopathology. However, as puberty advanced, the percentage of males and females with elevated scores increased.

1. Introduction

There is empirical evidence for sex differences in childhood mental health symptoms, with boys showing more aggression and noncompliance, and girls having more anxiety and depression (Chaplin & Aldao, 2013). Other studies suggest that sex differences in depression do not emerge until later adolescence (Wade et al., 2002). Early puberty is related to psychopathology across adolescence in both sexes (see Ullsperger & Nikolas, 2017 for review). Understanding sex differences and the role of puberty in children may clarify periods of risk and inform the developmental course of mental health disorders. The current study examines a large, diverse, sample of 9–10-year-olds to identify sex differences (1) in psychopathology, (2) among those with clinically elevated symptoms and (3) in pubertal effects on psychopathology.

2. Methods

Data were obtained from the Adolescent Brain and Cognitive Development (ABCD) ® Study’s NDA data release 2.0, which included data from 11,875 9–10-year-olds recruited from 22 sites across the United States. Exclusion criteria were minimal (Garavan et al., 2018). Participants provided informed consent/assent and study protocols were IRB approved.

11,384 participants (Med_age=119 months; 47.9% female) had complete Child Behavior Checklists (CBCL; Achenbach, 2009). These parent-reported scales yield dimensional scores and clinical cut-offs (T-Score > 60) for eight syndromes (anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior and aggressive behavior).

Random estimation mixed model analyses were conducted in SPSS to examine sex differences for each CBCL syndrome. Family was nested within site as a random factor to account for sibling relationships. Parent-reported sex was the predictor; and race/ethnicity, highest household education (HHE), pubertal development score (PDS; Petersen et al., 1988) and age were covariates. Raw CBCL scores were log transformed to correct for skewness. To account for multiple testing, an a priori alpha of p < .005 was used in all analyses.

To determine if sex differences were clinically meaningful, logistic regressions were conducted using sex to predict the likelihood of having a T-score>60 for each syndrome. Covariates were the same as above except age is adjusted for in T-scores and therefore was not included. To account for family relationships, we randomly included one participant for sibling pairs (N = 9595 after sibling exclusion).

Pubertal effects were examined using linear mixed models with puberty, sex and the interaction term as predictors and raw syndrome scores as DVs. All remaining covariates were included. Chi-square analyses were run separately by sex to assess the frequency of having any clinically elevated subscale score.

3. Results

There was a main effect of sex, with males having higher scores than females on all syndromes except anxious/depressed and somatic complaints (Table 1). Males were more likely than females to have clinically elevated scores on withdrawn/depressed, attention problems, aggressive behavior and social problems scales (Table 1). Mixed models revealed no interaction of sex and puberty on any syndrome. There was a main effect of puberty on all syndromes except anxious/depressed. The frequency of having a clinically elevated score was greater for participants of both sexes as puberty advanced (Table 1).

Table 1.

Sex differences and effects of puberty on CBCL Syndromes in 9-10 year-olds.

AIM 1a		Estimates	p-value	SE	95% CI (L, U)
DV: Syndrome raw score
Anxious/Depressed	Sex	.007	.315	.007	−.007, .022
Withdrawn/Depressed	Sex	.044	<.001	.006	.032, .055
Somatic Complaints	Sex	−.009	.149	.006	−.022, .003
Social Problems	Sex	.046	<.001	.007	.033, .059
Thought Problems	Sex	.075	<.001	.006	.062, .087
Attention Problems	Sex	.148	<.001	.008	.132, .164
Rule-Breaking	Sex	.010	<.001	.006	.088, .111
Aggressive Behavior	Sex	.104	<.001	.008	.088, .121
AIM 2b		Estimates (SE)	p-value	Exp	95% CI Exp (L, U)
DV: Above Clinical Threshold
Anxious/Depressed	Sex	.020 (.089)	.827	1.020	.856, 1.214
Withdrawn/Depressed	Sex	1.000 (.102)	<.001	2.719	2.227, 3.320
Somatic Complaints	Sex	−.010 (.085)	.906	.990	.837, 1.170
Social Problems	Sex	.966 (.135)	<.001	2.627	2.017, 3.422
Thought Problems	Sex	.189 (.089)	.034	1.208	1.014, 1.439
Attention Problems	Sex	.483 (.094)	<.001	1.621	1.349,1.948
Rule-Breaking	Sex	.211 (.122)	.084	1.235	.972, 1.569
Aggressive Behavior	Sex	.629 (.110)	<.001	1.876	1.512, 2.327
AIM 3c, d		Estimates	p-value	SE	95% CI (L, U)
DV: Syndrome Score
Anxious/Depressed	Sex	.009	.590	.017	−.024, .042
	PDS	.015	.008	.006	.004, .026
	Sex X PDS	−.001	.917	.009	−.019, .017
Withdrawn/Depressed	Sex	.050	<.001	.013	.025, .076
	PDS	.020	<.001	.004	.011, .028
	Sex X PDS	−.004	.567	.007	−.018, .010
Somatic Complaints	Sex	−.001	.934	.014	−.029, .027
	PDS	.020	<.001	.005	.010, .029
	Sex X PDS	−.005	.534	.008	−.020, .011
Social Problems	Sex	.028	.063	.015	−.001, .057
	PDS	.020	<.001	.005	.010, .030
	Sex X PDS	.011	.175	.008	−.005, .027
Thought Problems	Sex	.049	.001	.015	.020, .077
	PDS	.008	.099	.005	−.001, .017
	Sex X PDS	.016	.048	.008	.000, .032
Attention Problems	Sex	.133	<.001	.018	.098, .169
	PDS	.017	.004	.006	.006, .029
	Sex X PDS	.009	.367	.010	−.011, .029
Rule-Breaking	Sex	.067	<.001	.013	.040, .093
	PDS	.022	<.001	.004	.013, .030
	Sex X PDS	.020	.005	.007	.006, .035
Aggressive Behavior	Sex	.083	<.001	.019	.046, .121
	PDS	.023	<.001	.006	.011, .035
	Sex X PDS	.013	.218	.010	−.008, .033
1 or More Syndromes Above Clinical Threshold X Pubertal Status
	MALES			FEMALES
Pre-Puberty	1,027 (24.71 %)	X2 (2) = 12.71, p = .002		315 (18.81%)	X2 (2) = 11.85, p = .003
Early Puberty	365 (25.54%)			277 (21.61%)
Mid to Late Puberty	117 (33.33%)			582 (23.27%)

^aMixed model analyses of sex differences on each syndrome raw score.

^bLogistic regressions of sex differences in the likelihood of being above the clinical threshold (T-score>60) for each syndrome.

^cMixed models of pubertal status (PDS) X sex on each syndrome raw score.

^dChi-square of the frequency (n (%)) of one or more clinically elevated syndromes (T-score>60) at each level of puberty.

Sex estimates are for males.

4. Discussion

Our results show that males, age 9-10 have greater parent-reported psychopathology than females. Specifically, males have higher scores and greater likelihood of clinically elevated scores on withdrawn/depressed, attention problems, aggressive behavior and social problems. Females do not have higher scores or more frequent clinical elevation on any syndrome, including anxious/depressed. This is inconsistent with the suggestion that girls have greater anxiety in childhood (Chaplin & Aldao, 2013). While females were more advanced in puberty (70% of males were prepubescent versus 31% of females), puberty did not interact with sex in any model. However, as puberty advanced, both sexes were more likely to have a clinically elevated syndrome score. Consistent with previous research, this suggests that among 9–10-year-olds, early puberty is associated with psychopathology in both sexes (e.g. Ullsperger & Nikolas, 2017). It will be important to continue to characterize pubertal timing and psychopathology trajectories in both sexes within this large, demographically diverse sample.

Data used in the preparation of this article were obtained from the Adolescent Brain Cognitive Development ^SM Study (ABCD Study^®) (https://abcdstudy.org), held in the NIMH Data Archive (NDA). The ABCD Study is supported by the National Institutes of Health and additional federal partners

A full list of supporters is available at https://abcdstudy.org/federal-partners/. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/principal-investigators.html. This manuscript reflects the views of the authors and may not reflect the opinions or views of the NIH or ABCD Study consortium investigators.

Highlights.

• 9 to 10-year-old males had greater overall psychopathology across multiple syndromes.

• Males had a greater likelihood of clinically elevated scores.

• Puberty did not interact with sex to affect psychopathology.

• As puberty advanced, percentage of males and females with elevated scores increased.