Irritability and parenting practices as mediational variables between temperament and affective, anxiety, and oppositional defiant problems

An Expanded Conceptual Framework for Understanding Irritability in Childhood: The Role of Cognitive Control Processes

Children prone to irritability experience significant functional impairments and internalising and externalising problems. Contemporary models have sought to elucidate the underlying mechanisms in irritability, such as aberrant threat and reward biases to improve interventions. However, the cognitive control processes that underlie threat (e.g., attention towards threats) and reward (e.g., attention towards reward-related cues) biases and the factors which influence the differential activation of positive and negative valence systems and thus leading to maladaptive activation of cognitive control processes (i.e., proactive and reactive control) are unclear. Thus, we aim to integrate extant theoretical and empirical research to elucidate the cognitive control processes underlying threat and reward processing that contribute to irritability in middle childhood and provide a guiding framework for future research and treatment. We propose an expanded conceptual framework of irritability that includes broad intraindividual and environmental vulnerability factors and propose proximal 'setting' factors that activate the negative valence and positive valence systems and proactive and reactive cognitive control processes which underpin the expression and progression of irritability. We consider the implications of this expanded conceptualisation of irritability and provide suggestions for future research.

An examination of the relationship between conduct problems and depressive symptoms comorbidity and temperament among elementary school children

Although the comorbidity between conduct problems (CP) and depressive symptoms (DS) is associated with a host of negative outcomes, the factors, such as temperament, that might explain this comorbidity in school-aged boys and girls are poorly understood. This study compared elementary school children presenting co-occurring CP and DS to children with DS only, CP only, and those with low-level symptoms on temperament dimensions, and explored the moderating role of child sex in the associations. Participants are 487 children (M = 8.38 years, SD = 0.92, 52.2% girls) divided into four groups (CP + DS, DS only, CP only, control). Findings suggest that boys with CP and DS presented a lower level of fear than boys with DS and boys from the control group. They also presented higher levels of activity than boys with DS. Girls with CP and DS presented lower levels of fear than girls with DS, lower levels of approach and activity than girls with CP, and higher levels of shyness than girls from the control group. These findings suggest that temperament may discriminate children with comorbid CP and DS from those presenting only CP or DS.

Irritability and Temperament: Concurrent and Prospective Relationships in Childhood and Adolescence

OBJECTIVE

Irritability symptoms are closely associated with, and may reflect, temperament traits, particularly negative affectivity (NA). However, there are few empirical data on the relationships between child temperament and irritability symptoms.

METHOD

We investigated cross-sectional and longitudinal relationships between irritability symptoms and temperament traits from age 3-15 in a community sample of 609 children and their parents. Irritability symptoms were assessed through structured interviews with parents at ages 3/6, and inventories completed by parents and youth at ages 12/15. Temperament traits were assessed using parent reports at ages 3/6, and parent and child reports at ages 12/15. Path analysis and structural equation modeling were used to explore longitudinal associations from ages 3-6 and 12-15, respectively.

RESULTS

Higher levels of irritability symptoms at ages 3/6 were concurrently associated with higher levels of NA and lower levels of effortful control (EC). In adolescence, higher irritability symptoms were concurrently associated with higher negative temperament and disinhibition. In longitudinal analyses from age 3-6 and 12-15, irritability symptoms showed modest but significant stability after adjusting for the stability of temperament traits. However, there were significant differences in the stability paths at age 3-6, reflecting lower stability of irritability symptoms. Finally, EC at age 3 predicted increased irritability symptoms at age 6, while irritability symptoms at age 3 predicted increased NA at age 6.

CONCLUSION

Irritability symptoms are robustly associated with both temperamental NA and difficulty regulating attention and behavior. These findings help situate irritability symptoms within widely accepted temperament/personality taxonomies.

Systematic Review and Meta-Analysis: Early Irritability as a Transdiagnostic Neurodevelopmental Vulnerability to Later Mental Health Problems

OBJECTIVE

Irritability is a transdiagnostic indicator of child and adolescent internalizing and externalizing problems that is measurable from early life. The objective of this systematic review was to determine the strength of the association between irritability measured from 0 to 5 years and later internalizing and externalizing problems, to identify mediators and moderators of these relationships, and to explore whether the strength of the association varied according to irritability operationalization.

METHOD

Relevant studies published in peer-reviewed, English-language journals between the years 2000 and 2021 were sought from EMBASE, PsycINFO, MEDLINE, CINAHL, and ERIC. We synthesized studies that included a measure of irritability within the first 5 years of life and reported associations with later internalizing and/or externalizing problems. Methodological quality was assessed using the JBI-SUMARI Critical Appraisal Checklist.

RESULTS

Of 29,818 identified studies, 98 met inclusion criteria, with a total number of 932,229 participants. Meta-analysis was conducted on 70 studies (n = 831,913). Small, pooled associations were observed between infant irritability (0-12 months) and later internalizing (r = 0.14, 95% CI = 0.09, 0.20) and externalizing symptoms (r = 0.16, 95% CI = 0.11, 0.21) symptoms. For toddler/preschool irritability (13-60 months), small-to-moderate pooled associations were observed for internalizing (r = 0.21, 95% CI = 0.14, 0.28) and externalizing (r = 0.24, 95% CI = 0.18, 0.29) symptoms. These associations were not moderated by the lag between irritability and outcome assessment, although the strength of the associations varied according to irritability operationalization.

CONCLUSION

Early irritability is a consistent transdiagnostic predictor of internalizing and externalizing symptoms in childhood and adolescence. More work is required to understand how to accurately characterize irritability across this developmental period, and to understand mechanisms underlying the relationship between early irritability and later mental health problems.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

STUDY PREREGISTRATION INFORMATION

Early irritability as a transdiagnostic neurodevelopmental vulnerability to early onset mental health problems: A systematic review; https://www.crd.york.ac.uk/prospero/; CRD42020214658.

Socioemotional functioning across the transition to lower secondary school: The role of temperament and relationships with mothers and teachers

This Finnish longitudinal study investigated the role of relationships with mothers (n = 631) and teachers (n = 56), and adolescents' (n = 848; 53.9% girls, 46.1% boys) temperament in the development of the adolescents' socioemotional functioning during the transition to lower secondary school (Grade 6 to Grade 7; age in Grade 6: M = 12.32, SD = 0.36). The results showed that mother-adolescent closeness predicted a higher level and teacher-adolescent closeness predicted a smaller decrease in prosocial behavior. Teacher-adolescent conflict predicted a higher level, and mother-adolescent conflict predicted an increase in externalizing problems. Only temperament predicted internalizing problems. In addition, relationship quality both mediated and moderated some of the associations between temperament and socioemotional functioning.

Offspring irritability: associations with parental psychopathology and personality

Although there are well-established correlates and outcomes of irritability, there are fewer studies reporting on predictors of the longitudinal course of irritability in youth. The current report examined parent internalizing and externalizing psychopathology and dimensions of personality as predictors of the developmental course of irritability in youth. Offspring irritability was assessed between ages 2 and 10 years using the Irritability Factor from the parent-reported Child Behavior Checklist (N = 570, 53.51% female). Parental psychopathology was assessed with a clinical interview; parents also completed the General Temperament Survey as a measure of personality. Results demonstrated that offspring irritability decreased with age. Offspring irritability was associated with parental depressive and anxiety disorders, higher levels of negative emotionality/neuroticism (NE) and disinhibition, and lower levels of positive emotionality; parental NE and disinhibition remained unique predictors of offspring irritability in a multivariate model. Finally, parental externalizing disorders were associated with more stable trajectories of offspring irritability, whereas offspring of parents without a history of externalizing disorders showed decreasing irritability across time. Findings demonstrate that different aspects of parental personality and psychopathology have differential impacts on levels and course of offspring irritability.

Associations between childhood irritability and neural reactivity to maternal feedback in adolescence

Early irritability, a transdiagnostic vulnerability for psychopathology, is associated with alterations in neural reactivity to emotional stimuli and reward; however, associations between childhood irritability and neural markers of risk may be mitigated by the quality of caregiving youth receive. We examined longitudinal relationships between irritability in childhood and young adolescents' neural activity of regions typically associated with emotion regulation and reward processing during processing of maternal feedback and tested whether these associations were moderated by youth's perceptions of the parent-child relationship quality. Eighty-one adolescents (Mage = 11.1 years) listened to maternal critical and praising feedback while undergoing functional magnetic resonance imaging. Age 3 irritability, assessed observationally, was negatively associated with age 11 neural reactivity to maternal criticism in a cluster in the right dorsolateral prefrontal cortex (dlPFC), particularly for youths who reported more positive maternal parenting. Given the role of the dlPFC activation in the effortful processing of emotional stimuli, decreased activation may reflect disengagement from negatively valenced interpersonal feedback in the context of a positive caregiving environment, thereby mitigating psychopathology risk associated with irritability.

Negative Parenting Mediates the Longitudinal Association between Parental Internalizing Symptoms and Child Oppositional Symptoms

Research has pointed to both cross-sectional and longitudinal associations between parental internalizing symptoms and child externalizing symptoms. This study analyzed whether the association is mediated by negative parenting behavior in view of previous reports that both parental internalizing symptoms and child externalizing symptoms are related to parenting behaviors. Longitudinal data for the current analyses were derived from a randomized controlled trial on the efficacy of a web-assisted self-help intervention for parents of children with elevated levels of externalizing symptoms. Two different mediation models were analyzed, one using attention-deficit/hyperactivity disorder (ADHD) symptoms as the dependent variable and the other using oppositional defiant disorder (ODD) symptoms. Both models included parental internalizing symptoms as the independent variable, negative parenting behavior as a mediator, and study condition as a confounder. The longitudinal analyses support the mediating role of negative parenting behavior in the association between early parental internalizing symptoms and later child ODD symptoms.

Parenting Intervention for Psychological Flexibility and Emotion Regulation: Clinical Protocol and an Evidence-Based Case Study

Psychological flexibility has been found as a protective factor for several psychological problems, including the field of parenting. The present study aims to illustrate a clinical protocol, session by session, for the promotion of parental psychological flexibility and emotion regulation in a case study. The clinical protocol is based on third-wave behavior therapy in a brief intervention of four sessions. The intervention is presented in a clinical case of a mother with a child diagnosed with Oppositional Defiant Disorder. Both mother and child experienced problems with emotional regulation and psychological flexibility. The results show clinically significant improvements in psychological flexibility, emotional regulation, and stress parenting in the mother both after the intervention and at follow-up. In the child, emotional perspective-taking skills, acceptance, and valued actions improved. The case illustrates in detail the application of different strategies of acceptance, mindfulness, emotion regulation, and emotional defusion applicable to parenting. Clinical implications are discussed.

Understanding Phasic Irritability: Anger and Distress in Children's Temper Outbursts

Pediatric irritability can be highly impairing and is implicated in adverse outcomes. The phasic component, characterized by temper outbursts, is a frequent impetus to seek treatment. This study tested whether a previously described anger-distress model of tantrums applies to an outpatient sample of school-age children with clinically impairing temper outbursts (TO; 5.0-9.9 years; N = 86), and examined the clinical relevance of resulting factors through associations with measures of psychopathology, and differences between children with TO and two groups without: children with ADHD (n = 60) and healthy controls (n = 45). Factor analyses established a three-factor model: High Anger, Low Anger, Distress. These factors had unique associations with measures of irritability, externalizing problems, and internalizing problems in the TO group. Additionally, an interaction between groups and outburst factors emerged. Results provide evidence for the presence and clinical utility of the anger-distress model in children's outbursts and suggest avenues for future pediatric irritability research.

Treatment Response among Preschoolers with Disruptive Behavior Disorders: The Role of Temperament and Parenting

Objective: This study examined associations between temperament (negative affect, effortful control, and surgency) and symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) within a diverse preschool sample. Interactions between temperament and parenting in the prediction of ADHD/ODD symptoms before and after an 8-week early intervention program (i.e., Summer Treatment Program for Pre-kindergartners; STP-PreK) were also examined.Method: The sample included 215 children (Mage = 5.0, 80.9% male, 84.7% Latinx) with a diagnosis of ADHD and/or ODD who completed the STP-PreK. Temperament was measured via parent report while ADHD/ODD symptoms were assessed via combination of parent and teacher report. Positive and negative parenting were assessed via rating scales and a standardized parent-child interaction observation.Results: Higher surgency was associated with greater symptom severity of ADHD/ODD pre- and post-treatment. Higher negative affect was associated with greater symptom severity of ODD pre- and post-treatment, while higher effortful control was only associated with lower symptom severity of inattention pre-treatment. Positive parenting predicted lower symptom severity of ADHD/ODD post-treatment. Moderation analyses indicated that the benefits of low levels of negative parenting only occurred when paired with low temperament risk for symptoms of hyperactivity and ODD. Additionally, only the combination of high surgency and high observed negative parenting resulted in greater symptom severity of ODD. Finally, decreases in inconsistent discipline predicted decreases across all symptom domains post-treatment.Conclusions: Our findings add to the temperament-based model of ADHD/ODD by highlighting temperament's unique prediction of treatment response as well as important interactions with the caregiving environment.

Prospective association of parental and child internalizing symptoms: Mediation of parenting practices and irritability

Maternal internalizing symptoms have been linked with child internalizing symptoms, but paternal internalizing difficulties have received little attention. Our aims were to prospectively analyse the simultaneous effect of maternal and paternal internalizing symptoms on child internalizing difficulties, examining gender differences, and to verify the mediating effect of parenting practices and child irritability. The sample included 470 families assessed at child ages 3, 6, 8, and 11. Multi-group structural equation modelling was performed with Mplus8.2. Complete equivalence was found between boys and girls for all paths. Maternal internalizing symptoms at age 3 had an indirect effect on child internalizing symptoms at age 11, via irritability at age 8. Paternal internalizing symptoms at age 3 were not associated with any of the variables under study. Maternal internalizing symptoms and child irritability are targets for intervention in order to prevent child internalizing difficulties.