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Carlson GA, Althoff RR, Singh MK. Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately 1. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:309-327. [PMID: 38588602 DOI: 10.1080/15374416.2024.2332999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This "Future Directions" aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts "hang together," but have important distinctions and thus also need to "hang separately." Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.
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Affiliation(s)
- Gabrielle A Carlson
- Psychiatry and Pediatrics, Renaissance School of Medicine at Stony Brook University
| | - Robert R Althoff
- Psychiatry, Pediatrics, & Psychological Science, University of Vermont
| | - Manpreet Kaur Singh
- Professor of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine
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2
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Establishing the transdiagnostic contextual pathways of emotional outbursts. Sci Rep 2022; 12:7414. [PMID: 35523842 PMCID: PMC9076826 DOI: 10.1038/s41598-022-11474-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/22/2022] [Indexed: 12/27/2022] Open
Abstract
Emotional outbursts or temper outbursts are challenging behaviours commonly experienced by people with neurodevelopmental disorders and people who have experienced childhood adversity, which can negatively impact individuals and their families. Emotional outbursts may manifest in different situations via unique pathways distinguished by context-specific differences in the regulation and expression of emotions. Caregivers (N = 268) of young people (6-25 years) with emotional outbursts completed a bespoke caregiver-report questionnaire. Potential pathways were identified by examining the patterns of antecedents and setting events related to outbursts through factor and cluster analyses. Six contextual factors were derived from the Emotional Outburst Questionnaire. Based on these factors, the responses were classified into three clusters, which may represent potential pathways of emotional outbursts. The three clusters were characterized by the increased likelihood of outbursts: (1) across all setting events and triggers; (2) in safe setting events; (3) in unsafe setting events. These potential pathways may be related to: (1) differences in sensory processing; (2) masking of emotions in unsafe environments; (3) differences in safety perception. This framework supports a transdiagnostic account of emotional outbursts and may facilitate the development of pathway-specific intervention strategies.
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Understanding Phasic Irritability: Anger and Distress in Children's Temper Outbursts. Child Psychiatry Hum Dev 2022; 53:317-329. [PMID: 33547990 DOI: 10.1007/s10578-021-01126-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
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.
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Shafer AE, Wanless SB, Briggs JO. Toddler teachers' responses to tantrums and relations to successful resolutions. INFANT AND CHILD DEVELOPMENT 2022. [DOI: 10.1002/icd.2304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ashley E. Shafer
- Psychology in Education University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Shannon B. Wanless
- Psychology in Education University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Jennifer O. Briggs
- Office of Child Development University of Pittsburgh Pittsburgh Pennsylvania USA
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5
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A randomized controlled trial of an emotion socialization parenting program and its impact on parenting, children's behavior and parent and child stress cortisol: Tuning in to Toddlers. Behav Res Ther 2021; 149:104016. [PMID: 35007962 DOI: 10.1016/j.brat.2021.104016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/29/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023]
Abstract
This paper examines the efficacy of a universally-offered parenting program, Tuning in to Toddlers (TOTS), that aims to improve parent emotion socialization, reduce parent and toddler stress and improve social, emotional, and behavioral functioning in toddlers. Three hundred parents of an 18-36 month old toddler were cluster randomized into intervention or control. Parents in the intervention participated in 6 × 2 h group sessions of TOTS. Baseline and 12-months post-intervention measures were collected using parent-report questionnaires and hair samples from parents and toddlers of systemic cortisol stress. Compared to controls, intervention parents reported significantly greater reductions in difficulties in emotion regulation (difficulty remaining goal directed: 95% CI.10, 1.71, p = .028; lack of access to strategies: 95% CI 0.62, 2.42, p = .001), emotion dismissing (beliefs: 95% CI 2.33,4.82, p < .001; behaviors: 95% CI 0.32, 0.65, p = <.001), greater increase in empathy (95% CI -2.83, -1.50, p < .001), emotion coaching (beliefs: 95% CI -2.56, -0.27, p = .016; behaviors: 95% CI -0.58, -0.24, p = <.001), children's behavior (95% CI 0.19, 2.43, p = .022) and competence (95% CI -1.46, -0.22, p = .008). Significant greater reductions in systemic cortisol were found for intervention but not control children (95% CI 0.01, 0.35, p = .041). Findings provide preliminary support for the use of TOTS as a universal prevention program to improve parent emotion socialization and children's functioning. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12615000962538.
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Godovich SA, Adelsberg S, Roy AK. Parental Responses to Temper Outbursts in Children With ADHD: The Role of Psychological Factors. J Atten Disord 2020; 24:2054-2063. [PMID: 29224417 DOI: 10.1177/1087054717745595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Children with ADHD frequently exhibit temper outbursts (TO). One related factor may be parental responses, such as harsh discipline and accommodation. This study tests the hypotheses that these responses will be associated with greater TO, and parental characteristics of higher anger and lower sense of competence, in children with ADHD. Method: Participants included 79 5- to 9-year-old children with ADHD (77.22% boys). Regressions were used to determine the association between parental psychological factors and responses to TO while covarying for TO frequency, severity, and duration. Results: Parental anger and sense of competence were not significantly related to any discipline responses after covarying for TO characteristics, although sense of competence predicted spanking at trend-level significance. Both parental anger and sense of competence significantly predicted accommodation over and above TO characteristics. Conclusion: Results underscore the importance of parental anger and sense of competency in predicting parental behavior, specifically parental accommodation.
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Affiliation(s)
| | | | - Amy Krain Roy
- Fordham University, Bronx, NY, USA.,New York University Langone Medical Center, USA
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Wass SV, Smith CG, Clackson K, Mirza FU. In infancy, it's the extremes of arousal that are 'sticky': Naturalistic data challenge purely homeostatic approaches to studying self-regulation. Dev Sci 2020; 24:e13059. [PMID: 33147373 DOI: 10.1111/desc.13059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/01/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
Most theoretical models of arousal/regulatory function emphasise the maintenance of homeostasis; consistent with this, most previous research into arousal has concentrated on examining individuals' recovery following the administration of experimentally administered stressors. Here, we take a different approach: we recorded day-long spontaneous fluctuations in autonomic arousal (indexed via electrocardiogram, heart rate variability and actigraphy) in a cohort of 82 typically developing 12-month-old infants while they were at home and awake. Based on the aforementioned models, we hypothesised that extreme high or low arousal states might be more short-lived than intermediate arousal states. Our results suggested that, contrary to this, both low- and high-arousal states were more persistent than intermediate arousal states. The same pattern was present when the data were viewed over multiple epoch sizes from 1 s to 5 min; over 10-15-minute time-scales, high-arousal states were more persistent than low- and intermediate states. One possible explanation for these findings is that extreme arousal states have intrinsically greater hysteresis; another is that, through 'metastatic' processes, small initial increases and decreases in arousal can become progressively amplified over time. Rather than exclusively using experimental paradigms to study recovery, we argue that future research should also use naturalistic data to study the mechanisms through which states can be maintained or amplified over time.
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Affiliation(s)
| | - Celia G Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Carlson GA, Chua J, Pan K, Hasan T, Bied A, Martin A, Klein DN. Behavior Modification Is Associated With Reduced Psychotropic Medication Use in Children With Aggression in Inpatient Treatment: A Retrospective Cohort Study. J Am Acad Child Adolesc Psychiatry 2020; 59:632-641.e4. [PMID: 31381991 DOI: 10.1016/j.jaac.2019.07.940] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE There are few data to guide management of agitated and aggressive psychiatrically hospitalized children. Available studies do not account for setting, age, sex, diagnosis, admission reason, or clinical intervention. Seclusion, restraint, and physical holds (S/R/H) are usually the only outcome measure. In this study, we examine changes in PRN (pro re nata, or "as needed") psychotropic medication use to manage severe aggression on a children's psychiatric inpatient unit, comparing rates before and after a behavior modification program (BMP) was discontinued. METHOD We compare 661 children (aged 5-12 years) in 5 cohorts over 10 years, 510 (77%) of whom were admitted for aggressive behavior. PRN use per 1,000 patient-days was the primary outcome measure, but S/R/H was also examined. We use the following as predictors: BMP status, full- or half-time child and adolescent psychiatrist (CAP) oversight, diagnosis, age, length of stay, and neuroleptic use. RESULTS Children admitted for aggression had high rates of externalizing disorders (79%), low rates of mood (27%) and anxiety (21%) disorders, and significantly higher rates of PRN and S/R/H (p < .001) use. Rate of PRN use was significantly lower (p < .001) when the BMP was present (mean [SD], 163 [319] per 1,000 patient-days) than when it was absent (483 [569]; p < .001). Higher PRN use was predicted by BMP absence, neuroleptic treatment, and young patient age (p < .001), and by half-time CAP oversight (p = .002). CONCLUSION In this sample of young children with primarily externalizing disorders, data support the effectiveness of a BMP in lowering rates of PRN and S/R/H use.
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Affiliation(s)
| | - Jaclyn Chua
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Katherine Pan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Tahsin Hasan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Adam Bied
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT
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Panagiotou A, Mafreda C, Moustikiadis A, Prezerakos P. Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16-year retrospective study. Int J Ment Health Nurs 2019; 28:1078-1089. [PMID: 31169358 DOI: 10.1111/inm.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 11/28/2022]
Abstract
Violent incidents in acute inpatient units for children and adolescents are a major and persistent problem. The demographic, clinical, and modifiable (environmental-organizational) risk factors that affect inpatient violence in an Acute Child and Adolescent Psychiatric Unit were investigated via a retrospective study. Data were collected from nursing and medical reports and the unit's census and included 100 days per year for 16 years. Incidents of violence and assault types were recorded, and variables such as the diagnostic category of assailants, total number of patients, and staffing factors during the incident were examined. Of the 2390 violent incidents recorded, 50% were attributed to cases of physical violence towards another patient, 17% to physical violence towards nursing staff, 19% to physical violence towards self and 14% to destruction of property. According to the final multivariable model, for each additional patient in the unit, the risk of a violent event increased by 9.51%; for each additional offender patient, the risk increased by 14.06%; the number of assistant nurses was associated with a 25.03% increased risk; and, after 2006, the risk increased by 68.99%. The most significant factor associated with a 59.98% decreased risk was the total number of nursing staff. All variables significantly and independently contributed to the model. Acute inpatient psychiatric units with a small number of hospitalized patients, adequate, well-trained and specialized nursing staff, and the hospitalization of different types of patients in separate wards or units are expected to facilitate a reduction in the frequency of violent incidents.
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Affiliation(s)
- Aspasia Panagiotou
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Sparta, Greece
| | | | | | - Panagiotis Prezerakos
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Sparta, Greece
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10
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Cressey H, Oliver C, Crawford H, Waite J. Temper outbursts in Lowe syndrome: Characteristics, sequence, environmental context and comparison to Prader-Willi syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1216-1227. [PMID: 31144417 PMCID: PMC6851695 DOI: 10.1111/jar.12613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/01/2022]
Abstract
BACKGROUND There is limited research into the nature and aetiology of temper outbursts in people with intellectual disabilities. In this study, we describe the phenomenology and environmental context of temper outbursts in Lowe syndrome, a rare genetic syndrome in which outbursts are purportedly frequent. METHOD A temper outburst interview (TOI) was conducted with caregivers of seventeen individuals with Lowe syndrome to generate an account of the behavioural sequence, common antecedents and consequences of temper outbursts, and to enable comparisons with similar work on Prader-Willi syndrome. RESULTS Outbursts in Lowe syndrome were frequently triggered by thwarted goal-directed behaviour and were associated with high levels of physical aggression and property destruction. CONCLUSIONS Form and sequence of outbursts showed similarities to Prader-Willi syndrome and to behaviours reported in literature on typically developing children. The results highlight the importance of considering shared aetiology as well as syndrome-specific pathways in the development of outbursts.
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Affiliation(s)
- Helen Cressey
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - Chris Oliver
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - Hayley Crawford
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK.,Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Jane Waite
- School of Life and Health Sciences, Aston University, Birmingham, UK
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11
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Rice LJ, Woodcock K, Einfeld SL. The characteristics of temper outbursts in Prader-Willi syndrome. Am J Med Genet A 2018; 176:2292-2300. [PMID: 30289600 DOI: 10.1002/ajmg.a.40480] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/24/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022]
Abstract
The purpose of this study was to develop a comprehensive understanding of temper outbursts in Prader-Willi syndrome (PWS). A survey was developed from interviews conducted with individuals with PWS and their caregivers. The survey was completed by 101 primary caregivers. The findings suggest that outburst frequency decreases with age while duration increases. Adolescents exhibited more severe behaviors than children or adults. No differences were found across gender or genetic subtype. Provocations fit into three themes: goal blockage, social injustice, and difficulty dealing with change. Distracting the person or giving them space to calm down were the only management strategies judged effective. Risperidone, sertraline, and fluoxetine were the most common medications prescribed for outbursts, though parents reported only minor effects.
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Affiliation(s)
- Lauren J Rice
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kate Woodcock
- Centre for Applied Psychology, School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stewart L Einfeld
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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12
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Sullivan MW. Anger, sad, and blended expressions to contingency disruption in young infants. Dev Psychobiol 2018; 60:938-949. [PMID: 30221341 DOI: 10.1002/dev.21768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 11/07/2022]
Abstract
Three studies elicited young infants' (aged 17-23 weeks) anger and sad facial expressions during brief contingency disruptions to explore their potential organization over time as a biphasic process. Study 1 examined partial correlations among anger, sad, blended anger/sad, and neutral expressions during extinction in three extant, independently recruited samples. Across samples, all three negative expressions were inversely related to neutral expressions, but anger and sad expressions were not significantly correlated when anger/sad blends were controlled. Study 2 compared expressions during contingency and disruption minutes in two groups: one in which the disruption was an extinction phase (the absence of the formerly contingent event), or one in which the disruption was noncontingent presentations of the stimuli. Study 3 examined expression trajectories over time in two contingency and extinction sessions. Independent trajectories of anger and sad expressions occurred over time in Studies 2 and 3. Extinction and noncontingency differed in sad expression. The relation between expressions and blends also varied over time.
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13
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Carlson GA, Klein DN. Commentary: Frying pan to fire? Commentary on Stringaris et al. (2018). J Child Psychol Psychiatry 2018; 59:740-743. [PMID: 29924397 PMCID: PMC6093282 DOI: 10.1111/jcpp.12873] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 01/28/2023]
Abstract
The bipolar disorder diagnosis in prepubertal children became popular because it answered a clinical need to treat the explosive behavior component of irritability and the hope that antimanic strategies would be helpful. Poor definition of episodes resulted in mixing chronic and episodic irritability in samples of children with bipolar disorder. The subsequent dramatic increase in neuroleptic use is a testimony to the importance of the problem of irritability and our need to better understand it. Insofar as our use of the term irritability conflates proneness to anger with the subsequent aggressive response, it will again not be clear who is being studied. We need to uncouple the mood and behavior aspects of irritability for further study or we will have traded the imprecision of "bipolar" for the imprecision of irritability.
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Affiliation(s)
- Gabrielle A. Carlson
- Professor of Psychiatry and Pediatrics, Stony Brook University School of Medicine
| | - Daniel N. Klein
- Distinguished Professor of Psychology, Stony Brook University
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Wass SV, Clackson K, Leong V. Increases in Arousal are More Long-Lasting than Decreases in Arousal: On Homeostatic Failures During Emotion Regulation in Infancy. INFANCY 2018. [DOI: 10.1111/infa.12243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Sam V. Wass
- School of Psychology; University of East London
| | | | - Vicky Leong
- Cambridge University
- Nanyang Technological University
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15
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Potegal M, Drewel EH, MacDonald JT. Tantrums, Emotion Reactions and Their EEG Correlates in Childhood Benign Rolandic Epilepsy vs. Complex Partial Seizures: Exploratory Observations. Front Behav Neurosci 2018; 12:40. [PMID: 29593509 PMCID: PMC5854949 DOI: 10.3389/fnbeh.2018.00040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/20/2018] [Indexed: 11/13/2022] Open
Abstract
We explored associations between EEG pathophysiology and emotional/behavioral (E/B) problems of children with two types of epilepsy using standard parent questionnaires and two new indicators: tantrums recorded by parents at home and brief, emotion-eliciting situations in the laboratory. Children with Benign Rolandic epilepsy (BRE, N = 6) reportedly had shorter, more angry tantrums from which they recovered quickly. Children with Complex Partial Seizures (CPS, N = 13) had longer, sadder tantrums often followed by bad moods. More generally, BRE correlated with anger and aggression; CPS with sadness and withdrawal. Scores of a composite group of siblings (N = 11) were generally intermediate between the BRE and CPS groups. Across all children, high voltage theta and/or interictal epileptiform discharges (IEDs) correlated with negative emotional reactions. Such EEG abnormalities in left hemisphere correlated with greater social fear, right hemisphere EEG abnormalities with greater anger. Right hemisphere localization in CPS was also associated with parent-reported problems at home. If epilepsy alters neural circuitry thereby increasing negative emotions, additional assessment of anti-epileptic drug treatment of epilepsy-related E/B problems would be warranted.
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Affiliation(s)
- Michael Potegal
- Program in Occupational Therapy, Center for Allied Health Professions, University of Minnesota, Minneapolis, MN, United States
| | - Elena H Drewel
- Department of Neuro and Behavioral Psychology, St. Luke's Children's Center for Autism and Neurodevelopmental Disabilities, Boise, ID, United States
| | - John T MacDonald
- Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
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Johnco C, Salloum A, De Nadai AS, McBride N, Crawford EA, Lewin AB, Storch EA. Incidence, clinical correlates and treatment effect of rage in anxious children. Psychiatry Res 2015; 229:63-9. [PMID: 26235476 PMCID: PMC4561508 DOI: 10.1016/j.psychres.2015.07.071] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/10/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
Episodic rage represents an important and underappreciated clinical feature in pediatric anxiety. This study examined the incidence and clinical correlates of rage in children with anxiety disorders. Change in rage during treatment for anxiety was also examined. Participants consisted of 107 children diagnosed with an anxiety disorder and their parents. Participants completed structured clinical interviews and questionnaire measures to assess rage, anxiety, functional impairment, family accommodation and caregiver strain, as well as the quality of the child's relationship with family and peers. Rage was a common feature amongst children with anxiety disorders. Rage was associated with a more severe clinical profile, including increased anxiety severity, functional impairment, family accommodation and caregiver strain, as well as poorer relationships with parents, siblings, extended family and peers. Rage was more common in children with separation anxiety, comorbid anxiety, attention deficit/hyperactivity disorder and behavioral disorders, but not depressive symptoms. Rage predicted higher levels of functional impairment, beyond the effect of anxiety severity. Rage severity reduced over treatment in line with changes in anxiety symptoms. Findings suggest that rage is a marker of greater psychopathology in anxious youth. Standard cognitive behavioral treatment for anxiety appears to reduce rage without adjunctive treatment.
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Affiliation(s)
- Carly Johnco
- Department of Pediatrics, University of South Florida, USA.
| | | | | | - Nicole McBride
- Department of Pediatrics, University of South Florida, USA
| | | | - Adam B Lewin
- Department of Pediatrics, University of South Florida, USA; Department of Psychology, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, USA; Department of Psychology, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; Rogers Behavioral Health - Tampa Bay, USA; All Children's Hospital-Johns Hopkins Medicine, USA; Department of Health Policy and Management, University of South Florida, USA
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17
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Lokko HN, Stern TA. Regression: Diagnosis, Evaluation, and Management. Prim Care Companion CNS Disord 2015; 17:14f01761. [PMID: 26644947 DOI: 10.4088/pcc.14f01761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/02/2015] [Indexed: 10/23/2022] Open
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Tourian L, LeBoeuf A, Breton JJ, Cohen D, Gignac M, Labelle R, Guile JM, Renaud J. Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2015; 24:41-54. [PMID: 26336379 PMCID: PMC4357333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 12/18/2014] [Indexed: 06/05/2023]
Abstract
OBJECTIVE DSM-5 has added a new developmentally appropriate child and adolescent mood disorder subtype called disruptive mood dysregulation disorder (DMDD). The core features of DMDD are temper outbursts (manifested by either verbal rages and/or physical aggression) and unrelenting irritability or anger. Currently, the literature is lacking a thorough review of the possible treatment options for the cardinal symptoms constituting DMDD. The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD. METHODS Relevant articles for this study were obtained through Pubmed, Medline, PsychINFO and PsychINDEXplus using the key words: "adolescents," "children," "paediatric," "youth," "irritability," "temper outbursts," "aggression," "rage," "disruptive behaviour," "treatment," "dysphoria," "autism," "mental retardation/intellectual disability," "impulsivity," "ADHD," "oppositional defiant disorder," and "conduct disorder." A total of 823 studies were generated; only English studies focusing on pharmacological treatment were retained. RESULTS Currently there are no established guidelines or thorough reviews summarizing the treatment of DMDD. Pharmacotherapeutic treatment options of both aggression and chronic irritability include: antidepressants/selective norepinephrine reuptake inhibitors, mood stabilizers, psychostimulants, antipsychotics, and alpha-2 agonists. CONCLUSION Treatment options of severe, persistent irritability in youth are numerous, and a consensual treatment algorithm has not yet emerged from the literature. Further studies and clinical trials are warranted to determine efficacious and safe treatment modalities.
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Affiliation(s)
- Leon Tourian
- McGill University – Douglas Mental Health University Institute, Montreal, Quebec
| | - Amélie LeBoeuf
- McGill University – Douglas Mental Health University Institute, Montreal, Quebec
| | | | - David Cohen
- Université Pierre et Marie Curie, - GH Pitié Salpêtrière, Paris, France
| | - Martin Gignac
- Institut Philippe Pinel – Université de Montréal, Montreal, Quebec
| | - Réal Labelle
- Université du Québec à Montréal – Psychology, Montreal, Quebec
| | | | - Johanne Renaud
- McGill University – Douglas Mental Health University Institute, Montreal, Quebec
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Lokko HN, Stern TA. Sadness: diagnosis, evaluation, and treatment. Prim Care Companion CNS Disord 2014; 16:14f01709. [PMID: 25834755 DOI: 10.4088/pcc.14f01709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022] Open
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Eisbach SS, Cluxton-Keller F, Harrison J, Krall JR, Hayat M, Gross D. Characteristics of TEMPER TANTRUMS in Preschoolers with Disruptive Behavior in a Clinical Setting. J Psychosoc Nurs Ment Health Serv 2014; 52:32-40. [PMID: 24444385 DOI: 10.3928/02793695-20140110-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/17/2013] [Indexed: 11/20/2022]
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Roy AK, Klein RG, Angelosante A, Bar-Haim Y, Leibenluft E, Hulvershorn L, Dixon E, Dodds A, Spindel C. Clinical features of young children referred for impairing temper outbursts. J Child Adolesc Psychopharmacol 2013; 23:588-96. [PMID: 24168713 PMCID: PMC3842879 DOI: 10.1089/cap.2013.0005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. METHODS Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 non-referred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. RESULTS No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. CONCLUSIONS Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.
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Affiliation(s)
- Amy K. Roy
- Department of Psychology, Fordham University, Bronx, New York
| | | | | | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Erica Dixon
- Department of Psychology, American University, Washington DC
| | - Alice Dodds
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Carrie Spindel
- New York University Child Study Center, New York, New York
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He J, Qiu P, Park KY, Xu Q, Potegal M. Young Chinese children’s anger and distress. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2013. [DOI: 10.1177/0165025413477006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A hierarchical cluster analysis of the time course of the videotaped reactions of 75 Chinese 2–4-year olds to mothers’ toy-removal identified Distress, Low Anger, and High Anger behavior clusters. Anger often begins at low intensity; some children then escalate. The face-validity of Low and High Anger-cluster classifications was supported in that High Anger was displayed by a subset of the children who had first showed Low Anger. The three clusters had different and interpretable correlations with mothers’ temperament ratings. Developmentally, 2-year-olds displayed more Distress, including crying; 3-year-olds showed more Low Anger, including stamp-jump. While Low Anger is predominant during toy-removal in Chinese children, it is, contrastingly, the least-frequent component in the tantrums of North American children.
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Affiliation(s)
- Jie He
- Zhejiang University, Department of Psychology and Behavioral Sciences, China
| | - Peihua Qiu
- University of Minnesota, School of Statistics, USA
| | | | - Qinmei Xu
- Zhejiang University, Department of Psychology and Behavioral Sciences, China
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Baeza I, Correll CU, Saito E, Amanbekova D, Ramani M, Kapoor S, Chekuri R, De Hert M, Carbon M. Frequency, characteristics and management of adolescent inpatient aggression. J Child Adolesc Psychopharmacol 2013; 23:271-81. [PMID: 23647136 PMCID: PMC3657279 DOI: 10.1089/cap.2012.0116] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Inpatient aggression is a serious challenge in pediatric psychiatry. METHODS A chart review study in adolescent psychiatric inpatients consecutively admitted over 24 months was conducted, to describe aggressive events requiring an intervention (AERI) and to characterize their management. AERIs were identified based on specific institutional event forms and/or documentation of as-needed (STAT/PRN) medication administration for aggression, both recorded by nursing staff. RESULTS Among 408 adolescent inpatients (age: 15.2±1.6 years, 43.9% male), 1349 AERIs were recorded, with ≥1 AERI occurring in 28.4% (n=116; AERI+). However, the frequency of AERIs was highly skewed (median 4, range: 1-258). In a logistical regression model, the primary diagnosis at discharge of disruptive behavior disorders and bipolar disorders, history of previous inpatient treatment, length of hospitalization, and absence of a specific precipitant prior to admission were significantly associated with AERIs (R(2)=0.32; p<0.0001). The first line treatment of patients with AERIs (AERI+) was pharmacological in nature (95.6%). Seclusion or restraint (SRU) was used at least once in 59.4% of the AERI+ subgroup (i.e., in 16.9% of all patients; median within-group SRU frequency: 3). Treatment and discharge characteristics indicated a poorer prognosis in the AERI+ (discharge to residential care AERI+: 22.8%, AERI-: 5.6%, p<0.001) and a greater need for psychotropic polypharmacy (median number of psychotropic medications AERI+: 2; AERI-: 1, p<0.001). CONCLUSIONS Despite high rates of pharmacological interventions, SRU continue to be used in adolescent inpatient care. As both of these approaches lack a clear evidence base, and as adolescents with clinically significant inpatient aggression have increased illness acuity/severity and service needs, structured research into the most appropriate inpatient aggression management is sorely needed.
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Affiliation(s)
- Immaculada Baeza
- Child and Adolescent Psychiatry and Psychology Department, CIBERSAM IDIBAPS, Hospital Clinic i Universitari, Barcelona, Spain
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Hofstra North Shore Long Island Jewish School of Medicine, East Meadow, and Nassau County University Hospital, Hempstead, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Ema Saito
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Dinara Amanbekova
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Meena Ramani
- Hofstra North Shore Long Island Jewish School of Medicine, East Meadow, and Nassau County University Hospital, Hempstead, New York
| | - Sandeep Kapoor
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Raja Chekuri
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Marc De Hert
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Maren Carbon
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
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Revenge: an adaptive system for maximizing fitness, or a proximate calculation arising from personality and social-psychological processes? Behav Brain Sci 2012; 36:33-4. [PMID: 23211580 DOI: 10.1017/s0140525x12000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Revenge appears among a “suite” of social interactions that includes competition, alliance building (a prerequisite for tribal revenge raids), and so forth. Rather than a modular “system” directly reflecting evolutionary fitness constraints, revenge may be (another) social cost-benefit calculation involving potential or actual aggression and proximately controlled by individual personality characteristics and beliefs that can work against fitness.
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Abstract
Issues complicating the differential diagnosis of bipolar disorder in young people are discussed. They include: a) the subtype of bipolar disorder being considered; b) the person's age and stage of development; c) whether one views bipolar disorder more conservatively, requiring clear episodes that mark a distinct change from premorbid levels of function, or more liberally, focusing for instance on severe irritability/explosive outbursts as the mood change; d) who is reporting manic symptoms, and whether symptoms are past and must be recalled or current and more likely to be observed; e) impact of family history. The diagnosis of mania/bipolar I disorder may not become clear for a number of years. This is an impairing disorder, but so are the conditions from which it must be distinguished. Family history may increase the odds that certain symptoms/behaviors are manifestations of bipolar disorder but it does not make the diagnosis. Until there are biomarkers that can confirm the diagnosis, and treatments unique to the condition, it is wise to make a diagnosis of bipolar disorder in children and adolescents provisionally and keep an open mind to the likelihood that revisions may be necessary.
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Affiliation(s)
- GABRIELLE A. CARLSON
- Department of Psychiatry and Behavioral Sciences,
Stony Brook University School of Medicine, Putnam Hall-South Campus, Stony
Brook, NY 11794-8790, USA
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Green JA, Whitney PG, Potegal M. Screaming, yelling, whining, and crying: categorical and intensity differences in vocal expressions of anger and sadness in children's tantrums. ACTA ACUST UNITED AC 2012; 11:1124-33. [PMID: 21707157 DOI: 10.1037/a0024173] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Young children's temper tantrums offer a unique window into the expression and regulation of strong emotions. Previous work, largely based on parental report, suggests that two emotions, anger and sadness, have different behavioral manifestations and different time courses within tantrums. Individual motor and vocal behaviors, reported by parents, have been interpreted as representing different levels of intensity within each emotion category. The present study used high-fidelity audio recordings to capture the acoustic features of children's vocalizations during tantrums. Results indicated that perceptually categorized screaming, yelling, crying, whining, and fussing each have distinct acoustic features. Screaming and yelling form a group with similar acoustic features while crying, whining, and fussing form a second acoustically related group. Within these groups, screaming may reflect a higher intensity of anger than yelling while fussing, whining, and crying may reflect an increasing intensity of sadness.
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Affiliation(s)
- James A Green
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269-1020, USA.
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Sullivan MW, Lewis M. Relations of Early Goal Blockage Response and Gender to Subsequent Tantrum Behavior. INFANCY 2012; 17:159-178. [PMID: 22408573 PMCID: PMC3293480 DOI: 10.1111/j.1532-7078.2011.00077.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infants and their mothers participated in a longitudinal study of the sequelae of infant goal blockage responses. Four-month-old infants participated in a standard contingency learning/goal blockage procedure during which anger and sad facial expressions to the blockage were coded. When infants were 12- and 20- months-old, mothers completed a questionnaire about their children's tantrums. Tantrum scores increased with age and boys tended to show more tantrum behavior than girls. Anger expressed to goal blockage at 4 months was unrelated to tantrum behavior. There was a gender by sad expression interaction. Girls who expressed sadness in response to the goal blockage had lower total tantrum scores than boys; otherwise there was no difference. These results suggest that tantrums of infants who display sad, not anger expression, in response to goal blockage, are differentially influenced by children's gender.
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Affiliation(s)
- Margaret W Sullivan
- Institute for the Study of Child Development UMDNJ--Robert Wood Johnson Medical School, New Brunswick, NJ
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Giesbrecht GF, Miller MR, Müller U. The anger-distress model of temper tantrums: associations with emotional reactivity and emotional competence. INFANT AND CHILD DEVELOPMENT 2010. [DOI: 10.1002/icd.677] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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