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Silver J, Hawes MT, Carlson GA, Klein DN. Irritability: associations with real-time affect dynamics, social interactions, and daily substance use in older adolescents. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02504-9. [PMID: 38954054 DOI: 10.1007/s00787-024-02504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
Irritability is a common and clinically significant symptom associated with a wide range of negative outcomes. Ecological Momentary Assessment (EMA) is a valuable tool for capturing experiences, such as emotions, social interactions, and substance use in real-time, and may be useful in understanding how irritability is related to everyday functioning. We investigated cross-sectional associations between a widely used self-report irritability rating scale and affect dynamics, social interactions, and substance use captured with EMA (5 surveys daily for 14 days) in 349 18-year-olds. We also examined the associations of self- and parent-reported irritability at ages 12 and 15 with the age 18 EMA variables to explore whether these relationships persist over time. Youth-reported irritability at age 18 was linked to greater intensity, variability, and inertia of irritability, sadness, and anxiety, less positive and more negative interpersonal experiences, and greater cigarette and drug use. Most effect sizes were in the medium-small range. Associations of youth- and parent-reported irritability at ages 12 and 15 with the age 18 EMA measures were generally similar, although smaller in magnitude. Findings contribute to understanding how irritability is manifested in real-time affect dynamics and interpersonal functioning, as well as daily substance use. Most effects were evident over the course of up to 6 years - that is, early adolescent irritability, reported by both youth and their parents, was associated with similar real-time affect dynamics and interpersonal experiences at age 18. This study contributes to the literature on the developmental psychopathology of irritability by extending findings to everyday functioning.
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Affiliation(s)
- Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Mariah T Hawes
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | | | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
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Hall JH, Chawner SJRA, Wolstencroft J, Skuse D, Hall J, Holmans P, Owen MJ, van den Bree MBM. Irritability in young people with copy number variants associated with neurodevelopmental disorders (ND-CNVs). Transl Psychiatry 2024; 14:259. [PMID: 38890284 PMCID: PMC11189457 DOI: 10.1038/s41398-024-02975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/20/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
A range of rare mutations involving micro-deletion or -duplication of genetic material (copy number variants (CNVs)) have been associated with high neurodevelopmental and psychiatric risk (ND-CNVs). Irritability is frequently observed in childhood neurodevelopmental conditions, yet its aetiology is largely unknown. Genetic variation may play a role, but there is a sparsity of studies investigating the presentation of irritability in young people with ND-CNVs. This study aimed to investigate whether there is a difference in irritability in young people with rare ND-CNVs compared to those without ND-CNVs, and to what extent irritability is associated with psychiatric diagnoses and cognitive ability (IQ). Irritability and broader psychopathology were assessed in 485 young people with ND-CNVs and 164 sibling controls, using the child and adolescent psychiatric assessment. Autism was assessed using the social communication questionnaire, and intelligence quotient (IQ) by the Wechsler abbreviated scale of intelligence. Fifty four percent of young people with ND-CNVs met the threshold for irritability; significantly more than controls (OR = 3.77, CI = 3.07-7.90, p = 5.31 × 10-11). When controlling for the presence of other psychiatric comorbidities, ND-CNV status was still associated with irritability. There was no evidence for a relationship between irritability and IQ. Irritability is an important aspect of the clinical picture in young people with ND-CNVs. This work shows that genetic variation is associated with irritability in young people with ND-CNVs, independent of psychiatric comorbidities or IQ impairment. Clinicians should be aware of this increased risk to inform management and interventions.
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Affiliation(s)
- Jessica H Hall
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Samuel J R A Chawner
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Jeanne Wolstencroft
- BRC Great Ormond Street Institute of Child Health, University College London, London, UK
| | - David Skuse
- BRC Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jeremy Hall
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | - Peter Holmans
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | - Michael J Owen
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | - Marianne B M van den Bree
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK.
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Silver J, Sorcher L, Carlson GA, Dougherty LR, Klein DN. Irritability across adolescence: Examining longitudinal trajectory, stability, and associations with psychopathology and functioning at age 18. J Affect Disord 2024; 354:611-618. [PMID: 38494139 DOI: 10.1016/j.jad.2024.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Irritability, marked by diminished frustration tolerance, holds significant implications for youth mental health treatment. Despite prior research on irritability trajectories, understanding of individual differences during adolescence remains limited. This study examines the stability and trajectory of irritability across ages 12-18, investigating associations with psychopathology and functioning at age 18. METHODS A community sample of families with 3-year-old children (N = 518) was recruited via commercial mailing lists. Irritability was assessed at ages 12, 15, and 18 using the Affective Reactivity Index. Psychopathology at age 18 was evaluated with the Kiddie Schedule for Affective Disorders and Schizophrenia, and functioning was assessed through the UCLA Life Stress Interview. Measurement invariance analyses and latent growth curve modeling were conducted within a structural equation modeling (SEM) framework. RESULTS Configural, metric, and scalar invariance models were supported. Elevated irritability at age 12 predicted adverse outcomes at age 18, including increased psychotropic medication use, mental health treatment, suicidal ideation, self-injury, and psychiatric disorders. Importantly, these associations persisted even after accounting for corresponding variables at age 12. The trajectory of irritability during early adolescence significantly predicted heightened risks for various outcomes at age 18, including suicidal ideation, depression, anxiety, disruptive behavior disorders, and impaired interpersonal functioning. DISCUSSION Limitations include using only youth-reported data at age 18, limited generalizability from a mostly White, middle-class sample, and insufficient exploration of the broader developmental trajectory of irritability. Nevertheless, the findings emphasize the crucial role of irritability's trajectory in influencing various psychopathological and functional outcomes in late adolescence.
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Affiliation(s)
- Jamilah Silver
- Stony Brook University, Department of Psychology, Stony Brook, New York, USA.
| | - Leah Sorcher
- University of Maryland, Department of Psychology, College Park, MD, USA
| | | | - Lea R Dougherty
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Daniel N Klein
- Stony Brook University, Department of Psychology, Stony Brook, New York, USA
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Lee SY, Jao NC, Gaffey AE, Reid BM, Vergara-Lopez C, Bublitz MH, Stroud LR. Female adolescents' early life stress and body mass index: Differential effects of anger and anxiety in response to rejection. J Adolesc 2024; 96:830-840. [PMID: 38402417 DOI: 10.1002/jad.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Early life stress is linked to childhood obesity. As children enter adolescence, early life stress may be associated with increased rejection sensitivity, resulting in activation of behavioral and physiological changes that contribute to higher body mass index (BMI). Understanding the potential influence of rejection sensitivity on the association between early life stress and BMI is important to examine in female adolescents. For this secondary data analysis, we hypothesized that female adolescents with greater early life stress and greater rejection sensitivity would exhibit higher BMI-for-age 12 months later. METHODS Seventy-eight adolescents (Mage = 13.1 years; 100% female sex; MBMI = 23.2 kg/m2) in the United States completed study procedures from 2012 to 2016. Among these procedures, the Psychosocial Schedule was used to assess cumulative early life stress and the Children's Rejection Sensitivity Questionnaire was used to assess anger and anxiety in response to rejection. Twelve months later, height and weight were measured to derive BMI-for-age. RESULTS Higher early life stress was associated with higher BMI-for-age among female adolescents with low rejection-provoked anger (1 SD below the mean). However, this association was not observed among female adolescents with high rejection-provoked anger (1 SD above the mean). Finally, there was no significant interaction between early life stress and rejection-provoked anxiety in predicting BMI-for-age. CONCLUSIONS Experiencing early life stress may interact with rejection-provoked anger, but not anxiety, to predict BMI-for-age. Findings inform a developmental perspective of how rejection sensitivity may influence the association between early life stress and early cardiometabolic risk.
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Affiliation(s)
- Sharon Y Lee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Nancy C Jao
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Allison E Gaffey
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Brie M Reid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Chrystal Vergara-Lopez
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Margaret H Bublitz
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
| | - Laura R Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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Niu Y, Buzzell GA, Cosmoiu A, Fox NA, Nelson CA, Zeanah CH, Humphreys KL. Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01193-x. [PMID: 38642277 DOI: 10.1007/s10802-024-01193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
Irritability reflects a propensity for frustration and anger, and is a transdiagnostic symptom of both externalizing and internalizing psychopathology. While early adverse experiences are associated with higher levels of irritability, experiences of early psychosocial deprivation and whether family-based placements can mitigate the impact on subsequent irritability, remain underexplored. The current study examined irritability in 107 16-year-olds with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 49 community comparison children. At age 16 years, irritability was assessed using parent- and self-report forms of the Affective Reactivity Index. Compared to community adolescents, those with a history of institutional care exhibited significantly elevated irritability levels. Among those who experienced institutional care, those randomized to foster care had lower levels of irritability compared to participants randomized to the care-as-usual group, and this effect persists after controlling for baseline negative emotionality. These findings suggest a causal link between high-quality foster care and lower irritability following psychosocial deprivation. Additionally, longer duration in institutional care and non-family placement at age 16 years were associated with higher levels of irritability, highlighting the role of caregiving in explaining variation in irritability in adolescence. Policies that support long-term, high-quality family placements for children without regular caregivers should be prioritized.
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Affiliation(s)
- Yanbin Niu
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA
| | - George A Buzzell
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Ana Cosmoiu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Charles A Nelson
- Boston Children's Hospital of Harvard Medical School, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Charles H Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kathryn L Humphreys
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA.
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Perino MT, Harper-Lednicky JC, Vogel AC, Sylvester CM, Barch DM, Luby JL. Social anxiety moderates the association between adolescent irritability and bully perpetration. Dev Psychopathol 2024:1-8. [PMID: 38476047 DOI: 10.1017/s0954579424000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Preliminary work suggests anxiety moderates the relationship between irritability and bullying. As anxiety increases, the link between irritability and perpetration decreases. We hypothesize that any moderation effect of anxiety is driven by social anxiety symptoms. We sought to explicate the moderating effect of anxiety, while clarifying relations to other aggressive behaviors. METHODS A sample of adolescents (n = 169, mean = 12.42 years of age) were assessed using clinician rated assessments of anxiety, parent reports of irritability and bullying behaviors (perpetration, generalized aggression, and victimization). Correlations assessed zero-order relations between variables, and regression-based moderation analyses were used to test interactions. Johnson-Neyman methods were used to represent significant interactions. RESULTS Irritability was significantly related to bullying (r = .403, p < .001). Social, but not generalized, anxiety symptoms significantly moderated the effect of irritability on bully perpetration (t(160) = -2.94, b = -.01, p = .0038, ΔR2 = .0229, F(1, 160) = 8.635). As social anxiety symptoms increase, the link between irritability and perpetration decreases. CONCLUSIONS Understanding how psychopathology interacts with social behaviors is of great importance. Higher social anxiety is linked to reduced relations between irritability and bullying; however, the link between irritability and other aggression remains positive. Comprehensively assessing how treatment of psychopathology impacts social behaviors may improve future intervention.
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Affiliation(s)
- Michael T Perino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Alecia C Vogel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Chad M Sylvester
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychology and Brain Sciences, Washington University in St Louis, St. Louis, MO, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Finlay-Jones AL, Ang JE, Brook J, Lucas JD, MacNeill LA, Mancini VO, Kottampally K, Elliott C, Smith JD, Wakschlag LS. Systematic Review and Meta-Analysis: Early Irritability as a Transdiagnostic Neurodevelopmental Vulnerability to Later Mental Health Problems. J Am Acad Child Adolesc Psychiatry 2024; 63:184-215. [PMID: 36863413 PMCID: PMC10460834 DOI: 10.1016/j.jaac.2023.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 01/16/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
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.
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Affiliation(s)
- Amy L Finlay-Jones
- Telethon Kids Institute, Nedlands, Western Australia; Curtin University, Bentley, Western Australia; University of Western Australia, Crawley, Western Australia.
| | | | - Juliet Brook
- Telethon Kids Institute, Nedlands, Western Australia
| | | | | | | | | | - Catherine Elliott
- Telethon Kids Institute, Nedlands, Western Australia; Curtin University, Bentley, Western Australia
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Fipp-Rosenfield HL, Levy RS, Grauzer JM, Kaat A, Roberts MY. Autistic Children's Irritability During Social Communication Assessments. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:369-377. [PMID: 38010261 PMCID: PMC11000782 DOI: 10.1044/2023_ajslp-23-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Accurate measurement of autistic children's social communication is critical for assessing skills, setting intervention goals, evaluating change over time, determining service eligibility, and determining classroom placement. There are various types of assessments, some of which use specific tasks to elicit social communication. Structured tasks may frustrate children, inadvertently elicit irritability, and have a cascading effect on their ability to communicate. To date, no studies have evaluated how differing types of social communication assessments may exacerbate children's irritability and impact assessment scores. We examined the extent to which (a) social communication assessment type (structured vs. naturalistic) impacts autistic children's irritability and (b) child irritability is associated with social communication scores. METHOD Autistic toddlers (n = 114, Mage = 33.09 months, SD = 6.15) completed the Communication and Symbolic Behavior Scales (CSBS; structured) and a 10-min play-based mother-child interaction (MCX; naturalistic). Child irritability was scored on both assessments using a global rating scale of 0-15. RESULTS Child irritability during the CSBS was significantly higher than during the MCX (V = 4892, p < .001, r = .68). Higher irritability was associated with lower CSBS social communication scores (B = -0.05, p = .03), but not MCX scores (B = 0.04, p = .13; Theil's F = 6.92, p = .009). CONCLUSIONS Our findings suggest that the CSBS may pose unique challenges for autistic children, as it led to higher rates of irritability and negatively affected children's social communication scores. Evaluating the association between assessment type and irritability supports the complete characterization of autistic children's experience during assessments and clinicians in obtaining a more representative measure of social communication.
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Affiliation(s)
- Hannah L. Fipp-Rosenfield
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Rachel S. Levy
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jeffrey M. Grauzer
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Aaron Kaat
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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Hall JH, Chawner SJRA, Wolstencroft J, Skuse D, Holmans P, Owen MJ, van den Bree MBM. Irritability in young people with copy number variants associated with neurodevelopmental disorders (ND-CNVs). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299440. [PMID: 38106165 PMCID: PMC10723492 DOI: 10.1101/2023.12.05.23299440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background A range of rare mutations involving micro-deletion or -duplication of genetic material (copy number variants (CNVs)) have been associated with high neurodevelopmental and psychiatric risk (ND-CNVs). Irritability is frequently observed in childhood neurodevelopmental conditions, yet its aetiology is largely unknown. Genetic variation may play a role, but there is a sparsity of studies investigating presentation of irritability in young people with ND-CNVs. Aims This study aimed to investigate whether there is a difference in irritability in young people with rare ND-CNVs compared to those without ND-CNVs, and to what extent irritability is associated with psychiatric diagnoses and cognitive ability (IQ). Methods Irritability and broader psychopathology was assessed in 485 young people with ND-CNVs and 164 sibling controls, using the child and adolescent psychiatric assessment (CAPA). Autism was assessed using the Social Communication Questionnaire (SCQ), and Intelligence Quotient (IQ) by the Wechsler Abbreviated Scale of Intelligence (WASI). Results 54% of young people with ND-CNVs met the threshold for irritability; significantly more than controls (OR = 3.77, CI = 3.07-7.90, p= 5.31 × 10-11). When controlling for the presence of other psychiatric comorbidities, ND-CNV status was still associated with irritability. There was no evidence for a relationship between irritability and IQ. Conclusions Irritability is an important aspect of the clinical picture in young people with ND-CNVs. This work shows that genetic variation is associated with irritability in young people with ND-CNVs, independent of psychiatric comorbidities or IQ impairment. Clinicians should be aware of this increased risk to inform management and interventions.
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Affiliation(s)
- Jessica H Hall
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Samuel J R A Chawner
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Jeanne Wolstencroft
- BRC Great Ormond Street Institute of Child Health, University College London
| | - David Skuse
- BRC Great Ormond Street Institute of Child Health, University College London
| | - Peter Holmans
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Michael J Owen
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Marianne B M van den Bree
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, United Kingdom
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Saatchi B, Olshansky EF, Fortier MA. Irritability: A concept analysis. Int J Ment Health Nurs 2023; 32:1193-1210. [PMID: 36929104 DOI: 10.1111/inm.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as 'unpredictability and lowered emotion control', 'lowered threshold for negative emotional stimuli', 'being manifested in response to frustrative situations or physiological needs' and 'experience of disproportionate and unjustified emotional irritation'. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations.
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Affiliation(s)
- Babak Saatchi
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Ellen F Olshansky
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Michelle A Fortier
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
- Center on Stress & Health, University of California Irvine, Orange, California, USA
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Chad-Friedman E, Galano MM, Lemay EP, Olino TM, Klein DN, Dougherty LR. Parsing between- and within-person effects: Longitudinal associations between irritability and internalizing and externalizing problems from early childhood through adolescence. Dev Psychopathol 2023; 35:1371-1381. [PMID: 34955108 PMCID: PMC9234095 DOI: 10.1017/s0954579421001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This report examines between- and within-person associations between youth irritability and concurrent and prospective internalizing and externalizing symptoms from early childhood through adolescence. Distinguishing between- and within-person longitudinal associations may yield distinct, clinically relevant information about pathways to multifinality from childhood irritability. METHODS Children's irritability and co-occurring symptoms were assessed across five waves between ages 3 and 15 years using the mother-reported Child Behavior Checklist (N = 605, 46% female). Parental history of depressive disorders was assessed with a clinical interview. RESULTS Results demonstrated that between- and within-person irritability were uniquely associated with concurrent depressive, anxiety, and defiance symptoms, but not ADHD. Prior wave within-person irritability also predicted next wave depressive, anxiety, and defiance symptoms, controlling for prior symptoms; these prospective associations were bidirectional. Child sex and parental depressive disorders moderated associations. DISCUSSIONS Findings identify pathways from within- and between-person irritability to later internalizing and externalizing psychopathology. Results demonstrate the importance of parsing within- and between-person effects to understand nuanced relations among symptoms over childhood.
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12
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Leno VC, Wright N, Pickles A, Bedford R, Zaidman-Zait A, Kerns C, Zwaigenbaum L, Duku E, Bennett T, Georgiades S, Smith IM, Richards A, Vaillancourt T, Szatmari P, Elsabbagh M. Longitudinal associations between early childhood irritability and adolescent depression symptoms in autistic children are mediated by peer relationships but not educational engagement. Dev Psychopathol 2023; 36:1-11. [PMID: 36700357 PMCID: PMC7615659 DOI: 10.1017/s0954579422001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In the general population, irritability is associated with later depression. Despite irritability being more prevalent in autistic children, the long-term sequelae are not well explored. We tested whether irritability in early childhood predicted depression symptoms in autistic adolescents, and whether associations could be explained by difficulties in peer relationships and lower educational engagement. Analyses tested the longitudinal associations between early childhood irritability (ages 3-5) and adolescent depression symptoms (age 14) in a prospective inception cohort of autistic children (N = 390), followed from early in development shortly after they received a clinical diagnosis. Mediators were measured in mid-childhood (age 10) by a combination of measures, from which latent factors for peer relationships and educational engagement were estimated. Results showed early childhood irritability was positively associated with adolescent depression symptoms, and this association remained when adjusting for baseline depression. A significant indirect pathway through peer relationships was found, which accounted for around 13% of the association between early childhood irritability and adolescent depression, suggesting peer problems may partially mediate the association between irritability and later depression. No mediation effects were found for education engagement. Results highlight the importance of early screening and intervention for co-occurring irritability and peer problems in young autistic children.
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Affiliation(s)
- Virginia Carter Leno
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
| | - Nicola Wright
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Department of Psychology, Manchester Metropolitan University, United Kingdom
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
| | - Rachael Bedford
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Department of Psychology, University of Bath, United Kingdom
| | | | - Connor Kerns
- University of British Columbia, Vancouver, Canada
| | | | - Eric Duku
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - Isabel M. Smith
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Annie Richards
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ontario, Canada
| | - Peter Szatmari
- University of Toronto, Canada
- Centre for Addiction and Mental Health, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montreal, Quebec, Canada
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13
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Chen HWB, Gardner ES, Clarkson T, Eaton NR, Wiggins JL, Leibenluft E, Jarcho JM. Bullying Perpetration and Victimization in Youth: Associations with Irritability and Anxiety. Child Psychiatry Hum Dev 2022; 53:1075-1082. [PMID: 34024018 PMCID: PMC8711067 DOI: 10.1007/s10578-021-01192-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
Prior work on has demonstrated that irritability and anxiety are associated with bullying perpetration and victimization, respectively. Even though symptoms of irritability and anxiety often occur concurrently, few studies have tested their interactive effects on perpetration or victimization. The current study recruited 131 youths from a broader program of research that examines the pathophysiology and treatment of pediatric irritability and anxiety. Two moderation tests were performed to examine concurrent irritability and anxiety symptoms and their relation to perpetration and victimization of bullying. More severe anxiety was associated with greater victimization. However, more severe irritability was associated with, not just greater perpetration, but also greater victimization. An irritability-by-anxiety interaction demonstrated that youths with more severe irritability and lower levels of anxiety engaged in more perpetration. Our findings suggest a more nuanced approach to understanding how the commonly comorbid symptoms of irritability and anxiety interact in relation to peer-directed behavior in youths.
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Affiliation(s)
- Hung-Wei Bernie Chen
- Department of Psychological and Brain Sciences, University of Delaware, Wolf Hall Suite 108, 105 The Green, Newark, DE, 19716, USA.
| | | | - Tessa Clarkson
- Department of Psychology, Temple University, Philadelphia, PA
| | | | - Jillian Lee Wiggins
- Department of Psychology, San Diego State University, San Diego, CA,San Diego State University / University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Rockville, MD
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14
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Damme KSF, Norton ES, Briggs-Gowan MJ, Wakschlag LS, Mittal VA. Developmental patterning of irritability enhances prediction of psychopathology in preadolescence: Improving RDoC with developmental science. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2022; 131:556-566. [PMID: 35901387 PMCID: PMC9439570 DOI: 10.1037/abn0000655] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The transdiagnostic importance of irritability in psychopathology has been demonstrated. However, the contribution of developmentally unfolding irritability patterns to specific clinical and neural outcomes remains an important and unanswered question. To address this gap in the literature, irritability patterns of 110 youth from a large, diverse cohort were assessed at preschool age and again at early school age (∼2.5 years later) with a dimensional irritability scale designed to capture the normal:abnormal spectrum. At preadolescence (∼6 years later), clinical outcomes (internalizing/externalizing symptoms) derived from a semistructured clinical interview and neural outcomes (characterized as gray-matter-volume abnormalities) were assessed. For clinical outcomes, preschool-age irritability alone was a transdiagnostic predictor of internalizing and externalizing symptoms at preadolescence. However, in a model including both preschool and early school age, irritability provided greater specificity, suggesting that higher irritability at early school age related to elevated preadolescent externalizing but not internalizing symptoms. In terms of neural outcomes, elevated preschool irritability did not predict preadolescent gray-matter-volume abnormality; however, irritability at early school age demonstrated an interactive effect among regions, with reduced volume in preadolescence emotional regions (e.g., amygdala, medial orbitofrontal cortex) and increased volume in other regions (e.g., cerebellum). These complex patterns highlight the contribution of a developmentally informed approach, the National Institute of Mental Health's Research Domain Criteria (RDoC) approach, to yield transdiagnostic phenotypes and multiple units of analysis. Capturing these individual differences and developmental heterogeneity can provide critical insight into the unfolding of mechanisms underlying emerging psychopathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Elizabeth S Norton
- Department of Communication Sciences and Disorders, Northwestern University
| | | | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University
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15
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Development of the Anger Children’s Cognitive Error Scale and the Anger Children’s Automatic Thought Scale. Behav Cogn Psychother 2022; 50:481-492. [DOI: 10.1017/s135246582200025x] [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
Abstract
Background:
Empirical studies between anger and anger-provoking cognitive variables in children and adolescents are lacking, despite numerous studies on internalising and externalising problems.
Aim:
The purpose of this study was to develop new questionnaires for anger-provoking cognitive errors and automatic thoughts, and examine relationships between anger, cognitive errors, and automatic thoughts in children and adolescents.
Method:
Participants were 485 Japanese children and adolescents aged 9–15 years old (254 females; average age 12.07; SD = 1.81). They completed the Anger Children’s Cognitive Error Scale (A-CCES) and the Anger Children’s Automatic Thought Scale (A-CATS), which were developed in this study, as well as the Anger Scale for Children and Adolescents and the Japanese version of Short Spence Children’s Anxiety Scale.
Results:
Both the A-CCES and the A-CATS had adequate reliability (internal consistency) and validity (face validity, structural validity and construct validity). A hierarchal regression analysis indicated that automatic thoughts were positively and moderately related to anger (β = .37) after controlling for age, gender, anxiety symptoms, cognitive errors and interaction term. Moreover, a mediation analysis indicated that automatic thoughts significantly mediated the relationship between cognitive errors and anger (indirect effect, 0.24; 95% CI: .020 to .036).
Conclusions:
This study developed the new questionnaires to assess anger-provoking cognitive errors and automatic thoughts. In addition, this study revealed that automatic thoughts rather than cognitive errors are associated with anger in children and adolescents.
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16
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Speyer LG, Hall HA, Ushakova A, Luciano M, Auyeung B, Murray AL. Within-person Relations between Domains of Socio-emotional Development during Childhood and Adolescence. Res Child Adolesc Psychopathol 2022; 50:1261-1274. [PMID: 35670883 DOI: 10.1007/s10802-022-00933-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 02/04/2023]
Abstract
Adolescence is a critical period in the development of mental health with nearly 1 in 5 adolescents suffering from mental health problems and more than 40 percent of these experiencing at least one co-occurring mental health disorder. This study investigates whether there are differences in the relations between key dimensions of child and adolescent mental health in adolescence compared to childhood. Mental health and related socio-emotional traits were measured longitudinally at ages 4, 7, 8, 9, 11, 13, and 16 in the Avon Longitudinal Study of Parents and Children (N = 11279) using the Strengths and Difficulties Questionnaires. Graphical Vector Autoregression models were used to analyse the temporal within-person relations between conduct problems, emotional problems, hyperactivity/inattention, peer problems and prosociality across childhood (ages 4 to 9) and adolescence (11 to 16). Results suggest that adolescence is characterised by an increase in the number and strength of temporal relations between socio-emotional difficulties. In particular, in adolescence there were bidirectional connections between peer problems and emotional problems, between conduct problems and hyperactivity/inattention and between prosociality and conduct problems as well as hyperactivity/inattention. In childhood, conduct problems and prosociality were reciprocally related. Results also suggested peer problems as a potential mediating factor between conduct and emotional problems in childhood. Overall, this study suggests that different domains of socio-emotional development influence each other over development. Adolescence is characterised by an increase in temporal connections, which may be one factor underlying the increased vulnerability to the onset of mental health problems during that period.
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Affiliation(s)
- Lydia Gabriela Speyer
- Department of Psychology, University of Edinburgh, Edinburgh, UK. .,Department of Psychology, University of Cambridge, Downing Site, Cambridge, CB2 3EA, UK.
| | | | - Anastasia Ushakova
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Medical School, University of Lancaster, Lancashire, UK
| | - Michelle Luciano
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Bonnie Auyeung
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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17
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Margolis AE, Liu R, Conceição VA, Ramphal B, Pagliaccio D, DeSerisy ML, Koe E, Selmanovic E, Raudales A, Emanet N, Quinn AE, Beebe B, Pearson BL, Herbstman JB, Rauh VA, Fifer WP, Fox NA, Champagne FA. Convergent neural correlates of prenatal exposure to air pollution and behavioral phenotypes of risk for internalizing and externalizing problems: Potential biological and cognitive pathways. Neurosci Biobehav Rev 2022; 137:104645. [PMID: 35367513 DOI: 10.1016/j.neubiorev.2022.104645] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/20/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023]
Abstract
Humans are ubiquitously exposed to neurotoxicants in air pollution, causing increased risk for psychiatric outcomes. Effects of prenatal exposure to air pollution on early emerging behavioral phenotypes that increase risk of psychopathology remain understudied. We review animal models that represent analogues of human behavioral phenotypes that are risk markers for internalizing and externalizing problems (behavioral inhibition, behavioral exuberance, irritability), and identify commonalities among the neural mechanisms underlying these behavioral phenotypes and the neural targets of three types of air pollutants (polycyclic aromatic hydrocarbons, traffic-related air pollutants, fine particulate matter < 2.5 µm). We conclude that prenatal exposure to air pollutants increases risk for behavioral inhibition and irritability through distinct mechanisms, including altered dopaminergic signaling and hippocampal morphology, neuroinflammation, and decreased brain-derived neurotrophic factor expression. Future studies should investigate these effects in human longitudinal studies incorporating complex exposure measurement methods, neuroimaging, and behavioral characterization of temperament phenotypes and neurocognitive processing to facilitate efforts aimed at improving long-lasting developmental benefits for children, particularly those living in areas with high levels of exposure.
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Affiliation(s)
- Amy E Margolis
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Ran Liu
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Vasco A Conceição
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Bruce Ramphal
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - David Pagliaccio
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mariah L DeSerisy
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emily Koe
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ena Selmanovic
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Amarelis Raudales
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Nur Emanet
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Aurabelle E Quinn
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Beatrice Beebe
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Brandon L Pearson
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Virginia A Rauh
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA; Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - William P Fifer
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Pediatrics, Columbia University Medical Center, New York, NY, USA; Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Nathan A Fox
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA; Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
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18
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Barclay ME, Silvers JA, Lee SS. Childhood Irritability: Predictive Validity and Mediators of Adolescent Psychopathology. Res Child Adolesc Psychopathol 2022; 50:1165-1177. [PMID: 35522397 DOI: 10.1007/s10802-022-00908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
Despite its transdiagnostic significance, there is modest evidence with respect to the predictive validity of childhood irritability, especially across developmental periods; similarly, little is known about explanatory factors underlying these predictions. This study had two goals: (1) to test the predictive validity of childhood irritability with respect to adolescent internalizing and externalizing problems, controlling for baseline ADHD and related psychopathology and (2) to test theoretically-derived family (i.e., parenting behavior, parenting stress) and social (i.e., peer status, social skills) constructs as explanatory factors of adolescent psychopathology. Two hundred thirty ethnically diverse (51.5% White) 5-10-year-old youth (32% female) with (n = 121) and without (n = 110) ADHD completed three separate laboratory-based assessments across six to seven years. Temporally-ordered predictors, putative mediators, and psychopathology outcomes were assessed using multiple informants (i.e., parent, teacher, youth) and methods (i.e., structured interviews, normed rating scales). Controlling for demographic factors, clinical correlates, and baseline psychopathology, childhood irritability uniquely predicted adolescent externalizing problems, but not internalizing problems. Next, analyses revealed that low social skills partially explained predictions of adolescent internalizing problems. However, family or social factors did not underlie predictions of adolescent externalizing problems. These preliminary findings support the predictive validity of childhood irritability with respect to early adolescent externalizing problems and implicate low social skills as a potentially unique mediator of internalizing outcomes. Intervention-induced improvements in social skills may minimize emergent psychopathology initiated by significant childhood irritability.
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Affiliation(s)
- Margot E Barclay
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA
| | - Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA
| | - Steve S Lee
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA.
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19
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Preschool Irritability Predicts Adolescent Psychopathology and Functional Impairment: A 12-Year Prospective Study. J Am Acad Child Adolesc Psychiatry 2022; 61:554-564.e1. [PMID: 34481916 PMCID: PMC9951107 DOI: 10.1016/j.jaac.2021.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/30/2021] [Accepted: 08/26/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The long-term clinical and functional outcomes of preschool-age irritability are unknown. This study examined longitudinal associations of preschool irritability with psychiatric disorders and functional impairment assessed in adolescence in a large community sample. METHOD A total of 453 children were assessed at age 3 and again at ages 12 and/or 15. At age 3, parents were interviewed about their child's irritability, other psychiatric symptoms, and functional impairment with the Preschool Age Psychiatric Assessment (PAPA). In adolescence, both parents and youths were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) to assess youth psychopathology and functional impairment; youths also completed the UCLA Life Stress Interview (LSI) to assess different domains of functioning. Lastly, youths and parents completed the Children's Depression Inventory 2 (CDI 2) and the Screen for Child Anxiety Related Disorders (SCARED). RESULTS Irritability at age 3 predicted internalizing and externalizing disorders in adolescence; parent-reported anxiety and depressive symptoms; and greater functional impairment, including poorer peer functioning, poorer physical health, and antidepressant and educational service use, even after controlling for baseline psychiatric disorders. All longitudinal associations persisted after further adjusting for well-established early life risk markers for psychopathology. CONCLUSION The findings of this study underscore the clinical significance and predictive power of preschool irritability and provide support for its use in large-scale identification and intervention efforts.
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Sugaya LS, Kircanski K, Stringaris A, Polanczyk GV, Leibenluft E. Validation of an irritability measure in preschoolers in school-based and clinical Brazilian samples. Eur Child Adolesc Psychiatry 2022; 31:577-587. [PMID: 33389159 DOI: 10.1007/s00787-020-01701-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/30/2020] [Indexed: 01/18/2023]
Abstract
The Affective Reactivity Index (ARI) is an irritability measure with good psychometric properties. However, there are no published studies in preschool children, an important population in which to differentiate normative from non-normative irritability. The goal of this study was to validate the ARI in preschoolers. Two samples were included: a school-based sample (N = 487, mean age = 57.80 ± 7.23 months, 52.8% male) and a clinical sample of children with Attention Deficit Hyperactivity Disorder (ADHD; N = 153, mean age = 60.5 ± 7.6 months, 83.7% males). Confirmatory factor analysis assessed ARI unidimensionality. ARI criterion validity was tested through comparison to other scales measuring irritability, related constructs, and other aspects of psychopathology. Test-retest reliability was assessed in the school-based sample. Analyses confirmed a single-factor structure and good internal consistency. The ARI showed stronger correlations with irritability measures than with measures of other constructs. In the clinical sample, ADHD children with comorbid disruptive behavior disorders had higher ARI scores than those without this comorbidity. In the school-based sample, test-retest reliability was moderate. This is the first study to demonstrate ARI validity and reliability in preschoolers. The scale performed well in both school-based and clinical samples. Having a concise and validated irritability measure for preschoolers may facilitate both clinical assessment and research on early irritability.
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Affiliation(s)
- Luisa Shiguemi Sugaya
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA. .,Department of Psychiatry, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA
| | - Argyris Stringaris
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA
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21
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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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22
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Kishida K, Tsuda M, Takahashi F, Ishikawa SI. Irritability and mental health profiles among children and adolescents: A result of latent profile analysis. J Affect Disord 2022; 300:76-83. [PMID: 34952126 DOI: 10.1016/j.jad.2021.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Irritability is a transdiagnostic symptom that accompanies both internalizing and externalizing problems. However, there has been a scarcity of research concerning the relationships between irritability and mental health profiles among children and adolescents. AIM This study aimed to identify latent profiles in children and adolescents using anxiety, depression, oppositionality, and irritability. In addition, the profiles were further examined in their relationships with mental health symptoms. METHOD The study analyzed data from 1867 children and adolescents aged 6-15 years from the COVID-19 Online-Survey for Children and Adolescents in Japan (J-COSCA). Parent-reported questionnaires were used in this study. RESULTS A latent profile analysis detected five latent profiles. High oppositionality characterized the first profile ("oppositional": n = 405, 22%). High levels of depression and other less pronounced symptoms characterized the second profile ("depressed": n = 276, 15%). The third profile ("average": n = 602, 33%) presented average symptoms of anxiety, depression and oppositionality and low irritability. The fourth profile ("well-adjusted": n = 235, 13%) presented low values for all the applicable symptoms. The last profile ("comorbid": n = 308, 17%) exhibited high values for all the symptoms and the highest level of irritability of the five profiles. LIMITATION We analyzed the data from a community sample alone after capturing it using parent-reported questionnaires. CONCLUSION This study revealed that the five profiles (oppositional, depressed, average, well-adjusted, and comorbid) were identified, and children and adolescents in the comorbid profiles had high irritability as well as high anxiety, depression, and oppositionality.
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Affiliation(s)
- Kohei Kishida
- Organization for Research Initiatives and Development, Doshisha University, Japan; Faculty of Psychology, Doshisha University, Japan.
| | - Masami Tsuda
- Graduate School of Psychology, Doshisha University, Japan
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Evans SC, Corteselli KA, Edelman A, Scott H, Weisz JR. Is Irritability a Top Problem in Youth Mental Health Care? A Multi-informant, Multi-method Investigation. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01301-8. [PMID: 35064392 DOI: 10.1007/s10578-021-01301-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
Irritability is often described as a common problem affecting youth referred for mental health services; however, little is known about the prevalence and nature of irritability as a focus of treatment. We examined assessment data from a diverse sample of youths (N = 206; ages 7-15; 52% male, 48% female; 33% White, 27% Black, 25% Latinx) referred for outpatient treatment of emotional and behavioral concerns. Caregivers and youths completed nomothetic (standardized checklist) and idiographic (free response) measures at intake. Irritability was identified as a top problem (TP) in 58% of cases, commonly reported by caregivers (38%), youths (42%), or both (23%)-rates that were significantly greater than those of other TP domains (depression, anxiety, ADHD, conduct, and defiance). Further analyses identified clinical correlates of irritability TPs, with results supporting the incremental utility of multiple informants and methods. Findings suggest that irritability is among the most common problems for which families seek youth treatment.
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Affiliation(s)
- Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | | | - Audrey Edelman
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Hannah Scott
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Temperament and psychopathology in early childhood predict body dissatisfaction and eating disorder symptoms in adolescence. Behav Res Ther 2022; 151:104039. [PMID: 35139437 PMCID: PMC8923907 DOI: 10.1016/j.brat.2022.104039] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 12/10/2021] [Accepted: 01/14/2022] [Indexed: 01/08/2023]
Abstract
Eating disorders (ED) are highly impairing and dangerous conditions that typically onset in adolescence. However, very few prospective studies have examined early childhood risk factors for ED pathology. Given well-established links between temperament and psychopathology, examination of these factors could inform prevention efforts. The current multi-method, multi-informant prospective longitudinal study tested whether laboratory-observed and parent-reported temperament and psychiatric disorders at ages 3 and 6 (N = 609) predict body dissatisfaction at ages 12 and 15 and dimensional symptoms of EDs (anorexia nervosa [AN] and bulimia nervosa [BN]) at age 15 (n = 458) in a community sample. Results indicated that early childhood temperament (positive and negative emotionality, perceptual sensitivity, impulsivity, less shyness) and childhood psychopathology (anxiety, oppositional defiant, attention deficit/hyperactivity, and depressive disorders), predicted body dissatisfaction in adolescence. In addition, childhood perceptual sensitivity and oppositional defiant and depressive disorders predicted AN symptoms. Demographic characteristics (female sex, lower levels of fathers' education, and parental marital status) in childhood predicted body dissatisfaction and AN symptoms. No temperament or psychopathology variables predicted BN symptoms. This study is an important first step toward continuing to identify areas of focus for future research on early childhood risk factors for ED symptoms and body dissatisfaction.
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25
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Kaman A, Otto C, Devine J, Erhart M, Döpfner M, Banaschewski T, Görtz-Dorten A, Hanisch C, Kölch M, Roessner V, Ravens-Sieberer U. Assessing anger and irritability in children: psychometric evaluation and normative data for the German version of the PROMIS® Parent Proxy Anger Scale. Qual Life Res 2021; 31:831-839. [PMID: 34586583 PMCID: PMC8921038 DOI: 10.1007/s11136-021-03001-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/05/2022]
Abstract
Purpose Anger and irritability are common and impairing symptoms in children. The PROMIS Anger scales assess self- and parent-reported irritable and angry mood over the past 7 days. The aim of this study was to evaluate the psychometric properties of the German version of the PROMIS Parent Proxy Short Form v1.0—Anger and to provide normative data. Methods To evaluate the psychometric properties, data from the study ADOPT Epidemiology were used. In this study, the PROMIS Anger Scale was administered to a population-based sample of n = 8746 parents of children aged 8–12 years. Psychometric analyses were carried out including the investigation of distribution characteristics, factor structure, model fit, internal consistency, and congruent validity. Normative data were calculated as percentile ranks and T-scores. Results The PROMIS Anger Scale demonstrated good psychometric properties, including satisfactory distribution characteristics, unidimensionality, good internal consistency as well as congruent validity. German normative data for the PROMIS Anger Scale are presented. Conclusion Based on first psychometric analyses, the German version of the PROMIS Anger Scale can be recommended for use in research and practice; however, further investigations using clinical data are needed. The normative data will allow researchers and clinicians an interpretation of the test scores in future applications.
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Affiliation(s)
- Anne Kaman
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Otto
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janine Devine
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Psychosomatic Clinic and Outpatient Center, Argora Clinic, Berlin, Germany
| | - Michael Erhart
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Alice Salomon University of Applied Science, Berlin, Germany.,Apollon University of Applied Science, Bremen, Germany
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anja Görtz-Dorten
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Charlotte Hanisch
- Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Michael Kölch
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, Rostock University Medical Center, Rostock, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, TU Dresden, Dresden, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
Limited research has examined precursors/risk factors for adolescent irritability. This study examines continuity of irritability from early childhood to adolescence and identifies antecedents of adolescent irritability. Across self-reports and mother-reports, evidence was found for continuity of irritability. A range of variables assessed at age 3 predicted irritability at age 15. These findings suggest that adolescent irritability is characterized by distinct developmental pathways from age 3 that have potential to result in an irritable phenotype at age 15. Adolescent-reported and mother-reported irritability may be capturing distinct underlying constructs of irritability; both should be considered in assessments of adolescent irritability.
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Wilson MK, Cornacchio D, Brotman MA, Comer JS. Measuring Irritability in Early Childhood: A Psychometric Evaluation of the Affective Reactivity Index in a Clinical Sample of 3- to 8-Year-Old Children. Assessment 2021; 29:1473-1481. [PMID: 34060361 DOI: 10.1177/10731911211020078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The parent-report Affective Reactivity Index (ARI-P) is the most studied brief scale specifically developed to assess irritability, but relatively little is known about its performance in early childhood (i.e., ≤8 years). Support in such populations is particularly important given developmental shifts in what constitutes normative irritability across childhood. We examined the performance of the ARI-P in a diverse, treatment-seeking sample of children ages 3 to 8 years (N = 115; mean age = 5.56 years; 58.4% from ethnic/racial minority backgrounds). In this sample, confirmatory factor analysis supported the single-factor structure of the ARI-P previously identified with older youth. ARI-P scores showed large associations with another irritability index, as well as small-to-large associations with aggression, anxiety, depression, and attention problems, supporting the convergent and concurrent validity of the ARI-P when used with children in this younger age range. Findings support the ARI-P as a promising parent-report tool for assessing irritability in early childhood, particularly in clinical samples.
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Measurement and correlates of irritability in clinically referred youth: Further examination of the Affective Reactivity Index. J Affect Disord 2021; 283:420-429. [PMID: 33243553 PMCID: PMC7954902 DOI: 10.1016/j.jad.2020.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/10/2020] [Accepted: 11/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Research on youth irritability has proliferated in recent years, largely facilitated by items from existing measures and by key new instruments like the Affective Reactivity Index (ARI). The present study extends this literature by investigating the psychometric properties of the parent- and youth-report ARI and the correlates of irritability in an independent, clinically referred sample. METHOD Baseline assessment data were collected from 237 youths (ages 3-18; 36% female) and their parents, seen for outpatient therapy and/or assessment. We examined the ARI in terms of (1) its item, scale, and factor properties; (2) convergent/discriminant validity with internalizing, externalizing, and emotion regulation problems; (3) specificity of associations with reactive aggression, anger, dysregulation, and coping; and (4) robustness of associations after controlling for demographic variables (e.g., age, gender). RESULTS The ARI's internal consistency and unidimensional factor structure were acceptable or better, with some variation across items and informants. Irritability, as measured by parent- and youth-report, was associated with variables in the externalizing (inattention, hyperactivity, executive dysfunction, aggression), internalizing (anxiety, depression, suicidality), and emotion regulation domains. Associations with reactive aggression, anger, dysregulation, and coping problems were especially pronounced. Irritability's links with internalizing and externalizing problems remained robust after controlling for demographic covariates. LIMITATIONS The sample was limited in diversity and moderate in size. CONCLUSIONS Findings support the reliability and validity of the ARI for assessing parent- and youth-rated irritability among clinically referred youth. Future research is needed to understand variations in irritability's manifestations, measurement, and correlates across demographic groups.
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29
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Malhi GS, Das P, Outhred T, Bell E, Gessler D, Mannie Z. Irritability and mood symptoms in adolescent girls: Trait anxiety and emotion dysregulation as mediators. J Affect Disord 2021; 282:1170-1179. [PMID: 33601692 DOI: 10.1016/j.jad.2020.12.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Irritability is a common symptom in youth that is thought to be predictive of mood disorders. Its effects on mood are likely to be age-dependent, with direct and indirect mediators. We assessed age-related effects and mediators of irritability in adolescent girls with subthreshold depressive and manic symptoms. METHODS We analysed the irritability item from the Mood Disorder Questionnaire in 3 cohorts of girls aged 12-18years (N=229); 12-13years (N=82); 14-15years (N=68); and 16-18years (N=79). They also completed mood, anxiety and emotion regulation questionnaires. MANOVA, correlations and bootstrapped mediation analyses were performed with SPSS®v25 and Hayes Processv3.5®. RESULTS Overall, irritable girls had higher depressive and manic symptoms, trait anxiety and emotion dysregulation than those who were not irritable. Significantly higher rates of irritability were observed in mid-adolescents (aged 14-15years; p = 0.001). Notably, irritability exerted effects on depressive symptoms via trait anxiety, non-acceptance of emotions and dysregulation in emotion clarity throughout adolescence. However, irritability directly exerted effects on manic symptoms in mid-adolescence but in older adolescents, their relationship was indirect via impulse control dysregulation. LIMITATIONS The cross-sectional design and non-clinical sample limit generalisability of our findings. CONCLUSIONS Irritability is involved in subthreshold depressive symptoms, via trait anxiety and perceptual emotion dysregulation. On the other hand, irritability is directly and indirectly associated with subthreshold manic symptoms via dysregulated impulse control depending on age. Therefore, screening for irritability, trait anxiety and emotion dysregulation throughout adolescence may facilitate the early detection of subthreshold depressive and manic symptoms, and the implementation of preventive strategies.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia; Academic Department of Psychiatry, Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, St. Leonards, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065 Australia.
| | - Pritha Das
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia; Academic Department of Psychiatry, Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, St. Leonards, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065 Australia
| | - Tim Outhred
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia; Academic Department of Psychiatry, Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, St. Leonards, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065 Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia; Academic Department of Psychiatry, Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, St. Leonards, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065 Australia
| | - Danielle Gessler
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia; Academic Department of Psychiatry, Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, St. Leonards, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065 Australia; The University of Sydney, Brain and Mind Centre, Faculty of Medicine and Health, NSW Australia; School of Psychology, University of Sydney, NSW, Australia
| | - Zola Mannie
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia; Academic Department of Psychiatry, Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, St. Leonards, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065 Australia; NSW Health and Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia
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30
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Kahle S, Mukherjee P, Dixon JF, Leibenluft E, Hinshaw SP, Schweitzer JB. Irritability Predicts Hyperactive/Impulsive Symptoms Across Adolescence for Females. Res Child Adolesc Psychopathol 2021; 49:185-196. [PMID: 33294965 PMCID: PMC8202810 DOI: 10.1007/s10802-020-00723-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 10/22/2022]
Abstract
Irritability is common in Attention-Deficit Hyperactivity Disorder (ADHD), but little is known about whether irritability predicts the course of ADHD symptoms over time. Adolescence is a dynamic period of emotional development as well as shifts in ADHD symptoms; an important goal is to identify youth at risk of increasing or persisting symptoms. We examined irritability as a longitudinal predictor of change in adolescents' ADHD symptoms, as well as how this link may differ in females versus males. The sample included 108 youth (72 males) age 12-16 years (M = 14.21 years, SD = 1.44 years), 62 of whom met criteria for ADHD. Approximately 18 months later, 80 participants (48 males) were followed up at Time 2. A dimensional approach was used to examine changes over time in parent-reported inattentive and hyperactive/impulsive symptoms. Longitudinal path analysis revealed that irritability at Time 1 predicted higher relative hyperactive/impulsive symptoms at Time 2 after controlling for age and longitudinal stability in all variables. A multiple-group analysis examining moderation by sex/gender revealed that this association was significant only for females. These results suggest that irritability may play a key role in the persistence and worsening of hyperactive/impulsive symptoms across adolescence for females, with potential implications for the diagnosis and treatment of females with ADHD.
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Affiliation(s)
- Sarah Kahle
- MIND Institute, University of California, Davis, CA, USA
| | | | - J Faye Dixon
- MIND Institute, University of California, Davis, CA, USA
| | | | - Stephen P Hinshaw
- University of California, Berkeley, CA, USA
- University of California, San Francisco, CA, USA
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31
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Chavez Arana C, de Pauw SS, van IJzendoorn MH, de Maat DA, Kok R, Prinzie P. No differential susceptibility or diathesis stress to parenting in early adolescence: Personality facets predicting behaviour problems. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.110406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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32
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Leigh E, Lee A, Brown HM, Pisano S, Stringaris A. A Prospective Study of Rumination and Irritability in Youth. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1581-1589. [PMID: 33001331 PMCID: PMC7554009 DOI: 10.1007/s10802-020-00706-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
Although youth irritability is linked with substantial psychiatric morbidity and impairment, little is known about how personal characteristics influence its course. In this study we examined the prospective associations between angry and depressive rumination and irritability. A sample of 165 school pupils aged 12-14 years were assessed at two time points six months apart. They completed measures of irritability at Times 1 and 2 and depressive and angry rumination at Time 1. In line with our hypotheses, we found that angry rumination is significantly associated with irritability six months later, over and above baseline irritability and depressive rumination. The present findings suggest angry rumination is relevant to the genesis of irritability in adolescents, and point to possible routes for prevention and early intervention.
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Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK. .,OxCADAT, The Old Rectory, Paradise Square, Oxford, OX1 1TW, UK.
| | - Ailsa Lee
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah M Brown
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simone Pisano
- Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy.,Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Argyris Stringaris
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Di Giunta L, Rothenberg WA, Lunetti C, Lansford JE, Pastorelli C, Eisenberg N, Thartori E, Basili E, Favini A, Yotanyamaneewong S, Peña Alampay L, Al-Hassan SM, Bacchini D, Bornstein MH, Chang L, Deater-Deckard K, Dodge KA, Oburu P, Skinner AT, Sorbring E, Steinberg L, Tapanya S, Uribe Tirado LM. Longitudinal associations between mothers' and fathers' anger/irritability expressiveness, harsh parenting, and adolescents' socioemotional functioning in nine countries. Dev Psychol 2020; 56:458-474. [PMID: 32077717 PMCID: PMC7041852 DOI: 10.1037/dev0000849] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The present study examines parents' self-efficacy about anger regulation and irritability as predictors of harsh parenting and adolescent children's irritability (i.e., mediators), which in turn were examined as predictors of adolescents' externalizing and internalizing problems. Mothers, fathers, and adolescents (N = 1,298 families) from 12 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and United States) were interviewed when children were about 13 years old and again 1 and 2 years later. Models were examined separately for mothers and fathers. Overall, cross-cultural similarities emerged in the associations of both mothers' and fathers' irritability, as well as of mothers' self-efficacy about anger regulation, with subsequent maternal harsh parenting and adolescent irritability, and in the associations of the latter variables with adolescents' internalizing and externalizing problems. The findings suggest that processes linking mothers' and fathers' emotion socialization and emotionality in diverse cultures to adolescent problem behaviors are somewhat similar. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Dario Bacchini
- Department of Humanistic Studies, University of Naples Federico II
| | - Marc H Bornstein
- Child and Family Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Lei Chang
- Department of Psychology, University of Macau
| | - Kirby Deater-Deckard
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst
| | | | - Paul Oburu
- Department of Educational Psychology, Maseno University
| | | | - Emma Sorbring
- Department of Social and Behavioural Studies, University West
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McLean MA, Cobham VE, Simcock G, Kildea S, King S. Toddler Temperament Mediates the Effect of Prenatal Maternal Stress on Childhood Anxiety Symptomatology: The QF2011 Queensland Flood Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111998. [PMID: 31195616 PMCID: PMC6603961 DOI: 10.3390/ijerph16111998] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/27/2022]
Abstract
It is not known whether alterations to temperamental characteristics associated with prenatal maternal stress (PNMS) exposure account for the development of childhood anxiety symptomatology (internalizing behaviors and anxiety symptoms). The QF2011 Queensland flood study examined whether (1) toddler temperamental characteristics explained the association between PNMS exposure and childhood anxiety symptomatology; and (2) whether effects were dependent upon child sex or the timing of gestational exposure to PNMS. We investigated the effects of various aspects of flood-related stress in pregnancy (objective hardship, cognitive appraisal, subjective distress) on maternal report of 16-month toddler temperament (attentional control, shy-inhibition, negative reactivity), 4-year maternal-reported childhood anxiety symptomatology (internalizing and anxiety symptoms; N = 104), and teacher reports of internalizing behaviors (N = 77). Severity of maternal objective hardship during pregnancy and shy-inhibited behaviors were uniquely associated with 4-year child anxiety symptoms. Mediation analyses found that higher levels of 16-month negative reactivity accounted, in part, for the relationship between increased maternal objective flood-related hardship and greater internalizing behaviors (maternal but not teacher report). Neither child sex nor gestational timing of exposure moderated the hypothesized mediations. Our findings highlight several pathways through which varying aspects of disaster-related PNMS may influence early childhood anxiety symptomatology.
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Affiliation(s)
- Mia A McLean
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Vanessa E Cobham
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Gabrielle Simcock
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of Sunshine Coast, Sippy Downs, QLD 4556, Australia.
| | - Sue Kildea
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Suzanne King
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health University Institute, Verdun, QC H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada.
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35
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Bolhuis K, Muetzel RL, Stringaris A, Hudziak JJ, Jaddoe VWV, Hillegers MHJ, White T, Kushner SA, Tiemeier H. Structural Brain Connectivity in Childhood Disruptive Behavior Problems: A Multidimensional Approach. Biol Psychiatry 2019; 85:336-344. [PMID: 30119874 DOI: 10.1016/j.biopsych.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Studies of white matter connectivity in children with disruptive behavior have yielded inconsistent results, possibly owing to the trait's heterogeneity, which comprises diverse symptoms like physical aggression, irritability, and delinquency. This study examined associations of global and specific white matter connectivity with childhood disruptive behavior problems, while accounting for their complex multidimensionality. METHODS In a large cross-sectional population-based study of 10-year-old preadolescents (n = 2567), we assessed four previously described empirically derived dimensions of disruptive behavior problems using the Child Behavior Checklist: physical aggression, irritability, disobedient behavior, and delinquent behavior. Global and specific white matter microstructure was assessed by diffusion tensor imaging. RESULTS Global fractional anisotropy and mean diffusivity were not associated with broad measures of disruptive behavior, e.g., Child Behavior Checklist externalizing problems scale. Global fractional anisotropy was negatively associated with delinquent behavior (β = -.123, pfalse discovery rate adjusted = .028) and global mean diffusivity was positively associated with delinquent behavior (β = .205, pfalse discovery rate adjusted < 0.001), suggesting reduced white matter microstructure in preadolescents with higher levels of delinquent behavior. Lower white matter microstructure in the inferior longitudinal fasciculus, superior longitudinal fasciculus, cingulum, and uncinate underlie these associations. Global white matter microstructure was not associated with physical aggression, irritability, or disobedient behavior. CONCLUSIONS Delinquent behavior, a severe manifestation of childhood disruptive behavior, was associated with lower white matter microstructure in tracts connecting frontal and temporal lobes. These brain regions are involved in decision making, reward processing, and emotion regulation. This study demonstrated that incorporating the multidimensional nature of childhood disruptive behavior traits shows promise in advancing the search for elucidating neurobiological correlates of disruptive behavior.
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Affiliation(s)
- Koen Bolhuis
- Department of Child and Adolescent Psychiatry; Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ryan L Muetzel
- Department of Child and Adolescent Psychiatry; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Argyris Stringaris
- Mood Brain & Development Unit, Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - James J Hudziak
- Department of Psychiatry, Vermont Center for Children, Youth and Families, University of Vermont, Burlington, Vermont
| | - Vincent W V Jaddoe
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Steven A Kushner
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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