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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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2
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Herbein M, Barbosa S, Collet O, Khalfallah O, Navarro M, Bailhache M, IV N, Aouizerate B, Sutter-Dallay AL, Koehl M, Capuron L, Ellul P, Peyre H, Van der Waerden J, Melchior M, Côté S, Heude B, Glaichenhaus N, Davidovic L, Galera C. Cord serum cytokines at birth and children's trajectories of mood dysregulation symptoms from 3 to 8 years: The EDEN birth cohort. Brain Behav Immun Health 2024; 38:100768. [PMID: 38586283 PMCID: PMC10990861 DOI: 10.1016/j.bbih.2024.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
There is growing evidence that in utero imbalance immune activity plays a role in the development of neurodevelopmental and psychiatric disorders in children. Mood dysregulation (MD) is a debilitating transnosographic syndrome whose underlying pathophysiological mechanisms could be revealed by studying its biomarkers using the Research Domain Criteria (RDoC) model. Our aim was to study the association between the network of cord serum cytokines, and mood dysregulation trajectories in offsprings between 3 and 8 years of age. We used the data of a study nested in the French birth cohort EDEN that took place from 2003 to 2014 and followed mother-child dyads from the second trimester of pregnancy until the children were 8 years of age. The 2002 mother-child dyads were recruited from the general population through their pregnancy follow-up in two French university hospitals. 871 of them were included in the nested cohort and cord serum cytokine levels were measured at birth. Children's mood dysregulation symptoms were assessed with the Strengths and Difficulties Questionnaire Dysregulation Profile at the ages 3, 5 and 8 years in order to model their mood dysregulation trajectories. Out of the 871 participating dyads, 53% of the children were male. 2.1% of the children presented a high mood dysregulation trajectory whereas the others were considered as physiological variations. We found a significant negative association between TNF-α cord serum levels and a high mood dysregulation trajectory when considering confounding factors such as maternal depression during pregnancy (adjusted Odds Ratio (aOR) = 0.35, 95% Confidence Interval (CI) [0.18-0.67]). Immune imbalance at birth could play a role in the onset of mood dysregulation symptoms. Our findings throw new light on putative immune mechanisms implicated in the development of mood dysregulation and should lead to future animal and epidemiological studies.
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Affiliation(s)
- Marie Herbein
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Centre Hospitalier Perrens, Bordeaux, France
| | - Susana Barbosa
- Université Côte d’Azur, Nice, France
- Centre National de Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Ophélie Collet
- University of Bordeaux, France
- Research Unit on Children's Psychosocial Maladjustment, Montreal, Canada
| | - Olfa Khalfallah
- Université Côte d’Azur, Nice, France
- Centre National de Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Marie Navarro
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
| | - Marion Bailhache
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Centre Hospitalier Universitaire de Bordeaux, Département de Pédiatrie, France
| | - Nicolas IV
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
| | - Bruno Aouizerate
- University of Bordeaux, France
- Centre Hospitalier Perrens, Bordeaux, France
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Anne-Laure Sutter-Dallay
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Centre Hospitalier Perrens, Bordeaux, France
| | - Muriel Koehl
- University of Bordeaux, France
- INSERM, Neurocentre Magendie, UMR1215, Bordeaux, France
| | - Lucile Capuron
- University of Bordeaux, France
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Pierre Ellul
- Robert Debré Hospital, Child and Adolescent department, APHP, Paris University, Paris, France
- Immunology-Immunopathology-Immunotherapy (i3), UMRS 959, INSERM, Paris, France
| | - Hugo Peyre
- Robert Debré Hospital, Child and Adolescent department, APHP, Paris University, Paris, France
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France
- Université Paris Saclay, UVSQ, Inserm, CESP, Tem DevPsy, 94807, Villejuif, France
| | - Judith Van der Waerden
- INSERM U1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Maria Melchior
- INSERM U1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Sylvana Côté
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Research Unit on Children's Psychosocial Maladjustment, Montreal, Canada
- University of Montreal, Department of Social and Preventive Medicine, Montreal, Canada
| | - Barbara Heude
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), INSERM, INRAE, F-75004, Paris, France
- Paris University, France
| | - Nicolas Glaichenhaus
- Université Côte d’Azur, Nice, France
- Centre National de Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
- Fondation FondaMental, Créteil, France
| | - Laetitia Davidovic
- Université Côte d’Azur, Nice, France
- Centre National de Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
- Fondation FondaMental, Créteil, France
| | - Cedric Galera
- University of Bordeaux, France
- INSERM, Bordeaux Population Health Center, UMR1219, France
- Centre Hospitalier Perrens, Bordeaux, France
- Research Unit on Children's Psychosocial Maladjustment, Montreal, Canada
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Thompson KI, Schneider CJ, Lopez-Roque JA, Wakschlag LS, Karim HT, Perlman SB. A network approach to the investigation of childhood irritability: probing frustration using social stimuli. J Child Psychol Psychiatry 2024; 65:959-972. [PMID: 38124618 PMCID: PMC11161318 DOI: 10.1111/jcpp.13937] [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] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Self-regulation in early childhood develops within a social context. Variations in such development can be attributed to inter-individual behavioral differences, which can be captured both as facets of temperament and across a normal:abnormal dimensional spectrum. With increasing emphasis on irritability as a robust early-life transdiagnostic indicator of broad psychopathological risk, linkage to neural mechanisms is imperative. Currently, there is inconsistency in the identification of neural circuits that underlie irritability in children, especially in social contexts. This study aimed to address this gap by utilizing a functional magnetic resonance imaging (fMRI) paradigm to investigate pediatric anger/frustration using social stimuli. METHODS Seventy-three children (M = 6 years, SD = 0.565) were recruited from a larger longitudinal study on irritability development. Caregivers completed questionnaires assessing irritable temperament and clinical symptoms of irritability. Children participated in a frustration task during fMRI scanning that was designed to induce frustration through loss of a desired prize to an animated character. Data were analyzed using both general linear modeling (GLM) and independent components analysis (ICA) and examined from the temperament and clinical perspectives. RESULTS ICA results uncovered an overarching network structure above and beyond what was revealed by traditional GLM analyses. Results showed that greater temperamental irritability was associated with significantly diminished spatial extent of activation and low-frequency power in a network comprised of the posterior superior temporal sulcus (pSTS) and the precuneus (p < .05, FDR-corrected). However, greater severity along the spectrum of clinical expression of irritability was associated with significantly increased extent and intensity of spatial activation as well as low- and high-frequency neural signal power in the right caudate (p < .05, FDR-corrected). CONCLUSIONS Our findings point to specific neural circuitry underlying pediatric irritability in the context of frustration using social stimuli. Results suggest that a deliberate focus on the construction of network-based neurodevelopmental profiles and social interaction along the normal:abnormal irritability spectrum is warranted to further identify comprehensive transdiagnostic substrates of the irritability.
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Affiliation(s)
- Khalil I Thompson
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Clayton J Schneider
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Justin A Lopez-Roque
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburg School of Medicine, Pittsburgh, PA, USA
| | - Susan B Perlman
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
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Sorcher LK, Silver J, Chad-Friedman E, Carlson GA, Klein DN, Dougherty LR. Early Predictors and Concurrent Correlates of Tonic and Phasic Irritability in Adolescence. Res Child Adolesc Psychopathol 2024; 52:1105-1117. [PMID: 38478358 DOI: 10.1007/s10802-024-01185-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 07/03/2024]
Abstract
Irritability is a common presenting problem in youth mental health settings that is thought to include two components: tonic (e.g., irritable, touchy mood) and phasic (e.g., temper outbursts), each with unique correlates and outcomes, including later internalizing and externalizing problems, respectively. However, we are unaware of any studies of early predictors of tonic and phasic irritability. We utilized data from a longitudinal study of a community sample of 3-year-old children followed to age 15 (n = 444). We conducted confirmatory factor analysis (CFA) of items from several self-report irritability measures at age 15, including the Affective Reactivity Index, the International Personality Item Pool, the Schedule for Non-Adaptive and Adaptive Personality Youth Version, and the Child Depression Inventory, and examined their early childhood predictors. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability at age 15 was uniquely associated with concurrent internalizing disorders and suicidal behavior while phasic irritability was uniquely associated with concurrent externalizing disorders. When adolescent tonic and phasic irritability were examined together, female sex and parental depressive and substance use disorders at age 3 uniquely predicted adolescent tonic irritability. Additionally, male sex, less parental education, greater laboratory-observed anger and impulsivity, ODD symptoms, higher irritability, and no parental substance use history at age 3 uniquely predicted adolescent phasic irritability. Youth-reported tonic and phasic irritability at age 15 appear to be distinguishable constructs with distinct concurrent correlates and early antecedents. Findings have important implications for research on the etiology of irritability and developing effective treatments.
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Affiliation(s)
- Leah K Sorcher
- Department of Psychology, University of Maryland College Park, College Park, MD, 20742, USA.
| | - Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Emma Chad-Friedman
- Department of Psychology, University of Maryland College Park, College Park, MD, 20742, USA
| | - Gabrielle A Carlson
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Lea R Dougherty
- Department of Psychology, University of Maryland College Park, College Park, MD, 20742, USA
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Lu B, Fang Y, Cai J, Chen Z. Psychometric Evaluation of the Affective Reactivity Index Among Children and Adolescents in China: A Multi-Method Assessment Approach. Assessment 2024; 31:1020-1037. [PMID: 37837333 DOI: 10.1177/10731911231199424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
The Affective Reactivity Index (ARI) is one of the most studied scales for assessing youth irritability, but little is known about its measurement performance in community populations. This study applied item response theory (IRT), network analysis, and classical test theory (CTT) to examine the psychometric properties of the ARI in a sample of n = 395 community-based children (Mage = 13.44, SD = 2.51) and n = 403 parents. In this sample, the ARI demonstrated good reliability, as well as convergent and concurrent validity. The one-factor structure was supported by both confirmatory factor analysis (CFA) and network analysis. IRT analysis revealed that the ARI effectively distinguished between various levels of irritability within the community population. Network analysis identified "Loses temper easily,""Gets angry frequently," and "Often loses temper" are central aspects of irritability. The findings support the ARI as a brief, reliable, and valid instrument to assess irritability in community children and adolescents.
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Affiliation(s)
- Boqing Lu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuan Fang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jimin Cai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhiyan Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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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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7
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DeGroot H, Silver J, Klein DN, Carlson GA. Parent and Teacher Ratings of Tonic and Phasic Irritability in a Clinical Sample. Res Child Adolesc Psychopathol 2024; 52:891-903. [PMID: 38236382 DOI: 10.1007/s10802-023-01151-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] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 01/19/2024]
Abstract
Research on tonic (persistently angry or grumpy mood) and phasic (temper tantrums/outbursts) irritability in youth has utilized community samples and information from parents and youth. We examined whether tonic and phasic irritability are empirically distinguishable and have similar correlates using teacher, in addition to parent, reports in a clinical sample of children and adolescents. The sample included youth aged 5-18 evaluated at a university outpatient clinic, with complete information from 2481 parents and 2449 teachers. We conducted confirmatory factor analysis (CFA) using items from several parent- and teacher-report inventories and examined concurrent associations with psychopathology and functioning. The CFA supported a two-factor model consistent with tonic and phasic irritability in both parent- and teacher-reports. Parent-reported tonic irritability was associated with higher rates of depression and anxiety disorders, suicidality, and antidepressant medication use. Teacher-reported tonic irritability was associated with elevated rates of depression and antidepressant use. Both parent- and teacher-reported phasic irritability were linked to higher rates of ADHD combined type, oppositional defiant/conduct disorders, and referral for rages. Parent- and teacher-reported tonic and phasic irritability were all associated with impaired social functioning. Parents and teachers can distinguish tonic and phasic irritability, which are associated with internalizing and externalizing problems, respectively. Findings were generally consistent across informants, and with prior studies using community samples.
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Affiliation(s)
- Harriet DeGroot
- University of Alabama Psychology Department, Tuscaloosa, AL, USA.
| | - Jamilah Silver
- Stony Brook University, Department of Psychology, Stony Brook, NY, USA
| | - Daniel N Klein
- Stony Brook University, Department of Psychology, Stony Brook, NY, USA
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8
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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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9
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Elvin OM, Modecki KL, Waters AM. An Expanded Conceptual Framework for Understanding Irritability in Childhood: The Role of Cognitive Control Processes. Clin Child Fam Psychol Rev 2024; 27:381-406. [PMID: 38856946 PMCID: PMC11222227 DOI: 10.1007/s10567-024-00489-0] [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] [Accepted: 05/08/2024] [Indexed: 06/11/2024]
Abstract
Children prone to irritability experience significant functional impairments and internalising and externalising problems. Contemporary models have sought to elucidate the underlying mechanisms in irritability, such as aberrant threat and reward biases to improve interventions. However, the cognitive control processes that underlie threat (e.g., attention towards threats) and reward (e.g., attention towards reward-related cues) biases and the factors which influence the differential activation of positive and negative valence systems and thus leading to maladaptive activation of cognitive control processes (i.e., proactive and reactive control) are unclear. Thus, we aim to integrate extant theoretical and empirical research to elucidate the cognitive control processes underlying threat and reward processing that contribute to irritability in middle childhood and provide a guiding framework for future research and treatment. We propose an expanded conceptual framework of irritability that includes broad intraindividual and environmental vulnerability factors and propose proximal 'setting' factors that activate the negative valence and positive valence systems and proactive and reactive cognitive control processes which underpin the expression and progression of irritability. We consider the implications of this expanded conceptualisation of irritability and provide suggestions for future research.
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Affiliation(s)
- Olivia M Elvin
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia.
| | - Kathryn L Modecki
- Centre for Mental Health and School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia
- School of Psychological Science, University of Western Australia & Telethon Kids Institute, Perth, Australia
| | - Allison M Waters
- Centre for Mental Health and School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia.
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10
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Kaurin A, Wright AGC, Porta G, Hamilton E, Poling K, Bero K, Brent D, Goldstein TR. Weekly links among irritability and suicidal thoughts and behaviors in high-risk youth. J Child Psychol Psychiatry 2024. [PMID: 38651278 DOI: 10.1111/jcpp.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e. trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods. METHODS The present study used clinical data from 689 adolescents aged 12-19 years attending a total of 6,128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends via multilevel structural equation modeling. Youth completed self-report measures of irritability, depression, and STBs weekly as part of standard IOP clinical care. RESULTS Overall, two-thirds of variance in weekly irritable mood was accounted for by between-person differences and the remaining portion by weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity. CONCLUSIONS Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.
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Affiliation(s)
- Aleksandra Kaurin
- Department of Psychology, University of Wuppertal, Wuppertal, Germany
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Giovanna Porta
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edward Hamilton
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly Poling
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kelsey Bero
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Brent
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tina R Goldstein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Johns-Mead R, Vijayakumar N, Mulraney M, Melvin G, Anderson VA, Efron D, Silk TJ. The longitudinal relationship between socioemotional difficulties and irritability in ADHD. J Affect Disord 2024; 350:573-581. [PMID: 38244802 DOI: 10.1016/j.jad.2024.01.151] [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: 10/12/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Despite higher rates of irritability and socioemotional symptoms in ADHD, consensus is lacking regarding their developmental relationship and whether it differs by ADHD status. This longitudinal study sought to evaluate how peer and emotional difficulties relate to irritability in ADHD and control groups. METHODS A community sample of 336 participants (45 % ADHD) were recruited for the Children's Attention Project. Participants completed the Affective Reactivity Index and the Strengths and Difficulties Questionnaire's emotional and peer difficulties scales at baseline (mean age 10.5 years) and 18-month follow-up. Latent Change Score models assessed how emotional and peer difficulties related to irritability at baseline and longitudinally. RESULTS For both groups, more severe baseline difficulties were associated with higher concurrent irritability, and reductions in emotional and peer difficulties were associated with declining irritability. Baseline emotional difficulties predicted change in irritability for the ADHD group, while baseline peer difficulties predicted change in irritability for both groups. Baseline irritability did not predict change in emotional or peer difficulties for either. The ADHD group showed elevated irritability, emotional, and peer difficulties, and stronger baseline correlation between peer difficulties and irritability. LIMITATIONS Only two timepoints were captured, and associations with ADHD symptom severity and presentation were not investigated. Doing so may facilitate additional insights. CONCLUSIONS Change in irritability corresponded to change in socioemotional difficulties, and was driven by earlier levels of socioemotional difficulties. ADHD exacerbated aspects of the relationship between socioemotional difficulties and irritability. Socioemotional difficulties drive irritability, so may represent targets for clinical interventions.
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Affiliation(s)
- Rania Johns-Mead
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Nandita Vijayakumar
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Glenn Melvin
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tim J Silk
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
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12
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Hyde LW, Bezek JL, Michael C. The future of neuroscience in developmental psychopathology. Dev Psychopathol 2024:1-16. [PMID: 38444150 DOI: 10.1017/s0954579424000233] [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: 03/07/2024]
Abstract
Developmental psychopathology started as an intersection of fields and is now a field itself. As we contemplate the future of this field, we consider the ways in which a newer, interdisciplinary field - human developmental neuroscience - can inform, and be informed by, developmental psychopathology. To do so, we outline principles of developmental psychopathology and how they are and/or can be implemented in developmental neuroscience. In turn, we highlight how the collaboration between these fields can lead to richer models and more impactful translation. In doing so, we describe the ways in which models from developmental psychopathology can enrich developmental neuroscience and future directions for developmental psychopathology.
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Affiliation(s)
- Luke W Hyde
- Department of Psychology, Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Jessica L Bezek
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Cleanthis Michael
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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13
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Derella OJ, Butler EJ, Seymour KE, Burke JD. Frustration Response and Regulation Among Irritable Children: Contributions of Chronic Irritability, Internalizing, and Externalizing Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:199-215. [PMID: 37698941 DOI: 10.1080/15374416.2023.2246557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVE The need to understand and treat childhood chronic irritability (CI; i.e. frequent temper loss and angry/irritable mood) is imperative. CI predicts impairment across development and complex comorbidities with both internalizing and externalizing disorders. Research has emphasized frustration reactivity as a key mechanism of CI. However, there are understudied components of frustrative non-reward, particularly regulation-oriented frustration recovery, frustration tolerance, and cognitive control, that may further explain impairments specific to CI beyond comorbid symptoms. METHOD Sixty-three community children (N = 25 CI/38 non-CI) and a parent completed surveys and the computerized Frustration Go/No-Go (FGNG) and Mirror Tracing Persistence Task (MTPT). Analyses compared task performance and self-rated affect across youth with or without CI, with further comparison based on negative/positive screen for ADHD (N = 45-/18+). RESULTS In mixed effects models assessing change across task, the CI group did not demonstrate more intense frustration on the MTPT or rigged FGNG block but exhibited persisting frustration and inhibitory control difficulties into the FGNG recovery period; the CI+ADHD subgroup drove recovery effects. In GEE and logistic regression models including dimensional symptom clusters, only internalizing symptoms predicted child frustration intolerance and reactivity across tasks. ADHD severity was also associated with higher MTPT frustration reactivity, while oppositional behavior predicted lower frustration. Better frustration recovery was associated with lower irritability, but higher internalizing symptoms. CONCLUSIONS Co-occurring symptoms may better explain some frustration-related difficulties among youth with CI. Difficulties with postfrustration affect and inhibitory control recovery suggest the importance of characterizing CI by self-regulation impairments.
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Affiliation(s)
- Olivia J Derella
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center/Albert Einstein College of Medicine
- Department of Psychological Sciences, University of Connecticut
| | - Emilie J Butler
- Department of Psychological Sciences, University of Connecticut
| | | | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut
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14
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Evans SC, Karlovich AR, Khurana S, Edelman A, Buza B, Riddle W, López-Sosa D. Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:277-308. [PMID: 38275270 PMCID: PMC11042996 DOI: 10.1080/15374416.2023.2292041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents. METHOD We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3-18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability. RESULTS Overall, 68 instruments met criteria for inclusion, with scales covering irritability (n = 15), anger (n = 19), aggression (n = 45), and/or general overt externalizing problems (n = 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized. CONCLUSIONS Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth.
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Affiliation(s)
- Spencer C. Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Sakshi Khurana
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
- College of Education, DePaul University, Chicago, IL, USA
| | - Audrey Edelman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Bianca Buza
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - William Riddle
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Denise López-Sosa
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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15
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Shields A, Reardon K, Lawler T, Tackett J. Affective Contributions to Instrumental and Reactive Aggression in Middle Childhood: Variable- and Person-Centered Approaches. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:169-183. [PMID: 38039086 DOI: 10.1080/15374416.2023.2272951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Research on the role of affect in childhood aggression motives has largely focused on domain-level affective traits. Lower-order affective facets may show more distinct relationships with instrumental and reactive aggression - at both the variable and individual levels - and offer unique insights into whether and how several forms of affect are involved in aggression motives. METHOD Caregivers (98% mothers) of 342 children (Mage = 9.81 years, 182 girls, 31% White) reported on children's aggression and affect-relevant personality traits, personality pathology, and callous-unemotional traits. RESULTS Both reactive and instrumental aggressions were characterized by higher levels of trait irritability, fear, withdrawal, sadness, and callous-unemotional traits in zero-order analyses. Instrumental aggression was characterized by low trait positive emotions. Reactive aggression was uniquely associated with irritability, fear, withdrawal, and sadness, whereas instrumental aggression was uniquely associated with callous-unemotional traits and (low) positive emotions. Groups identified by latent profile analyses were differentiated only by aggression severity. CONCLUSIONS The findings support both the similarity and distinction of reactive and instrumental aggression vis-à-vis their affective phenomenology. Consistent with existing theories, reactive aggression was linked to multiple forms of negative emotionality, whereas instrumental aggression was linked to higher levels of callous-unemotional traits. In a novel finding, instrumental aggression was uniquely characterized by lower positive emotions. The findings highlight the utility of pre-registered approaches employing comprehensive personality-based affective frameworks to organize and understand similarities and differences between aggression functions.
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16
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Evans SC, Burke JD. The Affective Side of Disruptive Behavior: Toward Better Understanding, Assessment, and Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:141-155. [PMID: 38656139 DOI: 10.1080/15374416.2024.2333008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Historically, much of the progress made in youth mental health research can be classified as focusing on externalizing problems, characterized by disruptive behavior (e.g. aggression, defiance), or internalizing problems, characterized by intense negative affect (e.g. depression, anxiety). Until recently, however, less attention has been given to topics that lie somewhere in between these domains, topics that we collectively refer to as the affective side of disruptive behavior. Like the far side of the moon, the affective side of disruptive behavior captures facets of the phenomenon that may be less obvious or commonly overlooked, but are nonetheless critical to understand. This affective side clarifies socially disruptive aspects of traditionally "externalizing" behavior by elucidating proximal causation via intense negative affect (traditionally "internalizing"). Such problems include irritability, frustration, anger, temper loss, emotional outbursts, and reactive aggression. Given a recent explosion of research in these areas, efforts toward integration are now needed. This special issue was developed to help address this need. Beyond the present introductory article, this collection includes 4 empirical articles on developmental psychopathology topics, 4 empirical articles on applied treatment/assessment topics, 1 evidence base update review article on measurement, and 2 future directions review articles concerning outbursts, mood, dispositions, and youth psychopathology more broadly. By deliberatively investigating the affective side of disruptive behavior, we hope these articles will help bring about better understanding, assessment, and treatment of these challenging problems, for the benefit of youth and families.
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Affiliation(s)
| | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut
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17
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Archer C, Meza-Cervera T, Scheinberg B, Kircanski K, Brotman MA, Pine DS, Leibenluft E, Linke JO. Irritability, Negative Life Events and the Course of Anxiety and Depressive Symptoms in a Clinical Sample of Youth: A Longitudinal Study. JAACAP OPEN 2024; 2:45-54. [PMID: 38699439 PMCID: PMC11062628 DOI: 10.1016/j.jaacop.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Objective Irritability, the tendency to react with anger, and the experience of negative life events (NLE) have independently been associated with the emergence of anxiety and depression. Here, we investigate how irritability and cumulative effects of NLE interactively predict the course of anxiety and depression in the context of common psychiatric disorders. Method 432 youth with no psychiatric diagnosis, or a diagnosis of an anxiety disorder, Attention-Deficit/ Hyperactivity Disorder (ADHD), or Disruptive Mood Dysregulation Disorder (DMDD), participated in this study. At baseline, we assessed NLE, parent and youth reports of irritability and anxiety, and youth reports of depression. Symptoms were annually reassessed for up to four years. Results In youth without psychiatric diagnoses but with elevated baseline irritability, the presence of NLE predicted decreasing anxiety, while the absence of NLE predicted increasing anxiety. In youth with an anxiety disorder, elevated baseline irritability predicted decreasing anxiety independent of NLE, while a large cumulative effect of NLE predicted increasing depression. NLE predicted persisting mild anxiety in ADHD and persisting mild depressive symptoms in DMDD. Conclusion Our findings suggest that, particularly in non-referred samples, NLE might moderate the relationship between irritability and future anxiety such that irritability/ anger in the context of NLE can positively affect the course of anxiety. Future work replicating this finding while repeatedly measuring NLE and rigorously controlling for potentially confounding effects of treatment, is warranted.
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Affiliation(s)
- Camille Archer
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Tatiana Meza-Cervera
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Brooke Scheinberg
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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18
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Sánchez Hernández MO, Holgado-Tello FP, Carrasco MÁ. The dynamics of psychological attributes and symptomatic comorbidity of depression in children and adolescents. Soc Psychiatry Psychiatr Epidemiol 2024; 59:341-351. [PMID: 37477729 PMCID: PMC10838844 DOI: 10.1007/s00127-023-02532-x] [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: 12/14/2022] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE This investigation aimed to explore attribute dynamics and symptomatic comorbidity of depression with internalizing, externalizing, and other personal-contextual problems in children and adolescents from a network analysis. METHODS We tested an attribute network of regularized partial correlations, standard and alternative centrality measures, and comorbidity bridge symptoms according to centrality bridge measures. RESULTS Regularized partial correlation network and a centrality measures graph shown the prominent position of social problems and anxiety-depression. Minimum spanning tree (MST) found a hierarchical dynamics between attributes where mixed anxiety-depression was identified as the core and the other attributes were hierarchically connected to it by being positioned in six branches that are differentiated according to their theoretical contents. The most central connections are established with the attributes of their own community or theoretical groups, and 37 bridge symptoms were identified in all networks. CONCLUSIONS A significant role of mixed anxiety depression as an activator and intermediary of psychopathologies was supported as a central attribute of internalizing problems. Aggressive behavior as part of the broad externalizing dimension was one of the constructs that most intensively activate the network, and social problems were also distinguished as a relevant factor not only in terms of connections and central attributes but also in terms of bridge symptoms and comorbidity. This framework extends to the study of symptomatic "comorbidity."
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Dissanayake AS, Dupuis A, Arnold PD, Burton CL, Crosbie J, Schachar RJ, Levy T. Is irritability multidimensional: Psychometrics of The Irritability and Dysregulation of Emotion Scale (TIDES-13). Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02350-1. [PMID: 38228758 DOI: 10.1007/s00787-023-02350-1] [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: 04/11/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024]
Abstract
Irritability is a common, impairing, and potentially multifaceted manifestation of psychopathology. We designed The Irritability and Dysregulation of Emotion Scale (TIDES-13) to determine whether various expressions of irritability in children and youth form multiple subdimensions with distinct correlates. We administered parent-report (n = 3875, mean age = 8.9) and youth self-report (n = 579, mean age = 15.1) versions of TIDES-13 in a population and community-based sample. We conducted exploratory/confirmatory factor analyses and regression analyses to examine the dimensionality of TIDES-13 and the associations of the scale with age, gender, anxiety, depression, ODD, ADHD traits, and the Affective Reactivity Index (ARI). A higher-order model with a global irritability dimension and four subdimensions, including proneness to anger (PA), internalized negative emotional reactivity (iNER), externalized negative emotional reactivity (eNER), and reactive aggression (RA), showed good to excellent fit in both parent-report and self-report. The global irritability dimension showed excellent internal reliability (⍵Total; parent-report = 0.97, ⍵Total; self-report = 0.95), explained a majority of the item variance (⍵Hierarchical; parent-report = 0.94, ⍵Hierarchical; self-report = 0.90), and was moderately correlated with the ARI (rparent = 0.68, rself = 0.77). Subdimensions PA, eNER, and RA were negatively associated with age in males, whereas iNER was positively associated with age in females. Traits of ODD and ADHD were associated primarily with the global irritability dimension, whereas iNER was strongly associated with anxiety and depression traits over and above the global irritability dimension. Our results support a unidimensional interpretation of irritability in a population sample. However, limited evidence of specific behavioral, age, and sex correlates with particular irritability subdimensions may warrant further investigation.
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Affiliation(s)
| | - Annie Dupuis
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul D Arnold
- Department of Child and Adolescent Psychiatry, The Mathison Centre for Mental Health Research & Education, Calgary, AB, Canada
| | - Christie L Burton
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Tomer Levy
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Behavior Regulation Service, Geha Mental Health Center, Petach-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Anning KL, Langley K, Hobson C, van Goozen SHM. Cool and hot executive function problems in young children: linking self-regulation processes to emerging clinical symptoms. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02344-z. [PMID: 38183461 DOI: 10.1007/s00787-023-02344-z] [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: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024]
Abstract
Self-regulation (SR) difficulties are implicated in a wide range of disorders which develop in childhood, including attention deficit hyperactivity disorder (ADHD), oppositional defiance disorder (ODD), anxiety and depression. However, the integration of the existing research evidence is challenging because of varying terminology and the wide range of tasks used, as well as the heterogeneity and comorbidity within and across diagnostic categories. The current study used the Research Domain Criteria (RDoC) framework to guide the examination of different SR processes in young children showing a wide range of symptomatology. Children (aged 4-8) referred by teachers for moderate-to-high conduct, hyperactivity and/or emotional problems at school (assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales; n = 212), and children in SDQ typical ranges (n = 30) completed computerised cognitive control and decision-making tasks. Parents completed questionnaires to assess ADHD, ODD, anxiety and depression symptoms (n = 191). Compared to children with no teacher-reported difficulties, those with moderate-to-high problems showed poorer visuomotor control and decision-making. A factor analysis revealed that task variables adhered to RDoC dimensions and predicted variance in specific disorders: difficulties in cognitive control predicted ADHD symptoms, low reward-seeking was associated with depression and high reward-seeking was associated with ODD. This study highlights how the assessment of cognitive processes positioned within the RDoC framework can inform our understanding of disorder-specific and transdiagnostic difficulties in SR which are associated with diverse clinical symptoms in children.
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Affiliation(s)
- Kate L Anning
- School of Psychology, Cardiff University, Cardiff, UK.
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
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21
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Brænden A, Coldevin M, Zeiner P, Stubberud J, Melinder A. Executive function in children with disruptive mood dysregulation disorder compared to attention-deficit/hyperactivity disorder and oppositional defiant disorder, and in children with different irritability levels. Eur Child Adolesc Psychiatry 2024; 33:115-125. [PMID: 36680626 PMCID: PMC9867548 DOI: 10.1007/s00787-023-02143-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
Addressing current challenges in research on disruptive mood dysregulation disorder (DMDD), this study aims to compare executive function in children with DMDD, children with attention-deficit/hyperactivity disorder (ADHD), and children with oppositional defiant disorder (ODD). We also explore associations between irritability, a key DMDD characteristic, and executive function in a clinical sample regardless of diagnosis. Our sample include children (6-12 years) referred to child psychiatric clinics. Measures of daily-life (parent-reported questionnaire) and performance-based (neuropsychological tasks) executive function were applied. Identifying diagnoses, clinicians administered a standardized semi-structured diagnostic interview with parents. Irritability was assessed by parent-report. First, we compared executive function in DMDD (without ADHD/ODD), ADHD (without DMDD/ODD), ODD (without DMDD/ADHD) and DMDD + ADHD (without ODD). Second, we analyzed associations between executive function and irritability using the total sample. In daily life, children with DMDD showed clinically elevated and significantly worse emotion control scores compared to children with ADHD, and clinically elevated scores on cognitive flexibility compared to norm scores. Children with DMDD had significantly less working memory problems than those with ADHD. No differences were found between DMDD and ODD. Increased irritability was positively associated with emotional dyscontrol and cognitive inflexibility. For performance-based executive function, no diagnostic differences or associations with irritability were observed. We discuss how, in daily life, children with high irritability-levels get overwhelmed by feelings without accompanying regulatory capacities.
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Affiliation(s)
- Astrid Brænden
- Division of Mental Health and Addiction, Oslo University Hospital, Sognsveien 22, 0372, Oslo, Norway.
| | - Marit Coldevin
- Lovisenberg Diaconal Hospital, Nic Waals Institute, Oslo, Norway
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Sognsveien 22, 0372, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Annika Melinder
- Division of Mental Health and Addiction, Oslo University Hospital, Sognsveien 22, 0372, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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22
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Orsolini L, Longo G, Cicolini A, Volpe U. An expert opinion on the pharmacological interventions for Disruptive Mood Dysregulation Disorder (DMDD). Expert Opin Pharmacother 2024; 25:67-78. [PMID: 38186365 DOI: 10.1080/14656566.2024.2303422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Disruptive Mood Dysregulation Disorder (DMDD) was officially introduced as a new diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), under the category of depressive disorders. AREAS COVERED A comprehensive overview and a critical commentary on the currently investigated psychopharmacological approaches for the treatment of DMDD have been here provided. EXPERT OPINION Behavioral and psychosocial interventions should be considered as first-line treatment strategies. When ineffective or partially effective, psychopharmacological strategy is recommended. Overall, pharmacological strategy should be preferred in those individuals with psychiatric comorbidities (e.g. ADHD). Indeed, so far published studies on pharmacological strategies in DMDD are scant and heterogeneous (i.e. age, assessment tools, symptomatology profile, comorbidity, and so forth). Therefore, DMDD psychopharmacological guidelines are needed, particularly to guide clinicians toward the patient's typical symptom profile who could benefit from psychopharmacological strategy.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Longo
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Angelica Cicolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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Srinivasan R, Flouri E, Lewis G, Solmi F, Stringaris A, Lewis G. Changes in Early Childhood Irritability and Its Association With Depressive Symptoms and Self-Harm During Adolescence in a Nationally Representative United Kingdom Birth Cohort. J Am Acad Child Adolesc Psychiatry 2024; 63:39-51. [PMID: 37391129 PMCID: PMC11163475 DOI: 10.1016/j.jaac.2023.05.027] [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: 05/11/2022] [Revised: 04/28/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE This study aimed to investigate longitudinal associations between changes in early childhood irritability, and depressive symptoms and self-harm at 14 years. METHOD We used data from 7,225 children in a UK-based general population birth cohort. Childhood irritability was measured at 3, 5, and 7 years using 4 items from 2 questionnaires (the Children's Social Behaviour Questionnaire [CSBQ] and the Strengths and Difficulties Questionnaire [SDQ]). Participants reported depressive symptoms via the short Mood and Feelings Questionnaire (sMFQ) and self-harm via a single-item question, at 14 years. We used multilevel models to calculate within-child change in irritability between 3 and 7 years and examined associations between irritability, and depressive symptoms and self-harm at 14 years using linear and logistic regression models, respectively. We adjusted for child and family sociodemographic/economic characteristics, mental health difficulties, and child cognitive development. RESULTS Irritability at ages 5 and 7 years was positively associated with depressive symptoms and self-harm at age 14 years. Irritability that remained high between 3 and 7 years was associated with depressive symptoms and self-harm at 14 years in unadjusted (depressive symptoms: β coefficient = 0.22, 95 % CI = 0.08-0.37, p = .003; self-harm: odds ratio = 1.09, 95 % CI = 1.01-1.16, p = .019) and adjusted models (depressive symptoms: β coefficient = 0.31, 95 % CI = 0.17-0.45, p < .001; self-harm: odds ratio = 1.12, 95 % CI = 1.0.4-1.19, p = .004). Results were similar in imputed samples. CONCLUSION Children with irritability that remains high between 3 and 7 years are more likely to report higher depressive symptoms and self-harm during adolescence. These findings support early intervention for children with high irritability and universal interventions in managing irritability for parents of preschool-aged children.
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Affiliation(s)
| | | | - Gemma Lewis
- UCL Division of Psychiatry, London, United Kingdom
| | | | - Argyris Stringaris
- UCL Division of Psychiatry, London, United Kingdom; Emotion & Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Glyn Lewis
- UCL Division of Psychiatry, London, United Kingdom
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Burke JD, Butler EJ, Shaughnessy S, Karlovich AR, Evans SC. Evidence-Based Assessment of DSM-5 Disruptive, Impulse Control, and Conduct Disorders. Assessment 2024; 31:75-93. [PMID: 37551425 DOI: 10.1177/10731911231188739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The assessment of oppositional defiant disorder, conduct disorder, antisocial personality disorder, and intermittent explosive disorder-the Disruptive, Impulse Control and Conduct Disorders-can be affected by biases in clinical judgment, including overestimating concerns about distinguishing symptoms from normative behavior and stigma associated with diagnosing antisocial behavior. Recent nosological changes call for special attention during assessment to symptom dimensions of limited prosocial emotions and chronic irritability. The present review summarizes best practices for evidence-based assessment of these disorders and discusses tools to identify their symptoms. Despite the focus on disruptive behavior disorders, their high degree of overlap with disruptive mood dysregulation disorder can complicate assessment. Thus, the latter disorder is also included for discussion here. Good practice in the assessment of disruptive behavior disorders involves using several means of information gathering (e.g., clinical interview, standardized rating scales or checklists), ideally via multiple informants (e.g., parent-, teacher-, and self-report). A commitment to providing a full and accurate diagnostic assessment, with careful and attentive reference to diagnostic guidelines, will mitigate concerns regarding biases.
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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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26
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Levy T, Dupuis A, Andrade BF, Crosbie J, Kelley E, Nicolson R, Schachar RJ. Facial emotion recognition in children and youth with attention-deficit/hyperactivity disorder and irritability. Eur Child Adolesc Psychiatry 2023; 32:2271-2280. [PMID: 36050559 DOI: 10.1007/s00787-022-02033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
The ability to recognize emotions evident in people's faces contributes to social functioning and might be affected by ADHD and irritability. Given their high co-occurrence, we examined the relative contribution of ADHD and irritability to facial emotion recognition (FER). We hypothesized that irritability but not ADHD traits would predict increased likelihood of misrecognizing emotions as negative, and that FER performance would explain the association of ADHD and irritability traits with social skills. FER was measured using the Reading the Mind in the Eyes Test (RMET) in children (6-14 years old) referred for ADHD assessment (n = 304) and healthy controls (n = 128). ADHD, irritability and social skills were measured using parent ratings. We used repeated measure logistics regression, comparing the effects across emotion valence of images (i.e., neutral/positive/negative). High irritability but not ADHD diagnosis predicted lower RMET accuracy. ADHD traits predicted lower RMET accuracy in younger but not older participants, whereas irritability predicted poorer accuracy at all ages. ADHD traits predicted lower RMET accuracy across all emotion valences, whereas irritability predicted increased probability of misrecognizing neutral and positive but not negative emotions. Irritability did not increase the probability for erroneously recognizing emotions as negative. ADHD and irritability traits fully explained the association between RMET and social skills. ADHD and irritability traits might impact the ability to identify emotions portrayed in faces. However, irritability traits appear to selectively impair recognition of neutral and positive but not negative emotions. ADHD and irritability are important when examining the link between FER and social difficulties.
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Affiliation(s)
- Tomer Levy
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Annie Dupuis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brendan F Andrade
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Kelley
- Department of Psychology and Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Rob Nicolson
- Department of Psychiatry, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada
| | - Russell James Schachar
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Li Y, Tian W, Liu P, Geng F. A cross-sectional analysis of the relationships between anxiety sensitivity and youth irritability: the mediated roles of insomnia and selective attention for threat. BMC Psychiatry 2023; 23:782. [PMID: 37880675 PMCID: PMC10598902 DOI: 10.1186/s12888-023-05280-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: 05/25/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Irritability is common in multiple psychiatric disorders and is hallmark of disruptive mood dysregulation disorder. Child irritability is associated with higher risk of suicide and adulthood mental health problems. However, the psychological mechanisms of irritability are understudied. This study examined the relationship between anxiety sensitivity and irritability among youth, and further explored three possible mediated factors: selective attention for threat, delayed reward discounting, and insomnia. METHODS Participants were 1417 students (51.7% male; mean age 13.83 years, SD = 1.48) recruited from one high school in Hunan province, China. Self-report questionnaires were used to measure irritability (The Affective Reactivity Index and The Brief Irritability Test), anxiety sensitivity (The Childhood Anxiety Sensitivity Index), selective attention for threat (The Davos Assessment of Cognitive Biases Scale-attention for threat bias subscale), insomnia (The Youth Self-Rating Insomnia Scale), and delayed reward discounting (The 27-item Monetary Choice Questionnaire). Structural equation modal (SEM) was performed to examine mediated relations. RESULTS Anxiety sensitivity was modestly related to irritability and insomnia (r from 0.25 to 0.54) and slightly correlated with selective attention for threat (r from 0.12 to 0.28). However, there is no significant relationship of delayed rewards discounting with anxiety sensitivity and irritability. The results of SEM showed that selective attention for threat (indirect effect estimate = 0.04) and insomnia (indirect effect estimate = 0.20) partially mediate the relationship between anxiety sensitivity and irritability, which explained 34% variation. CONCLUSIONS Anxiety sensitivity is an important susceptibility factor for irritability. Selective attention for threat and insomnia are two mediated mechanisms to understand the relationship between anxiety sensitivity and irritability.
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Affiliation(s)
- Yalin Li
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, Jiangxi, 330022, China
| | - Wanfu Tian
- Chenzhou Xiangnan Middle School, Chenzhou, China
| | - Ping Liu
- Chenzhou Xiangnan Middle School, Chenzhou, China
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, Jiangxi, 330022, China.
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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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Johns‐Mead R, Vijayakumar N, Mulraney M, Melvin G, Youssef G, Sciberras E, Anderson VA, Nicholson JM, Efron D, Hazel P, Silk TJ. Categorical and dimensional approaches to the developmental relationship between ADHD and irritability. J Child Psychol Psychiatry 2023; 64:1422-1431. [PMID: 37170636 PMCID: PMC10952727 DOI: 10.1111/jcpp.13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and irritability commonly co-occur, and follow similar developmental trajectories from childhood to adolescence. Understanding of the developmental relationship between these co-occurrences is limited. This study provides a longitudinal assessment of how ADHD diagnostic status and symptom patterns predict change in irritability. METHODS A community sample of 337 participants (45.2% ADHD), recruited for the Childhood Attention Project, completed the Affective Reactivity Index (ARI) to measure irritability at baseline (mean age 10.5 years) and follow-up after 18-months. Latent change score models were used to assess how (a) baseline ADHD vs. control group status, (b) baseline symptom domain (inattention, hyperactivity-impulsivity) and (c) longitudinal change in ADHD symptom severity predicted change in irritability. RESULTS Irritability was significantly higher among the ADHD group than controls; however, change in irritability over time did not differ between groups. When assessed across the entire cohort, change in irritability was predicted by higher symptom count in the hyperactive-impulsive domain, but not the inattentive domain. Greater declines in ADHD symptoms over time significantly predicted greater declines in irritability. Baseline ADHD symptom severity was found to significantly predict change in irritability; however, baseline irritability did not significantly predict change in ADHD symptoms. CONCLUSIONS ADHD symptoms-particularly hyperactive-impulsive symptoms-predict the degree and trajectory of irritability during childhood and adolescence, even when symptoms are below diagnostic thresholds. The use of longitudinal, dimensional and symptom domain-specific measures provides additional insight into this relationship.
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Affiliation(s)
- Rania Johns‐Mead
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Nandita Vijayakumar
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Melissa Mulraney
- Institute for Social NeuroscienceISN PsychologyIvanhoeVic.Australia
| | - Glenn Melvin
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - George Youssef
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
- Murdoch Children's Research InstituteMelbourneVic.Australia
| | - Vicki A. Anderson
- Murdoch Children's Research InstituteMelbourneVic.Australia
- The Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | | | - Daryl Efron
- Murdoch Children's Research InstituteMelbourneVic.Australia
- The Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | - Philip Hazel
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
| | - Tim J. Silk
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
- Murdoch Children's Research InstituteMelbourneVic.Australia
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Fekih-Romdhane F, Azzi V, Hallit R, Malaeb D, Dabbous M, Sakr F, Obeid S, Hallit S. Validation of the Arabic version of the brief irritability test (Ar-BITe) in non-clinical adolescents. BMC Psychiatry 2023; 23:701. [PMID: 37752461 PMCID: PMC10521430 DOI: 10.1186/s12888-023-05211-y] [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: 06/02/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Despite the substantial clinical relevance of irritability in the development and maintenance of several mental disorders and its negative effects on functioning, no valid and reliable measures are available yet to identify the presence and consequences of irritability as a distinct construct among the Arabic-speaking populations. To bridge this gap, and help advance this field in the under-researched Arab region, we aimed to validate an Arabic-language version of the Brief Irritability Test (BITe). METHODS Eligible participants were native Arabic-speaking non-clinical adolescents from Lebanon; 527 participants aged 15.73 ± 1.81 years (56% females) completed the survey. RESULTS Utilizing the Confirmatory Factor Analysis approach, we found that the five items of the Arabic BITe loaded into a single factor structure. The scale showed excellent reliability, as both Cronbach's alpha and McDonald's omega coefficient values were of 0.88. Multi-group analyses showed invariance across sex groups in our sample at the configural, metric, and scalar levels. Female adolescents exhibited higher BITe scores than their male counterparts (14.01 vs. 13.25), but this difference did not reach the statistical significance. Good concurrent validity was supported based on positive correlations between irritability scores and measures of aggression, anger and hostility (r Pearson's coefficients ranging from 0.35 to 0.42), as well as positive correlations with insomnia symptoms scores. CONCLUSION The present findings allow us to conclude that the Arabic version of the BITe is a unidimensional, reliable, valid, brief, and economic self-report measure of the irritability construct for both male and female Arabic-speakers. Providing an Arabic validated version of the BITe will hopefully foster the research efforts of the Arab scientific community in this area, and promote the implementation of timely, evidence-informed and culturally-sensitive mental health interventions that appropriately address irritability-related problems and consequences among Arab young populations.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours, University Hospital Center, Byblos, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Evans SC, Shaughnessy S, Karlovich AR. Future Directions in Youth Irritability Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:716-734. [PMID: 37487108 DOI: 10.1080/15374416.2023.2209180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the "whats") for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability's phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the "hows") that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth.
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Sorcher LK, Mennies RJ, Robeson M, Seeley JR, Klein DN, Dougherty LR, Olino TM. Offspring irritability: associations with parental psychopathology and personality. Eur Child Adolesc Psychiatry 2023; 32:1691-1699. [PMID: 35416605 DOI: 10.1007/s00787-022-01985-w] [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: 12/16/2021] [Accepted: 04/02/2022] [Indexed: 12/01/2022]
Abstract
Although there are well-established correlates and outcomes of irritability, there are fewer studies reporting on predictors of the longitudinal course of irritability in youth. The current report examined parent internalizing and externalizing psychopathology and dimensions of personality as predictors of the developmental course of irritability in youth. Offspring irritability was assessed between ages 2 and 10 years using the Irritability Factor from the parent-reported Child Behavior Checklist (N = 570, 53.51% female). Parental psychopathology was assessed with a clinical interview; parents also completed the General Temperament Survey as a measure of personality. Results demonstrated that offspring irritability decreased with age. Offspring irritability was associated with parental depressive and anxiety disorders, higher levels of negative emotionality/neuroticism (NE) and disinhibition, and lower levels of positive emotionality; parental NE and disinhibition remained unique predictors of offspring irritability in a multivariate model. Finally, parental externalizing disorders were associated with more stable trajectories of offspring irritability, whereas offspring of parents without a history of externalizing disorders showed decreasing irritability across time. Findings demonstrate that different aspects of parental personality and psychopathology have differential impacts on levels and course of offspring irritability.
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Affiliation(s)
- Leah K Sorcher
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - Rebekah J Mennies
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA
| | - Mackenzie Robeson
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - John R Seeley
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, USA
| | - Lea R Dougherty
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA.
| | - Thomas M Olino
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA.
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Mohamed Ali O, Vandermeer MRJ, Liu P, Joanisse MF, Barch DM, Hayden EP. Associations between childhood irritability and neural reactivity to maternal feedback in adolescence. Biol Psychol 2023; 182:108645. [PMID: 37596151 DOI: 10.1016/j.biopsycho.2023.108645] [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: 04/12/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 08/20/2023]
Abstract
Early irritability, a transdiagnostic vulnerability for psychopathology, is associated with alterations in neural reactivity to emotional stimuli and reward; however, associations between childhood irritability and neural markers of risk may be mitigated by the quality of caregiving youth receive. We examined longitudinal relationships between irritability in childhood and young adolescents' neural activity of regions typically associated with emotion regulation and reward processing during processing of maternal feedback and tested whether these associations were moderated by youth's perceptions of the parent-child relationship quality. Eighty-one adolescents (Mage = 11.1 years) listened to maternal critical and praising feedback while undergoing functional magnetic resonance imaging. Age 3 irritability, assessed observationally, was negatively associated with age 11 neural reactivity to maternal criticism in a cluster in the right dorsolateral prefrontal cortex (dlPFC), particularly for youths who reported more positive maternal parenting. Given the role of the dlPFC activation in the effortful processing of emotional stimuli, decreased activation may reflect disengagement from negatively valenced interpersonal feedback in the context of a positive caregiving environment, thereby mitigating psychopathology risk associated with irritability.
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Affiliation(s)
- Ola Mohamed Ali
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada.
| | - Matthew R J Vandermeer
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada; St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Pan Liu
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada; Department of Psychology, North Dakota State University, Fargo, ND 58102, USA
| | - Marc F Joanisse
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Elizabeth P Hayden
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON N6A 5B7, Canada
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Kalvin CB, Jordan R, Rowley S, Weis AL, Ibrahim K, Sukhodolsky DG. Aggression Is Associated With Social Adaptive Functioning in Children With ASD and Anxiety. FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES 2023; 38:168-176. [PMID: 38469453 PMCID: PMC10927274 DOI: 10.1177/10883576231165265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Social adaptive functioning is notably compromised and may be further impaired by aggressive behavior in children with autism spectrum disorder (ASD). This study examined the association between aggressive behavior and social adaptive skills in children with ASD and the contribution of aggressive behavior to social adaptive skills in a combined sample of children with and without ASD. Participants consisted of children, ages 8 to 15 years, with ASD (n = 52) and who were typically developing (n = 29). Results indicate that aggressive behavior is negatively associated with social adaptive skills in children with ASD and that it contributes to reduced social adaptive functioning above and beyond ASD diagnosis. Findings underscore the importance of considering the role of aggressive behavior when evaluating and promoting social functioning in children with ASD.
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Ravi S, Havewala M, Kircanski K, Brotman MA, Schneider L, Degnan K, Almas A, Fox N, Pine DS, Leibenluft E, Filippi C. Parenting and childhood irritability: Negative emotion socialization and parental control moderate the development of irritability. Dev Psychopathol 2023; 35:1444-1453. [PMID: 35039102 PMCID: PMC9289071 DOI: 10.1017/s0954579421001346] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Irritability, characterized by anger in response to frustration, is normative in childhood. While children typically show a decline in irritability from toddlerhood to school age, elevated irritability throughout childhood may predict later psychopathology. The current study (n = 78) examined associations between trajectories of irritability in early childhood (ages 2-7) and irritability in adolescence (age 12) and tested whether these associations are moderated by parenting behaviors. Results indicate that negative emotion socialization moderated trajectories of irritability - relative to children with low stable irritability, children who exhibited high stable irritability in early childhood and who had parents that exhibited greater negative emotion socialization behaviors had higher irritability in adolescence. Further, negative parental control behavior moderated trajectories of irritability - relative to children with low stable irritability, children who had high decreasing irritability in early childhood and who had parents who exhibited greater negative control behaviors had higher irritability in adolescence. In contrast, positive emotion socialization and control behaviors did not moderate the relations between early childhood irritability and later irritability in adolescence. These results suggest that both irritability in early childhood and negative parenting behaviors may jointly influence irritability in adolescence. The current study underscores the significance of negative parenting behaviors and could inform treatment.
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Affiliation(s)
- Sanjana Ravi
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Mazneen Havewala
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Leslie Schneider
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathryn Degnan
- Department of Psychology, Catholic University of America, Washington, DC, USA
| | - Alisa Almas
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nathan Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Courtney Filippi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 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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Tseng WL, Naim R, Chue A, Shaughnessy S, Meigs J, Pine DS, Leibenluft E, Kircanski K, Brotman MA. Network analysis of ecological momentary assessment identifies frustration as a central node in irritability. J Child Psychol Psychiatry 2023; 64:1212-1221. [PMID: 36977629 PMCID: PMC10615387 DOI: 10.1111/jcpp.13794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Irritability presents transdiagnostically, commonly occurring with anxiety and other mood symptoms. However, little is known about the temporal and dynamic interplay among irritability-related clinical phenomena. Using a novel network analytic approach with smartphone-based ecological momentary assessment (EMA), we examined how irritability and other anxiety and mood symptoms were connected. METHODS Sample included 152 youth ages 8-18 years (M ± SD = 12.28 ± 2.53; 69.74% male; 65.79% White) across several diagnostic groups enriched for irritability including disruptive mood dysregulation disorder (n = 34), oppositional defiant disorder (n = 9), attention-deficit/hyperactivity disorder (n = 47), anxiety disorder (n = 29), and healthy comparisons (n = 33). Participants completed EMA on irritability-related constructs and other mood and anxiety symptoms three times a day for 7 days. EMA probed symptoms on two timescales: "since the last prompt" (between-prompt) versus "at the time of the prompt" (momentary). Irritability was also assessed using parent-, child- and clinician-reports (Affective Reactivity Index; ARI), following EMA. Multilevel vector autoregressive (mlVAR) models estimated a temporal, a contemporaneous within-subject and a between-subject network of symptoms, separately for between-prompt and momentary symptoms. RESULTS For between-prompt symptoms, frustration emerged as the most central node in both within- and between-subject networks and predicted more mood changes at the next timepoint in the temporal network. For momentary symptoms, sadness and anger emerged as the most central node in the within- and between-subject network, respectively. While anger was positively related to sadness within individuals and measurement occasions, anger was more broadly positively related to sadness, mood lability, and worry between/across individuals. Finally, mean levels, not variability, of EMA-indexed irritability were strongly related to ARI scores. CONCLUSIONS This study advances current understanding of symptom-level and temporal dynamics of irritability. Results suggest frustration as a potential clinically relevant treatment target. Future experimental work and clinical trials that systematically manipulate irritability-related features (e.g. frustration, unfairness) will elucidate the causal relations among clinical variables.
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Affiliation(s)
- Wan-Ling Tseng
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Reut Naim
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Amanda Chue
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Shannon Shaughnessy
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Jennifer Meigs
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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Elsayed AR, Hassan AK. The Effectiveness of a Recreational Behavioural Programme in Reducing Anger among Children with Intellectual Disabilities at the Primary Stage. Eur J Investig Health Psychol Educ 2023; 13:948-963. [PMID: 37366776 DOI: 10.3390/ejihpe13060072] [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] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
This study aimed to investigate the impact of a recreational behavioural programme on reducing the degree of anger among children with intellectual disabilities (ID) in the primary stage. The study was implemented with 24 children who were randomly divided into two groups: an experimental group (n = 12, age = 10.80 ± 1.03 years, IQ = 63.10 ± 4.43 scores, ASW = 55.50 ± 1.51 scores) and a control group (n = 12, age = 10.80 ± 0.92 years, IQ = 63.00 ± 4.16 scores, ASW = 56.00 ± 1.15 scores). We used the PROMIS anger scale with a modification that was used to measure the degree of anger, and the recreational behavioural programme was implemented three times per week for six weeks. The results of the research showed that the improvement percentages for Anger Triggers (AT), Inner Anger (IA), and External Anger (EA) were 9.73%, 9.04%, and 9.60%, respectively, and the Anger scale as a whole (ASW) rate was 9.46%. r = (0.89-0.91). The experimental group using the recreational behavioural programme also outperformed the control group, as the results indicated a decrease in the intensity of anger in the direction of the experimental group. The differences in the improvement percentages for Anger Triggers (AT) Inner Anger (IA), and External Anger (EA) were 32.97%, 31.03%, and 26.63%, respectively, and the Anger scale as a whole (ASW) rate was 30.09%, r = (0.82-0.86). The results of the study confirmed the effectiveness of the recreational activity programme in developing social interaction among children with intellectual disabilities, which indicates the success of the recreational behavioural programme in reducing the degree of anger among children with IDs. Therefore, the recreational behavioural programme had a positive effect in terms of reducing the degree of anger among children with IDs in the primary stage.
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Affiliation(s)
- Ahmed R Elsayed
- Department of Special Education, College of Education, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Ahmed K Hassan
- Department of Physical Education, College of Education, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Department of Team Sports and Racket Games, Faculty of Physical Education, Minia University, Minya 61519, Egypt
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Losiewicz OM, Metts AV, Zinbarg RE, Hammen C, Craske MG. Examining the indirect contributions of irritability and chronic interpersonal stress on symptoms of anxiety and depression in adolescents. J Affect Disord 2023; 329:350-358. [PMID: 36863468 DOI: 10.1016/j.jad.2023.02.125] [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: 10/24/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Chronic interpersonal stress has been identified as predictive of anxiety and depression. However, more research is needed to understand predictors of chronic interpersonal stress and mediators of its relationship with anxiety and depression. Irritability, a transdiagnostic symptom closely related to chronic interpersonal stress, may provide more insight into this relationship. While some research has demonstrated that irritability is related to chronic interpersonal stress, directionality is unknown. A bidirectional relationship between irritability and chronic interpersonal stress was hypothesized, such that irritability mediates the relationship between chronic interpersonal stress and internalizing symptoms and chronic interpersonal stress mediates the relationship between irritability and internalizing symptoms. METHODS This study used three cross-lagged panel models to investigate the indirect effects of irritability and chronic interpersonal stress on anxiety and depression symptoms using data from 627 adolescents (68.9 % female, 57.7 % white) over a six-year period. RESULTS In partial support for our hypotheses, we found that the relationships between chronic interpersonal stress and both fears and anhedonia were mediated by irritability, and that the relationship between irritability and anhedonia was mediated by chronic interpersonal stress. LIMITATIONS Study limitations include some temporal overlap in symptom measurements, an irritability measure that has not been previously validated to measure the construct, and lack of a lifespan perspective. CONCLUSIONS More targeted approaches in intervention for both chronic interpersonal stress and irritability may improve prevention and intervention efforts to address anxiety and depression.
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Affiliation(s)
- Olivia M Losiewicz
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Allison V Metts
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Richard E Zinbarg
- Northwestern University, Department of Psychology, 2029 Sheridan Road, Swift Hall 102, Evanston, IL 60208, USA; The Family Institute, Northwestern University, Evanston, IL, USA
| | - Constance Hammen
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Michelle G Craske
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA.
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40
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Blankenstein NE, de Rooij M, van Ginkel J, Wilderjans TF, de Ruigh EL, Oldenhof HC, Zijlmans J, Jambroes T, Platje E, de Vries-Bouw M, Branje S, Meeus WHJ, Vermeiren RRJM, Popma A, Jansen LMC. Neurobiological correlates of antisociality across adolescence and young adulthood: a multi-sample, multi-method study. Psychol Med 2023; 53:1834-1849. [PMID: 34446120 PMCID: PMC10106306 DOI: 10.1017/s0033291721003457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Antisociality across adolescence and young adulthood puts individuals at high risk of developing a variety of problems. Prior research has linked antisociality to autonomic nervous system and endocrinological functioning. However, there is large heterogeneity in antisocial behaviors, and these neurobiological measures are rarely studied conjointly, limited to small specific studies with narrow age ranges, and yield mixed findings due to the type of behavior examined. METHODS We harmonized data from 1489 participants (9-27 years, 67% male), from six heterogeneous samples. In the resulting dataset, we tested relations between distinct dimensions of antisociality and heart rate, pre-ejection period (PEP), respiratory sinus arrhythmia, respiration rate, skin conductance levels, testosterone, basal cortisol, and the cortisol awakening response (CAR), and test the role of age throughout adolescence and young adulthood. RESULTS Three dimensions of antisociality were uncovered: 'callous-unemotional (CU)/manipulative traits', 'intentional aggression/conduct', and 'reactivity/impulsivity/irritability'. Shorter PEPs and higher testosterone were related to CU/manipulative traits, and a higher CAR is related to both CU/manipulative traits and intentional aggression/conduct. These effects were stable across age. CONCLUSIONS Across a heterogeneous sample and consistent across development, the CAR may be a valuable measure to link to CU/manipulative traits and intentional aggression, while sympathetic arousal and testosterone are additionally valuable to understand CU/manipulative traits. Together, these findings deepen our understanding of the fundamental mechanisms underlying different components of antisociality. Finally, we illustrate the potential of using current statistical techniques for combining multiple datasets to draw robust conclusions about biobehavioral associations.
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Affiliation(s)
- Neeltje E. Blankenstein
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Mark de Rooij
- Unit of Methodology and Statistics, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands
| | - Joost van Ginkel
- Unit of Methodology and Statistics, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands
| | - Tom F. Wilderjans
- Unit of Methodology and Statistics, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands
- Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Esther L. de Ruigh
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Helena C. Oldenhof
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Josjan Zijlmans
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Tijs Jambroes
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | | | | | - Susan Branje
- Department of Youth and Family, Utrecht University, Utrecht, the Netherlands
| | - Wim H. J. Meeus
- Department of Youth and Family, Utrecht University, Utrecht, the Netherlands
| | - Robert R. J. M. Vermeiren
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Leiden, the Netherlands
| | - Arne Popma
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Lucres M. C. Jansen
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
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Grassi ML, Valente D, Berardi A, Tofani M, Galeoto G. Validation and Analysis of the Psychometric Properties of Two Irritability-Measuring Tools: The Affective Reactivity Index (ARI) and the Born-Steiner Irritability Scale (BSIS) in the Italian Adult and Adolescent Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4607. [PMID: 36901616 PMCID: PMC10001850 DOI: 10.3390/ijerph20054607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Irritability is a transdiagnostic symptom that affects quality of life during the lifespan of individuals. The objective of the present research was to validate two assessment tools, namely the Affective Reactivity Index (ARI) and the Born-Steiner Irritability Scale (BSIS). We investigated internal consistency as measured with Cronbach's alpha, test-retest with intraclass correlation coefficient (ICC) and convergent validity confronting ARI and BSIS scores with the strength and difficulties questionnaire (SDQ). Our results revealed ARI good internal consistency with a Cronbach's α of 0.79 for adolescent and 0.78 for adults. The BSIS also demonstrated good internal consistency for both samples with Cronbach's α = 0.87. Test-retest analysis showed excellent values for both tools. Convergent validity showed positive and significant correlation with SDW, albeit weak for some sub-scales. In conclusion, we found ARI and BSIS to be good tools for measuring irritability in adolescents and adults, and now, Italian healthcare professionals can use it with more confidence.
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Affiliation(s)
- Maria Letizia Grassi
- Department Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, 00185 Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Neuromed IRCCS, 86007 Pozzilli, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Neuromed IRCCS, 86007 Pozzilli, Italy
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Vogel AC, Brotman MA, Roy AK, Perlman SB. Review: Defining Positive Emotion Dysregulation: Integrating Temperamental and Clinical Perspectives. J Am Acad Child Adolesc Psychiatry 2023; 62:297-305. [PMID: 36007814 DOI: 10.1016/j.jaac.2022.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/19/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although emotion dysregulation has been defined as a maladaptive process of emotional experiences, there is no specific reference to the emotional valence of the dysregulation. To date, child psychiatry has focused primarily on dysregulation of negative affect. Here, we suggest that positive emotion dysregulation requires additional clinical and research attention. METHOD First, we present a developmental approach to the study of positive emotion regulation within a temperament framework. Second, we describe emerging research findings regarding dysregulation of positive emotion in early childhood. Third, we integrate neuroscientific approaches to positive emotion regulation and introduce a framework for future investigations and clinical applications. RESULTS Dysregulation in positive affect can be examined from temperamental, developmental, clinical, and neuroscientific perspectives. Both temperamental surgency, which includes positive affect, and the proposed clinical extension, excitability, are associated with increased risk of externalizing symptoms and clinical impairment in youth. CONCLUSION Studying the role of both temperamental surgency and clinically impairing positive affect, or excitability, in developmental psychopathology will help to elucidate the full spectrum of emotion dysregulation and to clarify the neural basis of dysregulation. A more comprehensive conceptualization of positively valanced emotion dysregulation will provide a more nuanced understanding of developmental risk and potential targets for intervention. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.
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Affiliation(s)
- Alecia C Vogel
- Drs. Vogel and Perlman are with Washington University School of Medicine, St. Louis, Missouri. Dr. Brotman is with the National Institute of Mental Health, Bethesda, Maryland. Dr. Roy is with Fordham University, Bronx, New York.
| | - Melissa A Brotman
- Drs. Vogel and Perlman are with Washington University School of Medicine, St. Louis, Missouri. Dr. Brotman is with the National Institute of Mental Health, Bethesda, Maryland. Dr. Roy is with Fordham University, Bronx, New York
| | - Amy Krain Roy
- Drs. Vogel and Perlman are with Washington University School of Medicine, St. Louis, Missouri. Dr. Brotman is with the National Institute of Mental Health, Bethesda, Maryland. Dr. Roy is with Fordham University, Bronx, New York
| | - Susan B Perlman
- Drs. Vogel and Perlman are with Washington University School of Medicine, St. Louis, Missouri. Dr. Brotman is with the National Institute of Mental Health, Bethesda, Maryland. Dr. Roy is with Fordham University, Bronx, New York
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Mohamed AK, Croarkin PE, Jha MK, Vande Voort JL. Early reduction in irritability is associated with improved outcomes among youth with depression: Findings from the AMOD study. J Affect Disord 2023; 324:77-81. [PMID: 36549343 DOI: 10.1016/j.jad.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/18/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Evaluate whether early improvement in irritability predicts improvement in depression severity in a naturalistic sample of adolescents undergoing pharmacologic treatment for major depressive disorder. METHODS Adolescents (N = 161) aged 13-18 years with a moderate to severe depressive episode were enrolled. Outcome measures included the Children's Depression Rating Scale-Revised (CDRS-R), Quick Inventory of Depressive Symptomatology (QIDS-A17), and Clinical Global Impression scale (CGI). Paired t-tests were used to estimate the change in irritability items from baseline to week-4, and Cohen's d effect sizes were computed. Separate linear regression analyses with CDRS-R, QIDS-A17, and CGI at week-8 as the dependent variables and baseline levels of irritability and baseline-to-week-4 changes in irritability as independent variables of interest were conducted. These analyses were repeated after controlling for overall depression severity (minus the irritability item) at baseline and baseline to week-4 change. RESULTS Greater baseline to week-4 reduction in irritability was associated with lower levels of CDRS-R, QIDS-A17, and CGI at week-8. These findings were significant for QIDS-A17 and CGI even after controlling for baseline-to-week-4 changes in other depressive symptoms. LIMITATIONS The single item evaluation of irritability reduced assessment reliability in the absence of validated measures of irritability. CONCLUSIONS Early reduction in irritability is strongly associated with better outcomes in depressed youths, regardless of baseline depression severity. Further research is needed to quantify the burden of irritability, explore it as a tool for measurement-based care, and to develop targeted treatments for irritability.
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Affiliation(s)
- Alaa K Mohamed
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Paul E Croarkin
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Manish K Jha
- Department of Psychiatry, UT Southwestern, United States of America
| | - Jennifer L Vande Voort
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States of America.
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Louveau C, Ellul P, Iftimovici A, Dubreucq J, Laidi C, Leyrolle Q, Purper-Ouakil D, Jacquemont S, Lyonnet S, Barthélémy C, Krebs MO, Bai J, Olivier P, Chaumette B. Neurodevelopmental disorders (NDD) without boundaries: research and interventions beyond classifications. J Neural Transm (Vienna) 2023; 130:473-479. [PMID: 36719463 DOI: 10.1007/s00702-023-02586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
On June 2022, the 2nd Webinar "Neurodevelopmental Disorders (NDD) without boundaries took place at the Imagine Institute in Paris and was broadcasted live and in replay. The aim of this webinar is to address NDD in a dimensional rather than in a categorical approach. Several speakers were invited to present their researches on the subject. Classifications in NDD were discussed: irritability in NDD, involvement of the immune system in neurodevelopment, nutrition and gut microbiota modulate brain inflammation and neurodevelopment, co-occurring conditions in autistic adolescents and adults without intellectual disability. Classifications in psychiatric disorders were asked: mapping the effect of genes on cognition and autism risk, epigenetics and symptomatic trajectory in neurodevelopmental disorders, the autism-schizophrenia continuum in two examples: minor neurological signs and EEG microstates, the cerebellum in schizophrenia and autism: from imaging to intervention perspectives. Both genetic and environmental factors, along with clinical and imaging features, argue toward a continnum between NDD but also with adult psychiatric presentations. This new paradigm could modify the therapeutic strategy, with the development of large-spectrum treatments or new psychotherapies addressing co-occuring symptoms. The complexity and the heterogeneity of NDD apply well to the next scientific and political challenges: developing international convergence to push back the frontiers of our knowledge. This article is a summary of the 2nd webinar "Neurodevelopmental Disorders (NDD) without boundaries: research and interventions beyond classifications" sponsored by the French National Academy of Medicine, the autism and neurodevelopmental disorders scientific interest group (GIS), the International Research Network Dev-O-Psy and the French Institute of Psychiatry (GDR3557). Oral presentations are available as a replay on the following website (in French): https://autisme-neurodev.org/evenements/2022/04/12/tnd-sans-frontieres-la-recherche-et-les-interventions-au-dela-des-classifications/ .
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Affiliation(s)
| | - Pierre Ellul
- Excellence Centre for Autism and Neuro-Developmental Disorders, Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris Cité University, Paris, France
- Immunology, Immunopathology, Immunotherapy, INSERM U959, Sorbonne University, Paris, France
| | - Anton Iftimovici
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Julien Dubreucq
- Child and Adolescent Psychiatry Department, Saint-Etienne University Hospital and CNRS UMR 5229, Institute of Cognitive Neuroscience Marc Jeannerod, University Lyon 1, Bron, France
| | | | - Quentin Leyrolle
- Univ. Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Unit of Child and Adolescent Psychiatry (MPEA1), Montpellier, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U 1018, Paris-Saclay University, Villejuif, France
| | - Sebastien Jacquemont
- Department of Pediatrics, Sainte Justine Hospital Research Center, University of Montreal, Montreal, QC, H4A3J1, Canada
| | - Stanislas Lyonnet
- INSERM-UMR1163, Université Paris Cité, Institut Imagine, Paris, France
| | - Catherine Barthélémy
- Faculty of Medicine, University of Tours, Tours, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
| | - Marie-Odile Krebs
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
| | - Jing Bai
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Paul Olivier
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France.
| | - Boris Chaumette
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
- Department of Psychiatry, McGill University, Montreal, Canada
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45
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Cai H, Chow IHI, Lei SM, Lok GKI, Su Z, Cheung T, Peshkovskaya A, Tang YL, Jackson T, Ungvari GS, Zhang L, Xiang YT. Inter-relationships of depressive and anxiety symptoms with suicidality among adolescents: A network perspective. J Affect Disord 2023; 324:480-488. [PMID: 36584712 DOI: 10.1016/j.jad.2022.12.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/18/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Persons with suicidality including suicidal ideation (SI), suicide plans (SP) and/or suicide attempts (SA) are at higher risk for future suicide than those without suicidality. To reduce the risk of future suicide, it is important to understand symptoms of emotional distress that have the strongest links with SI, SP and SA. This network analysis examined item-level relations of depressive and anxiety symptoms with suicidality among adolescents during the COVID-19 pandemic. METHODS Adolescents between 12 and 20 years of age were assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and individual binary reponse (no/yes) items assessing SI, SP, and SA during the pandemic. The structure of depressive symptoms, anxiety symptoms and suicidality was characterized using "Expected Influence" and "Bridge Expected Influence" as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Node-specific predictive betweenness was computed to examine short paths of anhedonia, other depressive symptoms and anxiety symptoms with suicidality. A Network Comparison Test (NCT) was conducted to examine whether network characteristics differed based on gender. RESULTS Prevalence rates of depressive symptoms, anxiety symptoms, and suicidality were 44.60 % (95% confidence interval (CI) = 41.53-47.67 %), 31.12 % (95%CI = 28.26-33.98 %), and 16.95 % (95%CI = 14.63-19.26 %), respectively, in the study sample. The network analysis identified GAD3 ("Worry too much") as the most central symptom, followed by GAD6 ("Irritability") and PHQ6 ("Guilt") in the sample. Additionally, PHQ6 ("Guilt"), GAD6 ("Irritability"), and PHQ2 ("Sad mood") were bridge nodes linking depressive and anxiety symptoms with suicidality. A flow network indicated that the connection between S ("Suicidality") and PHQ6 ("Guilt") reflected the strongest connection, followed by connections of S ("Suicidality") with GAD2 ("Uncontrollable worrying"), and S ("Suicidality") with PHQ2 ("Sad mood"). Finally, PHQ2 ("Sad mood") was the main bridge node linking anhedonia with other depressive and anxiety symptoms and suicidality in the sample. CONCLUSIONS Findings highlight the potential importance of reducing specific depressive and anxiety symptoms as possible means of reducing suicidality among adolescents during the pandemic. Central symptoms and key bridge symptoms identified in this study should be targeted in suicide prevention for at-risk adolescents.
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Affiliation(s)
- Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Ines H I Chow
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Si-Man Lei
- Faculty of Education, University of Macau, Macao SAR, China
| | | | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Anastasia Peshkovskaya
- Neuroscience Center, Tomsk State University, Tomsk, Russia; Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, SAR, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia / Graylands Hospital, Perth, Australia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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46
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Carlson GA, Singh MK, Amaya-Jackson L, Benton TD, Althoff RR, Bellonci C, Bostic JQ, Chua JD, Findling RL, Galanter CA, Gerson RS, Sorter MT, Stringaris A, Waxmonsky JG, McClellan JM. Narrative Review: Impairing Emotional Outbursts: What They Are and What We Should Do About Them. J Am Acad Child Adolesc Psychiatry 2023; 62:135-150. [PMID: 35358662 DOI: 10.1016/j.jaac.2022.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking. METHOD The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis. RESULTS Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses. CONCLUSION Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.
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Affiliation(s)
- Gabrielle A Carlson
- Renaissance School of Medicine at Stony Brook University, Putnam Hall, South Campus, Stony Brook, New York.
| | | | | | - Tami D Benton
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Jeff Q Bostic
- MedStar Georgetown University Hospital, Washington, DC
| | - Jaclyn Datar Chua
- Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Pennsylvania, Philadelphia
| | | | - Cathryn A Galanter
- SUNY Downstate, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York
| | | | - Michael T Sorter
- Cincinnati Children's Hospital and the University of Cincinnati, Ohio
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47
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Liuzzi MT, Kryza-Lacombe M, Christian IR, Owen C, Redcay E, Riggins T, Dougherty LR, Wiggins JL. Irritability in early to middle childhood: Cross-sectional and longitudinal associations with resting state amygdala and ventral striatum connectivity. Dev Cogn Neurosci 2023; 60:101206. [PMID: 36736018 PMCID: PMC9918422 DOI: 10.1016/j.dcn.2023.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Irritability is a common symptom that may affect children's brain development. This study aims to (1) characterize age-dependent and age-independent neural correlates of irritability in a sample of 4-8 year old children, and (2) examine early irritability as a predictor of change in brain connectivity over time. METHODS Typically developing children, ages 4-8 years, with varying levels of irritability were included. Resting state fMRI and parent-rated irritability (via Child Behavior Checklist; CBCL) were collected at up to three time points, resulting in a cross-sectional sample at baseline (N = 176, M = 6.27, SD = 1.49), and two subsamples consisting of children who were either 4 or 6 years old at baseline that were followed longitudinally for two additional timepoints, one- and two-years post-baseline. That is, a "younger" cohort (age 4 at baseline, n = 34, M age = 4.44, SD = 0.25) and an "older" cohort (age 6 at baseline, n = 29, M age = 6.50, SD = 0.30). Across our exploratory analyses, we examined how irritability related to seed-based intrinsic connectivity via whole-brain connectivity ANCOVAs using the left and right amygdala, and left and right ventral striatum as seed regions. RESULTS Cross-sectionally, higher levels of irritability were associated with greater amygdala connectivity with the posterior cingulate, controlling for child age. No age-dependent effects were observed in the cross-sectional analyses. Longitudinal analyses in the younger cohort revealed that early higher vs. lower levels of irritability, controlling for later irritability, were associated with decreases in amygdala and ventral striatum connectivity with multiple frontal and parietal regions over time. There were no significant findings in the older cohort. CONCLUSIONS Findings suggest that irritability is related to altered neural connectivity during rest regardless of age in early to middle childhood and that early childhood irritability may be linked to altered changes in neural connectivity over time. Understanding how childhood irritability interacts with neural processes can inform pathophysiological models of pediatric irritability and the development of targeted mechanistic interventions.
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Affiliation(s)
- Michael T. Liuzzi
- San Diego State University, Department of Psychology, San Diego, CA, USA,Correspondence to: 6363 Alvarado Ct., Ste 103, San Diego, CA 92120, USA.
| | - Maria Kryza-Lacombe
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Cassidy Owen
- San Diego State University, Department of Psychology, San Diego, CA, USA
| | - Elizabeth Redcay
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Tracy Riggins
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Lea R. Dougherty
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Jillian Lee Wiggins
- San Diego State University, Department of Psychology, San Diego, CA, USA,San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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48
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Glahn DC. Editorial: Irritable Imaging: Interpreting Null Results in Psychiatric Neuroimaging. J Am Acad Child Adolesc Psychiatry 2023; 62:130-132. [PMID: 36427758 DOI: 10.1016/j.jaac.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
There is a growing appreciation that clinically impairing irritability is an important transdiagnostic symptom among children and adolescents with mental illness. Severe irritability, defined by frequent, developmentally inappropriate temper outbursts and low frustration tolerance, is one of the most common reasons that youths are referred for psychiatric evaluation and care.1 Although chronic irritability is the primary symptom in disruptive mood dysregulation disorder, the symptom is common in a diverse set of DSM-5 diagnoses, including major depressive disorder, autism spectrum disorder, oppositional defiant disorder, bipolar disorder, and generalized anxiety disorder.1 Given that clinically impairing irritability is often predictive of poor outcomes in childhood and worse clinical course in adulthood, a concerted effort is being made to refine the definition of this symptom and determine if severe irritability could be better understood and treated as an independent diagnosis.1.
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Affiliation(s)
- David C Glahn
- Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts.
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49
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Zaccaria V, Maggi S, Bof A, Tofani M, Galeoto G, Ardizzone I. Validation of the Italian version of the clinician affective reactivity index (CL-ARI). Nord J Psychiatry 2022:1-6. [PMID: 36519296 DOI: 10.1080/08039488.2022.2154837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Irritability represents a transdiagnostic symptom in youths, which can become a predictor of long-term psychosocial adversity. Yet, few tools investigate this symptom in childhood. The aim of this study was to evaluate the psychometric properties of the CL-ARI in an Italian population, analyzing the correlations between irritability and other pathological constructs. MATERIALS AND METHODS A cross-sectional study was carried out in a Child Neuropsychiatry Unit in Rome. A transdiagnostic sample of 67 youths aged 7-17 years, which underwent to a psychodiagnostic evaluation, was administered by a clinician with the translated version of the CL-ARI, along with tools exploring irritability and other constructs (depressive symptoms, anxiety, global impairment in functioning). RESULTS The most frequent diagnosis obtained by the psychodiagnostic evaluation was anxiety disorder, followed by disruptive mood dysregulation disorder (DMDD) and no diagnosis. Cronbach's alpha values revealed good internal consistency for the total score (0.86), as well as for the score of each subscale of the tool (0.81 for temper outbursts, 0.89 for irritable mood, 0.71 for impairment). Test-retest reliability showed excellent values (ICC 0.89 to 0.98), and criterion validity exhibited good correlation among the sub-scales and between each sub-scale and the total score. Finally, positive correlations were found between total scores of the parent and the child interview, and between the CL-ARI, the measure of DMDD severity (CGI) and of depressive symptoms (CDI 2). CONCLUSIONS These data confirmed that the CL-ARI is a promising tool designed to intercept irritability, with good psychometric properties. Further research on the assessment of irritability is critical and thus encouraged.
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Affiliation(s)
- Valerio Zaccaria
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
| | - Susanna Maggi
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
| | - Alessia Bof
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy.,Continuous Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy.,Neuromed IRCCS, Pozzilli, Italy
| | - Ignazio Ardizzone
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
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Uccula A. Coping in Anger Episodes: Developmental Differences and Self-Efficacy Beliefs. J Genet Psychol 2022; 184:102-116. [PMID: 36154875 DOI: 10.1080/00221325.2022.2126294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Anger has been recognized as a natural emotion; however, its poor management in adolescence is associated with some adverse developmental outcomes. The aims of this study were to compare the antecedents and coping strategies of anger episodes between adolescents and adults and the role of perceived self-efficacy on the coping strategies. A total of 88 adolescents (44 female, Mage = 16.81 years, SD = 1.21) and 94 adults (49 female, Mage = 28.11 years, SD = 5.82) reported an anger episode and the coping strategy adopted. Participants also filled in the Regulatory Emotional Self-Efficacy Scale (RESE). The results show that there are no specific antecedents among only adolescents or adults, although there are differences between the two age groups. Furthermore, the results indicate a different use of coping strategies between adolescents and adults. Specifically, a greater propensity of adolescents to use more often maladaptive strategies such as avoidance and denial emerged, but in addiction inaction, considered an adaptive strategy, can also be found. However, although adults use less maladaptive coping strategies they report a high frequency of feeling of powerlessness. The adaptive differences in coping also are explained by the different levels of self-efficacy beliefs of the participants. These findings are discussed in the light of the adaptive role of the coping strategies.
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Affiliation(s)
- Arcangelo Uccula
- Department of History, Human Sciences and Education, University of Sassari, Sassari, Italy
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