An Open Pilot Study of Training Hostile Interpretation Bias to Treat Disruptive Mood Dysregulation Disorder

Abstract

These results set the stage for further research on computer-based treatment targeting interpretation bias of angry faces in DMDD. Such treatment may decrease irritability and alter neural responses to subtle expressions of happiness and anger.

Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people

“…For example, there is evidence that irritable children are more likely to direct attention to angry faces than are healthy volunteers (Hommer et al., ; Salum et al., ). Moreover, compared with healthy children, irritable children tend to interpret ambiguous or neutral facial stimuli as threatening (Brotman et al., ; Stoddard et al., ). Difficulties in modulating amygdala responses may underlie some of these aberrations in threat processing (Thomas et al., ).…”

Pediatric Irritability: A Systems Neuroscience Approach

“…On explicit processing tasks, irritable youth show behavioral deficits, in that they label face emotions inaccurately [27,28]. They also judge neutral faces as more hostile than do healthy youth, whether the stimulus duration is brief (i.e., 200 ms) [29] or not (i.e., 4000 ms) [30]. Irritable youth show amygdala, ventral visual stream, and association cortex dysfunction during explicit face processing [30–32], although the nature of the amygdala dysfunction (hypo- vs. hyperactivation) varies across tasks.…”

“…Thus, irritable or aggressive youth have a “hostile interpretation bias” which can be expressed in diverse contexts and studied from multiple scientific perspectives. On simpler paradigms, this bias could lead irritable children to label ambiguous faces as angry, while on more complex paradigms, this bias could cause irritable youth to interpret ambiguous peer behavior as threatening [29,45]. Studies suggest that aggressive responding on complex paradigms such as the Point Subtraction Aggression Paradigm or Ultimatum Game is associated with aberrant activity in a threat-mediating circuit including the amygdala, periaqueductal gray, ventromedial PFC, striatum and insula, along with decreased amygdala-ventromedial PFC connectivity [43,44].…”

Irritability in children: what we know and what we need to learn

“…Work with frustrating tasks shows associations between irritability and dysfunction in striatum, anterior cingulate cortex, amygdala, and parietal lobe, consistent with irritable youths’ deficits in reward processing and in maintaining attentional control when frustrated. Irritable youth are also more likely than their non‐irritable peers to view ambiguous faces as angry and, like youth with anxiety disorders, to attend preferentially to angry faces. One direction for future research would be identifying the extent to which abnormalities in reward or threat processing differentiate subtypes of irritable youth.…”