Context‐dependent irritability in Attention Deficit/Hyperactivity Disorder: correlates and stability of family‐restricted versus cross‐situational temper outbursts

Abstract

Background: Impairing irritability is highly prevalent in children with attention deficit/hyperactivity disorder (ADHD), although manifestations of irritability are not necessarily present in all settings (home, school, with peers). At the moment, little is known about the relative prevalence, stability, and etiologies of contextual versus cross-situational manifestations of irritability in ADHD. In this study, levels of dysfunctional parenting practices and sleep problems were compared in irritable versus nonirritable children with ADHD, in cases of family-restricted versus cross-situational irritability, and examined as predictors of irritability levels over a oneyear interval. Stability of irritability manifestations over time was investigated, and prevalence of cross-situational disruptive mood dysregulation disorder (DMDD) versus 'family-restricted' DMDD was compared. Method: One hundred and seventy children with ADHD (age 6-11) were examined. Parents completed a semistructured interview and questionnaire to assess irritability, and parent-report questionnaires were used to evaluate parenting practices and sleep problems. Questionnaires were completed for a second time after a one-year interval. Results: Parenting practices were more dysfunctional in the irritable group compared to the nonirritable group, while sleep problems did not differ between these two groups. Levels of parenting practices and sleep problems did not predict later irritability after correction for multiple comparison nor did they differ between the family-restricted and cross-situational irritable groups. Finally, family-restricted irritability was as prevalent and as stable over time as cross-situational irritability and family-restricted DMDD as prevalent as cross-situational DMDD. Conclusions: Factors associated with contextual versus cross-situational manifestations of irritability in ADHD remain elusive. More subtle measures of parenting practices should be considered, including psychological control or accommodation, and other constructs such as social inhibition. Despite not being captured by current nosography, severe forms of family-restricted irritability may be as prevalent as severe forms of cross-situational irritability.

Acceptability and expected changes in parental practices after an online behavioural parent program for ADHD during the Covid-19 pandemic

“…Positive encouragement was the dimension with the lowest scores. This pattern was also found in a previous study in children with ADHD and irritability (22), indicating the consistency of parental attitudes in similar clinical samples. A majority (51,2%) of participants declared motivation to change negative strategies or parental attitudes as assessed by the PAFAS after completion of the program.…”

Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial

“…The inventory consists of the parenting scale with two subscales measuring parenting practices and parent–child relationships and of the Family adjustment scale measuring parental emotional adjustment and partner support. A French version has been used in a study of ADHD and irritability [ 39 ].…”

Adapting a parent training program to the COVID-19 crisis in a mental health care setting in France

“…Attention-deficit/hyperactivity disorder (ADHD) is a common, early-onset, persistent neurodevelopmental disorder of childhood and adolescence, with a worldwide population-based prevalence of approximately 5% [1] . Beyond the core symptoms of inattentiveness, impulsivity, and hyperactivity, behavioral problems constitute a common reason for referral to Child/Adolescent Mental Health Services (CAMHS) [2] , [3] . In particular, emotional dysregulation, including reduced tolerance to frustration, irritability, lack of motivation and delay aversion, contribute to oppositional behaviors, causing further impairment in psychosocial functioning [4] , [5] , [6] , [7] .…”