Developmental pathways from preschool irritability to multifinality in early adolescence: the role of diurnal cortisol

Abstract

Background Early irritability predicts a broad spectrum of psychopathology spanning both internalizing and externalizing disorders, rather than any particular disorder or group of disorders (i.e. multifinality). Very few studies, however, have examined the developmental mechanisms by which it leads to such phenotypically diverse outcomes. We examined whether variation in the diurnal pattern of cortisol moderates developmental pathways between preschool irritability and the subsequent emergence of internalizing and externalizing symptoms 9 years later. Method When children were 3 years old, mothers were interviewed about children's irritability and completed questionnaires about their children's psychopathology. Six years later, children collected saliva samples at wake-up and bedtime on three consecutive days. Diurnal cortisol patterns were modeled as latent difference scores between evening and morning samples. When children were approximately 12 years old, mothers again completed questionnaires about their children's psychopathology. Results Among children with higher levels of irritability at age 3, a steeper diurnal cortisol slope at age 9 predicted greater internalizing symptoms and irritability at age 12, whereas a blunted slope at age 9 predicted greater externalizing symptoms at age 12, adjusting for baseline and concurrent symptoms. Conclusion Our results suggest that variation in stress system functioning can predict and differentiate developmental trajectories of early irritability that are relatively more internalizing v. those in which externalizing symptoms dominate in pre-adolescence.

Preschool Irritability Predicts Adolescent Psychopathology and Functional Impairment: A 12-Year Prospective Study

“…In children with high levels of irritability at age three, an enhanced ∆ERN at age six predicted internalizing disorders at age nine and a steeper diurnal cortisol slope at age nine predicted greater internalizing symptoms at age 12; a smaller ∆ERN predicted externalizing disorders at age nine while a blunted cortisol slope at age nine predicted greater externalizing symptoms at 12. 36,37 It will be important for future work in this sample and other samples to identify factors that differentiate developmental trajectories from early irritability to later internalizing versus externalizing outcomes.…”

Developmental Patterning of Irritability Enhances Prediction of Psychopathology in Pre-adolescence: Improving RDoC with Developmental Science

“…This approach has elucidated unfolding patterns of symptoms that predict later psychopathology and provide insight into etiology and inform developmentally-based interventions (Cicchetti & Sroufe, 2000;Mittal & Wakschlag, 2017;Wakschlag et al, 2010). Within this context, a wealth of evidence demonstrates that atypical patterns of early irritability are predictive of emerging and subsequent psychopathology (Brotman et al, 2017;Carter et al, 2013;Fishburn et al, 2019;Hawes et al, 2019;Humphreys et al, 2019;Kessel et al, 2020;Smith et al, 2019;Wakschlag et al, 2010, IRRITABILITY PREDITS CLINICAL OUTCOMES/GRAY MATTER VOLUMES 4 2015a, 2019. Despite the promise of irritability to predict psychopathology, it is not yet clear how a general behavioral phenotype of excessive irritability translates into diverse, specific symptoms of psychopathology.…”

“…This period also marks a shift in neurodevelopment, as cell and synaptic division peak; increased synaptic pruning, arborization, and myelination alter gray matter volumes, which peak in pre-adolescence (Giedd et al, 1999(Giedd et al, , 2012Kaczkurkin, Moore, et al, 2019). Despite this complex developmental context, preschool irritability can be measured reliably and is predictive of future psychopathology (Hawes et al, 2019;Kessel et al, 2020;Smith et al, 2019;Wiggins et al, 2020;Wiggins et al, 2018).…”

Developmental patterning of irritability enhances prediction of psychopathology in preadolescence: Improving RDoC with developmental science.

“…This approach has elucidated unfolding patterns of neurodevelopmental risk that presage psychopathology, provide insight into etiology, and inform developmentally based interventions at the earlier phase of the clinical sequence (Cicchetti & Sroufe, 2000; Finlay-Jones et al, 2019; Mittal & Wakschlag, 2017). Within this context, a wealth of evidence demonstrates that atypical patterns of early irritability are predictive of life-span psychopathology (Brotman et al, 2017; Hawes et al, 2019; Humphreys et al, 2019; Kessel et al, 2019; Wakschlag et al, 2015; Wiggins et al, 2020). Additionally, the changes in irritability may reflect the influence of parallel environmental and biological developmental processes (Pagliaccio et al, 2018; Wakschlag et al, 2010).…”