Don't Get Lost in Translation: Integrating Developmental and Implementation Sciences to Accelerate Real-World Impact on Children's Development, Health, and Wellbeing

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ObjectivesIn light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for a pragmatic irritability measure to identify at‐risk infant‐toddlers.MethodsData comprised N = 350 diverse infant‐toddlers and their mothers assessed at ∼14 months old for irritability (Multidimensional Assessment Profiles‐ Temper Loss‐Infant/Toddler (MAPS‐TL‐IT) and impairment (Early Childhood Irritability‐Related Impairment Interview, E‐CRI; and Family Life Impairment Scale (FLIS). Bimonthly follow‐up surveys assessed impairment (FLIS) over the following year.ResultsStepwise logistic regression indicated that 5 MAPS‐TL‐IT items were most informative for differentiating concurrent impairment on the FLIS: “frustrated about small things”; “hit, bite, or kick during tantrums”; “trouble cheering up when grumpy”; “grumpy during fun activities” and “tantrums in public”. With this summed score, Receiver Operating Characteristics analysis differentiating concurrent impairment on the E‐CRI indicated good classification accuracy for (Area under the curve = 0.755, p < 0.05), with a cutoff of 5 maximizing sensitivity (71.4%) and specificity (70.6%). Elevated irritability on this MAPS‐TL‐IT clinically optimized screener increased likelihood of persistently elevated FLIS impairment trajectories over the following year more than fourfold (OR = 4.37; Confidence intervals = 2.40–7.97, p < 0.001).ConclusionsOur findings represent the first step toward a pragmatic tool for screening for transdiagnostic mental health risk in toddlers, optimized for feasibility in clinical care. This has potential to strengthen resilience pathways via earlier identification of mental health risk and corollary prevention in toddlers.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood

Wiggins,

Ureña Rosario,

Zhang

et al. 2023

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“…We have provided initial evidence of the reliability and validity of the MAPS-TL-Youth scale as a dimensional irritability measure in preadolescents. We also applied a "translational mindset" (Wakschlag et al, 2022) to increase the practical applications of this work by empirically deriving a clinically optimized screener for the MAPS-TL-Youth in preadolescents. This is to advance the goal of providing a pragmatic transdiagnostic mental F I G U R E 2 Self-report items along severity dimension.…”

Section: Item Location Mean (B)mentioning

confidence: 99%

“…Here, we sought to characterize the normal:abnormal spectrum of irritable behavior as developmentally specified within preadolescence. Guided by a “translational mindset” (Wakschlag et al., 2022), we then derived a parsimonious clinically optimized irritability screener for psychopathology risk in preadolescence, based on the most psychometrically discriminative irritable behaviors.…”

Section: Introductionmentioning

confidence: 99%

Characterizing the spectrum of irritability in preadolescence: Dimensional and pragmatic applications

Alam,

Kirk,

Hirsch

et al. 2023

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ObjectivesCharacterize the dimensional spectrum of preadolescent (PA) irritability, a robust transdiagnostic vulnerability marker, using the youth version of the Multidimensional Assessment Profiles Temper Loss (MAPS‐TL‐Youth) scale including common and with developmentally specific items. Based on this, derive and validate a clinically optimized irritability screener to flag psychopathology risk in preadolescents.MethodsThe normal:abnormal irritability spectrum was modeled using MAPS‐TL‐Youth data from the Multidimensional Assessment of Preschoolers Study (MAPS) Study PA wave (n = 340) via item response theory. Both cross‐cutting core items from the MAPS scales and developmentally specific items were used to generate this dimension. Stepwise logistic regression was then used to optimize MAPS‐TL‐Youth irritability items in relation to Kiddie Schedule of Affective Disorders and Schizophrenia impairment to generate a clinically optimized irritability screener. Receiver operator characteristic analysis identified the irritability threshold for the screener. For the first time, youth self‐report of their own irritability on the MAPS‐TL was also modeled via the MAPS‐TL‐Youth‐Self‐Report (MAPS‐TL‐Youth‐SR).ResultsIrritability was unidimensional and ranged from mild and common to severe and rare behaviors. Developmentally specific items allowed detection of more severe irritability. Items for the screener were identified in relation to concurrent impairment. These included low frustration tolerance and pathognomonic severe behaviors. The clinically optimized screener demonstrated very good sensitively (87%) and specificity (81%) in regard to concurrent irritability‐related DSM disorders. Modeling of the MAPS‐TL‐Youth‐SR yielded similar results.ConclusionCharacterizing the normal: abnormal spectrum of irritability in preadolescence advances application of Research Domain Criteria methods to this developmental period. This foundational work yielded two developmentally specified tools for irritability characterization in preadolescence: a nuanced dimensional scale to precisely characterize the full normal‐abnormal irritability spectrum, and a pragmatic, clinically optimized screener suitable for real world use. Future application in mechanistic and clinical studies will be important for establishing validity and incremental utility.

“…Building on this convergent evidence base, the Multidimensional Assessment Profiles ‐ Internalizing (MAPS‐INT) Scales measure was designed to characterize the dimensional spectra of anxious and depressive behavior across the early childhood period (ages 1–5 years) within a survey form. Validation of pragmatic, developmentally based survey methods is key for utilization in large epidemiologic studies and in real world clinical settings (Morris et al., 2020; Wakschlag et al., 2022). We descriptively examine whether normal:abnormal differentiation in these internalizing behaviors mirrors what has been previously reported, and model anxious and disruptive behavior dimensions with the MAPS‐INT.…”

Section: Introductionmentioning

confidence: 99%

Modeling the normal:abnormal spectrum of early childhood internalizing behaviors: A clinical‐developmental approach for the Multidimensional Assessment Profiles Internalizing Dimensions

Wakschlag,

Sherlock,

Blackwell

et al. 2023

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BackgroundWe expanded the Multidimensional Assessment Profiles (MAPS) Scales developmental specification model to characterize the normal:abnormal spectrum of internalizing (anxious and depressive) behaviors in early childhood via the MAPS‐Internalizing (MAPS‐INT) scale.MethodsThe MAPS‐INT item pool was generated based on clinical expertise and prior research. Analyses were conducted on a sub‐sample of families (n = 183) from the diverse When to Worry early childhood sample.ResultsNormal:abnormal descriptive patterns for both anxious and depressive behaviors were consistent with prior work: (1) extremes of normative variation are abnormal when very frequent; and (2) pathognomonic indicators that most children do not engage in and are abnormal, even if infrequent. Factor analysis revealed a two‐factor MAPS‐INT Anxious Behaviors structure (Fearful‐Worried and Separation Distress) and a unidimensional MAPS‐INT Depressive Behaviors factor with good fit and good‐to‐excellent test‐retest reliability and validity.ConclusionsWe characterized the normal:abnormal spectrum of internalizing behaviors in early childhood via the MAPS‐INT. Future research in larger representative samples can replicate and extend findings, including clinical thresholds and predictive utility. The MAPS‐INT helps lay the groundwork for dimensional characterization of the internalizing spectrum to advance neurodevelopmental approaches to emergent psychopathology and its earlier identification.