Irritability and Severity of Anxious Symptomatology Among Youth With Anxiety Disorders

Abstract

Objective Most research on irritability and child psychopathology has focused on depressive disorders, bipolar disorder, and/or oppositional defiant disorder (ODD). Less is known about relationships between child anxiety and irritability and moderators of such associations. Method Structural equation modeling (SEM) examined associations between anxiety severity and irritability in a large sample of treatment-seeking youth with anxiety disorders (N=663, ages 7–19 years, M=12.25), after accounting for comorbid depressive disorders and ODD. Additional analyses examined whether associations were moderated by child gender, age, and generalized anxiety disorder (GAD) status. Results There was a direct link between child anxiety and irritability even after accounting for comorbid depressive disorders and ODD. Links between child anxiety and irritability were robust across child gender and age. Further, relationships between child anxiety and irritability were comparable across youth with and without GAD, suggesting that the anxiety–irritability link is relevant across child anxiety disorders and not circumscribed to youth with GAD. Conclusion Findings add to an increasing body of evidence linking child irritability to a range of internalizing and externalizing psychopathologies, and suggest that child anxiety assessment should systematically incorporate irritability evaluations. Further, youth in clinical settings displaying irritability should be assessed for the presence of anxiety. Moreover, treatments for childhood anxiety may do well to incorporate new treatment modules as needed that specifically target problems of irritability.

Irritability in Children and Adolescents

“…Irritability is one of the most common reasons that children and adolescents are referred for psychiatric evaluation and care (Peterson et al 1996). In addition to being linked to other forms of psychopathology (e.g., anxiety and depressive disorders), irritability in youth predicts significant impairment in adulthood, including academic problems, poverty, and suicidality (Conner et al 2004, Copeland et al 2014, Cornacchio et al 2016, Leibenluft et al 2006, Nock et al 2007, Pickles et al 2010, Stringaris et al 2009. Given this substantial public health impact, further research is needed to elucidate the biological underpinnings of severe irritability.…”

Empirically derived patterns of psychiatric symptoms in youth: A latent profile analysis

“…Such work requires the creation of symptom-based dimensions from multiple DSM categories, which can be linked to measures of genetics and psychobiology (Garvey, Avenevoli, & Anderson, 2016). Among youth, irritability and anxiety represent two dimensional, impairing, and correlated traits (e.g., Copeland, Brotman, & Costello, 2015; Cornacchio, Crum, Coxe, Pincus, & Comer, 2016; Savage et al, 2015; Stoddard et al, 2014; Stringaris et al, 2012), which may arise from shared biological vulnerabilities (i.e., multifinality, Cicchetti & Rogosch, 1996). Such interdependent relations among symptom dimensions have implications for the RDoC framework, but have yet to be empirically integrated (see Krueger & DeYoung, 2016).…”

“…Irritability aligns with the RDoC construct of frustrative nonreward (Dickstein, 2015), while anxiety aligns with the potential threat construct (Blackford & Pine, 2012). Although irritability and anxiety are often studied separately, they significantly co-vary in both community and clinical samples of youth (e.g., Cornacchio et al, 2016; Savage et al, 2015; Stoddard et al, 2014). Recent work suggests common biological substrates (Blair, 2010; Savage et al, 2015) and behavioral deficits (Hommer et al, 2014) across irritability and anxiety.…”

“…Symptoms of depression and ADHD were included because they often co-occur with irritability and anxiety (e.g., Brotman et al, 2006; Costello, Mustillo, Erkanli, Keeler, & Angold, 2003) and, similarly, may share biological mechanisms with irritability and/or anxiety (e.g., Eley & Stevenson, 1999; Savage et al, 2015; Stringaris, Zavos, Leibenluft, Maughan, & Eley, 2012). Based on previous research (e.g., Brotman et al, 2006; Cornacchio et al, 2016; Costello et al, 2003; Savage et al, 2015; Stoddard et al, 2014), we hypothesized that the LPA would identify several different multidimensional symptom profiles, including classes of youth characterized by co-occurring irritability and anxiety, co-occurring irritability and ADHD, and co-occurring anxiety and depression, and that classes characterized by the greatest degree of symptom co-occurrence would exhibit the poorest functioning. Further, we hypothesized that the LPA would not conform to traditional diagnostic boundaries, such that the target conditions or diagnoses for which youth were initially evaluated would be distributed across the obtained classes.…”

Emotional and behavioural dysregulation in children of health care workers in the frontline of COVID-19 response in Sri Lanka

“…The 9-year-old boy presented with irritability and oppositional defiance as his mother was engaged in the COVID-19 health response. In a prior study among children and adolescents between the ages of 7 to 19 years, it was shown that there is a direct link between child anxiety and irritability (11). He was treated with guided imagery leading to reduction of his symptoms.…”