Is Irritability a Top Problem in Youth Mental Health Care? A Multi-informant, Multi-method Investigation

Evans, Spencer C.; Corteselli, Katherine A.; Edelman, Audrey; Scott, Hannah; Weisz, John R.

doi:10.1007/s10578-021-01301-8

Cited by 30 publications

(20 citation statements)

References 82 publications

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“…Irritability is among the most common reasons that children are brought for psychiatric evaluation and care (1, 2, 6, 33, 34). Despite the significant impact of irritability on mental health, little is known about its underlying neural mechanisms and limited treatment options are available (4, 35).…”

Section: Discussionmentioning

confidence: 99%

“…Irritability, defined as proneness to anger that can reach a pathological extent, is one of the most common reasons for psychiatric evaluation and treatment in youth (1). It is associated with significant impairment and long-lasting adverse outcomes including high rates of school suspensions, hospitalizations, suicidality, and diagnoses of anxiety and depression (2, 3) .…”

Section: Introductionmentioning

confidence: 99%

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A New Behavioral Paradigm for Frustrative Non-reward Reveals a Global Change in Brain Networks by Frustration

Naik

Munyeshyaka

et al. 2023

Preprint

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BackgroundIrritability, which can be defined as proneness to anger that can reach a pathological extent, is one of the most common reasons youth present for psychiatric evaluation and care. Aberrant responses to frustrative non-reward (FNR, the response to omission of an expected reward) are central to the pathophysiology of irritability. FNR is a cross-species RDoC construct. The development of preclinical FNR models could advance mechanistic studies of the important, and relatively understudied, clinical phenomenon of irritability.MethodsWe used FNR, a translational construct across species, as a conceptual framework for a novel behavioral paradigm (Alternate Poking Reward Omission, APRO) in mice. After APRO, mice were examined with a battery of behavioral tests to determine the effects of frustration. Also, whole brain imaging of c-Fos expression was used to identify brain regions activated by FNR.ResultsMice, regardless of sex, increased locomotion, and aggression towards conspecifics after APRO. There was no change in anxiety-like, depression-like, or non-aggressive social behaviors. APRO causes activation of 13 regions in the prelimbic, ACC, hippocampus, dorsal thalamus, cuneiform nucleus, pons, and pallidum areas, and shifts the brain network towards a more global processing mode.ConclusionOur novel FNR paradigm produces a frustration effect and alters brain processing in ways resembling the symptoms and brain network reconfiguration observed in youth with severe irritability. The novel behavioral paradigm and brain regions identified to be selectively activated by it lay the groundwork for further mechanistic studies of frustration and irritability in rodents.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A New Behavioral Paradigm for Frustrative Non-reward Reveals a Global Change in Brain Networks by Frustration

Naik

Munyeshyaka

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Pediatric irritability, when frequent, dysregulated, and disproportionate to context, is one of the most common reasons for treatment referral and predictive of future psychopathology, suicidality, and impairment (Dougherty et al., 2013; Evans et al., 2022; Hawes et al., 2020; Orri et al., 2019; Sorcher et al., 2022; Stringaris et al., 2009; Vidal‐Ribas et al., 2016). As such, modeling the normal: abnormal spectrum of irritability and generating clinically optimized screening tools that allow for quick and efficient identification of clinically significant irritability are paramount for researchers and clinicians (Wiggins, Roy, et al., 2023).…”

Section: Introductionmentioning

confidence: 99%

Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening

Hirsch,

Alam,

Kirk

et al. 2023

Int J Methods Psych Res

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ObjectivesDevelopmentally specified measures that identify clinically salient irritability are needed for early school‐age youth to meaningfully capture this transdiagnostic risk factor for psychopathology. Thus, the current study modeled the normal:abnormal irritability spectrum and generated a clinically optimized screening tool for this population.MethodsThe irritability spectrum was modeled via the youth version of the Multidimensional Assessment Profile Scales—Temper Loss Scale (MAPS‐TL‐Youth) in children (n = 474; 6.0–8.9 years) using item response theory (IRT). Both cross‐cutting core irritability items from the early childhood version and new developmentally specific items were included. Items uniquely associated with impairment were identified and used to derive a brief, clinically optimized irritability screener. Longitudinal data were then utilized to test the predictive utility of this clinically optimized screener in preadolescence (n = 348; 8.0–12.9 years).ResultsMost children exhibit irritability regularly, but daily occurrence was rare. Of the top 10 most severe items from the IRT analyses, 9 were from the developmentally specific items added for the MAPS‐TL Youth version. Two items associated with concurrent impairment were identified for the clinically optimized irritability screener (“Become frustrated easily” and “Act irritable”). The MAPS‐TL‐Youth clinically optimized screener demonstrated good sensitivity (69%) and specificity (84%) in relation to concurrent DSM 5 irritability‐related diagnoses. Youth with elevated scores on the screener at early school age (ESA) had more than 7x greater odds of irritability‐related psychopathology at pre‐adolescence.ConclusionsThe MAPS‐TL‐Youth characterized the developmental spectrum of irritability at ESA and a clinically optimized screener showed promise at predicting psychopathology risk. Rigorous testing of clinical applications is a critical next step.

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“…DSM-5’s inclusion of DMDD in 2013). Irritability is among the most common reasons for which families seek child mental health services [ 3 ]. Irritability is linked to severe outcomes such as high levels of functional impairments, poor psychological and physical health [ 4 , 5 ], suicidality [ 6 ], and continued impairment in adulthood [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Executive function in children with disruptive mood dysregulation disorder compared to attention-deficit/hyperactivity disorder and oppositional defiant disorder, and in children with different irritability levels

Brænden

Coldevin

Stubberud

et al. 2023

Eur Child Adolesc Psychiatry

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Addressing current challenges in research on disruptive mood dysregulation disorder (DMDD), this study aims to compare executive function in children with DMDD, children with attention-deficit/hyperactivity disorder (ADHD), and children with oppositional defiant disorder (ODD). We also explore associations between irritability, a key DMDD characteristic, and executive function in a clinical sample regardless of diagnosis. Our sample include children (6–12 years) referred to child psychiatric clinics. Measures of daily-life (parent-reported questionnaire) and performance-based (neuropsychological tasks) executive function were applied. Identifying diagnoses, clinicians administered a standardized semi-structured diagnostic interview with parents. Irritability was assessed by parent-report. First, we compared executive function in DMDD (without ADHD/ODD), ADHD (without DMDD/ODD), ODD (without DMDD/ADHD) and DMDD + ADHD (without ODD). Second, we analyzed associations between executive function and irritability using the total sample. In daily life, children with DMDD showed clinically elevated and significantly worse emotion control scores compared to children with ADHD, and clinically elevated scores on cognitive flexibility compared to norm scores. Children with DMDD had significantly less working memory problems than those with ADHD. No differences were found between DMDD and ODD. Increased irritability was positively associated with emotional dyscontrol and cognitive inflexibility. For performance-based executive function, no diagnostic differences or associations with irritability were observed. We discuss how, in daily life, children with high irritability-levels get overwhelmed by feelings without accompanying regulatory capacities.

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Is Irritability a Top Problem in Youth Mental Health Care? A Multi-informant, Multi-method Investigation

Cited by 30 publications

References 82 publications

A New Behavioral Paradigm for Frustrative Non-reward Reveals a Global Change in Brain Networks by Frustration

A New Behavioral Paradigm for Frustrative Non-reward Reveals a Global Change in Brain Networks by Frustration

Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening

Executive function in children with disruptive mood dysregulation disorder compared to attention-deficit/hyperactivity disorder and oppositional defiant disorder, and in children with different irritability levels

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