The Clinician Affective Reactivity Index: Validity and Reliability of a Clinician-Rated Assessment of Irritability

Haller, Simone P.; Kircanski, Katharina; Stringaris, Argyris; Clayton, Michal; Bui, Hong; Agorsor, Courtney; Cardenas, Sofia I.; Towbin, Kenneth E.; Pine, Daniel S.; Leibenluft, Ellen; Brotman, Melissa A.

doi:10.1016/j.beth.2019.10.005

Cited by 41 publications

(43 citation statements)

References 46 publications

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“…Ratings were administered by trained master's-level or doctoral-level clinicians. Primary outcome measures assessed changes in irritability using the Clinician Affective Reactivity Index (CL-ARI), 39 Clinical Global Impressions ScaleÀImprovement for DMDD (CGI-I), 38 and parent-and child-report Affective Reactivity Index (ARI-C/P). 40 Secondary outcome measures were ratings of anxiety, rated by clinicians (Pediatric Anxiety Rating Scale [PARS]), 41 and the Screen for Childhood Anxiety Related Emotional DisordersÀparent/ child [SCARED]), 42 as well as measures of depression assessed via clinician-report (Children's Depression Rating Scale [CDRS]) 43 and child-report (Children's Depression Inventory [CDI].…”

Section: Methodsmentioning

confidence: 99%

A Randomized Controlled Trial of Computerized Interpretation Bias Training for Disruptive Mood Dysregulation Disorder: A Fast-Fail Study

Haller

Stoddard

Botz-Zapp

et al. 2022

Journal of the American Academy of Child & Adolescent Psych

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To examine targeted, mechanism-based interventions is the next generation of treatment innovation. Biased threat labeling of ambiguous face emotions (interpretation bias) is a potential behavioral treatment target for anger, aggression, and irritability. Changing biases in face-emotion labeling may improve irritability-related outcomes. Here, we report the first randomized, double-blind placebo-controlled targeted trial of interpretation bias training (IBT) in youths with chronic, severe irritability. Method: Patients with current Disruptive Mood Dysregulation Disorder (DMDD; N ¼ 44) were randomly assigned to complete 4 sessions of active (n ¼ 22) or sham (n ¼ 22) computerized IBT training within a 1-week period. The first and last trainings were completed onsite, and 2 trainings were completed at home. We examined the effects of active IBT on labeling bias, primary outcome measures of irritability, and secondary outcome measures of anxiety, depression, and functional impairment. Follow-up assessments were completed immediately after and 2 weeks after the intervention Q5 .Results: We found that active IBT engaged the behavioral target in the active relative to the sham condition, as shown by a significant shift toward labeling ambiguous faces as happy. However, there was no consistent clinical improvement in active IBT relative to the sham condition either immediately after or 2 weeks after training in either the primary or secondary outcome measure. Conclusion: Although this randomized controlled trial of IBT in youths with DMDD engaged the proposed behavioral target, there was no statistically significant improvement on clinical outcome. Identifying and changing behavioral targets is a first step in novel treatment development; these results have broader implications for targeted-based intervention development. Clinical trial registration information: Psychological Treatments for Youth With Severe Irritability; https://clinicaltrials.gov/; NCT02531893.

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Section: Methodsmentioning

confidence: 99%

A Randomized Controlled Trial of Computerized Interpretation Bias Training for Disruptive Mood Dysregulation Disorder: A Fast-Fail Study

Haller

Stoddard

Botz-Zapp

et al. 2022

Journal of the American Academy of Child & Adolescent Psych

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“…CL-ARI had a good reliabilty (Cronbach'sα=0.89) and validity scores. 84 CGI-S is is a single-item, 7-point measure of overall DMDD severity (1=normal, 7=most extreme) over the past month. The CGI scales are commonly used in psychiatric clinical trials, for which they have established utility and reliability.…”

Section: Patient and Public Involvementmentioning

confidence: 99%

Across-subjects multiple baseline trial of exposure-based cognitive-behavioral therapy for severe irritability: a study protocol

et al. 2021

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IntroductionIrritability is defined as a tendency towards anger in response to frustration. Clinically, impairing irritability is a significant public health problem. There is a need for mechanism-based psychotherapies targeting severe irritability as it manifests in the context of disruptive mood dysregulation disorder (DMDD). This study protocol describes a randomised multiple baseline design testing the preliminary efficacy of a new treatment, exposure-based cognitive-behavioral therapy for severe irritability in youth, which also integrates components of parent management training. We will investigate associations of this intervention with primary clinical measures, as well as ecological momentary assessment measures.Methods and analysisForty youth will be enrolled. Participants, aged 8–17 years, must present at least one of two core symptoms of DMDD: abnormal mood or increased reactivity to negative emotional stimuli, with severe impairment in one domain (home, school, peers) and moderate in another, or moderate impairment in at least two domains. Each participant is randomised to a 2-week, 4-week or 6-week baseline observation period, followed by 12 active treatment sessions. Clinical ratings are conducted at baseline, biweekly (clinician), weekly (parent/child) throughout treatment, post-treatment, and 3-month and 6-month follow-up (clinician). Clinician ratings on the Affective Reactivity Index and Clinical Global Impressions-Improvement scale for DMDD are our primary outcome measures. Secondary outcome measures include parent and child reports of irritability. Post hoc additional symptom measures include clinician, parent and self-ratings of depression, anxiety and overall functional impairment. Prospective, digitally based event sampling of symptoms is acquired for a week pre-treatment, mid-treatment and post-treatment. Based on our pathophysiological model of irritability implicating frustrative non-reward, aberrant threat processing and instrumental learning, we probe these three brain-based targets using functional MRI paradigms to assess target engagement.Ethics and disseminationThe research project and all related materials were submitted and approved by the appropriate Institutional Review Board (IRB) of the National Institute of Mental Health (NIMH).Trial registration numbersNCT02531893 and NCT00025935.

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“…The CL-ARI , a semi-structured interview conceived by Haller et al in 2020 in which parents and children are asked to describe the frequency, duration and severity of outbursts of anger and irritable moods (Haller et al, 2020);…”

Section: Irritability Measuresmentioning

confidence: 99%

Irritability in developmental age: A narrative review of a dimension crossing paediatric psychopathology

Breda

Ardizzone

2021

Aust N Z J Psychiatry

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Objective: Irritability is an important theme in paediatric psychiatry considering its high frequency in developmental age, its association with negative outcomes and consequently significant public health impact. Present as main or associated feature of several psychiatric diagnoses, irritability represents a challenge for clinicians who try to understand its origin and role in developmental psychopathology. In this review we try to: (1) get an overview of this dimension and its relationship with each of the main neuropsychiatric disorders in paediatric population and (2) provide a summary of currently available instruments to assess irritability in children and adolescents. Method: In this narrative review, an overview of irritability in children and adolescents is proposed focusing on selected literature. Results: Irritability as feature of many paediatric psychiatric conditions has been evaluated by many authors and included in classifications of paediatric psychiatric diseases. Framework of irritability evolved over time and dimension of irritability has been investigated using different tools and methodologies, both qualitative and quantitative. Metrics of irritability as clinical dimension are important in the diagnostic process of paediatric diseases. Conclusion: Investigating the presence of irritability in all children with related disorders is mandatory if we consider the risk for functional impairment and affective and behavioural disorders associated with high levels of irritability. Using rigid threshold in developmental age to differentiate physiological from pathological irritability could lead many children having subthreshold levels of irritability to receive no diagnosis and, consequently, no treatment where instead a dimensional approach to irritability could allow to identify prodromal phase and prevent the evolution towards clinical pathological expressions.

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The Clinician Affective Reactivity Index: Validity and Reliability of a Clinician-Rated Assessment of Irritability

Cited by 41 publications

References 46 publications

A Randomized Controlled Trial of Computerized Interpretation Bias Training for Disruptive Mood Dysregulation Disorder: A Fast-Fail Study

A Randomized Controlled Trial of Computerized Interpretation Bias Training for Disruptive Mood Dysregulation Disorder: A Fast-Fail Study

Across-subjects multiple baseline trial of exposure-based cognitive-behavioral therapy for severe irritability: a study protocol

Irritability in developmental age: A narrative review of a dimension crossing paediatric psychopathology

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