Using ecological momentary assessment to enhance irritability phenotyping in a transdiagnostic sample of youth

Abstract

Irritability is a transdiagnostic symptom dimension in developmental psychopathology, closely related to the Research Domain Criteria (RDoC) construct of frustrative nonreward. Consistent with the RDoC framework and calls for transdiagnostic, developmentally-sensitive assessment methods, we report data from a smartphone-based, naturalistic ecological momentary assessment (EMA) study of irritability. We assessed 109 children and adolescents (Mage = 12.55 years; 75.20% male) encompassing several diagnostic groups – disruptive mood dysregulation disorder (DMDD), attention-deficit/hyperactivity disorder (ADHD), anxiety disorders (ANX), healthy volunteers (HV). The participants rated symptoms three times per day for 1 week. Compliance with the EMA protocol was high. As tested using multilevel modeling, EMA ratings of irritability were strongly and consistently associated with in-clinic, gold-standard measures of irritability. Further, EMA ratings of irritability were significantly related to subjective frustration during a laboratory task eliciting frustrative nonreward. Irritability levels exhibited an expected graduated pattern across diagnostic groups, and the different EMA items measuring irritability were significantly associated with one another within all groups, supporting the transdiagnostic phenomenology of irritability. Additional analyses utilized EMA ratings of anxiety as a comparison with respect to convergent validity and transdiagnostic phenomenology. The results support new measurement tools that can be used in future studies of irritability and frustrative nonreward.

Real‐time assessment of positive and negative affective fluctuations and mood lability in a transdiagnostic sample of youth

“…Two participants were excluded from the analyses due to low EMA compliance rate (completed prompts N < 5). This threshold allows sufficient time points for within-person variability analyses and was determined based on commonly used standards in previous EMA studies (Wen et al, 2017) across both adults (Williams-Kerver et al, 2021) and youth (Russell & Gajos, 2020) samples, also consistent with prior work in our group (Naim et al, 2021;Smith et al, 2019). The mean compliance rate of the overall sample was 78.54% (SD = 16.38%), with all groups presenting high compliance rates (de Vries et al, 2021;Wrzus & Neubauer, 2022).…”

“…Training sessions were standardized and were intended to familiarize families with the text messages and the hardware (i.e., cellphone). The EMA survey included 21 prompts (3 prompts per day for 7 days; for full description of EMA procedures see Naim et al, 2021 ). Following EMA, clinicians assessed global impairment using a clinician‐rated questionnaire.…”

“…Items were measured using a 5‐point Likert scale (ranging from 1 “not at all” to 5 “extremely”). These EMA items have been previously examined by our group and shown to correlate with established gold‐standard self‐, parent‐, and clinician‐report measures (Naim et al, 2021 ; Smith et al, 2019 ). While most of these items were designed to capture affect in a more absolute sense, others (e.g., the giddiness item) were designed to capture how participants were feeling relative to their typical affective state.…”

Measuring irritability in young adults: An integrative review of measures and their psychometric properties

“…Finally, examining irritability needs to be further investigated not only in terms of behavioral manifestations with self‐report questionnaires, but by utilizing more novel methods of assessment (Vidal‐Ribas et al, 2016 ), namely heart rate, heart rate variability (Naim, Goodwin, et al, 2021a ), neuroendocrine markers such as cortisol (Kessel et al, 2019 ; Mikita et al, 2015 ), functional Magnetic Resonance Imaging (fMRI), and employing Ecological Momentary Assessment (EMA) and digital technology (e.g. smartwatches and ring sensors) (Naim, Smith, et al, 2021b ).…”

Network analysis of ecological momentary assessment identifies frustration as a central node in irritability

“…EMA items. The full EMA protocol assessed various dimensions of mood and anxiety symptoms (Naim et al, 2021;Smith et al, 2022). The current analyses focused on irritability-related symptoms (i.e.…”