An Expanded Conceptual Framework for Understanding Irritability in Childhood: The Role of Cognitive Control Processes

Understanding irritability through the lens of self-regulatory control processes in children and adolescents: a systematic review

Among youths, pathological irritability is highly prevalent and severely disabling. As a frequent symptom, it often leads to referrals to child and adolescent mental health services. Self-regulatory control (SRC) processes are a set of socio-psycho-physiological processes that allow individuals to adapt to their ever-changing environments. This conceptual framework may enhance the current understanding of the cognitive, emotional, behavioural and social dysregulations underlying irritability. The present systematic review (PROSPERO registration: #CRD42022370390) aims to synthesize existing studies that examine irritability through the lens of SRC processes among youths (< 18 years of age). We conducted a comprehensive literature search among six bibliographic databases: Embase.com, Medline ALL Ovid, APA PsycInfo Ovid, Web of Science Core Collection, the Cochrane Database of Systematic Reviews Wiley and ProQuest Dissertations & Theses A&I. Additional searches were performed using citation tracing strategies. The retrieved reports totalled 2612, of which we included 82 (i.e., articles) from 74 studies. More than 85% of reports were published during the last 6 years, highlighting the topicality of this work. The studies sampled n = 26,764 participants (n = 12,384 girls and n = 12,905 boys, n = 1475 no information) with an average age of 8.08 years (SD = 5.26). The included reports suggest that irritability has an association with lower effortful control, lower cognitive control and delay intolerance. Further, evidence indicates both cross-sectional and longitudinal associations between irritability and a lack of regulation skills for positive and negative emotions, particularly anger. Physiological regulation seems to moderate the association between irritability and psychopathology. Finally, the mutual influence between a child's irritability and parenting practice has been established in several studies. This review uses the lens of SRC to illustrate the current understanding of irritability in psychopathology, discusses important gaps in the literature, and highlights new avenues for further research.

Irritability as a Transdiagnostic Construct Across Childhood and Adolescence: A Systematic Review and Meta-analysis

This meta-analytic review examined irritability across childhood and adolescence as it relates to symptoms of common mental health disorders in these periods. Of key interest was whether the relationship between irritability and symptom severity varies according to symptom domain. This was tested at the level of broad symptom dimensions (internalizing versus externalizing problems) as well as discrete diagnostic domains (e.g., anxiety, depression, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder; autism spectrum disorder). Following PRISMA guidelines, a systematic search of five databases was conducted to identify studies reporting on associations between irritability and mental health symptoms in samples of children aged 2-18 years. Meta-analytic tests based on random effects models examined concurrent and longitudinal associations between irritability and symptom severity. Meta-regression tested potential moderators including symptom domain, child age, sex, informant type, and study quality. 119 studies met inclusion criteria with a total of 122,456 participants. A significant and positive association was found between irritability and severity of concurrent overall psychopathology in the order of a moderate effect size, while small to moderate effect sizes characterized the association between irritability and later mental health outcomes in prospective data. Further variation in this association was seen across specific diagnostic domains and methodological moderators. Findings support the conceptualization of irritability as a transdiagnostic construct reflecting emotion dysregulation across diverse forms of psychopathology in childhood and adolescence. Further research into the risk mechanisms underlying irritability is needed, in addition to translational approaches to early intervention.