Parent and Teacher Ratings of Tonic and Phasic Irritability in a Clinical Sample

Development and Validation of a Multi-Informant Scale for Assessing Youth Tonic and Phasic Irritability

Irritability is a common mental health issue in children and adolescents which strongly predicts later psychopathology and impairment. It can manifest in tonic (persistent angry mood) and phasic (short temper outbursts) forms, but research on this distinction is limited due to the lack of validated measures. We developed and evaluated the first multi-informant measure of tonic/phasic irritability for school-age children and adolescents. Data was collected from four samples including three community samples (a total of 1208 parents of 6-17-year-old children and 876 unrelated 13-17-year-old youth) and a small clinical sample (92 parents and their 10-17-year-old children). The Tonic and Phasic Irritability Scale (TAPIS) consists of 8 items measuring tonic, and 11 items measuring phasic, irritability. It demonstrated strong psychometric properties, including structural validity, test-retest stability, and construct validity. Consistent with the literature, tonic irritability was associated with internalizing problems (i.e., anxiety, depression), while phasic irritability was related to externalizing behaviors (e.g., aggression, conduct problems, substance use). The TAPIS exhibited measurement invariance across gender, age, informant, and history of mental health treatment. These findings provide preliminary support for the TAPIS' reliability and validity and demonstrate its promise helping to elucidate differences in the development and treatment of tonic and phasic irritability.

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

Children prone to irritability experience significant functional impairments and internalising and externalising problems. Contemporary models have sought to elucidate the underlying mechanisms in irritability, such as aberrant threat and reward biases to improve interventions. However, the cognitive control processes that underlie threat (e.g., attention towards threats) and reward (e.g., attention towards reward-related cues) biases and the factors which influence the differential activation of positive and negative valence systems and thus leading to maladaptive activation of cognitive control processes (i.e., proactive and reactive control) are unclear. Thus, we aim to integrate extant theoretical and empirical research to elucidate the cognitive control processes underlying threat and reward processing that contribute to irritability in middle childhood and provide a guiding framework for future research and treatment. We propose an expanded conceptual framework of irritability that includes broad intraindividual and environmental vulnerability factors and propose proximal 'setting' factors that activate the negative valence and positive valence systems and proactive and reactive cognitive control processes which underpin the expression and progression of irritability. We consider the implications of this expanded conceptualisation of irritability and provide suggestions for future research.

Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately1

Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This "Future Directions" aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts "hang together," but have important distinctions and thus also need to "hang separately." Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.