Irritability and Emotional Impulsivity as Core Feature of ADHD and ODD in Children

Association of Lower COMT Activity Alleles with Aggressive Traits in Male Youth with Conduct Disorder Living in a Correctional Facility

Aggression constitutes a significant behavioral issue associated with delinquent behavior, commonly observed in youth diagnosed with conduct disorder (CD) and living in correctional facilities. Catechol-o-methyl-transferase (COMT) gene variants modify the environmental sensitivity associated with the risk of aggression. This study evaluated the association of COMT rs4680 and rs4818 polymorphisms with aggressive behavior in 341 male adolescents living inside and outside a correctional facility, with or without a diagnosis of CD. Aggression was assessed using the Hare Psychopathy Checklist: Youth Version (PCL-YV), Modified Overt Aggression Scale (MOAS) and Swanson, Nolan and Pelham Questionnaire. COMT rs4680 and rs4818 polymorphisms were genotyped using TaqMan SNP Genotyping Assays. A similar prevalence of the COMT genotypes or haplotypes was found between adolescents with or without CD, suicidal behavior, or detention in correctional facility. In youth with CD, the COMT rs4680 A allele was associated with higher MOAS verbal aggression, aggression toward objects, irritability (subjective and open), and PCL-YV interpersonal domain scores compared with carriers of the COMT rs4680 G allele. COMT rs4818 GC carriers with CD had higher scores on the MOAS subjective irritability than GG heterozygotes. These novel findings revealed the association of lower COMT rs4680 and rs4818 activity alleles with aggression in detained male adolescents with CD.

A novel framework to predict ADHD symptoms using irritability in adolescents and young adults with and without ADHD

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents characterized by persistent patterns of hyperactivity, impulsivity, and inattentiveness. ADHD persists for many into adulthood. While irritability is not a diagnostic symptom of ADHD, temper outbursts and irritable moods are common in individuals with ADHD. However, research on the association between irritability and ADHD symptoms in adolescents and young adults remains limited.

Method

Prior research has used linear regression models to examine longitudinal relations between ADHD and irritability symptoms. This method may be impacted by the potential presence of highly colinear variables. We utilized a hierarchical clustering technique to mitigate these collinearity issues and implemented a non-parametric machine learning (ML) model to predict the significance of symptom relations over time. Our data included adolescents (N=148, 54% ADHD) and young adults (N=124, 42% ADHD) diagnosed with ADHD and neurotypical (NT) individuals, evaluated in a longitudinal study.

Results

Results from the linear regression analysis indicate a significant association between irritability at time-point 1 (T1) and hyperactive-impulsive symptoms at time-point 2 (T2) in adolescent females (β=0.26, p-value < 0.001), and inattentiveness at T1 with irritability at T2 in young adult females (β=0.49, p-value < 0.05). Using a non-parametric-based approach, employing the Random Forest (RF) method, we found that among both adolescents and young adults, irritability in adolescent females significantly contributes to predicting impulsive symptoms in subsequent years, achieving a performance rate of 86%.

Conclusion

Our results corroborate and extend prior findings, allowing for an in-depth examination of longitudinal relations between irritability and ADHD symptoms, namely hyperactivity, impulsivity, and inattentiveness, and the unique association between irritability and ADHD symptoms in females.

Self-Rated Symptoms of Oppositional Defiant Disorder and Conduct Disorder: Factor Structure, Reliability, and Validity in a Clinical Sample of Adolescents

This study examined the psychometric properties of self-rated symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD). We analyzed symptom ratings from a clinical outpatient sample of 658 adolescents aged 11;0-17;11 years diagnosed with ODD/CD and/or attention-deficit hyperactivity disorder. In two steps, we examined the factor structure of ODD models and an additional CD symptom dimension using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM). Our preferred three-factor CFA and ESEM models (CFI = 0.937-0.975, TLI = 0.926-0.962, RMSEA = 0.049-0.068, SRMR = 0.045-0.070) demonstrated scalar measurement invariance across age groups (≥ 14;0 years) and metric measurement invariance across informants (parents, teachers). With exceptions, the self-rated symptom scales showed acceptable internal consistencies (α = 0.68-0.84). Convergent (r =.27-.65) and divergent validity (r =.13-.41) were supported using Achenbach's Youth Self Report Form. Our results provide implications for using self-rated ODD/CD symptoms in clinical practice and research.

Assessment of affective dysregulation in children: development and evaluation of a semi-structured interview for parents and for children

BACKGROUND

Children with affective dysregulation (AD) show an excessive reactivity to emotionally positive or negative stimuli, typically manifesting in chronic irritability, severe temper tantrums, and sudden mood swings. AD shows a large overlap with externalizing and internalizing disorders. Given its transdiagnostic nature, AD cannot be reliably and validly captured only by diagnostic categories such as disruptive mood dysregulation disorder (DMDD). Therefore, this study aimed to evaluate two semi-structured clinical interviews-one for parents and one for children.

METHODS

Both interviews were developed based on existing measures that capture particular aspects of AD. We analyzed internal consistencies and interrater agreement to evaluate their reliability. Furthermore, we analyzed factor loadings in an exploratory factor analysis, differences in interview scores between children with and without co-occurring internalizing and externalizing disorders, and associations with other measures of AD and of AD-related constructs. The evaluation was performed in a screened community sample of children aged 8-12 years (n = 445). Interrater reliability was additionally analyzed in an outpatient sample of children aged 8-12 years (n = 27).

RESULTS

Overall, internal consistency was acceptable to good. In both samples, we found moderate to excellent interrater reliability on a dimensional level. Interrater agreement for the dichotomous diagnosis DMDD was substantial to perfect. In the exploratory factor analysis, almost all factor loadings were acceptable. Children with a diagnosis of disruptive disorder, attention-deficit/hyperactivity disorder, or any disorder (disruptive disorder, attention-deficit/hyperactivity disorder, and depressive disorder) showed higher scores on the DADYS interviews than children without these disorders. The correlation analyses revealed the strongest associations with other measures of AD and measures of AD-specific functional impairment. Moreover, we found moderate to very large associations with internalizing and externalizing symptoms and moderate to large associations with emotion regulation strategies and health-related quality of life.

CONCLUSIONS

The analyses of internal consistency and interrater agreement support the reliability of both clinical interviews. Furthermore, exploratory factor analysis, discriminant analyses, and correlation analyses support the interviews' factorial, discriminant, concurrent, convergent, and divergent validity. The interviews might thus contribute to the reliable and valid identification of children with AD and the assessment of treatment responses.

TRIAL REGISTRATION

ADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963. Registered 27 June 2018.

Screening for affective dysregulation in school-aged children: relationship with comprehensive measures of affective dysregulation and related mental disorders

Affective dysregulation (AD) is characterized by irritability, severe temper outbursts, anger, and unpredictable mood swings, and is typically classified as a transdiagnostic entity. A reliable and valid measure is needed to adequately identify children at risk of AD. This study sought to validate a parent-rated screening questionnaire, which is part of the comprehensive Diagnostic Tool for Affective Dysregulation in Children (DADYS-Screen), by analyzing relationships with comprehensive measures of AD and related mental disorders in a community sample of children with and without AD. The sample comprised 1114 children aged 8-12 years and their parents. We used clinical, parent, and child ratings for our analyses. Across all raters, the DADYS-Screen showed large correlations with comprehensive measures of AD. As expected, correlations were stronger for measures of externalizing symptoms than for measures of internalizing symptoms. Moreover, we found negative associations with emotion regulation strategies and health-related quality of life. In receiver operating characteristic (ROC) analyses, the DADYS-Screen adequately identified children with AD and provided an optimal cut-off. We conclude that the DADYS-Screen appears to be a reliable and valid measure to identify school-aged children at risk of AD.

Vicious cycle of emotion regulation and ODD symptoms among Chinese school-age children with ODD: a random intercept cross-lagged panel model

A strong link between children's emotion regulation and oppositional defiant disorder (ODD) symptoms has been documented; however, the within-person mechanisms remain unclear. Based on the self-control theory and self-regulation theory, our study investigated the longitudinal, bidirectional relationship between emotion regulation and ODD symptoms in school-age children with ODD using parent- and teacher-reported data, respectively. A total of 256 Chinese elementary school students participated in a three-wave longitudinal study spanning two years. We used the random intercept cross-lagged panel model (RI-CLPM) to investigate the concurrent and longitudinal associations between emotion regulation and ODD symptoms. Results from the RI-CLPMs revealed that ODD symptoms were negatively correlated with emotion regulation and positively correlated with emotion lability/negativity at both the between-person and within-person levels across settings. Additionally, in the school setting, emotion regulation negatively predicted subsequent ODD symptoms but not vice versa, whereas emotion lability/negativity was bidirectionally associated with ODD symptoms over time. The longitudinal associations of ODD symptoms with emotion regulation and lability/negativity were not observed in the home setting. These findings suggest a circular mechanism between children's emotion regulation and ODD symptoms and support the view that emotion regulation, particularly emotion lability/negativity, plays an important role in the development of ODD symptoms.

Validation of a new emotion regulation self-report questionnaire for children

OBJECTIVE

To examine and validate the self-report Questionnaire on the Regulation of Unpleasant Moods in Children (FRUST), which is a modified and shortened version of the Questionnaire for the Assessment of Emotion Regulation in Children and Adolescents (FEEL-KJ).

METHODS

The data comprised child and parent ratings of a community-screened sample with differing levels of affective dysregulation (AD) (N = 391, age: M = 10.64, SD = 1.33, 56% male). We conducted latent factor analyses to establish a factor structure. Subsequently, we assessed measurement invariance (MI) regarding age, gender, and AD level and evaluated the internal consistencies of the scales. Finally, we examined the convergent and divergent validity of the instrument by calculating differential correlations between the emotion regulation strategy (ERS) scales and self- and parent-report measures of psychopathology.

RESULTS

A four-factor model, with one factor representing Dysfunctional Strategies and the three factors Distraction, Problem-Solving and Social Support representing functional strategies provided the best fit to our data and was straightforward to interpret. We found strong MI for age and gender and weak MI for AD level. Differential correlations with child and parent ratings of measures of psychopathology supported the construct validity of the factors.

CONCLUSIONS

We established a reliable and valid self-report measure for the assessment of ERS in children. Due to the reduced number of items and the inclusion of highly specific regulatory behaviors, the FRUST might be a valuable contribution to the assessment of ER strategies for diagnostic, therapeutic, and research purposes.