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DeGroot H, Silver J, Klein DN, Carlson GA. Parent and Teacher Ratings of Tonic and Phasic Irritability in a Clinical Sample. Res Child Adolesc Psychopathol 2024; 52:891-903. [PMID: 38236382 DOI: 10.1007/s10802-023-01151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 01/19/2024]
Abstract
Research on tonic (persistently angry or grumpy mood) and phasic (temper tantrums/outbursts) irritability in youth has utilized community samples and information from parents and youth. We examined whether tonic and phasic irritability are empirically distinguishable and have similar correlates using teacher, in addition to parent, reports in a clinical sample of children and adolescents. The sample included youth aged 5-18 evaluated at a university outpatient clinic, with complete information from 2481 parents and 2449 teachers. We conducted confirmatory factor analysis (CFA) using items from several parent- and teacher-report inventories and examined concurrent associations with psychopathology and functioning. The CFA supported a two-factor model consistent with tonic and phasic irritability in both parent- and teacher-reports. Parent-reported tonic irritability was associated with higher rates of depression and anxiety disorders, suicidality, and antidepressant medication use. Teacher-reported tonic irritability was associated with elevated rates of depression and antidepressant use. Both parent- and teacher-reported phasic irritability were linked to higher rates of ADHD combined type, oppositional defiant/conduct disorders, and referral for rages. Parent- and teacher-reported tonic and phasic irritability were all associated with impaired social functioning. Parents and teachers can distinguish tonic and phasic irritability, which are associated with internalizing and externalizing problems, respectively. Findings were generally consistent across informants, and with prior studies using community samples.
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Affiliation(s)
- Harriet DeGroot
- University of Alabama Psychology Department, Tuscaloosa, AL, USA.
| | - Jamilah Silver
- Stony Brook University, Department of Psychology, Stony Brook, NY, USA
| | - Daniel N Klein
- Stony Brook University, Department of Psychology, Stony Brook, NY, USA
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Bellaert N, Morreale K, Tseng WL. Peer functioning difficulties may exacerbate symptoms of attention-deficit/hyperactivity disorder and irritability over time: a temporal network analysis. J Child Psychol Psychiatry 2024; 65:809-821. [PMID: 37859512 PMCID: PMC11026298 DOI: 10.1111/jcpp.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Children with attention-deficit/hyperactivity disorder (ADHD) have been consistently found to experience impairments in peer functioning. Irritability is highly prevalent in children with ADHD and may worsen social impairments given the frequent temper outbursts and low frustration tolerance characterizing irritability. However, it is still unclear how ADHD and irritability symptoms interact with peer functioning difficulties over time. Assessing these temporal dynamics using a novel longitudinal approach (i.e., temporal network analysis) may reveal precise targets for intervention. METHODS This study investigates the dynamic associations between ADHD symptoms, irritability, and peer functioning in a community sample of 739 children (ages 8-11 years, Mage = 10.06 [SD = 0.59], 47.77% females) assessed at three timepoints, 6 months apart, in a school-based study. Parents reported their child's ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV), and irritability symptoms using the Child Behavior Checklist (CBCL) irritability items. Children's peer functioning (i.e., peer acceptance, peer rejection, number of friendships, and victimization) was measured via peer nomination. To estimate the longitudinal associations between the variables, we built a graphical vector autoregression model for panel data. RESULTS The longitudinal network highlighted that poor peer functioning contributed to increases in symptoms over time. Specifically, (1) physical victimization predicted increases in inattention, hyperactivity, and irritability; (2) peer rejection predicted increases in inattention, which in turn predicted increases in irritability; (3) peer acceptance predicted decreases in inattention and irritability; and (4) higher numbers of mutual friendships increased inattention. CONCLUSIONS These results suggest that a negative social environment involving physical bullying and rejection may aggravate ADHD and irritability symptoms. Conversely, positive social interactions, such as being liked by peers, may improve inattention and irritability symptoms. Fostering social-emotional skills and positive social interactions and environments in children with ADHD and irritability may be a promising target for future interventions to reduce symptoms.
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Affiliation(s)
- Nellia Bellaert
- Cognitive Psychology and Neuropsychology Department, University of Mons, Mons, Belgium
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Kristina Morreale
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
- University of New Haven, New Haven, CT, United States
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
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Cotter G, Morreale K, Valdegas A, Fish M, Beebe R, Grasso D, Stover C, Tseng WL. Associations between trauma exposure and irritability within the family unit: a network approach. J Child Psychol Psychiatry 2024. [PMID: 38710637 DOI: 10.1111/jcpp.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Pediatric irritability is a pervasive psychiatric symptom, yet its etiology remains elusive. While trauma exposure may contribute to the development of irritability, empirical research is limited. This study examined the prevalence of irritability among trauma-exposed children, identified factors that differentiate trauma-exposed children with and without irritability, and employed a network analysis to uncover associations between irritability and trauma exposure in the family unit. METHODS Sample included 676 children (56.3% male, mean age = 9.67 ± 3.7 years) and their parents referred by the Connecticut Department of Children and Families to Fathers for Change - a psychotherapy intervention designed to reduce intimate partner violence (IPV) and child maltreatment. Child's trauma exposure, post-traumatic stress disorder (PTSD) symptoms, and irritability were assessed pre-intervention using self- and caregiver-report. Parents self-reported their childhood and adulthood trauma exposures, PTSD symptoms, irritability, psychopathology, and IPV. RESULTS Across caregiver- and child-reports, 16%-17% of children exhibited irritability. Irritable children experienced greater trauma exposure, interpersonal violence, emotional abuse, and PTSD severity. They had caregivers, particularly mothers, with greater trauma histories, IPV, and psychopathology. Network analysis revealed 10 nodes directly correlated to child's irritability including child's PTSD severity, parental IPV (specifically psychological violence), and parental psychopathology. CONCLUSIONS Results provide initial empirical evidence that pediatric irritability is linked to trauma exposure, suggesting trauma histories be considered in the diagnosis and treatment of irritability. Interventions addressing caregiver trauma, IPV, and psychopathology may ameliorate pediatric irritability. Future studies could benefit from adopting network approaches with longitudinal or time series data to elucidate causality and points of intervention.
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Affiliation(s)
- Grace Cotter
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
- Northeastern University, Boston, MA, USA
| | - Kristina Morreale
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | | | - Meghan Fish
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Rebecca Beebe
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Damion Grasso
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Carla Stover
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
| | - Wan-Ling Tseng
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, USA
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Lee H, Park Y, Kim D, Choi J, Park SC, Kim I, Kim E. Validity of the Korean Version of the Brief Irritability Test in Psychiatric Patients. Psychiatry Investig 2024; 21:396-402. [PMID: 38695047 PMCID: PMC11065526 DOI: 10.30773/pi.2023.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/08/2023] [Accepted: 01/26/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the validity and reliability of the Korean version of the Brief Irritability Test (BITe) and adapt it for Korean patients with psychiatric disorders. METHODS A total of 296 patients at the Department of Psychiatry of Hanyang University Guri Hospital completed the BITe, Korean Beck Depression Inventory-II, Korean Beck Anxiety Inventory, the Korean version of the State-Trait Anger Expression Inventory, and Barratt Impulsiveness Scale-11. Construct validity was confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability testing included assessments of internal consistency (Cronbach's α) and item-total correlations. Convergent validity was examined through correlational analyses with variables such as anxiety, depression, anger, and impulsivity. RESULTS First, the scale had good internal consistency with a Cronbach's α of 0.88. Second, EFA indicated a single dimensionality of the BITe, and CFA demonstrated a reasonable fit for the single-factor model (comparative fit index=0.97, Tucker-Lewis Index=0.95, normed fit index=0.97, goodness-of-fit index=0.96, root mean square error of approximation=0.12, standardized root mean residual=0.03). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and anger, except for anger control, which is a sub-variable of anger. CONCLUSION The results showed that the Korean version of the BITe had good psychometric properties, and might serve as a valuable tool for assessing irritability in Korean patients with psychiatric disorders.
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Affiliation(s)
- Hyerin Lee
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Yongchon Park
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Deaho Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joonho Choi
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ilbin Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eunkyung Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
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Johns-Mead R, Vijayakumar N, Mulraney M, Melvin G, Anderson VA, Efron D, Silk TJ. The longitudinal relationship between socioemotional difficulties and irritability in ADHD. J Affect Disord 2024; 350:573-581. [PMID: 38244802 DOI: 10.1016/j.jad.2024.01.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Despite higher rates of irritability and socioemotional symptoms in ADHD, consensus is lacking regarding their developmental relationship and whether it differs by ADHD status. This longitudinal study sought to evaluate how peer and emotional difficulties relate to irritability in ADHD and control groups. METHODS A community sample of 336 participants (45 % ADHD) were recruited for the Children's Attention Project. Participants completed the Affective Reactivity Index and the Strengths and Difficulties Questionnaire's emotional and peer difficulties scales at baseline (mean age 10.5 years) and 18-month follow-up. Latent Change Score models assessed how emotional and peer difficulties related to irritability at baseline and longitudinally. RESULTS For both groups, more severe baseline difficulties were associated with higher concurrent irritability, and reductions in emotional and peer difficulties were associated with declining irritability. Baseline emotional difficulties predicted change in irritability for the ADHD group, while baseline peer difficulties predicted change in irritability for both groups. Baseline irritability did not predict change in emotional or peer difficulties for either. The ADHD group showed elevated irritability, emotional, and peer difficulties, and stronger baseline correlation between peer difficulties and irritability. LIMITATIONS Only two timepoints were captured, and associations with ADHD symptom severity and presentation were not investigated. Doing so may facilitate additional insights. CONCLUSIONS Change in irritability corresponded to change in socioemotional difficulties, and was driven by earlier levels of socioemotional difficulties. ADHD exacerbated aspects of the relationship between socioemotional difficulties and irritability. Socioemotional difficulties drive irritability, so may represent targets for clinical interventions.
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Affiliation(s)
- Rania Johns-Mead
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Nandita Vijayakumar
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Glenn Melvin
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tim J Silk
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
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Leibenluft E, Allen LE, Althoff RR, Brotman MA, Burke JD, Carlson GA, Dickstein DP, Dougherty LR, Evans SC, Kircanski K, Klein DN, Malone EP, Mazefsky CA, Nigg J, Perlman SB, Pine DS, Roy AK, Salum GA, Shakeshaft A, Silver J, Stoddard J, Thapar A, Tseng WL, Vidal-Ribas P, Wakschlag LS, Stringaris A. Irritability in Youths: A Critical Integrative Review. Am J Psychiatry 2024; 181:275-290. [PMID: 38419494 DOI: 10.1176/appi.ajp.20230256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Irritability, defined as proneness to anger that may impair an individual's functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps. Clinicians and researchers should assess irritability routinely, and specific assessment tools are now available. Informant effects are prominent, are stable, and vary by age and gender. The prevalence of irritability is particularly high among individuals with attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Developmental trajectories of irritability (which may begin early in life) have been identified and are differentially associated with clinical outcomes. Youth irritability is associated with increased risk of anxiety, depression, behavioral problems, and suicidality later in life. Irritability is moderately heritable, and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for treating psychological problems related to irritability, but its efficacy in treating irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeting exposure to frustration). Associations between irritability and suicidality and the impact of cultural context are important, underresearched topics. Analyses of large, diverse longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, revealing important translational opportunities.
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Affiliation(s)
- Ellen Leibenluft
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Laura E Allen
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Robert R Althoff
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Melissa A Brotman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Jeffrey D Burke
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Gabrielle A Carlson
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Daniel P Dickstein
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Lea R Dougherty
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Spencer C Evans
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Katharina Kircanski
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Daniel N Klein
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Eleanor P Malone
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Carla A Mazefsky
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Joel Nigg
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Susan B Perlman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Daniel S Pine
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Amy Krain Roy
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Giovanni A Salum
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Amy Shakeshaft
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Jamilah Silver
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Joel Stoddard
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Anita Thapar
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Wan-Ling Tseng
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Pablo Vidal-Ribas
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Lauren S Wakschlag
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Argyris Stringaris
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
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7
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Byrne G, Cullen C. Acceptance and Commitment Therapy for Anger, Irritability, and Aggression in Children, Adolescents, and Young Adults: A Systematic Review of Intervention Studies. TRAUMA, VIOLENCE & ABUSE 2024; 25:935-946. [PMID: 37129045 DOI: 10.1177/15248380231167393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The onset of childhood disruptive behaviors is one of the most common presenting difficulties to clinics worldwide. Acceptance and commitment therapy (ACT) has shown to be effective in the reduction of anger and aggression among adults, however to date there has been no systematic review that has examined the effectiveness of ACT in addressing anger and aggression among children, adolescents, and young adults. The current systematic review aimed to evaluate the methodological standing and effectiveness of the peer-reviewed literature of ACT on anger and aggression for this population. PsycINFO, PubMed, and MEDLINE databases were searched systematically in June 2022 to identify studies in English published on the use of ACT for anger and aggression in children, adolescents, and young adults. Seven studies met the inclusion criteria with a combined sample of 305 participants across the interventions. The most common outcome measures used were self-report ratings of anger among participants. Studies were characterized by poor methodological rigor and findings were mixed as regards the effectiveness of ACT in addressing anger and aggression in this population. Some evidence suggests that group ACT may be effective in reducing self-report measures of anger, but no firm conclusions can be drawn from the extant literature due to the heterogeneous nature of the studies, and limited information about ACT protocols and treatment delivery. Further higher-powered studies comparing ACT to treatment as usual or waitlist are needed to clarify what ACT may add as a treatment to anger and aggression in this population.
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Affiliation(s)
- Gary Byrne
- HSE Community Healthcare East, Dublin, Ireland
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Naim R, Dombek K, German RE, Haller SP, Kircanski K, Brotman MA. An Exposure-Based Cognitive-Behavioral Therapy for Youth with Severe Irritability: Feasibility and Preliminary Efficacy. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:260-276. [PMID: 37851393 PMCID: PMC11024061 DOI: 10.1080/15374416.2023.2264385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Clinically impairing irritability and temper outbursts are among the most common psychiatric problems in youth and present transdiagnostically; however, few mechanistically informed treatments have been developed. Here, we test the acceptability, feasibility, and preliminary efficacy of a novel exposure-based treatment with integrated parent management skills for youth with severe irritability using a randomized between-subjects multiple baseline design. METHOD N = 41 patients (Age, Mean (SD) = 11.23 years (1.85), 62.5% male, 77.5% white) characterized by severe and impairing temper outbursts and irritability were randomized to different baseline observation durations (2, 4, or 6 weeks) prior to active treatment; 40 participants completed the 12 session treatment of exposure-based cognitive-behavioral therapy for irritability with integrated parent management skills. Masked clinician ratings were acquired throughout baseline and treatment phases, as well as 3- and 6-months post-treatment. To examine acceptability and feasibility, drop-out rates and adverse events were examined. Primary clinical outcome measures included clinician-administered measures of irritability severity and improvement. Secondary clinical outcome measures included multi-informant measures of irritability, depression, anxiety, and attention-deficit/hyperactivity disorder symptoms. RESULTS No patients dropped out once treatment began, and no adverse events were reported. Irritability symptoms improved during the active phase of treatment across all measurements (all βs > -0.04, ps < .011, Cohen's d range: -0.33 to -0.98). Treatment gains were maintained at follow-up (all βs(39) < -0.001, ps > .400). Sixty-five percent of patients were considered significantly improved or recovered post-treatment based on the primary clinician-rated outcome measure. CONCLUSIONS Results support acceptability, feasibility, and preliminary efficacy of this novel treatment for youth with severe irritability. Limitations and future directions are also discussed.
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Affiliation(s)
- Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kelly Dombek
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ramaris E. German
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Simone P. Haller
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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9
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Evans SC, Karlovich AR, Khurana S, Edelman A, Buza B, Riddle W, López-Sosa D. Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:277-308. [PMID: 38275270 PMCID: PMC11042996 DOI: 10.1080/15374416.2023.2292041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents. METHOD We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3-18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability. RESULTS Overall, 68 instruments met criteria for inclusion, with scales covering irritability (n = 15), anger (n = 19), aggression (n = 45), and/or general overt externalizing problems (n = 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized. CONCLUSIONS Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth.
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Affiliation(s)
- Spencer C. Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Sakshi Khurana
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
- College of Education, DePaul University, Chicago, IL, USA
| | - Audrey Edelman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Bianca Buza
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - William Riddle
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Denise López-Sosa
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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10
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Carlson GA, Althoff RR, Singh MK. Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately 1. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:309-327. [PMID: 38588602 DOI: 10.1080/15374416.2024.2332999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
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.
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Affiliation(s)
- Gabrielle A Carlson
- Psychiatry and Pediatrics, Renaissance School of Medicine at Stony Brook University
| | - Robert R Althoff
- Psychiatry, Pediatrics, & Psychological Science, University of Vermont
| | - Manpreet Kaur Singh
- Professor of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine
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Dissanayake AS, Dupuis A, Arnold PD, Burton CL, Crosbie J, Schachar RJ, Levy T. Is irritability multidimensional: Psychometrics of The Irritability and Dysregulation of Emotion Scale (TIDES-13). Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02350-1. [PMID: 38228758 DOI: 10.1007/s00787-023-02350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024]
Abstract
Irritability is a common, impairing, and potentially multifaceted manifestation of psychopathology. We designed The Irritability and Dysregulation of Emotion Scale (TIDES-13) to determine whether various expressions of irritability in children and youth form multiple subdimensions with distinct correlates. We administered parent-report (n = 3875, mean age = 8.9) and youth self-report (n = 579, mean age = 15.1) versions of TIDES-13 in a population and community-based sample. We conducted exploratory/confirmatory factor analyses and regression analyses to examine the dimensionality of TIDES-13 and the associations of the scale with age, gender, anxiety, depression, ODD, ADHD traits, and the Affective Reactivity Index (ARI). A higher-order model with a global irritability dimension and four subdimensions, including proneness to anger (PA), internalized negative emotional reactivity (iNER), externalized negative emotional reactivity (eNER), and reactive aggression (RA), showed good to excellent fit in both parent-report and self-report. The global irritability dimension showed excellent internal reliability (⍵Total; parent-report = 0.97, ⍵Total; self-report = 0.95), explained a majority of the item variance (⍵Hierarchical; parent-report = 0.94, ⍵Hierarchical; self-report = 0.90), and was moderately correlated with the ARI (rparent = 0.68, rself = 0.77). Subdimensions PA, eNER, and RA were negatively associated with age in males, whereas iNER was positively associated with age in females. Traits of ODD and ADHD were associated primarily with the global irritability dimension, whereas iNER was strongly associated with anxiety and depression traits over and above the global irritability dimension. Our results support a unidimensional interpretation of irritability in a population sample. However, limited evidence of specific behavioral, age, and sex correlates with particular irritability subdimensions may warrant further investigation.
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Affiliation(s)
| | - Annie Dupuis
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul D Arnold
- Department of Child and Adolescent Psychiatry, The Mathison Centre for Mental Health Research & Education, Calgary, AB, Canada
| | - Christie L Burton
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Tomer Levy
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Behavior Regulation Service, Geha Mental Health Center, Petach-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Naik AA, Ma X, Munyeshyaka M, Leibenluft E, Li Z. A New Behavioral Paradigm for Frustrative Nonreward in Juvenile Mice. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:31-38. [PMID: 38045768 PMCID: PMC10689275 DOI: 10.1016/j.bpsgos.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background Irritability, defined as proneness to anger, can reach a pathological extent. It is a defining symptom of disruptive mood dysregulation disorder and one of the most common reasons youths present for psychiatric evaluation and care. Aberrant responses to frustrative nonreward (FNR), the response to omission of expected reward, are central to the pathophysiology of irritability. FNR is a translational construct to study irritability across species. The development of preclinical FNR models would advance mechanistic studies of the important and relatively understudied clinical phenomenon of irritability. Methods We used FNR as a conceptual framework to develop a novel mouse behavioral paradigm named alternate poking reward omission. Juvenile mice were exposed to alternate poking reward omission and then examined with a battery of behavioral tests to determine the behavioral effect of FNR. Results FNR increased locomotion and aggression regardless of sex. These behavioral changes elicited by FNR resemble the symptoms observed in youth with severe irritability. FNR had no effect on anxiety-like, depression-like, or nonaggressive social behaviors. Conclusions Our alternate poking reward omission paradigm effectively elevated aggression and locomotion in juvenile mice. These frustration effects are directly related to behavioral symptoms of youth with severe irritability. Our novel behavioral paradigm lays the groundwork for further mechanistic studies of frustration and irritability in rodents.
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Affiliation(s)
- Aijaz Ahmad Naik
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
- Center on Compulsive Behaviors, Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Xiaoyu Ma
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Maxime Munyeshyaka
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Zheng Li
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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Orsolini L, Longo G, Cicolini A, Volpe U. An expert opinion on the pharmacological interventions for Disruptive Mood Dysregulation Disorder (DMDD). Expert Opin Pharmacother 2024; 25:67-78. [PMID: 38186365 DOI: 10.1080/14656566.2024.2303422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Disruptive Mood Dysregulation Disorder (DMDD) was officially introduced as a new diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), under the category of depressive disorders. AREAS COVERED A comprehensive overview and a critical commentary on the currently investigated psychopharmacological approaches for the treatment of DMDD have been here provided. EXPERT OPINION Behavioral and psychosocial interventions should be considered as first-line treatment strategies. When ineffective or partially effective, psychopharmacological strategy is recommended. Overall, pharmacological strategy should be preferred in those individuals with psychiatric comorbidities (e.g. ADHD). Indeed, so far published studies on pharmacological strategies in DMDD are scant and heterogeneous (i.e. age, assessment tools, symptomatology profile, comorbidity, and so forth). Therefore, DMDD psychopharmacological guidelines are needed, particularly to guide clinicians toward the patient's typical symptom profile who could benefit from psychopharmacological strategy.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Longo
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Angelica Cicolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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Srinivasan R, Flouri E, Lewis G, Solmi F, Stringaris A, Lewis G. Changes in Early Childhood Irritability and Its Association With Depressive Symptoms and Self-Harm During Adolescence in a Nationally Representative United Kingdom Birth Cohort. J Am Acad Child Adolesc Psychiatry 2024; 63:39-51. [PMID: 37391129 DOI: 10.1016/j.jaac.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 04/28/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE This study aimed to investigate longitudinal associations between changes in early childhood irritability, and depressive symptoms and self-harm at 14 years. METHOD We used data from 7,225 children in a UK-based general population birth cohort. Childhood irritability was measured at 3, 5, and 7 years using 4 items from 2 questionnaires (the Children's Social Behaviour Questionnaire [CSBQ] and the Strengths and Difficulties Questionnaire [SDQ]). Participants reported depressive symptoms via the short Mood and Feelings Questionnaire (sMFQ) and self-harm via a single-item question, at 14 years. We used multilevel models to calculate within-child change in irritability between 3 and 7 years and examined associations between irritability, and depressive symptoms and self-harm at 14 years using linear and logistic regression models, respectively. We adjusted for child and family sociodemographic/economic characteristics, mental health difficulties, and child cognitive development. RESULTS Irritability at ages 5 and 7 years was positively associated with depressive symptoms and self-harm at age 14 years. Irritability that remained high between 3 and 7 years was associated with depressive symptoms and self-harm at 14 years in unadjusted (depressive symptoms: β coefficient = 0.22, 95 % CI = 0.08-0.37, p = .003; self-harm: odds ratio = 1.09, 95 % CI = 1.01-1.16, p = .019) and adjusted models (depressive symptoms: β coefficient = 0.31, 95 % CI = 0.17-0.45, p < .001; self-harm: odds ratio = 1.12, 95 % CI = 1.0.4-1.19, p = .004). Results were similar in imputed samples. CONCLUSION Children with irritability that remains high between 3 and 7 years are more likely to report higher depressive symptoms and self-harm during adolescence. These findings support early intervention for children with high irritability and universal interventions in managing irritability for parents of preschool-aged children.
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Affiliation(s)
| | | | - Gemma Lewis
- UCL Division of Psychiatry, London, United Kingdom
| | | | - Argyris Stringaris
- UCL Division of Psychiatry, London, United Kingdom; Emotion & Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Glyn Lewis
- UCL Division of Psychiatry, London, United Kingdom
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15
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Hall JH, Chawner SJRA, Wolstencroft J, Skuse D, Holmans P, Owen MJ, van den Bree MBM. Irritability in young people with copy number variants associated with neurodevelopmental disorders (ND-CNVs). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299440. [PMID: 38106165 PMCID: PMC10723492 DOI: 10.1101/2023.12.05.23299440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background A range of rare mutations involving micro-deletion or -duplication of genetic material (copy number variants (CNVs)) have been associated with high neurodevelopmental and psychiatric risk (ND-CNVs). Irritability is frequently observed in childhood neurodevelopmental conditions, yet its aetiology is largely unknown. Genetic variation may play a role, but there is a sparsity of studies investigating presentation of irritability in young people with ND-CNVs. Aims This study aimed to investigate whether there is a difference in irritability in young people with rare ND-CNVs compared to those without ND-CNVs, and to what extent irritability is associated with psychiatric diagnoses and cognitive ability (IQ). Methods Irritability and broader psychopathology was assessed in 485 young people with ND-CNVs and 164 sibling controls, using the child and adolescent psychiatric assessment (CAPA). Autism was assessed using the Social Communication Questionnaire (SCQ), and Intelligence Quotient (IQ) by the Wechsler Abbreviated Scale of Intelligence (WASI). Results 54% of young people with ND-CNVs met the threshold for irritability; significantly more than controls (OR = 3.77, CI = 3.07-7.90, p= 5.31 × 10-11). When controlling for the presence of other psychiatric comorbidities, ND-CNV status was still associated with irritability. There was no evidence for a relationship between irritability and IQ. Conclusions Irritability is an important aspect of the clinical picture in young people with ND-CNVs. This work shows that genetic variation is associated with irritability in young people with ND-CNVs, independent of psychiatric comorbidities or IQ impairment. Clinicians should be aware of this increased risk to inform management and interventions.
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Affiliation(s)
- Jessica H Hall
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Samuel J R A Chawner
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Jeanne Wolstencroft
- BRC Great Ormond Street Institute of Child Health, University College London
| | - David Skuse
- BRC Great Ormond Street Institute of Child Health, University College London
| | - Peter Holmans
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Michael J Owen
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Marianne B M van den Bree
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, United Kingdom
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16
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Pan PY, Yeh CB. Characteristic Similarities of Irritability Between Autism and Disruptive Mood Dysregulation Disorder. J Child Adolesc Psychopharmacol 2023; 33:428-432. [PMID: 37883643 DOI: 10.1089/cap.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Objective: Irritability in children with autism spectrum disorder (ASD) is prominent and often leads to distress to both autistic children and their families. However, the nature of irritability in autism and the difference from nonautistic children have rarely been examined. This study aimed to investigate the clinical characteristics of irritability in autism, and to compare the symptom profiles with those of disruptive mood dysregulation disorder (DMDD) in nonautistic children. Methods: Fifty-six children aged 7-17 years (mean age 10.36 ± 3.05) were recruited into this study (21 with DMDD, 21 with high-functioning autism [hfASD], and 14 healthy volunteers [HV]). Their parents completed the Aberrant Behavior Checklist-Irritability (ABC-I) subscale and the Strengths and Difficulties Questionnaire (SDQ) parent report form. The ABC-I subscale was analyzed as a whole and broken into subsets (ABC-I-Irritability, ABC-I-Agitation, and ABC-I-Crying). The symptom profiles of irritability and the association with psychosocial difficulties were compared between groups. Results: The ABC-I-Irritability scores of children with hfASD closely matched to those of children with DMDD. In addition, both DMDD and hfASD groups could be differentiated from HV group in five of the six items except "depressed mood." However, in the ABC-I-Agitation scale, children with DMDD, but not hfASD, had higher scores in "Aggressive to other patients and staff" and "Stamps feet while banging objects or slamming doors" than HV. Regarding psychosocial outcomes, irritability in children with DMDD and hfASD were associated with emotional problems as measured by the SDQ. Moreover, irritability in DMDD was associated with conduct problems, and the hfASD group exhibited the similar trend. Conclusions: Symptom profiles of irritability and the associated emotional and conduct problems in children with hfASD were similar to those of DMDD in the nonautistic population. Future studies are warranted to explore the underlying neurophysiological mechanisms of irritability between autistic and nonautistic children for further insight into the nature of irritability in autism.
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Affiliation(s)
- Pei-Yin Pan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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17
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Lee KS, Lebowitz ER, Silverman WK, Tseng W. Transactional associations of child irritability and anxiety with parent psychological control in Taiwanese school-aged children. JCPP ADVANCES 2023; 3:e12192. [PMID: 38054061 PMCID: PMC10694542 DOI: 10.1002/jcv2.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/13/2023] [Indexed: 12/07/2023] Open
Abstract
Background Child irritability and anxiety are associated with parent psychological control; yet their transactional relations over time are not well-characterized at the within-person level. Research addressing generalizability of past Western-based literature in non-Western, collectivist community samples is lacking. Methods Sample comprised 285 children aged 8.8-11.4 years (145 girls; Mage = 9.9 years, SD = 0.6) in Northern Taiwan. Participants were assessed at baseline (T1), 6-month (T2), and 12-month (T3) follow-ups. Child irritability and anxiety symptoms were assessed using parent-rated Child Behavior Checklist. Parent psychological control was assessed using the parent- and child-rated Psychological Control Scale. Within-person processes were specified using the random-intercept cross-lagged panel models. Results Models showed that psychological control predicted increased child irritability when analyzing parenting data from parents and children. However, the lagged effect from psychological control to child anxiety was only seen in parent-rated parenting data. We found limited evidence for a back-and-forth transactional pathway among constructs. Child irritability predicted increased child anxiety in all models. Conclusions Directional effects from psychological control to child irritability and anxiety support parent-involved interventions that prioritize collaborative parenting and positive reinforcement techniques. Future validations in combined clinical and typically developing samples and direct cross-cultural comparisons are warranted.
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Affiliation(s)
- Ka Shu Lee
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Yale Child Study CenterYale School of MedicineNew HavenConnecticutUSA
| | - Eli R. Lebowitz
- Yale Child Study CenterYale School of MedicineNew HavenConnecticutUSA
| | | | - Wan‐Ling Tseng
- Yale Child Study CenterYale School of MedicineNew HavenConnecticutUSA
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18
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Brænden A, Lebena A, Faresjö Å, Theodorsson E, Coldevin M, Stubberud J, Zeiner P, Melinder A. Excessive hair cortisol concentration as an indicator of psychological disorders in children. Psychoneuroendocrinology 2023; 157:106363. [PMID: 37573627 DOI: 10.1016/j.psyneuen.2023.106363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
Cortisol in hair is a new biomarker assessing long-term hypothalamic-pituitary-adrenal (HPA) axis activity, which is related to emotion regulation. We compare hair cortisol concentrations (HCC), in clinically referred children with disruptive mood dysregulation disorder (DMDD) (n = 19), children with other types of psychological disorders (n = 48), and healthy subjects (n = 36). We also investigate the association between HCC and irritability, age, and sex. Our results show that children with DMDD or other types of psychological disorders have higher HCC than healthy subjects, p < .001, ηp2 = .39. No difference between children with DMDD and those with other types of psychological disorders was found, p = .91, nor an association between HCC and irritability in the clinical sample, p = .32. We found a significant negative correlation between HCC and age in those with DMDD, r = -0.54, p < .05, but not in the normative sample, r = -0.20, p = .25. No differences in HCC between girls and boys were found in the normative sample, p = .49. Children in need of psychological treatment, including those with DMDD, seem to have dysregulated HPA-axis activity over time. Excessive accumulated cortisol concentrations in hair could be an indicator of a psychological disorder in children.
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Affiliation(s)
- Astrid Brænden
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway.
| | - Andrea Lebena
- Department of Health, Medicine and Caring Sciences, University of Linköping, Sweden
| | - Åshild Faresjö
- Department of Health, Medicine and Caring Sciences, University of Linköping, Sweden
| | - Elvar Theodorsson
- Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden
| | - Marit Coldevin
- Lovisenberg Diaconal Hospital, Nic Waals Institute, Oslo, Norway
| | - Jan Stubberud
- Lovisenberg Diaconal Hospital, Department of Research, Oslo, Norway; University of Oslo, Department of Psychology, Oslo, Norway
| | - Pål Zeiner
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Annika Melinder
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway; University of Oslo, Department of Psychology, Oslo, Norway
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19
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Saatchi B, Olshansky EF, Fortier MA. Irritability: A concept analysis. Int J Ment Health Nurs 2023; 32:1193-1210. [PMID: 36929104 DOI: 10.1111/inm.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as 'unpredictability and lowered emotion control', 'lowered threshold for negative emotional stimuli', 'being manifested in response to frustrative situations or physiological needs' and 'experience of disproportionate and unjustified emotional irritation'. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations.
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Affiliation(s)
- Babak Saatchi
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Ellen F Olshansky
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Michelle A Fortier
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
- Center on Stress & Health, University of California Irvine, Orange, California, USA
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20
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Johns‐Mead R, Vijayakumar N, Mulraney M, Melvin G, Youssef G, Sciberras E, Anderson VA, Nicholson JM, Efron D, Hazel P, Silk TJ. Categorical and dimensional approaches to the developmental relationship between ADHD and irritability. J Child Psychol Psychiatry 2023; 64:1422-1431. [PMID: 37170636 PMCID: PMC10952727 DOI: 10.1111/jcpp.13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and irritability commonly co-occur, and follow similar developmental trajectories from childhood to adolescence. Understanding of the developmental relationship between these co-occurrences is limited. This study provides a longitudinal assessment of how ADHD diagnostic status and symptom patterns predict change in irritability. METHODS A community sample of 337 participants (45.2% ADHD), recruited for the Childhood Attention Project, completed the Affective Reactivity Index (ARI) to measure irritability at baseline (mean age 10.5 years) and follow-up after 18-months. Latent change score models were used to assess how (a) baseline ADHD vs. control group status, (b) baseline symptom domain (inattention, hyperactivity-impulsivity) and (c) longitudinal change in ADHD symptom severity predicted change in irritability. RESULTS Irritability was significantly higher among the ADHD group than controls; however, change in irritability over time did not differ between groups. When assessed across the entire cohort, change in irritability was predicted by higher symptom count in the hyperactive-impulsive domain, but not the inattentive domain. Greater declines in ADHD symptoms over time significantly predicted greater declines in irritability. Baseline ADHD symptom severity was found to significantly predict change in irritability; however, baseline irritability did not significantly predict change in ADHD symptoms. CONCLUSIONS ADHD symptoms-particularly hyperactive-impulsive symptoms-predict the degree and trajectory of irritability during childhood and adolescence, even when symptoms are below diagnostic thresholds. The use of longitudinal, dimensional and symptom domain-specific measures provides additional insight into this relationship.
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Affiliation(s)
- Rania Johns‐Mead
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Nandita Vijayakumar
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Melissa Mulraney
- Institute for Social NeuroscienceISN PsychologyIvanhoeVic.Australia
| | - Glenn Melvin
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - George Youssef
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
- Murdoch Children's Research InstituteMelbourneVic.Australia
| | - Vicki A. Anderson
- Murdoch Children's Research InstituteMelbourneVic.Australia
- The Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | | | - Daryl Efron
- Murdoch Children's Research InstituteMelbourneVic.Australia
- The Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | - Philip Hazel
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
| | - Tim J. Silk
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
- Murdoch Children's Research InstituteMelbourneVic.Australia
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21
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Hoyniak CP, Donohue MR, Quiñones-Camacho LE, Vogel AC, Perino MT, Hennefield L, Tillman R, Barch DM, Luby JL. Developmental pathways from preschool temper tantrums to later psychopathology. Dev Psychopathol 2023; 35:1643-1655. [PMID: 35440360 PMCID: PMC10863336 DOI: 10.1017/s0954579422000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Temper tantrums are sudden, overt negative emotional displays that are disproportionate to the eliciting event. Research supports that severe temper tantrums during the preschool period are associated with preschool psychopathology, but few studies have identified which characteristics of preschool tantrums are predictive of distal psychopathological outcomes in later childhood and adolescence. To examine this question, we used a prospective, longitudinal dataset enriched for early psychopathology. Participants (N = 299) included 3-to 6-year-old children (47.8% female) assessed for tantrums and early childhood psychopathology using diagnostic interviews and then continually assessed using diagnostic interviews over 10 subsequent time points throughout childhood and adolescence. We identified two unique groupings of tantrum behaviors: aggression towards others/objects (e.g., hitting others) and aggression towards self (e.g., hitting self). While both types of tantrum behaviors were associated with early childhood psychopathology severity, tantrum behaviors characterized by aggression towards self were more predictive of later psychopathology. Children displaying high levels of both types of tantrum behaviors had more severe externalizing problems during early childhood and more severe depression and oppositional defiant disorder across childhood and adolescence. Findings suggest that tantrum behaviors characterized by aggression towards self are particularly predictive of later psychopathology.
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Affiliation(s)
- Caroline P Hoyniak
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Meghan R Donohue
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Laura E Quiñones-Camacho
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Alecia C Vogel
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michael T Perino
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Laura Hennefield
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- The Program in Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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22
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Evans SC, Shaughnessy S, Karlovich AR. Future Directions in Youth Irritability Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:716-734. [PMID: 37487108 DOI: 10.1080/15374416.2023.2209180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the "whats") for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability's phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the "hows") that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth.
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23
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Zhang Y, Silver JI, Perlman G, Kotov R, Klein DN, Eaton NR. Longitudinal Stability and Interrelations of Tonic and Phasic Irritability in Adolescent Girls. Res Child Adolesc Psychopathol 2023; 51:1343-1355. [PMID: 37155026 DOI: 10.1007/s10802-023-01072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
Irritability is a transdiagnostic feature and a common mental health problem in adolescence. Prior studies indicate that irritability is composed of two correlated but separable dimensions, tonic irritability (i.e., irritable mood) and phasic irritability (i.e., temper outbursts), which are respectively associated with internalizing and externalizing outcomes. However, little is known about the stability and interrelations of tonic and phasic irritability. The current study examined the longitudinal interplay between tonic and phasic irritability during adolescence. A community sample of 544 girls (age 13.5-15.5 years) was assessed at 5 waves (over 3 years, in 9-month intervals). A random-intercept cross-lagged panel model was used to examine the within-person stability and longitudinal interrelations of tonic and phasic irritability. Pseudo-indicator models were used to help analyze all available data. Results suggest that tonic and phasic irritability had distinct patterns of development and co-development. Between individuals, tonic and phasic irritability showed moderate rank-order stability and high concurrent correlations. Within individuals, phasic irritability was found to positively predict both tonic and phasic irritability at the subsequent wave, whereas tonic irritability did not predict later phasic irritability and showed weaker within-person stability. These results suggest that increased or decreased phasic irritability in adolescent girls may signify continued increase or decrease in both tonic and phasic irritability. The study was among the first to demonstrate the discriminant validity of tonic and phasic irritability from a developmental perspective.
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Affiliation(s)
- Yinghao Zhang
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Jamilah I Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
- Department of Psychiatry, Stony Brook University, Stony Brook, USA
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24
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Silver J, Bufferd SJ, Dougherty LR, Goldstein BL, Carlson GA, Klein DN. Is the distinction between tonic and phasic irritability meaningful in 3-year-old children? Eur Child Adolesc Psychiatry 2023; 32:1755-1763. [PMID: 35523899 DOI: 10.1007/s00787-022-01995-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/16/2022] [Indexed: 11/24/2022]
Abstract
Irritability encompasses both normative misbehavior in early childhood and clinically significant problems across development. Recent studies have distinguished between tonic (i.e., persistently angry or grumpy mood) and phasic (i.e., temper tantrums or outbursts) forms of irritability and shown that they have different implications for psychopathology and functioning. However, data on this distinction in young (i.e., preschool aged) children are nonexistent. We utilized data from a longitudinal study of a community sample of 462 3-year-olds followed to age 15. We conducted confirmatory factor analysis (CFA) using items from a diagnostic interview and several parent-report inventories and examined concurrent and prospective associations with clinically relevant variables. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent-reported temperamental negative affectivity and surgency, and depressive and oppositional defiant (ODD) disorders, and predicted higher rates of disruptive behavior disorders (DBD) and suicidal behavior in later childhood and adolescence. Phasic irritability was independently associated with concurrent laboratory observations of child impulsivity, parent-reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting, and generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), and ODD, but it did not predict later psychopathology. Tonic and phasic irritability are separable in 3-year-old children, but their correlates and outcomes are not as distinct as in older youth. This may reflect the greater difficulty characterizing normative and pathological irritability in the preschool period.
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Affiliation(s)
- Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA.
| | | | | | | | | | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA
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25
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Hassiotis A. Time to rethink behaviours that challenge in people with intellectual disabilities. Lancet Psychiatry 2023; 10:654-655. [PMID: 37595994 DOI: 10.1016/s2215-0366(23)00253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/11/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Angela Hassiotis
- Division of Psychiatry, University College London, London W1T 7BN, UK.
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Cabrera VM, Buitron V, Patriarca GC, Rey Y, Lebowitz ER, Silverman WK, Pettit JW. Parent Accommodation Contemporaneously Mediates the Association Between Youth Irritability and Youth Anxiety Treatment Outcome. Behav Ther 2023; 54:852-862. [PMID: 37597962 PMCID: PMC10440415 DOI: 10.1016/j.beth.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 08/21/2023]
Abstract
Research documents that child and adolescent (youth) irritability and anxiety have high co-occurrence, and anxious-irritable presentations are associated with greater impairment than anxious nonirritable presentations. This study examines the association between irritability and youth anxiety treatment outcome and tests a conceptual model of the associations among youth irritability, parent accommodation, and youth anxiety severity following cognitive behavioral treatment (CBT). Participants were N = 128 clinic-referred youths ages 6 to 17 years (M = 9.76 years; 57% female) who met criteria for primary anxiety disorder diagnoses and completed a 12- to 14-week CBT anxiety protocol. Parent- and youth-report on youth irritability, parent accommodation of their child's anxiety, and youth anxiety severity were assessed pretreatment and posttreatment. Using parent-report, youth irritability at pretreatment was associated with high parent accommodation of youth anxiety and high youth anxiety severity at posttreatment. The association between irritability and youth anxiety outcome was mediated contemporaneously by parent accommodation at posttreatment. These findings show that parent accommodation of their anxious-irritable children's anxiety may account for high youth anxiety severity following treatment. Developing strategies to target irritability in anxious youth and/or reduce parent accommodation in the presence of youth irritability represent important directions for future research.
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Affiliation(s)
| | - Victor Buitron
- Center for Children and Families, Florida International University
| | | | - Yasmin Rey
- Center for Children and Families, Florida International University
| | | | | | - Jeremy W Pettit
- Center for Children and Families, Florida International University.
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Chad-Friedman E, Galano MM, Lemay EP, Olino TM, Klein DN, Dougherty LR. Parsing between- and within-person effects: Longitudinal associations between irritability and internalizing and externalizing problems from early childhood through adolescence. Dev Psychopathol 2023; 35:1371-1381. [PMID: 34955108 PMCID: PMC9234095 DOI: 10.1017/s0954579421001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This report examines between- and within-person associations between youth irritability and concurrent and prospective internalizing and externalizing symptoms from early childhood through adolescence. Distinguishing between- and within-person longitudinal associations may yield distinct, clinically relevant information about pathways to multifinality from childhood irritability. METHODS Children's irritability and co-occurring symptoms were assessed across five waves between ages 3 and 15 years using the mother-reported Child Behavior Checklist (N = 605, 46% female). Parental history of depressive disorders was assessed with a clinical interview. RESULTS Results demonstrated that between- and within-person irritability were uniquely associated with concurrent depressive, anxiety, and defiance symptoms, but not ADHD. Prior wave within-person irritability also predicted next wave depressive, anxiety, and defiance symptoms, controlling for prior symptoms; these prospective associations were bidirectional. Child sex and parental depressive disorders moderated associations. DISCUSSIONS Findings identify pathways from within- and between-person irritability to later internalizing and externalizing psychopathology. Results demonstrate the importance of parsing within- and between-person effects to understand nuanced relations among symptoms over childhood.
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28
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Naik AA, Ma X, Munyeshyaka M, Leibenluft E, Li Z. A New Behavioral Paradigm for Frustrative Non-reward Reveals a Global Change in Brain Networks by Frustration. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.28.530477. [PMID: 36909498 PMCID: PMC10002733 DOI: 10.1101/2023.02.28.530477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Irritability, defined as proneness to anger, can reach a pathological extent. It is a defining symptom of Disruptive Mood Dysregulation Disorder (DMDD) and one of the most common reasons youth presents for psychiatric evaluation and care. Aberrant responses to frustrative non-reward (FNR, the response to omission of expected reward) are central to the pathophysiology of irritability. FNR is a translational construct to study irritability across species. The development of preclinical FNR models would advance mechanistic studies of the important and relatively understudied clinical phenomenon of irritability. Methods We used FNR as a conceptual framework to develop a novel mouse behavioral paradigm named Alternate Poking Reward Omission (APRO). After APRO, mice were examined with a battery of behavioral tests and processed for whole brain c-Fos imaging. FNR increases locomotion and aggression in mice regardless of sex. These behavioral changes resemble the symptoms observed in youth with severe irritability. There is no change in anxiety-like, depression-like, or non-aggressive social behaviors. FNR increases c-Fos+ neurons in 13 subregions of thalamus, iso-cortex and hippocampus including the prelimbic, ACC, hippocampus, dorsal thalamus, cuneiform nucleus, pons, and pallidum areas. FNR also shifts the brain network towards a more global processing mode. Conclusion Our novel FNR paradigm produces a frustration effect and alters brain processing in ways resembling the symptoms and brain network reconfiguration observed in youth with severe irritability. The novel behavioral paradigm and identified brain regions lay the groundwork for further mechanistic studies of frustration and irritability in rodents.
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Affiliation(s)
- Aijaz Ahmad Naik
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
- Center on Compulsive Behaviors, Intramural Research program, NIH, Bethesda, MD, USA
| | - Xiaoyu Ma
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
| | - Maxime Munyeshyaka
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
| | - Zheng Li
- Section on Synapse Development Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
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Panda TK, Singhai K, Nebhinani N, Pareek V, Jain S. Diagnostic and Therapeutic Challenges in an Adolescent with Comorbid Oppositional Defiant Disorder and Bipolar Disorder. JOURNAL OF INDIAN ASSOCIATION FOR CHILD AND ADOLESCENT MENTAL HEALTH 2023. [DOI: 10.1177/09731342231156497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Oppositional defiant disorder (ODD) is often found to be comorbid with bipolar disorder (BD) in children and adolescents. Both disorders are characterized by chronic irritability, emotional dysregulation, and behavioral problems. These overlapping symptoms often lead to diagnostic difficulty. In addition, ODD-BD comorbidity also presents multiple therapeutic challenges. Here, we describe the case of an adolescent male, who presented with comorbid ODD and BD, along with multiple diagnostic and therapeutic challenges.
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Affiliation(s)
- Tushar Kanta Panda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kartik Singhai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Vrinda Pareek
- Department of Psychiatry, Medical College, Baroda, Gujarat, India
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Louveau C, Ellul P, Iftimovici A, Dubreucq J, Laidi C, Leyrolle Q, Purper-Ouakil D, Jacquemont S, Lyonnet S, Barthélémy C, Krebs MO, Bai J, Olivier P, Chaumette B. Neurodevelopmental disorders (NDD) without boundaries: research and interventions beyond classifications. J Neural Transm (Vienna) 2023; 130:473-479. [PMID: 36719463 DOI: 10.1007/s00702-023-02586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
On June 2022, the 2nd Webinar "Neurodevelopmental Disorders (NDD) without boundaries took place at the Imagine Institute in Paris and was broadcasted live and in replay. The aim of this webinar is to address NDD in a dimensional rather than in a categorical approach. Several speakers were invited to present their researches on the subject. Classifications in NDD were discussed: irritability in NDD, involvement of the immune system in neurodevelopment, nutrition and gut microbiota modulate brain inflammation and neurodevelopment, co-occurring conditions in autistic adolescents and adults without intellectual disability. Classifications in psychiatric disorders were asked: mapping the effect of genes on cognition and autism risk, epigenetics and symptomatic trajectory in neurodevelopmental disorders, the autism-schizophrenia continuum in two examples: minor neurological signs and EEG microstates, the cerebellum in schizophrenia and autism: from imaging to intervention perspectives. Both genetic and environmental factors, along with clinical and imaging features, argue toward a continnum between NDD but also with adult psychiatric presentations. This new paradigm could modify the therapeutic strategy, with the development of large-spectrum treatments or new psychotherapies addressing co-occuring symptoms. The complexity and the heterogeneity of NDD apply well to the next scientific and political challenges: developing international convergence to push back the frontiers of our knowledge. This article is a summary of the 2nd webinar "Neurodevelopmental Disorders (NDD) without boundaries: research and interventions beyond classifications" sponsored by the French National Academy of Medicine, the autism and neurodevelopmental disorders scientific interest group (GIS), the International Research Network Dev-O-Psy and the French Institute of Psychiatry (GDR3557). Oral presentations are available as a replay on the following website (in French): https://autisme-neurodev.org/evenements/2022/04/12/tnd-sans-frontieres-la-recherche-et-les-interventions-au-dela-des-classifications/ .
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Affiliation(s)
| | - Pierre Ellul
- Excellence Centre for Autism and Neuro-Developmental Disorders, Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris Cité University, Paris, France
- Immunology, Immunopathology, Immunotherapy, INSERM U959, Sorbonne University, Paris, France
| | - Anton Iftimovici
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Julien Dubreucq
- Child and Adolescent Psychiatry Department, Saint-Etienne University Hospital and CNRS UMR 5229, Institute of Cognitive Neuroscience Marc Jeannerod, University Lyon 1, Bron, France
| | | | - Quentin Leyrolle
- Univ. Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Unit of Child and Adolescent Psychiatry (MPEA1), Montpellier, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U 1018, Paris-Saclay University, Villejuif, France
| | - Sebastien Jacquemont
- Department of Pediatrics, Sainte Justine Hospital Research Center, University of Montreal, Montreal, QC, H4A3J1, Canada
| | - Stanislas Lyonnet
- INSERM-UMR1163, Université Paris Cité, Institut Imagine, Paris, France
| | - Catherine Barthélémy
- Faculty of Medicine, University of Tours, Tours, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
| | - Marie-Odile Krebs
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
| | - Jing Bai
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Paul Olivier
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France.
| | - Boris Chaumette
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
- Department of Psychiatry, McGill University, Montreal, Canada
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Breaux R, Baweja R, Eadeh HM, Shroff DM, Cash AR, Swanson CS, Knehans A, Waxmonsky JG. Systematic Review and Meta-analysis: Pharmacological and Nonpharmacological Interventions for Persistent Nonepisodic Irritability. J Am Acad Child Adolesc Psychiatry 2023; 62:318-334. [PMID: 35714838 DOI: 10.1016/j.jaac.2022.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 04/11/2022] [Accepted: 06/07/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This meta-analysis examined the efficacy of available pharmacological and nonpharmacological interventions for irritability among youth with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), disruptive mood dysregulation disorder (DMDD), and/or severe mood dysregulation (SMD). METHOD Literature searches were conducted in October 2020, resulting in 564 abstracts being reviewed to identify relevant papers, with 387 articles being reviewed in full. A random effects model was used for the meta-analysis, with subgroup meta-regressions run to assess effects of study design, intervention type, medication class, and clinical population. RESULTS A total of 101 studies were included (80 pharmacological, 13 nonpharmacological, 8 combined). Despite high heterogeneity in effects (I2 = 94.3%), pooled posttreatment effect size for decreasing irritability was large (Hedges' g = 1.62). Large effects were found for pharmacological (g = 1.85) and nonpharmacological (g = 1.11) interventions; moderate effects were found for combined interventions relative to monotherapy interventions (g = 0.69). Antipsychotic medications provided the largest effect for reducing irritability relative to all other medication classes and nonpharmacological interventions. A large effect was found for youth with ASD (g = 1.89), whereas a medium effect was found for youth with ADHD/DMDD/DBD/SMD (g = 0.64). CONCLUSION This meta-analysis provides a comprehensive review of interventions targeting persistent nonepisodic irritability among youth with various psychiatric disorders. Strong evidence was found for medium-to-large effects across study design, intervention type, and clinical populations, with the largest effects for pharmacological interventions, particularly antipsychotic medications and combined pharmacological interventions, and interventions for youth with ASD.
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Affiliation(s)
- Rosanna Breaux
- Virginia Polytechnic Institute and State University, Blacksburg.
| | - Raman Baweja
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Annah R Cash
- Virginia Polytechnic Institute and State University, Blacksburg
| | | | - Amy Knehans
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Brotman MA, Kircanski K. Editorial: A Cry for Help: We Need Nonpharmacological Randomized Controlled Trials for Pediatric Irritability. J Am Acad Child Adolesc Psychiatry 2023; 62:292-293. [PMID: 35917843 DOI: 10.1016/j.jaac.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
Research on the assessment, diagnosis, and treatment of clinically impairing irritability in children and adolescents has increased dramatically over the past several decades.1-5 Increased attention can be traced to controversy arising in the 1990s regarding the nosological status of youth with severe nonepisodic irritability (for a review, see1). Growing out of this work, disruptive mood dysregulation disorder was introduced in DSM-5.6 Critically, in recent years, irritability has been conceptualized as a symptom or feature manifesting transdiagnostically across numerous mood, anxiety, disruptive behavior, and neurodevelopmental disorders.7,8 The comprehensive and timely meta-analysis by Breaux et al.9 in the current issue of the Journal reviews pharmacological and nonpharmacological interventions for this transdiagnostic conceptualization of irritability.
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Affiliation(s)
- Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland.
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
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Prior D, Win S, Hassiotis A, Hall I, Martiello MA, Ali AK. Behavioural and cognitive-behavioural interventions for outwardly directed aggressive behaviour in people with intellectual disabilities. Cochrane Database Syst Rev 2023; 2:CD003406. [PMID: 36745863 PMCID: PMC9901280 DOI: 10.1002/14651858.cd003406.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Outwardly directed aggressive behaviour in people with intellectual disabilities is a significant issue that may lead to poor quality of life, social exclusion and inpatient psychiatric admissions. Cognitive and behavioural approaches have been developed to manage aggressive behaviour but the effectiveness of these interventions on reducing aggressive behaviour and other outcomes are unclear. This is the third update of this review and adds nine new studies, resulting in a total of 15 studies in this review. OBJECTIVES To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly directed aggressive behaviour compared to usual care, wait-list controls or no treatment in people with intellectual disability. We also evaluated enhanced interventions compared to non-enhanced interventions. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was March 2022. We revised the search terms to include positive behaviour support (PBS). SELECTION CRITERIA We included randomised and quasi-randomised trials of children and adults with intellectual disability of any duration, setting and any eligible comparator. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were change in 1. aggressive behaviour, 2. ability to control anger, and 3. adaptive functioning, and 4. ADVERSE EFFECTS Our secondary outcomes were change in 5. mental state, 6. medication, 7. care needs and 8. quality of life, and 9. frequency of service utilisation and 10. user satisfaction data. We used GRADE to assess certainty of evidence for each outcome. We expressed treatment effects as mean differences (MD) or odds ratios (OR), with 95% confidence intervals (CI). Where possible, we pooled data using a fixed-effect model. MAIN RESULTS This updated version comprises nine new studies giving 15 included studies and 921 participants. The update also adds new interventions including parent training (two studies), mindfulness-based positive behaviour support (MBPBS) (two studies), reciprocal imitation training (RIT; one study) and dialectical behavioural therapy (DBT; one study). It also adds two new studies on PBS. Most studies were based in the community (14 studies), and one was in an inpatient forensic service. Eleven studies involved adults only. The remaining studies involved children (one study), children and adolescents (one study), adolescents (one study), and adolescents and adults (one study). One study included boys with fragile X syndrome. Six studies were conducted in the UK, seven in the USA, one in Canada and one in Germany. Only five studies described sources of funding. Four studies compared anger management based on cognitive behaviour therapy to a wait-list or no treatment control group (n = 263); two studies compared PBS with treatment as usual (TAU) (n = 308); two studies compared carer training on mindfulness and PBS with PBS only (n = 128); two studies involving parent training on behavioural approaches compared to wait-list control or TAU (n = 99); one study of mindfulness to a wait-list control (n = 34); one study of adapted dialectal behavioural therapy compared to wait-list control (n = 21); one study of RIT compared to an active control (n = 20) and one study of modified relaxation compared to an active control group (n = 12). There was moderate-certainty evidence that anger management may improve severity of aggressive behaviour post-treatment (MD -3.50, 95% CI -6.21 to -0.79; P = 0.01; 1 study, 158 participants); very low-certainty evidence that it might improve self-reported ability to control anger (MD -8.38, 95% CI -14.05 to -2.71; P = 0.004, I2 = 2%; 3 studies, 212 participants), adaptive functioning (MD -21.73, 95% CI -36.44 to -7.02; P = 0.004; 1 study, 28 participants) and psychiatric symptoms (MD -0.48, 95% CI -0.79 to -0.17; P = 0.002; 1 study, 28 participants) post-treatment; and very low-certainty evidence that it does not improve quality of life post-treatment (MD -5.60, 95% CI -18.11 to 6.91; P = 0.38; 1 study, 129 participants) or reduce service utilisation and costs at 10 months (MD 102.99 British pounds, 95% CI -117.16 to 323.14; P = 0.36; 1 study, 133 participants). There was moderate-certainty evidence that PBS may reduce aggressive behaviour post-treatment (MD -7.78, 95% CI -15.23 to -0.32; P = 0.04, I2 = 0%; 2 studies, 275 participants) and low-certainty evidence that it probably does not reduce aggressive behaviour at 12 months (MD -5.20, 95% CI -13.27 to 2.87; P = 0.21; 1 study, 225 participants). There was low-certainty evidence that PBS does not improve mental state post-treatment (OR 1.44, 95% CI 0.83 to 2.49; P = 1.21; 1 study, 214 participants) and very low-certainty evidence that it might not reduce service utilisation at 12 months (MD -448.00 British pounds, 95% CI -1660.83 to 764.83; P = 0.47; 1 study, 225 participants). There was very low-certainty evidence that mindfulness may reduce incidents of physical aggression (MD -2.80, 95% CI -4.37 to -1.23; P < 0.001; 1 study; 34 participants) and low-certainty evidence that MBPBS may reduce incidents of aggression post-treatment (MD -10.27, 95% CI -14.86 to -5.67; P < 0.001, I2 = 87%; 2 studies, 128 participants). Reasons for downgrading the certainty of evidence were risk of bias (particularly selection and performance bias); imprecision (results from single, often small studies, wide CIs, and CIs crossing the null effect); and inconsistency (statistical heterogeneity). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that cognitive-behavioural approaches such as anger management and PBS may reduce outwardly directed aggressive behaviour in the short term but there is less certainty about the evidence in the medium and long term, particularly in relation to other outcomes such as quality of life. There is some evidence to suggest that combining more than one intervention may have cumulative benefits. Most studies were small and there is a need for larger, robust randomised controlled trials, particularly for interventions where the certainty of evidence is very low. More trials are needed that focus on children and whether psychological interventions lead to reductions in the use of psychotropic medications.
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Affiliation(s)
- David Prior
- Forensic Intellectual and Neurodevelopmental Disabilities (FIND) Community Team South London Partnership, Oxleas NHS Foundation Trust, London, UK
| | - Soe Win
- Services for People with Learning Disabilities (Luton), East London NHS Foundation Trust, London, UK
| | | | - Ian Hall
- Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Michele A Martiello
- More Ward, Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Afia K Ali
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
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Carlson GA, Singh MK, Amaya-Jackson L, Benton TD, Althoff RR, Bellonci C, Bostic JQ, Chua JD, Findling RL, Galanter CA, Gerson RS, Sorter MT, Stringaris A, Waxmonsky JG, McClellan JM. Narrative Review: Impairing Emotional Outbursts: What They Are and What We Should Do About Them. J Am Acad Child Adolesc Psychiatry 2023; 62:135-150. [PMID: 35358662 DOI: 10.1016/j.jaac.2022.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking. METHOD The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis. RESULTS Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses. CONCLUSION Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.
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Affiliation(s)
- Gabrielle A Carlson
- Renaissance School of Medicine at Stony Brook University, Putnam Hall, South Campus, Stony Brook, New York.
| | | | | | - Tami D Benton
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Jeff Q Bostic
- MedStar Georgetown University Hospital, Washington, DC
| | - Jaclyn Datar Chua
- Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Pennsylvania, Philadelphia
| | | | - Cathryn A Galanter
- SUNY Downstate, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York
| | | | - Michael T Sorter
- Cincinnati Children's Hospital and the University of Cincinnati, Ohio
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Lee KS, Hagan CN, Hughes M, Cotter G, McAdam Freud E, Kircanski K, Leibenluft E, Brotman MA, Tseng WL. Systematic Review and Meta-analysis: Task-based fMRI Studies in Youths With Irritability. J Am Acad Child Adolesc Psychiatry 2023; 62:208-229. [PMID: 35944754 PMCID: PMC9892288 DOI: 10.1016/j.jaac.2022.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/22/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Childhood irritability, operationalized as disproportionate and frequent temper tantrums and low frustration tolerance relative to peers, is a transdiagnostic symptom across many pediatric disorders. Studies using task-dependent functional magnetic resonance imaging (fMRI) to probe neural dysfunction in irritability have increased. However, an integrated review summarizing the published methods and synthesized fMRI results remains lacking. METHOD We conducted a systematic search using irritability terms and task functional neuroimaging in key databases in March 2021, and identified 30 studies for our systematic review. Sample characteristics and fMRI methods were summarized. A subset of 28 studies met the criteria for extracting coordinate-based data for quantitative meta-analysis. Ten activation-likelihood estimations were performed to examine neural convergence across irritability measures and fMRI task domains. RESULTS Systematic review revealed small sample sizes (median = 58, mean age range = 8-16 years) with heterogeneous sample characteristics, irritability measures, tasks, and analytical procedures. Meta-analyses found no evidence for neural activation convergence of irritability across neurocognitive functions related to emotional reactivity, cognitive control, and reward processing, or within each domain. Sensitivity analyses partialing out variances driven by heterogeneous tasks, irritability measures, stimulus types, and developmental ages all yielded null findings. Results were compared with a review on irritability-related structural anomalies from 11 studies. CONCLUSION The lack of neural convergence suggests a need for common, standardized irritability assessments and more homogeneous fMRI tasks. Thoughtfully designed fMRI studies probing commonly defined neurocognitive functions may be more fruitful to elucidate the neural mechanisms of irritability. Open science practices, data mining in large neuroscience databases, and standardized analytical methods promote meaningful collaboration in irritability research.
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Affiliation(s)
- Ka Shu Lee
- Yale School of Medicine, New Haven, Connecticut; University of Oxford, United Kingdom.
| | | | - Mina Hughes
- Yale School of Medicine, New Haven, Connecticut
| | | | - Eva McAdam Freud
- Yale School of Medicine, New Haven, Connecticut.,University College London, United Kingdom, and Anna Freud National
Centre for Children and Families, London, United Kingdom
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36
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Diagnostic instruments for the assessment of disruptive mood dysregulation disorder: a systematic review of the literature. Eur Child Adolesc Psychiatry 2023; 32:17-39. [PMID: 34232390 PMCID: PMC9908712 DOI: 10.1007/s00787-021-01840-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Disruptive mood dysregulation disorder (DMDD) involves non-episodic irritability and frequent severe temper outbursts in children. Since the inclusion of the diagnosis in the DSM-5, there is no established gold-standard in the assessment of DMDD. In this systematic review of the literature, we provide a synopsis of existing diagnostic instruments for DMDD. Bibliographic databases were searched for any studies assessing DMDD. The systematic search of the literature yielded K = 1167 hits, of which n = 110 studies were included. The most frequently used measure was the Kiddie Schedule for Affective Disorders and Schizophrenia DMDD module (25%). Other studies derived diagnostic criteria from interviews not specifically designed to measure DMDD (47%), chart review (7%), clinical diagnosis without any specific instrument (6%) or did not provide information about the assessment (9%). Three structured interviews designed to diagnose DMDD were used in six studies (6%). Interrater reliability was reported in 36% of studies (ranging from κ = 0.6-1) while other psychometric properties were rarely reported. This systematic review points to a variety of existing diagnostic measures for DMDD with good reliability. Consistent reporting of psychometric properties of recently developed DMDD interviews, as well as their further refinement, may help to ascertain the validity of the diagnosis.
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37
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Fredrick JW, Rodriguez B, Lynch JD, Loren RE, Tamm L. Differential diagnoses of irritability and temper loss in a 6-year-old. Clin Child Psychol Psychiatry 2022; 27:1263-1276. [PMID: 35090368 DOI: 10.1177/13591045211070166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Irritability and temper loss are common concerns among young children seen for mental health diagnostic evaluations and represent features of nearly a dozen childhood mental health conditions. Thus, careful assessment of irritability and temper loss is essential for informing case conceptualization, diagnosis, and treatment recommendations. The current case study provides a clinical description of a 6-year-old Black male ("Tyler") seen in a tertiary pediatric medical center for concerns related to significant inattention, hyperactivity, impulsivity, oppositional behaviors, irritability, and severe temper loss displayed at home and school. The clinical description summarizes findings from rating scales and diagnostic evaluations, case conceptualization, as well as treatment recommendations. Detailed suggestions for clinicians regarding strategies for assessing irritability and temper loss and questions to consider when seeking clarification to inform differential diagnoses are provided.
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Affiliation(s)
- Joseph W Fredrick
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beatriz Rodriguez
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, RinggoldID:2515Xavier University, Cincinnati, OH, USA
| | - James D Lynch
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, RinggoldID:2514University of Cincinnati, Cincinnati, OH, USA
| | - Richard Ea Loren
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leanne Tamm
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, RinggoldID:2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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38
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Ezpeleta L, Penelo E, Navarro JB, de la Osa N, Trepat E, Wichstrøm L. Reciprocal relations between dimensions of Oppositional defiant problems and callous-unemotional traits. Res Child Adolesc Psychopathol 2022; 50:1179-1190. [PMID: 35290553 PMCID: PMC9525336 DOI: 10.1007/s10802-022-00910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/03/2022]
Abstract
Although irritability, headstrong/defiant behavior, and callous-unemotional traits (CU traits) often co-occur, the prospective associations between them are not well known. A general population sample of 622 children was followed up yearly from ages 3 to 12 years and assessed using dimensional measures of irritability, headstrong/defiant, and CU traits with teacher provided information. A random intercept cross-lagged panel model, accounting for all unmeasured time-invariant confounding using the children as their own controls, revealed cross-lagged reciprocal associations between increased headstrong/defiant and increased CU traits at all ages and a unidirectional association from headstrong/defiant to irritability. The findings are consistent with headstrong/defiant behavior and CU traits mutually influencing each other over time and headstrong/defiant behavior enhancing irritability. School-based intervention and prevention programs should take these findings into consideration. They also suggest that irritability acts as a distinct developmental dimension of headstrong/defiant and callous-unemotional behaviors and needs to be addressed independently.
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Affiliation(s)
- Lourdes Ezpeleta
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain.
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, 08193, Barcelona, Bellaterra, Spain.
| | - Eva Penelo
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Blas Navarro
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria de la Osa
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, 08193, Barcelona, Bellaterra, Spain
| | - Esther Trepat
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, 08193, Barcelona, Bellaterra, Spain
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Psychometric Validation of the Greek Version of the Scale “Temper Loss” of the Questionnaire “Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB)”. CHILDREN 2022; 9:children9091328. [PMID: 36138637 PMCID: PMC9497524 DOI: 10.3390/children9091328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022]
Abstract
It has become increasingly evident that vulnerability to psychopathology is identifiable early in life. A body of evidence suggests that the recognition and prevention of a spectrum of typical/atypical behaviors in preschoolers can lead to earlier diagnosis and treatment. The Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) is a parent-completed instrument that has been developed recently to differentiate normative misbehaviors in early childhood from markers of clinical risk. The aim of the present study was to validate the “Temper Loss” Subscale in the Greek language and to assess its psychometric properties in healthy children. An on-print parent-report survey was conducted among Greek children, aged between 3 and 5.5 years. The survey included the MAP-DB and the Child Behavior Checklist (CBCL). A total of 400 respondents participated in the study. The analysis suggested that the Greek version of the MAP-DB’s “Temper Loss” scale has good psychometric properties. The results of the Exploratory Factor Analysis (EFA) of the 22 items were able to explain 64.4% of the total variance. Internal consistency for the one subscale was satisfactory, with Cronbach’s alpha at 0.970. This scale can be used by researchers and practitioners for the evaluation of dimensional phenotypes in early childhood.
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40
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Barclay ME, Silvers JA, Lee SS. Childhood Irritability: Predictive Validity and Mediators of Adolescent Psychopathology. Res Child Adolesc Psychopathol 2022; 50:1165-1177. [PMID: 35522397 DOI: 10.1007/s10802-022-00908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
Despite its transdiagnostic significance, there is modest evidence with respect to the predictive validity of childhood irritability, especially across developmental periods; similarly, little is known about explanatory factors underlying these predictions. This study had two goals: (1) to test the predictive validity of childhood irritability with respect to adolescent internalizing and externalizing problems, controlling for baseline ADHD and related psychopathology and (2) to test theoretically-derived family (i.e., parenting behavior, parenting stress) and social (i.e., peer status, social skills) constructs as explanatory factors of adolescent psychopathology. Two hundred thirty ethnically diverse (51.5% White) 5-10-year-old youth (32% female) with (n = 121) and without (n = 110) ADHD completed three separate laboratory-based assessments across six to seven years. Temporally-ordered predictors, putative mediators, and psychopathology outcomes were assessed using multiple informants (i.e., parent, teacher, youth) and methods (i.e., structured interviews, normed rating scales). Controlling for demographic factors, clinical correlates, and baseline psychopathology, childhood irritability uniquely predicted adolescent externalizing problems, but not internalizing problems. Next, analyses revealed that low social skills partially explained predictions of adolescent internalizing problems. However, family or social factors did not underlie predictions of adolescent externalizing problems. These preliminary findings support the predictive validity of childhood irritability with respect to early adolescent externalizing problems and implicate low social skills as a potentially unique mediator of internalizing outcomes. Intervention-induced improvements in social skills may minimize emergent psychopathology initiated by significant childhood irritability.
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Affiliation(s)
- Margot E Barclay
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA
| | - Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA
| | - Steve S Lee
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, 90095, CA, Los Angeles, USA.
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41
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Sugaya LS, Kircanski K, Stringaris A, Polanczyk GV, Leibenluft E. Validation of an irritability measure in preschoolers in school-based and clinical Brazilian samples. Eur Child Adolesc Psychiatry 2022; 31:577-587. [PMID: 33389159 DOI: 10.1007/s00787-020-01701-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/30/2020] [Indexed: 01/18/2023]
Abstract
The Affective Reactivity Index (ARI) is an irritability measure with good psychometric properties. However, there are no published studies in preschool children, an important population in which to differentiate normative from non-normative irritability. The goal of this study was to validate the ARI in preschoolers. Two samples were included: a school-based sample (N = 487, mean age = 57.80 ± 7.23 months, 52.8% male) and a clinical sample of children with Attention Deficit Hyperactivity Disorder (ADHD; N = 153, mean age = 60.5 ± 7.6 months, 83.7% males). Confirmatory factor analysis assessed ARI unidimensionality. ARI criterion validity was tested through comparison to other scales measuring irritability, related constructs, and other aspects of psychopathology. Test-retest reliability was assessed in the school-based sample. Analyses confirmed a single-factor structure and good internal consistency. The ARI showed stronger correlations with irritability measures than with measures of other constructs. In the clinical sample, ADHD children with comorbid disruptive behavior disorders had higher ARI scores than those without this comorbidity. In the school-based sample, test-retest reliability was moderate. This is the first study to demonstrate ARI validity and reliability in preschoolers. The scale performed well in both school-based and clinical samples. Having a concise and validated irritability measure for preschoolers may facilitate both clinical assessment and research on early irritability.
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Affiliation(s)
- Luisa Shiguemi Sugaya
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA. .,Department of Psychiatry, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA
| | - Argyris Stringaris
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA
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42
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So FK, Chavira D, Lee SS. ADHD and ODD Dimensions: Time Varying Prediction of Internalizing Problems from Childhood to Adolescence. J Atten Disord 2022; 26:932-941. [PMID: 34632828 DOI: 10.1177/10870547211050947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although childhood ADHD is a risk factor for internalizing problems, it consists of separable inattention and hyperactivity dimensions that differentially predict outcomes. Oppositional defiant disorder also consists of separable dimensions (i.e., irritable, oppositional), co-occurs with ADHD, and predicts internalizing outcomes. To discern independent associations with internalizing problems, dimensions must be considered simultaneously. METHODS Controlling for age, sex, and race, we tested inattention, hyperactivity, irritability, and oppositionality as time-varying predictors of 6 to 7-year prospective change in parent- and teacher-rated internalizing problems in 230 ethnically- diverse (50% Caucasian) 5 to 10 year old youth (M = 7.4 years, 68% male) with (n = 120) and without ADHD (n = 110). RESULTS Escalating inattention and irritability, but not hyperactivity and oppositionality, uniquely predicted internalizing problems. CONCLUSION These findings suggest that inattention and irritability are unique risk factors for later internalizing problems. These dimensions may catalyze internalizing problems across development and constitute important intervention targets.
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Affiliation(s)
- Felix K So
- University of California, Los Angeles, USA
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43
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Psychometric properties of The Clinician Affective Reactivity Index for Assessment of Irritability in a clinical sample of Turkish children and adolescents. Scand J Child Adolesc Psychiatr Psychol 2022; 10:24-32. [PMID: 35719699 PMCID: PMC9154355 DOI: 10.2478/sjcapp-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background No clinician-oriented scale exists to assess irritability in Turkey. This pilot study aimed to evaluate the psychometric properties of the Turkish version of The Clinician Affective Reactivity Index (CL-ARI). Method A total of 116 children and adolescents aged between 10 to 17 years (14.1 ± 2.1 years) were recruited from the psychiatric outpatient clinics. The participants completed a set of scales (Strengths and Difficulties Questionnaire [SDQ], Affective Reactivity Index [ARI], Revised Child Anxiety and Depression Scale, Swanson, Nolan, and Pelham, Version IV Scale). Diagnostic interviews were administered to confirm psychiatric diagnoses. Cronbach’s alpha was calculated to assess internal consistency. Discriminant validity was further tested using independent sample t-test and Receiver Operating Characteristic curves. Interrater reliability was tested using intraclass correlation coefficients (ICC). Convergent validity was also tested using Pearson’s correlation. Results Cronbach’s alpha values of CL-ARI were 0.919 total score, 0.842 for the temper outbursts score, 0.861 for the irritable mood score, and 0.840 for the impairment score. ICC values for interrater reliability were high for the temper outbursts (r = 0.993), the irritable mood (r = 0.993), the impairment (r = 0.917), and the total score (r = 0.991). In the sample, there was a high level of correlation between the self-report ARI-child/parent form and the CL-ARI total and subscale scores. Likewise, moderate-high level of correlations were found between the behavioral SDQ child/parent forms and the CL-ARI total and subscale scores. Conclusions This is the Turkish validation of the CL-ARI, a dedicated interview and rating scale to assess irritability in the clinical sample. The results of this study suggest that the Turkish version of CL-ARI has adequate internal consistency and interrater reliability, and sufficient convergent and discriminant validity to be used in research settings.
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Lee KS, Xiao J, Luo J, Leibenluft E, Liew Z, Tseng WL. Characterizing the Neural Correlates of Response Inhibition and Error Processing in Children With Symptoms of Irritability and/or Attention-Deficit/Hyperactivity Disorder in the ABCD Study®. Front Psychiatry 2022; 13:803891. [PMID: 35308882 PMCID: PMC8931695 DOI: 10.3389/fpsyt.2022.803891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD), characterized by symptoms of inattention and/or hyperactivity and impulsivity, is a neurodevelopmental disorder associated with executive dysfunctions, including response inhibition and error processing. Research has documented a common co-occurrence between ADHD and pediatric irritability. The latter is more characterized by affective symptoms, specifically frequent temper outbursts and low frustration tolerance relative to typically developing peers. Shared and non-shared neural correlates of youths with varied profiles of ADHD and irritability symptoms during childhood remain largely unknown. This study first classified a large sample of youths in the Adolescent Brain Cognitive Development (ABCD) study at baseline into distinct phenotypic groups based on ADHD and irritability symptoms (N = 11,748), and then examined shared and non-shared neural correlates of response inhibition and error processing during the Stop Signal Task in a subset of sample with quality neuroimaging data (N = 5,948). Latent class analysis (LCA) revealed four phenotypic groups, i.e., high ADHD with co-occurring irritability symptoms (n = 787, 6.7%), moderate ADHD with low irritability symptoms (n = 901, 7.7%), high irritability with no ADHD symptoms (n = 279, 2.4%), and typically developing peers with low ADHD and low irritability symptoms (n = 9,781, 83.3%). Latent variable modeling revealed group differences in the neural coactivation network supporting response inhibition in the fronto-parietal regions, but limited differences in error processing across frontal and posterior regions. These neural differences were marked by decreased coactivation in the irritability only group relative to youths with ADHD and co-occurring irritability symptoms and typically developing peers during response inhibition. Together, this study provided initial evidence for differential neural mechanisms of response inhibition associated with ADHD, irritability, and their co-occurrence. Precision medicine attending to individual differences in ADHD and irritability symptoms and the underlying mechanisms are warranted when treating affected children and families.
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Affiliation(s)
- Ka Shu Lee
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Jingyuan Xiao
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Jiajun Luo
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Institute for Population and Precision Health, The University of Chicago, Chicago, IL, United States
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Zeyan Liew
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
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45
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Findling RL, Zhou X, George P, Chappell PB. Diagnostic Trends and Prescription Patterns in Disruptive Mood Dysregulation Disorder and Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:434-445. [PMID: 34091008 DOI: 10.1016/j.jaac.2021.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/05/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Disruptive mood dysregulation disorder (DMDD) was introduced in DSM-5 to distinguish a subset of chronically irritable youth who may be incorrectly diagnosed and/or treated for pediatric bipolar disorder (BPD). This study characterized the rate of new treatment episodes and treated prevalence of BPD and DMDD from a longitudinal electronic health record database and examined the impact of DMDD on prescription trends. METHOD A retrospective cohort study using 2008-2018 Optum electronic health record data was conducted. Youth aged 10 to < 18 years with ≥ 183 days of database enrollment before the study cohort entry were included. Annual new treatment episode rates per 1,000 patient-years and treated prevalence (%) were estimated. Prescriptions for medications, concomitant diagnoses, and acute mental health service use for 2016-2018 were evaluated. RESULTS There were 7,677 youths with DMDD and 6,480 youths with BPD identified. Mean age (13-15 years) and ethnicity were similar for both groups. A rise in new treatment episode rates (0.87-1.75 per 1,000 patient-years, p < .0001) and treated prevalence (0.08%-0.35%, p < .0001) of DMDD diagnoses (2016-2018) following diagnosis inception was paralleled by decreasing new treatment episode rates (1.22-1.14 per 1,000 patient-years, p < .01) and treated prevalence (0.42%-0.36%, p < .0001) of BPD diagnoses (2015-2018). More youth in the DMDD group were prescribed medications compared with the BPD group (81.9% vs 69.4%), including antipsychotics (58.9% vs 51.0%). Higher proportions of youth with DMDD vs youth with BPD had disruptive behavior disorders (eg, 35.9% vs 20.5% had oppositional defiant disorder), and required inpatient hospitalization related to their mental health disorder (45.0% vs 33.0%). CONCLUSION Diagnosis of DMDD has had rapid uptake in clinical practice but is associated with increased antipsychotic and polypharmacy prescriptions and higher rates of comorbidity and inpatient hospitalization in youth with a DMDD diagnosis compared with a BPD diagnosis.
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Affiliation(s)
| | - Xiaofeng Zhou
- Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc, New York
| | - Prethibha George
- Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc, New York
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Sorter M, Chua J, Lamy M, Barzman D, Ryes L, Shekhtman JA. Management of Emotion Dysregulation and Outbursts in Children and Adolescents. Curr Psychiatry Rep 2022; 24:213-226. [PMID: 35316849 DOI: 10.1007/s11920-022-01325-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Emotion dysregulation and outbursts are very common reasons for referral to child and adolescent mental health services and a frequent cause of admission to hospitals and residential programs. Symptoms of emotion dysregulation and outburst are transdiagnostic, associated with many disorders, have the potential to cause severe impairment and their management presents a major challenge in clinical practice. RECENT FINDINGS There are an increasing number of psychosocial interventions that demonstrate promise in improving emotion dysregulation and outbursts. Acute care systems to manage the most severely ill patients have limited best practice guidelines but program advancements indicate opportunities to improve care models. Pharmacotherapy may be of assistance to psychosocial interventions but must be used with caution due to potential adverse effects. Much remains to be discovered however evidence informed, targeted treatments for specific populations show potential for future improvements in outcomes.
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Affiliation(s)
- Michael Sorter
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, USA.
| | - Jaclyn Chua
- Children's Hospital of Philadelphia, Philadelphia, USA
| | - Martine Lamy
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Drew Barzman
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Louis Ryes
- Xavier University, Cincinnati, USA.,University of Kentucky College of Medicine, Lexington, USA
| | - Joshua Abraham Shekhtman
- The Ohio State University, Columbus, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
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47
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Kishida K, Tsuda M, Takahashi F, Ishikawa SI. Irritability and mental health profiles among children and adolescents: A result of latent profile analysis. J Affect Disord 2022; 300:76-83. [PMID: 34952126 DOI: 10.1016/j.jad.2021.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Irritability is a transdiagnostic symptom that accompanies both internalizing and externalizing problems. However, there has been a scarcity of research concerning the relationships between irritability and mental health profiles among children and adolescents. AIM This study aimed to identify latent profiles in children and adolescents using anxiety, depression, oppositionality, and irritability. In addition, the profiles were further examined in their relationships with mental health symptoms. METHOD The study analyzed data from 1867 children and adolescents aged 6-15 years from the COVID-19 Online-Survey for Children and Adolescents in Japan (J-COSCA). Parent-reported questionnaires were used in this study. RESULTS A latent profile analysis detected five latent profiles. High oppositionality characterized the first profile ("oppositional": n = 405, 22%). High levels of depression and other less pronounced symptoms characterized the second profile ("depressed": n = 276, 15%). The third profile ("average": n = 602, 33%) presented average symptoms of anxiety, depression and oppositionality and low irritability. The fourth profile ("well-adjusted": n = 235, 13%) presented low values for all the applicable symptoms. The last profile ("comorbid": n = 308, 17%) exhibited high values for all the symptoms and the highest level of irritability of the five profiles. LIMITATION We analyzed the data from a community sample alone after capturing it using parent-reported questionnaires. CONCLUSION This study revealed that the five profiles (oppositional, depressed, average, well-adjusted, and comorbid) were identified, and children and adolescents in the comorbid profiles had high irritability as well as high anxiety, depression, and oppositionality.
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Affiliation(s)
- Kohei Kishida
- Organization for Research Initiatives and Development, Doshisha University, Japan; Faculty of Psychology, Doshisha University, Japan.
| | - Masami Tsuda
- Graduate School of Psychology, Doshisha University, Japan
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48
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Mulraney M, Sciberras E, Payne JM, De Luca C, Mills J, Tennant M, Coghill D. Collaborative and Proactive Solutions compared with usual care to treat irritability in children and adolescents: a pilot randomized controlled trial. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2041983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Melissa Mulraney
- Institute for Social Neuroscience, ISN Psychology, Ivanhoe, Australia
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Emma Sciberras
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville, Australia
- School of Psychology, Deakin University, Geelong, Australia
| | - Jonathan M Payne
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Mental Health, The Royal Children’s Hospital, Parkville, Australia
| | - Cinzia De Luca
- Brain and Mind, Murdoch Children’s Research Institute, Parkville, Australia
- Children’s Cancer Centre, The Royal Children’s Hospital, Parkville, Australia
| | - John Mills
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville, Australia
| | - Michelle Tennant
- School of Psychology, Deakin University, Geelong, Australia
- Brain and Mind, Murdoch Children’s Research Institute, Parkville, Australia
| | - David Coghill
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Mental Health, The Royal Children’s Hospital, Parkville, Australia
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Brænden A, Zeiner P, Coldevin M, Stubberud J, Melinder A. Underlying mechanisms of disruptive mood dysregulation disorder in children: A systematic review by means of research domain criteria. JCPP ADVANCES 2022. [DOI: 10.1002/jcv2.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Astrid Brænden
- Department of Child and Adolescent Psychiatry Oslo University Hospital Oslo Norway
| | - Pål Zeiner
- Child and Adolescent Mental Health Research Unit, Department of Research and Innovation Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Marit Coldevin
- Nic Waals Institute Lovisenberg Diaconal Hospital Oslo Norway
- Department of Research Lovisenberg Diaconal Hospital Oslo Norway
| | - Jan Stubberud
- Department of Research Lovisenberg Diaconal Hospital Oslo Norway
- Department of Psychology University of Oslo Oslo Norway
| | - Annika Melinder
- Department of Child and Adolescent Psychiatry Oslo University Hospital Oslo Norway
- Department of Psychology University of Oslo Oslo Norway
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Vacher C, Romo L, Dereure M, Soler M, Picot MC, Purper-Ouakil D. Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial. Trials 2022; 23:124. [PMID: 35130934 PMCID: PMC8819925 DOI: 10.1186/s13063-022-05996-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation (ED). ED is characterized by excessive and inappropriate emotional reactions compared to social norms, uncontrolled and rapid shifts in emotion, and attention focused on emotional stimuli. Few studies have evaluated non-pharmacological interventions to improve ED in children with ADHD. The current randomized controlled trial assesses the efficacy of a cognitive behavioral therapy (CBT) intervention compared with a theater-based intervention (TBI) in children with ADHD and ED. METHODS Sixty-eight 7- to 13-year-old children with ADHD and ED will be recruited and randomly assigned to the CBT or TBI group. CBT aims to reduce ED by teaching anger management strategies. TBI seeks to reduce ED by improving emotion understanding and expression through mimics and movement. In both groups, children participate in 15 1-h sessions, and parents participate in 8 sessions of a parent management program. The primary outcome measure is the change in the "Aggression" sub-score of the Child Behavior Checklist (CBCL). Secondary outcome measures include overall impairment (Children's Global Assessment Scale, Strengths and Difficulties Questionnaire), personality profile (Hierarchical Personality Inventory for Children), executive function (Behavioral Rating Inventory of Executive Function), quality of life (Kidscreen-27), parental stress (Parenting Stress Index, 4th edition), parental depression (Beck Depression Inventory-II), and impact of child disorders on the quality of the family life (Parental Quality of Life and Developmental Disorder). DISCUSSION Children with ADHD and ED are at risk of functional impairment and poor outcomes and have specific therapeutic needs. This randomized controlled trial wants to assess non-pharmacological treatment options for this population. TRIAL REGISTRATION Clinicaltrials.gov. NCT03176108 . Registered on June 5, 2017.
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Affiliation(s)
- C Vacher
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France. .,CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France. .,INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Montpellier, France.
| | - L Romo
- CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France.,Service de Pathologies professionnelles et de l'environnement, Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Raymond Poincaré, Garches, France
| | - M Dereure
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - M Soler
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - M C Picot
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France.,Centre d'Investigation Clinique, Hôpital Saint Eloi, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - D Purper-Ouakil
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France.,INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Montpellier, France
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