Neural mechanisms of frustration in chronically irritable children

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

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

Children's Narratives of Sad Events: Attachment Security and Psychopathological Symptoms

BACKGROUND

This study aims to explore how children's experiences of sadness are related to their coping strategies, attachment, and psychopathology.

METHOD

A sample of 517 children described a sad event and related coping strategies. Events included bullying/quarrelling, frustration, accidents/illness, experienced/anticipated separation, and loss. Coping strategies included constructive coping, disengagement, and absence-of-coping.

RESULTS

Constructive coping was associated with secure attachment. Secure children used constructive and disengagement strategies for frustration, constructive coping particularly for bullying situations, and absence-of-coping for loss. Children reporting absence-of-coping during episodes of frustration exhibited more externalizing symptoms.

CONCLUSIONS

The results highlight relationships between circumstancialdimensions and specific emotional experiences, and the importance of context-specific coping strategies in promoting emotional well-being.

Annual Research Review: What processes are dysregulated among emotionally dysregulated youth? - a systematic review

Proliferation of the term "emotion dysregulation" in child psychopathology parallels the growing interest in processes that influence negative emotional reactivity. While it commonly refers to a clinical phenotype where intense anger leads to behavioral dyscontrol, the term implies etiology because anything that is dysregulated requires an impaired regulatory mechanism. Many cognitive, affective, behavioral, neural, and social processes have been studied to improve understanding of emotion dysregulation. Nevertheless, the defective regulatory mechanism that might underlie it remains unclear. This systematic review of research on processes that affect emotion dysregulation endeavors to develop an integrative framework for the wide variety of factors investigated. It seeks to ascertain which, if any, constitutes an impaired regulatory mechanism. Based on this review, we propose a framework organizing emotion-relevant processes into categories pertaining to stimulus processing, response selection and control, emotion generation, closed- or open-loop feedback-based regulation, and experiential influences. Our review finds scant evidence for closed-loop (automatic) mechanisms to downregulate anger arousal rapidly. Open-loop (deliberate) regulatory strategies seem effective for low-to-moderate arousal. More extensive evidence supports roles for aspects of stimulus processing (sensory sensitivity, salience, appraisal, threat processing, and reward expectancy). Response control functions, such as inhibitory control, show robust associations with emotion dysregulation. Processes relating to emotion generation highlight aberrant features in autonomic, endocrine, reward functioning, and tonic mood states. A large literature on adverse childhood experiences and family interactions shows the unique and joint effects of interpersonal with child-level risks. We conclude that the defective closed-loop regulatory mechanisms that emotion dysregulation implies require further specification. Integrating research on emotion-relevant mechanisms along an axis from input factors through emotion generation to corrective feedback may promote research on (a) heterogeneity in pathogenesis, (b) interrelationships between these factors, and (c) the derivation of better-targeted treatments that address specific pathogenic processes of affected youth.

Network analysis of loneliness, mental, and physical health in Czech adolescents

BACKGROUND

The increasing urgency to address rising loneliness among adolescents has become a critical issue, underscoring the need for further studies on its association with mental and physical health. The objective was to examine the changes in loneliness and its relation to mental and physical health issues in three adolescent age groups.

METHODS

A total sample of 14,588 Czech pupils (50.7% boys, mean age 13.6 ± 1.7 years) in grades 5, 7 and 9 was used from a representative dataset of the Health Behaviour in School-aged Children (HBSC) study. The network analysis based on undirected graphical models was used as an exploratory technique to assess and test the structure of the data.

RESULTS

The association between loneliness and health decreased with age. There was a significant positive association between loneliness, feeling low, and irritability. No significant direct association between loneliness and physical health complaints was found.

CONCLUSION

Further studies, preferably of longitudinal character, are needed to confirm the changes in associations between loneliness and mental and physical health outcomes.

Neural Correlates of Irritability and Potential Moderating Effects of Inhibitory Control

Background

Irritability affects up to 20% of youth and is a primary reason for referral to pediatric mental health clinics. Irritability is thought to be associated with disruptions in processing of reward, threat, and cognitive control; however, empirical study of these associations at both the behavioral and neural level have yielded equivocal findings that may be driven by small sample sizes and differences in study design. Associations between irritability and brain connectivity between cognitive control and reward- or threat-processing circuits remain understudied. Furthermore, better inhibitory control has been linked to lower irritability and differential neural functioning among irritable youth, suggesting that good inhibitory control may serve as a protective factor.

Methods

We hypothesized that higher irritability scores would be associated with less positive (or negative) connectivity between cognitive control and threat-processing circuits and between cognitive control and reward-processing circuits in the Healthy Brain Network dataset (release 10.0; N = 4135). We also hypothesized that these associations would be moderated by inhibitory control such that weaker associations between irritability and connectivity would be detected in youths with better than with worse inhibitory control. Regression models were used to test whether associations between irritability and between-network connectivity were moderated by inhibitory control.

Results

Counter to our hypothesis, we detected higher irritability associated with reduced connectivity between threat- and reward-processing and cognitive control networks only in 5- to 9-year-old boys. Inhibitory control did not moderate associations of irritability with between-network connectivity.

Conclusions

Exploratory findings indicate that reduced between-network connectivity may underlie difficulty regulating negative emotions, leading to greater irritability.

Neural mechanisms of reward processing in preadolescent irritability: Insights from the ABCD study

Elevated youth irritability is characterized by increased proneness to frustration relative to peers when rewards are blocked, and is a transdiagnostic symptom that predicts multiple forms of psychopathology and poorer socioeconomic outcomes in adulthood. Although mechanistic models propose that irritability is the result of aberrant reward-related brain function, youth irritability as it relates to multiple components of reward processes, including reward anticipation, gain, and loss, has yet to be examined in large, population-based samples. Data from the Adolescent Brain and Cognitive Development (ABCD) baseline sample (N = 5923) was used to examine associations between youth irritability (measured by parent-report) and reward-related brain activation and connectivity in a large, preadolescent sample. Preadolescents (M age = 9.96 years, SD = 0.63) performed the Monetary Incentive Delay task during functional MRI acquisition. In the task, during the anticipation period, participants were informed of the upcoming trial type (win money, lose money, no money at stake) and waited to hit a target; during the feedback period, participants were informed of their success. Whole brain and region of interest (ROI) analyses evaluated task conditions in relation to irritability level. Preadolescents with higher compared to lower levels of irritability demonstrated blunted prefrontal cortex activation in the anticipation period and exaggerated striatum-prefrontal connectivity differences among reward conditions during the feedback period. These effects persisted after adjusting for co-occurring anxiety, depression, and attention-deficit/hyperactivity disorder symptoms. These findings provide evidence for the role of reward salience in pathophysiological models of youth irritability, suggesting a mechanism that may contribute to exaggerated behavioral responses.

Irritability in stroke: a protocol for a prospective study

Background

Poststroke irritability (PSI) is common among stroke survivors and can lead to a poor quality of life, difficulties in social interactions, criticism from caregivers, and caregiver stress. The planned study will evaluate the clinical, neuropsychological, and magnetic resonance imaging (MRI) correlates of PSI in a cohort of stroke survivors. In addition, the study will examine the 15-month progression of PSI.

Methods

This will be a prospective cohort study that will recruit 285 participants. Participants and their caregivers will undergo detailed assessments at a research clinic at 3, 9, and 15 months after stroke onset (T1/T2/T3). The irritability/lability subscale of the Chinese version of the Neuropsychiatric Inventory (CNPI) will be completed by caregivers. Potential covariates will also be measured. Patients will undergo MRI, including diffusion-weighted imaging, within 1 week of stroke onset. A stepwise logistic regression will be performed to evaluate the importance of lesions in the regions of interest (ROIs) along with other significant variables identified in univariate analyses. These analyses will be repeated for patients with and without PSI at T2 and T3. Repeated measures analysis of covariance (ANCOVA) will be used to assess changes in CNPI scores for the entire sample. In ANCOVA analyses, the frequency of infarcts in the ROIs will be treated as the predictor.

Discussion

This will be the first MRI study on PSI in stroke survivors. The findings will provide insights into the association of the orbitofrontal cortex, anterior cingulate cortex, anterior temporal lobe, insula, amygdala, thalamus, and basal ganglia lesions with the risk of PSI.

Autonomic response and attachment style in disruptive mood dysregulation disorder

Background

Disruptive mood dysregulation disorder (DMDD) is characterised by severe emotion regulation difficulties, particularly anger and irritability, in children. Despite the impact of attachment on emotional and behavioural regulation, the link between attachment style and DMDD is under-researched.

Aim

This study investigated whether attachment style and parasympathetic regulation differentiate the response profiles to frustrating conditions between children diagnosed with DMDD and controls.

Setting

Participants were assessed at schools in Johannesburg, Gauteng, South Africa.

Methods

Thirty participants were divided into two matched groups (n DMDD = 15; n Control = 15) and assessed. Respiratory sinus arrhythmia (RSA) and heart period were measured during an Affective Posner Task, inducing frustration. Attachment style was assessed using the Attachment Style Classification Questionnaire for children. Parents of children with DMDD completed a social interaction problems questionnaire.

Results

The DMDD group showed a higher prevalence of avoidant attachment style (p = 0.013) compared to controls. Both groups displayed adaptive vagal withdrawal and recovery during the task (p = 0.005; p = 0.021). Controls had significantly higher heart period throughout the assessment (game 1: p = 0.006; game 2: p = 0.013; game 3: p = 0.007). In the DMDD group, lower vagal tone during frustration correlated with more social interaction problems (p = 0.049).

Conclusion

The study demonstrates a potential link between attachment style and altered physiological state in children with DMDD.

Contribution

The findings provide insight into possible atypical vagal regulation of the heart and avoidant attachment styles in DMDD, highlighting potential therapeutic and intervention targets.

Neural mechanisms of inhibitory control in preadolescent irritability: Insights from the ABCD study

OBJECTIVE

Elevated pediatric irritability is a transdiagnostic symptom that predicts multiple mental health problems in adolescence and adulthood. Altered top-down regulatory networks, such as inhibitory control networks that suppress an impulse in favor of goal-directed behavior, are thought to contribute to high levels of youth irritability. Nevertheless, little work has examined links between youth irritability and neural processes supporting inhibitory control in large diverse samples, nor have they focused on the key period ramping up to adolescence (i.e., preadolescence).

METHOD

Functional MRI data from 5380 preadolescents (age M=9.97 years, SD=0.62) in the baseline Adolescent Brain and Cognitive Development (ABCD) Study were analyzed. Parents reported on their preadolescent's irritability. The stop signal task (SST) was leveraged to probe successful and failed inhibitory control. Activation and functional connectivity with amygdala, ventral striatum, and prefrontal seed regions were calculated during the SST and used in whole brain and region of interest (ROI) group-level analyses evaluating irritability effects.

RESULTS

Preadolescents with higher levels of irritability displayed decreases in functional connectivity among amygdala, ventral striatum, and prefrontal cortex regions during both successful and failed inhibitory control conditions. These results remained after adjusting for co-occurring anxiety, depression, and attention-deficit/hyperactivity symptoms.

CONCLUSIONS

Findings suggest neural aberrations in inhibitory control play a role in the pathophysiology of preadolescent irritability and associations are not merely due to co-occurring symptoms. Neural mechanisms of inhibitory control associated with irritability may provide novel intervention targets.

A network approach to the investigation of childhood irritability: probing frustration using social stimuli

BACKGROUND

Self-regulation in early childhood develops within a social context. Variations in such development can be attributed to inter-individual behavioral differences, which can be captured both as facets of temperament and across a normal:abnormal dimensional spectrum. With increasing emphasis on irritability as a robust early-life transdiagnostic indicator of broad psychopathological risk, linkage to neural mechanisms is imperative. Currently, there is inconsistency in the identification of neural circuits that underlie irritability in children, especially in social contexts. This study aimed to address this gap by utilizing a functional magnetic resonance imaging (fMRI) paradigm to investigate pediatric anger/frustration using social stimuli.

METHODS

Seventy-three children (M = 6 years, SD = 0.565) were recruited from a larger longitudinal study on irritability development. Caregivers completed questionnaires assessing irritable temperament and clinical symptoms of irritability. Children participated in a frustration task during fMRI scanning that was designed to induce frustration through loss of a desired prize to an animated character. Data were analyzed using both general linear modeling (GLM) and independent components analysis (ICA) and examined from the temperament and clinical perspectives.

RESULTS

ICA results uncovered an overarching network structure above and beyond what was revealed by traditional GLM analyses. Results showed that greater temperamental irritability was associated with significantly diminished spatial extent of activation and low-frequency power in a network comprised of the posterior superior temporal sulcus (pSTS) and the precuneus (p < .05, FDR-corrected). However, greater severity along the spectrum of clinical expression of irritability was associated with significantly increased extent and intensity of spatial activation as well as low- and high-frequency neural signal power in the right caudate (p < .05, FDR-corrected).

CONCLUSIONS

Our findings point to specific neural circuitry underlying pediatric irritability in the context of frustration using social stimuli. Results suggest that a deliberate focus on the construction of network-based neurodevelopmental profiles and social interaction along the normal:abnormal irritability spectrum is warranted to further identify comprehensive transdiagnostic substrates of the irritability.

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

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

Frustration Response and Regulation Among Irritable Children: Contributions of Chronic Irritability, Internalizing, and Externalizing Symptoms

OBJECTIVE

The need to understand and treat childhood chronic irritability (CI; i.e. frequent temper loss and angry/irritable mood) is imperative. CI predicts impairment across development and complex comorbidities with both internalizing and externalizing disorders. Research has emphasized frustration reactivity as a key mechanism of CI. However, there are understudied components of frustrative non-reward, particularly regulation-oriented frustration recovery, frustration tolerance, and cognitive control, that may further explain impairments specific to CI beyond comorbid symptoms.

METHOD

Sixty-three community children (N = 25 CI/38 non-CI) and a parent completed surveys and the computerized Frustration Go/No-Go (FGNG) and Mirror Tracing Persistence Task (MTPT). Analyses compared task performance and self-rated affect across youth with or without CI, with further comparison based on negative/positive screen for ADHD (N = 45-/18+).

RESULTS

In mixed effects models assessing change across task, the CI group did not demonstrate more intense frustration on the MTPT or rigged FGNG block but exhibited persisting frustration and inhibitory control difficulties into the FGNG recovery period; the CI+ADHD subgroup drove recovery effects. In GEE and logistic regression models including dimensional symptom clusters, only internalizing symptoms predicted child frustration intolerance and reactivity across tasks. ADHD severity was also associated with higher MTPT frustration reactivity, while oppositional behavior predicted lower frustration. Better frustration recovery was associated with lower irritability, but higher internalizing symptoms.

CONCLUSIONS

Co-occurring symptoms may better explain some frustration-related difficulties among youth with CI. Difficulties with postfrustration affect and inhibitory control recovery suggest the importance of characterizing CI by self-regulation impairments.

Novel Assessment of the Impact of Irritability on Physiological and Psychological Frustration Responses in Adolescents

OBJECTIVE

Irritability, typically defined as a proneness to anger, particularly in response to frustration, falls at the intersection of emotion and disruptive behavior. Despite well-defined translational models, there are few convergent findings regarding the pathophysiology of irritability. Most studies utilize computer-based tasks to examine neural responses to frustration, with little work examining stress-related responding to frustration in social contexts. The present study is the first to utilize the novel Frustration Social Stressor for Adolescents (FSS-A) to examine associations between adolescent irritability and psychological and physiological responses to frustration.

METHOD

The FSS-A was completed by a predominantly male, racially, ethnically, and socioeconomically diverse sample of 64 12- to 17-year-olds, who were originally recruited as children with varying levels of irritability. Current irritability was assessed using the Multidimensional Assessment Profiles-Temper Loss scale (MAP-TL-Youth). Adolescents rated state anger and anxiety before and after the FSS-A, and usable salivary cortisol data were collected from 43 participants.

RESULTS

Higher MAP-TL-Youth scores were associated with greater increases in anger during the FSS-A, but not increases in anxiety, or alterations in cortisol. Pre-task state anger negatively predicted the slope of the rise in cortisol observed in anticipation of the FSS-A.

CONCLUSIONS

Results provide support for unique associations between adolescent irritability and anger during, and in anticipation of, frustrating social interactions. Such findings lay a foundation for future work aimed at informing physiological models and intervention targets.

A New Behavioral Paradigm for Frustrative Nonreward in Juvenile Mice

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.

Stage 2 Registered Report: The Bidirectional Relationship Between Brain Features and the Dysregulation Profile: A Longitudinal, Multimodal Approach

OBJECTIVE

Youth with symptoms of emotion dysregulation are at risk for a multitude of psychiatric diagnoses later in life. However, few studies have focused on the underlying neurobiology of emotion dysregulation. This study assessed the bidirectional relationship between emotion dysregulation symptoms and brain morphology throughout childhood and adolescence.

METHOD

A combined total of 8,235 children and adolescents drawn from 2 large population-based cohorts, the Generation R Study and Adolescent Brain Cognitive Development (ABCD) Study, were included. Data were acquired in 3 waves in Generation R (mean [SD] age = 7.8 [1.0] wave 1 [W1]; 10.1 [0.6] W2; 13.9 [0.5] W3) and in 2 waves in ABCD (mean [SD] age = 9.9 [0.6] W1; 11.9 [0.6] W2). Cross-lagged panel models were used to determine the bidirectional relationships between emotion dysregulation symptoms and brain morphology. The study was preregistered before performing analyses.

RESULTS

In the Generation R sample, emotion dysregulation symptoms at W1 preceded lower hippocampal (β = -.07, SE = 0.03, p = .017) and temporal pole (β = -.19, SE = 0.07, p = .006) volumes at W2. Emotion dysregulation symptoms at W2 preceded lower fractional anisotropy in the uncinate fasciculus (β = -.11, SE = 0.05, p = .017) and corticospinal tract (β = -.12, SE = 0.05, p = .012). In the ABCD sample, emotion dysregulation symptoms preceded posterior cingulate (β = .01, SE = 0.003, p = .014) and nucleus accumbens volumes (left hemisphere: β = -.02, SE = 0.01, p = .014; right hemisphere: β = -.02, SE = 0.01, p = .003).

CONCLUSION

In population-based samples, with relatively low psychopathology symptoms in the majority of children, symptoms of emotion dysregulation can precede differential development of brain morphology. This provides the foundation for future work to assess to what extent optimal brain development can be promoted through early intervention.

STUDY REGISTRATION INFORMATION

The Bidirectional Relationship Between Brain Features and the Dysregulation Profile: A Longitudinal, Multimodal Approach; https://doi.org/10.1016/j.jaac.2022.03.008.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

A cross-sectional analysis of the relationships between anxiety sensitivity and youth irritability: the mediated roles of insomnia and selective attention for threat

BACKGROUND

Irritability is common in multiple psychiatric disorders and is hallmark of disruptive mood dysregulation disorder. Child irritability is associated with higher risk of suicide and adulthood mental health problems. However, the psychological mechanisms of irritability are understudied. This study examined the relationship between anxiety sensitivity and irritability among youth, and further explored three possible mediated factors: selective attention for threat, delayed reward discounting, and insomnia.

METHODS

Participants were 1417 students (51.7% male; mean age 13.83 years, SD = 1.48) recruited from one high school in Hunan province, China. Self-report questionnaires were used to measure irritability (The Affective Reactivity Index and The Brief Irritability Test), anxiety sensitivity (The Childhood Anxiety Sensitivity Index), selective attention for threat (The Davos Assessment of Cognitive Biases Scale-attention for threat bias subscale), insomnia (The Youth Self-Rating Insomnia Scale), and delayed reward discounting (The 27-item Monetary Choice Questionnaire). Structural equation modal (SEM) was performed to examine mediated relations.

RESULTS

Anxiety sensitivity was modestly related to irritability and insomnia (r from 0.25 to 0.54) and slightly correlated with selective attention for threat (r from 0.12 to 0.28). However, there is no significant relationship of delayed rewards discounting with anxiety sensitivity and irritability. The results of SEM showed that selective attention for threat (indirect effect estimate = 0.04) and insomnia (indirect effect estimate = 0.20) partially mediate the relationship between anxiety sensitivity and irritability, which explained 34% variation.

CONCLUSIONS

Anxiety sensitivity is an important susceptibility factor for irritability. Selective attention for threat and insomnia are two mediated mechanisms to understand the relationship between anxiety sensitivity and irritability.

Attention-deficit hyperactivity disorder and youth's emotion dysregulation: A systematic review of fMRI studies

A number of adverse outcomes are associated with emotion dysregulation, and ADHD secondary to emotion dysregulation is a frequent comorbidity that may result in poorer performance and quality of life among youth. Recent neuroimaging research has observed significant functional differences in youth with ADHD compared to healthy controls. Therefore, the aims of this systematic review were to summarize the literature on functional connectivity of emotion dysregulation in youth with ADHD, identify methodological challenges and limitations, and provide directions for future research. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed to conduct a systematic review across three databases, and 13 studies were identified for inclusion. Across the studies, 14 primary regions were examined; 12 of the 13 studies identified a significant association between functional connectivity of emotion dysregulation and youth with ADHD. Although studies varied in the structures investigated, the most notable differences appeared in the prefrontal cortex, orbitofrontal cortex, amygdala, and ventral striatum in ADHD participants. Future research concerning this topic may help contribute to the understanding of this association by utilizing longitudinal research designs, controlling for psychiatric comorbidities and emotion dysregulation severity, inclusion of more diverse samples and ensuring that studies are adequately powered.

Future Directions in Youth Irritability Research

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.

Associations between childhood irritability and neural reactivity to maternal feedback in adolescence

Early irritability, a transdiagnostic vulnerability for psychopathology, is associated with alterations in neural reactivity to emotional stimuli and reward; however, associations between childhood irritability and neural markers of risk may be mitigated by the quality of caregiving youth receive. We examined longitudinal relationships between irritability in childhood and young adolescents' neural activity of regions typically associated with emotion regulation and reward processing during processing of maternal feedback and tested whether these associations were moderated by youth's perceptions of the parent-child relationship quality. Eighty-one adolescents (Mage = 11.1 years) listened to maternal critical and praising feedback while undergoing functional magnetic resonance imaging. Age 3 irritability, assessed observationally, was negatively associated with age 11 neural reactivity to maternal criticism in a cluster in the right dorsolateral prefrontal cortex (dlPFC), particularly for youths who reported more positive maternal parenting. Given the role of the dlPFC activation in the effortful processing of emotional stimuli, decreased activation may reflect disengagement from negatively valenced interpersonal feedback in the context of a positive caregiving environment, thereby mitigating psychopathology risk associated with irritability.

The effects of reward and frustration on the task performance of autistic children and adolescents

BACKGROUND

Autistic individuals often exhibit social communication and socio-emotional styles that may interfere with achieving social and academic outcomes. At a more specific level, they may perform differently in various social and academic tasks due to different modes of processing rewards or unpleasant experiences (e.g., frustrating events).

AIM

The present experiment examines how rewards and frustration affect the task performance of autistic children and adolescents METHODS AND PROCEDURES: An affective Posner task was applied to introduce rewards and induce frustration. Forty-four autistic children and adolescents and forty-four typically developing (TD) peers participated in this study OUTCOMES AND RESULTS: Results showed that presenting social and non-social rewards resulted in shorter reaction times and lower error rates in autistic participants, but not in their TD peers. While frustration increased error rates in both autistic and TD individuals, the effect was more pronounced in the autistic group.

CONCLUSIONS AND IMPLICATIONS

Social and non-social rewards help the performance of autistic children and adolescents, whereas frustration (induced through unpredictable feedback) significantly interferes with their task performance. Therefore, receiving two types of rewards and providing predictable feedback may help to improve interventions designed to optimize task performance for autistic children and adolescents.

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

BACKGROUND

Irritability presents transdiagnostically, commonly occurring with anxiety and other mood symptoms. However, little is known about the temporal and dynamic interplay among irritability-related clinical phenomena. Using a novel network analytic approach with smartphone-based ecological momentary assessment (EMA), we examined how irritability and other anxiety and mood symptoms were connected.

METHODS

Sample included 152 youth ages 8-18 years (M ± SD = 12.28 ± 2.53; 69.74% male; 65.79% White) across several diagnostic groups enriched for irritability including disruptive mood dysregulation disorder (n = 34), oppositional defiant disorder (n = 9), attention-deficit/hyperactivity disorder (n = 47), anxiety disorder (n = 29), and healthy comparisons (n = 33). Participants completed EMA on irritability-related constructs and other mood and anxiety symptoms three times a day for 7 days. EMA probed symptoms on two timescales: "since the last prompt" (between-prompt) versus "at the time of the prompt" (momentary). Irritability was also assessed using parent-, child- and clinician-reports (Affective Reactivity Index; ARI), following EMA. Multilevel vector autoregressive (mlVAR) models estimated a temporal, a contemporaneous within-subject and a between-subject network of symptoms, separately for between-prompt and momentary symptoms.

RESULTS

For between-prompt symptoms, frustration emerged as the most central node in both within- and between-subject networks and predicted more mood changes at the next timepoint in the temporal network. For momentary symptoms, sadness and anger emerged as the most central node in the within- and between-subject network, respectively. While anger was positively related to sadness within individuals and measurement occasions, anger was more broadly positively related to sadness, mood lability, and worry between/across individuals. Finally, mean levels, not variability, of EMA-indexed irritability were strongly related to ARI scores.

CONCLUSIONS

This study advances current understanding of symptom-level and temporal dynamics of irritability. Results suggest frustration as a potential clinically relevant treatment target. Future experimental work and clinical trials that systematically manipulate irritability-related features (e.g. frustration, unfairness) will elucidate the causal relations among clinical variables.

The longitudinal contributions of child language, negative emotionality, and maternal positive affect on toddler executive functioning development

Executive functions (EF) develop rapidly across early childhood and play a prominent role in promoting adaptive outcomes later in development. Although the existing literature suggests that the development of early EF is sensitive to the influence of intrinsic and extrinsic factors, limited research has examined the joint contributions of multiple child and contextual factors in infancy/toddlerhood. The purpose of our longitudinal study was therefore to identify early environmental, behavioral, biologically-based factors that influence children's EF outcomes in late toddlerhood. Participants included 409 mother-child dyads (209 girls) and the data was collected across children's first three postnatal years. Parent-report measures were used to assess infant negative affectivity (5-months; IBQ-R) and toddler language (age 2; MCDI), and both maternal positive affect (5-months) and toddler frustration (age 2) were coded during mother-child interaction tasks. A battery of behavioral tasks was used to measure child EF in late toddlerhood (age 3). After controlling for maternal education (a proxy for children's socio-economic environment), path analysis indicated that both infant and maternal affect at 5-months directly predicted toddlers' language skills and frustration expression at age 2. Toddler language (but not frustration) also predicted child performance on multiple EF tasks at age 3. Finally, 5-month infant and maternal affect indirectly predicted age 3 EF via age 2 language. Our results identify language as a mechanism through which children's early caregiving environment influences their EF development. Taken together, these findings illustrate the importance of applying a biopsychosocial perspective to the examination of early childhood EF development.

Keeping up with the kids: the value of co-production in the study of irritability in youth depression and its underlying neural circuitry

Irritability is a core symptom of adolescent depression, characterized by an increased proneness to anger or frustration. Irritability in youth is associated with future mental health problems and impaired social functioning, suggesting that it may be an early indicator of emotion regulation difficulties. Adolescence is a period during which behavior is significantly impacted by one's environment. However, existing research on the neural basis of irritability typically use experimental paradigms that overlook the social context in which irritability occurs. Here, we bring together current findings on irritability in adolescent depression and the associated neurobiology and highlight directions for future research. Specifically, we emphasize the importance of co-produced research with young people as a means to improve the construct and ecological validity of research within the field. Ensuring that our research design and methodology accurately reflect to lives of young people today lays a strong foundation upon which to better understand adolescent depression and identify tractable targets for intervention.

A New Behavioral Paradigm for Frustrative Non-reward Reveals a Global Change in Brain Networks by Frustration

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.

Persistent Frustration-Induced Reconfigurations of Brain Networks Predict Individual Differences in Irritability

OBJECTIVE

Aberrant responses to frustration are central mechanisms of pediatric irritability, which is a common reason for psychiatric consultation and a risk factor for affective disorders and suicidality. This pilot study aimed to characterize brain network configuration during and after frustration and test whether characteristics of networks formed during or after frustration relate to irritability.

METHOD

During functional magnetic resonance imaging, a transdiagnostic sample enriched for irritability (N = 66, mean age = 14.0 years, 50% female participants) completed a frustration-induction task flanked by pretask and posttask resting-state scans. We first tested whether and how the organization of brain regions (ie, nodes) into networks (ie, modules) changes during and after frustration. Then, using a train/test/held-out procedure, we aimed to predict past-week irritability from global efficiency (Eglob) (ie, capacity for parallel information processing) of these modules.

RESULTS

Two modules present in the baseline pretask resting-state scan (one encompassing anterior default mode and temporolimbic regions and one consisting of frontoparietal regions) contributed most to brain circuit reorganization during and after frustration. Only Eglob of modules in the posttask resting-state scans (ie, after frustration) predicted irritability symptoms. Self-reported irritability was predicted by Eglob of a frontotemporal-limbic module. Parent-reported irritability was predicted by Eglob of ventral-prefrontal-subcortical and somatomotor-parietal modules.

CONCLUSION

These pilot results suggest the importance of the postfrustration recovery period in the pathophysiology of irritability. Eglob in 3 specific posttask modules, involved in emotion processing, reward processing, or motor function, predicted irritability. These findings, if replicated, could represent specific intervention targets for irritability.

Irritability Moderates the Association between Cognitive Flexibility Task Performance and Related Prefrontal Cortex Activation in Young Children

The association between cognitive flexibility and related neural functioning has been inconsistent. This is particularly true in young children, where previous studies have found heterogenous results linking behavior and neural function, raising the possibility of unexplored moderators. The current study explored the moderating role of dimensional irritability in the association between cognitive flexibility task performance and prefrontal activation in young children. A total of 106 3- to 7-year-old children were recruited to complete a custom-designed, child-adapted, cognitive flexibility task, and 98 of them were included in the data analysis. The children's dorsolateral prefrontal cortex activation was monitored using functional near-infrared spectroscopy, and their levels of irritability were reported by parents using the MAP-DB Temper Loss subscale. Results indicated that the mean reaction time of the cognitive flexibility task was negatively correlated with concurrent prefrontal activation. No evidence was found for the association between task accuracy and prefrontal activation. Moreover, irritability moderated the association between the mean reaction time and prefrontal activation. Children high in irritability exhibited a stronger negative association between the mean reaction time and related prefrontal activation than children low in irritability. The moderating model suggested a novel affective-cognitive interaction to investigate the associations between cognitive task performance and their neural underpinnings.

Irritability in early to middle childhood: Cross-sectional and longitudinal associations with resting state amygdala and ventral striatum connectivity

BACKGROUND

Irritability is a common symptom that may affect children's brain development. This study aims to (1) characterize age-dependent and age-independent neural correlates of irritability in a sample of 4-8 year old children, and (2) examine early irritability as a predictor of change in brain connectivity over time.

METHODS

Typically developing children, ages 4-8 years, with varying levels of irritability were included. Resting state fMRI and parent-rated irritability (via Child Behavior Checklist; CBCL) were collected at up to three time points, resulting in a cross-sectional sample at baseline (N = 176, M = 6.27, SD = 1.49), and two subsamples consisting of children who were either 4 or 6 years old at baseline that were followed longitudinally for two additional timepoints, one- and two-years post-baseline. That is, a "younger" cohort (age 4 at baseline, n = 34, M age = 4.44, SD = 0.25) and an "older" cohort (age 6 at baseline, n = 29, M age = 6.50, SD = 0.30). Across our exploratory analyses, we examined how irritability related to seed-based intrinsic connectivity via whole-brain connectivity ANCOVAs using the left and right amygdala, and left and right ventral striatum as seed regions.

RESULTS

Cross-sectionally, higher levels of irritability were associated with greater amygdala connectivity with the posterior cingulate, controlling for child age. No age-dependent effects were observed in the cross-sectional analyses. Longitudinal analyses in the younger cohort revealed that early higher vs. lower levels of irritability, controlling for later irritability, were associated with decreases in amygdala and ventral striatum connectivity with multiple frontal and parietal regions over time. There were no significant findings in the older cohort.

CONCLUSIONS

Findings suggest that irritability is related to altered neural connectivity during rest regardless of age in early to middle childhood and that early childhood irritability may be linked to altered changes in neural connectivity over time. Understanding how childhood irritability interacts with neural processes can inform pathophysiological models of pediatric irritability and the development of targeted mechanistic interventions.

Dysfunction in differential reward-punishment responsiveness in conduct disorder relates to severity of callous-unemotional traits but not irritability

BACKGROUND

Conduct disorder (CD) has been associated with dysfunction in reinforcement-based decision-making. Two forms of affective traits that reflect the components of CD severity are callous-unemotional (CU; reduced guilt/empathy) traits and irritability. The form of the reinforcement-based decision-making dysfunction with respect to CD and CU traits remains debated and has not been examined with respect to irritability in cases with CD. The goals of the current study were to determine the extent of dysfunction in differential (reward v. punishment) responsiveness in CD, and CU traits and irritability in participants with CD.

METHODS

The study involved 178 adolescents [typically developing (TD; N = 77) and cases with CD (N = 101)]. Participants were scanned with fMRI during a passive avoidance task that required participants to learn to respond to (i.e. approach) stimuli that engender reward and refrain from responding to (i.e. passively avoid) stimuli that engender punishment.

RESULTS

Adolescents with CD showed reduced differential reward-punishment responsiveness within the striatum relative to TD adolescents. CU traits, but not irritability, were associated with reduced differential reward-punishment responsiveness within the striatum, rostromedial, and lateral frontal cortices.

CONCLUSIONS

The results suggest CD is associated with reduced differential reward-punishment responsiveness and the extent of this dysfunction in participants with CD is associated with the severity of CU traits but not irritability.

How Obstructed Action Efficacy Impacts Reward-based Decision-making in Adolescent Depression: An fMRI Study

OBJECTIVE

Disruption of reward seeking behavior by unforeseen obstacles can promote negative affect, including frustration and irritability, in adolescents. Repeated experiences of obstructed reward may in fact contribute to the development of depression in adolescents. However, the neurocognitive mechanisms whereby goal disruption impacts reward processing in adolescent depression have not yet been characterized. The present study addresses this gap using neuroimaging and a novel paradigm to assess how incidental action obstruction impacts reward-based decision-making.

METHOD

We assessed 62 unmedicated adolescents with Major Depressive Disorder (MDD; mean age=15.6, SD=1.4, 67% female participants) and 68 matched healthy control participants (mean age=15.3, SD=1.4, 50% female participants) using functional magnetic resonance imaging (fMRI) while they played a card game in which they had to guess between two options to earn points, in low- and high-stake conditions. Functioning of button presses through which they made decisions was intermittently blocked, thereby blocking action efficacy.

RESULTS

Participants with MDD made fewer button press repetitions in response to action efficacy obstruction, which was more apparent in the low-stake condition (Rate Ratio =0.85, p=0.034). During response repetition across stake conditions, MDDs exhibited higher activation in regions in the ventromedial prefrontal cortex, caudate, and putamen (F_(1,125)= 16.4-25.6, df=1,125; ps<0.001; Hedges' g=0.85-0.98).

CONCLUSION

Adolescent with depression tend to exhibit less flexible behavioral orientation in the face of blocked action efficacy, and abnormalities in neural systems critical to regulating negative affect during reward-based decision-making. This research highlights possible mechanisms relevant to understanding and treating affective dysregulation in adolescent depression.

Editorial: Can Too Much Positive Emotion Be Bad for You?

There has been increasing focus on the assessment and treatment of irritability over the past decade in recognition of the impairment produced by abnormally persistent or excessive displays of negative emotions. However, emotional dysregulation may not be valence specific, and the impact of excessive or abnormally persistent displays of positive affect has received little attention. In their review in this issue of the Journal, Vogel et al.¹ argue that it should receive more attention. They do an admirable job synthesizing the developmental and clinical literature to support the potential value of assessing the capacity to regulate positive affect in an attempt to determine if too much of good thing can in fact be bad for you.

Review: Defining Positive Emotion Dysregulation: Integrating Temperamental and Clinical Perspectives

OBJECTIVE

Although emotion dysregulation has been defined as a maladaptive process of emotional experiences, there is no specific reference to the emotional valence of the dysregulation. To date, child psychiatry has focused primarily on dysregulation of negative affect. Here, we suggest that positive emotion dysregulation requires additional clinical and research attention.

METHOD

First, we present a developmental approach to the study of positive emotion regulation within a temperament framework. Second, we describe emerging research findings regarding dysregulation of positive emotion in early childhood. Third, we integrate neuroscientific approaches to positive emotion regulation and introduce a framework for future investigations and clinical applications.

RESULTS

Dysregulation in positive affect can be examined from temperamental, developmental, clinical, and neuroscientific perspectives. Both temperamental surgency, which includes positive affect, and the proposed clinical extension, excitability, are associated with increased risk of externalizing symptoms and clinical impairment in youth.

CONCLUSION

Studying the role of both temperamental surgency and clinically impairing positive affect, or excitability, in developmental psychopathology will help to elucidate the full spectrum of emotion dysregulation and to clarify the neural basis of dysregulation. A more comprehensive conceptualization of positively valanced emotion dysregulation will provide a more nuanced understanding of developmental risk and potential targets for intervention.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Systematic Review and Meta-analysis: Task-based fMRI Studies in Youths With Irritability

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.

The Impact of Irritability and Callous Unemotional Traits on Reward Positivity in Youth with ADHD and Conduct Problems

Children with attention-deficit/hyperactivity disorder (ADHD) and conduct problems exhibit significant variability in functioning and treatment response that cannot be fully accounted for by differences in symptom severity. Reward responsivity (RR) is a potential transdiagnostic means to account for this variability. Irritability and callous-unemotional (CU) traits moderate associations between both ADHD and conduct problems with multiple realms of functioning. Both are theorized to be associated with RR, but associations in clinical samples are unknown. In 48 youth ages 5-12 with ADHD referred for treatment of conduct problems, we examined RR using a guessing task where participants select a door icon to win and lose money. Analyses focused on the reward positivity (RewP) event-related potential in response to gain and loss feedback, which reliably peaks approximately 300 ms after feedback. Frequentist and Bayesian approaches assessed main effects of ADHD, Conduct Disorder (CD) and non-irritable Oppositional Defiant Disorder (ODD) symptoms with RR, plus interactions between symptoms and affective dimensions (irritability, CU). CD and ODD were hypothesized to be associated with altered RR, with irritability and CU moderating these associations. Across models, a reliable CD x irritability interaction emerged, indicating enhanced RewP when irritability was elevated and CD symptoms were low. CU did not moderate any associations with RR, and little support was found for associations between RR and other symptom domains. As neural response to reward varied with levels of irritability and CD symptoms, RR may hold potential as a clinically-relevant biomarker in youth with ADHD and conduct problems.

White matter integrity in adolescent irritability: A preliminary study

Irritability is a prevalent, impairing transdiagnostic symptom, especially during adolescence, yet little is known about irritability's neural mechanisms. A few studies examined the integrity of white matter tracts that facilitate neural communication in irritability, but only with extreme, disorder-related symptom presentations. In this preliminary study, we used a group connectometry approach to identify white matter tracts correlated with transdiagnostic irritability in a community/clinic-based sample of 35 adolescents (mean age = 14 years, SD = 2.0). We found positive and negative associations with irritability in local white matter tract bundles including sections of the longitudinal fasciculus; frontoparietal, parolfactory, and parahippocampal cingulum; corticostriatal and thalamocortical radiations; and vertical occipital fasciculus. Our findings support functional neuroimaging studies that implicate widespread neural pathways, particularly emotion and reward networks, in irritability. Our findings of positive and negative associations reveal a complex picture of what is "good" white matter connectivity. By characterizing irritability's neural underpinnings, targeted interventions may be developed.

Use of Consumer Neuroscience in the Choice of Aromatisation as Part of the Shopping Atmosphere and a Way to Increase Sales Volume

The point of purchase is considered to be one of the few communication channels that is not yet saturated, and it has a relatively large potential for the future. A pleasant smell is also part of the shopping atmosphere. How smell affects customer behaviour and purchasing decisions is addressed by a relatively young scientific field, one of the existing kinds of sensory marketing—aroma marketing, otherwise called aromachology. Smell has mainly a subconscious influence; therefore, its examination is appropriate to be carried out using consumer neuroscience tools. This paper examined the perception of the shopping atmosphere in Slovak grocery shops and comprehensive interdisciplinary research on the impact of selected aromatic compounds on the cognitive and affective processes of the consumer, as well as the evaluation of the effectiveness of their implementation in food retail establishments. At the end of the paper, we recommend the possibilities of effective selection and the implementation of aromatisation of different premises, by which the retailer can achieve not only a more positive perception of the shopping atmosphere, but also an increase in retail turnover in individual sales sections.

Executive functioning moderates neural mechanisms of irritability during reward processing in youth

Pediatric irritability is the most robust indicator of transdiagnostic psychopathology risk. It is associated with altered neural reward processing, including neural networks related to cognitive control, and better cognitive control has been hypothesized to mitigate irritability. We evaluated the relationship of executive functioning (EF) with irritability-related neural correlates of reward processing in youths with varying levels of irritability. Participants (N = 51, mean age=13.80 years, SD=1.94) completed a monetary incentive delay task during multiband fMRI acquisition. Irritability and EF were measured via the Affective Reactivity Index and the NIH Toolbox cognition battery, respectively. Whole-brain analyses, controlling for age, examined the moderating role of EF on irritability-related brain activation and connectivity (seeds: striatum, amygdala) during reward anticipation and performance feedback. Irritability-related neural patterns during reward processing depended on EF, in occipital areas during reward anticipation and limbic, frontal, and temporal networks during performance feedback. Higher irritability combined with higher EF was associated with neural patterns opposite to those observed for higher irritability with lower co-occurring EF. Although preliminary, findings suggest that EF may buffer irritability-related reward processing deficits. Additionally, individual differences in EF and their relation to irritability may be related to varied etiologic mechanisms of irritability with important implications for personalized prevention and intervention.

The effect of obstructed action efficacy on reward-based decision-making in healthy adolescents: a novel functional MRI task to assay frustration

Frustration is common in adolescence and often interferes with executive functioning, particularly reward-based decision-making, and yet very little is known about how incidental frustrating events (independent of task-based feedback) disrupt the neural circuitry of reward processing in this important age group. While undergoing functional magnetic resonance imaging (fMRI), 45 healthy adolescents played a card game in which they had to guess between two options to earn points, in low- and high-stake conditions. Functioning of button presses through which they made decisions was intermittently blocked, thereby increasing frustration potential. Neural deactivation of the precuneus, a Default Mode Network region, was observed during obstructed action blocks across stake conditions, but less so on high- relative to low-stake trials. Moreover, less deactivation in goal-directed reward processing regions (i.e., caudate), frontoparietal "task control" regions, and interoceptive processing regions (i.e., somatosensory cortex, thalamus) were observed on high-stake relative to low-stake trials. These findings are consistent with less disruption of goal-directed reward seeking during blocked action efficacy in high-stake conditions among healthy adolescents. These results provide a roadmap of neural systems critical to the processing of frustrating events during reward-based decision-making in youths and could help to characterize how frustration regulation is altered in a range of pediatric psychopathologies.

Frustration, Cognition, and Psychophysiology in Dysregulated Children: A Research Domain Criteria Approach

OBJECTIVE

Dysregulated children experience significant impairment in regulating their affect, behavior, and cognitions and are at risk for numerous adverse sequelae. The unclear phenomenology of their symptoms presents a barrier to evidence-based diagnosis and treatment.

METHOD

The cognitive, behavioral, and psychophysiological mechanisms of dysregulation were examined in a mixed clinical and community sample of 294 children ages 7-17 using the Research Domain Criteria constructs of cognitive control and frustrative nonreward.

RESULTS

Results showed that caregivers of dysregulated children viewed them as having many more problems with everyday executive function than children with moderate or low levels of psychiatric symptoms; however, during standardized assessments of more complex cognitive control tasks, performance of dysregulated children differed only from children with low symptoms on tests of cognitive flexibility. In addition, when frustrated, dysregulated children performed more poorly on the Go/No-Go Task and demonstrated less autonomic flexibility as indexed by low respiratory sinus arrhythmia and pre-ejection period scores.

CONCLUSION

The findings of this study suggest that autonomic inflexibility and impaired cognitive function in the context of frustration may be mechanisms underlying childhood dysregulation.

Neural correlates of attachment in adolescents with trauma: a preliminary study on frustrative non-reward

Despite the proposed early life origins of attachment style and its implications for risk for psychopathology, little is known about its neurodevelopmental course. Adolescence represents a key transition period when neural substrates of emotion regulation and reward undergo dramatic maturational shifts. Thus, maladaptive coping strategies associated with insecure attachment styles may have an exaggerated effect during adolescence. The current study, therefore, examined the neural correlates of insecure attachment in a diverse sample of adolescents using a frustrative non-reward task (i.e. repeatedly being denied an expected reward). Although there were no significant interactions in the whole-brain activation averaged over the course of the task, the use of complementary analytic approaches (connectivity, change in activation over the course of the task) revealed widespread alterations associated with avoidant attachment during the immediate reaction to, and ensuing recovery from, being denied a reward. Most strikingly, increased avoidant attachment, adjusting for anxious attachment, predicted functional connectivity and change in activity over time in amygdala-prefrontal and frontostriatal networks to reward blocked vs received trials. These patterns were in the opposite direction compared to those exhibited by adolescents lower in avoidant attachment. The findings suggest that negative emotional experiences, such as receiving frustrating feedback, may be uniquely aversive internal experiences for avoidantly attached adolescents and provide preliminary evidence that early coping strategies may persist into adolescence in the form of altered emotion- and reward-related neural patterns.

Beach balls: Assessing frustration tolerance in young children using a computerized task

Frustration tolerance is a skill related to emotional regulation processes and is important insofar as it affects people's social relationships and even health. Low levels of frustration tolerance in children have been associated with a greater number of externalizing symptoms such as aggression or anger. Despite its importance, there are a limited number of tasks that attempt to evaluate this construct objectively. Therefore, the aim of our work was the design of a computerized task, programmed as a videogame in order to assess frustration tolerance in children from 6 to 10 years old. The results obtained showed that the test had a good internal consistency and could be useful as an objective measure of frustration tolerance in children. In line with the literature, our data have shown no influence of gender or laterality of participants during the task and only 7% of the frustration measure could be explained by the influence of participants' age. On the other hand, the performance of the participants during the task has allowed us to classify them into six groups according to their performance, namely Low/High Frustration, Low/High Performance and Low/High Reaction Time. This test would permit to compare participants' performance with their reference group but also with their own results, facilitating the obtention of an objective assessment of frustration tolerance in young children.

Annual Research Review: The contributions of the RDoC research framework on understanding the neurodevelopmental origins, progression and treatment of mental illnesses

The National Institute of Mental Health (NIMH) proposed the Research Domain Criteria (RDoC) initiative as an alternate way to organize research of mental illnesses, by looking at dimensions of functioning rather than being tied to categorical diagnoses. This paper briefly discusses the motivation for and organization of RDoC, and then explores the NIMH portfolio and recent work to monitor the utility and progress that RDoC has afforded developmental research. To examine how RDoC has influenced the NIMH developmental research portfolio over the last decade, we employed a natural language processing algorithm to identify the number of developmental science grants classified as incorporating an RDoC approach. Additional portfolio analyses examine temporal trends in funded RDoC-relevant grants, publications and citations, and research training opportunities. Reflecting on how RDoC has influenced the focus of grant applications, we highlight examples from research on Attention-Deficit Hyperactivity Disorder (ADHD), childhood irritability, and Autism Spectrum Disorder (ASD). Lastly, we consider how the dimensional and transdiagnostic approaches emphasized in RDoC have facilitated research on personalized intervention for heterogeneous disorders and preventive/early interventions targeting emergent or subthreshold psychopathology.

Diagnosis of disruptive mood dysregulation disorder in offsprings of bipolar parents

Background

Disruptive mood dysregulation disorder (DMDD) was introduced in (DSM-5) as a new diagnostic category to get control on the exaggerated diagnosis of bipolar disorder in children and adolescents which was elevated more than 40 times in the last decade. Few studies were done recently to explore the role of family history of bipolar disorder in the occurrence of DMDD in children and adolescents. Unfortunately, there is limited number of studies about the familial transmission of DMDD.

The aim of this study is to examine the presence of a relation between DMDD and the presence of a family history of bipolar disorder through comparing the diagnosis of DMDD in offspring of parents with (a) bipolar disorder and (b) a control group.

Results

The distribution of psychiatric disorders among the studied groups highlighted that DMDD and depressive disorder are significantly present in the offsprings of bipolar parents more than in the offsprings of control parents. DMDD is significantly present among offsprings of bipolar parents aged ≤ 11 years old (p = 0.008*). Also, DMDD is significantly (p = 0.02) present among male offsprings of bipolar parents. Also, depressive disorder is significantly (p = 0.002) present among female offsprings of control parents. While significant comorbidity between DMDD and depressive disorders (p = 0.018*) was detected.

Conclusions

This study revealed that DMDD and depressive disorders are significantly present in the offsprings of bipolar parents higher than in the offsprings of control parents. DMDD is significantly present among the offsprings of bipolar parents aged ≤ 11 years old.

The relation between sex and affective disorders among the offsprings was also assessed revealing that DMDD is significantly present among male offsprings of bipolar parents. Also, depressive disorders are significantly present among female offsprings of control parents.

Potential implications

This study has several clinical implications. This study draws attention to the importance of the careful assessment of the offsprings of bipolar patients to check the presence of different childhood psychiatric disorders such as DMDD. Also, symptoms of temper outbursts and persistent irritability in childhood require the necessary of psychiatric evaluation not only for the patients but also for their families. In addition, this study highlights the need for accurate updated diagnostic instruments to differentiate between these overlapping symptoms.

As regards implications for future research, following-up of children diagnosed with DMDD to recognize the prognostic outcome of this new diagnostic category is necessary.

Underlying mechanisms of disruptive mood dysregulation disorder in children: A systematic review by means of research domain criteria

Background

A systematic overview of underlying mechanisms in the new disruptive mood dysregulation disorder (DMDD) diagnosis is needed. The Research Domain Criteria (RDoC) represent a system of six domains of human functioning, which aims to structure the understanding of the nature of mental illnesses. By means of the RDoC framework, the objective of this systematic review is to synthesize available data on children and youths <18 years suffering from DMDD as reported in peer reviewed papers.

Methods

A literature search guided by PRISMA was conducted using Medline, PsychInfo, and Embase, while the RDoC domains were employed to systematize research findings. Risk of bias in the included studies was examined.

Results

We identified 319 studies. After study selection, we included 29 studies. Twenty-one of these had findings relating to >1 RDoC domain. The risk of bias assessment shows limitations in the research foundation of current knowledge on mechanisms of DMDD.

Discussion

Reviewing self-report, behavior and neurocircuit findings by means of RDoC domains, we suggest that DMDD youths have a negative interpretation bias in social processes and valence systems. In occurrence of a negative stimuli interpretation, aberrant cognitive processing may arise. However, current knowledge of DMDD is influenced by lack of sample diversity and open science practices.

Conclusion

We found the six RDoC domains useful in structuring current evidence of the underlying mechanisms of DMDD. Important opportunities for future studies in this field of research are suggested. In clinical practice, this comprehensive summary on DMDD mechanisms can be used in psychoeducation and treatment plans.

The effects of reward and frustration in patients with bipolar disorder: Evidence from a computerized task with non-contingent feedback

BACKGROUND

Bipolar disorder (BD) is characterized by mood changes that implies alterations in reward sensitivity and frustration tolerance. This study examined the effects of monetary reward and frustration on attentional performance and on affective experience across mood states in BD.

METHODS

An Affective Posner Task in which the nature of contingencies are divided in the three successive blocks (baseline condition, monetary reward and non-contingent feedback) was applied to BD individuals in their different episodes: mania (n = 30), depression (n = 30), and euthymia (n =  30) as well as to a group of healthy controls (n = 30).

RESULTS

Monetary reward improved performance (in terms of faster response times) in the euthymic group and the control group, whereas it impaired performance in the manic group and has not significant effect in the depressed group. In addition, an increased interference of frustration on response accuracy was exhibited in the three groups of BD patients (including euthymia) compared with healthy controls.

LIMITATIONS

Participants' affective experience was self-informed by a Likert scale, so the reliability of this measure can be undermined in symptomatic patients in terms of stability and objectivity. Although it was statistically controlled, at the time of testing, all BD patients were medicated.

CONCLUSIONS

A dissociated effect of reward and frustration was found between symptomatic and euthymic states in BD: whereas the benefit from monetary reward is affected only during symptomatic episodes (i.e., a state), the notably increased interference of frustration is exhibited also during euthymia (i.e., a trait).

Quantitative EEG Changes in Youth With ASD Following Brief Mindfulness Meditation Exercise

Mindfulness has growing empirical support for improving emotion regulation in individuals with Autism Spectrum Disorder (ASD). Mindfulness is cultivated through meditation practices. Assessing the role of mindfulness in improving emotion regulation is challenging given the reliance on self-report tools. Electroencephalography (EEG) has successfully quantified neural responses to emotional arousal and meditation in other populations, making it ideal to objectively measure neural responses before and after mindfulness (MF) practice among individuals with ASD. We performed an EEG-based analysis during a resting state paradigm in 35 youth with ASD. Specifically, we developed a machine learning classifier and a feature and channel selection approach that separates resting states preceding (Pre-MF) and following (Post-MF) a mindfulness meditation exercise within participants. Across individuals, frontal and temporal channels were most informative. Total power in the beta band (16-30 Hz), Total power (4-30 Hz), relative power in alpha band (8-12 Hz) were the most informative EEG features. A classifier using a non-linear combination of selected EEG features from selected channel locations separated Pre-MF and Post-MF resting states with an average accuracy, sensitivity, and specificity of 80.76%, 78.24%, and 82.14% respectively. Finally, we validated that separation between Pre-MF and Post-MF is due to the MF prime rather than linear-temporal drift. This work underscores machine learning as a critical tool for separating distinct resting states within youth with ASD and will enable better classification of underlying neural responses following brief MF meditation.

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

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

Cardiovascular reactivity as a measure of irritability in a transdiagnostic sample of youth: Preliminary associations

OBJECTIVES

Irritability is a transdiagnostic symptom in developmental psychopathology, conceptualized as a low threshold for frustration and increased proneness to anger. While central to emotion regulation, there is a vital need for empirical studies to explore the relationship between irritability and underlying physiological mechanisms of cardiovascular arousal.

METHODS

We examined the relationship between irritability and cardiovascular arousal (i.e., heart rate [HR] and heart rate variability [HRV]) in a transdiagnostic sample of 51 youth (M = 12.63 years, SD = 2.25; 62.7% male). Data was collected using the Empatica E4 during a laboratory stop-signal task. In addition, the impact of motion activity, age, medication, and sleep on cardiovascular responses was explored.

RESULTS

Main findings showed that irritability was associated with increased HR and decreased HRV during task performance.

CONCLUSIONS

Findings support the role of peripheral physiological dysregulation in youth with emotion regulation problems and suggest the potential use of available wearable consumer electronics as an objective measure of irritability and physiological arousal in a transdiagnostic sample of youth.

The centrality of temperament to the research domain criteria (RDoC): The earliest building blocks of psychopathology

The research domain criteria (RDoC) is an innovative approach designed to explore dimensions of human behavior. The aim of this approach is to move beyond the limits of psychiatric categories in the hope of aligning the identification of psychological health and dysfunction with clinical neuroscience. Despite its contributions to adult psychopathology research, RDoC undervalues ontogenetic development, which circumscribes our understanding of the etiologies, trajectories, and maintaining mechanisms of psychopathology risk. In this paper, we argue that integrating temperament research into the RDoC framework will advance our understanding of the mechanistic origins of psychopathology beginning in infancy. In illustrating this approach, we propose the incorporation of core principles of temperament theories into a new "life span considerations" subsection as one option for infusing development into the RDoC matrix. In doing so, researchers and clinicians may ultimately have the tools necessary to support emotional development and reduce a young child's likelihood of psychological dysfunction beginning in the first years of life.