7.9 OUTBURSTS IN THE AFTERTIME: WHERE DO WE GO FROM HERE?

Abstract

Outbursts and chronic irritability are indicators of emotional dysregulation across multiple mental health diagnoses, and they have the potential to disrupt or delay achievement of typical developmental milestones and result in lifelong functional impairment. Evidence-based preventive interventions are limited, and more research is needed to determine whether irritability and outbursts are disorder-specific or share common neurobiological underpinnings. We will summarize the primary, secondary, and tertiary relapse prevention strategies, with an emphasis on strategies that build resilience in youth that mitigate the onset, recurrence, and progression of outbursts in children and adolescents. Preemptive interventions promote resilience through encouraging the regulation of emotion and teaching prosocial behaviors. Parent (targeting parental psychopathology and teaching parenting skills), child (eg, targeting emotion dysregulation, self-esteem, and self-compassion), and community-based approaches (eg, after-school programs for at-risk youth to promote socioemotional learning, gun control, and violence prevention programs) have empirical support. Secondary prevention studies that target family functioning have the potential to change the course of high-risk syndromes and can help clarify treatment targets and mechanisms. Tertiary prevention in youth with mental health disorders aims to reduce symptom severity and enhance psychosocial functioning. A research agenda focused on systematically measuring outbursts and their premorbid risk factors in order to develop more targeted primary, secondary, and tertiary preventions will be essential to promoting resilience and reducing risks of later psychopathology and functional impairment.