IRRITABILITY AND REACTIVE AGGRESSION: IMPLICATIONS FOR DIAGNOSIS, TREATMENT, AND EQUITY

Abstract

This session aims to facilitate discussion regarding irritability and its role in the diagnosis and treatment of childhood mental health disorders. The interpretation of irritability varies among child and adolescent psychiatrists and results in different diagnoses, treatments, and clinical outcomes. This session will describe the concept of irritability as a mood symptom, extrinsic factors that impact diagnostic patterns, considerations for improved diagnostic accuracy and equity, and treatment recommendations. Four presentations will discuss: 1) an overview of irritability as a mood symptom; 2) irritability in ADHD and autism spectrum disorder (ASD); 3) irritability diagnostic patterns in vulnerable and minority youth; and 4) treatment strategies for targeting mood and anxiety symptoms underlying irritability. Irritability is a core feature of externalizing and disruptive disorders, such as ODD and conduct disorder (CD); it is also highly associated with ADHD and adverse childhood experiences including traumatic stress, neglect, and abuse. Diagnostic patterns indicate that irritability is more often interpreted to be “disruptive” in Black and Brown youth, who receive fewer ADHD, DMDD, or affective/anxiety diagnoses than Non-Latinx White (NLW) youth with similar symptoms. Youth diagnosed with ODD are likely to have underlying anxiety or mood symptoms that are predictive of anxiety and depressive disorders in adolescence or adulthood and may therefore be better classified under one of these diagnoses. Similarly, youth with ASD experience irritability that may be best understood through their social communication deficits and impulsivity/anxiety symptoms, rather than through an ODD diagnosis. Treatment approaches that target underlying affective, anxiety, and neurodevelopmental disorders and instruct caregivers in appropriate management strategies may be most effective for these youth. 1) Irritability is a core feature of multiple child and adolescent mental illness diagnoses. 2) The resulting diagnosis is often driven by racial and socioeconomic factors. 3) Youth with co-occurring neurodevelopmental disorders are also at increased risk for misdiagnosis. 4) Targeting underlying mood and anxiety symptoms and bolstering caregiver skills are primary interventions.