Irritability In Adolescents Research Articles

Irritability through Research Domain Criteria: an opportunity for transdiagnostic conceptualisation.

Irritability is a transdiagnostic phenomenon that, despite its ubiquity and significant impact, is poorly conceptualised, defined and measured. As it lacks specificity, efforts to examine irritability in adults by using a diagnostic category perspective have been hamstrung. Therefore, using a Research Domain Criteria (RDoC) approach to examine irritability in adults, which spans many constructs and domains, may have a better chance of yielding underlying mechanisms that can then be mapped onto various diagnostic categories. Recently, a model has been proposed for irritability in children and adolescents that uses the RDoC framework; however, this model, which accounts for chronic, persistent irritability, may not necessarily transpose to adults. Therefore, use of the RDoC framework to examine irritability in adults is urgently needed, as it may shed light on this currently amorphous phenomenon and the many disorders within which it operates.

Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.

A Prospective Study of Rumination and Irritability in Youth

Although youth irritability is linked with substantial psychiatric morbidity and impairment, little is known about how personal characteristics influence its course. In this study we examined the prospective associations between angry and depressive rumination and irritability. A sample of 165 school pupils aged 12–14 years were assessed at two time points six months apart. They completed measures of irritability at Times 1 and 2 and depressive and angry rumination at Time 1. In line with our hypotheses, we found that angry rumination is significantly associated with irritability six months later, over and above baseline irritability and depressive rumination. The present findings suggest angry rumination is relevant to the genesis of irritability in adolescents, and point to possible routes for prevention and early intervention.

Neural Correlates of Adolescent Irritability and Its Comorbidity With Psychiatric Disorders

Irritable mood, a common and impairing symptom in psychopathology, has been proposed to underlie the developmental link between oppositional problems in youth and depression in adulthood. We examined the neural correlates of adolescent irritability in IMAGEN, a sample of 2,024 14-year-old adolescents from 5 European countries. The Development and Well-Being Assessment (DAWBA) was used to assess attention-deficit/hyperactivity disorder, major depressive disorder, oppositional defiant disorder, and generalized anxiety disorder. Three items from the DAWBA, selected as close matches to the Affective Reactivity Index, were used to assess irritability. Structural magnetic resonance imaging was examined using whole-brain voxel-based morphometry analysis, and functional magnetic resonance imaging was examined during a stop signal task of inhibitory control. Imaging data were included in structural equation models to examine the direct and indirect associations between irritable mood and comorbid DSM diagnoses. Whole-brain voxelwise analysis showed that adolescent irritable mood was associated with less gray matter volume and less neural activation underlying inhibitory control in frontal and temporal cortical areas (cluster-correction at p< .05). Structural equation models suggested that part of the observed smaller gray matter volume was exclusively driven by irritability separate from direct relationships between generalized anxiety disorder (or attention-deficit/hyperactivity disorder, major depressive disorder, or oppositional defiant disorder) and gray matter volume. This study identifies adolescent irritability as an independent construct and points to a neurobiological correlate to irritability that is an important contributing feature to many psychopathological disorders.

Irritability and its relationships with psychological symptoms in adolescents with migraine: a case-control study.

The aim of this study was to investigate self- and parent-reported irritability in adolescents with migraine and to evaluate the relationship between self- and parent-reported irritability and psychological symptoms in adolescents with migraine. The sample of this single-center cross-sectional case-control study consisted of 71 adolescents with migraine (who were followed in a pediatric neurology clinic) and their parents. The control group consisted of 41 age- and sex-matched healthy adolescents and their parents. It was observed that there were significant differences in both self- (p<0.001) and parent-reported (p<0.001) irritability scores between the migraine and control groups. When the two groups were compared in terms of psychological symptoms, adolescents with migraine had significantly higher levels of anxiety (p<0.001) and emotional problems (p<0.001) than their healthy peers. This significant difference persisted even after controlling for confounding factors such as age, gender, family income, and maternal and paternal educational level. Our results revealed a moderate positive correlation between irritability scores and anxiety scores (r= 0.522, p<0.001) and between irritability scores and emotional/behavioral problem scores (r= 0.487, p<0.001) in the migraine group. In addition to these results, the odds ratios of self-reported irritability scores and emotional problem scores for migraine were 1.31 and 1.41, respectively. The levels of anxiety, emotional/behavioral, and attention deficit/hyperactivity problems increased as the levels of irritability increased in the migraine group, suggesting that the psychosocial functionality of these adolescents may be impaired. Therefore, all adolescents with migraine (especially those with irritability) may have need of psychosocial support.

Longitudinal associations between mothers' and fathers' anger/irritability expressiveness, harsh parenting, and adolescents' socioemotional functioning in nine countries.

The present study examines parents' self-efficacy about anger regulation and irritability as predictors of harsh parenting and adolescent children's irritability (i.e., mediators), which in turn were examined as predictors of adolescents' externalizing and internalizing problems. Mothers, fathers, and adolescents (N = 1,298 families) from 12 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and United States) were interviewed when children were about 13 years old and again 1 and 2 years later. Models were examined separately for mothers and fathers. Overall, cross-cultural similarities emerged in the associations of both mothers' and fathers' irritability, as well as of mothers' self-efficacy about anger regulation, with subsequent maternal harsh parenting and adolescent irritability, and in the associations of the latter variables with adolescents' internalizing and externalizing problems. The findings suggest that processes linking mothers' and fathers' emotion socialization and emotionality in diverse cultures to adolescent problem behaviors are somewhat similar. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Dimensions of irritability in adolescents: longitudinal associations with psychopathology in adulthood.

There is an emerging consensus in developmental psychopathology that irritable youth are at risk for developing internalizing problems later in life. The current study explored if irritability in youth is multifactorial and the impact of irritability dimensions on psychopathology outcomes in adulthood. We conducted exploratory factor analysis on irritability symptom items from a semi-structured diagnostic interview administered to a community sample of adolescents (ages 14-19; 42.7% male; 89.1% white). The analysis identified two factors corresponding to items from the mood disorders v. the oppositional defiant disorder (ODD) (Leibenluft and Stoddard) sections of the interview. These factors were then entered together into regression models predicting psychopathology assessed at age 24 (N = 941) and again at age 30 (N = 816). All models controlled for concurrent psychopathology in youth. The two irritability dimensions demonstrated different patterns of prospective relationships, with items from the ODD section primarily predicting externalizing psychopathology, items from the mood disorder sections predicting depression at age 24 but not 30, and both dimensions predicting borderline personality disorder symptoms. These results suggest that the current standard of extracting and compositing irritability symptom items from diagnostic interviews masks distinct dimensions of irritability with different psychopathological outcomes. Additionally, these findings add nuance to the prevailing notion that irritability in youth is specifically linked to later internalizing problems. Further investigation using more sensitive and multifaceted measures of irritability are needed to parse the meaning and clinical implications of these dimensions.

7.6 ASSESSMENT AND MANAGEMENT OF IRRITABILITY AND AGITATION IN ASD

The objective of this presentation is to share current evidence about treatment for irritability and agitation in children, adolescents, and adults with ASD and to outline a comprehensive approach to assessment and treatment for these symptoms.

Irritability and brain volume in adolescents: cross-sectional and longitudinal associations.

Irritability is garnering increasing attention in psychiatric research as a transdiagnostic marker of both internalizing and externalizing disorders. These disorders often emerge during adolescence, highlighting the need to examine changes in the brain and in psychological functioning during this developmental period. Adolescents were recruited for a longitudinal study examining the effects of early life stress on the development of psychopathology. The 151 adolescents (73 M/78 F, average age = 11.5 years, standard deviation = 1.1) were scanned with a T1-weighted MRI sequence and parents completed reports of adolescent irritability using the Affective Reactivity Index. Of these 151 adolescents, 94 (46 M/48 F) returned for a second session (average interval = 1.9 years, SD = 0.4). We used tensor-based morphometry to examine cross-sectional and longitudinal associations between irritability and regional brain volume. Irritability was associated with brain volume across a number of regions. More irritable individuals had larger hippocampi, insula, medial orbitofrontal cortex and cingulum/cingulate cortex and smaller putamen and internal capsule. Across the brain, more irritable individuals also had larger volume and less volume contraction in a number of areas that typically decrease in volume over the developmental period studied here, suggesting delayed maturation. These structural changes may increase adolescents’ vulnerability for internalizing and externalizing disorders.

&lt;p&gt;The effect of stimulants on irritability in autism comorbid with ADHD: a systematic review&lt;/p&gt;

Introduction: While there is a very high rate of comorbidity of autism and ADHD, there are controversies about prescribing stimulants in children with autism. This is a systematic review about the effect of stimulants on irritability in children with both autism and ADHD.Methods: A systematic review was conducted to study the possible effect of stimulants on irritability in autism and ADHD using the databases of PubMed, Scopus, EMBASE, and ScienceDirect in September 2018. Eligible clinical trials of stimulants in the treatment of Autism and ADHD without restriction of language were included. The primary outcome was irritability score. The full texts of relevant articles were studied, and their references were scanned for any possible related article.Results: Out of 1,315 citations, there were 26 relevant articles. Of the relevant articles, 16 were not interventional studies and were excluded. There were 10 interventional studies. None of them considered irritability as a main outcome. Also, none of them studied the effect of stimulants on irritability in autism plus ADHD. Current uncontrolled evidence about the association of stimulants with irritability is controversial.Conclusion: The current evidence is not enough to support or discourage the effect of stimulants on irritability in children and adolescents with both autism and ADHD. Well-designed controlled clinical trials need to be conducted for this ignored research area.

Effects of Parental Internalizing Problems on Irritability in Adolescents: Moderation by Parental Warmth and Overprotection

Research has shown a link between parental and offspring internalizing problems and that parental warmth and overprotection affect these relationships. However, less research has examined how parental warmth and overprotection affect the link between parental internalizing problems and irritability in adolescents. Thus, the current study investigated the moderating effect of parental warmth and overprotection on the relationship between parental internalizing problems and adolescent irritability in the context of parent and child gender. Participants were parents of adolescents aged 10–24 years and completed surveys online about themselves, the adolescent, and the adolescent’s other primary caregiver. Questionnaires assessed parental warmth and overprotection, parental internalizing problems, and adolescent irritability. Results indicated a moderating effect of parental warmth (b = −0.08, p< 0.01) and overprotection (b = 0.21, p< 0.01) on the relationship between parental internalizing problems and adolescent irritability. Parent and child gender further moderated the relationship when examining parental overprotection (b = −0.16, p< 0.01) but not parental warmth. Results highlight the importance of examining factors, such as parental internalizing problems, warmth, and overprotection, that influence the development of irritability symptoms in adolescents. Additionally, results highlight the importance of examining how gender moderates these relationships. For example, the effect of maternal overprotection on male adolescents was particularly important, which suggests that more research should be done to further understand the complex nature of this relationship.

Prevalence and predictors of psychotropic medication use in adolescents and adults with autism spectrum disorder in Italy: A cross-sectional study

Autism spectrum disorder (ASD) is a group of life-long neurodevelopmental conditions with a prevalence of 1.5% in developed countries. Beside core symptomatology, ASD people are frequently affected by psychiatric comorbidities and behavioral problems. To date, only risperidone and aripiprazole have been approved for the pharmacological treatment of ASD-associated irritability in children and adolescents, while no guidelines exist for adults. The present cross-sectional study examined the prevalence and predictors of psychotropic medication use in 195 autistic subjects, aged between 14 and 58, treated in two Italian tertiary care centers. 58.5% of the sample were taking at least one medication; one third of the sample were on polypharmacotherapy. Antipsychotics were prescribed to 40% of the sample. Nearly 30% of the sample were on anticonvulsants/mood stabilizers. Both antidepressants and benzodiazepines were prescribed to approximately 16% of the subjects. IQ, epilepsy and psychiatric comorbidities were regarded as independent predictors of both mono- and polypharmacotherapy, while severity of repetitive behaviors predicted only polypharmacotherapy. Our data highlighted that medications prescribed to adolescents and adults with ASD are heterogeneous and often rely only on clinicians’ experience. Future research should investigate the effectiveness of psychotropic drugs in this specific population, to promote the development of appropriate treatment guidelines.

Developmental mechanisms of preschool irritability and multifinality in early adolescence: The role of diurnal cortisol

Developmental mechanisms of preschool irritability and multifinality in early adolescence: The role of diurnal cortisol

Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association.

While many psychiatric disorders are associated with an increased risk for suicidal behaviors (SB) in children and adolescents, a few studies have explored the role of clinical symptoms based on a dimensional approach. Irritability is seen as a marker, a general psychopathology, and a symptom of both externalizing and internalizing disorders. In this review, we are interested in determining whether and how irritability can predict SB in youth. First, we reviewed consistencies and variation in the literature linking irritability to suicidal ideation (SI) and suicide attempt (SA). Second, based on the available models, we proposed specific mechanistic pathways, whereby irritability may modulate the risk for SB. Irritability has been found associated with SB both in cross-sectional and in longitudinal studies. The relation is consistent in different settings (i.e., general population and clinical settings) and across psychiatric disorders. The association is reduced but persists after adjusting for psychiatric disorder, including depression. On one hand, irritability constitutes a risk factor for SI via the onset of internalized disorder. On the other hand, irritable youth may be more prone to attempt suicide when experiencing SI. The measures for irritability were heterogeneous. A limited number of studies were designed to explore the role of mediators and/or moderators. Recognizing irritability in children and adolescents is a key issue with regards to suicide prevention.

5.35 The Efficacy and Side-Effect Profile of Lurasidone in the Treatment of Irritability and Aggression Present in Children, Adolescents, and Young Adults With ASD: A Chart Review

5.35 The Efficacy and Side-Effect Profile of Lurasidone in the Treatment of Irritability and Aggression Present in Children, Adolescents, and Young Adults With ASD: A Chart Review

5.50 Assessment and Treatment of Irritability in Children and Adolescents: A Review of Literature for Evidence-Based Recommendations

5.50 Assessment and Treatment of Irritability in Children and Adolescents: A Review of Literature for Evidence-Based Recommendations

A Developmental Twin Study of Emotion Recognition and Its Negative Affective Clinical Correlates

Youth with psychiatric disorders distinguished by irritability, including depression and associated trait neuroticism, show deficits in the ability to recognize facial expressions of emotion, particularly happiness. However, the contribution of genetic and environmental factors to this ability remains unknown. The present study examined this trait in twins to assess the genetic and environmental influences on face-emotion recognition abilities and their association with irritability, neuroticism, and depression. Child and adolescent twins (N= 957 from 496 families) 9 to 17 years old rated their irritability (on the Affective Reactivity Index), neuroticism (on the Junior Eysenck Personality Questionnaire), and depression (on the Short Mood and Feelings Questionnaire) and completed a face-emotion labeling task. Faces depicting anger, disgust, fear, happiness, sadness, and surprise were morphed with a neutral face, yielding 10 levels of increasing emotional expressivity. Biometrical twin analyses evaluated contributions of genetic and environmental factors to the etiology of face-emotion recognition and its association with irritability, neuroticism, and depression. Recognition of each emotion was heritable; common and specific sets of genetic factors influenced all emotions and individual emotions, respectively. Irritability, neuroticism, and depression were modestly and negatively correlated with emotion recognition, particularly the recognition of happiness. For irritability and neuroticism, this correlation appeared largely due to genetic factors. This study maps genetic and environmental contributions to face-emotion recognition and its association with irritability, neuroticism, and depression. Findings implicate common genetic factors in deficits regarding the recognition of happiness associated with irritability and neuroticism in childhood and adolescence.

Aripiprazole for Irritability in Asian Children and Adolescents with Autistic Disorder: A 12-Week, Multinational, Multicenter, Prospective Open-Label Study.

We investigated the effectiveness and tolerability of aripiprazole in the treatment of irritability in Asian children and adolescents (6-17 years) with autistic disorder in a 12-week, multinational, multicenter, open-label study. Sixty-seven subjects (10.0 ± 3.1 years old, 52 boys) were enrolled and treated with flexibly dosed aripiprazole for 12 weeks (mean dose, 5.1 ± 2.5 mg; range 2-15 mg). Aripiprazole significantly reduced the mean caregiver-rated scores for the Irritability, Lethargy/Social Withdrawal, Stereotypy, Hyperactivity, and Inappropriate Speech subscales of the Aberrant Behavior Checklist from baseline to week 12 (p < 0.001 for all subscales). Clinician-rated Clinical Global Impression Severity of Illness scale score also improved from baseline through week 12 (p < 0.001). The most common adverse event was weight gain and no serious adverse event related to aripiprazole treatment was noted. Our results suggest that aripiprazole is effective and generally tolerable in the treatment of irritability in Asian children and adolescents with autistic disorder. Further studies with larger sample sizes and longer treatment durations are required.

Irritability and Parenting Styles in Adolescents With Attention-Deficit/Hyperactivity Disorder: A Controlled Study.

Attention-deficit/hyperactivity disorder (ADHD) affects functioning of the family, decreasing interactions and loyalty and increasing conflict between adolescents with ADHD and their families. Irritable mood and difficulties with emotional dysregulation are common in children with ADHD. The objective of the current study was to assess levels of irritability in adolescents with ADHD using self- and parent-report scales, and investigate the relationship between irritability levels and parental attitudes. A total of 47 adolescents with ADHD and 39 adolescents with typical development participated in the current study. Findings demonstrated that higher levels of parent-reported irritability were associated with decreased egalitarian attitudes in the ADHD group. Although other parental attitudes were not associated with self- and parent-reported irritability, evaluation of the relationship between parental attitudes and irritability in adolescents with ADHD, which can guide diagnosis and treatment of ADHD, is of critical importance. [Journal of Psychosocial Nursing and Mental Health Services, 56(9), 33-43.].

Psychosocial Treatment of Irritability in Youth.

Chronic, severe irritability is a common presenting problem in children and adolescents. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in recognition of this public health need. Currently there are no well-established, evidence-based pharmacological or psychosocial treatments specifically for DMDD. Here, we focus on psychosocial interventions. In addition to reviewing published research, we present preliminary, open trial data on a novel exposure-based cognitive-behavioral therapy (CBT) targeting severe irritability, as is present in DMDD. In the published literature, parent management training (PMT) comprises parent-based interventions designed to treat youth disruptive behavior. Child-based interventions for disruptive behavior include CBT focused on social cognition and problem-solving. Based on identified treatment gaps for severe irritability in children and adolescents, novel psychosocial interventions are being developed. We have developed a CBT for severe irritability that integrates exposure techniques, drawn from anxiety treatment, with selected PMT techniques. Data from an open pilot trial (N=10) suggest feasibility. Promising psychosocial treatments are being developed for DMDD. Future directions include testing these new therapies against extant interventions. Increased research on the biological and psychological mechanisms mediating irritability will further bridge the treatment gap for youth and families.