Temper Loss Research Articles

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.

Psychometric Validation of the Greek Version of the Scale "Temper Loss" of the Questionnaire "Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB)".

It has become increasingly evident that vulnerability to psychopathology is identifiable early in life. A body of evidence suggests that the recognition and prevention of a spectrum of typical/atypical behaviors in preschoolers can lead to earlier diagnosis and treatment. The Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) is a parent-completed instrument that has been developed recently to differentiate normative misbehaviors in early childhood from markers of clinical risk. The aim of the present study was to validate the “Temper Loss” Subscale in the Greek language and to assess its psychometric properties in healthy children. An on-print parent-report survey was conducted among Greek children, aged between 3 and 5.5 years. The survey included the MAP-DB and the Child Behavior Checklist (CBCL). A total of 400 respondents participated in the study. The analysis suggested that the Greek version of the MAP-DB’s “Temper Loss” scale has good psychometric properties. The results of the Exploratory Factor Analysis (EFA) of the 22 items were able to explain 64.4% of the total variance. Internal consistency for the one subscale was satisfactory, with Cronbach’s alpha at 0.970. This scale can be used by researchers and practitioners for the evaluation of dimensional phenotypes in early childhood.

#49 Nasal microbiota differences in young infants are associated with early childhood irritability

Abstract Background The etiology and pathophysiology of childhood mental health are poorly understood. Early childhood irritability is a transdiagnostic marker that portends significant risk for subsequent mental health problems. Robust evidence demonstrates irritability can be quantified early in infancy. The early life microbiome is implicated in defining health trajectories including neurodevelopment. In contrast to the gut microbiome, however, a relationship between the infant nasal microbiome and early childhood irritability remains undefined. We sought to investigate associations between the nasal microbiota of infants <60 days of age and early childhood irritability. Method This case-control study included infants with archived respiratory nasal samples collected for routine clinical care at ≤60 days of age from an emergency department visit (1/2016-5/2019). Parents completed an online survey when children were 14-42 months of age that included questions about medical history, development, and irritability (Multidimensional Assessment of Preschool Disruptive Behavior, MAP-DB). The upper quartile of the MAP-DB Temper Loss Score was classified as high dysregulation. Additional clinical data were collected from the electronic health record. DNA extracted from archived viral media specimens were subjected to 16S rRNA gene (V3-V4 region) next generation sequencing (NGS). Ecological diversity and differential taxon analysis were performed. Results Seventy-two children were initially included, with 16 categorized as high dysregulation. The median age at nasal sample collection was 30 days (IQR 14-44), and age at parent survey was 28 months (IQR 19-31). Fifty-weight percent of the cohort was white, 6% Black, 6% Asian, 20% other, and 25% identified as Lantine ethnicity. The infants were 49% female sex, 77% were born by vaginal delivery, and 43% had a virus identified at time of nasal sample. After removal of extraction/PCR contaminants, taxa present only or at higher levels in media, and samples with <80 sequences, the final microbiota comparison dataset was n=33 children, 7 with high dysregulation. Alpha-diversity (Shannon index) was lower in the high dysregulation group (p=0.0031 pre-background taxa removal, p=0.1288 post-correction, Figure 1A-B). Of the 18 taxa that were compared, Haemophilus, Streptococcus, Staphylococcus, and Gardnerella were significantly less abundant in the high dysregulation group (false discovery corrected significance q<0.005, Figure 1C). Parasutterella was more abundant in a subset of the high dysregulation group. Conclusion Differences in the nasal microbiota of infants, decreased diversity and abundance of certain respiratory bacteria, are associated with early childhood irritability, a marker of mental health risk. Further study may provide mechanistic insights and potentially guide new risk assessment or treatment options.

Calibrating temper loss severity in the transition to toddlerhood: Implications for developmental science

The integration of neurodevelopmental perspectives into clinical science has identified irritability as an early dimensional marker of lifespan mental health risk. Elucidating the developmental patterning of irritable behavior is key to differentiating normative variation from risk markers. Accounting for dysregulation and contextual features of irritability is useful for differentiation at preschool age, laying the groundwork for even earlier characterization. We provide initial evidence for the validity of the Multidimensional Assessment Profile of Disruptive Behavior Temper Loss Scale, Infant-Toddler version in two independent samples of 12-18-month-olds from the US. We calibrated the measure using item response theory in a large representative sample, then validated within an independent sample. We characterized the developmental patterning of irritable behaviors and their dimensional spectrum, and demonstrated test-retest reliability, and convergent validity. The MAP-DB-IT is a standardized, dimensional survey assessing irritability that serves as a tool for characterizing the developmental expression of early mental health risk.

Toward a Developmental Nosology for Disruptive Mood Dysregulation Disorder in Early Childhood

Disruptive mood dysregulation disorder (DMDD) in DSM, characterized by severe, chronic irritability, currently excludes children<6 years of age. However, capitalizing on a burgeoning developmental science base to differentiate clinically salient irritability in young children may enable earlier identification. The objective of this study was to advance an empirically derived framework for early childhood DMDD (EC-DMDD) by modeling and validating DMDD patterns in early childhood and generating clinically informative, optimized behaviors with thresholds. Data (N= 425) were from 3 longitudinal assessments of the MAPS Study, spanning preschool (means= 4.7 and 5.5 years) to early school age (mean= 6.8 years). The Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) Temper Loss scale captured irritability, the Family Life Impairment Scale (FLIS) assessed cross-domain impairment at the preschool time points and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was used to assess clinical status at early school age. Latent transition analyses differentiated children with EC-DMDD from children with low, transient, or nonimpairing irritability. Developmental patterning of irritability proved important for normal:abnormal differentiation. Of children, 27% had initially high irritability, but only two-thirds of these were persistently highly irritable. Thus, "false positives" based on a single screen would be substantial. Yet, "false negatives" are low, as<1% of children with baseline low irritability demonstrated later high irritability. Based on the sequential preschool-age time points, 6.7% of children were identified with EC-DMDD, characterized by persistent irritability with pervasive impairment, similar to prevalence at older ages. Specific behaviors included low frustration tolerance; dysregulated, developmentally unexpectable tantrums; and sustained irritable mood, all of which sensitively (0.85-0.96) and specifically (0.80-0.91) identified EC-DMDD. EC-DMDD predicted irritability-related syndromes (DMDD, oppositional defiant disorder) at early school age better than downward extension of DSM DMDD criteria to preschool age. These findings provide empirical thresholds for preschool-age clinical identification of DMDD patterns. The results lay the foundation for validation of DMDD in early childhood and inform revision of DSM criteria.

Temporally sensitive neural measures of inhibition in preschool children across a spectrum of irritability.

Irritability is a prominent feature of chronic mental disorders and a developmental marker of their early emergence. The most salient feature of irritability in early childhood is temper tantrums. While temper tantrums are normative in young children, they can be clinically concerning when they are dysregulated, very frequent, and/or occur in unexpected contexts. The present study uses behavioral and event-related brain potential (ERP) measures to characterize the relationship between irritability and neural markers of response inhibition in very young children. Forty-six children (ages 4-7years) completed a go/no-go task under nonfrustrating and frustrating conditions. ERPs elicited by go and no-go stimuli were examined as a function of frustration condition and irritability, operationalized via the well-validated Temper Loss scale of the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB). Higher Temper Loss scores were associated with larger N2no-go amplitudes and reduced no-go accuracy during frustration. This suggests that higher levels of irritability corresponded with increased conflict monitoring and poorer task performance during frustration. These findings add to a developing literature identifying the neurocognitive markers of varying levels of irritability in young children.

Linking the Child Behavior Checklist (CBCL) with the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB): Advancing a dimensional spectrum approach to disruptive behavior.

Disruptive behavior in childhood is common. It spans from normative child misbehaviors to clinically-significant and impairing problems. While there are many rating scales evaluating such behaviors, historically, measurement has emphasized counting the number of symptoms present rather than assessing the normal-abnormal spectrum of behavioral expression. This study uses data from 644 early school age children aggregated from two data sources to statistically link a commonly used symptom count measure, the Child Behavior Checklist (CBCL), to a more developmentally-sensitive measure, the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB). Two links between conceptually similar scales on each measure were developed: CBCL Conduct Problems and MAP-DB Aggression; and CBCL Oppositional Defiant Problems and MAP-DB Temper Loss. We compared two innovative methods-Item Response Theory (IRT) and Deming regression-to determine the optimal linking relationship. Results suggest IRT methods were superior in reducing linking error compared to Deming regression. While Deming regression accurately modeled the mean scores (thus minimizing linking bias), this method could not adequately address the floor effect for scores on the CBCL. For practical purposes, this study provides a crosswalk of score conversions between the CBCL and MAP-DB, such that data aggregation and group comparisons can be made across the two measures; this enables longitudinal analyses with historically-collected CBCL data to transition to the more innovative dimensional scales of the MAP-DB without undo loss of extant data. This study furthers efforts to shift from historical symptom counts to more developmentally-sensitive measurement across the disruptive behaviors spectrum.

Identifying Clinically Significant Irritability in Early Childhood

Advances in developmentally sensitive measurement have enabled differentiation of normative versus clinically salient irritability in early childhood. However, clinical application of these measures is still nascent. The authors developed an optimized model of clinically salient irritable behaviors at preschool age. Based on this model, the authors derived an empirically based cutoff in relation to concurrent DSM-5 irritability-related disorders (i.e., oppositional defiant disorder, disruptive mood dysregulation disorder, other depressive disorders) and used longitudinal models to test the predictive validity of the cutoff for impairment and irritability trajectories and later DSM disorders. Preschool children oversampled for irritability were followed over 3 time points into early school age (N= 425; mean age at baseline 4.7 years, mean follow-up 2.9 years). Mothers reported on children's irritability using the developmentally validated Multidimensional Assessment of Profile of Disruptive Behavior (MAP-DB) Temper Loss scale, impairment using the Family Life Impairment Scale, and DSM categories using the Preschool Age Psychiatric Assessment and the Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. Of 22 MAP-DB Temper Loss behaviors, 2 behaviors-1 normative (easily frustrated) and 1 rare dysregulated (destructive tantrums)-were uniquely related to cross-domain impairment. At baseline, these 2 irritability items identified diagnostic status (oppositional defiant disorder, disruptive mood dysregulation disorder, other depressive disorders) with good sensitivity (70-73%) and specificity (74-83%). Children above the irritability cutoff at baseline also exhibited more persistent irritability and impairment and greater likelihood of DSM disorders in early school age. Clinical identification of early-onset irritability can be enhanced using brief, developmentally optimized indicators. Further research to apply these findings to tiered early intervention is important.

Dimensional Latent Structure of Early Disruptive Behavior Disorders: A Taxometric Analysis in Preschoolers.

Although disruptive behavior disorders (DBDs) are used as a distinct categorical diagnosis in clinical practice, they have repeatedly been described as having a dimensional structure in taxometric analyses. In the current study the authors analyzed the latent status of disruptive behaviors (DB) in a large sample (N = 2,808) of German preschool children (2-6years old, mean age 53.7months, SD = 13.5, 48.4% girls). The Eyberg Child Behavior Inventory (ECBI) as well as the Strengths and Difficulties Questionnaire (SDQ) were used to compile indicators of the DB core dimensions (Temper Loss, Aggression, Noncompliance, and Low Concern for others). Three widely used taxometric methods (a) MAXEIG, (b) MAMBAC, and (c) L-Mode were applied. Simulation data were created to evaluate the Comparison Curve Fit Index values (CCFIs), which were below 0.45, supporting a dimensional solution. Hence, in the current study the latent structure of DB in preschoolers encompassed differences in degree rather than kind. Researchers and practitioners should be mindful of the dimensional latent status of DB in theory building, assessment, classification, and labeling.

Temper Loss and Persistent Irritability in Preschoolers: Implications for Diagnosing Disruptive Mood Dysregulation Disorder in Early Childhood.

Disruptive Mood Dysregulation Disorder (DMDD) is a new and controversial child psychiatric disorder characterized by persistent irritability and frequent temper loss. Among the controversies surrounding DMDD is whether the age of onset criterion-that DMDD may not be diagnosed before age 6years-is justified. This study examined DMDD symptoms and associated patterns of psychiatric comorbidity, behavioral, and family functioning in a sample of 139 preschoolers (ages 4-0 to 5-11years) admitted to an early childhood psychiatric day treatment program. DMDD symptoms were common in this acute clinical sample, with 63 children (45.3%) presenting with frequent temper outbursts and chronic irritability. As compared to children who did not present with DMDD symptoms, these children demonstrated more aggression and emotional reactivity and lower receptive language skills, with high rates of comorbidity with the disruptive behavior disorders. Findings contribute to an emerging literature on preschool DMDD, with implications for early childhood psychiatric assessment and clinical interventions.

Loss of Temper and Irritability: The Relationship to Tantrums in a Community and Clinical Sample.

This study explores the relationship of irritability to tantrums and loss of temper in a community and clinical sample. The community sample, recruited via commercial mailing lists, consisted of 462 6-year-olds whose parents completed the Child Behavior Checklist (CBCL), and Preschool Age Psychiatric Assessment (PAPA). Tantrums were assessed in the oppositional defiant disorder (ODD) section of the PAPA. Irritability was assessed in the depression section to identify persistently irritable and/or angry mood. The clinic sample, drawn from a child psychiatry clinic, included 229 consecutively referred 6-year-olds from 2005 through 2014 whose parents completed the CBCL and Child and Adolescent Symptom Inventory (CASI). Temper loss and irritability items came from the ODD and depression sections of the CASI, and tantrum description was taken from an irritability inventory. Children's Global Assessment Scale (CGAS) and the CBCL Dysregulation Profile were examined in both samples. Logistic and multiple regression were used to compare rates of diagnosis, CBCL subscales, CGAS, and tantrum quality between children with tantrums only and tantrums with irritability. Almost half (45.9%) of clinic children had severe tantrums; only 23.8% of those were said to be irritable. In the community, 11% of children had tantrums, but 78.4% of those were called irritable. However, irritability in the clinic, although less common, was associated with aggressive tantrums and substantial impairment. In contrast, irritability was associated with only a relatively small increase in impairment in the community sample. Irritability may have different implications in community versus clinic samples, and tantrums assessed in the community may be qualitatively different from those seen in clinics.

Clinical Implications of a Dimensional Approach: The Normal:Abnormal Spectrum of Early Irritability

The importance of dimensional approaches is widely recognized, but an empirical base for clinical application is lacking. This is particularly true for irritability, a dimensional phenotype that cuts across many areas of psychopathology and manifests early in life. We examine longitudinal, dimensional patterns of irritability and their clinical import in early childhood. Irritability was assessed longitudinally over an average of 16 months in a clinically enriched, diverse community sample of preschoolers (N= 497; mean= 4.2 years; SD= 0.8). Using the Temper Loss scale of the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) as a developmentally sensitive indicator of early childhood irritability, we examined its convergent/divergent, clinical, and incremental predictive validity, and modeled its linear and nonlinear associations with clinical risk. The Temper Loss scale demonstrated convergent and divergent validity to child and maternal factors. In multivariate analyses, Temper Loss predicted mood (separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and depression/dysthymia), disruptive (oppositional defiant disorder [ODD], attention-deficit/hyperactivity disorder [ADHD], and conduct disorder [CD]) symptoms. Preschoolers with even mildly elevated Temper Loss scale scores showed substantially increased risk of symptoms and disorders. For ODD, GAD, SAD, and depression, increases in Temper Loss scale scores at the higher end of the dimension had a greater impact on symptoms relative to increases at the lower end. Temper Loss scale scores also showed incremental validity over DSM-IV disorders in predicting subsequent impairment. Finally, accounting for the substantial heterogeneity in longitudinal patterns of Temper Loss significantly improved prediction of mood and disruptive symptoms. Dimensional, longitudinal characterization of irritability informs clinical prediction. A vital next step will be empirically generating parameters for the incorporation of dimensional information into clinical decision-making with reasonable certainty.

Advancing a Multidimensional, Developmental Spectrum Approach to Preschool Disruptive Behavior

Dimensional approaches are gaining scientific traction. However, their potential forelucidating developmental aspects of psychopathology has not been fully realized. The goal of this article is to apply a multidimensional, developmental framework to model the normal-abnormal spectrum of preschool disruptive behavior. The Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), a novel measure, was used to model dimensional severity across developmental parameters theorized to distinguish the normative misbehavior of early childhood from clinically salient disruptive behavior. The 4 MAP-DB dimensions are Temper Loss, Noncompliance, Aggression, and Low Concern for Others. Parents of a diverse sample of 1,488 preschoolers completed the MAP-DB. Multidimensional item response theory (IRT) was used for dimensional modeling. The 4-dimensional, developmentally informed model demonstrated excellent fit. Its factor loadings did not differ across demographic subgroups. All dimensions provided good coverage of the abnormal end of the severity continuum, but only Temper Loss and Noncompliance provided good coverage of milder, normatively occurring behaviors. The developmental expectability and quality of behaviors distinguished normative from atypical behaviors. The point at which frequency of behaviors was atypical varied based on dimensional location for Temper Loss, Noncompliance, and Aggression. The MAP-DB provides an innovative method for operationalizing developmentally specified, dimensional phenotypes in early childhood. Establishing the validity of these dimensional phenotypes in relation to clinical outcomes, neurocognitive substrates, and etiologic pathways will be a crucial test of their clinical utility.

Defining the developmental parameters of temper loss in early childhood: implications for developmental psychopathology.

Temper modulation problems are both a hallmark of early childhood and a common mental health concern. Thus, characterizing specific behavioral manifestations of temper loss along a dimension from normative misbehaviors to clinically significant problems is an important step toward identifying clinical thresholds. Parent-reported patterns of temper loss were delineated in a diverse community sample of preschoolers (n = 1,490). A developmentally sensitive questionnaire, the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), was used to assess temper loss in terms of tantrum features and anger regulation. Specific aims were: (a) document the normative distribution of temper loss in preschoolers from normative misbehaviors to clinically concerning temper loss behaviors, and test for sociodemographic differences; (b) use Item Response Theory (IRT) to model a Temper Loss dimension; and (c) examine associations of temper loss and concurrent emotional and behavioral problems. Across sociodemographic subgroups, a unidimensional Temper Loss model fit the data well. Nearly all (83.7%) preschoolers had tantrums sometimes but only 8.6% had daily tantrums. Normative misbehaviors occurred more frequently than clinically concerning temper loss behaviors. Milder behaviors tended to reflect frustration in expectable contexts, whereas clinically concerning problem indicators were unpredictable, prolonged, and/or destructive. In multivariate models, Temper Loss was associated with emotional and behavioral problems. Parent reports on a developmentally informed questionnaire, administered to a large and diverse sample, distinguished normative and problematic manifestations of preschool temper loss. A developmental, dimensional approach shows promise for elucidating the boundaries between normative early childhood temper loss and emergent psychopathology.

Putting Theory to the Test: Modeling a Multidimensional, Developmentally-Based Approach to Preschool Disruptive Behavior

There is increasing emphasis on dimensional conceptualizations of psychopathology, but empirical evidence of their utility is just emerging. In particular, although a range of multidimensional models have been proposed, the relative fit of competing models has rarely been tested. Furthermore, developmental considerations have received scant attention. In this study, we tested a developmentally based, four-dimensional model of disruptive behavior theorized to represent the defining features of disruptive behavior at preschool age: Temper Loss, Noncompliance, Aggression, and Low Concern for Others. Model testing was conducted in two independent samples of preschoolers: Clinically Enriched Sample (n = 336) and Epidemiologic Sample (n = 532). The tau-equivalent confirmatory factor analyses were used to test the fit of the Developmental Model relative to three leading competing models (DSM opositional defiant disorder (ODD)/conduct disorder (CD) Model, "Callous" Model, and an "Irritable/Headstrong/Hurtful" Model). Reliability of the four dimensions was also tested. Validity of the dimensions was tested by predicting multi-informant, multi-method ratings of disruptive behavior and impairment, and incremental utility relative to DSM symptoms. In both samples, the Developmental Model demonstrated a superior fit compared with the competing models within the full sample, and across key demographic subgroups. Validity was also demonstrated, including incremental utility relative to DSM-IV disruptive behavior symptoms. Critical next steps for achieving scientific consensus about the optimal dimensional model of disruptive behavior and its clinical application are discussed.

Unpacking the association: Individual differences in the relation of prenatal exposure to cigarettes and disruptive behavior phenotypes

Prenatal exposure to cigarettes has been robustly associated with disruptive behavior in diverse samples and across developmental periods. In this paper we aim to elucidate exposure related behavioral phenotypes and developmental pathways by testing: (a) differential associations of exposure and four disruptive behavior dimensional phenotypes: Aggression, Noncompliance, Temper Loss and Low Concern for Others; and (b) moderation of these pathways including sex differences and moderation by parental responsive engagement. Participants were 211 teens and their parents from the East Boston Family Study (EBFS), an adolescent follow-up of a pregnancy cohort over-sampled for exposure. A best estimate serum cotinine corrected score was used to characterize exposure. In multivariate models controlling for parental antisocial behavior, family adversity and secondhand exposure, exposure uniquely predicted Aggression and Noncompliance. Paternal responsiveness moderated exposure effects on disruptive behavior. There were no sex differences in these patterns. Phenotypic findings suggest the possibility of specific neural mechanisms. In conjunction with prior research, protective effects of parental responsiveness occurring as late as adolescence point to the potential benefit of parenting-based prevention efforts to reduce risk to exposed offspring.