These data extend prior work conducted in youths with irritability or anxiety alone and suggest that research may miss important findings if the pathophysiology of irritability and anxiety are studied in isolation. Decreased amygdala-medial prefrontal cortex connectivity may mediate emotion dysregulation when very anxious and irritable youth process threat-related faces. Activation in the ventral visual circuitry suggests a mechanism through which signals of social approach (ie, happy and angry expressions) may capture attention in irritable youth.

Irritability cuts across many pediatric disorders and is a common presenting complaint in child psychiatry; however, its neural mechanisms remain unclear. One core pathophysiological deficit of irritability is aberrant responses to frustrative nonreward. Here, we conducted a preliminary fMRI study to examine the ability of functional connectivity during frustrative nonreward to predict irritability in a transdiagnostic sample. This study included 69 youths (mean age = 14.55 years) with varying levels of irritability across diagnostic groups: disruptive mood dysregulation disorder (n = 20), attention-deficit/hyperactivity disorder (n = 14), anxiety disorder (n = 12), and controls (n = 23). During fMRI, participants completed a frustrating cognitive flexibility task. Frustration was evoked by manipulating task difficulty such that, on trials requiring cognitive flexibility, “frustration” blocks had a 50% error rate and some rigged feedback, while “nonfrustration” blocks had a 10% error rate. Frustration and nonfrustration blocks were randomly interspersed. Child and parent reports of the affective reactivity index were used as dimensional measures of irritability. Connectome-based predictive modeling, a machine learning approach, with tenfold cross-validation was conducted to identify networks predicting irritability. Connectivity during frustration (but not nonfrustration) blocks predicted child-reported irritability (ρ = 0.24, root mean square error = 2.02, p = 0.03, permutation testing, 1000 iterations, one-tailed). Results were adjusted for age, sex, medications, motion, ADHD, and anxiety symptoms. The predictive networks of irritability were primarily within motor-sensory networks; among motor-sensory, subcortical, and salience networks; and between these networks and frontoparietal and medial frontal networks. This study provides preliminary evidence that individual differences in irritability may be associated with functional connectivity during frustration, a phenotype-relevant state.

The purpose of the present investigation was to examine the association between physiological reactivity to peer stressors and physical and relational aggression. Potential moderation by actual experiences of peer maltreatment (i.e., physical and relational victimization) and gender were also explored. One hundred ninety-six children (M = 10.11 years, SD = 0.64) participated in a laboratory stress protocol during which their systolic blood pressure, diastolic blood pressure, and skin conductance reactivity to recounting a relational stressor (e.g., threats to relationships) and an instrumental stressor (e.g., threats to physical well-being, dominance, or property) were assessed. Teachers provided reports of aggression and victimization. In both boys and girls, physical aggression was associated with blunted physiological reactivity to relational stress and heightened physiological reactivity to instrumental stress, particularly among youth higher in victimization. In girls, relational aggression was most robustly associated with blunted physiological reactivity to relational stressors, particularly among girls exhibiting higher levels of relational victimization. In boys, relational aggression was associated with heightened physiological reactivity to both types of stressors at higher levels of peer victimization and blunted physiological reactivity to both types of stressors at lower levels of victimization. Results underscore the shared and distinct emotional processes underlying physical and relational aggression in boys and girls.

The Affective Posner 2 paradigm and the ARI and CBCL irritability scales may be useful tools for longitudinal or treatment research on irritability.