Longitudinal Associations Between Preschool Disruptive Mood Dysregulation Disorder Symptoms and Neural Reactivity to Monetary Reward During Preadolescence

Abstract

Objective: Reward-processing abnormalities are thought to be a key feature of various psychiatric disorders and may also play a role in disruptive mood dysregulation disorder (DMDD), a new diagnosis in DSM-5. In the current study, we used eventrelated potentials (ERP) sensitive to monetary gains (i.e., the reward positivity [RewP]) and losses (i.e., the N200) to examine associations between symptoms of DMDD during early childhood and later reward processing during preadolescence. Methods: To assess early emerging DMDD symptoms in a large longitudinal community sample (n = 373) of 3-year old children, we administered a diagnostic interview, Preschool Age Psychiatric Assessment (PAPA) with parents. At a later assessment, *6 years later, children completed a monetary reward task while an electroencephalogram (EEG) was recorded. Children's lifetime history of psychopathology was also assessed at that time using Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with the child and parent. Results: Multiple regression analyses revealed that age 3 DMDD symptoms predicted an enhanced RewP to monetary rewards in preadolescence. This association is independent of demographics and lifetime history of symptoms of depression, any anxiety disorder, attention-deficit disorder, oppositional defiant disorder, or conduct disorder Conclusions: Early manifestations of DMDD in children as young as 3 years old predicted enhanced reward processing later in development. These findings add to the growing corpus of literature on the pathophysiology of DMDD, and underscore the predictive validity of preschool DMDD on a neural level.

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

“…The present study joins emerging research linking dimensional assessments of irritability with neurocognitive functioning (Dougherty et al, ; Grabell et al, ; Kessel, Dougherty, et al, ; Kessel, Meyer, et al, ; Li et al, ; Perlman et al, ). We add to extant literature by providing evidence that higher levels of early irritability are associated with response inhibition impairments and enhanced activation of a conflict monitoring circuit during marked negative affect.…”

“…In young children, irritability can also manifest as long periods of angry or negative mood (e.g., “stays angry for a long time”; Wakschlag et al, ). While progress has been made in carefully cataloging the full range and characteristics of irritability in very young children (Biedzio and Wakschlag, in press; Wakschlag et al, ; Wakschlag et al, ; Wiggins et al, ), emerging evidence suggests that integrating neurocognitive measures can aid in identifying when a young child's irritability is likely to be associated with adverse long‐term outcomes (Dougherty et al, ; Grabell et al, ; Grabell, Olson, Tardif, Thompson, & Gehring, ; Kessel, Dougherty, et al, ; Kessel, Meyer, et al, ; Li, Grabell, Wakschlag, Huppert, & Perlman, ; Perlman et al, ; Perlman, Luna, Hein, & Huppert, ). For example, interactions between early childhood irritability and neural measures of cognitive control predicted whether children developed internalizing or externalizing symptoms at age 9 (Kessel, Meyer, et al, ).…”

“…Another laboratory has linked higher levels of preschool irritability with lateral and medial prefrontal cortex activation patterns during tests of cognitive control and cognitive flexibility (Li et al, ; Perlman et al, ). A series of studies emerging from a carefully characterized sample of children at risk for depression has revealed links between levels of preschool irritability and altered neural activation patterns and functional connectivity during reward and cognitive control tasks (Dougherty et al, ; Kessel, Dougherty, et al, ; Kessel, Meyer, et al, ). In one study, as irritability progressed from mild to moderate, lateral prefrontal activation during a cognitive control task increased.…”

Disruptive Mood Dysregulation Disorder (DMDD): An RDoC perspective

“…However, it is unknown whether children with DMDD would respond more like those with SMD or those with ODD, as no studies have been conducted. One recent study suggests that early symptoms of DMDD are predictive of enhanced reward processing during preadolescence (Kessel et al, 2016). However, this is clearly an area for further investigation.…”

Neurophysiological Processing of Emotion in Children of Mothers with a History of Depression: the Moderating Role of Preschool Persistent Irritability

“…However, given evidence that symptoms of irritability show moderate stability over time (Leibenluft et al, 2006), it is possible that irritability could also be associated with similar biological correlates at other ages. In addition to the literature on SMD, we have recently shown that persistent irritability in 3-year-old children prospectively predicted enhanced reward sensitivity in middle childhood (Kessel et al, 2016). Taken together, these studies suggest that irritability may be related to increased reactivity, regardless of the valence of the precipitating stimuli.…”