Prevalence, stability, and predictive utility of the Multidimensional Assessment of Preschoolers Scales clinically optimized irritability score: Pragmatic early assessment of mental disorder risk

Abstract

ObjectivesCharacterizing the scope and import of early childhood irritability is essential for real‐world actualization of this reliable indicator of transdiagnostic mental health risk. Thus, we utilize pragmatic assessment to establish prevalence, stability, and predictive utility of clinically significant early childhood irritability.MethodsData included two independent, diverse community samples of preschool age children (N = 1857; N = 1490), with a subset enriched for risk (N = 425) assessed longitudinally from early childhood through preadolescence (∼4–9 years old). A validated, brief (2‐item) scale pragmatically assessed clinically significant irritability. In the longitudinal subsample, clinical interviews assessed internalizing/externalizing disorders.ResultsOne in five preschool‐age children had clinically significant irritability, which was independently replicated. Irritability was highly stable through preadolescence. Children with versus without clinically significant early childhood irritability had greater odds of early onset, persistent internalizing/externalizing disorders. The pragmatic assessment effectively screened out low‐risk children and identified 2/3 of children with early‐onset, persistent psychopathology.ConclusionsClinically significant early childhood irritability prevalence is akin to the pediatric obesity epidemic and may warrant similar universal screening/intervention. Also, irritability's stability demonstrates the common guidance “they'll grow out of it” to be false. Finally, pragmatic irritability assessment has transdiagnostic predictive power and addresses a need for feasible measures to flag risk.

Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood

“…Elevated irritability is the most robust transdiagnostic indicator of early childhood behavioral vulnerability to psychopathology (Wakschlag et al., 2018; Klein et al., 2021; Wiggins et al., 2023), and can be conceptualized as a low threshold for anger in response to frustration, relative to peers (Beauchaine & Tackett, 2020; Brotman et al., 2017; Evans et al., 2017). Our work in infants/toddlers, preschool age, early school age and pre‐adolescent children supports a single dimension characterizes the normal:abnormal spectrum of irritability (Krogh‐Jespersen et al., 2021; Wakschlag et al., 2012; Hirsch et al., 2023; Alam et al., 2023).…”

“…Drawing on the Research Domain Criteria neurodevelopmental, dimensional framework (Cuthbert, 2020), we developed the Multidimensional Assessment Profiles Temper Loss (MAPS‐TL) scale to differentiate typical from atypical features of irritability within the developmental context of early childhood along the normal‐abnormal spectrum. We validated this ssurvey tool in over 3000 preschoolers across two independent samples (Wakschlag et al., 2015, 2018), including for clinical and mechanistic prediction (Wiggins et al., 2021, 2023; Damme et al., 2022). With the MAPS‐TL tool, we documented that elevated irritability, expressed via tantrums and irritable mood, is normative misbehavior in preschool age.…”

MAPping affective dimensions of behavior: Methodologic and pragmatic advancement of the Multidimensional Assessment Profiles scales

“…Our prior efforts to achieve this with the MAPS‐TL preschool version has yielded promising results (Wiggins et al., 2018). In this special issue, we expand this pragmatic approach across the pediatric range, by developing clinically optimized screeners for infancy/toddlerhood through adolescence (Hirsch et al., 2023; Kirk et al., 2023; Wiggins, Ureña Rosario, MacNeill et al., 2023; Wiggins, Ureña Rosario, Zhang et al., 2023). Strikingly, across developmental periods, all the parent‐report clinically optimized screeners include the combination of low frustration tolerance (a normative misbehavior that occurs in most children regularly but not daily) as well as severe, pathognomonic behavior (uncommon at any frequency) as indicative of impairment.…”

“…In this issue, Preschool Age Samples 1 and 2, including the Longitudinal Subset, were used in Wiggins, Ureña Rosario, MacNeill et al. (2023) and Alam et al. (2023) and Hirsch et al.…”

“…The W2W sample was used in Wiggins, Urena Rosario, MacNeill et al. (2023) and a sub‐sample of W2W was used in Wakschlag et al. (2023).…”