Roads Diverged: Developmental Trajectories of Irritability From Toddlerhood Through Adolescence

Yu, Qiongru; Hodgdon, Elizabeth A.; Kryza‐Lacombe, Maria; Osuna, Lilliana; Bozzetto, Lauren E.; Ciro, Dianne; Wakschlag, Lauren S.; Wiggins, Jillian Lee

doi:10.1016/j.jaac.2022.07.849

Cited by 17 publications

(15 citation statements)

References 52 publications

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“…This builds on its validation in previous early childhood studies (Krogh‐Jespersen et al., 2021; Wakschlag et al., 2012, 2014, 2018; Wiggins et al., 2018). A developmental lens is particularly useful for identifying irritabilty patterns that are cause for concern at ESA, a time when irritability typically begins to decrease (Wiggins et al., 2014; Yu et al., 2022) due to the development of improved self‐regulatory capacities (Zeman et al., 2006). We have identified frequences and qualities of behavior during this developmental period indicates cause for concern.…”

Section: Discussionmentioning

confidence: 99%

Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening

Hirsch,

Alam,

Kirk

et al. 2023

Int J Methods Psych Res

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ObjectivesDevelopmentally specified measures that identify clinically salient irritability are needed for early school‐age youth to meaningfully capture this transdiagnostic risk factor for psychopathology. Thus, the current study modeled the normal:abnormal irritability spectrum and generated a clinically optimized screening tool for this population.MethodsThe irritability spectrum was modeled via the youth version of the Multidimensional Assessment Profile Scales—Temper Loss Scale (MAPS‐TL‐Youth) in children (n = 474; 6.0–8.9 years) using item response theory (IRT). Both cross‐cutting core irritability items from the early childhood version and new developmentally specific items were included. Items uniquely associated with impairment were identified and used to derive a brief, clinically optimized irritability screener. Longitudinal data were then utilized to test the predictive utility of this clinically optimized screener in preadolescence (n = 348; 8.0–12.9 years).ResultsMost children exhibit irritability regularly, but daily occurrence was rare. Of the top 10 most severe items from the IRT analyses, 9 were from the developmentally specific items added for the MAPS‐TL Youth version. Two items associated with concurrent impairment were identified for the clinically optimized irritability screener (“Become frustrated easily” and “Act irritable”). The MAPS‐TL‐Youth clinically optimized screener demonstrated good sensitivity (69%) and specificity (84%) in relation to concurrent DSM 5 irritability‐related diagnoses. Youth with elevated scores on the screener at early school age (ESA) had more than 7x greater odds of irritability‐related psychopathology at pre‐adolescence.ConclusionsThe MAPS‐TL‐Youth characterized the developmental spectrum of irritability at ESA and a clinically optimized screener showed promise at predicting psychopathology risk. Rigorous testing of clinical applications is a critical next step.

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Section: Discussionmentioning

confidence: 99%

Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening

Hirsch,

Alam,

Kirk

et al. 2023

Int J Methods Psych Res

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“…To chart the trajectory of transdiagnostic neurodevelopmental vulnerability to pediatric psychopathology, indexed by irritability, requires a lifespan coherent approach that incorporates developmental specificity with consistency across developmental periods (Wakschlag et al., 2010). The current paper advances this RDoC informed approach by characterizing the normal:abnormal spectrum of irritability within the PA period, one which is a crucial developmental inflection point (Yu et al., 2023). We have provided initial evidence of the reliability and validity of the MAPS‐TL‐Youth scale as a dimensional irritability measure in preadolescents.…”

Section: Discussionmentioning

confidence: 99%

“…Also, in a longitudinal study following youth from ages 3 to 15, Yu et al. (2023) found around age 9 is an inflection point in the trajectories of irritability, with irritability decreasing in some youth and increasing in others from age 9 through 15. This highlights the salience of modeling the normal:abnormal irritability spectrum, as well as a companion screener for real world use.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, identifying youth (ages ∼9–12 years) during the pre‐clinical phase who are at risk for impairing psychopathology prior to the dramatic uptick of mental disorders during (Merikangas et al., 2010) will be crucial for timely and effective prevention. Further bolstering the argument for identifying atypical irritability within the developmental context of preadolescence, variable irritability patterns have differential predictive utility (Damme et al., 2022), and evidence suggests that preadolescence is a particularly vulnerable turning point when trajectories of irritability can shift and change direction (Yu et al., 2023). Here, we sought to characterize the normal:abnormal spectrum of irritable behavior as developmentally specified within preadolescence.…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, irritability normatively decreases with age, following a well‐defined trajectory that decreases into later childhood and further into adulthood (Brotman, Kircanski, & Leibenluft, 2017; Brotman, Kircanski, Stringaris, et al., 2017; Leibenluft & Stoddard, 2013; Sorcher et al., 2022; Wiggins et al., 2014). However, there exists a subset of youth for whom irritability remains chronically elevated and/or dysregulated across childhood and adolescence (Pagliaccio et al., 2018; Sorcher et al., 2022; Wiggins et al., 2014; Yu et al., 2023; Zhang et al., 2023). This highlights the need for developmentally meaningful assessment over time.…”

Section: Introductionmentioning

confidence: 99%

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Characterizing the spectrum of irritability in preadolescence: Dimensional and pragmatic applications

Alam,

Kirk,

Hirsch

et al. 2023

Int J Methods Psych Res

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ObjectivesCharacterize the dimensional spectrum of preadolescent (PA) irritability, a robust transdiagnostic vulnerability marker, using the youth version of the Multidimensional Assessment Profiles Temper Loss (MAPS‐TL‐Youth) scale including common and with developmentally specific items. Based on this, derive and validate a clinically optimized irritability screener to flag psychopathology risk in preadolescents.MethodsThe normal:abnormal irritability spectrum was modeled using MAPS‐TL‐Youth data from the Multidimensional Assessment of Preschoolers Study (MAPS) Study PA wave (n = 340) via item response theory. Both cross‐cutting core items from the MAPS scales and developmentally specific items were used to generate this dimension. Stepwise logistic regression was then used to optimize MAPS‐TL‐Youth irritability items in relation to Kiddie Schedule of Affective Disorders and Schizophrenia impairment to generate a clinically optimized irritability screener. Receiver operator characteristic analysis identified the irritability threshold for the screener. For the first time, youth self‐report of their own irritability on the MAPS‐TL was also modeled via the MAPS‐TL‐Youth‐Self‐Report (MAPS‐TL‐Youth‐SR).ResultsIrritability was unidimensional and ranged from mild and common to severe and rare behaviors. Developmentally specific items allowed detection of more severe irritability. Items for the screener were identified in relation to concurrent impairment. These included low frustration tolerance and pathognomonic severe behaviors. The clinically optimized screener demonstrated very good sensitively (87%) and specificity (81%) in regard to concurrent irritability‐related DSM disorders. Modeling of the MAPS‐TL‐Youth‐SR yielded similar results.ConclusionCharacterizing the normal: abnormal spectrum of irritability in preadolescence advances application of Research Domain Criteria methods to this developmental period. This foundational work yielded two developmentally specified tools for irritability characterization in preadolescence: a nuanced dimensional scale to precisely characterize the full normal‐abnormal irritability spectrum, and a pragmatic, clinically optimized screener suitable for real world use. Future application in mechanistic and clinical studies will be important for establishing validity and incremental utility.

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Caregivers’ Attention Toward, and Response to, Their Child's Interoceptive Hunger and Thirst Cues

Stevenson,

Serebro,

Mruk

et al. 2024

Developmental Psychobiology

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People can use their internal state to determine if they are hungry or thirsty. Although the meaning of some interoceptive cues may be innate (e.g., pain), it is possible that others—including those for hunger and thirst—are acquired. There has been little exploration of this idea in humans. Consequently, we conducted a survey among child caregivers to determine if the basic conditions necessary for interoceptive learning were present. Two‐hundred and thirty‐five caregivers of children aged 1–12 years were asked if they had recently noticed stomach rumbling, hunger‐related irritability, and a dry mouth in their child. They were also asked how they would respond. The impact of several moderating variables, especially caregiver beliefs about the causes of hunger, fullness, and thirst, was also explored. Fifteen percent of caregivers had recently noticed stomach rumbling in their child, 28% hunger‐related irritability, and 14% a dry mouth. Forty‐four percent of caregivers had noticed at least one of these three cues. Noticing hunger cues was significantly moderated by caregiver beliefs about their cause, by child age, and in one case by temporal context (around vs. outside mealtimes). Key caregiver responses were providing the need (e.g., offer food) and/or asking the child if they had a need (e.g., hungry?). Each type of response could potentially support a different form of interoceptive learning. In conclusion, we suggest the necessary conditions for children to learn interoceptive hunger and thirst cues, are present in many caregiver–offspring dyads.

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Roads Diverged: Developmental Trajectories of Irritability From Toddlerhood Through Adolescence

Cited by 17 publications

References 52 publications

Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening

Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening

Characterizing the spectrum of irritability in preadolescence: Dimensional and pragmatic applications

Caregivers’ Attention Toward, and Response to, Their Child's Interoceptive Hunger and Thirst Cues

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