Tonic and phasic irritability in 6‐year‐old children: differential correlates and outcomes

Abstract

Objective Irritability is a common and clinically important problem in children and adolescents and a risk factor for later psychopathology and impairment. Irritability can manifest in both tonic (e.g., irritable, touchy mood) and phasic (e.g., temper outburst) forms, and recent studies of adolescents suggest that they predict different outcomes. However, no studies have examined whether tonic and phasic irritability are empirically distinguishable in 6‐year‐old children and whether they have distinct correlates and outcomes. Method We utilized data from a longitudinal study of an unselected community sample of four hundred fifty‐two 6‐year‐olds followed at 3‐year intervals to age 15. We conducted confirmatory factor analysis (CFA) using relevant items from a diagnostic interview and several parent‐report inventories. Results The CFA identified dimensions that were consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent‐reported temperamental negative affectivity and internalizing and externalizing disorders at age 6 and predicted higher rates of internalizing psychopathology, and suicidal ideation, in adolescence. Phasic irritability was independently associated with concurrent parent‐reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting styles and practices, and externalizing disorders at age 6, and predicted higher rates of externalizing psychopathology in adolescence. Conclusions Tonic and phasic irritability in 6‐year‐old children appear to be distinguishable constructs with different temperament and parenting correlates and psychopathological outcomes. Distinguishing these components has implications for research on the etiology and pathophysiology of irritability and developing effective treatments.

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

“…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). While there is some evidence for tonic (mood) versus phasic (outburst) components in older children (i.e., early school age through adolescence; Zhang et al., in press; Silver et al., 2023; Silver et al., 2021), any such distinctions are attenuated in younger children (preschool age; Silver et al., 2022). Indeed, our work on infant/toddlers shows irritability behaviors to lie on a single dimension (Krogh‐Jespersen et al., 2021).…”

A network approach to the investigation of childhood irritability: probing frustration using social stimuli

“…In order to characterize the normative temperamental and clinical features of the sample, parents/guardians of the participants completed two measures: the Child Behavior Questionnaire -Short Form (CBQ; Putnam & Rothbart, 2006) and the Multidimensional Assessment Profiles (MAPS; Krogh-Jespersen et al, 2022;Zhang et al, 2023). The anger/ frustration subscale of the CBQ is six items and was used as a measure of irritable temperament, consistent with previous studies (Fishburn et al, 2019;Karim & Perlman, 2017;Silver et al, 2023). Example items from the subscale include "Gets frustrated when prevented from doing something s/he wants to do" and "Gets angry when s/he can't find something s/he wants to play with".…”

Irritability in Youths: A Critical Integrative Review

“…It is important to test whether interventions targeting irritability reduce suicidality and other clinical problems e.g., substance abuse, and to study mechanistic links between irritability and depression. Further research is warranted on longitudinal outcomes of tonic and phasic irritability (29,80), including mechanisms mediating those predictions. Given high correlations between tonic and phasic irritability, large samples will be needed.…”