Editorial: Roads Less Traveled: New Directions for Novel Outcomes in Youth Irritability Research

Road metaphors are ubiquitous in youth mental health. Developmental psychopathology research is described in terms of pathways, trajectories, cascades, and transitions. Children's behavioral concerns are discussed as warning signs and rough spots. Although these metaphors have long been useful abstractions, modern quantitative methods and large-scale longitudinal studies have made it possible to empirically investigate the "roads" traveled by individuals across development. One goal here is to chart the paths most often followed by different subgroups of youth. Another goal involves surveying variables that nudge children toward (or away from) psychopathology and other key outcomes. These 2 goals-finding trajectories and predictors thereof-have important implications for research, intervention, and policy; and some of the most important studies, in our view, accomplish both

Transdiagnostic Treatment Models for Child and Adolescent Anxiety Disorders

This chapter discussed transdiagnostic treatment models for child and adolescent anxiety disorders. The chapter begins with a discussion of the issues of a “disorder-specific” approach to treatment, specifically with youth samples with anxious features. Evidence for transdiagnostic mechanisms in these populations is discussed. Future directions are highlighted

Future Directions in Youth Irritability Research

Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the "whats") for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability's phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the "hows") that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth

Longitudinal Associations Between Peer Victimization and Emotional Difficulties in Schoolchildren: The Role of Sleep Quality

Children who are victimized by their peers are at increased risk of developing emotional difficulties and disorders (e.g., mental health diagnoses); conversely, children experiencing emotional difficulties may also be more likely to experience peer victimization. Sleep quality could serve as a protective buffer or risk factor in these longitudinal associations. In the present study, we examined bidirectional pathways between peer victimization and emotional difficulties, testing sleep quality as a potential moderator. Children (N = 293 ages 8-11; 52% girls) in grades 3-5 completed measures of emotional difficulties (anxiety, depression, irritability, emotion coping, and emotion dysregulation), peer victimization, and sleep quality in the fall (T1) and spring (T2) semesters of one school year. Path models, controlling for covariates and stabilities, showed that peer victimization at T1 predicted higher levels of anxiety, depression, irritability, and poor emotion coping at T2. Sleep quality moderated one path: the link between T1 peer victimization and T2 emotion dysregulation, which was positive and significant only among those with high sleep quality; those with low sleep quality at T1 showed moderate levels of dysregulation irrespective of victimization. Longitudinal paths from T1 emotional difficulties to T2 victimization were all nonsignificant. Model results were not moderated by grade or gender. Overall, results support the unidirectional conclusion that peer victimization contributes to various forms of emotional difficulties, but not vice versa. Sleep quality is relevant as a moderator, underscoring the need for further research. Findings suggest implications for prevention and intervention efforts to promote social-emotional development in school settings

Toward greater specificity in the nonspecific: Estimating the prevalence of diagnostic irritability and sleep symptoms in adolescents

The Diagnostic and Statistical Manual of Mental Disorders (DSM) descriptive criterial approach to diagnosis has been criticized for contributing to comorbidity, heterogeneity within conditions, and nonspecificity across conditions. Much research has examined comorbidity and heterogeneity, but less is known about nonspecificity. Here, we examined two nonspecific symptoms: irritability and sleep disturbance. Both are common, clinically significant, and appear in several DSM disorder criteria sets, but their transdiagnostic prevalence is unknown. Leveraging a nationally representative epidemiological study of adolescents (n = 10,148; ages = 13–18), we first identified all instances where irritability or sleep disturbance appears in DSM-5-TR criteria for bipolar, depressive, anxiety, traumatic stress, or disruptive/impulse-control disorders; then found their DSM-IV equivalents in study variables; and finally estimated their prevalence individually and cumulatively across categories. Weighted lifetime prevalence estimates were 79.5% (95% CI [77.8, 81.2]) for irritability and 60.8% [58.7, 62.9] for sleep disturbance. Associations with age and gender were significant but small. Most youth reported multiple symptoms of irritability (weighted M = 3.04, Mdn = 2) and at least one symptom of sleep disturbance (weighted M = 1.61, Mdn = 1). Both problems were extremely common among individuals with specific disorders but were underestimated by the criteria for those conditions. Results suggest that the high prevalence of DSM-defined irritability and sleep problems may be obfuscated by these symptoms being scattered across diagnostic entities. There is a need for more research on assessing, treating, and understanding problems related to irritability and sleep in their own right, cutting across, rather than confined to, particular diagnoses. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Source: journal abstract

Irritability and Suicidality in Clinically Referred Youth: Clarifying the Link by Examining the Roles of Age and Hope

Research has found an association between irritability and suicidal thoughts and behaviors (STB) in children and adolescents, but the overall evidence has been mixed and the nature of this association remains unclear. In this study, we investigated whether the link between irritability and STB might be more pronounced among older youth and those with lower levels of hope. Participants were 142 children and adolescents (ages 6-18) referred for mental health services at a university outpatient clinic. At intake, clinicians administered self-report measures assessing irritability, STB, hope, and depression. Multiple regression models with robust maximum likelihood estimation were used to test irritability's association with STB, as well as age and hope as moderators. Irritability, hope, and age all showed significant associations with STB. Further, hope and age moderated the associations between irritability and STB; specifically, the link between irritability and STB was evident only at older ages (among adolescents, not children) and only at lower levels of hope. These findings are consistent with the view that hope may be a protective factor, and adolescence a vulnerability factor, in the association between irritability and STB. Results may help explain previous mixed findings on this association while also underscoring the role of irritability as a risk factor. Further research is warranted to better understand irritability and hope as transdiagnostic mechanisms in STB from childhood through adulthood, and through other informants and methods

Evidence-Based Assessment of DSM -5 Disruptive, Impulse Control, and Conduct Disorders

The assessment of oppositional defiant disorder, conduct disorder, antisocial personality disorder, and intermittent explosive disorder—the Disruptive, Impulse Control and Conduct Disorders—can be affected by biases in clinical judgment, including overestimating concerns about distinguishing symptoms from normative behavior and stigma associated with diagnosing antisocial behavior. Recent nosological changes call for special attention during assessment to symptom dimensions of limited prosocial emotions and chronic irritability. The present review summarizes best practices for evidence-based assessment of these disorders and discusses tools to identify their symptoms. Despite the focus on disruptive behavior disorders, their high degree of overlap with disruptive mood dysregulation disorder can complicate assessment. Thus, the latter disorder is also included for discussion here. Good practice in the assessment of disruptive behavior disorders involves using several means of information gathering (e.g., clinical interview, standardized rating scales or checklists), ideally via multiple informants (e.g., parent-, teacher-, and self-report). A commitment to providing a full and accurate diagnostic assessment, with careful and attentive reference to diagnostic guidelines, will mitigate concerns regarding biases

Brief Transdiagnostic Intervention for Parents With Emotional Disorder Symptoms During the COVID-19 Pandemic: A Case Example

•Caregivers with children at home are especially vulnerable to COVID-19-related stress.•Developed a 4-session cognitive-behavioral intervention for parent emotional distress during COVID-19.•Case example describes intervention components and implementation methods.•Preliminary results show improved psychopathology and emotion regulation. Concerns regarding parent mental health and well-being during the COVID-19 pandemic are justifiably on the rise. Although anxiety, depression, and traumatic stress levels have risen precipitously across all demographics during the pandemic, parents residing with their children are under particular and unique strain. Caregivers with children in the home are responsible not only for their own health, financial security, and safety during this time, but often full-time caregiving, household management and, in many cases, their children’s schooling. In this case paper, we describe the development of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Caregivers (UP-Caregiver) and provide a case example of its implementation. This 4-session indicated prevention for caregivers is a modification of existing versions of the Unified Protocols for adults and children, modified to maximize its responsiveness to issues faced by parents and caregivers living with youth (ages 6–13) during the current pandemic. UP-Caregiver was offered as part of a randomized, controlled trial via telehealth in a small group format to any parent with a child in the specified age range with mild or greater anxiety, depression or traumatic stress symptoms during an initial screening. The case example provided is of a White, Hispanic mother with a range of self-reported emotional disorder concerns at an initial assessment. Declines in anxiety, depression and traumatic stress symptoms were all noted, as well as improvements in parenting self-efficacy and distress tolerance 6-weeks after initiating UP-Caregiver. An ongoing randomized, controlled trial of UP-Caregiver will further evaluate the utility and feasibility of this approach to alleviate parental distress during COVID-19

Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth

Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents.We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3-18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability.Overall, 68 instruments met criteria for inclusion, with scales covering irritability (= 15), anger (= 19), aggression (= 45), and/or general overt externalizing problems (= 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized.Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth