The effects of verbal information and approach-avoidance training on children's fear-related responses.

BACKGROUND AND OBJECTIVES This study examined the effects of verbal information and approach-avoidance training on fear-related cognitive and behavioural responses about novel animals. METHODS One hundred and sixty children (7-11 years) were randomly allocated to receive: a) positive verbal information about one novel animal and threat information about a second novel animal (verbal information condition); b) approach-avoidance training in which they repeatedly pushed away (avoid) or pulled closer (approach) pictures of the animals (approach-avoidance training), c) a combined condition in which verbal information was given prior to approach-avoidance training (verbal information + approach-avoidance training) and d) a combined condition in which approach-avoidance training was given prior to verbal information (approach-avoidance training + verbal information). RESULTS Threat and positive information significantly increased and decreased fear beliefs and avoidance behaviour respectively. Approach-avoidance training was successful in training the desired behavioural responses but had limited effects on fear-related responses. Verbal information and both combined conditions resulted in significantly larger effects than approach-avoidance training. We found no evidence for an additive effect of these pathways. LIMITATIONS This study used a non-clinical sample and focused on novel animals rather than animals about which children already had experience or established fears. The study also compared positive information/approach with threat information/avoid training, limiting specific conclusions regarding the independent effects of these conditions. CONCLUSIONS The present study finds little evidence in support of a possible causal role for behavioural response training in the aetiology of childhood fear. However, the provision of verbal information appears to be an important pathway involved in the aetiology of childhood fear

Mood dysregulation

The publication of the DSM-5 is nearing, yet a debate continues about the boundaries of bipolar disorder (BP) in children and adolescents. This article focuses on two key components of this debate that are often treated under the collective term mood dysregulation: the first is chronic irritability (and the proposed DSM-5 category of disruptive mood dysregulation disorder) and the other concerns short episodes of mania-like symptoms. We update our previous review [Stringaris in Eur Child Adolesc Psychiatry 20(2):61–66, 2011] and also present relevant neurobiological evidence. Most findings so far suggests that chronic, severe irritability is not a developmental presentation of mania. The diagnostic status of brief duration hypomania is less clear, with some evidence in support of its clinical relevance to BP. We end with recommendations for future research to inform classification and treatment

Irritability in boys with autism spectrum disorders:an investigation of physiological reactivity

BACKGROUND: Irritability in people with autism spectrum disorders (ASD) is common and impairing, yet its mechanisms remain understudied. We investigated symptom reporting and mechanisms of irritability in ASD, focusing on the relation between irritability and physiological stress responses. METHODS: Forty‐seven unmedicated boys with high‐functioning ASD (hfASD) and 23 typically developing boys aged 10–16 years completed a psychosocial stress test. Changes in cortisol, heart rate and heart rate variability throughout the test were recorded. Self‐ and parent‐reported measures of irritability were obtained. Irritability symptom reporting in the hfASD group was compared to two groups of boys without ASD: highly irritable boys (severe mood dysregulation, SMD; n = 40) and healthy‐control boys (HC; n = 30). RESULTS: Boys with hfASD scored significantly higher on irritability than HC boys, and they reported a pattern of irritability symptoms closely resembling that of boys with SMD. The internal consistency of irritability in hfASD was high by parent‐ and self‐report. Although boys with hfASD showed significant stress‐induced changes in cortisol and heart rate, those who rated themselves as highly irritable had lower cortisol levels throughout the test compared to those low on irritability. Participants rated as highly irritable by their parents showed blunted cortisol and heart rate responses to stress. The effects of irritability on heart rate, but not cortisol, were accounted for by trait anxiety. CONCLUSIONS: Irritability can be measured reliably in hfASD and is associated with distinct biological responses to stress