Adult Outcomes of Youth Irritability: A 20-Year Prospective Community-Based Study

Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Mood and Anxiety Program, NIMH Bldg. 15K, MSC-2670, Bethesda, MD 20892-2670,USA.
American Journal of Psychiatry (Impact Factor: 12.3). 08/2009; 166(9):1048-54. DOI: 10.1176/appi.ajp.2009.08121849
Source: PubMed


Irritability is a widely occurring DSM-IV symptom in youths. However, little is known about the relationship between irritability in early life and its outcomes in mid-adulthood. This study examines the extent to which youth irritability is related to adult psychiatric outcomes by testing the hypothesis that it predicts depressive and generalized anxiety disorders.
The authors conducted a longitudinal community-based study of 631 participants whose parents were interviewed when participants were in early adolescence (mean age=13.8 years [SD=2.6]) and who were themselves interviewed 20 years later (mean age=33.2 years [SD=2.9]). Parent-reported irritability in adolescence was used to predict self-reported psychopathology, assessed by standardized diagnostic interview at 20-year follow-up.
Cross-sectionally, irritability in adolescence was widely associated with other psychiatric disorders. After adjustment for baseline emotional and behavioral disorders, irritability in adolescence predicted major depressive disorder (odds ratio=1.33, 95% confidence interval [CI]=1.00-1.78]), generalized anxiety disorder (odds ratio=1.72, 95% CI=1.04-2.87), and dysthymia (odds ratio=1.81, 95% CI=1.06-3.12) at 20-year follow-up. Youth irritability did not predict bipolar disorder or axis II disorders at follow-up.
Youth irritability as reported by parents is a specific predictor of self-reported depressive and anxiety disorders 20 years later. The role of irritability in developmental psychiatry, and in the pathophysiology of mood and anxiety disorders specifically, should receive further study.

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    • "Given that reactive aggression is linked to emotional and social problems (Fite et al., 2012; Vitaro & Brendgen, 2012) and shares commonalities with irritability (e.g., losing temper), a link between reactive aggression and irritability seems likely. Conversely, proactive aggression and defiant/hurtful behavior are both linked to conduct problems (Fite et al., 2012; Stringaris & Goodman, 2009a, b; Vitaro & Brendgen, 2012) and represent a form of deliberate externalizing behavior; thus, an association between defiant behavior and proactive aggression seems likely. In contrast, extant evidence does not suggest clear hypotheses regarding ODD dimensions in relation to forms of aggression (relational/physical), forms of victimization (relational/physical), and peer rejection. "

    School Mental Health 11/2015; DOI:10.1007/s12310-015-9163-y
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    • "Other aspects of ED differentiate disorders from one another. For example, chronic irritability predicts major depressive disorder (MDD), dysthymia , and GAD but not BD (Stringaris et al. 2009). Similarly, heightened emotion intensity differentiates GAD from SAD. "
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    ABSTRACT: Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527–551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.
    Clinical Child and Family Psychology Review 08/2015; 18(3). DOI:10.1007/s10567-015-0187-5 · 4.75 Impact Factor
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    • "Other aspects of ED differentiate disorders from one another. For example, chronic irritability predicts major depressive disorder (MDD), dysthymia , and GAD but not BD (Stringaris et al. 2009). Similarly, heightened emotion intensity differentiates GAD from SAD. "

    Clinical Child and Family Psychology Review 08/2015; · 4.75 Impact Factor
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May 28, 2014