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.

Download full-text


Available from: Daniel S Pine, Dec 16, 2013
  • Source
    • "DMDD at age six also predicted a greater likelihood of using psychological (outpatient psychosocial and pharmacological) and educational services, and the association with later educational services persisted after accounting for all age six psychiatric disorders. The link between DMDD and academic problems is consistent with longitudinal findings demonstrating that DMDD and chronic irritability in older youth predicted lower educational attainment in adults (Copeland et al., 2014;Stringaris et al., 2009). Studies have found that children with SMD perform poorly on tasks of cognitive flexibility (Adleman et al., 2011;Leibenluft & Stoddard, 2013); this may contribute to the educational problems observed in children with DMDD. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Little is known about the predictive validity of disruptive mood dysregulation disorder (DMDD). This longitudinal, community-based study examined associations of DMDD at the age of 6 years with psychiatric disorders, functional impairment, peer functioning and service use at the age of 9 years. Method: A total of 473 children were assessed at the ages of 6 and 9 years. Child psychopathology and functional impairment were assessed at the age of 6 years with the Preschool Age Psychiatric Assessment with parents and at the age of 9 years with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. At the age of 9 years, mothers, fathers and youth completed the Child Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders, and teachers and K-SADS interviewers completed measures of peer functioning. Significant demographic covariates were included in all models. Results: DMDD at the age of 6 years predicted a current diagnosis of DMDD at the age of 9 years. DMDD at the age of 6 years also predicted current and lifetime depressive disorder and attention-deficit/hyperactivity disorder (ADHD) at the age of 9 years, after controlling for all age 6 years psychiatric disorders. In addition, DMDD predicted depressive, ADHD and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive symptoms on the CDI, after controlling for the corresponding symptom scale at the age of 6 years. Last, DMDD at the age of 6 years predicted greater functional impairment, peer problems and educational support service use at the age of 9 years, after controlling for all psychiatric disorders at the age of 6 years. Conclusions: Children with DMDD are at high risk for impaired functioning across childhood, and this risk is not accounted for by co-morbid conditions.
    Full-text · Article · Jan 2016 · Psychological Medicine
  • Source
    • "Second, as will also be detailed below, youth with chronic irritability have deficits in labeling face emotions. Finally, chronic, severe irritability in youth shares concurrent, longitudinal, and genetic associations with depression and anxiety (Brotman et al. 2006; Stringaris et al. 2009; Leibenluft 2011; Copeland et al. 2014; Stringaris et al. 2014; Savage et al. 2015) for which interpretation biases of ambiguous cues are established targets for cognitive bias modification training (Hallion and Ruscio 2011; MacLeod and Mathews 2012). HIB has been associated with irritability-related phenomena such as dispositions toward anger (Wilkowski and Robinson 2010) and verbally or physically aggressive reactions (Crick and Dodge 1996; Orobio de Castro et al. 2002). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Irritability in disruptive mood dysregulation disorder (DMDD) may be associated with a biased tendency to judge ambiguous facial expressions as angry. We conducted three experiments to explore this bias as a treatment target. We tested: 1) whether youth with DMDD express this bias; 2) whether judgment of ambiguous faces can be altered in healthy youth by training; and 3) whether such training in youth with DMDD is associated with reduced irritability and associated changes in brain function. Methods: Participants in all experiments made happy versus angry judgments of faces that varied along a happy to angry continuum. These judgments were used to quantify a "balance point," the facial expression at which a participant's judgment switches from predominantly happy to predominantly angry. We first compared balance points in youth with DMDD (n = 63) versus healthy youth (n = 26). We then conducted a double-blind, randomized controlled trial of active versus sham balance-point training in 19 healthy youth. Finally, we piloted open, active balance-point training in 14 youth with DMDD, with 10 completing an implicit functional MRI (fMRI) face-emotion processing task. Results: Relative to healthy youth, DMDD youth manifested a shifted balance point, expressed as a tendency to classify ambiguous faces as angry rather than happy. In both healthy and DMDD youth, active training is associated with a shift in balance point toward more happy judgments. In DMDD, evidence suggests that active training may be associated with decreased irritability and changes in activation in the lateral orbitofrontal cortex. Conclusions: These results set the stage for further research on computer-based treatment targeting interpretation bias of angry faces in DMDD. Such treatment may decrease irritability and alter neural responses to subtle expressions of happiness and anger.
    Full-text · Article · Jan 2016 · Journal of Child and Adolescent Psychopharmacology
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous research suggests that the symptoms of oppositional defiant disorder (ODD) reflect both a general diagnostic construct and two distinct symptom dimensions, irritability and defiant behavior. Recent studies have found that these two symptom dimensions exhibit different patterns of correlates and outcomes (e.g., irritability linked to depressive symptoms, defiant behavior linked to conduct problems). The present study investigated common and unique correlates of the irritable and defiant dimensions of ODD symptoms in a sample of 706 school-age children (49 % female, ages 5–12) in grades K-5. Classroom teachers rated their students’ ODD symptoms, proactive and reactive aggression, relational and physical aggression and victimization, withdrawn/depressed symptoms, peer rejection, and academic performance. Multilevel regression models—controlling for grade level, gender, and shared variance between symptom dimensions and variable subtypes—showed that teacher-reported irritability and defiant behavior exhibit common correlates of physical and relational aggression, relational victimization, and peer rejection. With respect to differential correlates, irritability was uniquely associated with physical victimization and withdrawn/depressed symptoms, whereas defiant behavior was uniquely associated with proactive aggression and hyperactive–impulsive symptoms. Further, reactive aggression was more strongly linked to irritability than to defiant behavior. These findings provide further support for a multidimensional conceptualization of ODD symptoms within the school context and suggest that irritability and defiant behavior have important implications across several domains of children’s social–emotional development.
    Full-text · Article · Nov 2015 · School Mental Health
Show more