Scaling and Identifying Clinically Significant Behaviors of Irritability in Preadolescence

• In Event: MAPping Emotional and Behavioral Dysregulation in Youth

Abstract

Introduction: Irritability, defined as a lowered threshold for experiencing anger in comparison to peers, is distributed on a normal:abnormal spectrum in youth, and when elevated, serves as one of the most frequent reasons for treatment referrals (Brotman et al., 2017; Dougherty et al., 2015). Despite its feature in numerous pediatric disorders and association with mood and anxiety disorders in adulthood, effective treatments are sparse, and little is known about its development during preadolescence (Sukhodolsky et al., 2016). Preadolescence is a developmentally challenging transitory phase when children are expected to accomplish many social and educational targets (Khan & Avan, 2020); thus, high levels of emotional problems at this age may be linked to more severe and chronic types of emotional disturbances (e.g., presence of irritability or an increase in it during preadolescence is associated with suicide, even when no symptoms of depression are present) (Breda & Ardizzone, 2021). It is, therefore, of grave importance to identify developmentally specific irritability manifestations to advance interventions for at-risk preadolescents.
The Multidimensional Assessment Profile of Disruptive Behavior Temper Loss (MAP-DB-TL) scale characterizes irritability along a severity spectrum within a developmental framework (Wakschlag et al., 2014; Wakschlag et al., 2012); this study equipped the MAP-DB-TL preadolescence version (MAP-DB-TL-PA) to model irritable behaviors along a severity spectrum and describe its pattern during preadolescence.
Objectives: The current study: 1) tested whether the data supported a unidimensional factor model and had one underlying latent construct, 2) characterized the common to severe manifestations of irritability during preadolescence, 3) identified clinically significant irritable behaviors at preadolescence, and 4) empirically derived a cutoff clinically optimized irritability score for DSM irritability related syndromes.
Methods: Data was collected from a diverse sample of 340 preadolescents (Mage = 9.30) who completed the MAP-DB-TL-PA scale. A confirmatory factor analysis was equipped to test factor modeling, a unidimensional item response theory was employed to model the severity continuum, a stepwise logistic regression was conducted to identify items that were most predictive of cross domain impairment, and the sum score of the MAP-DB-TL-PA items were used to derive the clinically optimized cutoff score for DSM irritability related syndromes.
Results: An excellent model fit of unidimensionality was indicated: χ2 (740) = 1242.087, p < .001, RMSEA = .045, TLI = .978, CFI = .979. Items varied across the spectrum from normative to severe manifestations, depending on their context, quality, and frequency. The MAP-DB-TL-PA items that were most predictive of cross domain impairments were: “become frustrated easily”, “yell angrily at someone”, and “lose temper or have a temper outburst to get something (s)he wanted.” A clinically optimized cutoff score of 3 (AUC = .90, p = <.001) was derived to be a sensitive (95%) and specific (74%) indicator of being diagnosed with DSM irritability-related syndromes.
Conclusion: The MAP-DB-TL-PA scale provided developmentally scaled irritability phenotypes in preadolescence, which will help distinguish clinically significant behaviors from normative ones. These optimized indicators will assist towards improving prediction for DSM irritability related syndromes and progress the development of early irritability treatment.

Authors

• Tasmia Tasnim Alam, San Diego State University
  Presenting Author

• Emily Hirsch, Fordham University

• Amanda Nili, Northwestern University

• Nathan Kirk

• Yudong Zhang, Northwestern University

• Amy Krain Roy, Fordham University

• Jillian Lee Wiggins

• Lauren S Wakschlag, Northwestern University