Identifying Clinically Salient Irritability in Adolescents and Understanding Key Differences in Parent and Child-Reported Irritability

• In Event: MAPping Emotional and Behavioral Dysregulation in Youth

Abstract

Objective: Currently, most measures of irritability are entrusted to the parent to report on their child’s behaviors; however, prior research has found that as children become older, they are increasingly better reporters on their behaviors. Additionally, there have been recent advancements in developmentally sensitive measurement which have led to stronger differentiation of normative and severe irritability, and clinical applications of these measurements are burgeoning in necessity. Using a previously developed and optimized model of clinically salient irritable behaviors in adolescents, the authors empirically derived a cutoff in relation to DSM irritability related syndromes (i.e. oppositional defiant disorder, disruptive mood dysregulation disorder, other depressive disorders) and tested the validity of the cutoff with youth quality of life. Cutoff scores were developed using both parent and child-report measures to develop unique screening tools specifically for parent and child-reported irritability and to discover if children can be reliable reporters of irritability and perhaps provide more context to their irritable behaviors.
Method: Adolescents aged 12-17 years old and their parents (N= 80; mean age= 13.4 years) participated in a follow-up study for when these children were initially 5-10 years old and were sampled for severe temper outbursts and ADHD. Both parent (mother) and child (adolescent) reports were collected to measure irritability using the developmentally validated Multidimensional Assessment of Profile of Disruptive Behavior (MAP-DB) and to measure impairment using the Affective Reactivity Index (ARI). The Youth Quality of Life instrument was collected as a child-report measure to ascertain overall youth quality of life, and the Kiddie Schedule for Affective Disorders and Schizophrenia was conducted with parents to obtain participant diagnoses of DSM Irritability Related Syndromes (oppositional defiant disorder, disruptive mood dysregulation disorder, major depressive disorder, and persistent depressive disorder.)
Results: Overall, children reported more irritable behaviors than parents, while parents reported slightly more impairment than children. Of 22 MAP-DB Temper-Loss behaviors, 2 behaviors in the parent-reported MAP-DB (“frustrated easily” and “extremely angry”) were most predictive of parent reported impairment. Of the same 22 behaviors, the child-reported MAP-DB revealed 2 different behaviors (“hit/shove/kick when lost temper” and “trouble calming down when angry”) to be uniquely related to child reported impairment. Both the parent-reported and child-reported irritability items shown to predict impairment identified diagnostic status (oppositional defiant disorder, disruptive mood dysregulation disorder, other depressive disorders) with good sensitivity (parent-report: 82%; child-report: 73%) and specificity (parent-report: 74%; child-report: 75%). Parent and child-reported irritability scores above the clinically optimized cutoff indicated lower youth quality of life. However, when accounting for the total scores of the MAP-DB Temper-Loss Scale, child-report was a better predictor of youth quality of life than parent-report.
Conclusion: Clinical identification of adolescent irritability can be improved with the use of developmentally optimized screening tools, and including child-reported irritability along with parent-report measures may be quintessential to understanding the entire scope of the child’s irritability, impairment, and overall quality of life. An important direction for further research is to apply these findings to both children and parents in intervention settings.

Authors

• Nathan Kirk
  Presenting Author

• Emily Hirsch, Fordham University

• Tasmia Tasnim Alam, San Diego State University

• Amy Krain Roy, Fordham University

• Jillian Lee Wiggins

• Lauren S Wakschlag, Northwestern University