Irritability in Youths: A Critical Integrative Review.

Irritability, defined as proneness to anger that may impair an individual's functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps.

Novel Assessment of the Impact of Irritability on Physiological and Psychological Frustration Responses in Adolescents.

Objective: Irritability, typically defined as a proneness to anger, particularly in response to frustration, falls at the intersection of emotion and disruptive behavior. Despite well-defined translational models, there are few convergent findings regarding the pathophysiology of irritability. Most studies utilize computer-based tasks to examine neural responses to frustration, with little work examining stress-related responding to frustration in social contexts.

An investigation of the neural basis of anger attributions in irritable youth.

Neurocognitive models of pediatric irritability suggest a prominent role of anger; however, few studies have investigated anger-related biases and their neural correlates. Resting state functional connectivity (rsFC) of the amygdala was examined in relation to anger attribution bias (AAB) in a sample of young children (5-9 years old; = 60; 55% White, 26.7% Hispanic) with clinically significant irritability characterized by impairing emotional outbursts (IEOs).

Characterizing the spectrum of irritability in preadolescence: Dimensional and pragmatic applications.

Objectives: Characterize the dimensional spectrum of preadolescent (PA) irritability, a robust transdiagnostic vulnerability marker, using the youth version of the Multidimensional Assessment Profiles Temper Loss (MAPS-TL-Youth) scale including common and with developmentally specific items. Based on this, derive and validate a clinically optimized irritability screener to flag psychopathology risk in preadolescents.

Methods: The normal:abnormal irritability spectrum was modeled using MAPS-TL-Youth data from the Multidimensional Assessment of Preschoolers Study (MAPS) Study PA wave (n = 340) via item response theory.

Review: Defining Positive Emotion Dysregulation: Integrating Temperamental and Clinical Perspectives.

Objective: Although emotion dysregulation has been defined as a maladaptive process of emotional experiences, there is no specific reference to the emotional valence of the dysregulation. To date, child psychiatry has focused primarily on dysregulation of negative affect. Here, we suggest that positive emotion dysregulation requires additional clinical and research attention.

Mediating role of the default mode network on parental acceptance/warmth and psychopathology in youth.

Humans are reliant on their caregivers for an extended period of time, offering numerous opportunities for environmental factors, such as parental attitudes and behaviors, to impact brain development. The default mode network is a neural system encompassing the medial prefrontal cortex, posterior cingulate cortex, precuneus, and temporo-parietal junction, which is implicated in aspects of cognition and psychopathology. Delayed default mode network maturation in children and adolescents has been associated with greater general dimensional psychopathology, and positive parenting behaviors have been suggested to serve as protective mechanisms against atypical default mode network development.

Measuring Emotion Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder: Revisiting the Factor Structure of the Emotion Regulation Checklist.

Emotion dysregulation (ED) is prevalent among youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and significantly impacts functioning. Nuanced measurement of ED is central to understanding its role in this disorder and informing treatment approaches. The present study examined the factor structure of the Emotion Regulation Checklist (ERC) among children with ADHD with and without Oppositional Defiant Disorder (ODD).

Understanding Phasic Irritability: Anger and Distress in Children's Temper Outbursts.

Pediatric irritability can be highly impairing and is implicated in adverse outcomes. The phasic component, characterized by temper outbursts, is a frequent impetus to seek treatment. This study tested whether a previously described anger-distress model of tantrums applies to an outpatient sample of school-age children with clinically impairing temper outbursts (TO; 5.

Editorial: A Call for Developmental Psychopathology Approaches to Diagnostic Nosology.

The publication of DSM-5 came with a number of significant advances, including shifts in disorder classifications and a new focus on dimensional assessment. It also introduced disruptive mood dysregulation disorder (DMDD), which was met with some criticism and concern. Although there was research to support the establishment of this new diagnosis aimed at improving classification of children and adolescents with persistent and impairing irritability, specific symptoms and definitions of frequency and impairment were not as empirically supported, and concerns arose regarding validity and reliability.

A Preliminary Investigation of the Effects of a Western Diet on Hippocampal Volume in Children.

Over the course of the 20th century, there has been a sharp increase in the consumption of saturated fat and refined sugars. This so-called "western diet" (WD) has been extensively linked to biological alterations and associated functional deficits in the hippocampus of animals. However, the effects of a WD on the human hippocampus are less well-characterized.

Heterogeneity of the Anxiety-Related Attention Bias: A Review and Working Model for Future Research.

The anxiety-related attention bias (AB) has been studied for several decades as a clinically-relevant output of the dynamic and complex threat detection-response system. Despite research enthusiasm for the construct of AB, current theories and measurement approaches cannot adequately account for the growing body of mixed, contradictory, and null findings. Drawing on clinical, neuroscience, and animal models, we argue that the apparent complexity and contradictions in the empirical literature can be attributed to the field's failure to clearly conceptualize AB heterogeneity and the dearth of studies in AB that consider additional cognitive mechanisms in anxiety, particularly disruptions in threat-safety discrimination and cognitive control.

Evidence of Altered Habenular Intrinsic Functional Connectivity in Pediatric ADHD.

The habenula is a small region in the epithalamus that contributes to the regulation of midbrain dopaminergic circuits implicated in attention-deficit hyperactivity disorder (ADHD). This investigation aims to evaluate the intrinsic functional connectivity (iFC) of the habenula in children with ADHD. A total of 112 children (5-9 years; 75 ADHD, 37 healthy comparisons) completed anatomical and resting-state functional magnetic resonance imaging (MRI) scans.

The Contribution of Sensory Sensitivity to Emotional Lability in Children with ADHD Symptoms.

Emotional lability and sensory sensitivity have been shown to contribute to the overall clinical picture in children with attention deficit hyperactivity disorder (ADHD; Dunn & Bennett, 2002; Sobanski et al., 2010). Further, both of these characteristics have been individually demonstrated to contribute to poorer quality of life, increased functional impairment, and poorer treatment response (Anastopoulos et al.

Parental Responses to Temper Outbursts in Children With ADHD: The Role of Psychological Factors.

Children with ADHD frequently exhibit temper outbursts (TO). One related factor may be parental responses, such as harsh discipline and accommodation. This study tests the hypotheses that these responses will be associated with greater TO, and parental characteristics of higher anger and lower sense of competence, in children with ADHD.

Altered intrinsic functional connectivity of the cingulate cortex in children with severe temper outbursts.

Severe temper outbursts (STO) in children are associated with impaired school and family functioning and may contribute to negative outcomes. These outbursts can be conceptualized as excessive frustration responses reflecting reduced emotion regulation capacity. The anterior cingulate cortex (ACC) has been implicated in negative affect as well as emotional control, and exhibits disrupted function in children with elevated irritability and outbursts.

Disruptive Mood Dysregulation Disorder (DMDD): An RDoC perspective.

In recent years, there has been much debate regarding the most appropriate diagnostic classification of children exhibiting emotion dysregulation in the form of irritability and severe temper outbursts. Most recently, this has resulted in the addition of a new diagnosis, Disruptive Mood Dysregulation Disorder (DMDD) in the DSM 5. The impetus for including this new disorder was to reduce the number of diagnoses that these children would typically receive; however, there is concern that it has only complicated matters rather than simplifying them.

Disruptive Mood Dysregulation Disorder: A New Diagnostic Approach to Chronic Irritability in Youth.

(Reprinted from the 2014; 171:918-924 with permission from American Psychiatric Association Publishing).

Neural Correlates of Aggression in Medication-Naive Children with ADHD: Multivariate Analysis of Morphometry and Tractography.

Aggression is widely observed in children with attention deficit/hyperactivity disorder (ADHD) and has been frequently linked to frustration or the unsatisfied anticipation of reward. Although animal studies and human functional neuroimaging implicate altered reward processing in aggressive behaviors, no previous studies have documented the relationship between fronto-accumbal circuitry-a critical cortical pathway to subcortical limbic regions-and aggression in medication-naive children with ADHD. To address this, we collected behavioral measures and parental reports of aggression and impulsivity, as well as structural and diffusion MRI, from 30 children with ADHD and 31 healthy controls (HC) (mean age, 10±2.

A Critical Review of Attentional Threat Bias and Its Role in the Treatment of Pediatric Anxiety Disorders.

Threat bias, or exaggerated selective attention to threat, is considered a key neurocognitive factor in the etiology and maintenance of pediatric anxiety disorders. However, upon closer examination of the literature, there is greater heterogeneity in threat-related attentional biases than typically acknowledged. This is likely impacting progress that can be made in terms of interventions focused on modifying this bias and reducing anxiety, namely attention bias modification training.

The neural correlates of emotional face-processing in adolescent depression: a dimensional approach focusing on anhedonia and illness severity.

Deficits in emotion processing, a known clinical feature of major depressive disorder (MDD), have been widely investigated using emotional face paradigms and neuroimaging. However, most studies have not accounted for the high inter-subject variability of symptom severity. Similarly, only sparse research has focused on MDD in adolescence, early in the course of the illness.

Alterations in amygdala functional connectivity reflect early temperament.

Behavioral inhibition (BI) is a temperament identified early in life that is associated with increased risk for anxiety disorders. Amygdala hyperresponsivity, found both in behaviorally inhibited and anxious individuals, suggests that amygdala dysfunction may represent a marker of anxiety risk. However, broader amygdala networks have not been examined in individuals with a history of childhood BI.

Disruptive mood dysregulation disorder: a new diagnostic approach to chronic irritability in youth.

Disruptive mood dysregulation disorder (DMDD), a newcomer to psychiatric nosology, addresses the need for improved classification and treatment of children exhibiting chronic nonepisodic irritability and severe temper outbursts. In recent years, many of these children have been diagnosed with bipolar disorder, despite the lack of distinct mood episodes. This diagnostic practice has raised concerns, in part because of the escalating prescription of atypical antipsychotics.

Abnormal amygdala functional connectivity associated with emotional lability in children with attention-deficit/hyperactivity disorder.

Objective: A substantial proportion of children with attention-deficit/hyperactivity disorder (ADHD) also display emotion regulation deficits manifesting as chronic irritability, severe temper outbursts, and aggression. The amygdala is implicated in emotion regulation, but its connectivity and relation to emotion regulation in ADHD has yet to be explored. The purpose of this study was to examine the relationship between intrinsic functional connectivity (iFC) of amygdala circuits and emotion regulation deficits in youth with ADHD.

Uncovering putative neural markers of risk avoidance.

Risk avoidance is a hallmark of psychopathological conditions such as anxiety disorders. Yet few studies have examined its neural basis. The present work sought to identify the neural correlates of risk avoidance.

Relationship between cingulo-insular functional connectivity and autistic traits in neurotypical adults.

Objective: The Social Responsiveness Scale-Adult Version (SRS-A) measures autistic traits that are continuously distributed in the general population. Based on increased recognition of the dimensional nature of autistic traits, the authors examined the neural correlates of these traits in neurotypical individuals using the SRS-A and established a novel approach to assessing the neural basis of autistic characteristics, attempting to directly relate SRS-A scores to patterns of functional connectivity observed in the pregenual anterior cingulate cortex, a region commonly implicated in social cognition.

Method: Resting state functional magnetic resonance imaging scans were collected for 25 neurotypical adults.