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Is the distinction between tonic and phasic irritability meaningful in 3-year-old children?

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Abstract

Irritability encompasses both normative misbehavior in early childhood and clinically significant problems across development. Recent studies have distinguished between tonic (i.e., persistently angry or grumpy mood) and phasic (i.e., temper tantrums or outbursts) forms of irritability and shown that they have different implications for psychopathology and functioning. However, data on this distinction in young (i.e., preschool aged) children are nonexistent. We utilized data from a longitudinal study of a community sample of 462 3-year-olds followed to age 15. We conducted confirmatory factor analysis (CFA) using items from a diagnostic interview and several parent-report inventories and examined concurrent and prospective associations with clinically relevant variables. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent-reported temperamental negative affectivity and surgency, and depressive and oppositional defiant (ODD) disorders, and predicted higher rates of disruptive behavior disorders (DBD) and suicidal behavior in later childhood and adolescence. Phasic irritability was independently associated with concurrent laboratory observations of child impulsivity, parent-reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting, and generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), and ODD, but it did not predict later psychopathology. Tonic and phasic irritability are separable in 3-year-old children, but their correlates and outcomes are not as distinct as in older youth. This may reflect the greater difficulty characterizing normative and pathological irritability in the preschool period.

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Acknowledgements

Support for this research was provided through NIMH R01 MH069942 (Klein) and the National Science Foundation Graduate Research Fellowship Program, Grant NSF 16-588 (Silver).

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Authors and Affiliations

  1. Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA

    Jamilah Silver & Daniel N. Klein

  2. University of Louisville, Louisville, USA

    Sara J. Bufferd

  3. University of Maryland, College Park, USA

    Lea R. Dougherty

  4. University of Connecticut, Connecticut, USA

    Brandon L. Goldstein

  5. Stony Brook University Medical Center, Stony Brook, NY, USA

    Gabrielle A. Carlson

Authors
  1. Jamilah Silver
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  2. Sara J. Bufferd
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  3. Lea R. Dougherty
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  4. Brandon L. Goldstein
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  5. Gabrielle A. Carlson
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  6. Daniel N. Klein
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Correspondence to Jamilah Silver.

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The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975. We obtained written consent from subjects.

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Silver, J., Bufferd, S.J., Dougherty, L.R. et al. Is the distinction between tonic and phasic irritability meaningful in 3-year-old children?. Eur Child Adolesc Psychiatry 32, 1755–1763 (2023). https://doi.org/10.1007/s00787-022-01995-8

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  • DOI: https://doi.org/10.1007/s00787-022-01995-8

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