Journal of the American Academy of Child & Adolescent Psychiatry
New researchClinical Implications of a Dimensional Approach: The Normal:Abnormal Spectrum of Early Irritability
Section snippets
Participants
The Multidimensional Assessment of Preschoolers (MAPS) Study includes a large, diverse sample of preschoolers recruited from the waiting rooms of multiple pediatric clinics in a large urban area of the United States. This unselected sample (N = 1,857) was seen only at baseline and is the sample on which the psychometric modeling of the Temper Loss scale is based.15 The primary analytic sample for the present study is an intensive subsample of this MAPS pediatric cohort (n = 497), which was
Convergent/Divergent Validity
Temper loss was associated in expected directions with convergent and divergent measures. Temper Loss correlated with preschoolers’ composite irritability symptoms scores (β = .52, p < .0001) and maternal PROMIS anger scores (β = 0.37, p < .0001). It was also associated with poorer response reversal on the Candy Game (β = −0.11, p < .05). Specifically, higher Temper Loss scores were associated with greater decrements in Candy Game performance after the rule switch, signifying poorer capacity to
Discussion
Dimensional measurement of irritability has added value for short-term longitudinal prediction of clinical outcomes and impairment in early childhood and is associated with theorized correlates. It is evident from these data that clinical risk is not an “either/or” phenomenon, and that children well below traditional clinical cut-points are at substantial clinical risk. Extreme (and sometimes arbitrary) cut-points may sacrifice important information by lumping together children below the
References (40)
- et al.
Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions
J Am Acad Child Adolesc Psychiatry
(2009) - et al.
Temper tantrums in healthy versus depressed and disruptive preschoolers: defining tantrum behaviors associated with clinical problems
J Pediatr
(2008) - et al.
Preschool irritability: longitudinal associations with psychiatric disorders at age 6 and parental psychopathology
J Am Acad Child Adolesc Psychiatry
(2013) - et al.
The test-retest reliability of the Preschool Age Psychiatric Assessment (PAPA)
J Am Acad Child Adolesc Psychiatry
(2006) - et al.
DSM-IV symptoms in community and clinic preschool children
J Am Acad Child Adolesc Psychiatry
(2001) - et al.
Long-term consistency in speech/language profiles: II. Behavioral, emotional, and social outcomes
J Am Acad Child Adolesc Psychiatry
(1996) Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths
Am J Psychiatry
(2011)- et al.
Adolescent irritability: phenotypic associations and genetic links with depressed mood
Am J Psychiatry
(2012) - et al.
Delineating the structure of normal and abnormal personality: an integrative hierarchical approach
J Pers Soc Psychol
(2005) - et al.
Anger and irritability
“Ain’t misbehavin”: towards a developmentally-specified nosology for preschool disruptive behavior
J Child Psychol Psychiatry
Putting theory to the test: added value of a multidimensional, developmentally-sensitive approach to disruptive behavior in early childhood
J Am Acad Child Adolesc Psychiatry
Defining the developmental parameters of temper loss in early childhood: implications for developmental psychopathology
J Child Psychol Psychiatry
Advancing a multidimensional, developmental spectrum approach to preschool disruptive behavior
J Am Acad Child Adolesc Psychiatry
The development of self-regulation in the first four years of life
Child Dev
Developmental trajectories of irritability and bidirectional associations with maternal depression
J Am Acad Child Adolesc Psychiatry
Punishment insensitivity in early childhood: a developmental, dimensional approach
J Abnormal Child Psychology
Comparative fit indexes in structural models
Psychology
A reliability coefficient for maximum likelihood factor analysis
Pschometrika
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This article was reviewed under and accepted by ad hoc editor Shelli Avenevoli, PhD.
Drs. Wakschlag, Estabrook, Henry, Voss, and Briggs-Gowan were supported by National Institute of Mental Health grants R01MH082830, UO1MH090301, and 2U01MH082830, and Dr. Perlman was supported by K01MH094467. Dr. Wakschlag was also supported by the Walden and Jean Young Shaw Foundation.
Dr. Estabrook served as the statistical expert for this research.
Drs. Wakschlag and Estabrook contributed equally to the article.
The authors thank Alice Carter, PhD, University of Massachusetts-Boston, Patrick Tolan, PhD, University of Virginia, Carri Hill, PhD, Jewish Children and Family Services, and Barbara Danis, PhD, Family Institute, for their contributions to the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB). This study would not have been possible without the outstanding efforts of Jacqueline Kestler, MPH, Erica Anderson, PhD, of Northwestern University, and their dedicated team, and the generous participation of the Multidimensional Assessment of Preschoolers (MAPS) Study families. The authors also thank the pediatric clinics and participants from Rush University, the University of Illinois at Chicago, NorthShore University HealthSystem, North Suburban Pediatrics, and the following pediatric research group practices for their participation: Healthlinc in Valparaiso, IN, Healthlinc in Michigan City, IN, and Associated Pediatricians in Valparaiso, IN.
Disclosure: Drs. Wakschlag, Estabrook, Petitclerc, Henry, Perlman, Voss, Pine, Leibenluft, Briggs-Gowan, and Mr. Burns report no biomedical financial interests or potential conflicts of interest.