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Irritability in Children - Facial Emotion Study


Leibenluft: So one of the things that we’ve learned is that children who are irritable have difficulty identifying face emotions accurately. And in particular they have difficulty with what we call processing. They have difficulty processing angry faces.  When they look at angry faces, different things go on for them in terms of what they pay attention to – and in terms of how they’re brain responds to the angry face.  So, for example, children who are very irritable, if there’s an angry face, will tend to focus on it right away.  That’s actually true of children who are anxious also.  But its true of children who are irritable.  So an angry face really captures their attention.  The other thing we know is that if children look at ambiguous faces, faces that are created by morphing together happy faces and angry faces – so you have these faces that span from angry to happy and you mix them all up randomly.  Just mix up the order. And you ask people to tell you: Is this face angry or is this face happy? And these ambiguous faces, these faces in the middle, some of those faces that healthy kids will say are happy, the irritable kids will say that’s angry. OK.  And we also know that there are some parts of the brain that are more responsive to angry faces in irritable children than they are in non-irritable children.  So we can also see evidence of this at the brain level. So to use that knowledge to design and test a new treatment – what we’ve done is that we’ve done some preliminary work, some pilot work where we came up with a computer game that can be used to help change how irritable children view angry faces.  And we did a small study, an open study, looking to see if this might help.  If we change how irritable children view angry faces or ambiguous faces -- if we changed that -- perhaps they would become less irritable. And that did seem to work.  But it was a very early study. It didn’t have all the proper scientific controls in it.  So now what we’re doing is we’re doing a larger study and a more carefully controlled study to see if we can change how irritable children view these ambiguous faces.  And to change how they process angry faces.

One of the reasons we think these children are irritable is that they’re perceiving things in the world that are ambiguous that other children are perceiving in a more neutral or positive way – they’re perceiving in a more angry way. A more hostile way. And by training them to perceive neutral stimuli or ambiguous stimuli in a more positive way, they can take this with them into the real world and apply it to other situations with other people.

What we’ll do is we have them do this computer training and then we scan their brains before and after they do the training. The brain scanning is what’s called functional MRI. It doesn’t involve any needles or any radiation. It’s not painful at all and it’s very safe for children. We’ve done these kinds of studies with literally hundreds of children. Actually thousands of children have been studied internationally using these techniques. So they’re very safe.  So what we’re doing is we’re testing this new brain training treatment to see if we can have children become less irritable. At the same time we’re also developing cognitive behavioral treatment, which will also involve helping the child develop new strategies to deal with when they become frustrated.  And also help them to learn how to tolerate being frustrated to a greater degree than now – than they can currently.  So those are a number of the new kinds of psychotherapeutic brain training kinds of approaches that we’re developing to try help these children with this very impairing irritability that they have.