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Characterizing Childhood Irritability Across Ages and Stages

Science Update

The occasional meltdown is a common experience in childhood, as many parents and caregivers will attest. How frequent and intense these outbursts are, and the triggers that set them off, varies from child to child, reflecting differences in the trait of irritability. For example, some children seem primed to explode with anger and frustration in response to the slightest challenge or request. Others struggle to calm down once they're upset.

Most of the time, behavioral expressions of anger and frustration are considered normal, but research has shown that high levels of irritability can be an early predictor of later mental illness. So, how can families and health care providers tell if a child’s irritability is a cause for concern?

Researchers Lauren S. Wakschlag, Ph.D. , Jillian Lee Wiggins, Ph.D. , Amy K. Roy, Ph.D. , and colleagues tackled this challenge head-on by drawing on data from the Multidimensional Assessment of Preschoolers (MAPS) Study and other NIMH-funded studies. Through detailed analyses, the researchers capture expressions of irritability across developmental stages via a clinically relevant measurement tool: the MAPS Temper Loss Scale (MAPS-TL). Their findings are published in a series of papers in a special issue  of the International Journal of Methods in Psychiatric Research.

Establishing nuanced approaches to measurement

The special issue details efforts to adapt and validate the MAPS-TL so that it is applicable across a range of ages, from 12 months all the way up to 17 years. These age-specific versions of the MAPS-TL are designed to indicate whether a child's irritability differs from what's typical for their age and developmental stage. This developmental lens helps distinguish expected behaviors that are considered part of growing up (such as “the terrible twos”) from those that warrant clinical concern.

The research presented in the issue also expands the dimensional approach of the MAPS-TL. Rather than presenting irritability as a binary trait—something a child either has or doesn’t have—the MAPS-TL scale accounts for specific expressions of irritable behaviors and the frequency of these behaviors. The scale also accounts for situational context, such as whether the behaviors emerge with peers, parents, or other adults during moments of transition or seemingly out of the blue. The aim is to provide a nuanced understanding of a child’s behavior that reflects the dynamic nature of cognitive, social, and emotional development and the child’s ability to function in the world around them.

Validating measurement tools for real-world use

Importantly, the special issue focuses on translating these advances so they can be applied to real-world clinical practice. In several studies, the researchers demonstrated that brief versions of the MAPS-TL are both reliable and practical in clinical settings. These tools show promise in helping health care providers and families determine when to intervene and make use of available treatments, supports, and services. This is critical because early intervention can change a child’s developmental path, benefitting their mental health and well-being over the long term. 

By advancing a dimensional, transdiagnostic approach to measurement and charting a path toward clinical application, the special issue has implications for many domains beyond irritability.

“Taken together, we hope these papers will illuminate the state of dimensional methodology with irritability as exemplar, highlight pragmatic applications and predictive utility and catalyze interest in their scientific and real-world utility,” Wiggins, Roy, and Wakschlag write in their introduction to the issue .

The special issue includes a commentary  from Daniel Pine, M.D., Chief of the Section on Development and Affective Neuroscience in the NIMH Intramural Research Program. The entire special issue is available to the public online .

Reference

Wiggins, J. L., Roy, A. K., & Wakschlag, L. S. (2023). MAPping affective dimensions of behavior: Methodologic advancement of the Multidimensional Assessment Profiles Scales (MAPS) with pragmatic applications [Special issue]. International Journal of Methods in Psychiatry Research, 32(S1).

Grants

MH107652 , MH082830 , MH090301 , MH091140 , MH115356 , OD023319