Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood

Jillian Lee Wiggins*, Ana Ureña Rosario, Yudong Zhang, Leigha MacNeill, Qiongru Yu, Elizabeth Norton, Justin D. Smith, Lauren S. Wakschlag

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objectives: In light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for a pragmatic irritability measure to identify at-risk infant-toddlers. Methods: Data comprised N = 350 diverse infant-toddlers and their mothers assessed at ∼14 months old for irritability (Multidimensional Assessment Profiles- Temper Loss-Infant/Toddler (MAPS-TL-IT) and impairment (Early Childhood Irritability-Related Impairment Interview, E-CRI; and Family Life Impairment Scale (FLIS). Bimonthly follow-up surveys assessed impairment (FLIS) over the following year. Results: Stepwise logistic regression indicated that 5 MAPS-TL-IT items were most informative for differentiating concurrent impairment on the FLIS: “frustrated about small things”; “hit, bite, or kick during tantrums”; “trouble cheering up when grumpy”; “grumpy during fun activities” and “tantrums in public”. With this summed score, Receiver Operating Characteristics analysis differentiating concurrent impairment on the E-CRI indicated good classification accuracy for (Area under the curve = 0.755, p < 0.05), with a cutoff of 5 maximizing sensitivity (71.4%) and specificity (70.6%). Elevated irritability on this MAPS-TL-IT clinically optimized screener increased likelihood of persistently elevated FLIS impairment trajectories over the following year more than fourfold (OR = 4.37; Confidence intervals = 2.40–7.97, p < 0.001). Conclusions: Our findings represent the first step toward a pragmatic tool for screening for transdiagnostic mental health risk in toddlers, optimized for feasibility in clinical care. This has potential to strengthen resilience pathways via earlier identification of mental health risk and corollary prevention in toddlers.

Original languageEnglish (US)
Article numbere1989
JournalInternational Journal of Methods in Psychiatric Research
StatePublished - Nov 2023


  • infant
  • irritability
  • pediatric
  • risk
  • screening
  • toddler
  • transdiagnostic

ASJC Scopus subject areas

  • Psychiatry and Mental health


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