Abstract
Objective The importance of dimensional approaches is widely recognized, but an empirical base for clinical application is lacking. This is particularly true for irritability, a dimensional phenotype that cuts across many areas of psychopathology and manifests early in life. We examine longitudinal, dimensional patterns of irritability and their clinical import in early childhood. Method Irritability was assessed longitudinally over an average of 16 months in a clinically enriched, diverse community sample of preschoolers (N = 497; mean = 4.2 years; SD = 0.8). Using the Temper Loss scale of the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) as a developmentally sensitive indicator of early childhood irritability, we examined its convergent/divergent, clinical, and incremental predictive validity, and modeled its linear and nonlinear associations with clinical risk. Results The Temper Loss scale demonstrated convergent and divergent validity to child and maternal factors. In multivariate analyses, Temper Loss predicted mood (separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and depression/dysthymia), disruptive (oppositional defiant disorder [ODD], attention-deficit/hyperactivity disorder [ADHD], and conduct disorder [CD]) symptoms. Preschoolers with even mildly elevated Temper Loss scale scores showed substantially increased risk of symptoms and disorders. For ODD, GAD, SAD, and depression, increases in Temper Loss scale scores at the higher end of the dimension had a greater impact on symptoms relative to increases at the lower end. Temper Loss scale scores also showed incremental validity over DSM-IV disorders in predicting subsequent impairment. Finally, accounting for the substantial heterogeneity in longitudinal patterns of Temper Loss significantly improved prediction of mood and disruptive symptoms. Conclusion Dimensional, longitudinal characterization of irritability informs clinical prediction. A vital next step will be empirically generating parameters for the incorporation of dimensional information into clinical decision-making with reasonable certainty.
Original language | English (US) |
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Article number | 1231 |
Pages (from-to) | 626-634 |
Number of pages | 9 |
Journal | Journal of the American Academy of Child and Adolescent Psychiatry |
Volume | 54 |
Issue number | 8 |
DOIs | |
State | Published - Aug 1 2015 |
Funding
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.
Keywords
- developmental psychopathology
- dimensional
- irritability
- longitudinal modeling
- normal:abnormal spectrum
ASJC Scopus subject areas
- Psychiatry and Mental health
- Developmental and Educational Psychology