Category: Child / Adolescent - Externalizing

Symposium

Cognitive-Behavioral Mechanisms of Irritability in Children: Implications for Prevention and Intervention

Friday, November 17
12:00 PM - 1:30 PM
Location: Cobalt 501, Level 5, Cobalt Level

Keywords: Anger / Irritability | Transdiagnostic | Emotion Regulation
Presentation Type: Symposium

BACKGROUND: Irritability is longitudinally associated with internalizing and externalizing problems in children (Burke et al., 2010; Vidal-Ribas et al., 2016). Despite advances in the understanding and assessment of youth irritability, little is known about the underlying mechanisms or how treatments might address them (Evans et al., 2017). Emotion regulation may play a mediating role (Derella et al., 2017; Malhi et al., 2017), but this evidence is limited. The present study examines several cognitive-behavioral processes as mediators in the progression from irritability to internalizing and externalizing problems.

METHODS: Participants (N = 318; 50% female; grades 3-5) were assessed in fall and spring of the same school year, and the next fall. Self-report measures of irritability, emotion coping, intolerance of uncertainty, rumination, depressive symptoms, anxiety, and proactive/reactive aggression, and teacher ratings of oppositionality were collected. Path models—controlling for gender, grade, and baseline—were estimated using robust maximum likelihood estimation, with bootstrapping to assess indirect effects.

RESULTS: Irritability predicted subsequent depressive symptoms, anxiety, oppositionality, and reactive (not proactive) aggression (ps < .05). Partial mediation was found for sadness coping in the link between irritability and reactive aggression (indirect effects 95% CI: .010, .127), and for intolerance of uncertainty in the link between irritability and depressive symptoms (.003, .080). 

CONCLUSIONS: Results suggest that emotion coping and intolerance of uncertainty play key roles in the development of aggression and mood problems among irritable youth. Rumination may be linked to depression and anxiety for non-irritable youth. Clinically, cognitive strategies for managing uncertainty might be helpful for irritable-internalizing youth, while behavioral emotion regulation approaches might be helpful for irritable-externalizing youth. Further assessment, prevention, and intervention work targeting youth irritability is needed.

Spencer C. Evans

Doctoral Candidate
University of Kansas

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