Category: Child / Adolescent - Externalizing

Symposium

Irritability and Noncompliant Symptoms Reduce Quality of Life

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

Keywords: Anger / Irritability | Externalizing | Aggression / Disruptive Behaviors / Conduct Problems
Presentation Type: Symposium

BACKGROUND: Quality of life (QoL) is a multidimensional concept that taps a person’s subjective functioning in multiple domains (Wallander et al., 2001). Youth with psychiatric disorders have lower overall QoL than healthy youth (Sawyer et al., 2002) and comorbid ODD lowers QoL among youth with ADHD (Dallos et al., 2014). In the context of ODD, irritability and noncompliant symptoms display distinct associations with outcomes of interest such as the development of mood and conduct disorders. Despite chronic, severe irritability being associated with more severe impairment (Copeland et al., 2013), no studies have examined its impact on QoL. The purpose of the current study is to examine whether: (a) ODD is associated with decreases in QoL relative to other youth with psychiatric disorders and (b) irritability or noncompliant symptoms are associated with decreases in QoL.


METHOD: Youth aged 4-18 years (n = 747; 60% male) and their caregivers were recruited from all intakes at a community mental health center and drug trial recruitment at an academic medical center. Dyads completed the KSADS to ascertain ODD diagnosis (39%) and ODD symptom domains. Caregivers rated youth’s QoL using the KINDL-R and mood symptoms on the General Behavior Inventory.


RESULTS: After controlling for age, gender and total number of comorbid diagnoses, ODD was associated with decreases in Family QoL (β = -.20, p < .001), but not physical, self-esteem, friend, school, or total QoL, ps > .11. After controlling for age, gender, total number of diagnoses, and ODD diagnosis, irritability and noncompliant symptoms were not associated with physical or school QoL, ps > .10. Noncompliant symptoms were associated with a decline in Family QoL, β = -.12, p = .04. Significant interactions between irritable and noncompliant symptoms for self-esteem, friend, and total QoL (ps < .05) indicated that for youth with above average noncompliant symptoms, increases in irritability decreased QoL but for youth with below average or average noncompliant symptoms, irritability did not affect QoL. These effects remained even after controlling for the presence of caregiver-rated mood symptoms.


DISCUSSION: ODD was associated with a decrease in Family QoL and not other components of a youth’s QoL. Clinician-rated noncompliant symptoms accounted for the decline in Family QoL. In contrast, irritable symptoms moderated the impact of a youth’s noncompliant symptoms on Self-Esteem, Friend, and Total QoL. Youth with high levels of noncompliance who were also very irritable had the lowest QoL. Our findings are consistent with recent work indicating that irritability explains unique aspects of impairment in the context of disruptive behavior disorders.

Andrew J. Freeman

Assistant Professor of Psychology
University of Nevada, Las Vegas

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