Category: Comorbidity - Anxiety and Other

Symposium

Mapping Mood Dysregulation in Daily Life: The Affective Topography of Severely Irritable Youth

Saturday, November 18
1:45 PM - 3:15 PM
Location: Aqua Salon E & F, Level 3, Aqua Level

Keywords: Ecological Momentary Assessment | Anger / Irritability | Child
Presentation Type: Symposium

Chronic, impairing irritability is one of the most common reasons that youth present for psychiatric care, yet few effective treatments are available. While severe irritability is codified in the new DSM-5 diagnosis of disruptive mood dysregulation disorder (DMDD), many phenotypic questions remain that may be uniquely addressed by ecological momentary assessment (EMA) (reviewed in Brotman et al., 2017). In the present study, we are using EMA to clinically phenotype youth with DMDD. Currently, the first participants are completing the procedures; an estimated 15 youth diagnosed with DMDD, 15 diagnosed with ADHD, 15 diagnosed with anxiety disorders, and 15 healthy comparison youth will complete the study by August 2017. Participants and their parents are provided with smartphones. Over the subsequent 7 days, each child and parent are prompted 3 times per day (in the morning, late afternoon, and before bedtime) to report on the child’s mood, behavior, and situational context. Data are analyzed using hierarchical linear modeling to address three research questions. First, we are examining the daily levels of and correlations between the two symptom criteria of DMDD: ‘tonic’ irritability (irritable, grumpy mood) and ‘phasic’ irritability (temper outbursts), within and across child and parent informants, and across EMA and clinic-based assessments. Second, we are examining the diagnostic specificity of self-reported irritability by comparing these symptoms among youth with primary DMDD, ADHD, and anxiety disorders. Third, we are examining key situational modulators of irritability, focusing on parent-child interactions. Parents of youth with DMDD report on parenting behaviors such as positive reinforcement for child behavior. Cross-informant, time-lagged analyses assess the degree to which specific parenting behaviors moderate levels of child irritability. The development and testing of interventions for chronic, impairing irritability relies on accurate measurement of the phenotype. Results of this study will improve clinical understanding of DMDD and provide new tools for the assessment of irritability that may be used in pathophysiological and treatment studies.

Katharina Kircanski

Research Fellow
Emotion and Development Branch, NIMH

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