Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening

Abstract

AbstractObjectivesDevelopmentally specified measures that identify clinically salient irritability are needed for early school‐age youth to meaningfully capture this transdiagnostic risk factor for psychopathology. Thus, the current study modeled the normal:abnormal irritability spectrum and generated a clinically optimized screening tool for this population.MethodsThe irritability spectrum was modeled via the youth version of the Multidimensional Assessment Profile Scales—Temper Loss Scale (MAPS‐TL‐Youth) in children (n = 474; 6.0–8.9 years) using item response theory (IRT). Both cross‐cutting core irritability items from the early childhood version and new developmentally specific items were included. Items uniquely associated with impairment were identified and used to derive a brief, clinically optimized irritability screener. Longitudinal data were then utilized to test the predictive utility of this clinically optimized screener in preadolescence (n = 348; 8.0–12.9 years).ResultsMost children exhibit irritability regularly, but daily occurrence was rare. Of the top 10 most severe items from the IRT analyses, 9 were from the developmentally specific items added for the MAPS‐TL Youth version. Two items associated with concurrent impairment were identified for the clinically optimized irritability screener (“Become frustrated easily” and “Act irritable”). The MAPS‐TL‐Youth clinically optimized screener demonstrated good sensitivity (69%) and specificity (84%) in relation to concurrent DSM 5 irritability‐related diagnoses. Youth with elevated scores on the screener at early school age (ESA) had more than 7x greater odds of irritability‐related psychopathology at pre‐adolescence.ConclusionsThe MAPS‐TL‐Youth characterized the developmental spectrum of irritability at ESA and a clinically optimized screener showed promise at predicting psychopathology risk. Rigorous testing of clinical applications is a critical next step.