Irritability is increasingly recognized as a significant clinical problem in youth. It is a criterion for multiple diagnoses and predicts the development of a wide range of disorders. Research on its etiology suggests that genetic and family environmental factors play a role, as do abnormalities in reward and cognitive-control neural circuitry. However, many of these effects are age dependent. Threat-responsive self-regulatory systems and the degree to which irritability is tonic or phasic influence whether irritable youth exhibit more internalizing or more externalizing outcomes.
AliO. M.GabelL. N.StantonK.KaufmanE. A.KleinD. N.HaydenE. P. (2021). Observational measures of early irritability predict children’s psychopathology risk. Development and Psychopathology. Advance online publication. https://doi.org/10.1017/S0954579421000183
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
3.
BeauchaineT. P.TackettJ. L. (2020). Irritability as a transdiagnostic vulnerability trait: Current issues and future directions. Behavior Therapy, 51(2), 350–364.
4.
BrotmanM. A.KircanskiK.LeibenluftE. (2017). Irritability in children and adolescents. Annual Review of Clinical Psychology, 13, 317–341.
5.
CarlsonG. A.KleinD. N. (2014). How to understand divergent views on bipolar disorder in youth. Annual Review of Clinical Psychology, 10, 529–551.
6.
CarlsonG. A.KleinD. N. (2018). Commentary: Frying pan to fire? Commentary on Stringaris et al. (2018). Journal of Child Psychology and Psychiatry, 59(7), 740–743. https://doi.org/10.1111/jcpp.12873
7.
CarlsonG. A.SinghM. K. (Eds.). (2021). Emotion dysregulation and outbursts in children and adolescents: Part I [Special issue]. Child and Adolescent Psychiatric Clinics of North America, 30(2).
8.
Chad-FriedmanE.GalanoM. M.LemayE. P.OlinoT. M.KleinD. N.DoughertyL. R. (2021). Parsing between- and within-person effects: Longitudinal associations between irritability and internalizing and externalizing problems from early childhood through adolescence [Manuscript submitted for publication]. Department of Psychology, University of Maryland, College Park.
9.
CuthbertB. N. (2020). The role of RDoC in future classification of mental disorders. Dialogues in Clinical Neuroscience, 22(1), 81–85.
10.
DoughertyL. R.SchwartzK. T. G.Kryza-LacombeM.WeisbergJ.SpechlerP. A.WigginsJ. L. (2018). Preschool- and school-age irritability predict reward-related brain function. Journal of the American Academy of Child & Adolescent Psychiatry, 57(6), 407–417. https://doi.org/10.1016/j.jaac.2018.03.012
11.
DoughertyL. R.SmithV. C.BufferdS. J.KesselE.CarlsonG. A.KleinD. N. (2015). Preschool irritability predicts child psychopathology, functional impairment, and service use at age nine. Journal of Child Psychology and Psychiatry, 56(9), 999–1007. https://doi.org/10.1111/jcpp.12403
12.
EvansS. C.BurkeJ. D.RobertsM. C.FiteP. J.LochmanJ. E.de la PeñaF. R.ReedG. M. (2017). Irritability in child and adolescent psychopathology: An integrative review for ICD-11. Clinical Psychology Review, 53, 29–45. https://doi.org/10.1016/j.cpr.2017.01.004
13.
FaraoneS. V.RostainA. L.BladerJ.BuschB.ChildressA. C.ConnorD. F.NewcornJ. H. (2019). Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder – implications for clinical recognition and intervention. Journal of Child Psychology and Psychiatry, 60(2), 133–150. https://doi.org/10.1111/jcpp.12899
14.
HawesM. T.CarlsonG. A.FinsaasM. C.OlinoT. M.SeelyJ. R.KleinD. N. (2020). Dimensions of irritability in adolescents: Longitudinal associations with psychopathology in adulthood. Psychological Medicine, 50(16), 2759–2767. https://doi.org/10.1017/S0033291719002903
15.
KesselE. M.DoughertyL. R.HubacheckS.Chad-FriedmanE.OlinoT.CarlsonG. A.KleinD. N. (2021). Early predictors of adolescent irritability. Child and Adolescent Psychiatric Clinics of North America, 30(3), 475–490. https://doi.org/10.1016/j.chc.2021.04.002
16.
KesselE. M.DoughertyL. R.KujawaA.HajcakG.CarlsonG. A.KleinD. N. (2016). Longitudinal associations between preschool Disruptive Mood Dysregulation Disorder symptoms and neural reactivity to monetary reward during preadolescence. Journal of Child and Adolescent Psychopharmacology, 26(2), 131–137. https://doi.org/10.1089/cap.2015.0071
17.
KesselE. M.FrostA.GoldsteinB. L.BlackS. R.DoughertyL. R.CarlsonG. A.KleinD. N. (2021). Developmental pathways from preschool irritability to multifinality in early adolescence: The role of diurnal cortisol. Psychological Medicine, 51(5), 761–769. https://doi.org/10.1017/S0033291719003684
18.
KesselE. M.MeyerA.HajcakG.DoughertyL. R.Torpey-NewmanD. C.CarlsonG. A.KleinD. N. (2016). Transdiagnostic factors and pathways to multifinality: The error-related negativity predicts whether preschool irritability is associated with internalizing versus externalizing symptoms at age 9. Development and Psychopathology, 28(4, pt. 1), 913–926. https://doi.org/10.1017/S0954579416000626
19.
KesselE. M.NelsonB. D.FerryR.CarlsonG. A.KleinD. N. (2021). Neural correlates of cognitive inflexibility and associations with childhood irritability [Manuscript submitted for publication]. Division of Child and Adolescent Psychiatry, Columbia University and New York State Psychiatric Institute.
20.
KleinD. N.KotovR.BufferdS. J. (2011). Personality and depression: Explanatory models and review of the evidence. Annual Review of Clinical Psychology, 7, 269–295.
21.
KotovR.KruegerR. F.WatsonD.AchenbachT. M.AlthoffR. R.BagbyR. M.BrownT. A.CarpenterW. T.CaspiA.ClarkL. A.EatonN. R.ForbesM. K.ForbushK. T.GoldbergD.HasinD.HymanS. E.IvanovaM. Y.LynamD. R.MarkonK.. . . ZimmermanM. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454–477. http://doi.org/10.1037/abn0000258
22.
LeibenluftE. (2011). Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. American Journal of Psychiatry, 168(2), 129–142. https://doi.org/10.1176/appi.ajp.2010.10050766
23.
LeibenluftE. (2017). Pediatric irritability: A systems neuroscience approach. Trends in Cognitive Sciences, 21(4), 277–289.
24.
OrriM.GaleraC.TureckiG.BoivinM.TremblayR. E.GeoffroyM.-C.CôtéS. M. (2019). Pathways of association between childhood irritability and adolescent suicidality. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1), 99–107. https://doi.org/10.1016/j.jaac.2018.06.034
25.
RiglinL.EyreO.ThaparA. K.StringarisA.LeibenluftE.PineD. S.TillingK.Davey SmithG.O’DonovanM. C.ThaparA. (2019). Identifying novel types of irritability using a developmental genetic approach. American Journal of Psychiatry, 176(8), 635–642. https://doi.org/10.1176/appi.ajp.2019.18101134
26.
Roberson-NayR.LeibenluftE.BrotmanM. A.MyersJ.LarssonH.LichtensteinP.KendlerK. S. (2015). Longitudinal stability of genetic and environmental influences on irritability: From childhood to young adulthood. American Journal of Psychiatry, 172(7), 657–664. https://doi.org/10.1176/appi.ajp.2015.104050
27.
RoyA. K.BrotmanM. A.LeibenluftE. (Eds.). (2019). Irritability in pediatric psychopathology. Oxford University Press.
28.
RoyA. K.ComerJ. S. (2020). Advances in the conceptualization, assessment, and treatment of pediatric irritability. Behavior Therapy, 51(2), 207–210. https://doi.org/10.1016/j.beth.2019.10.010
29.
SilverJ.CarlsonG. A.OlinoT. M.PerlmanG.MackinD.KotovR.KleinD. N. (2021). Differential outcomes of tonic and phasic irritability in adolescent girls. Journal of Child Psychology and Psychiatry. Advance online publication. https://doi.org/10.1111/jcpp.13402
30.
SilverJ. I.BufferdS. J.DoughertyL. R.GoldsteinB. L.CarlsonG. A.KleinD. N. (2021). Tonic and phasic irritability in early childhood: Differential correlates and outcomes [Manuscript submitted for publication]. Department of Psychology, Stony Brook University.
31.
SorcherL. K.CarlsonG. A.GoldsteinB. L.MackinD. M.KleinD. N.DoughertyL. R. (2021). Preschool irritability predicts adolescent psychopathology and functional impairment: A 12-year prospective study [Manuscript submitted for publication]. Department of Psychology, University of Maryland, College Park.
32.
StringarisA.GoodmanR. (2009). Longitudinal outcome of youth oppositionality: Irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of the American Academy of Child & Adolescent Psychiatry, 48(4), 404–412. https://doi.org/10.1097/CHI.0b013e3181984f30
33.
StringarisA.Vidal-RibasP.BrotmanM. A.LeibenluftE. (2018). Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people. Journal of Child Psychology and Psychiatry, 59(7), 721–739. https://doi.org/10.1111/jcpp.12823
34.
Vidal-RibasP.BrotmanM. A.ValdiviesoI.LeibenluftE.StringarisA. (2016). The status of irritability in psychiatry: A conceptual and quantitative review. Journal of the American Academy of Child & Adolescent Psychiatry, 55(7), 556–570. https://doi.org/10.1016/j.jaac.2016.04.014
35.
WakschlagL. S.ChoiS. W.CarterA. S.HullsiekH.BurnsJ.McCarthyK.LeibenluftE.Briggs-GowanM. J. (2012). Defining the developmental parameters of temper loss in early childhood: Implications for developmental psychopathology. Journal of Child Psychology and Psychiatry, 53(11), 1099–1108. https://doi.org/10.1111/j.1469-7610.2012.02595.x
36.
WigginsJ. L.MitchellC.StringarisA.LeibenluftE. (2014). Developmental trajectories of irritability and bidirectional associations with maternal depression. Journal of the American Academy of Child & Adolescent Psychiatry, 53(11), 1191–1205. https://doi.org/10.1016/j.jaac.2014.08.005
