Clinical Implications of a Dimensional Approach: The Normal:Abnormal Spectrum of Early Irritability - 24/07/15
, Ryne Estabrook, PhD b, Amelie Petitclerc, PhD b, David Henry, PhD c, James L. Burns, MS b, Susan B. Perlman, PhD d, Joel L. Voss, PhD b, Daniel S. Pine, MD e, Ellen Leibenluft, MD e, Margaret L. Briggs-Gowan, PhD fAbstract |
Objective |
The importance of dimensional approaches is widely recognized, but an empirical base for clinical application is lacking. This is particularly true for irritability, a dimensional phenotype that cuts across many areas of psychopathology and manifests early in life. We examine longitudinal, dimensional patterns of irritability and their clinical import in early childhood.
Method |
Irritability was assessed longitudinally over an average of 16 months in a clinically enriched, diverse community sample of preschoolers (N = 497; mean = 4.2 years; SD = 0.8). Using the Temper Loss scale of the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) as a developmentally sensitive indicator of early childhood irritability, we examined its convergent/divergent, clinical, and incremental predictive validity, and modeled its linear and nonlinear associations with clinical risk.
Results |
The Temper Loss scale demonstrated convergent and divergent validity to child and maternal factors. In multivariate analyses, Temper Loss predicted mood (separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and depression/dysthymia), disruptive (oppositional defiant disorder [ODD], attention-deficit/hyperactivity disorder [ADHD], and conduct disorder [CD]) symptoms. Preschoolers with even mildly elevated Temper Loss scale scores showed substantially increased risk of symptoms and disorders. For ODD, GAD, SAD, and depression, increases in Temper Loss scale scores at the higher end of the dimension had a greater impact on symptoms relative to increases at the lower end. Temper Loss scale scores also showed incremental validity over DSM-IV disorders in predicting subsequent impairment. Finally, accounting for the substantial heterogeneity in longitudinal patterns of Temper Loss significantly improved prediction of mood and disruptive symptoms.
Conclusion |
Dimensional, longitudinal characterization of irritability informs clinical prediction. A vital next step will be empirically generating parameters for the incorporation of dimensional information into clinical decision-making with reasonable certainty.
Le texte complet de cet article est disponible en PDF.Key Words : irritability, dimensional, developmental psychopathology, normal:abnormal spectrum, longitudinal modeling
Plan
| This article was reviewed under and accepted by ad hoc editor Shelli Avenevoli, PhD. |
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| Drs. Wakschlag, Estabrook, Henry, Voss, and Briggs-Gowan were supported by National Institute of Mental Health grants R01MH082830, UO1MH090301, and 2U01MH082830, and Dr. Perlman was supported by K01MH094467. Dr. Wakschlag was also supported by the Walden and Jean Young Shaw Foundation. |
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| Dr. Estabrook served as the statistical expert for this research. |
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| Drs. Wakschlag and Estabrook contributed equally to the article. |
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| The authors thank Alice Carter, PhD, University of Massachusetts-Boston, Patrick Tolan, PhD, University of Virginia, Carri Hill, PhD, Jewish Children and Family Services, and Barbara Danis, PhD, Family Institute, for their contributions to the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB). This study would not have been possible without the outstanding efforts of Jacqueline Kestler, MPH, Erica Anderson, PhD, of Northwestern University, and their dedicated team, and the generous participation of the Multidimensional Assessment of Preschoolers (MAPS) Study families. The authors also thank the pediatric clinics and participants from Rush University, the University of Illinois at Chicago, NorthShore University HealthSystem, North Suburban Pediatrics, and the following pediatric research group practices for their participation: Healthlinc in Valparaiso, IN, Healthlinc in Michigan City, IN, and Associated Pediatricians in Valparaiso, IN. |
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| Disclosure: Drs. Wakschlag, Estabrook, Petitclerc, Henry, Perlman, Voss, Pine, Leibenluft, Briggs-Gowan, and Mr. Burns report no biomedical financial interests or potential conflicts of interest. |
Vol 54 - N° 8
P. 626-634 - août 2015 Retour au numéro
Article précédent
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