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The Clinician Affective Reactivity Index: Validity and Reliability of a Clinician-Rated Assessment of Irritability.

Published on Mar 1, 2020in Behavior Therapy
· DOI :10.1016/J.BETH.2019.10.005
Simone P.W. Haller4
Estimated H-index: 4
(NIH: National Institutes of Health),
Simone P. Haller1
Estimated H-index: 1
(NIH: National Institutes of Health)
+ 8 AuthorsMelissa A. Brotman26
Estimated H-index: 26
(NIH: National Institutes of Health)
Abstract
Abstract Irritability is impairing in youth and is the core feature of disruptive mood dysregulation disorder (DMDD). Currently, there are no established clinician-rated instruments to assess irritability in pediatric research and clinical settings. Clinician-rated measures ensure consistency of assessment across patients and are important specifically for treatment research. Here, we present data on the psychometric properties of the Clinician Affective Reactivity Index (CL-ARI), the first semistructured interview focused on pediatric irritability. The CL-ARI was administered to a transdiagnostic sample of 98 youth (M age = 12.66, SD = 2.47; 41% female). With respect to convergent validity, CL-ARI scores were (a) significantly higher for youth with DMDD than for any other diagnostic group, and (b) showed uniquely strong associations with other clinician-, parent-, and youth-report measures of irritability compared to measures of related constructs, such as anxiety. The three subscales of the CL-ARI (temper outbursts, irritable mood, impairment) showed excellent internal consistency. Test-retest reliability of the CL-ARI was adequate. These data support that irritability can be feasibly, validly, and reliably assessed by clinicians using the CL-ARI. A validated, gold-standard assessment of pediatric irritability is critical in advancing research and treatment efforts.
  • References (48)
  • Citations (2)
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References48
Newest
#1Kenneth Towbin (NIH: National Institutes of Health)H-Index: 11
#2Pablo Vidal-Ribas ('KCL': King's College London)H-Index: 8
Last. Argyris Stringaris (NIH: National Institutes of Health)H-Index: 32
view all 21 authors...
Objective Despite the clinical importance of chronic and severe irritability, there is a paucity of controlled trials for its pharmacological treatment. Here, we examine the effects of adding citalopram (CTP) to methylphenidate (MPH) in the treatment of chronic severe irritability in youth using a double-blind randomized placebo-controlled design. Method After a lead-in phase of open treatment with stimulant, 53 youth meeting criteria for severe mood dysregulation (SMD) were randomly assigned to...
5 CitationsSource
The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a measure widely used to assess childhood anxiety based on parent and child report. However, while the SCARED is a reliable, valid, and sensitive measure to screen for pediatric anxiety disorders, informant discrepancy can pose clinical and research challenges. The present study assesses informant discrepancy, measurement invariance, test–retest reliability, and external validity of the SCARED in 1092 anxious and healthy parent...
2 CitationsSource
#1Sarah L. Karalunas (OHSU: Oregon Health & Science University)H-Index: 14
#2Hanna C. Gustafsson (OHSU: Oregon Health & Science University)H-Index: 12
Last. Joel T. Nigg (OHSU: Oregon Health & Science University)H-Index: 78
view all 5 authors...
: Attention deficit hyperactivity disorder (ADHD) is emblematic of unresolved heterogeneity in psychiatric disorders-the variation in biological, clinical, and psychological correlates that impedes progress on etiology. One approach to this problem is to characterize subgroups using measures rooted in biological or psychological theory, consistent with the National Institute of Mental Health's research domain criteria initiative. Within ADHD, a promising application involves using emotion trait ...
5 CitationsSource
#1Simone P. Haller (NIH: National Institutes of Health)H-Index: 1
#2Joel Stoddard (University of Colorado Denver)H-Index: 13
Last. Melissa A. Brotman (NIH: National Institutes of Health)H-Index: 26
view all 9 authors...
Background Severe, chronic, and impairing irritability is a common presenting clinical problem in youth. Indeed, it was recently operationalized as disruptive mood dysregulation disorder (DMDD) in the DSM-5. However, to date, there are no evidence-based treatments that were specifically developed for DMDD. The current randomized controlled trial assesses the efficacy of a computer-based cognitive training intervention (Interpretation Bias Training; IBT) in youth with DMDD. IBT aims to reduce irr...
Source
#1Katharina Kircanski (NIH: National Institutes of Health)H-Index: 17
#2Michal E. Clayton (NIH: National Institutes of Health)H-Index: 1
Last. Melissa A. Brotman (NIH: National Institutes of Health)H-Index: 26
view all 4 authors...
Purpose of review Chronic, severe irritability is a common presenting problem in children and adolescents. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in recognition of this public health need. Currently, there are no well-established, evidence-based pharmacological or psychosocial treatments specifically for DMDD. Here, we focus on psychosocial interventions. In addition to reviewing published research, we present preliminary, open trial data on a novel exposure-based c...
4 CitationsSource
#1Olga Eyre (Cardiff University)H-Index: 7
#2Kate Langley (Cardiff University)H-Index: 38
Last. Anita Thapar (Cardiff University)H-Index: 70
view all 6 authors...
Background: Irritability and the new DSM-5 diagnostic category of Disruptive Mood Dysregulation Disorder (DMDD) have been conceptualised as related to mood disorder. Irritability is common in Attention Deficit Hyperactivity Disorder (ADHD) but little is known about its association with depression risk in this group. This study aims to establish levels of irritability and prevalence of DMDD in a clinical sample of children with ADHD, and examine their association with anxiety, depression and fami...
15 CitationsSource
Although irritability is among the most common reasons that children and adolescents are brought for psychiatric care, there are few effective treatments. Developmentally sensitive pathophysiological models are needed to guide treatment development. In this review, the authors present a mechanistic model of irritability that integrates clinical and translational neuroscience research. Two complementary conceptualizations of pathological irritability are proposed: 1) aberrant emotional and behavi...
41 CitationsSource
Irritability is a common and impairing clinical presentation in children and adolescents. Despite its significant public health impact, irritability remains an elusive construct. Chronic and severe irritability is the primary symptom of the new DSM-5 diagnosis, disruptive mood dysregulation disorder (DMDD). However, empirical and clinical approaches to irritability are in their relative infancy, and questions regarding the validity of the DMDD diagnosis have been raised. Moreover, irritability i...
23 CitationsSource
#1Ellen Leibenluft (NIH: National Institutes of Health)H-Index: 73
Irritability, defined as an increased propensity to exhibit increased anger relative to one’s peers, is a common clinical problem in youth. Irritability can be conceptualized as aberrant responses to frustration (where frustration is the emotional response to blocked goal attainment) and/or aberrant ‘approach’ responses to threat. Irritable youth show hyper-reactivity to threat mediated by dysfunction in amygdala, medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum...
27 CitationsSource
#1Pablo Vidal-Ribas ('KCL': King's College London)H-Index: 8
#2Melissa A. Brotman (NIH: National Institutes of Health)H-Index: 26
Last. Argyris Stringaris ('KCL': King's College London)H-Index: 32
view all 5 authors...
Objective Research and clinical interest in irritability have been on the rise in recent years. Yet several questions remain about the status of irritability in psychiatry, including whether irritability can be differentiated from other symptoms, whether it forms a distinct disorder, and whether it is a meaningful predictor of clinical outcomes. In this article, we try to answer these questions by reviewing the evidence on how reliably irritability can be measured and its validity. Method We com...
103 CitationsSource
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#1Amy Krain Roy (Fordham University)H-Index: 18
#2Jonathan S. Comer (FIU: Florida International University)H-Index: 29
Abstract Pediatric irritability is a functionally impairing transdiagnostic symptom underlying a substantial proportion of child mental health referrals. The past twenty years have witnessed a striking uptick in empirical work focused on pediatric irritability, with increasing recognition of its role across multiple internalizing and externalizing disorders. That said, it has only been in recent years that research has begun to make advances in understanding the natural course and neurobiologica...
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#1Carmen Martín-Moreno (Hospital General Universitario Gregorio Marañón)H-Index: 20
#2Alessandro Zuddas (University of Cagliari)H-Index: 30
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