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Validation of an irritability measure in preschoolers in school-based and clinical Brazilian samples

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Abstract

The Affective Reactivity Index (ARI) is an irritability measure with good psychometric properties. However, there are no published studies in preschool children, an important population in which to differentiate normative from non-normative irritability. The goal of this study was to validate the ARI in preschoolers. Two samples were included: a school-based sample (N = 487, mean age = 57.80 ± 7.23 months, 52.8% male) and a clinical sample of children with Attention Deficit Hyperactivity Disorder (ADHD; N = 153, mean age = 60.5 ± 7.6 months, 83.7% males). Confirmatory factor analysis assessed ARI unidimensionality. ARI criterion validity was tested through comparison to other scales measuring irritability, related constructs, and other aspects of psychopathology. Test–retest reliability was assessed in the school-based sample. Analyses confirmed a single-factor structure and good internal consistency. The ARI showed stronger correlations with irritability measures than with measures of other constructs. In the clinical sample, ADHD children with comorbid disruptive behavior disorders had higher ARI scores than those without this comorbidity. In the school-based sample, test–retest reliability was moderate. This is the first study to demonstrate ARI validity and reliability in preschoolers. The scale performed well in both school-based and clinical samples. Having a concise and validated irritability measure for preschoolers may facilitate both clinical assessment and research on early irritability.

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References

  1. Brotman MA, Kircanski K, Leibenluft E (2017) Irritability in children and adolescents. Annu Rev Clin Psychol 13:317–341. https://doi.org/10.1146/annurev-clinpsy-032816-044941

    Article  PubMed  Google Scholar 

  2. Wakschlag LS, Briggs-Gowan MJ, Carter AS, Hill C, Danis B, Keenan K, McCarthy KJ, Leventhal BL (2007) A developmental framework for distinguishing disruptive behavior from normative misbehavior in preschool children. J Child Psychol Psychiatry 48(10):976–987. https://doi.org/10.1111/j.1469-7610.2007.01786.x

    Article  PubMed  Google Scholar 

  3. Wakschlag LS, Estabrook R, Petitclerc A, Henry D, Burns JL, Perlman SB, Voss JL, Pine DS, Leibenluft E, Briggs-Gowan ML (2015) Clinical implications of a dimensional approach: the normal: abnormal spectrum of early irritability. J Am Acad Child Adolesc Psychiatry 54(8):626–634. https://doi.org/10.1016/j.jaac.2015.05.016

    Article  PubMed  PubMed Central  Google Scholar 

  4. Stringaris A, Goodman R, Ferdinando S, Razdan V, Muhrer E, Leibenluft E, Brotman MA (2012) The Affective Reactivity Index: a concise irritability scale for clinical and research settings. J Child Psychol Psychiatry 53(11):1109–1117. https://doi.org/10.1111/j.1469-7610.2012.02561.x

    Article  PubMed  PubMed Central  Google Scholar 

  5. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5 5. American Psychiatric Publishing, Inc., Washington, DC

    Book  Google Scholar 

  6. Polanczyk G, Salum G, Sugaya L, Caye A, Rohde L (2015) Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 56(3):345–365. https://doi.org/10.1111/jcpp.12381

    Article  PubMed  Google Scholar 

  7. Posner J, Polanczyk G, Sonuga-Barke E (2020) Attention-deficit hyperactivity disorder. Lancet 395(10222):450–462. https://doi.org/10.1016/S0140-6736(19)33004-1

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dougherty LR, Smith VC, Bufferd SJ, Stringaris A, Leibenluft E, Carlson GA, Klein DN (2013) Preschool irritability: longitudinal associations with psychiatric disorders at age 6 and parental psychopathology. J Am Acad Child Adolesc Psychiatry 52(12):1304–1313. https://doi.org/10.1016/j.jaac.2013.09.007

    Article  PubMed  Google Scholar 

  9. Dougherty LR, Smith VC, Bufferd SJ, Kessel E, Carlson GA, Klein DN (2015) Preschool irritability predicts child psychopathology, functional impairment, and service use at age nine. J Child Psychol Psychiatry 56(9):999–1007. https://doi.org/10.1111/jcpp.12403

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wakschlag LS, Choi SW, Carter AS, Hullsiek H, Burns J, McCarthy K, Leibenluft E, Briggs-Gowan MJ (2012) Defining the developmental parameters of temper loss in early childhood: implications for developmental psychopathology. J Child Psychol Psychiatry 53(11):1099–1108. https://doi.org/10.1111/j.1469-7610.2012.02595.x

    Article  PubMed  PubMed Central  Google Scholar 

  11. Li Y, Grabell AS, Wakschlag LS, Huppert TJ, Perlman SB (2017) The neural substrates of cognitive flexibility are related to individual differences in preschool irritability: a fNIRS investigation. Dev Cogn Neurosci 25:138–144. https://doi.org/10.1016/j.dcn.2016.07.002

    Article  CAS  PubMed  Google Scholar 

  12. Grabell AS, Li Y, Barker JW, Wakschlag LS, Huppert TJ, Perlman SB (2018) Evidence of non-linear associations between frustration-related prefrontal cortex activation and the normal: abnormal spectrum of irritability in young children. J Abnorm Child Psychol 46(1):137–147. https://doi.org/10.1007/s10802-017-0286-5

    Article  PubMed  PubMed Central  Google Scholar 

  13. Diaz-Stransky A, Rowley S, Zecher E, Grodberg D, Sukhodolsky DG (2020) Tantrum tool: development and open pilot study of online parent training for irritability and disruptive behavior. J Child Adolesc Psychopharmacol. https://doi.org/10.1089/cap.2020.0089

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tseng WL, Deveney CM, Stoddard J, Kircanski K, Frackman AE, Yi JY, Hsu D, Moroney E, Machlin L, Donahue L, Roule A, Perhamus G, Reynolds RC, Roberson-Nay R, Hettema JM, Towbin KE, Stringaris A, Pine DS, Brotman MA, Leibenluft E (2019) Brain mechanisms of attention orienting following frustration: associations with irritability and age in youths. Am J Psychiatry 176(1):67–76. https://doi.org/10.1176/appi.ajp.2018.18040491

    Article  PubMed  Google Scholar 

  15. Rappaport LM, Carney DM, Verhulst B, Neale MC, Blair J, Brotman MA, Pine DS, Leibenluft E, Hettema JM, Roberson-Nay R (2018) A developmental twin study of emotion recognition and its negative affective clinical correlates. J Am Acad Child Adolesc Psychiatry 57(12):925-933.e923. https://doi.org/10.1016/j.jaac.2018.05.028

    Article  PubMed  PubMed Central  Google Scholar 

  16. Humphreys K, Schouboe S, Kircanski K, Leibenluft E, Stringaris A, Gotlib I (2019) Irritability, externalizing, and internalizing psychopathology in adolescence: cross-sectional and longitudinal associations and moderation by sex. J Clin Child Adolesc Psychol 48(5):781–789. https://doi.org/10.1080/15374416.2018.1460847

    Article  PubMed  Google Scholar 

  17. Mulraney MA, Melvin GA, Tonge BJ (2014) Psychometric properties of the affective reactivity index in Australian adults and adolescents. Psychol Assess 26(1):148–155. https://doi.org/10.1037/a0034891

    Article  PubMed  Google Scholar 

  18. Pan PY, Yeh CB (2019) Irritability and maladaptation among children: the utility of chinese versions of the affective reactivity index and aberrant behavior checklist-irritability subscale. J Child Adolesc Psychopharmacol 29(3):213–219. https://doi.org/10.1089/cap.2018.0070

    Article  PubMed  Google Scholar 

  19. DeSousa DA, Stringaris A, Leibenluft E, Koller SH, Manfro GG, Salum GA (2013) Cross-cultural adaptation and preliminary psychometric properties of the affective reactivity index in Brazilian youth: implications for DSM-5 measured irritability. Trends Psychiatry Psychother 35(3):171–180. https://doi.org/10.1590/s2237-60892013000300004

    Article  PubMed  Google Scholar 

  20. Programa das Nações Unidas para o Desenvolvimento (2013) Atlas de desenvolvimento humano do Brasil. http://www.atlasbrasil.org.br/2013/. Accessed 1 May 2020

  21. Bussing R, Fernandez M, Harwood M, Wei H, Garvan CW, Eyberg SM, Swanson JM (2008) Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment 15(3):317–328. https://doi.org/10.1177/1073191107313888

    Article  PubMed  PubMed Central  Google Scholar 

  22. Achenbach TM, Rescorla LA (2000) Manual for the ASEBA Preschool Forms & Profiles. University of Vermont, Research Center for Children, Youth, & Families, Burlington

    Google Scholar 

  23. Lucio PS, Cogo-Moreira H, Puglisi M, Polanczyk GV, Little TD (2019) Psychometric investigation of the Raven’s colored progressive matrices test in a sample of preschool children. Assessment 26(7):1399–1408. https://doi.org/10.1177/1073191117740205

    Article  PubMed  Google Scholar 

  24. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988. https://doi.org/10.1097/00004583-199707000-00021

    Article  CAS  PubMed  Google Scholar 

  25. Brasil HH, Bordin IA (2010) Convergent validity of K-SADS-PL by comparison with CBCL in a Portuguese speaking outpatient population. BMC Psychiatry 10:83. https://doi.org/10.1186/1471-244X-10-83

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wakschlag LS, Briggs-Gowan MJ, Choi SW, Nichols SR, Kestler J, Burns JL, Carter AS, Henry D (2014) Advancing a multidimensional, developmental spectrum approach to preschool disruptive behavior. J Am Acad Child Adolesc Psychiatry 53(1):82-96e83. https://doi.org/10.1016/j.jaac.2013.10.011

    Article  PubMed  Google Scholar 

  27. Rothbart MK, Ahadi SA, Hershey KL, Fisher P (2001) Investigations of temperament at three to seven years: the Children’s Behavior Questionnaire. Child Dev 72(5):1394–1408. https://doi.org/10.1111/1467-8624.00355

    Article  CAS  PubMed  Google Scholar 

  28. Mattos P, Serra-Pinheiro M, Rohde L, Pinto D (2006) A Brazilian version of the MTA-SNAP-IV for evaluation of symptoms of attention-deficit/hyperactivity disorder and oppositional-defiant disorder. Rev de Psiquiatria do Rio Grande do Sul 28(3):290–297

    Article  Google Scholar 

  29. Costa DS, de Paula JJ, Malloy-Diniz LF, Romano-Silva MA, Miranda DM (2019) Parent SNAP-IV rating of attention-deficit/hyperactivity disorder: accuracy in a clinical sample of ADHD, validity, and reliability in a Brazilian sample. J Pediatr (Rio J) 95(6):736–743. https://doi.org/10.1016/j.jped.2018.06.014

    Article  Google Scholar 

  30. Fernandez de la Cruz L, Simonoff E, McGough JJ, Halperin JM, Arnold LE, Stringaris A (2015) Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD (MTA). J Am Acad Child Adolesc Psychiatry 54(1):62-70e63. https://doi.org/10.1016/j.jaac.2014.10.006

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bordin I, Mari J, Caeiro M (1995) Validação da versão brasileira do child behavior checklist (CBCL) (Inventário de Comportamentos da Infância e da Adolescência): dados preliminares. Rev Bras de Psiquiatr antiga APAL 17(2):55–66

    Google Scholar 

  32. Rocha MMD (2018) Avaliação de problemas emocionais/comportamentais em pré-escolares na perspectiva dos pais e das mães. Cad de Pós Grad em Distúrb do Desenvolv 18(2):65–82

    Google Scholar 

  33. Stringaris A, Zavos H, Leibenluft E, Maughan B, Eley TC (2012) Adolescent irritability: phenotypic associations and genetic links with depressed mood. Am J Psychiatry 169(1):47–54. https://doi.org/10.1176/appi.ajp.2011.10101549

    Article  PubMed  Google Scholar 

  34. Wiggins J, Mitchell C, Stringaris A, Leibenluft E (2014) Developmental trajectories of irritability and bidirectional associations with maternal depression. J Am Acad Child Adolesc Psychiatry 53(11):1191–1205. https://doi.org/10.1016/j.jaac.2014.08.005

    Article  PubMed  PubMed Central  Google Scholar 

  35. Klein V, Putnam S, Linhares M (2009) Assessment of temperament in children: translation of instruments to Portuguese (Brazil) language. Interam J Psychol 43(3):552–557

    Google Scholar 

  36. Nobre F, Gaspardo C, Linhares M (2020) Effortful control and attention as predictors of cognition in children born preterm. Clin Child Psychol Psychiatry 25(2):372–385. https://doi.org/10.1177/1359104519871652

    Article  PubMed  Google Scholar 

  37. R Core Team (2019) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  38. Hu L-t, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6(1):1–55. https://doi.org/10.1080/10705519909540118

    Article  Google Scholar 

  39. Browne MW, Cudeck R (1992) Alternative ways of assessing model fit. Sociol Methods Res 21(2):230–258. https://doi.org/10.1177/0049124192021002005

    Article  Google Scholar 

  40. Steiger JH (1980) Testing pattern hypotheses on correlation matrices: alternative statistics and some empirical results. Multivar Behav Res 15(3):335–352. https://doi.org/10.1207/s15327906mbr1503_7

    Article  CAS  Google Scholar 

  41. Hair J, William C, Barry J, Rolph E (2006) Multivariate data analysis, 8th edn. Pearson Prentice Hall, Upper Saddle River

    Google Scholar 

  42. McGraw KO, Wong SP (1996) Forming inferences about some intraclass correlation coefficients. Psychol Methods 1(1):30–46. https://doi.org/10.1037/1082-989X.1.1.30

    Article  Google Scholar 

  43. Qin S, Nelson L, McLeod L, Eremenco S, Coons SJ (2019) Assessing test–retest reliability of patient-reported outcome measures using intraclass correlation coefficients: recommendations for selecting and documenting the analytical formula. Qual Life Res 28(4):1029–1033. https://doi.org/10.1007/s11136-018-2076-0

    Article  PubMed  Google Scholar 

  44. Dancey C, Reidy J (2017) Statistics without maths for psychology, 7th edn. Pearson, New York

    Google Scholar 

  45. Copeland WE, Brotman MA, Costello EJ (2015) Normative irritability in youth: developmental findings from the great smoky mountains study. J Am Acad Child Adolesc Psychiatry 54(8):635–642. https://doi.org/10.1016/j.jaac.2015.05.008

    Article  PubMed  PubMed Central  Google Scholar 

  46. Stringaris A, Vidal-Ribas P, Brotman MA, Leibenluft E (2018) Practitioner review: definition, recognition, and treatment challenges of irritability in young people. J Child Psychol Psychiatry 59(7):721–739. https://doi.org/10.1111/jcpp.12823

    Article  PubMed  Google Scholar 

  47. Bolhuis K, Lubke GH, van der Ende J, Bartels M, van Beijsterveldt CEM, Lichtenstein P, Larsson H, Jaddoe VWV, Kushner SA, Verhulst FC, Boomsma DI, Tiemeier H (2017) Disentangling heterogeneity of childhood disruptive behavior problems into dimensions and subgroups. J Am Acad Child Adolesc Psychiatry 56(8):678–686. https://doi.org/10.1016/j.jaac.2017.05.019

    Article  PubMed  Google Scholar 

  48. Stringaris A, Goodman R (2009) Three dimensions of oppositionality in youth. J Child Psychol Psychiatry 50(3):216–223. https://doi.org/10.1111/j.1469-7610.2008.01989.x

    Article  PubMed  Google Scholar 

  49. Overgaard KR, Oerbeck B, Aase H, Torgersen S, Reichborn-Kjennerud T, Zeiner P (2018) Emotional lability in preschoolers with symptoms of ADHD. J Atten Disord 22(8):787–795. https://doi.org/10.1177/1087054715576342

    Article  PubMed  Google Scholar 

  50. Shaw P, Stringaris A, Nigg J, Leibenluft E (2014) Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 171(3):276–293. https://doi.org/10.1176/appi.ajp.2013.13070966

    Article  PubMed  PubMed Central  Google Scholar 

  51. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163. https://doi.org/10.1016/j.jcm.2016.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  52. Price L (2017) Psychometric methods: theory into practice methodology in social sciences. The Guildford Press, New York

    Google Scholar 

  53. Tremblay RE (2010) Developmental origins of disruptive behaviour problems: the “original sin” hypothesis, epigenetics and their consequences for prevention. J Child Psychol Psychiatry 51(4):341–367. https://doi.org/10.1111/j.1469-7610.2010.02211.x

    Article  PubMed  Google Scholar 

  54. Schmitt N (1996) Uses and abuses of coefficient alpha. Psychol Assess 8(4):350–353. https://doi.org/10.1037/1040-3590.8.4.350

    Article  Google Scholar 

  55. Gadermann A, Guhn M, Zumbo BD (2012) Estimating ordinal reliability for likert-type and ordinal item response data: a conceptual, empirical, and practical guide. Pract Assess Res Eval 17(3):1–13. https://doi.org/10.7275/n560-j767

    Article  Google Scholar 

  56. Ezpeleta L, Penelo E, de la Osa N, Navarro JB, Trepat E (2020) How the affective reactivity index (ARI) works for teachers as informants. J Affect Disord 261:40–48. https://doi.org/10.1016/j.jad.2019.09.080

    Article  PubMed  Google Scholar 

  57. Haller SP, Kircanski K, Stringaris A, Clayton M, Bui H, Agorsor C, Cardenas SI, Towbin KE, Pine DS, Leibenluft E, Brotman MA (2020) The clinician affective reactivity index: validity and reliability of a clinician-rated assessment of irritability. Behav Ther 51(2):283–293. https://doi.org/10.1016/j.beth.2019.10.005

    Article  PubMed  Google Scholar 

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Funding

This study was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (Capes) under Grant: 88887.371159/2019-00; and São Paulo Research Foundation (FAPESP) under Grants 2012/51624-1 and 2016/22455-8.

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Authors and Affiliations

  1. Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bldg. 15K-MSC 2670, Bethesda, MD, 20892-2670, USA

    Luisa Shiguemi Sugaya, Katharina Kircanski, Argyris Stringaris & Ellen Leibenluft

  2. Department of Psychiatry, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Luisa Shiguemi Sugaya & Guilherme V. Polanczyk

Authors
  1. Luisa Shiguemi Sugaya
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  2. Katharina Kircanski
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  3. Argyris Stringaris
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  4. Guilherme V. Polanczyk
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  5. Ellen Leibenluft
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Corresponding author

Correspondence to Luisa Shiguemi Sugaya.

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Conflict of interest

Dr. Polanczyk, in the last 3 years, has been a consultant, member of advisory board, and/or speaker for Shire/Takeda, Medice, Aché, Novo Nordisk and Pfizer; and he has received travel expenses for continuing education support from Shire/Takeda and royalties from Editora Manole. Dr. Stringaris has developed the ARI with his colleagues and has made it openly available for free use. The other authors have no conflicts of interest to disclose.

Ethical standards

The “Randomized Clinical Trial Comparing Executive Function and Language Skills Training on School Readiness in Preschool Children” (NCT02807831), and the “Medication and Parent Training Study for Preschoolers with ADHD” (Mappa Study, NCT02807870) were approved by the HC-FMUSP Ethical Committee. In accordance with the declaration of Helsinki, parents or legal representatives of all children were informed about the research and provided written consent.

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Sugaya, L.S., Kircanski, K., Stringaris, A. et al. Validation of an irritability measure in preschoolers in school-based and clinical Brazilian samples. Eur Child Adolesc Psychiatry 31, 577–587 (2022). https://doi.org/10.1007/s00787-020-01701-6

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