Psychosocial Treatment of Irritability in Youth
- 21 Downloads
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 cognitive-behavioral therapy (CBT) targeting severe irritability, as is present in DMDD.
In the published literature, parent management training (PMT) comprises parent-based interventions designed to treat youth disruptive behavior. Child-based interventions for disruptive behavior include CBT focused on social cognition and problem-solving. Based on identified treatment gaps for severe irritability in children and adolescents, novel psychosocial interventions are being developed. We have developed a CBT for severe irritability that integrates exposure techniques, drawn from anxiety treatment, with selected PMT techniques. Data from an open pilot trial (N = 10) suggest feasibility.
Promising psychosocial treatments are being developed for DMDD. Future directions include testing these new therapies against extant interventions. Increased research on the biological and psychological mechanisms mediating irritability will further bridge the treatment gap for youth and families.
KeywordsIrritability Disruptive mood dysregulation disorder Cognitive-behavioral therapy Exposure Parent management training
Compliance with ethical standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.
- 3.•• Brotman MA, Kircanski K, Stringaris A, Pine DS, Leibenluft E. Irritability in youths: a translational model. Am. J. Psychiatry. 2017;174:520–32. Proposes a pathophysiological model of pediatric irritability and provides rationale for exposure-based cognitive-behavioral therapy.CrossRefPubMedGoogle Scholar
- 13.• Leibenluft E. Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. Am J Psychiatry. 2011;168:129–42. Reviews longitudinal, family history, and pathophysiological research on pediatric irritability as distinct from bipolar disorder.CrossRefPubMedGoogle Scholar
- 25.••Stringaris A, Vidal-Ribas P, Brotman MA, Leibenluft E Practitioner review: definition, recognition, and treatment challenges of irritability in young people. J Child Psychol Psychiatry 2017; doi: https://doi.org/10.1111/jcpp.12823. Reviews pharmacological and psychosocial treatment options for irritability and related problems.
- 26.Barkley RA. Defiant children: a clinician’s manual for assessment and parent training. New York: Guilford Press; 2013.Google Scholar
- 27.Kazdin AE. Problem-solving skills training and parent management training for oppositional defiant disorder and conduct disorder. In: Weisz JR, Kazdin AE, editors. Evidence-based psychotherapies for children and adolescents. 2nd ed. New York: Guilford Press; 2010.Google Scholar
- 28.Weisz JR, Kazdin AE, editors. Evidence-based psychotherapies for children and adolescents. Second ed. New York: Guilford Press; 2010.Google Scholar
- 31.Patterson GR. Coercive family process. Eugene, OR: Castalia Pub Co; 1982.Google Scholar
- 32.Patterson GR, Reid JB, Dishion TJ. Antisocial boys. Eugene OR: Castalia Pub. Co.; 1992.Google Scholar
- 33.Webster-Stratton C, Reid MJ. The Incredible Years parents, teachers and children training series: a multifaceted treatment approach for young children with conduct problems. In: Weisz JR, Kazdin AE, editors. Evidence-based psychotherapies for children and adolescents. 2nd ed. New York: Guilford Press; 2010.Google Scholar
- 34.Brinkmeyer M, Eyberg SM. Parent-child interaction therapy for oppositional children. In: Kazdin AE, Weisz JR, editors. Evidence-based psychotherapies for children and adolescents. New York: Guilford Press; 2003.Google Scholar
- 37.Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database Syst. Rev. 2012;CD008225.Google Scholar
- 38.NICE. Antisocial behaviour and conduct disorders in children and young people: recognition and management. NICE guideline (CG158). London: National Institute for Health and Care Excellence; 2013.Google Scholar
- 39.Waxmonsky J, Pelham WE, Gnagy E, Cummings MR, O’Connor B, Majumdar A, et al. The efficacy and tolerability of methylphenidate and behavior modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation. J Child Adolesc Psychopharmacol. 2008;18:573–88.CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Kendall PC. Child and adolescent therapy, 4th edition: cognitive-behavioral procedures. New York: Guilford Press; 2011.Google Scholar
- 45.Dodge KA. Do social information-processing patterns mediate aggressive behavior? In: Lahey B, Moffitt T, Caspi A, editors. Causes of conduct disorder and juvenile delinquency. New York: Guilford Press; 2003.Google Scholar
- 46.Lochman JE, Barry TD, Pardini DA. Anger control training for aggressive youth. In: Kazdin AE, Weisz JR, editors. Evidence-based psychotherapies for children and adolescents. New York: Guilford Press; 2003.Google Scholar
- 47.Sukhodolsky DG, Scahill L. Cognitive-behavioral therapy for anger and aggression in children. New York: Guilford Press; 2012.Google Scholar
- 50.Sukhodolsky DG, Vander Wyk BC, Eilbott JA, SA MC, Ibrahim K, Crowley MJ, et al. Neural mechanisms of cognitive-behavioral therapy for aggression in children and adolescents: design of a randomized controlled trial within the national institute for mental health research domain criteria construct of frustrative non-reward. J Child Adolesc Psychopharmacol. 2016;26:38–48.CrossRefPubMedPubMedCentralGoogle Scholar
- 52.• Perepletchikova F, Nathanson D, Axelrod SR, Merrill C, Walker A, Grossman M, et al. Randomized clinical trial of dialectical behavior therapy for preadolescent children with disruptive mood dysregulation disorder: feasibility and outcomes. J Am Acad Child Adolesc Psychiatry. 2017;56:832–40. Important randomized controlled trial of dialectical behavior therapy for preadolescent children with disruptive mood dysregulation disorder.CrossRefPubMedGoogle Scholar
- 53.Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press; 1993.Google Scholar
- 68.Brotman MA, Kircanski K, Gold AL, Leibenluft E. Exposure-based cognitive behavioral therapy for irritability and disruptive mood dysregulation disorder (DMDD). Unpublished manual.Google Scholar
- 69.Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: The Guilford Press; 1991.Google Scholar
- 70.Kircanski K, Haller SP, Stringaris A, Clayton ME, Leibenluft E, Brotman MA Psychometric properties of the Clinician Affective Reactivity Index. In preparation.Google Scholar
- 71.Barlow DH, Nock MK, Hersen M. Single case experimental designs: strategies for studying behavior change. 3rd ed. Boston: Pearson; 2008.Google Scholar