Advances in the Measurement of Pediatric Irritability
2 - (Sym 104) Validating a Novel Measure of Tonic and Phasic Irritability: Preliminary Evidence
Sunday, November 20, 2022
8:00 AM – 9:00 AM EST
Location: Juilliard/Imperial, 5th Floor
Keywords: Anger / Irritability, Measurement, Child Recommended Readings: Dougherty, L. R., Galano, M. M., Chad-Friedman, E., Olino, T. M., Bufferd, S. J., & Klein, D. N. (2021). Using item response theory to compare irritability measures in early adolescent and childhood samples. Assessment, 28(3), 918-927. https://doi.org/10.1177/1073191120936363 Wakschlag, L. S., Estabrook, R., Petitclerc, A., Henry, D., Burns, J. L., Perlman, S. B., Voss, J. L., Pine, D. S., Leibenluft, E., & Briggs-Gowan, M. L. (2015). Clinical implications of a dimensional approach: The normal:abnormal spectrum of early irritability. Journal of the American Academy of Child & Adolescent Psychiatry, 54(8), 626–634. https://doi.org/10.1016/j.jaac.2015.05.016 Silver, J., Carlson, G. A., Olino, T. M., Perlman, G., Mackin, D., Kotov, R., & Klein, D. N. (2021). Differential outcomes of tonic and phasic irritability in adolescent girls. Journal of Child Psychology and Psychiatry, 62(10), 1220-1227. https://doi.org/10.1111/jcpp.13402
Distinguished Professor Stony Brook University Stony Brook, NY
Introduction: Interest in the assessment of youth irritability has markedly increased in recent years (Carlson, 2020; Stringaris et al., 2018). There is a particularly pressing need to develop measures that can distinguish the tonic (irritable, easily annoyed) and phasic (temper outbursts) components of irritability given recent evidence that the two are correlated but separable constructs with different correlates and psychopathological and functional outcomes (e.g., Moore et al., 2019; Silver et al., 2021). Currently, no measure exists that has been developed and validated to assess both tonic and phasic irritability.
Method: We developed and provided initial psychometric support for a parent and child-report rating scale of tonic and phasic irritability. Parents of children ages 6-17 (N = 200) and youth ages 13-17 (N = 200) were recruited through Qualtrics XM and completed a pool of 40 items measuring tonic/phasic irritability and a brief version of the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). The present sample is stratified by age and gender, but is not racially/ethnically diverse (youth; 53% white; 76% non hispanic). However, additional data, stratified by race/ethnicity, is being collected.
Results: Confirmatory Factor Analysis (CFA) supported a 32-item scale with tonic (12 items; parent 𝛼 = .96, child 𝛼 = .93) and phasic (20 items; parent 𝛼 = .97, child 𝛼 = .94) subscales. As expected, the candidate tonic and phasic items were highly correlated (parents: r = .88; youth: r = .78). We tested a bifactor model with a general irritability factor and specific tonic and phasic factors. Model fit for both the parent and youth versions was excellent (CFI > .98, RMSEA = . 04). The general factor was associated with both SDQ emotional (parents: 𝛽 = .63, p < .01; youth: 𝛽 = .56, p < .01) and conduct (parents: 𝛽 = .33, p < .01; youth: 𝛽 = .35, p < .01) problems, whereas the specific tonic factor was uniquely associated with emotional problems (parents: 𝛽 = .14, p < .05; youth: 𝛽 = .39, p < .01), and the specific phasic factor was uniquely associated with conduct problems (parents: 𝛽 = .31, p < .01; youth: 𝛽 = .28, p < .01). We are currently collecting additional data to cross-validate the scale, determine test-retest stability, and examine associations with other external validators.
Discussion: These results provide initial support for the first tonic/phasic irritability scale. This will add to the limited group of measures of youth irritability currently available and facilitate research on mechanisms and treatment.