Neural Markers of Chronic, Persistent Pediatric Irritability
Irritability, an increased propensity to experience anger and
frustration, affects up to 3.7 million children and adolescents in the U.S.
Irritability and anger outbursts are among the most common reasons why children
are referred to mental health services, accounting for up to 70% inpatient
admissions. Occasional irritability and tantrums are normal parts of childhood.
However, some children never outgrow them and remain persistently, highly
irritable over development. This group of children with chronic irritability is
at increased risks of having multiple psychiatric disorders, school
suspensions, and social impairment. Importantly, chronic irritability in
childhood is a strong predictor of adolescent and adult anxiety, depression,
and suicidality. Despite the significant personal and public health impact,
very little is known about the risk factors and causes of chronic irritability,
limiting efforts to guide evidence-based preventions and interventions. This
project—the first of its kind—addresses this critical gap by mapping out the
developmental trajectories of irritability from childhood to adolescence and
identifying brain markers that predict risks of chronic irritability. The
sample includes 80 children ages 8–15 years (50% with clinically-impairing
irritability), followed over two years. Irritability is assessed yearly at 3
timepoints (Y0, Y1, Y2) using smartphone-based measures and child-, parent-,
and clinician-reports. fMRI (functional Magnetic Resonance Imaging) data are
collected at the first and last timepoints (Y0 and Y2), using an established
task designed to elicit frustration, given that many irritable children have
low frustration tolerance. Taking a novel approach, we will use a data-driven
modeling technique to map out each individual child’s irritability trajectory
over time, and then apply machine learning to predict individual trajectory
using fMRI data. We hypothesize that abnormal activity/connectivity in the
fronto-parietal regions and striatum—brain regions supporting attention control
and reward-related processes, respectively—will predict a chronic, persistent
irritability trajectory. This project has great promise to identify brain
markers that predict which child will follow a chronic irritability trajectory
from childhood to adolescence. Results may pinpoint potential neural targets
for the development and testing of novel early preventions/interventions to
reduce chronic irritability, thereby preventing its negative downstream effects
including depression and suicidality.