Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, USA.
University of Louisville, Louisville, USA.
Eur Child Adolesc Psychiatry. 2023 Sep;32(9):1755-1763. doi: 10.1007/s00787-022-01995-8. Epub 2022 May 6.
Irritability encompasses both normative misbehavior in early childhood and clinically significant problems across development. Recent studies have distinguished between tonic (i.e., persistently angry or grumpy mood) and phasic (i.e., temper tantrums or outbursts) forms of irritability and shown that they have different implications for psychopathology and functioning. However, data on this distinction in young (i.e., preschool aged) children are nonexistent. We utilized data from a longitudinal study of a community sample of 462 3-year-olds followed to age 15. We conducted confirmatory factor analysis (CFA) using items from a diagnostic interview and several parent-report inventories and examined concurrent and prospective associations with clinically relevant variables. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent-reported temperamental negative affectivity and surgency, and depressive and oppositional defiant (ODD) disorders, and predicted higher rates of disruptive behavior disorders (DBD) and suicidal behavior in later childhood and adolescence. Phasic irritability was independently associated with concurrent laboratory observations of child impulsivity, parent-reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting, and generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), and ODD, but it did not predict later psychopathology. Tonic and phasic irritability are separable in 3-year-old children, but their correlates and outcomes are not as distinct as in older youth. This may reflect the greater difficulty characterizing normative and pathological irritability in the preschool period.
易激惹既包括儿童早期的正常行为问题，也包括整个发育过程中具有临床意义的问题。最近的研究已经区分了紧张（即持续愤怒或脾气暴躁的情绪）和阶段性（即发脾气或发作）的易激惹形式，并表明它们对精神病理学和功能有不同的影响。然而，关于幼儿（即学龄前儿童）中这种区别的数据是不存在的。我们利用了一项对 462 名 3 岁儿童进行的纵向研究的数据，这些儿童被随访到 15 岁。我们使用来自诊断访谈和几个父母报告量表的项目进行了验证性因素分析（CFA），并检查了与临床相关变量的同期和前瞻性关联。CFA 确定了与紧张和阶段性易激惹一致的维度。紧张性易激惹与同期父母报告的气质性负性情绪和易冲动性以及抑郁和对立违抗性障碍（ODD）独立相关，并预测了儿童后期和青春期破坏性行为障碍（DBD）和自杀行为的发生率更高。阶段性易激惹与同期儿童冲动性的实验室观察、父母报告的气质性负性情绪、易冲动性、低努力控制、适应不良的育儿方式以及广泛性焦虑障碍（GAD）、注意缺陷多动障碍（ADHD）和 ODD 独立相关，但它不能预测后期的精神病理学。3 岁儿童的紧张性和阶段性易激惹是可分离的，但它们的相关性和结果并不像在年长的青少年中那样明显。这可能反映了在学龄前阶段更难以描述正常和病理性易激惹的困难。
