Department of Psychology, San Diego State University, San Diego, California, USA.
San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.
Int J Methods Psychiatr Res. 2023 Nov;32(S1):e1989. doi: 10.1002/mpr.1989. Epub 2023 Sep 18.
In light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for a pragmatic irritability measure to identify at-risk infant-toddlers.
Data comprised N = 350 diverse infant-toddlers and their mothers assessed at ∼14 months old for irritability (Multidimensional Assessment Profiles- Temper Loss-Infant/Toddler (MAPS-TL-IT) and impairment (Early Childhood Irritability-Related Impairment Interview, E-CRI; and Family Life Impairment Scale (FLIS). Bimonthly follow-up surveys assessed impairment (FLIS) over the following year.
Stepwise logistic regression indicated that 5 MAPS-TL-IT items were most informative for differentiating concurrent impairment on the FLIS: "frustrated about small things"; "hit, bite, or kick during tantrums"; "trouble cheering up when grumpy"; "grumpy during fun activities" and "tantrums in public". With this summed score, Receiver Operating Characteristics analysis differentiating concurrent impairment on the E-CRI indicated good classification accuracy for (Area under the curve = 0.755, p < 0.05), with a cutoff of 5 maximizing sensitivity (71.4%) and specificity (70.6%). Elevated irritability on this MAPS-TL-IT clinically optimized screener increased likelihood of persistently elevated FLIS impairment trajectories over the following year more than fourfold (OR = 4.37; Confidence intervals = 2.40-7.97, p < 0.001).
Our findings represent the first step toward a pragmatic tool for screening for transdiagnostic mental health risk in toddlers, optimized for feasibility in clinical care. This has potential to strengthen resilience pathways via earlier identification of mental health risk and corollary prevention in toddlers.
鉴于儿童心理健康危机，有五分之一的儿童在 3 岁前被诊断出患有精神障碍，因此必须在临床序列的早期阶段发现潜在的跨诊断行为脆弱性。在这里，我们为识别有风险的婴儿-学步儿童的实用易怒性测量奠定了基础。
数据包括 350 名不同的婴儿-学步儿童及其母亲，他们在大约 14 个月大时接受了易怒性评估（多维评估概况-脾气丧失-婴儿/学步儿童（MAPS-TL-IT）和损伤（幼儿易怒相关损伤访谈，E-CRI；和家庭生活损伤量表（FLIS）。每两个月进行一次后续调查，在接下来的一年里评估损伤（FLIS）。
逐步逻辑回归表明，MAPS-TL-IT 中的 5 项最能提供信息，以区分 FLIS 上的并发损伤：“对小事感到沮丧”；“发脾气时打、咬或踢”；“在发脾气时很难高兴起来”；“在有趣的活动中脾气暴躁”和“在公共场合发脾气”。根据这个总和得分，ROC 分析区分 E-CRI 上的并发损伤表明分类准确性良好（曲线下面积为 0.755，p<0.05），截断值为 5 时，灵敏度（71.4%）和特异性（70.6%）最高。这种 MAPS-TL-IT 临床优化筛选器上的易怒性升高，使随后一年中持续升高的 FLIS 损伤轨迹的可能性增加了四倍以上（OR=4.37；置信区间=2.40-7.97，p<0.001）。
我们的研究结果代表了为在幼儿中筛选跨诊断心理健康风险而开发实用工具的第一步，该工具在临床护理中具有可行性。这有可能通过更早地识别心理健康风险和相应的预防措施，增强幼儿的适应能力。
