Irritability and Severity of Anxious Symptomatology Among Youth With Anxiety Disorders

Abstract

Objective: Most research on irritability and child psychopathology has focused on depressive disorders, bipolar disorder, and/or oppositional defiant disorder (ODD). Less is known about relationships between child anxiety and irritability and moderators of such associations.

Method: Structural equation modeling (SEM) was used to examine associations between anxiety severity and irritability in a large sample of treatment-seeking youth with anxiety disorders (N = 663, aged 7-19 years, mean = 12.25 years), after accounting for comorbid depressive disorders and ODD. Additional analyses examined whether associations were moderated by child gender, age, and generalized anxiety disorder (GAD) status.

Results: There was a direct link between child anxiety and irritability even after accounting for comorbid depressive disorders and ODD. Links between child anxiety and irritability were robust across child gender and age. Furthermore, relationships between child anxiety and irritability were comparable across youth with and without GAD, suggesting that the anxiety-irritability link is relevant across child anxiety disorders and not confined to youth with GAD.

Conclusion: Findings add to an increasing body of evidence linking child irritability to a range of internalizing and externalizing psychopathologies, and suggest that child anxiety assessment should systematically incorporate irritability evaluations. Moreover, youth in clinical settings displaying irritability should be assessed for the presence of anxiety. Treatments for childhood anxiety may do well to incorporate new treatment modules as needed that specifically target problems of irritability.

Keywords: anxiety; child; irritability; structural equation modeling; tantrums.

Figure 1

Parameter estimates for base model. Note: Endogenous variables are correlated, although these correlations are omitted from this figure for ease of interpretation. CSR = Clinical severity rating of principal DSM-IV-TR anxiety diagnosis, as determined by the Anxiety Disorders Interview Schedule for Children (ADIS-IV-C/P); DD = Depressive disorder CSR; IRRIT1, IRRIT2, IRRIT3 = Child Behavior Checklist items 86, 87, and 95 (respectively); MASC = Multidimensional Anxiety Scale for Children (Child Report) Total Score; ODD = Oppositional defiant disorder CSR. *** p < .001