The Early Childhood Irritability-Related Impairment Interview (E-CRI): A Novel Method for Assessing Young Children's Developmentally Impairing Irritability

Abstract

Irritability is a substrate of more than one dozen clinical syndromes. Thus, identifying when it is atypical and interfering with functioning is crucial to the prevention of mental disorder in the earliest phase of the clinical sequence. Advances in developmentally based measurement of irritability have enabled differentiation of normative irritable mood and tantrums from indicators of concern, beginning in infancy. However, developmentally sensitive assessments of irritability-related impairment are lacking. We introduce the Early Childhood Irritability-Related Impairment Interview (E-CRI), which assesses impairment associated with irritable mood and tantrums across contexts. Reliability and validity are established across two independent samples varied by developmental period: the Emotional Growth preschool sample (EmoGrow; N = 151, M = 4.82 years) and the When to Worry infant/toddler sample (W2W; N = 330, M = 14 months). We generated a well-fitting two-factor E-CRI model, with tantrum- and irritable mood-related impairment factors. The E-CRI exhibited good interrater, test-retest, and longitudinal reliability. Construct and clinical validity were also demonstrated. In both samples, E-CRI factors showed association to internalizing and externalizing problems, and to caregiver-reported concern in W2W. Tantrum-related impairment demonstrated stronger and more consistent explanatory value across outcomes, while mood-related impairment added explanatory utility for internalizing problems. The E-CRI also showed incremental utility beyond variance explained by the Family Life Impairment Scale (FLIS) survey indicator of developmental impairment. The E-CRI holds promise as an indicator of impairment to inform identification of typical versus atypical patterns reflecting early emerging irritability-related syndromes in the initial phase of the clinical sequence.

Keywords: developmental psychopathology; early childhood; irritability.

FIGURE 1

Illustration of the Decision Tree for scoring parental responses in the Early Childhood Irritability-Related Impairment Interview (E-CRI). General Decision Tree: 1. Starting Probe: Please tell us about ways in which… This question looks to the general picture and how the behaviors/moods can affect the situation and people in it. The probe allows the parent to respond without thinking about answering a specific question; they are allowed to start the conversation however they see fit. It gives us clues as to what to focus on in the directed questions. 2. Behavior/Mood Specific Probes: Start with general questions about whether outbursts occur in the particular context, then delve into the specifics of what happens, how often, how long, and how intense, as well as who is it affecting and what is the transition out of the outburst like. Extra detail is necessary when a situation seems vague or the parent is not giving enough detail for you to be able to confidently score. Some questions could include asking how the child can calm down from outbursts/moods, how these affect the others, whether the child has varying levels of outbursts/moods, whether the parent is able to see the outbursts/moods coming, or whether these seem to occur out of nowhere or for no reason. 3. Summarizing Questions: All questions get asked regardless of how the parent responds to the starting probe or the specific questions about behavior/mood, as this provides a fuller picture and offers different situations of which parents may not have thought about. If the parent answers yes to any of the general questions, ask about frequency and for more context (when/how it affects, which person, etc.). These questions might lead you back to the general outburst/mood sections for more situations/detail. SCORING: Scoring factors include frequency, intensity, length of time, pervasiveness, and disruptiveness. All these factors are taken into consideration when scoring. The context and pervasiveness are very important for determining severity of outbursts/moods. Frequency, intensity, and length of time are key points to determining the disruptiveness of the outbursts/moods. Also, keep the normative expressions of anger/frustration in mind when scoring. A child who has a bad mood once a week when tired is different from a child who has a bad mood three to four times per week when told to go to bed.