Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth

ABSTRACT

Objective

Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents.

Method

We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3–18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability.

Results

Overall, 68 instruments met criteria for inclusion, with scales covering irritability (n = 15), anger (n = 19), aggression (n = 45), and/or general overt externalizing problems (n = 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized.

Conclusions

Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth.

Acknowledgments

The authors thank Nour Abduljawad, Patricia Gao, Sophia Ross, and Kate Simmons for their assistance in carrying out this project.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Editor’s Note

This article is part of a special issue, “The Affective Side of Disruptive Behavior: Toward Better Understanding, Assessment, and Treatment,” published in the Journal of Clinical Child and Adolescent Psychology in 2024. Spencer C. Evans and Jeffrey D. Burke served as editors of the special issue; Andres De Los Reyes served as conflict-of-interest editor.

Data Availability Statement

This is a review paper that has no data associated with it. The supplement provides detailed information (references, links) on all the sources consulted to inform this review.

Supplementary Data

Supplemental material for this article can be accessed online at https://doi.org/10.1080/15374416.2023.2292041.

Preregistration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021283556

Notes

¹ For relevant diagnostic guidance on assessment, readers are referred to the following sources (Burke et al., 2023; Evans et al., 2024; Lochman & Matthys, 2018; Matthys & Lochman, 2017; McKinney & Morse, 2012; McMahon & Frick, 2005; Steiner & Remsing, 2007; Stringaris et al., 2018; Walker et al., 2020).

² For the sake of illustration, nearly all specific problems related to anxiety (e.g., separation anxiety disorder, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder) are classified as Anxiety Disorders in DSM-5; and most specific problems related to low mood (e.g., major depressive disorder, major depressive episodes, persistent depressive disorder) are classified as Depressive Disorders in DSM-5. There is no such section for disorders of irritability, anger, or aggression. We lump together “irritability, anger, and aggression” here for reasons outlined in the next section.

³ Some iterations of this definition specify that irritability is an increased proneness to anger compared to peers, a between-person conceptualization. More recently, there has been increasing recognition that irritability can also be viewed as an increased proneness to anger compared to one’s oneself or one’s own baseline (i.e., a within-person, contextual, or longitudinal conceptualization). We adopt a definition that accommodates both views.

⁴ Multi-informant data are limited, and this is not a comprehensive review, but these studies suggest that within-informant correlations vary somewhat across informants (roughly 0.4–0.8 for parent-report, 0.6–0.9 for teacher-report, and 0.2–0.7 for youth-report) and drop considerably when the same construct is rated by different informants (most cross-informant correlations around 0.1–0.5), with no clear construct-specific patterns.

⁵ We define “psychometric results” broadly based on the rubric’s domains (see Table 1). Importantly, this definition did not limit our focus exclusively to assessment papers. For example, any relevant empirical study reporting Cronbach’s alpha could be considered for rating internal consistency, or means/SDs for rating norms. At the same time, however, we did not simply review all empirical studies that used a measure and reported statistics from it. In practice, this approach meant that we leaned toward including all relevant empirical papers for measures that were newer or less frequently used. In contrast, for widely used measures with dozens or hundreds of studies, we were more selective to identify a robust corpus of relevant evidence to inform our evaluations. More on this below.

Table 1. Rubric for evaluating norms, validity, and utility (Hunsley & Mash, 2008; extended by Youngstrom et al., 2017).

⁶ Aggression refers to any behavior enacted with an intent to harm another person who does not want to be harmed (Baron & Richardson, 1994). Bullying is defined by three criteria: (a) the intentionality criterion from aggression, plus (b) repetitiveness of the aggressive behaviors over time, and (c) a power imbalance favoring the perpetrator over victim (Olweus, 2013). Given the conceptual overlap, we included “bullying” in our search strategies—to capture tools that measured youth aggression broadly—but we explicitly excluded scales that were defined by the full definition of bullying, as that was beyond the focus of the review.

⁷ The following criteria were omitted: (a) interrater reliability, because only multi-informant data could be construed as such; this was rarely reported, and we view different informants as different perspectives, not meant to show high levels of agreement (De Los Reyes et al., 2015, 2023); (b) repeatability, because evaluation of this essentially required Bland-Altman plots and/or a coefficient of repeatability, which was virtually never reported; (c) discriminative validity, because this usually focused on discriminating among those with vs. without a diagnosis, but our transdiagnostic approach excludes diagnoses, leaving little basis for discriminative validity; and similarly (d) prescriptive validity, involves identifying a diagnosis with a well-specified matching intervention or a significant treatment moderator, and this seemed rare and not an appropriate fit for our transdiagnostic approach.

⁸ This was the case for all measures and studies included in this review. Thus, any “adult/youth measures” were evaluated solely for their performance among children and adolescents, defined as non-undergraduate samples with a mean age between 3.0 years and 18.9 years. Evidence from adult samples was not considered.

Additional information

Funding

This project was not specifically associated with any source of funding. SCE received partial support from the AIM Clinical Science Fellowship, NIH Loan Repayment Program (L30MH120708), and University of Miami faculty start-up funds during the preparation of this work.