Predictive Utility of Irritability “In Context”: Proof-of-Principle for an Early Childhood Mental Health Risk Calculator

ABSTRACT

Objective

We provide proof-of-principle for a mental health risk calculator advancing clinical utility of the irritability construct for identification of young children at high risk for common, early onsetting syndromes.

Method

Data were harmonized from two longitudinal early childhood subsamples (total N = 403; 50.1% Male; 66.7% Nonwhite; M_age = 4.3 years). The independent subsamples were clinically enriched via disruptive behavior and violence (Subsample 1) and depression (Subsample 2). In longitudinal models, epidemiologic risk prediction methods for risk calculators were applied to test the utility of the transdiagnostic indicator, early childhood irritability, in the context of other developmental and social-ecological indicators to predict risk of internalizing/externalizing disorders at preadolescence (M_age = 9.9 years). Predictors were retained when they improved model discrimination (area under the receiver operating characteristic curve [AUC] and integrated discrimination index [IDI]) beyond the base demographic model.

Results

Compared to the base model, the addition of early childhood irritability and adverse childhood experiences significantly improved the AUC (0.765) and IDI slope (0.192). Overall, 23% of preschoolers went on to develop a preadolescent internalizing/externalizing disorder. For preschoolers with both elevated irritability and adverse childhood experiences, the likelihood of an internalizing/externalizing disorder was 39–66%.

Conclusions

Predictive analytic tools enable personalized prediction of psychopathological risk for irritable young children, holding transformative potential for clinical translation.

Acknowledgments

We are most appreciative of the contributions of our many collaborators to these studies, particularly Margaret Briggs-Gowan. Special thanks to Yudong Zhang, Roshaye Poleon, Becky Tillman, James Burns, and Katie Jackson for contributions to various stages of the analysis. We gratefully acknowledge the families who generously participated in these studies.

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.

Supplementary material

Supplemental material for this article can be accessed online at https://doi.org/10.1080/15374416.2023.2188553

Additional information

Funding

This work was supported in part by grants from the National Institute of Mental Health: [R01MH082830 and U01MH082830] (PI Wakschlag), MH090301 (PI Briggs-Gowan), R01MH064769 (PIs Luby & Barch), R01MH121877 (PIs Luby, Rogers, & Wakschlag), R01MH113883 (PIs Luby & Smyser), and R01MH107652 (PI Wakschlag).