Developing and Validating a Definition of Impulsive/Reactive Aggression in Youth

Abstract

The goal of this study is to develop a rational data-driven definition of impulsive/reactive aggression and establish distinctions between impulsive/reactive aggression and other common childhood problems. This is a secondary analysis of data from Assessing Bipolar: A Community Academic Blend (ABACAB; N = 636, ages 5–18), Stanley Medical Research Institute N = 392, ages 5–17), and the Longitudinal Assessment of Manic Symptoms (LAMS; N = 679, ages 6–12) studies, which recruited youths seeking outpatient mental health services in academic medical centers and community clinics. Following Jensen et al.’s (2007) procedure, 3 judges independently rated items from several widely used scales in terms of assessing impulsive/reactive aggression. Principal components analyses (PCA) modeled structure of the selected items supplemented by items related to mood symptoms, rule-breaking behavior, and hyperactivity/impulsivity to better define the boundaries between impulsive/reactive aggression and other common childhood symptoms. In the rational item selection process, there was good agreement among the 3 experts who rated items as characterizing impulsive/reactive aggression or not. PCA favored 5 dimension solutions in all 3 samples. Across all samples, PCA resulted in rule-breaking behavior, aggression-impulsive/reactive (AIR), mania, and depression dimensions; there was an additional hyperactive/impulsive dimension in the LAMS sample and a self-harm dimension in ABACAB and Stanley samples. The dimensions demonstrated good internal consistency; criterion validity coefficients also showed consistency across samples. This study is a step toward developing an empirically derived nosology of impulsive aggression/AIR. Findings support the validity of the AIR construct, which can be distinguished from manic and depressive symptoms as well as rule-breaking behavior.

Disclosure Statement

Andrea Young has received research funding from the Brain and Behavior Research Foundation, PsychNostics, LLC and Supernus Pharmaceuticals. Ekaterina Stepanova and Dana Kaplin have received research funding from PsychNostics, LLC and Supernus Pharmaceuticals. Eric Youngstrom has consulted about psychological assessment with Pearson, Janssen, Joe Startup Technologies, and Western Psychological Services; he has received royalties from the American Psychological Association and Guilford Press. Robert Findling receives or has received research support, acted as a consultant and/or served on a speaker’s bureau for Aevi, Akili, Alcobra, Amerex, American Academy of Child & Adolescent Psychiatry, American Psychiatric Press, Bracket, Epharma Solutions, Forest, Genentech, Guilford Press, Ironshore, Johns Hopkins University Press, KemPharm, Lundbeck, Merck, NIH, Neurim, Nuvelution, Otsuka, PCORI, Pfizer, Physicians Postgraduate Press, Purdue, Roche, Sage, Shire, Sunovion, Supernus Pharmaceuticals, Syneurx, Teva, Tris, TouchPoint, Validus, and WebMD. Jennifer Youngstrom and Joseph Calabrese do not have any disclosures to report.

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Additional information

Funding

This research was supported in part by NIH R01 MH066647 (PI: E. Youngstrom), a grant from the Stanley Medical Research Institute (PI: R.L. Findling), the National Institute of Mental Health (R01 MH073967, R01 MH073801, R01 MH73953, and R01 MH073816), and Supernus Pharmaceuticals. A. S. Young was also supported in part by a NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation and by the National Institute on Drug Abuse (NIDA) (K23DA044288).