ABSTRACT

Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the “whats”) for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability’s phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the “hows”) that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth.

摘要

过去 20 年来，针对儿童和青少年烦躁情绪的研究激增。证据显示了青少年烦躁情绪和行为的临床和发展意义，并导致了心理健康分类、诊断和服务的重大变化。与此同时，这项研究（包括我们自己的研究）在改善干预措施和结果的实用、基于经验的指导方面带来的新内容相对较少。在本文中，我们简要总结了其中一些进展和当前的循证实践。然后，我们提出了未来研究要解决的两个关键的实质性挑战（“什么”）：（a）需要更有效的治疗方法，特别是评估和调整已经针对烦躁相关问题建立的循证治疗方法（例如，针对内化和外化问题的认知行为疗法）；(b) 需要更好地从机制上理解烦躁的现象（例如，阶段性烦躁与强直性烦躁，挫败感如何展开）和假定的潜在机制（例如，认知控制、威胁和奖励功能障碍）。最后，我们提出了三种可能加快这些领域进展的方法（“方法”）：（a）生态瞬时评估，（b）数字健康应用，以及（c）利用现有数据集。我们希望这篇文章对有兴趣解决其中一些重要问题以更好地满足严重易怒青少年的需求的学生和早期职业研究人员有用。