Disruptive Mood: Irritability in Children and Adolescents

Disruptive Mood: Irritability in Children and Adolescents

Disruptive Mood: Irritability in Children and Adolescents

Disruptive Mood: Irritability in Children and Adolescents


A practical guide to understanding and treating children and adolescents prone to extreme levels of angry outbursts, Disruptive Mood: Irritability in Children and Adolescents is based on the very latest research and theory. Providing both a clinical and scientific perspective on irritability in children, this book is a timely look at recent developments in the field. Abnormal states of anger are a common reason for referral to child health services, and cause concern in clinics, schools, and families. Misdiagnosis and treatment can stem from a lack of understanding of the mechanisms involved in high levels of anger in children, and Disruptive Mood: Irritability in Children and Adolescents provides clear guidance on the development of abnormal states of anger, their consequences for later development, and how to assess and make differential diagnoses between them. A useful resource for clinical practice, this book is concise and accessible, and offers tools for evaluating treatments. Disruptive Mood: Irritability in Children and Adolescents is designed for practitioners involved in child and adolescent mental health and education and researchers who need an introduction to this complex field.


Is irritability a problem?

Irritability will often be the main reason for the referral of a child to a clinic. Parents and children may use a variety of terms to refer to the same problem. Box 3.1 lists some common ways of describing irritability.

There are other presentations, however, in which it is important to ask directly about problems of anger. Sometimes, young people and families present to a clinic with a problem that occurs before the feeling or other manifestation of irritability. Such events can vary from intense anxiety to problems with communication (see Johnny’s case in Box 8.1), both of which may give rise to irritability. Similarly, the presenting complaint can be a problem that occurs after the manifestation of irritability. This is typically the case with children who end up having fights or being otherwise antisocial. In such cases it is easy for the clinician to overlook irritability.

Sometimes irritability is present and impairing, but is overshadowed by other problems such as disobedience and antisocial acts. An initial evaluation should include a screen for symptoms of irritability. At a busy clinic or in a primary-care setting this initial screen can be done using scales such as the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) or the Child Behavior Checklist (CBCL; Achenbach, 1991), which enquire about psychopathology in general and include a few items on irritability.

Who reports irritability?

This will depend on characteristics of the clinical setting, such as the age range of the children referred or the area of psychopathology the clinic specializes in. Both parents and teachers will be good at noticing the behaviours that are characteristic of irritability, i.e. temper outbursts. Teachers are usually not as good at describing the intense distress that children feel as part of their irritability. Parents are usually better at recognizing the subjective suffering, the brooding, angry ruminations, and overall dysphoria that accompanies irritability. Young people themselves can be excellent at describing . . .

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