Irritability in Youth: A Critical Integrative Review

Abstract

Irritability, defined as proneness to anger that may reach an impairing extent, is common in youth. There has been a recent upsurge in relevant research. We combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions to address research gaps. Clinicians and researchers should assess irritability routinely; specific assessment tools are now available. Informant effects are prominent, stable, and vary by age and gender. The prevalence of irritability is particularly high in attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occuring diagnoses. Irritability trajectories have been identified that are differentially associated with clinical outcomes; some begin early in life. Youth irritability is associated with increased risk later in life for anxiety, depression, behavioral problems, and suicidality. Irritability is moderately heritable and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for constructs related to irritability, but its efficacy in irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeted to frustration exposure). Associations between irritability and suicidality and the impact of cultural context are important, under-researched topics. Large, diverse, longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, thus affording important translational opportunities.