An Examination of Child Irritability and Behavioral Aggression

Maria Naclerio, BA

McLean Hospital – Research Assistant

Scientific Abstract

Background: Irritability is the leading reason that children are brought in for psychiatric evaluation, accounting for over 40% of ER cases and over 20% of outpatient visits for mental health. Irritability is a feature of several disorders in adolescents and often leads to aggressive behavior. However, there are no behavioral markers to distinguish irritability among different disorders. In this study, we examined the relationship between self and parent-reported irritability and a behavioral indication of aggression in a transdiagnostic sample using the Point Subtraction Aggression Paradigm (PSAP). We hypothesized that more irritable children would exhibit higher levels of aggression.

Methods: Participants (N = 168) ages 8-16 (M = 11.39 ± 2.57, 45.2% female) were recruited from an ongoing IRB-approved study. Participants were assigned to three levels of irritability (low, medium, high), based on child and parent responses to the Affective Reactivity Index (ARI). We used the Point Subtraction Aggression Paradigm (PSAP), a computerized game involving opportunities to earn and steal points, as a behavioral indicator of aggression. Univariate Analysis of Variance (ANOVA) was used to determine whether there were significant differences in behavioral aggression based on irritability groups. 

Results: A one-way ANOVA indicated that there was a statistically significant difference between child-reported irritability groups on behavioral aggression, (F(2,165) = 4.565, p = .012). A Tukey post hoc test revealed that children in the low irritability group displayed significantly less behavioral aggression on the PSAP (M = 26.88 ± 24.75) compared to those in the medium irritability group (M = 44.90 ± 51.83), p = .011. There were no statistically significant differences between low and high (p = .98) or medium and high groups (p = .118). There was no significant difference between parent-reported irritability groups on behavioral aggression (p = .098).

Conclusions: The PSAP may be a valuable behavioral indicator of aggression and irritability in children. Future research should examine whether the PSAP can be used to distinguish irritability among different disorders.

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research Areas


Maria Naclerio, B.A., Eileen Lee, B.A., Courtney Kaplan, B.A., Emma Cho, B.S., Jillian Russo, Psy.D., Josephine Au, Ph.D., Julianne Tirpak, Ph.D., Daniel Dickstein, M.D.

Principal Investigator

Daniel Dickstein, M.D.

Affiliated Website