Psychosocial Treatment of Irritability in Youth
Purpose of review
Chronic, severe irritability is a common presenting problem in children and adolescents. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in recognition of this public health need. Currently, there are no well-established, evidence-based pharmacological or psychosocial treatments specifically for DMDD. Here, we focus on psychosocial interventions. In addition to reviewing published research, we present preliminary, open trial data on a novel exposure-based cognitive-behavioral therapy (CBT) targeting severe irritability, as is present in DMDD.
In the published literature, parent management training (PMT) comprises parent-based interventions designed to treat youth disruptive behavior. Child-based interventions for disruptive behavior include CBT focused on social cognition and problem-solving. Based on identified treatment gaps for severe irritability in children and adolescents, novel psychosocial interventions are being developed. We have developed a CBT for severe irritability that integrates exposure techniques, drawn from anxiety treatment, with selected PMT techniques. Data from an open pilot trial (N = 10) suggest feasibility.
Promising psychosocial treatments are being developed for DMDD. Future directions include testing these new therapies against extant interventions. Increased research on the biological and psychological mechanisms mediating irritability will further bridge the treatment gap for youth and families.
KeywordsIrritability Disruptive mood dysregulation disorder Cognitive-behavioral therapy Exposure Parent management training
The authors’ research is supported by the National Institute of Mental Health (NIMH) Intramural Research Program (ZIAMH002786–15, ZIAMH002778–17), conducted under NIH Clinical Study Protocols 15-M-0182 (ClinicalTrials.gov identifier: NCT02531893), 02-M-0021 (ClinicalTrials.gov identifier: NCT00025935), and 00-M-0198 (ClinicalTrials.gov identifier: NCT00006177).
Compliance with ethical standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
References and Recommended Reading
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