Developmental shifts in irritable behaviors from preschool to school age: Longitudinal network analysis of heterotypic and homotypic continuity

Abstract

Irritability comprises a set of behaviors that span normal:abnormal proneness to anger. When dysregulated and developmentally atypical, irritability indicates neurodevelopmental vulnerability for mental health problems. Yet, mental health risk indicators such as irritability likely present differently during specific developmental stages, especially across the crucial transition from preschool to early school age, when the presence of sustained elevated irritability predicts psychiatric disorders, increased impairment, and service use in school-age children. The goal of this study is to chart how behavioral manifestations of irritability unfold and shift across the developmental transition from preschool to early school age and identify key irritability behaviors that are most strongly predictive of other irritability behaviors in the next developmental stage. The sample was drawn from the Multidimensional Assessment of Preschoolers Study (MAPS, N = 382), a diverse early childhood sample enriched for psychopathology via oversampling for disruptive behavior and family violence exposure. Objective frequency of normative to severe irritability captured as tantrum features and irritable mood across contexts were longitudinally measured at preschool- (M_age = 4.49 years, SD = 0.83) and early school-age (M_age = 7.08, SD = 0.94) using the developmentally specified Multidimensional Assessment Profile Scales-Temper Loss. A cross-lagged panel network was estimated to depict the longitudinal predictive connections between individual irritability items from preschool to early school age. The strongest cross-lagged association was hit/bit/kick during a tantrum at preschool predicting tantrums in normative contexts at early school age. Severe tantrum behaviors (e.g., hit/bite/kick) and difficulty recovering from anger/tantrums at preschool age are key irritability behaviors that predict the development of widespread irritability features in early school age, including severity and length of tantrums, tantrums across contexts, and irritable mood expressions. As development unfolds, severe and violent irritable behaviors in preschool age influence a wide range of less dysregulated irritable behaviors, yet expressed at developmentally abnormally high frequencies, during early school age. Highlighting the central behavioral indicators of irritability and how expressions change over the crucial transition from preschool to early school age can inform pragmatic clinical screening measures to identify children who experience high levels of key irritability behaviors (i.e., severe tantrums or difficulty recovering from anger or tantrums in preschool-age) and novel interventions to target these behaviors and interrupt the clinical cascade toward entrenched psychiatric disorders.

Keywords

Developmental psychopathology irritability behavior problems

Introduction

One of the key tenets—and measurement challenges—in developmental psychology is heterotypic continuity (Jung & Kim, 2023), which describes a phenomenon where underlying constructs (e.g., neurodevelopmental vulnerability to psychopathology) that remain constant may manifest differently as individuals develop. Capturing how behavioral manifestations of underlying neurodevelopmental vulnerability, that is, susceptibility to environmental stressors or genetic predisposition to psychopathology, morph in their presentation through key developmental transitions is crucial to identifying mental health risk (Marquand et al., 2019; Mittal & Wakschlag, 2017). Elevated irritability, which comprises a set of dysregulated, severe, frequent, and/or developmentally unexpectable tantrum behaviors and mood features (Wiggins et al., 2018), is one of the most common manifestations of underlying neurodevelopmental vulnerability to psychopathology (Leibenluft & Stoddard, 2013). Elevated irritability is a robust transdiagnostic predictor of psychopathology (Wiggins, Roy, et al., 2023), and when present in preschool-age (3–6 years), predicts later psychiatric disorders, increased impairment, and use of services in school-age children (Dougherty et al., 2015; Wiggins et al., 2018). Moreover, elevated irritability is one of the most common reasons families seek pediatric psychiatric evaluation (Mikita & Stringaris, 2013; Peterson et al., 1996) and is a major public health concern (Stringaris et al., 2018). The transdiagnostic nature of irritability, cutting across both internalizing and externalizing disorders (Vidal-Ribas et al., 2016), makes it an optimal target for large-scale screening of risk for common psychological, behavioral, and emotional disorders (Vidal-Ribas et al., 2016; Wakschlag et al., 2019). Thus, it is crucial to characterize how the behavioral manifestations of irritability evolve over development to mitigate these negative effects.

Several studies examining the developmental trajectories of irritability found that most children experience low irritability levels that stay stable over time or, if they do have elevated irritability in preschool age, that irritability decreases as they age. However, some children experience an increase in irritability or persistently elevated irritability across preschool to early school age (e.g., Dugre & Potvin, 2022; Ezpeleta et al., 2016; Pagliaccio et al., 2018), which is associated with a higher likelihood of psychiatric diagnoses later in life, such as mood disorders, anxiety disorders, attention-deficit/hyperactivity disorder, and self-harm behaviors (Pagliaccio et al., 2018; Srinivasan et al., 2024). While some levels of mild irritability behaviors, such as tantrums in expectable contexts, are developmentally normative, these same behaviors may be indicative of clinically significant problems when occurring at a high frequency or at a later developmental stage. Severe and violent tantrum behaviors are often suggestive of abnormal irritability, even if in low frequency (Wakschlag et al., 2012).

There have been recent measurement advances to meet the need for developmentally specific characterization of irritability, including the Multidimensional Assessment Profile Scales-Temper Loss (MAPS-TL), a well-validated developmentally sensitive questionnaire that utilizes a dimensional continuum to measure several behavioral manifestations of irritability, ranging from behaviors developmentally expected to those suggestive of psychopathology (Wakschlag et al., 2012). Originally developed for preschool-age children, the MAPS-TL includes multiple developmentally specific versions: infant-toddlerhood (Krogh-Jespersen et al., 2022), early school-age (Hirsch et al., 2023), and preadolescence-adolescence (Alam et al., 2023; Kirk et al., 2023). To assess irritability, all MAPS-TL versions include 22 core items that remain the same across development (with only minor changes), such as “lose temper or have a tantrum with a parent,” as well as additional, age-specific items for each developmental period (e.g., “have a temper tantrum when asked to stop playing and do something else” for the Toddler version). These core items were found to be relevant to irritability across these developmental stages (Wiggins, Roy, et al., 2023), which provides the opportunity for tracking the changes and stability of specific behaviors over time. Yet, while such developmentally validated measurement exists for each age period separately, it is unclear how these specific behaviors relate to each other across ages, particularly during critical developmental transitions when children experience changes in their social-developmental contexts and expectations such as the preschool to early school period.

As a first step to link differing manifestations of irritability across age periods, the present study aimed to characterize shifts from preschool to early school age, a transition period marked by rapid development in cognitive and social-emotional skills as well as changes in academic, social, and family expectations (Likhar et al., 2022; Miguel et al., 2019). Understanding shifts during this transition is important, as there is strong evidence suggesting irritability persisting into early school age is associated with widespread, detrimental effects in adolescence and beyond (Wiggins et al., 2018). Here, we leveraged a well-characterized longitudinal sample, which allows for measurement of multifaceted irritability features at preschool and school age, and employed a novel network analysis technique to examine how these behaviors unfold and develop over time, allowing us to capture the temporal relationship between individual irritability behaviors and potential symptom “evolution” from a developmental perspective (Wysocki et al., 2022). While previous studies have highlighted the significance of screening for early irritability, the current study further advances this line of research by pinpointing key irritable behaviors that lead to continued irritability as children age across the transition to school. These key irritable behaviors may be leveraged as targets for prevention programs. Based on prior literature on the normal:abnormal spectrum of irritability, we hypothesized that behaviors uncommon or atypical in preschool-age participants due to severity (Wakschlag et al., 2012), such as staying angry for a long time and hitting/biting/kicking during a tantrum, would be more strongly predictive of other irritability symptoms at early school age.

Methods

Participants

The current study used a sample drawn from the Multidimensional Assessment of Preschoolers Study (MAPS), a large-scale study enriched for children from diverse backgrounds who exhibit disruptive behaviors. Procedures were approved by the Northwestern University Institutional Review Board (STU00025235 and STU00083564). Mothers of children recruited from the greater Chicago area completed the assessment battery at the preschool- (M_age = 4.49 years, SD = 0.83) and early school-age (M_age = 7.08, SD = 0.94) time points.

Among those who enrolled in the study, 473 of 497 participants at preschool-age baseline and 402 at school-age follow-up had complete data for the MAPS-TL. The longitudinal sample consisted of 382 participants with complete MAPS-TL data across the two time points. Because network analysis requires complete data, the participants with missing data were excluded from analyses. Included versus excluded participants did not differ in gender ( $χ^{2}$ = 3.30, df = 1, p = .07), race/ethnicity ( $χ^{2}$ = 4.32, df = 3, p = .21), poverty status ( $χ^{2}$ = 0.002, df = 1, p > .99), or parental education ( $χ^{2}$ = 2.80, df = 6, p = .73). The included participants were on average 3 months younger than the excluded participants younger (t = 2.39, df = 145.25, p = .018). Sample demographics are shown in Table 1.

Table 1.

Demographic Information of Analytic Sample.

	N (%)
Gender
Male	179 (46.9)
Female	203 (53.1)
Race/Ethnicity
Black/African American	183 (47.9)
White	87 (22.8)
Hispanic	106 (27.7)
Other	6 (1.6)
Parental Education
Less than high school	13 (3.4)
High school/GED	79 (20.7)
Some college	121 (31.7)
Associates	61 (16.0)
Bachelors	59 (15.4)
Graduates	42 (11.0)
Missing	7 (1.8)
Poverty
Not poor	205 (53.7)
Poor	177 (46.3)

Note. Poverty status was determined using federal poverty guidelines based on annual household income and household size, as well as receipt of TANF services.

Measures

The MAPS-TL (Wakschlag et al., 2012) was completed by the mothers at both the preschool and early school-age time points. To reduce informant bias, all informants in this study were mothers. To facilitate comparison across ages, we focused on the core 22 items, which span three primary types of features: irritable mood, behavioral expression of tantrums, and context in which tantrums occur. To increase power and interpretability, items within the same aspect of irritability that had high correlations and face validity suggesting similar target construct were combined by computing the mean, resulting in a total of 16 target irritability features (see Supplemental Methods). Mothers reported on their children’s disruptive behaviors using an objective frequency scale from 0 = never to 5 = many times each day. Scores equal to or greater than 2 (1–3 days of the week) were collapsed due to skewness, resulting in a scale of 0 = never, 1 = rarely (less than once per week), and 2 = 1–3 days of the week or more.

Statistical Analyses

A directed cross-lagged panel network (CLPN, Wysocki et al., 2022) was estimated to depict the connections between irritability symptoms in preschool and early school age. Instead of examining irritability as a homogeneous construct, the network approach allows for the investigation of the interrelationship among these nuanced behaviors that may involve different internal processes. To construct this network, LASSO regularized regressions were performed in R (version 4.0.3, R Core Team, 2020) using the “glmnet” package (version 4.1-8, Friedman et al., 2010), which estimated the autoregressive and cross-lagged (non-autoregressive) associations among irritability features in preschool-age and early school-age children. Specifically, autoregressive associations were estimated by regressing each variable at early school age (T2) on itself measured at preschool age (T1), controlling for all other variables at early school age (T2). Therefore, this relationship indicates the degree to which a symptom predicts itself over time. Similarly, the cross-lagged associations were estimated by regressing each variable at early school age (T2) on each other variable at preschool age (T1), controlling for all other variables at early school age (T2), measuring a longitudinal predictive relationship between two different symptoms. Ten-fold validation was applied to select the λ within 1 SE of the minimum; this produced a parsimonious model that preserved the most salient connections while shrinking the others to zeros.

The regularized regression coefficients were then extracted to visualize the CLPN using the R package “qgraph” (version 1.9.2, Epskamp et al., 2012) with the regression coefficients as the edge weights. Network accuracy and stability were evaluated through nonparametric and case-dropping bootstrapping using the “bootnet” R package (Epskamp et al., 2018). The centrality indices provide a summary quantitative indicator of the strength, expected influence, and closeness of each node within the network. To evaluate the relative importance of the irritable behaviors, centrality indices, including in-expected influence (in-EI) and out-expected influence (out-EI), were computed as the sum of the incoming connections (i.e., predicted by other variables) and outgoing connections (i.e., predictive of other variables), respectively. Because we aimed to identify key behavioral and mood indicators that are predictive of later irritability features, out-EI was chosen to be the primary centrality measure, as it measures the extent to which a certain irritability behavior at preschool age is predictive of all other irritability behaviors at early school age.

Results

Overall Model Quality

The CLPN from preschool age to early school age produced a total of 256 possible connections among irritable behaviors, 16 of which were autoregressive connections, and 240 of which were non-autoregressive connections. After LASSO regularization, 15 non-zero autoregressive coefficients and 101 non-zero non-autoregressive coefficients remained (Figure 1). Bootstrapping results suggest acceptable to good stability for out-EI (Correlation Stability [CS] = 0.36) and in-EI (CS = 0.52) but low stability for bridge-expected influence (bridge-EI, CS = 0.13). Thus, bridge-EI results are not presented. Results regarding the in-EI are presented in the Supplementary Materials.

Key “Hub” Indicators: Strongest Overall Preschool-Age Predictors Across All Early School-Age Behaviors

Among the 16 candidate irritable behaviors at preschool age, “Hit, bite, or kick during a tantrum, fall-out, or melt-down” emerged as a key “hub” behavior (i.e., strongest out-EI, z = 2.74) that had the strongest predictive value across all early school age irritable behaviors (Figure 2). Other preschool-age irritable behaviors that strongly predicted across all irritable behaviors at early school age included “Have difficulty calming down when angry” (out-EI z = 1.09) and “Have a temper tantrum that lasted more than 5 min/even when tried calm him or her down/until exhausted” (out-EI z = 0.85).

Specific Pathways From One Behavior at Preschool Age to Another at School Age

“Hit, bite, or kick during a tantrum” at preschool age also emerged as the strongest predictor of other specific irritable behaviors (i.e., non-autoregressive) at early school age, particularly “Losing temper in [various contexts]” (ß = .24). Protracted tantrums (“Have a temper tantrum that lasted more than 5 min/even when tried calm him or her down/until exhausted”) was the next strongest non-autoregressive preschool-age predictor; this behavior at preschool age was associated with both unexpectable tantrums (“Lose temper or have a tantrum out of the blue or for no reason,” ß = .23) and maintained anger (“Stay angry for a long time,” ß = .18) at early school age.

Behaviors That Maintained Homotypic Continuity (Same Manifestation Over Time)

Behaviors that were most likely to persist in the same form (autoregressive associations) from preschool to school age included “Act irritable” (ß = .28), “Yell angrily at someone” (ß = .28), and “Have a short fuse (become angry quickly)” (ß = .24).

Additional Analyses

Undirected cross-sectional networks, which depict the unique cross-sectional association between irritability features, were identified for the preschool-age and early school-age time points separately (Figure S2 in Supplementary Materials). The network models achieved good stability for the centrality indices. Given the longitudinal focus of the present study, the details of the cross-sectional network results are included in the Supplementary Materials.

To control for sociodemographic variables, a CLPN that included gender, race/ethnicity, age at the preschool-age time point, and poverty status as covariates was performed, with results consistent with the CLPN without covariates (i.e., identifying the same items with the highest out-EI and strongest connections, see Supplementary Material for details). However, the model stability indices were not able to be accurately calculated for the model with covariates. Thus, the discussion focuses on the results from the CLPN without covariates. Future studies sufficiently powered to conduct separate analyses for each sociodemographic subgroup may wish to examine the network structure in different sociodemographic groups separately.

Discussion

Irritability is often discussed as a homogeneous concept, yet irritability is composed of multiple behaviors that can change over development. The present study is the first to examine how behavioral manifestations of irritability shift over time and how certain developmentally salient, early irritable behaviors can lead to other manifestations of irritability in later developmental stages. Indeed, while prior work has been fruitful in identifying age-banded irritable behaviors of interest (Alam et al., 2023; Hirsch et al., 2023; Krogh-Jespersen et al., 2022), no work had yet linked these developmentally sensitive characterizations of irritability to characterize how manifestations of irritable behavior may change over development. Tracing how neurodevelopmental vulnerability manifests differently across time, including key “hub” behaviors that may give rise to additional manifestations of irritability as time passes, will improve prevention and interventions by pinpointing behaviors to be triaged. These key “hub” behaviors have prognostic value, as they strongly predict a variety of future irritable behaviors and can be prioritized in pragmatic screening such as computer adaptive testing.

In the present study, we identified that hitting, biting, or kicking during a tantrum in preschool age was a key “hub” behavior more predictive of a large variety of future school-age irritable behaviors compared to other preschool-age irritability behaviors. Previous work has also identified hitting/biting/kicking as a primary behavior uniquely indicative of later impairment (Wiggins, Ureña Rosario, et al., 2023), in addition to other, similarly severe, violent/destructive tantrum behaviors, “break or destroy things during a temper tantrum” (Wiggins et al., 2018). Here, hit/bite/kick was only endorsed by 27% of the present study’s participants, making it the least frequently endorsed of the candidate irritable behaviors; yet, when families did endorse it at preschool age, it was associated with an increase in multiple other irritable behaviors at early school-age, highlighting its predictive potency. Our results, in combination with prior work (Wiggins et al., 2018; Wiggins, Ureña Rosario, et al., 2023), suggest that severe, pathognomonic irritable behaviors are critical for identifying at-risk children and, moreover, in preschool age, may be a precursor to other irritable behaviors at early school age.

Protracted, dysregulated tantrums (“Have difficulty calming down when angry” and “Have a temper tantrum that lasted more than 5 min/even when tried calm him or her down/until exhausted”) emerged as other key “hub” behaviors strongly predictive of multiple other irritable behaviors at early school age, which speaks to the possibility of preschool-age emotional dysregulation as foundational for risk. These findings are similar to previous work suggesting that the foundation of irritability is low frustration tolerance (Alam et al., 2023; Kirk et al., 2023; Wiggins et al., 2018, 2021; Wiggins, Ureña Rosario, et al., 2023), supporting the idea that a fundamental aspect of irritability is difficulty regulating negative emotions (e.g., frustration and anger). Indeed, in considering the key “hub” behaviors together (hit/bite/kick, a pathognomonic, severe indicator; and protracted dysregulated tantrums, a mood regulation component), our findings corroborate ongoing work on pragmatic screening deriving parsimonious models of key irritable behaviors (Alam et al., 2023; Hirsch et al., 2023; Wakschlag, Carroll, et al., 2024; Wakschlag, Zhang, et al., 2024; Wiggins et al., 2018; Wiggins, Ureña Rosario, et al., 2023). Indeed, across all these pragmatic screeners and in our present findings, the combination of a pathognomonic, severe behavior that most children do not do (e.g., violent/destructive tantrums) and a mood dysregulation component (e.g., protracted dysregulated tantrums) appears to indicate problematic irritability. Beyond the converging results with these studies that focused on identifying age-banded behaviors for irritability screeners, the current study further advanced the understanding of the developmentally sensitive presentation of irritability by examining how specific behaviors in one developmental stage predict behaviors in subsequent developmental stages, explicating the underlying heterotypic continuity processes.

We also identified preschool-age behaviors (that happened to overlap with the key “hub” behaviors) showing strong individual pathways to specific early school-age behaviors. In one of the cases, a pathognomonic, inherently severe behavior (hit/bite/kick) at preschool age led to what prior item response theory had deemed a mild behavior (have tantrums in various contexts, Wakschlag et al., 2012) when occurring at low frequencies; this “mild” behavior becomes problematic at higher frequencies (i.e., every day). Our results suggest that early, pathognomonic behavior can lead to later behaviors that may appear mild but are problematic at a higher frequency and/or at an older age. The other strong pathways were from protracted, dysregulated tantrums (tantrum more than 5 min/even when tried to calm down/until exhausted) at preschool age leading to unexpectable tantrums (out of the blue) and to maintained anger (angry for a long time) in early school age; in these cases, as expected, pathognomonic behavior led to more pathognomonic behaviors. Of note, the homotypically continuous behaviors, manifesting the same from preschool to school age (i.e., act irritable, yell angrily, angry quickly), were, importantly, identified as truly “core” behaviors that span age periods and are less developmentally specific. These behaviors likely persist from preschool to early school age, which is consistent with previous studies suggesting these items are relevant and should be assessed at these developmental stages.

While this study has several strengths, including a sociodemographically diverse sample, developmentally sensitive and nuanced measurement of irritability behaviors, and novel analytic techniques, the findings should be interpreted with consideration of the following limitations. The present study leveraged a community sample, and while it was enriched for irritability, the severity and/or frequency of irritable behaviors may be low relative to clinical samples. To address the skewness in the irritability items, the highest four categories of the objective frequency responses were combined, which could have masked nuances in the network model. While it is important to employ community samples, as community settings are where general screening for these behaviors takes place, future studies may wish to leverage clinical samples with more severe irritability features. Of note, while the current study utilized the mother-report MAPS-TL as the irritability behavior measure, which provides objective frequencies of irritability behaviors, the questionnaire may not fully capture the child’s behavioral patterns in other salient social contexts (e.g., interactions with other caregivers or teacher). Future studies may wish to utilize a multi-method approach by including father-report, teacher-report, or observational data to measure irritability behaviors and capture the nuanced connections between context-dependent irritability behaviors. In addition, because the analyses required listwise deletion for missing data, the sample size was limited. Therefore, the effect of sociodemographic variables on the network structure was not explored due to limited power. Future studies may wish to replicate these findings with large consortium data sets that have specialized irritability measures, which are not currently available, and to explore the impact of sociodemographic characteristics on network structure of irritability behaviors using sample stratification. In addition, future research may wish to investigate aspects of irritability, such as its tonic and phasic expressions, more in depth by including measures specifically geared toward these constructs, such as The Irritability and Dysregulation of Emotion Scale (TIDES-13, Dissanayake et al., 2024), to examine the developmental transitions of these constructs.

This study characterized how behavioral manifestations of irritability shift over the transition from preschool age to early school age. The findings highlight the developmental nature of irritability behaviors, as not all behaviors are equally persistent or predictive of other behaviors and suggest that developmental stages should be considered when measuring irritability-related symptoms in children. As our results indicated several behaviors in preschool age to be significantly predictive of future irritability behaviors, when measuring irritability symptoms at early developmental stages, emphasis should be placed on these identified behaviors, as they can reflect a risk of broader and more pervasive psychopathology later on. The area of developmental science is emerging, and the current study contributes to the literature to support the growth of developmental theories.

In this study, we contribute to a burgeoning science base for the creation of early screening tools that prioritize developmentally salient irritability features associated with expanding, worsening symptoms. Our work highlights key irritability behavioral expressions that may be significant for the development and maintenance of other irritable behaviors, which may inform the development of intervention programs targeting these key “hub” behaviors to stop the emergence or exacerbation of later irritability manifestations. Such key irritability behaviors can be prioritized for assessment in brief, pragmatic screening measures. Preventive interventions can focus on these hub behaviors to prevent the downstream of a variety of symptoms. Future studies would benefit from further examining the possible mechanism of these behavioral shifts, more complex interactive effects, and additional symptom dimension outcomes (e.g., anxiety, depression, and attention-deficit/hyperactivity) to better understand the full extent of how irritable behaviors shift into psychopathology beyond temper and irritable mood-related constructs.

Supplemental Material

sj-docx-1-jbd-10.1177_01650254251344595 – Supplemental material for Developmental shifts in irritable behaviors from preschool to school age: Longitudinal network analysis of heterotypic and homotypic continuity

Supplemental material, sj-docx-1-jbd-10.1177_01650254251344595 for Developmental shifts in irritable behaviors from preschool to school age: Longitudinal network analysis of heterotypic and homotypic continuity by Qiongru Yu, Erin O. Peterson, Alyssa J. Parker, Margaret J. Briggs-Gowan, Lauren S. Wakschlag and Jillian Lee Wiggins in International Journal of Behavioral Development

Footnotes

Authors’ Note

The preliminary findings of this study were presented as a poster at the Association for Psychological Science (APS) Annual Convention, San Francisco, CA, 23–26 May, 2024.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by National Institutes of Health/National Institute of Mental Health grants R01MH082830, R01MH107652, 2U01MH082830 to Dr. Wakschlag and U01MH090301 to Dr. Briggs-Gowan.

ORCID iDs

Qiongru Yu

Alyssa J. Parker

Jillian Lee Wiggins

Supplemental Material

Supplemental material for this article is available online.

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