OBJECTIVE: In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. METHODS: Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 non-referred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. RESULTS: No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. CONCLUSIONS: Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.
OBJECTIVE: In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. METHODS: Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 non-referred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. RESULTS: No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. CONCLUSIONS: Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.
Authors: Melissa A Brotman; Layla Kassem; Michelle M Reising; Amanda E Guyer; Daniel P Dickstein; Brendan A Rich; Kenneth E Towbin; Daniel S Pine; Francis J McMahon; Ellen Leibenluft Journal: Am J Psychiatry Date: 2007-08 Impact factor: 18.112
Authors: Daniel P Dickstein; Brendan A Rich; Anna B Binstock; Anne G Pradella; Kenneth E Towbin; Daniel S Pine; Ellen Leibenluft Journal: J Child Adolesc Psychopharmacol Date: 2005-08 Impact factor: 2.576
Authors: Brendan A Rich; Mariana Schmajuk; Koraly E Perez-Edgar; Nathan A Fox; Daniel S Pine; Ellen Leibenluft Journal: Am J Psychiatry Date: 2007-02 Impact factor: 18.112
Authors: James G Waxmonsky; Daniel A Waschbusch; Peter Belin; Tan Li; Lysett Babocsai; Hugh Humphery; Meaghan E Pariseau; Dara E Babinski; Martin T Hoffman; Jenifer L Haak; Jessica R Mazzant; Gregory A Fabiano; Jeremy W Pettit; Negar Fallahazad; William E Pelham Journal: J Am Acad Child Adolesc Psychiatry Date: 2015-12-28 Impact factor: 8.829
Authors: Leslie A Hulvershorn; Maarten Mennes; F Xavier Castellanos; Adriana Di Martino; Michael P Milham; Tom A Hummer; Amy Krain Roy Journal: J Am Acad Child Adolesc Psychiatry Date: 2013-12-14 Impact factor: 8.829
Authors: Gabrielle A Carlson; Allison P Danzig; Lea R Dougherty; Sara J Bufferd; Daniel N Klein Journal: J Child Adolesc Psychopharmacol Date: 2016-01-19 Impact factor: 2.576
Authors: Christen M Deveney; Margaret J Briggs-Gowan; David Pagliaccio; Christopher R Estabrook; Elvira Zobel; James L Burns; Elizabeth S Norton; Daniel S Pine; Melissa A Brotman; Ellen Leibenluft; Lauren S Wakschlag Journal: Dev Psychobiol Date: 2018-10-17 Impact factor: 3.038
Authors: Katharina Kircanski; Michelle G Craske; Bruno B Averbeck; Daniel S Pine; Ellen Leibenluft; Melissa A Brotman Journal: Behav Res Ther Date: 2019-04-22
Authors: Amy Krain Roy; Randi Bennett; Jonathan Posner; Leslie Hulvershorn; F Xavier Castellanos; Rachel G Klein Journal: Dev Psychopathol Date: 2017-08-14