(PS4-B26) Mapping Relations Among Irritability, Oppositionality, Inattention, and Hyperactivity/impulsivity Symptoms in Youth: A Network Analysis Approach

Irritability, oppositionality, intention, and hyperactivity/impulsivity are common, co-occurring, and impairing externalizing symptoms in youth (Stringaris & Goodman, 2009). These symptoms are dimensional and transcend numerous mental health disorders, including disruptive mood dysregulation disorder (DMDD) and oppositional defiant disorder (ODD), and it is imperative to understand how they are related and maintained. Network analysis provides a novel, data-driven approach to understanding associations among mental health symptoms within and across disorders; however, few studies have leveraged this approach in the context of youth externalizing psychopathology (Borsboom & Cramer, 2013). The present study uses network analysis to investigate the associations between irritability, oppositionality, inattention, and hyperactivity/impulsivity symptoms in youth. The sample was comprised of pediatric clinical research participants (N=1157, ages 8-18) representing a variety of diagnostic profiles (including attention-deficit/hyperactivity disorder [ADHD], anxiety disorders, mood disorders, severe irritability, and healthy volunteers). Caregivers rated their child’s externalizing symptoms on the Conners’ Parent Rating Scale - Revised (CPRS-R; Conners, 2001). We analyzed 33 externalizing-spectrum items from the CPRS-R, including those comprising the ODD and ADHD subscales, along with frustration and emotional lability items. A regularized partial correlation network was estimated in R with the package bootnet (Epskamp et al., 2017) and we used the function spinglass.community from the R package igraph to identify communities within the network (Csardi & Nepusz, 2006). Results initially revealed clustering consistent with CPRS-R and DSM categories (ODD, ADHD, Emotional Lability, and Frustration; American Psychiatric Association, 2022). Three nodes emerged with the highest centrality across the network: Distracted, Avoids Tasks, and Temper Outbursts. Further, the distinct categories were bridged by the nodes Frustrated, Temper Outbursts, and Frustrated in Efforts. Community detection revealed four data-driven clusters, with irritability items splitting from defiance in ODD to form the communities Irritability, Defiance, Hyperactivity/Impulsivity, and Inattention. Taken together, our findings reveal a data-driven network structure underlying youth externalizing symptoms, which differs in striking ways from the structure implied by DSM criteria. In particular, oppositionality symptoms seem to split into a defiance and an irritability/frustration/lability cluster, consistent with recent research on the multidimensional structure of ODD symptoms (Evans et al., 2017). Results also implicate distraction, task avoidance, temper outbursts, and frustration as being central to these concerns, highlighting potential targets for intervention.