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The Meaning of Irritability in ADHD: Systematic Review
Renata Maria Silva Santos1, Jamile Noele de Andrade2, André Soares da Silva3
1Postgraduate Program in Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.
Insights
Irritability in children with Attention-Deficit/Hyperactivity Disorder (ADHD) is linked to worse symptoms and more mental health issues. Addressing irritability is key for better ADHD treatment outcomes.
Area of Science:
- Child and Adolescent Psychiatry
- Neurodevelopmental Disorders
- Behavioral Science
Background:
- Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder.
- Irritability is frequently observed in children with ADHD but its specific role requires further elucidation.
Purpose of the Study:
- To systematically review and synthesize the existing literature on the role of irritability in the psychopathology and functioning of children diagnosed with ADHD.
Main Methods:
- Systematic review conducted following PRISMA guidelines.
- Searched multiple databases for relevant studies, yielding 3,902 initial results.
- Included 24 articles after removing duplicates and applying exclusion criteria.
Main Results:
- Higher irritability levels strongly correlate with more severe ADHD symptoms and increased psychiatric comorbidities (depression, anxiety, bipolar disorder).
- Irritability is associated with Oppositional Defiant Disorder, internalizing/externalizing behaviors, poorer cognitive function (language, emotion recognition), and impaired inhibitory control.
- Chronic irritability links to reduced social skills, task abandonment, faster reaction times with lower accuracy, and significantly correlates with suicidality.
Conclusions:
- Irritability exacerbates ADHD symptoms and elevates the risk of psychiatric comorbidities.
- Considering irritability in ADHD assessment and treatment is crucial for improving mental health outcomes and prognosis.
Abstract:
To investigate the role of irritability in the psychopathology and functioning of children with ADHD. This review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA, a protocol that standardizes the collection of evidence, and was registered at the International Prospective Register of Systematic Review - PROSPERO. Of the 3,902 studies returned from the databases, duplicates and studies that met the exclusion criteria were removed, leaving 24 articles in the review. In children with ADHD, higher levels of irritability were strongly associated with more severe ADHD symptoms and a greater presence of psychiatric comorbidities, including depression, anxiety, and mood disorders, such as bipolar disorder. Irritability showed a positive correlation with Oppositional Defiant Disorder and both internalizing and externalizing behaviors. Cognitive functioning was notably affected, with irritability linked to poorer language skills and lower accuracy in emotion recognition. Children with chronic irritability demonstrated poorer inhibitory control, reduced social skills, and an increased tendency to abandon tasks. Furthermore, irritability was associated with faster reaction times but also lower task accuracy, and it was significantly correlated with suicidality. Irritability appears to exacerbate symptoms in patients with ADHD and increase psychiatric comorbidities. It is essential to consider irritability in the assessment and treatment of ADHD to improve mental health outcomes and the overall prognosis for these individuals.
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