Dysfunctional Attention Processing in Children with Clinical Irritability

Irritability is a transdiagnostic psychiatric symptom that spans the internalizing- externalizing divide and places children at greater risk for common mental health problems. There is evidence for disrupted affect-biased attention processing in children with high levels of irritability, but the underlying mechanisms supporting this dysfunction are not well understood. 24 children with clinical irritability (IRR) and 25 typically-developing comparison children (TD) ages 6-10 years old completed a modified visual Oddball task, which is optimized for probing the attention system, during functional magnetic resonance imaging (fMRI). Influence of happy, angry, or neutral distractor stimuli were analyzed using two methods. One analysis compared the two groups within each condition using voxel-wise whole brain t-tests. A second analysis examines dimensional irritability (assessed using the Multidimensional Assessment Profile of Disruptive Behavior or MAP-DB) predicting neural functioning across the sample within each condition. Both analytical approaches revealed increased activity in sensorimotor cortex with increased irritability in the affective conditions. In the Neutral condition, there were negative associations between primary sensory and parietal cortex activation and MAP-DB irritability scores. Our findings suggest maladaptive integration of visual-spatial information during sustained attention in clinically irritable children that may underlie disruptions in emotion processing.