Background

Irritability is common in multiple psychiatric disorders and is hallmark of disruptive mood dysregulation disorder. Child irritability is associated with higher risk of suicide and adulthood mental health problems. However, the psychological mechanisms of irritability are understudied. This study examined the relationship between anxiety sensitivity and irritability among youth, and further explored three possible mediated factors: selective attention for threat, delayed reward discounting, and insomnia.

Methods

Participants were 1417 students (51.7% male; mean age 13.83 years, SD = 1.48) recruited from one high school in Hunan province, China. Self-report questionnaires were used to measure irritability (The Affective Reactivity Index and The Brief Irritability Test), anxiety sensitivity (The Childhood Anxiety Sensitivity Index), selective attention for threat (The Davos Assessment of Cognitive Biases Scale-attention for threat bias subscale), insomnia (The Youth Self-Rating Insomnia Scale), and delayed reward discounting (The 27-item Monetary Choice Questionnaire). Structural equation modal (SEM) was performed to examine mediated relations.

Results

Anxiety sensitivity was modestly related to irritability and insomnia (r from 0.25 to 0.54) and slightly correlated with selective attention for threat (r from 0.12 to 0.28). However, there is no significant relationship of delayed rewards discounting with anxiety sensitivity and irritability. The results of SEM showed that selective attention for threat (indirect effect estimate = 0.04) and insomnia (indirect effect estimate = 0.20) partially mediate the relationship between anxiety sensitivity and irritability, which explained 34% variation.

Conclusions

Anxiety sensitivity is an important susceptibility factor for irritability. Selective attention for threat and insomnia are two mediated mechanisms to understand the relationship between anxiety sensitivity and irritability.

Irritability is a common phenomenon in children and adolescence [1] and is also one of the main reasons for seeking psychiatric treatment in youth [2]. It is defined as a state of proneness to anger, specifically, having lower threshold and more intense response to frustration. Children and adolescents with irritability are characterized by frequent, intense, and disproportionate outbursts of temper and anger [3]. Although irritable symptoms decline with age, a considerable proportion of teens showed significant irritability [4]. Irritability is associated with multiple mental disorders, such as autism spectrum disorders, oppositional defiant disorder, attention deficit hyperactivity disorder, anxiety disorder, major depressive disorder and posttraumatic stress disorder [,,,,9]. Pathological irritability, that is chronic and persistent anger, is the core feature of disruptive mood dysregulation disorder. Without effective treatment, pediatric irritability could have long-term adverse effects. Two recent review studies indicate that irritability is one very important indicator of suicide [10, 11]. Several longitudinal studies found that childhood irritability was associated with increased mental health problems in adulthood [12].

Despite the clinical significance of irritability, research into the etiological and pathophysiological mechanisms of this symptom is in its nascent stages. Behavioral genetic studies suggest that irritable mood appears to be moderately heritable and is influenced by unique environmental events [2]. This study aimed to examine the relationship between anxiety sensitivity and irritability among youth in a cross-sectional design, and further explore the possibilities of insomnia, selective attention for threat, and delayed reward discounting as mediators. Below, we will briefly review related literature.

Youth with some personality traits (e.g., nervousness) tend to be at higher risk of irritability [13]. Anxiety sensitivity (AS) is a personality trait and characterized by fear that feelings and symptoms associated with anxiety could yield harmful physical or social consequences. According to the “fear expectation model”, it is defined as “fear from fear” or “fear from anxiety” [14], including physical concerns (e.g., fear of a heart attack from a racing heart), cognitive concerns (e.g., fear of “going crazy” because of difficulty concentrating) and social concerns (e.g., fear of being embarrassed by trembling in public) [15]. As an important susceptibility factor of affective disorders, AS has been reported to be association with major depression disorder, generalized anxiety disorder, post-traumatic stress disorder and obsessive-compulsive disorder [16]. Irritability is one of the diagnostic criteria for multiple affective disorders, and is highly correlated with depression disorder, anxiety disorder, and post-traumatic stress disorder [1]. Thus, common risk factors, such as AS, may be shared between irritability and affective disorders. However, to our best knowledge, the relationship between AS and irritability has yet been examined.

Irritability and insomnia

Sleep deprivation has identified as important environmental factors for irritability [17]. An experimental research on sleep has shown that lack of sleep has a causal effect on emotional regulation and irritability [18]. Insomnia is an important reason for lack of sleep, and individuals with symptoms of insomnia often experience sleep-related cognitive, emotional, and physical hyperarousal. Dysfunctional emotional responses may be linked to sleep-related hyperarousal [19]. When sleep is restricted, teens are unable to regulate their emotional responses properly, leading to temper outbursts and exaggerated responses to small triggers [20].

Irritability and the processing of threat and reward

Given that irritability is a trans-diagnostic symptom, researchers generally use Research Domain Criteria (RDoC) strategy to explore its pathological mechanism. Aberrant processing of fear and reward are two more studied lines. Neurophysiology and behavioral studies have shown that individuals with irritability or severe mood dysregulation are more easier to interpret obscure faces as threatening [21, 22] and more likely to turn their attention to threatening faces, relative to neutral faces [23]. Enhanced attention to threat, as well as, selective attention to hostile or threat-related information would inversely contribute to increased levels of anger [24]. Frustration is central to irritability, and irritable youth may be particularly vulnerable to frustration as a result of having impairments in reward processing. Children and adolescents with irritability show significant deficits in learning to reward in the face of unexpected events and a heightened sensitivity to the receipt of rewards and tend to be inclined towards more timely rewards [25, 26]. Irritable youth have a propensity to choose smaller immediate rather than larger delayed rewards [27]. In turn, delayed reward discounting reflects a form of dysfunction seen across externalizing and internalizing psychiatric conditions that may increases risks for irritability [27]. Rewards and threats are not independent of each other and in the context of threats, the processing of rewards also changes, including increased expressions of anger at frustration [2].

Anxiety sensitivity, insomnia and the processing of threat and reward

Anxiety sensitivity amplifies attention to physiological sensations associated with fear, as well as particular sensitivity to external stimuli that may trigger anxiety, which may explain the bias in threat information processing [28]. Several studies provide evidence that individuals with high anxiety sensitivity prioritize threat information [29, 30]. For example, individuals with high levels of physical AS showed higher vigilance for stimuli associated with anxiety symptomatology compared to neutral words [31]. Recent studies indicated that AS was associated with increased risks of addiction-related problems [32]. Delayed reward discounting is one core feature of individuals with various addictive behaviors. Probably, AS may be related to delayed reward discounting. In addition, anxiety sensitivity is an important risk factor of insomnia severity [33]. Rumination about negative events, excessive worry about future events, and cognitive intrusions, which are frequent and disturbing amongst people on anxiety sensitivity, can hinder the onset of sleep in the pre-sleep period [34].

Insomnia and processing of threat and reward

A key feature of sleep is the necessary loss of awareness and responsiveness to environmental cues, and this state that is attenuated by excessive focus on threats [35, 36]. As an adaptive function, alertness and mobilization will be promoted in threatening environmental conditions [36]. Insomnia may be associated with a propensity to display vigilant attention to threat. Additionally, some evidence suggests a link between sleep disturbance and reward processing deficits [37, 38]. For example, fewer minutes asleep, later sleep onset time, and lower sleep quality were related to hypoactivation in reward system circuitry during anticipation of rewards [37]. Insomnia has been correlated with decreased effort expended for rewards [39].

Summary

Irritability is one significant clinical problem that should be elucidated. AS may be one important predisposing factor of irritability, but this possibility has yet been examined. As reviewed above, both irritability and AS are linked to abnormal processing of fear and reward, and AS may increase people’s sleep disturbance and then cause irritable symptoms. Thus, selective attention for threat, delayed reward discounting , and insomnia are three candidate mechanisms to explain the effects of AS on irritability, see Fig. 1. In the present study, we examined the hypothetical model in a sample of Chinese youth.

Initial hypothetical model

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Participants and procedure

Data are derived from one ongoing longitudinal study of psychological mechanisms of irritability among adolescents. Participants were Grade seven and Grade ten students from one middle high school in Chenzhou City, Hunan Province, China. A total of 1600 self-report questionnaires were distributed to target students, 183 of students refused to answer this questionnaire. Finally, 1417 valid data were obtained with a response rate of 88.6%. The mean age of these participants was 13.83 years (SD = 1.48; range from 11 to 17); 51.7% (n = 732) were male; 42.4% (n = 601) were Grade seven students.

The survey was conducted between October 25 and November 22 in 2022. Participants were invited to complete the survey during school days with group format. Two postgraduate students majored in clinical psychology introduced the purposes of the research and answered students’ questions in classrooms. The whole survey took about 30–35 min.

Measures

Anxiety sensitivity

The Childhood Anxiety Sensitivity Index (CASI) is a 18-item self-report measure that can be used to assess the fear of anxious arousal [40]. It comprises three subscales, including physical concerns (e.g., “It scares me when I feel like I am going to faint”), cognitive concerns (e.g., “It scares me when I am unable to keep my mind on a task”) and social concerns (e.g., “It scares me when I blush in front of other people”). Items are rated on a 3-ponit scale from 0 for “None” to 2 for “A lot”. The CASI total score ranges from 0 to 36, with high score indicating more severity of anxiety sensitivity. The CASI has demonstrated great reliability and validity in Chinese children and adolescents [41]. In the present study, the Cronbach’s α was 0.89.

Irritability

The Affective Reactivity Index (ARI) is used to measure irritability of self-report in previous six months [42]. It comprises seven items and the seventh item is functional impairment. The ARI is a three-point scale, ranged from 0 for “not true” to 2 for “certainly true”. The sum of scores of first six items was used in the current study. In the Chinese population, the reliability and validity of ARI were great [43]. In the present study, the Cronbach’s α was 0.84.

Brief Irritability Test (BITe) is a 5-item subjective assessment of irritability [44]. Each item is rated on 6-point Likert scale, ranged from 0 for “never” to 5 for “always”. The total scores of BITe range from 0 to 25. The BITe has been reported the excellent reliability and validity [44]. The Chinese version of BITe has been used in one previous study [45]. The Cronbach’s α was 0.85 in the current study.

Insomnia

The Youth Self-Rating Insomnia Scale (YSIS) is a 8-item measure designed to assess the insomnia in the past two weeks [46]. The YSIS comprises two factors which are daytime impairment and insomnia assessed eight symptoms (e.g., difficulty in initiating sleep, difficulty in maintaining sleep, early morning awakening and so on). The items are rated on a 5-point scale and the total score of the YSIS ranged from 8 to 40. The cutoffs for insomnia severity are: normal (< 22), mild insomnia (22–25), moderate insomnia (26–29), and severe insomnia (≥ 30) [46]. The Cronbach’s α was 0.80 in the current study.

Selective attention for threat

The Davos Assessment of Cognitive Biases Scale (DACOBS) attention for threat bias subscale was used to measure students’ propensity to selective attention for threat [47]. Four items from the Chinese version subscale were included in this study: “I pay more attention to detail in terms of big picture”, “I want to make sure every window is locked”, “To protect myself, I stayed alert” and “I avoid considering information that shakes my opinion” Each term contains seven options, using a scale of 1–7. High score indicates stronger attention for threat bias. The Chinese version of DACOBS has good reliability and validity [48]. The Cronbach’s α was 0.64 in the present study.

Delayed reward discounting

The 27-item Monetary Choice Questionnaire was used to measure delayed reward discounting to choose between small rewards available immediately or larger rewards available after a delay [49]. Delayed rewards are grouped into 3 categories (small, medium, and large) based on size, with 9 items per category. The immediate choice ratios (ICR) of MCQ were calculated by using a specific syntax [50]. Higher ICR indicates lower level of delayed reward discounting. In the current study, the Cronbach’s α was 0.94.

Statistical analyses

Pearson correlation was used to explore the associations of AS with other mediating variables and outcome variables. To keep the model more concise and easier to understand, only significant associations were used in the following analyses. Structural equation model (SEM) was used to examine our hypothetical model. First, measurement models were evaluated using the maximum likelihood (ML). All our core concepts would be modeled as latent variables. The hypothesized indicators are as follows: the CASI three subscale total scores are indicators of AS; the four items from the DACOBS attention for threat bias subscale are indicators of selective attention for threat; the YSIS two subscale total scores are indicators of insomnia; the three ICRs of MCQ are indicators of delayed reward discounting, and the ARI and BITe total scores are two indictors of irritability. Finally, a structural equation model was established to test the psychological mechanisms from AS to irritability with sex and age as covariates for irritability. The model was performed using ML method, and indirect effects were calculated using bootstrap method with 5000 resampling. Model fitting were evaluated using comparative fit index (CFI; > 0.90), Tucker-Lewis index (TLI; > 0.90), the root-mean-square error of approximation (RMSEA; < 0.08), and standardized root mean square residual (SRMR; <0.05/0.08) [51]. Statistical analyses were conducted by using the SPSS21.0 software and the Mplus 8.3 software. In the current sample, the percentage of missing data is pretty low (< 0.5%), thus missing data were dealt with default setting in software, with listwise deletion for SPSS and ML for Mplus.

Preliminary analyses

In the current sample, the prevalence rates of mild, moderate, and severe insomnia were 22.6%, 12.8%, and 7.4%, respectively. The irritability was relatively common, as the means of ARI (range from 0 to 12) and BITe (range from 0 to 25) were 1.65 and 6.01, respectively. The details of descriptive statistics and results of Pearson correlations are presented in Table 1. The three dimensions of AS were positively related to irritability, generally the effect sizes are modest. Insomnia and selective attention for threat were significantly related to both AS and irritability, but the magnitudes are pretty low in selective attention for threat. However, there was no significant relations of delayed reward discounting with both AS and irritability.

SEM analyses

Given that delayed reward discounting was not related to other variables, it was excluded in the following models. The measurement model included AS, insomnia, selective attention for threat, and irritability. The model fit the data pretty well, χ²(38) = 155.082, CFI = 0.972, TLI = 0.959, RESEA = 0.047, SRMR = 0.03. All the indicators were loaded on hypothesized latent variables, and the factor loading were all greater than 0.4, although some loadings in the items of selective attention for threat were relatively low. Then, one SEM model, shown in Fig. 2, was evaluated to examine the indirect effects of AS to irritability via insomnia and selective attention for threat. The model also fit the data well, χ²(59) = 389.025, CFI = 0.924, TLI = 0.901, RESEA = 0.063, SRMR = 0.057.

Final structural equation model. Note: BITe = brief irritability test; ARI = affective reaction index

Full size image

The results of bootstrap showed that both the two indirect effects were significant, the estimated effect was higher for insomnia (0.20) and lower for selective attention for threat (0.04). The direct effect from AS to irritability was still significantly after controlling for the above indirect effects, indicating that insomnia and selective attention for threat played partial mediations, see Table 2.

Anxiety sensitivity and irritability

This study explored the etiological and pathological mechanisms of irritability in a sample of Chinese youth with cross-sectional design. The findings suggest that AS is an important susceptibility factor for irritability. AS has been extensively studied in various affective disorders, such as general anxiety disorder, major depressive disorder and posttraumatic stress disorder [,,54]. Generally, AS is considered as an important transdiagnostic risk factor [55]. Extending previous studies, this study firstly found strong relationship between AS and irritability. This opens up new possibilities to elucidate and intervene irritability, as studies have demonstrated that AS is a key change element in the treatment of pathological anxiety [56]. Both AS and irritability can be deconstructed into different components. Our findings showed that AS may be more tightly linked to emotional component of irritability. Compared to the ARI scale, the BITe is designed to measure emotional component [44] and got the highest correlations among all three dimensions of AS. Additionally, the findings suggest that physical concern is more closely associated with irritability than cognitive concerns and social concerns. One previous study reported that only cognitive concerns was associated with depression [57]. Together, these findings imply that the mechanisms from AS to various affective disorders might be different.

Delayed reward discounting

Following the RDoC strategy, we further examined whether delayed reward discounting, insomnia, and selective attention for threat played mediating roles between AS and irritability. It is a little surprised that delayed reward discounting was not significantly related both AS and irritability. Considerable research has reported abnormal reward processing and difficulties of impulse control in irritable youth [58, 59]. Specifically, several studies demonstrated that irritability is associated with alterations during multiple reward processing phases, including reward anticipation, reward outcome, and frustrative non-reward [60]. Furthermore, individual traits (e.g., executive function) may buffer irritability-related reward processing deficits [61]. In a sample of adolescents with conduct disorder, one recent study also found that irritability was significantly associated with temporal reward discounting impulsivity [27] using one computer-based delayed discounting task, which is similar to the MCQ scale in this study. Differences in types of reward processing, samples, and measurements may explain the negative findings in this study. Considering that delayed reward discounting is strongly associated with anhedonia and affective disorders [62], more studies are needed to replicate our findings.

Insomnia

As expected, insomnia was an important mediating factors between AS and irritability, which can explain 20% variation of irritable symptoms. A significant association of AS and sleep related problems has been reported in various samples of adolescents [63]. AS is characterized by heightened focus on physical sensations, cognitive concerns, and social performance. Individual with high AS may be particularly susceptible to this phenomenon at bedtime, which may delay the ability to fall asleep and disturb sleep maintenance. Further, sleep loss would cause impaired ability of sleep regulation and difficulties in impulse control [20]. When facing frustration or inappropriate reward, then these individuals tend to show irritable symptoms [18].

Selective attention for threat

Consistent with our hypothesis, selective attention for threat also mediated the relationship between AS and irritability. AS amplifies anxiety-related fear and may lead to an abnormal sensitivity to threat in the environment [31]. Excessive attention to potentially threatening stimuli in environment may lead to a lower threshold for frustration [2]. However, the effect size of relationship between elective attention for threat and irritability was small. This may reflect some truth, as some studies reported no significant attention bias to threat among high irritability [64]. It is also may be that the self-report question used in this study can’t effectively measure attention bias.

Limitations

The present study has several limitations that should be noted when interpreting the results. First, this study reported cross-sectional data of the project, prospective data are needed to determine the longitudinal relationships. Second, self-report questionnaires are used to measure our main outcomes, parents/teachers’ reports or interview methods should be considered to reduce bias. Finally, we only used four items from the Chinese DACOBS subscale to assess attention for threat bias. Other measures such as dot-probe task may be more effective to measure attentional bias.

The raw data and analysis scripts are openly available at https://data.mendeley.com/drafts/yxbmj2b4jw.

1. Stringaris A. Irritability in children and adolescents: a challenge for DSM-5. Eur Child Adoles Psy. 2011;20(2):61–6.

   Article  Google Scholar 

2. Brotman MA, Kircanski K, Leibenluft E. Irritability in children and adolescents. Annu Rev Clin Psychol. 2017;13:317–41.

   Article  PubMed  Google Scholar 

3. Deveney CM, Connolly ME, Haring CT, Bones BL, Reynolds RC, Kim P, Pine DS, Leibenluft E. Neural mechanisms of frustration in chronically irritable children. Am J Psychiat. 2013;170(10):1186–94.

   Article  PubMed  Google Scholar 

4. Pickles A, Aglan A, Collishaw S, Messer J, Rutter M, Maughan B. Predictors of suicidality across the life span: the Isle of Wight study. Psychol Med. 2010;40(9):1453–66.

   Article  CAS  PubMed  Google Scholar 

5. Ambrosini PJ, Bennett DS, Elia J. Attention deficit hyperactivity disorder characteristics: II. Clinical correlates of irritable mood. J Affect Disorders. 2013;145(1):70–6.

   Article  PubMed  Google Scholar 

6. Burke JD, Boylan K, Rowe R, Duku E, Stepp SD, Hipwell AE, Waldman ID. Identifying the irritability dimension of ODD: application of a modified bifactor model across five large community samples of children. J Abnorm Psychol. 2014;123(4):841–51.

   Article  PubMed  PubMed Central  Google Scholar 

7. Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiat. 2014;171(3):276–93.

   Article  PubMed  Google Scholar 

8. Stoddard J, Stringaris A, Brotman MA, Montville D, Pine DS, Leibenluft E. Irritability in child and adolescent anxiety disorders. Depress Anxiety. 2014;31(7):566–73.

   Article  PubMed  Google Scholar 

9. McGuire K, Fung LK, Hagopian L, Vasa RA, Mahajan R, Bernal P, Silberman AE, Wolfe A, Coury DL, Hardan AY, et al. Irritability and problem behavior in autism spectrum disorder: a practice pathway for pediatric primary care. Pediatrics. 2016;137(Suppl 2):136–48.

   Article  Google Scholar 

10. Benarous X, Consoli A, Cohen D, Renaud J, Lahaye H, Guile JM. Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association. Eur Child Adoles Psy. 2019;28(5):667–83.

    Article  Google Scholar 

11. Orri M, Perret LC, Turecki G, Geoffroy MC. Association between irritability and suicide-related outcomes across the life-course. Systematic review of both community and clinical studies. J Affect Disorders. 2018;239:220–33.

    Article  PubMed  Google Scholar 

12. Finlay-Jones AL, Ang JE, Brook J, Lucas JD, MacNeill LA, Mancini VO, Kottampally K, Elliott C, Smith JD, Wakschlag LS. Systematic review and meta-analysis: early irritability as a transdiagnostic neurodevelopmental vulnerability to later mental health problems. J Am Acad Child Psy 2023.

13. Beauchaine TP, Tackett JL. Irritability as a transdiagnostic vulnerability trait: current issues and future directions. Behav Ther. 2020;51(2):350–64.

    Article  PubMed  Google Scholar 

14. Reiss S, McNally R. The expectancy model of fear. In S. Reiss, & R. R. Bootzin, editors,. Behav Res Ther 1985:(pp. 107–122). New York, NY: Academic Press.

15. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, Abramowitz JS, Holaway RM, Sandin B, Stewart SH, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the anxiety sensitivity Index-3. Psychol Assess. 2007;19(2):176–88.

    Article  PubMed  Google Scholar 

16. Mantar A, Yemez B, TunAlkın. Anxiety sensitivity and its importance in psychiatric disorders. Turkish J Pediatr. 2011;No3:187–93.

    Google Scholar 

17. Klein DN, Dougherty LR, Kessel EM, Silver J, Carlson GA. A transdiagnostic perspective on youth irritability. Curr Dir Psychol Sci. 2021;30(5):437–43.

    Article  PubMed  PubMed Central  Google Scholar 

18. Poznanski B, Cornacchio D, Coxe S, Pincus DB, McMakin DL, Comer JS. The link between anxiety severity and irritability among anxious youth: evaluating the mediating role of sleep problems. Child Psychiat Hum D. 2018;49(3):352–9.

    Article  Google Scholar 

19. Baglioni C, Spiegelhalder K, Lombardo C, Riemann D. Sleep and emotions: a focus on insomnia. Sleep Med Rev. 2010;14(4):227–38.

    Article  PubMed  Google Scholar 

20. Baum KT, Desai A, Field J, Miller LE, Rausch J, Beebe DW. Sleep restriction worsens mood and emotion regulation in adolescents. J Child Psychol Psyc. 2014;55(2):180–90.

    Article  Google Scholar 

21. Brotman MA, Rich BA, Guyer AE, Lunsford JR, Horsey SE, Reising MM, Thomas LA, Fromm SJ, Towbin K, Pine DS, et al. Amygdala activation during emotion processing of Neutral faces in children with severe mood dysregulation versus ADHD or bipolar disorder. Am J Psychiat. 2010;167(1):61–9.

    Article  PubMed  Google Scholar 

22. Guyer AE, McClure EB, Adler AD, Brotman MA, Rich BA, Kimes AS, Pine DS, Ernst M, Leibenluft E. Specificity of facial expression labeling deficits in childhood psychopathology. J Child Psychol Psyc. 2007;48(9):863–71.

    Article  Google Scholar 

23. Hommer RE, Meyer A, Stoddard J, Connolly ME, Mogg K, Bradley BP, Pine DS, Leibenluft E, Brotman MA. Attention bias to threat faces in severe mood dysregulation. Depress Anxiety. 2014;31(7):559–65.

    Article  PubMed  Google Scholar 

24. Salum GA, Mogg K, Bradley BP, Stringaris A, Gadelha A, Pan PM, Rohde LA, Polanczyk GV, Manfro GG, Pine DS, et al. Association between irritability and bias in attention orienting to threat in children and adolescents. J Child Psychol Psyc. 2017;58(5):595–602.

    Article  Google Scholar 

25. Adleman NE, Kayser R, Dickstein D, Blair RJ, Pine D, Leibenluft E. Neural correlates of reversal learning in severe mood dysregulation and pediatric bipolar disorder. J Am Acad Child Psy. 2011;50(11):1173–1185e1172.

    Article  Google Scholar 

26. Dickstein DP, Nelson EE, Mc CE, Grimley ME, Knopf L, Brotman MA, Rich BA, Pine DS, Leibenluft E. Cognitive flexibility in phenotypes of pediatric bipolar disorder. J Am Acad Child Psy. 2007;46(3):341–55.

    Article  Google Scholar 

27. Blair RJR, Bashford-Largo J, Zhang R, Lukoff J, Elowsky JS, Leibenluft E, Hwang S, Dobbertin M, Blair KS. Temporal discounting impulsivity and its association with conduct disorder and irritability. J Child Adol Psychop. 2020;30(9):542–8.

    Article  Google Scholar 

28. Zvolensky MJ, Forsyth JP. Anxiety sensitivity dimensions in the prediction of body vigilance and emotional avoidance. Cogn Ther Res 2002(No.4):449–60.

29. Koven NS, Heller W, Banich MT, Miller GA. Relationships of distinct affective dimensions to performance on an emotional strpop task. Cogn Ther Res. 2003;No6:671–80.

    Article  Google Scholar 

30. Schoth DE, Golding L, Johnson E, Liossi C. Anxiety sensitivity is associated with attentional bias for pain-related information in healthy children and adolescents. J Health Psychol. 2015;21(10):2434–44.

    Article  PubMed  Google Scholar 

31. Hunt C, Keogh E, French CC. Anxiety sensitivity: the role of conscious awareness and selective attentional bias to physical threat. Emotion. 2006;6(3):418–28.

    Article  PubMed  Google Scholar 

32. Stathopoulou G, Gold AK, Hoyt DL, Milligan M, Hearon BA, Otto MW. Does anxiety sensitivity predict addiction severity in opioid use disorder? Addict Behav. 2021;112:106644.

    Article  PubMed  Google Scholar 

33. Kim N-H, Choi H-M, Lim S-W, Oh K-S. The relationship between Insomnia Severity and Depression, anxiety and anxiety sensitivity in General Population. Sleep Med Psychol 2006(No.2):59–66.

34. Calkins AW, Hearon BA, Capozzoli MC, Otto MW. Psychosocial predictors of sleep dysfunction: the role of anxiety sensitivity, dysfunctional beliefs, and neuroticism. Behav Sleep Med. 2013;11(2):133–43.

    Article  PubMed  Google Scholar 

35. Boyer P, Bergstrom B. Threat-detection in child development: an evolutionary perspective. Neurosci Biobehav R. 2011;35(4):1034–41.

    Article  Google Scholar 

36. Neuberg SL, Kenrick DT, Schaller M. Human threat management systems: self-protection and Disease avoidance. Neurosci Biobehav R. 2011;35(4):1042–51.

    Article  Google Scholar 

37. Holm SM, Forbes EE, Ryan ND, Phillips ML, Tarr JA, Dahl RE. Reward-related brain function and sleep in pre/early pubertal and mid/late pubertal adolescents. J Adolesc Health. 2009;45(4):326–34.

    Article  PubMed  PubMed Central  Google Scholar 

38. Casement MD, Keenan KE, Hipwell AE, Guyer AE, Forbes EE. Neural reward Processing mediates the relationship between insomnia symptoms and Depression in Adolescence. Sleep. 2016;39(2):439–47.

    Article  PubMed  PubMed Central  Google Scholar 

39. Traupman EK, Dixon MA. Cognitive-behavioral therapy for insomnia for primary care: review of components and application for residents in primary care. Int J Psychiat Med. 2022;57(5):423–33.

    Article  Google Scholar 

40. Silverman WKFIU, Miami US, Fleisig W, Rabian B, Peterson RA. Child anxiety sensitivity index. J Clin Child Adolesc Psychol 1991(No.2):162–8.

41. Zhao PL, Shi ZB, Zhang JF. Psychometric properties of the childhood anxiety sensitivity index in children and adolescent. Chin J Clin Psychol. 2013;21(3):393–7.

    Google Scholar 

42. Stringaris A, Goodman R, Ferdinando S, Razdan V, Muhrer E, Leibenluft E, Brotman MA. The affective reactivity index: a concise irritability scale for clinical and research settings. J Child Psychol Psyc. 2012;53(11):1109–17.

    Article  Google Scholar 

43. Pan PY, Yeh CB. Irritability and maladaptation among children: the utility of Chinese versions of the affective reactivity index and aberrant behavior checklist-irritability subscale. J Child Adol Psychop. 2019;29(3):213–9.

    Article  Google Scholar 

44. Holtzman S, O’Connor BP, Barata PC, Stewart DE. The brief irritability test (BITe): a measure of irritability for use among men and women. Assessment. 2015;22(1):101–15.

    Article  PubMed  Google Scholar 

45. Zhan NL, Zhang L, Gong ML, Geng FL. Clinical correlates of irritability, anger, hostility, and aggression in posttraumatic stress disorder. Psychol Trauma. 2023. Advance online publication.

46. Liu X, Yang Y, Liu Z-Z, Luo Y, Fan F, Jia C-X. Psychometric properties of Youth Self-Rating Insomnia Scale (YSIS) in Chinese adolescents. Sleep Biol Rhythms. 2019;17(3):339–48.

    Article  Google Scholar 

47. van der Gaag M, Schutz C, Ten Napel A, Landa Y, Delespaul P, Bak M, Tschacher W, de Hert M. Development of the Davos assessment of cognitive biases scale (DACOBS). Schizophr Res. 2013;144(1–3):63–71.

    Article  PubMed  Google Scholar 

48. Yang JY, Zhu YH, Wang YG, Chen ZY, Liu WB, Tian Q, Lin MX, Zachary C, Yulia L. Reliability and validity of the Davos Assessment of Cognitive biases Scale. Chin J Psychiatry. 2014;4(5):232–6.

    Google Scholar 

49. Kirby KN, Petry NM, Bickel WK. Heroin addicts have higher discount rates for delayed rewards than non-drug-using controls. J Exp Psychol Gen. 1999;128(1):78–87.

    Article  CAS  PubMed  Google Scholar 

50. Gray JC, Amlung MT, Palmer AA, MacKillop J. Syntax for calculation of discounting indices from the monetary choice questionnaire and probability discounting questionnaire. J Exp Anal Behav. 2016;106(2):156–63.

    Article  PubMed  Google Scholar 

51. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1–55.

    Article  Google Scholar 

52. Zvolensky MJ, Clausen BK, Shepherd JM, Kabel KE, Kauffman B, Garey L. Anxiety sensitivity in relation to post-traumatic stress disorder symptom clusters among young adults with probable post-traumatic stress disorder. Cogn Behav Therapy. 2022;51(6):470–85.

    Article  Google Scholar 

53. Knapp AA, Blumenthal H, Mischel ER, Badour CL, Leen-Feldner EW. Anxiety sensitivity and its factors in relation to generalized anxiety disorder among adolescents. J Abnorm Child Psych. 2016;44(2):233–44.

    Article  Google Scholar 

54. Allan NP, Felton JW, Lejuez CW, MacPherson L, Schmidt NB. Longitudinal investigation of anxiety sensitivity growth trajectories and relations with anxiety and depression symptoms in adolescence. Dev Psychopathol. 2016;28(2):459–69.

    Article  PubMed  Google Scholar 

55. Short NA, van Rooij SJH, Murty VP, Stevens JS, An X, Ji Y, McLean SA, House SL, Beaudoin FL, Zeng D, et al. Anxiety sensitivity as a transdiagnostic risk factor for trajectories of adverse posttraumatic neuropsychiatric sequelae in the AURORA study. J Psychiat Res. 2022;156:45–54.

    Article  PubMed  Google Scholar 

56. Olatunji BO, Wolitzky-Taylor KB. Anxiety sensitivity and the anxiety disorders: a meta-analytic review and synthesis. Psychol Bull. 2009;135(6):974–99.

    Article  PubMed  Google Scholar 

57. Saulnier KG, Allan NP, Raines AM, Schmidt NB. Anxiety sensitivity cognitive concerns drive the relation between anxiety sensitivity and symptoms of depression. Cogn Behav Therapy. 2018;47(6):495–507.

    Article  Google Scholar 

58. Kryza-Lacombe M, Hernandez B, Owen C, Reynolds RC, Wakschlag LS, Dougherty LR, Wiggins JL. Neural mechanisms of reward processing in adolescent irritability. Dev Psychobiol. 2021;63(5):1241–54.

    Article  PubMed  PubMed Central  Google Scholar 

59. Nili AN, Krogh-Jespersen S, Perlman SB, Estabrook R, Petitclerc A, Briggs-Gowan MJ, Sherlock PR, Norton ES, Wakschlag LS. Joint Consideration of Inhibitory Control and Irritability in Young children: contributions to Emergent Psychopathology. Res Child Adoles Psy. 2022;50(11):1415–27.

    Google Scholar 

60. Deveney CM. Reward processing and irritability in young adults. Biol Psychol. 2019;143:1–9.

    Article  PubMed  Google Scholar 

61. Kryza-Lacombe M, Palumbo D, Wakschlag LS, Dougherty LR, Wiggins JL. Executive functioning moderates neural mechanisms of irritability during reward processing in youth. Psychiat Res-Neuroim. 2022;323:111483.

    Article  Google Scholar 

62. Berridge KC, Kringelbach ML. Pleasure systems in the brain. Neuron. 2015;86(3):646–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

63. Weiner CL, Elkins RM, Pincus D, Comer J. Anxiety sensitivity and sleep-related problems in anxious youth. J Anxiety Disord. 2015;32:66–72.

    Article  PubMed  PubMed Central  Google Scholar 

64. Zhang R, Bashford-Largo J, Lukoff J, Elowsky J, Carollo E, Schwartz A, Dobbertin M, Bajaj S, Blair KS, Leibenluft E, et al. Callous-unemotional traits moderate the relationship between irritability and threatening responding. Front Psychiatry. 2021;12:617052.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

1. School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, Jiangxi, 330022, China

   Yalin Li & Fulei Geng

2. Chenzhou Xiangnan Middle School, Chenzhou, China

   Wanfu Tian & Ping Liu

Contributions

Fulei Geng designed the study. Yalin Li, Wanfu Tian, and Ping Liu collected the data. Yalin Li performed data analysis. Yalin Li and Fulei Geng drafted the manuscript. All authors provided critical revision of the manuscript.

Corresponding author

Correspondence to Fulei Geng.

Ethics approval and consent to participate

The project was approved by the Moral & Ethics Committee of the School of Psychology, Jiangxi Normal University and adheres to the Declaration of Helsinki. Written informed consents were obtained from all the participants and also from their legal guardian.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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