(PS11-B46) Ecological Momentary Assessment of Mood and Cognitions: Irritability Is Associated with Unfairness in Clinical versus Non-clinical Samples

Irritability, defined as an increased susceptibility to anger and frustration, is one of the main reasons children are referred to psychiatric care and increases risk for depression and general impairment in adulthood (Brotman et al., 2017; Vidal-Ribas et al., 2016). Research has shown that retrospective reports of unfairness are often linked to anger (Straub and Murnighan, 1995; Pillutla and Murnighan, 1996). However, classic clinical symptom measures in youth are often inaccurate due to underreporting of symptoms (Pan & Yeh, 2019; Stoddard et al., 2014) and biases due to retrospective report. Assessment of irritability in naturalistic settings via new technologies can gather symptoms and cognitions in vivo and in real time. The present study uses ecological momentary assessment (EMA) to examine the temporal co-occurrence of irritability symptoms and perception of unfairness among youth with high levels of irritability versus youth with no clinical symptoms. EMA serves as an advantageous method of assessment because it can be utilized at home on the participants’ own devices during public health emergencies, such as the COVID-19 pandemic, with children with irritability symptoms who may be reluctant to accurately report with other assessments methods due to stigma. Participants from ages 8-18 (M = 12.14, SD = 2.45, 68.5% male) with a primary diagnosis of either Disruptive Mood Dysregulation Disorder (DMDD, N = 43), Attention Deficit Hyperactivity Disorder (ADHD, N = 49), or without psychiatric diagnoses (HV, N = 35) completed surveys three times a day for one week assessing irritability-related symptoms of frustration, grouchiness, and perception of unfairness. We applied hierarchical linear models, including irritability-related symptoms as within-subject repeated measures, to explore associations among these symptoms. Diagnostic group was entered as a between-subject variable to explore differences between groups. Results indicated that the DMDD group had higher levels of irritability symptoms compared to the HV group, including frustration (β = 0.679, p</span> < 0.001), grouchiness (β = 0.693, p</span> < 0.001), and perception of unfairness (β = 0.661, p</span> < 0.001). The ADHD group had higher levels of perception of unfairness (β = 0.240, p = 0.020) compared to the HV group. Comparing the clinical groups, the DMDD group had higher levels of frustration (β = -0.369, p = 0.008). Grouchiness (β = -0.299, p = 0.057) and perception of unfairness (β = -0.263, p = 0.058) were higher in the DMDD group compared to the ADHD group at a trend level. Finally, increased perception of unfairness predicted higher levels of frustration (β = 0.478, p</span> < 0.001) and grouchiness (β = 0.239, p</span> < 0.001), with no difference in slopes between the groups. Current findings indicate that as expected, a DMDD diagnosis is associated with greater severity of irritability symptoms. Additionally, irritability symptoms are co-occurring in youth’s daily lives, and particularly, increased perception of unfairness is associated with increased frustration, suggesting unfairness to be a potential trigger. Thus, intervening during treatment to reduce the perception of unfairness could potentially help decrease irritability symptoms in diagnoses enriched with irritability.