Network analysis of ecological momentary assessment identifies frustration as a central node in irritability

Wan Ling Tseng, Reut Naim, Amanda Chue, Shannon Shaughnessy, Jennifer Meigs, Daniel S. Pine, Ellen Leibenluft, Katharina Kircanski, Melissa A. Brotman

Research output: Contribution to journalArticlepeer-review


Background: Irritability presents transdiagnostically, commonly occurring with anxiety and other mood symptoms. However, little is known about the temporal and dynamic interplay among irritability-related clinical phenomena. Using a novel network analytic approach with smartphone-based ecological momentary assessment (EMA), we examined how irritability and other anxiety and mood symptoms were connected. Methods: Sample included 152 youth ages 8–18 years (M ± SD = 12.28 ± 2.53; 69.74% male; 65.79% White) across several diagnostic groups enriched for irritability including disruptive mood dysregulation disorder (n = 34), oppositional defiant disorder (n = 9), attention-deficit/hyperactivity disorder (n = 47), anxiety disorder (n = 29), and healthy comparisons (n = 33). Participants completed EMA on irritability-related constructs and other mood and anxiety symptoms three times a day for 7 days. EMA probed symptoms on two timescales: “since the last prompt” (between-prompt) versus “at the time of the prompt” (momentary). Irritability was also assessed using parent-, child- and clinician-reports (Affective Reactivity Index; ARI), following EMA. Multilevel vector autoregressive (mlVAR) models estimated a temporal, a contemporaneous within-subject and a between-subject network of symptoms, separately for between-prompt and momentary symptoms. Results: For between-prompt symptoms, frustration emerged as the most central node in both within- and between-subject networks and predicted more mood changes at the next timepoint in the temporal network. For momentary symptoms, sadness and anger emerged as the most central node in the within- and between-subject network, respectively. While anger was positively related to sadness within individuals and measurement occasions, anger was more broadly positively related to sadness, mood lability, and worry between/across individuals. Finally, mean levels, not variability, of EMA-indexed irritability were strongly related to ARI scores. Conclusions: This study advances current understanding of symptom-level and temporal dynamics of irritability. Results suggest frustration as a potential clinically relevant treatment target. Future experimental work and clinical trials that systematically manipulate irritability-related features (e.g. frustration, unfairness) will elucidate the causal relations among clinical variables.

Original languageEnglish
Pages (from-to)1212-1221
Number of pages10
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number8
StatePublished - Aug 2023
Externally publishedYes


  • Irritability
  • anger
  • anxiety
  • ecological momentary assessment
  • frustration
  • mood
  • network analysis

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health
  • Developmental and Educational Psychology
  • Pediatrics, Perinatology, and Child Health


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