A computer game that changes a tendency to misread ambiguous faces as angry is showing promise as a potential treatment for irritability in children.  The game shifts a child’s judgment for perceiving ambiguous faces from angry to happy.  In a small pilot study, irritable children who played it experienced less irritability, accompanied by changes in activation of mood-related brain circuitry. Researchers are now following up with a larger study to confirm its effectiveness.

Melissa Brotman, Ph.D., Ellen Leibenluft, M.D., Joel Stoddard, M.D., of the NIMH Emotion and Development Branch, and colleagues, reported on findings of their pilot study of “interpretation bias training” for child irritability online January 8, 2016 in the Journal of Child and Adolescent Psychopharmacology.

About 3 percent of youth experience chronic severe irritability. They are prone to temper outbursts and are often in a grumpy mood. Parents complain of having to “walk on eggshells” to avoid unleashing verbal – and sometimes physical – outbursts. These behaviors can lead to problems with friends, family, and at school.

While irritability is common in disorders such as attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder , it is a core feature of disruptive mood dysregulation disorder (DMDD), which is associated with risk for developing mood and anxiety disorders – and socioeconomic underachievement later  in life.

While research suggests that parent training, psychotherapy, and some medications may be helpful for severe irritability, there are no established treatments for DMDD. Evidence suggests that irritable youth with DMDD tend to misperceive emotional expressions. Compared to healthy controls, children with DMDD were more prone to rate neutral faces as angry. So Leibenluft’s team set out to test interpretation bias training (IBT), a computer game designed to diminish irritable children’s tendency to view ambiguous faces as angry.

Participants rated a continuum of 15 ambiguous faces appearing on a computer monitor as either happy or angry.  After computer training, the children shifted their ratings toward seeing some of these ambiguous faces as “happy.” This effect was maintained for at least 2 weeks and was associated with decreased irritability, as rated by parents and by clinicians who interviewed both parents and children.

Some of these DMDD participants also performed a face-viewing task while their brain activity was being measured by functional magnetic resonance imaging (fMRI). They showed activity changes in emotional learning areas suggesting that the computer-based training may alter neural responses to emotional faces.

Encouraged by these findings, the researchers have launched a larger, more controlled study to learn whether IBT might be effective as a treatment. They are also testing cognitive behavioral therapy (CBT), a talk therapy that aims to change behaviors in response to frustrating events. These are among the first non-drug interventions that seek to help those with DMDD.

Families with affected children can choose to receive CBT alone, IBT alone, or IBT followed by CBT. Those who elect IBT will perform most computer training sessions at home, over the course of a training program which can last from 3 to 13 weeks. Participants who are interested in brain scanning will also undergo before-and-after fMRI scans while they are looking at the same ambiguous faces presented in the training sessions. The researchers hope these scans will show changes in brain activity that relate to symptom improvement following treatment.

“The training may be calming irritability by altering circuit activity underlying interpretive biases and – hopefully – reducing anger-based reactions like outbursts,” said Leibenluft.

Reference

Neural Correlates of Irritability in Disruptive Mood Dysregulation and Bipolar Disorders.  Wiggins JL, Brotman MA, Adleman NE, Kim P, Oakes AH, Reynolds RC, Chen G, Pine DS, Leibenluft E. Am J Psychiatry. 2016 Feb 19:appiajp201515060833. [Epub ahead of print]PMID: 26892942

Illustration of irritable child adapted from Crimfants (http://flickr.com/photos/crimfants/327861820/ ) [CC-BY-SA-2.0 (http://creativecommons.org/licenses/by-sa/2.0) ], via Wikimedia Commons,