Both Positive and Negative Emotional Lability Observed in Pediatric Psychopathology

This study utilizes ecological momentary assessment to determine emotional lability in a pediatric sample.

A study published in Depression and Anxiety found that both positive and negative emotional lability were prominent in pediatric psychopathology and associated with functional impairment.

Investigators from the National Institute of Mental Health recruited pediatric participants (N=130) with attention-deficit/hyperactivity disorder (ADHD; n=33), anxiety (ANX; n=33), disruptive mood dysregulation disorder (DMDD; n=31), and no psychopathology (n=33) through social media advertisements and clinician referrals. Ecological momentary assessment of emotional lability data were collected between 2017 and 2021, in which caregivers were trained on collecting data and received three text prompts daily for seven days to facilitate data collection. The participants also underwent the Clinician-assessed Global Impressions Severity (CGI-S) scale. Affect fluctuations were compared between groups and associated with functional impairment.

Among the whole study cohort, the children had a mean age of 12.55 (SD, 2.51) years, 70.00% were boys, 65.40% were White, the average intellectual quotient was 114.03 (SD, 12.06), 32.30% were on psychotropic medications, 26.90% on stimulants, and 13.80% on antidepressants. Among the patient groups, psychiatric comorbidities were common, in which 77.40% of the DMDD group had ADHD, 48.50% of the ANX group had social phobia, and 27.30% of the ADHD group had oppositional defiant disorder.

Mood change scores were highest for the DMDD group (mean, 2.17) and lowest for the controls (mean, 1.39). Similarly, the DMDD cohort had the highest positive (mean, 0.98) and negative (mean, 0.72) emotional lability scores and controls the lowest (mean, 0.49 and 0.27, respectively).

The current study provides evidence that emotional lability is a salient mechanism to understand in the context of childhood mood disorders, particularly DMDD.

Compared between groups, mood change was significantly lower among controls compared with DMDD (P <.001) and ANX (P =.046) groups. Within patient groups, DMDD adolescents had higher levels of mood change than those with ADHD (P =.039) and ANX (P =.049).

In general, positive and negative emotional lability were correlated (t, 0.61; P <.001).

Global impairment scores (CGI-S) were predicted by mood change in the whole study cohort (β, .11; P =.015) and controls (β, -.14; P =.005). Stratified by emotional lability, negative emotional lability predicted CGI-S scores among the whole sample (β, 0.30; P =.008). No other significant associations were observed.

In a sensitivity analysis which accounted for data collected prior to and during the COVID-19 pandemic, no significant differences in positive (P =.27) and negative (P =.55) emotional liabilities were observed.

These data may have been limited by a lack of power due to the small sample size.

The study authors concluded, “The current study provides evidence that emotional lability is a salient mechanism to understand in the context of childhood mood disorders, particularly DMDD. Our findings also highlight the importance of real‐time, in vivo assessment. Targeting labile mood in vivo may be a potential treatment for DMDD, which is essential as few treatments for the disorder have been developed.”


Naim R, Shaughnessy S, Smith A, Karalunas SL, Kircanski K, Brotman MA. Real‐time assessment of positive and negative affective fluctuations and mood lability in a transdiagnostic sample of youth. Depress Anxiety. Published online November 3, 2022. doi:10.1002/da.23293