***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We investigated the effects of emotion perception training on depressive symptoms and mood in young adults reporting high levels of depressive symptoms ( trial registration : IS RCT N02532638 ) . Participants were r and omised to an intervention procedure design ed to increase the perception of happiness over sadness in ambiguous facial expressions or a control procedure , and completed self-report measures of depressive symptoms and mood . Those in the intervention condition had lower depressive symptoms and negative mood at 2-week follow-up , but there was no statistical evidence for a difference . There was some evidence for increased positive mood . Modification of emotional perception may lead to an increase in positive affect BACKGROUND There is a pressing need for cost-effective population -based interventions to tackle early-onset antisocial behaviour . As this is determined by many factors , it would seem logical to devise interventions that address several influences while using an efficient means of delivery . The aim of this trial was to change four risk factors that predict poor outcome : ineffective parenting , conduct problems , attention deficit/hyperactivity disorder ( ADHD ) symptoms , and low reading ability . METHODS A r and omised controlled trial was carried out in eight schools in London , Engl and . Nine hundred and thirty-six ( 936 ) 6-year-old children were screened for antisocial behaviour , then parents of 112 high scorers were r and omised to parenting groups held in schools or control ; 109 were followed up a year later . The intervention lasted 28 weeks and was novel as it had components to address both child behaviour ( through the Incredible Years programme ) and child literacy ( through a new ' SPOKES ' programme to help parents read with their children ) . Fidelity of implementation was emphasised by careful training of therapists and weekly supervision . Controls received an information helpline . Assessment of conduct problems was by parent interview , parenting by direct observation and child reading by psychometric testing . RESULTS At follow-up parents allocated to the intervention used play , praise and rewards , and time out more often than controls , and harsh discipline less ; effect sizes ranged from .31 to .59 sd ( p-values .046 to .005 ) . Compared to control children , whose behaviour did n't change , intervention children 's conduct problems reduced by .52sd , ( p < .001 ) , dropping from the 80th to the 61st percentile ; oppositional-defiant disorder ( ODD ) halved from 60 % to 31 % ( p = .003 ) . ADHD symptoms reduced by .44sd ( p = .002 ) , and reading age improved by six months ( .36sd , p = .027 ) . Teacher-rated behaviour did n't change . The programme cost pound2,380 ( $ 3,800 ) per child . CONCLUSIONS Effective population -based early intervention to improve the functioning of with antisocial behaviour is practically feasible by targeting multiple risk factors and emphasising implementation fidelity OBJECTIVE The diagnosis and treatment of youth with severe nonepisodic irritability and hyperarousal , a syndrome defined as severe mood dysregulation ( SMD ) by Leibenluft , has been the focus of increasing concern . We conducted the first r and omized double-blind , placebo-controlled trial in SMD youth , choosing lithium on the basis of its potential in treating irritability and aggression and neuro-metabolic effects . METHODS SMD youths 7 - 17 years were tapered off their medications . Those who continued to meet SMD criteria after a 2-week , single-blind , placebo run-in were r and omized to a 6-week double-blind trial of either lithium ( n = 14 ) or placebo ( n = 11 ) . Clinical outcome measures were : ( 1 ) Clinical Global Impressions-Improvement ( CGI-I ) score less than 4 at trial 's end and ( 2 ) the Positive and Negative Syndrome Scale ( PANSS ) factor 4 score . Magnetic resonance spectroscopy ( MRS ) outcome measures were myoinositol ( mI ) , N-acetyl-aspartate ( NAA ) , and combined glutamate/glutamine ( GLX ) , all referenced to creatine ( Cr ) . RESULTS In all , 45 % ( n = 20/45 ) of SMD youths were not r and omized due to significant clinical improvement during the placebo run-in . Among r and omized patients , there were no significant between-group differences in either clinical or MRS outcome measures . CONCLUSION Our study suggests that although lithium may not result in significant clinical or neurometabolic alterations in SMD youths , further SMD treatment trials are warranted given its prevalence OBJECTIVE A consumer-oriented efficacy assessment in clinical trials should measure changes in chief complaint and consumer request ( symptoms of most concern to patient/caregiver ) , which may be diluted in change scores of multisymptom scales . METHOD In the Research Units on Pediatric Psychopharmacology ( RUPP ) Autism Network 8-week double-blind trial of risperidone versus placebo , the chief concerns of parents were collected at 0 , 4 , and 8 weeks ( endpoint ) , in addition to st and ardized primary measures . Blinded clinical judges rated change from baseline to 4 and 8 weeks on a 9-point scale ( 1 = normalized , 5 = unchanged , 9 = disastrous ) ; 94 participants had usable data . RESULTS The most common symptoms identified by parents were tantrums , aggression , and hyperactivity . Interrater reliability was excellent . Mean ratings at endpoint were 2.8 + /- 1.2 on risperidone and 4.5 + /- 1.3 on placebo ( p < .001 ) . Ratings were collinear with Clinical Global Impression-Improvement and Aberrant Behavior Checklist Irritability subscale ( primary dimensional measure ) . Effect size d was 1.4 , compared to 1.2 on the Aberrant Behavior Checklist Irritability subscale . Effect sizes varied twofold by symptom category , largest for self-injury ( 2.11 ) and tantrums ( 1.95 ) . CONCLUSIONS Risperidone was superior to placebo in reducing symptoms of most concern to parents of autistic children with irritable behavior .  Rating individualized participant-chosen target symptoms seems a reliable , sensitive , efficient , and consumer-friendly way to assess treatment effect and might have clinical application OBJECTIVES This study examines the tolerability and efficacy of methylpheni date ( MPH ) and behavior modification therapy ( BMOD ) in children with attention-deficity/hyperactivity disorder ( ADHD ) and severe mood dysregulation ( SMD ) . METHODS Children ( ages 5 - 12 ) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessment s and direct clinical interview with the Young Mania Rating Scale ( YMRS ) . The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores ( mean = 23.7 ) . They underwent weekly mood assessment s plus the daily ADHD measures that are part of the program . The comparison group ( n = 68 ) was comprised of the rest of the program participants . Using a crossover design , all subjects in both groups were treated with three varying intensities of BMOD ( no , low , high ) each lasting 3 weeks , with MPH dose ( placebo , 0.15 mg/kg t.i.d . , 0.3mg/kg t.i.d . , and 0.6 mg/kg t.i.d . ) varying daily within each behavioral treatment . RESULTS Groups had comparable ADHD symptoms at baseline , with the SMD group manifesting more oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms ( p < 0.001 ) . Both groups showed robust improvement in externalizing symptoms ( p < 0.001 ) . There was no evidence of differential treatment efficacy or tolerability . Treatment produced a 34 % reduction in YMRS ratings in SMD subjects ( p - 0.001 ) . However , they still exhibited elevated YMRS ratings , more ODD/CD symptoms ( p < 0.001 ) , and were more likely to remain significantly impaired at home than non-SMD subjects ( p < 0.05 ) . CONCLUSIONS MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD , but additional treatments may be needed to optimize their functioning BACKGROUND To test the factor structure of oppositional defiant disorder ( ODD ) symptoms and to study the relationships between the proposed dimensions and external variables in a community sample of preschool children . METHOD A sample of 1,341 3-year-old preschoolers was r and omly selected and screened for a double-phase design . In total , 622 families were assessed with a diagnostic semi-structured interview and question naires on psychopathology , temperament and executive functioning completed by parents and teachers . RESULTS Using categorical and dimensional symptoms of ODD it was possible to confirm , cross-informant and cross- method , distinct dimensions for defining the structure of ODD : one made up of irritable and headstrong and the other of negative affect , oppositional behaviour and antagonistic behaviour . Specific associations with DSM-IV disorders were found , and irritable was associated with anxiety disorders , whereas headstrong was associated with disruptive disorders , including aggressive and non-aggressive CD symptoms . Also , negative affect was associated with anxiety disorders and non-aggressive CD symptoms , oppositional behaviour with disruptive disorders and aggressive CD symptoms , and antagonistic behaviours with disruptive disorders and , in boys , with mood disorders . The dimensions correlated with specific scales of psychopathology , temperament and executive functioning . CONCLUSIONS Oppositional defiant disorder is a heterogeneous disorder from preschool age . Different dimensions , with moderate to acceptable reliability and convergent and discriminant validity with other psychological constructs , can be identified early in life Objective Clinical ly impairing irritability affects 25 % to 45 % of children with attention-deficit/hyperactivity disorder ( ADHD ) ; yet , we know little about what interventions are effective in treating children with ADHD and co-occurring irritability . We used data from the Multimodal Treatment Study of Children With ADHD ( MTA ) to address 3 aims : to establish whether irritability in children with ADHD can be distinguished from other symptoms of oppositional defiant disorder ( ODD ) ; to examine whether ADHD treatment is effective in treating irritability ; and to examine how irritability influences ADHD treatment outcomes . Method Secondary analyses of data from the MTA included multivariate analyses , and intent-to-treat r and om-effects regression models were used . Results Irritability was separable from other ODD symptoms . For treating irritability , systematic stimulant treatment was superior to behavioral management but not to routine community care ; a combination of stimulants and behavioral treatment was superior to community care and to behavioral treatment alone , but not to medication alone . Irritability did not moderate the impact of treatment on parent- and teacher-reported ADHD symptoms in any of the 4 treatment groups . Conclusion Treatments targeting ADHD symptoms are helpful for improving irritability in children with ADHD . Moreover , irritability does not appear to influence the response to treatment of ADHD . Clinical trial registration information Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder ( MTA ) ; http://www . clinical trials.gov ; NCT00000388 OBJECTIVE There is increasing scientific and clinical attention to chronic irritability in youth . However , little is known about the predictive validity and clinical significance of chronic irritability during early childhood . This prospect i ve , longitudinal study examined associations of chronic irritability with psychiatric disorders and parental psychopathology in a large community sample of preschoolers . METHOD Four hundred sixty-two preschool-age children were assessed at 3 and 6 years of age . Child psychopathology was assessed at baseline ( 3 years ) and follow-up ( 6 years ) using a diagnostic interview , the Preschool Age Psychiatric Assessment , with parents . Items from the Preschool Age Psychiatric Assessment were used to create a dimensional measurement of chronic irritability . Parental psychopathology was assessed with a diagnostic interview at baseline . RESULTS Chronic irritability was concurrently associated with a wide range of psychiatric disorders and functional impairment at 3 and 6 years of age . Irritability at 3 years predicted depression , oppositional defiant disorder , and functional impairment at 6 years after controlling for baseline disorders . Irritability also was associated with parental depression and anxiety . CONCLUSIONS Findings underscore the central role of irritability in early-emerging mental health problems . They are consistent with longitudinal studies in older youth indicating that chronic irritability predicts later depression and anxiety and support the importance of early detection and interventions targeting preschool irritability BACKGROUND The concept of differential susceptibility has challenged the potential meaning of personal traits such as poor ability to regulate emotions . Under the traditional model of diathesis/stress , personal characteristics such as liability to angry outbursts are seen as essentially disadvantageous , emerging under duress in a way that is maladaptive . In contrast , with differential susceptibility , there is the same poorer functioning under adverse conditions but , under favorable conditions , individuals with the trait function better than those without it . To date , there have been limited studies on response under positive environments . We used the experimental power of an intervention trial to test the differential susceptibility hypothesis that children with emotional dysregulation would show greater response to an experimentally induced improvement in their parenting environment . METHODS Data were from the SPOKES trial ( IS RCT N 77566446 ) , a r and omized controlled trial of 11 
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RESULTS We found that irritability forms a distinct dimension with substantial stability across time , and that it is specifically associated with depression and anxiety in longitudinal studies .
Evidence from genetic studies reveals that irritability is moderately heritable , and its overlap with depression is explained mainly by genetic factors .
Behavioral and neuroimaging studies show that youth with persistent irritability  exhibit altered activations in the amygdala , striatum , and frontal regions compared with age-matched healthy volunteers .