Developmental Trajectories of Irritability across the Transition to Toddlerhood: Associations with Effortful Control and Psychopathology.

Preschool-age irritability is a transdiagnostic marker of internalizing and externalizing problems. However, researchers have generally been reluctant to examine irritability within a clinically salient framework at younger ages due to some instability during the "terrible twos" period. Developmentally sensitive and dense measurements to capture intra- and inter-individual variability, as well as exploration of developmental processes that predict change, are needed. This study aimed to examine (1) the trajectories of irritability at the transition to toddlerhood (12-24 months of age) using repeated measures, (2) whether effortful control was associated with individual differences in level and growth rate of irritability, and (3) whether individual differences in the irritability trajectories were associated with later psychopathology. Families were recruited when the child was 12-18 months old (N = 333, 45.65% female). Mothers reported on their toddler's irritability at baseline and every two months until a follow-up laboratory assessment approximately one year later. Effortful control was measured at baseline. Clinical internalizing/externalizing symptoms were measured at the follow-up assessment. Hierarchical linear models revealed an increase in irritability over time, yet there was relatively little within-person variability. Effortful control was only associated with the level of irritability and not growth rate. Level of irritability was associated with internalizing, externalizing, and combined symptoms, but growth rate was not. Findings suggest intraindividual stability in irritability at the transition to toddlerhood and the possibility that screening for elevated irritability at toddler age is meaningful.

Outcomes in patients hospitalized for COVID-19 among Asian, Pacific Islander, and Hispanic subgroups in the American Heart Association COVID-19 registry.

BACKGROUND: Coronavirus disease 2019 (COVID-19) data from race/ethnic subgroups remain limited, potentially masking subgroup-level heterogeneity. We evaluated differences in outcomes in Asian American/Pacific Islander (AAPI) and Hispanic/Latino subgroups compared with non-Hispanic White patients hospitalized with COVID-19. METHODS: In the American Heart Association COVID-19 registry including 105 US hospitals, mortality and major adverse cardiovascular events in adults age ≥18 years hospitalized with COVID-19 between March-November 2020 were evaluated. Race/ethnicity groups included AAPI overall and subgroups (Chinese, Asian Indian, Vietnamese, and Pacific Islander), Hispanic/Latino overall and subgroups (Mexican, Puerto Rican), compared with non-Hispanic White (NHW). RESULTS: Among 13,511 patients, 7% were identified as AAPI (of whom 17% were identified as Chinese, 9% Asian Indian, 8% Pacific Islander, and 7% Vietnamese); 35% as Hispanic (of whom 15% were identified as Mexican and 1% Puerto Rican); and 59% as NHW. Mean [SD] age at hospitalization was lower in Asian Indian (60.4 [17.4] years), Pacific Islander (49.4 [16.7] years), and Mexican patients (57.4 [16.9] years), compared with NHW patients (66.9 [17.3] years, p<0.01). Mean age at death was lower in Mexican (67.7 [15.5] years) compared with NHW patients (75.5 [13.5] years, p<0.01). No differences in odds of mortality or MACE in AAPI or Hispanic patients relative to NHW patients were observed after adjustment for age. CONCLUSIONS: Pacific Islander, Asian Indian, and Mexican patients hospitalized with COVID-19 in the AHA registry were significantly younger than NHW patients. COVID-19 infection leading to hospitalization may disproportionately burden some younger AAPI and Hispanic subgroups in the US.