Advancing the understanding, assessment, and treatment of emotional and behavioral dysregulation in youth
The goal of my research is to help advance the understanding, assessment, and treatment of behavioral and emotional dysregulation in youth, with a particular focus on irritability and aggressive behavior. My interests are organized around three interrelated areas: (1) the developmental course, correlates, and outcomes of irritability and aggression in children and adolescents; (2) the assessment, diagnosis, and diagnostic classification of youth behavioral and emotional problems; and (3) improving the effectiveness of psychosocial interventions in youth mental health. A detailed description and summary of each of these lines of work follows below.
Our lab adopts an applied developmental psychopathology framework. That is, we anchor our work around the tenets of developmental psychopathology (e.g., equifinality and multifinality; the mutually informative interplay of typical and atypical development; and the importance of multiple levels and methods of analysis). At the same time, we approach this work with an eye toward translational implications for application within an evidence-based framework. Finally, we strive to perform work that is community-engaged and actively includes youth and families from diverse backgrounds. Much of our research involves partnering with community agencies.
We leverage a variety of methodological approaches. For example, we have used, or are currently using, longitudinal designs, experimental and observational studies, meta-analytic/ systematic reviews, ecological momentary assessment, diagnostic interviews, and multi-informant survey measures. I also have an interest in quantitative methods (e.g., general linear and generalized models; multilevel and growth curve models; latent variable/class analyses; meta-analysis), which I enjoy sharing with students and trainees.
Our research is highly collaborative. I thoroughly enjoy mentorship. I typically include graduate students and trainees as co-authors on manuscripts, and I try to facilitate mentored first-author opportunities for students whenever possible. Over the years, I have worked on several large projects with teams at Kansas, Harvard, Miami, MUSC, and WHO. This work yielded several rich datasets that we are continuing to publish from to this day. See here for a summary of current projects and existing datasets that may be available for collaborative and mentored research.
1. Developmental course, correlates, and outcomes of youth irritability and aggression. My early research began with a search for specificity regarding what problem dimensions led to what outcomes, and why. With colleagues at Kansas, I showed that it is reactive aggression (i.e., emotional, impulsive, “hot” aggressive responses to a perceived threat)—not proactive aggression (i.e., instrumental, calculated, “cold” aggression to achieve a goal)—that leads to poor social, emotional, and academic outcomes from early childhood (Evans, Frazer, et al., 2018) through adolescence (Evans, Fite et al., 2015). By incorporating these distinct subtypes of aggression into longitudinal models, my doctoral research (Evans & Fite, 2019) helped refine Patterson’s Failure Model, in which social and academic problems are viewed as dual pathways linking early antisocial behavior to later depression. We recently extended this research and found that youth who follow trajectories of chronic reactive aggression across elementary school are at greatest risk for poor social, affective, and school outcomes (Evans, Diaz, et al., 2021).
Closely related to reactive aggression, irritability is a common problem in youth that relates to a variety of forms of psychopathology. My colleagues and I carried out a series of studies to disentangle irritability from defiance in school-age children (Evans, Pederson, et al., 2016). Longitudinally, irritability and defiance were linked to acute disturbances in functioning whereas attention and hyperactivity problems predicted more long-term problems (Evans, Cooley, et al., 2020). Our findings lend support for conceptualizing irritability both as a normative phenomenon and as problem that can be quite severe, impairing, and leading to subsequent problems over time. More recent work has identified potential longitudinal mechanisms—intolerance of uncertainty and poor emotion coping—that may explain how irritability confers risk for negative outcomes and could be viable targets for intervention (Evans, Blossom, & Fite, 2020).
2. Assessment, diagnosis, and classification of emotional and behavioral problems. I was fortunate to get involved with the World Health Organization’s (WHO) revision of the International Classification of Diseases (ICD-11) Chapter on Mental and Behavioural Disorders (Evans & Roberts, 2015). In this role, I was part of a large program of research aimed at improving the ICD’s utility for global mental health care (Keeley et al., 2016, AP). For instance, we used cluster-analytic methodologies to understand clinicians’ cognitive models of mental disorders (Reed et al., 2013), and surveys to examine global psychologists’ perspectives and experiences (Evans et al., 2013). The ICD-11 guidelines were later evaluated in a series of case-controlled field studies using clinical vignettes and experimental designs (Evans, Roberts et al., 2015). I contributed to ICD-11 Disruptive Behavior and Dissocial Disorders, writing comprehensive (Evans, Burke, et al., 2017) and brief (Lochman, Evans, et al., 2015) reviews of the literature on youth irritability. Later, I served as PI on one of the global, multilingual online field studies, with results supporting the utility of ICD-11’s formulation of Oppositional Defiant Disorder (with or without chronic irritability) as compared to ICD-10 and DSM-5 (Evans, Roberts, et al., 2021).
Apart from this work with the WHO, I have taken interest in carrying out psychometric projects to advance rigorous, brief, and economical forms of assessment, particularly involving multiple informants and diverse samples. To this end, my colleagues and I have investigated the properties of measures of irritable and defiant dimensions of oppositionality (Evans, Bonadio, et al., 2020), emotion reactivity (Evans, Blossom, et al., 2016), and general irritability (Evans, Abel, et al., 2021). We have also examined measures of autism symptoms for screening purposes (Evans, Boan, et al., 2019), and a new measure of internalizing and externalizing problems for therapeutic outcomes monitoring (Weisz, Vaugh-Coaxum, et al., 2020).
3. Psychosocial intervention, especially evidence-based and transdiagnostic approaches. While on postdoc, I expanded my research into the realm of intervention broadly (e.g., Weisz et al., 2020a,b), with a specific interest in treatment of severe irritability. In a comprehensive re-analysis of randomized trial data, I showed that established modular behavioral/CBT interventions are effective in treating severe irritability (Evans, Weisz, et al., 2020). I then demonstrated, using separate data, that behavioral parent training and CBT-depression techniques are likely to be helpful for irritability/dysregulation, when the treatment selection is guided by comprehensive baseline assessment. We developed a clinically oriented paper for how to apply modular transdiagnostic interventions to youth irritability (Evans & Santucci, 2021). This continues to be an area of interest for collaborative, meta-analysis, and secondary analysis projects; however, our lab generally does not carry out clinical trials or other primary research in intervention.