Executive functioning moderates neural mechanisms of irritability during reward processing in youth.

Pediatric irritability is the most robust indicator of transdiagnostic psychopathology risk. It is associated with altered neural reward processing, including neural networks related to cognitive control, and better cognitive control has been hypothesized to mitigate irritability. We evaluated the relationship of executive functioning (EF) with irritability-related neural correlates of reward processing in youths with varying levels of irritability. Participants (N = 51, mean age=13.80 years, SD=1.94) completed a monetary incentive delay task during multiband fMRI acquisition. Irritability and EF were measured via the Affective Reactivity Index and the NIH Toolbox cognition battery, respectively. Whole-brain analyses, controlling for age, examined the moderating role of EF on irritability-related brain activation and connectivity (seeds: striatum, amygdala) during reward anticipation and performance feedback. Irritability-related neural patterns during reward processing depended on EF, in occipital areas during reward anticipation and limbic, frontal, and temporal networks during performance feedback. Higher irritability combined with higher EF was associated with neural patterns opposite to those observed for higher irritability with lower co-occurring EF. Although preliminary, findings suggest that EF may buffer irritability-related reward processing deficits. Additionally, individual differences in EF and their relation to irritability may be related to varied etiologic mechanisms of irritability with important implications for personalized prevention and intervention.