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This pilot randomised controlled trial evaluated the acceptability and feasibility of a psychological intervention to manage severe irritability in children and adolescents. Children with severe irritability (9–14 years; 42% male) were randomised to receive six sessions of Collaborative & Proactive Solutions (CPS) or usual clinical care. The primary outcome was acceptability and feasibility of the intervention (participant enrollment, drop-out, intervention session attendance). Key secondary outcomes assessed 4-month post-randomisation included child irritability, quality of life, executive functioning, parent mental health and family functioning. Twelve children enrolled in the study (52% uptake). All participants in the CPS group attended ≥2 intervention sessions, and one participant in the usual care group was lost to follow-up. Compared to usual care, the CPS group had improvements in child irritability (Effect Size (ES): −0.4), quality of life (ES: 0.4), executive functioning (ES: −0.4), and family functioning (ES: −0.7). It is acceptable and feasible to deliver CPS to severely irritable children and adolescents. Preliminary evidence suggests this non-pharmacological intervention improves important areas of functioning for severely irritable children. The trial was prospectively registered on 11 October 2017 with the Australian New Zealand Clinical Trials Registry (: ACTRN12617001445369). [ABSTRACT FROM AUTHOR]