Disruptive Mood Dysregulation Disorder pdf
Disruptive Mood Dysregulation Disorder pdf
Disruptive Mood Dysregulation disorder (DMDD) is an emotional disorder with severe mood and behavioral dysregulation. It includes significant behavioral challenges but is not a behavioral control disorder. Children with DMDD tend to throw fits very often. They may break things, throw things, scream, yell, and hit. They are highly emotional; often alternating between happy, anxious, depressed, and angry.
DMDD is a new diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). The core features of DMDD include large tantrums that seem have a mood component, that are way more intense than you would expect (occurring multiple times per week), and are combined with a generally irritated mood. These symptoms must be observable and cause clinically significant distress that impacts functioning. The DSM-5 classifies DMDD under the category of Depressive Disorders while Conduct Disorder and Oppositional Defiant Disorder are classified in a separate section (Disruptive Impulse and Conduct Disorders).
Children who have significant problems in this area may have any of the following potential disability. *Note, this does not serve as a diagnosis in any way. See ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.
Obvious symptoms include temper outbursts (seen as either verbal rages and/or physical aggression) and near constant irritability or anger related to mood challenges. Said another way: dysregulated mood and extremely low frustration tolerance. These outbursts may include anger, despair or seem manipulative or oppositional. They may be quite frightening. These outbursts are clinically understood as exaggerated and developmentally inappropriate temper tantrums including anger and distress and are out of proportion in intensity or length to the situation.
Thoughts of worthlessness. Your child may make a lot of negative self-statements. “I’m not good enough.” “Everyone else can do that but I can’t.” “I never do anything right.”
Withdrawal. Your child may not spend time with friends or family and spend all his or her time quietly in a bedroom. Playdates may increase irritability.
Thoughts of death/suicidal. Your child may report wishing he or she had not been born, may discuss life without him or her, or may try to give away treasured possessions. He or she may express a desire to hurt him or herself and share a plan. Be open to listening to your child and hear his or her feelings instead of saying not to feel that way. Seek support immediately and make sure no weapons or other dangerous opportunities are available. Keep close supervision of your child.
Medication, psychotherapy, and a combination of these are a recommended course of treatment. Since the diagnosis is still new, research is still being conducted to determine the best course of treatment. Stimulant medication, antidepressants, and behavior analysis have shown positive outcomes in recent clinical studies. That said, careful monitoring of interventions is critical due to the complex presentation of the disorder. CBT. Cognitive Behavioral Therapy is a modality in which strategies can be taught and practiced. This is often individual therapy but may also be delivered in a group setting. Some goals of CBT include the following: Increase Emotional Awareness. Recognize Triggers. Improve Coping Skills. Work to improve self-confidence. Mindfulness. Mindfulness involves recognizing and accepting feelings and allowing them to just be. Techniques include: Relaxation and Meditation and Accepting Thoughts. ABA Therapy is recommended to increase coping behaviors and decrease tantrums. Medication is recommended to treat underlying mood/depressive symptoms of the disorder.
Many tests and measures may be part of an evaluation to determine whether DMDD is a relevant diagnosis. This can be hard with children who are sometimes less able to report on this directly.
Projectives. Questions, open ended sentences, drawing tasks can allow a child to express emotions and experiences indirectly. Themes can emerge related to sadness or rejection and some insight may be derived from the collection of these measures.
Story Telling. Tests like the Roberts or TAT involve presenting story cards to an individual and having him or her tell a story about the vague card. Again themes and emotional content is noted as well as support of self and support from others.
Rating Scales. Sometimes it is easier for children to express feelings by answering questions. Parents and teachers can also complete questionnaires to provide a sense of how each child appears and performs in different settings. This adds to the data since an evaluation is conducted in one setting that is not natural to the individual.
School observation. Watching a child at school or in their natural environment may provide insight into explosive behaviors and underlying mood.
Play observation. Watching a child play with toys can provide insight into feelings of sadness by attending to themes introduced by the child.
Observation during testing. Looking for depressed mood, sad facial affect, slow processing, verbal fluency, body language and noting interactions with examiners can provide insight into depression.
A referral for a comprehensive neuropsychological evaluation may be warranted to confirm DMDD and work to support your child. This type of assessment includes evaluation of cognitive ability, adaptive skills, language skills, social skills, mood and anxiety. Other areas may be evaluated as concerns arise. Taking a comprehensive neuropsychological report to any of these professionals will help them to get an understanding of your child. It’ll be important to think about how these therapies fit together and how different skills are being built and addressed to best support your child. Referrals may include ABA therapy, Psychotherapy, psychiatrist, parent consultations, IEP or Section 504 plan.
Psychotherapy. Psychotherapy occurs in an office with a psychologist or therapist and is often focused on improving emotional awareness, coping skills, and restructuring negative thoughts. Therapy focuses on, developing plans to avoid triggers and adjust how to react when triggers are present. The psychotherapy modality that has the most research for treating depression is cognitive behavioral therapy. DMDD is a depressive disorder.
Psychiatrist. Often children with DMDD take medication prescribed by a psychiatrist. Usually this is to stabilize mood and decrease the intensity of anger and frustration. Medications can be quite effective for these symptoms. Keep your pediatrician in the loop about your child’s mental health and request a referral to a child psychiatrist to learn more about the benefits and side effects of medication.
ABA Therapy. ABA therapy means Applied Behavior Analysis and refers to behavioral therapy that is used to increase communicative behaviors or decrease problem behaviors. A therapist often comes into your home or preschool to do this therapy and takes extensive data on a child’s progress. Parents work with therapy supervisors, known as BCBAs (Board Certified Behavior Analysts) to determine goals of treatment and track progress.
Parent Consult. Parent consultation can follow a CBT or Family Systems model and provide guidance to parents on strategies to use. Strategies will help a parent to hear and support their child, help the child feel understood and manage behaviors. It also may focus on principles of reinforcement noting that punishment is not effective for depressed children. Consultation can also focus on the parent’s experience and emotional well-being.
School Services. School-based supports like an IEP or Section 504 plan can help your child receive accommodations and modifications that they may require to access learning in the classroom setting. Emotional disabilities like DMDD can impact school performance and social skills. Individual meetings with the school counselor or school psychologist may provide emotional support. A behavior intervention plan can support tantrum reduction. A lunch bunch or social group may also help build peer support. In order to qualify for a formal plan, the school team will need to find an educational impact of the behaviors in some aspect of your child’s education. It may be easier to obtain support through a Section 504 plan if your child’s grades and test scores are not at all impacted. A 504 plan requires a medical condition that impacts functioning but academics and test scores need not be directly impacted. An IEP is a more detailed document that does require clear educational impact of symptoms. Ask your school about both an IEP and a 504 to determine which would best serve your child.
DMDD is a new diagnosis and therefore outcome literature is quite sparse. That said, it is in the family of depressive disorders which are common and treatable. Taken together, it is valuable to obtain a diagnosis and engage in the appropriate therapies as early as is feasible. In this way, children with DMDD are not being misidentified as oppositional or with conduct problems. It is important that the emotional underpinnings of DMDD can be addressed. With supports in place, it is possible to see improvement in behavioral symptoms, better coping skills and emotional awareness, and the potential to live a fulfilled life.
 Seligman, Martin E.P. (1995). The optimistic child: A revolutionary program that safeguards children against depression and builds lifelong resilience.
 Eastman, P.D. (2003). Big dog…little dog.
 Yamada, Kobi (2016). What do you do with a problem?
 Huebner, Dawn (2006). What to do when you grumble too much (A kid’s guide to overcoming negativity).
 Cook, Julia (2011). Soda pop head.
 Meiners, Cheri J. (2010). Cool down and work through anger (Learning to get along).
 Mulcahy, William (2012). Zach gets frustrated (Zach rules series).