Disruptive Mood Dysregulation Disorder (DMDD) CLINICAL PEARLS • DMDD is a relatively new diagnosis with limited evidence to support pharmacological treatment of core symptoms. • Core symptoms include temper outbursts that occur at frequent intervals that are not considered developmentally appropriate. • It is important to rule out other diagnoses that have supported evidence-based treatments (e.g. ADHD, depression, anxiety, ODD, etc.) If co-morbid diagnoses exist treatment should include addressing those as well. • First-line treatment should include therapeutic support. • Medication uses often guided by post-hoc studies on disruptive behavior disorders. RATING SCALES • The Modified Overt Aggression Scale can be used to screen and track treatment response. https://depts.washington.edu/dbpeds/Screening%20Tools/Modified-Overt-Aggression-ScaleMOAS.pdf TREATMENT APPROACH Stage 1: Behavioral therapy focusing on targeted behaviors. Current supported therapies include delayed goal attainment; cognitive behavioral therapy, play therapy, interpretation bias training, dialectical behavioral therapy adapted for children. 1A: Monitor for treatment response with rating scale. If improving continue therapy, if not improving follow up with therapist. Stage 2: If symptoms of aggression persist, consider the aggression guidelines. Stage 3: Consider use of methylphenidate if concerns with impulsivity/hyperactivity and DMDD symptoms (caution with co-morbid trauma-reactive symptoms). Stage 4: If symptoms are severe and not responsive to stimulant medication, stop stimulant medications and include a trial of second-generation antipsychotic (e.g. risperidone or aripiprazole).
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