Disruptive Mood Dysregulation Disorder (DMDD

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).

RESOURCES

Child Mind Institute https://childmind.org/guide/guide-to-disruptive-mood-dysregulation-disorder/

National Institute of Mental Health https://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd/ disruptive-mood-dysregulation-disorder.shtml

REFERENCES

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7. Benarous, X., Consoli, A., Guilé, J., Rivière, S. G., Cohen, D., & Olliac, B. (2016) Evidence-based treatments for youths with severely dysregulated mood: A qualitative systematic review of trials for SMD and DMDD. European Child & Adolescent Psychiatry, 26(1):5–23. doi:10.1007/s00787- 016-0907-5

Bruno, A., Celebre, L., et al. (2019) Focus on Disruptive Mood Dysregulation Disorder: A Review of the Literature. Psychiatry Research

Mayes, S., Baweja, R., Hameed, U., Waxmonsky, J. (2016) Disruptive mood dysregulation disorder: Current insights. Neuropsychiatric Disease and Treatment, 12:2115–2124. doi:10.2147/ndt. s100312

Pappadopulos, E, Woolston, S., et al (2006) Pharmacotherapy of Aggression in Children and Adolescents: Efficacy and Effect Size. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal De L’Academie Canadienne De Psychiatrie De L’enfant Et De L’adolescent, 15(1):27–39.

Perepletchikova, F., Nathanson, D., et al. (2017) Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10):832–840.

Roy, A.K., Lopes, V. and Klein, R.G. (2014) Disruptive Mood Dysregulation Disorder: A New Diagnostic Approach to Chronic Irritability in Youth. The American Journal of Psychiatry, 171(9):918–924.

Tourian, L., LeBoeuf, A., Breton, J.J., Cohen, D., Gignac, M., Labelle, R., et al. (2015) Treatment options for the cardinal symptoms of disruptive mood dysregulation disorder. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 24(1):41–54. PubMed PMID: 26336379.