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Disruptive Mood Dysregulation Disorder


What is disruptive mood dysregulation disorder (DMDD)?

DMDD is a condition that causes your child to have outbursts. Dysregulation means your child has trouble preventing or stopping the outbursts. DMDD begins between the ages of 6 and 10 years and can continue for several years. The risk for DMDD is higher in boys and in children who have concentration problems, such as ADHD.

What are the signs and symptoms of DMDD?

Your child may have any of the following for at least 1 year:

  • Angry outbursts at least 3 times each week, and the reaction seems extreme
  • Feeling extremely sad, angry, or irritable, or at times extremely happy
  • Outbursts or behavior problems in at least 2 places, such as home and when he is with friends
  • Trouble concentrating because of irritability
  • Trouble keeping friends because of angry or aggressive behavior

How is DMDD diagnosed?

Your child's healthcare provider will talk to you and to your child. Tell the provider about your child's outbursts. Include how often they happen and what tends to start them. Tell the provider about how you and other caregivers respond to the outbursts. If you are able to help calm your child, tell the provider what works and how quickly it works. Tests may be used to rule out other conditions that can cause your child's symptoms.

How is DMDD treated?

Your child's healthcare providers will work with you and your child to create an individualized plan. The plan will be designed to meet the needs of your child and your family.

  • Behavior therapy is used to help your child find new ways to express emotion. Your child may work with a therapist alone, or your family may go to therapy sessions together. Therapists can help your child talk about anything that causes frustration or irritability. Family members can express their feelings about your child's outbursts.
  • Parent training is therapy to help parents develop skills and strategies to handle outbursts. It is important for you to learn as much as you can about DMDD. This will help you manage your child's outbursts and develop ways to prevent outbursts in the future. Therapists can teach you ways to interact with your child without triggering anger or an outburst. You may also be shown how to create a rewards system. Rewards for no outbursts can be more effective than punishment for outbursts.
  • Computer training may help your child change some of thoughts that can lead to irritability. Children with DMDD may think the facial expressions of other people are angry when they are not. Some computer training is designed to help your child start to see the expressions as happy or neutral. Over time, this can help your child prevent irritability when he is around others.
  • Medicines may be given to help your child control concentration, anger, or depression. Your child will still need to go to therapy. Medicine is not meant to be the only treatment. Your child may need to try more than one kind of medicine to find what works best. Common medicines used to help manage DMDD include stimulants and antidepressants. You will need to make sure your child takes these medicines exactly as directed. Rarely, antidepressants can increase thoughts of suicide in adolescents.

What can I do to support my child?

  • Stay calm and be supportive. You may be frustrated or angry with your child because of the outbursts. It is important to stay calm. An angry response from you can make your child's outburst worse. After your child is calm again, talk about what caused the outburst. You may start to see a pattern. Record details about the outburst, including what happened and what your child says about it. Note any patterns you see. Bring the record with you to follow-up visits with your child's healthcare providers.
  • Be consistent. Your child needs to know the rules he is expected to follow. An example of a rule is limiting computer or TV time to 1 hour each day. The rule can help prevent your child from becoming angry when he is told to turn off the computer or TV. Every person who cares for your child needs to know and follow the same rules. Make sure every caregiver knows how you try to calm your child during an outburst. Have caregivers tell you about each outburst your child has when you are not there. Record where your child was, what happened, and how the caregiver handled the outburst.
  • Work with officials at your child's school. Your child's teachers and officials need to know your child has DMDD in case an outburst happens at school. Explain what tends to trigger outbursts, and what helps calm your child. Officials may need to create rules or other safety measures to make sure your child and others are safe.
  • Help your child set up healthy routines. Make sure your child gets enough sleep every night. Your child may be more likely to become irritable or frustrated without enough sleep. Routines such as regular sleep, meal, homework, and play times can help your child feel secure. Regular exercise can help improve your child's energy and moods.

Call 911 for any of the following:

  • Your child hurts himself or herself, or hurts another person.
  • Your child threatens to hurt himself, herself, or another person.

When should I contact my child's healthcare provider?

  • Your child seems or tells you he or she often feels depressed.
  • You have questions or concerns about your child's condition or care.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.