Does your child experience chronic, severe, and persistent irritability? Children are moody, but your child may be experiencing irritability, anger, mood swings and temper outbursts at levels that are intensely out of proportion to the situation and frequent enough that you are looking for an explanation.
Disruptive Mood Dysregulation Disorder (DMMD) was recently introduced in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This disorder describes children who have a consistently irritable or angry mood, outbursts at least 3 times a week, and difficulty functioning in multiple settings. DMDD symptoms occur before the age of 10, but cannot be diagnosed in children younger than 6 or adults over 18. Children experiencing the symptoms of DMDD often experience interpersonal issues and can develop anxiety or depressive disorders.
DMDD captures some of the symptoms and behaviors of children and adolescents that at times had been previously diagnosed with Bipolar Disorder. Misdiagnosis of DMDD as Bipolar Disorder could lead to unnecessary excessive medication; while misdiagnosis of Bipolar Disorder as DMDD could prevent a child with Bipolar from receiving the mood stabilization they might need.
The standard treatment for DMDD is psychotherapy (including parent training) and medication, if needed. Cognitive behavior therapy is usually the treatment of choice for supporting these dysregulated children in processing and coping with their overwhelming thoughts and feelings. Skills developed through therapy may include emotional coping, communication skills, frustration tolerance and awareness of thoughts, feelings, and sensations; the primary goal of treatment is to support children in recognizing when they are becoming angry/irritable and implementing an appropriate skill to de-escalate themselves/the situation or to withstand the uncomfortable feelings.
In addition, parent trainings highlight the importance of validation, consistentcy, predictability and the importance of reinforcement to reward good, appropriate, and effective behaviors.
Here is a key observation for you as parent to check whether your kid is experiencing irritability at a rate that is higher than expected. Be on the lookout for:
- 3 or more tantrums a week.
- Severe irritability and angry mood even in between tantrums
- Difficulty functioning in multiple environments such as home, school, daycare, with friends, etc
- Blowing up when frustrated or unable to get what they want
- Temper tantrum seems out of proportion to the incident
If you are concerned about your child’s temper tantrums, anger, and/or irritability in parent coaching session you can collaborate on a behavioral plan to address your kid’s outbursts and provide support for the whole family. Here are the basics of how to elaborate behavioral plans: here.
Also, you can begin to carry out the following skills:
- Keeping a reliable and consistent schedule for your child.
- Identifying triggers for outbursts and tantrums
- Reflecting back your child’s feelings to increase their emotional identification skills and feelings of validation
- Setting clear rules and boundaries with predictable and known consequences
- Using positive reinforcement to increase target emotional regulation and coping skills
Benny tends to have temper tantrums when he goes on long shopping trips to the grocery store. (2) His mom, Anna, sets a schedule where they go to the grocery store together every Thursday after school. (1) She tells him before they go that if he is patient while they are shopping and doesn’t have an outburst, then he will get a treat after; however, if he misbehaves then he will not be rewarded (4). While shopping Anna sees that Benny is becoming tired and frustrated and looks like he may be on the verge of a meltdown. She reflects this back to him, “I can see that you’re getting tired with all of this shopping. It seems like you are almost at your limit! We are almost done.” (3) She also reminds him about his fidget spinner and encourages him to play with that to pass the time. Benny, still tired and frustrated, plays with his fidget spinner for the last minutes of shopping. While in line, Anna asks Benny if he would like to pick out a piece of candy since he had been so patient by playing with his fidget spinner while he was really frustrated.
Last words, checking whether your kid is struggling with mood dysregulation disorder it’s extremely important because unless he learns to manage his response to his emotions he could be easily be kidnapped by those intense emotions and engage in ineffective behaviors that are hard for him, for you as the parent, and for the whole family. Emotion regulation is a key skill in life!
American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.: DSM-5. Washington, D.C: American Psychiatric Association.
Roy, A. K., Lopes, V., & Klein, R. G. (2014). Disruptive Mood Dysregulation Disorder: A New Diagnostic Approach to Chronic Irritability in Youth. American Journal of Psychiatry, 171(9), 918–924. https://doi.org/10.1176/appi.ajp.2014.13101301