What is DMDD?

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What is DMDD, Disruptive Mood Dysregulation Disorder?

Kids with DMDD are born irritated. Even when raised in a stable environment, they exhibit a consistently angry and irritated outlook on life. Symptoms include low frustration tolerance and despite the most patient care, frequent and intense temper tantrums are the norm. The diagnosis occurs between the ages of six and 18 and is not related to childhood trauma. Kids with DMDD cannot self-sooth and are often called moody and out of control. DMDD also includes the symptom of feeling uncomfortable in the body.


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Why do we need the DMDD diagnosis?

Even though the name is a ridiculous tongue twister, DMDD fills a gap in childhood mental health diagnoses. Many DMDD kids receive incorrect diagnoses of bipolar, ODD, or ADHD. This leads to ineffective treatment protocols. As a result, the lack of socialization that comes with being in a bad mood throughout childhood creates more irritated and violent behavior as the child ages. The child is then given a personality disorder diagnosis, often borderline personality disorder or antisocial as an adult. What a vicious circle.


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What does DMDD feel like for kids?

“When I hear the word no, I feel like a big soda bottle that someone shakes and shakes, and all of the contents are expanding, but no one lets me take the top off! I have to yell and scream and kick and punch just to get the top off that bottle so that I can calm down!” DMDD kids can’t process the frustration that comes with learning to share or waiting for a turn. They’re unable to self-soothe and have no outlet for the intense and often physical feelings that build up in the body when they don’t get what they want.


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What is the difference between DMDD and pediatric bipolar disorder?

Bipolar is an episodic mood disorder that always includes mania. Unlike bipolar, DMDD is consistent over time with a persistent angry mood that doesn’t have a clear beginning, middle, or end. DMDD can involve anger, rage, screaming, crying and sometimes physical violence, but does not include the typical mania symptoms of sleeping less without being tired, pressured speech, hypersexuality, and poor decision-making. DMDD is not bipolar and will not become bipolar as a child ages.


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What causes DMDD?

There is no known cause for DMDD. The symptoms suggest an overactive amygdala and a lack of frontal lobe engagement. It’s as though the parts of the brain that allow a child to be reasonable when faced with frustration have not developed normally. Some kids get upset and flail around on the floor for a few minutes when they hear a no. Kids with DMDD can stay upset for hours at a time. It’s important to reassure parents that DMDD is not a trauma-based illness and the child is not a spoiled brat who needs discipline.


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How to report DMDD symptoms to a health care professional

Write down what the child thinks, says, and does in the areas of sleep, communication, concentration, frustration tolerance, crying, physical behaviors, and interaction with others at home and in school. Contrast this to siblings and peers if possible. List what triggers a meltdown: location, who the child is with, time of day and situation. If the child also has mood changes such as being sad or overly happy, chart these symptoms as they are NOT a sign of DMDD and may indicate a mood disorder.


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What is the treatment for DMDD?

Create a family plan to help the child manage irritation and frustration. Utilize behavioral, DBT, and occupational therapy that teaches the child to be in touch with the mind and body during a meltdown. Learn about juggling, tennis, basketball, martial arts, and other movements that help integrate the left and right brain. Explore yoga for kids with an emphasis on breathing. Ask for cranial sacral therapy and teach the family about the brain and frustration. Read The Explosive Child by Dr. Ross Greene.


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What doesn’t work for DMDD

DMDD kids rarely respond well to the discipline and boundaries that work with stable kids. A time out or taking away a phone has little impact on a child who is controlled by an out-of-control brain. Touching or physically moving the child who is in a meltdown can also increase pain in the child’s already overly sensitive body. Having a plan in place that the child knows will happen when a meltdown occurs is the answer. When the child is calm, ask what works and what doesn’t work to help a meltdown.


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Teach a child with DMDD symptoms to be a brain detective

Approach DMDD as a brain disorder that no one caused. You can talk openly with very young children about the brain in the same way you talk about the physical body. Teach the child to verbalize what they feel by talking about and writing down what they go through during meltdowns. Make this a normal part of daily life. Get siblings involved as much as possible and be consistent as a family. A child with DMDD can be taught to examine their behavior with interest, just like a detective solves a crime.


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What to do next if your child has DMDD symptoms

Get an evaluation using the lists suggested in the earlier slide. A DMDD diagnosis and management plan may be an answer to your worries over a very angry child. If you have wondered what on earth you did wrong as a parent, go easy on yourself and know that children can have brains that don’t process the world in a positive way. DMDD is not a result of childhood trauma or poor parenting. Some children are simply born irritated and next extra help to function and find stability in our world. There is help available.