Bella, for example, once came to session angry at her sister and refused to speak to her therapist. His temper outbursts were frequent at least 3 per week , severe, and explosive, causing impairment at home and school. In this sample 6— However, because of his temper tantrums and hostile attributions, peers began to avoid him. Teachers noted that Dillon often appeared to be in an irritable, agitated mood, and that they were pleasantly surprised when he smiled or appeared happy. Parent ratings of depression and anxiety conducted per the Child Depression Inventory Kovacs, and the Multidimensional Anxiety Scale for Children March, indicated that Bella was experiencing normative levels of internalizing symptoms. Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation.

The joint treatment package was found to be feasible and well received by families, with greater reduction in parent-rated irritability than with CNS stimulants alone. There are growing concerns about the increasingly common trends of using the combination of CNS stimulants and antipsychotics to treat persistent aggression and other behavioral problems. Although Bella demonstrated many strengths, such as athletic ability and sense of humor, many of her social experiences became overshadowed by negative interactions, which were interfering with her enjoyment of home and school life. They used to think I was cool but kind of crazy. We do not know whether DMDD will reduce diagnoses of pediatric bipolar disorder. Notably, Bella was a participant in our ongoing randomized controlled study that tests the utility of CBT for irritability in children across diagnostic categories.

DMDD does provide a home for a large percentage of referred children with severe persistent irritability that did not fit well into any DSM-IV diagnostic category.

dmdd case study

As such, Bella and her mother collaborated with the therapist to identify a goal for the form and duration of irritable behavior. It seems prudent to obtain ratings from both parents and teachers, which is particularly important for disorders like DMDD that have DSM-5 cross-setting diagnostic requirements.


Opposition and defiance were noted since age 3; however, the outbursts and irritability described here had manifested for approximately 2 years preceding assessment since age 7.

Cognitive-Behavioral Therapy for a 9-Year-Old Girl With Disruptive Mood Dysregulation Disorder

Karim IbrahimMS, is a former trainee of the Yale Child Study Center where his focus was on behavioral interventions for autism and disruptive behavior disorders. Cognitive-behavioral therapy for anger in children sstudy adolescents: It can be helpful to frame the treatment in terms of tangible benefits for the child; there is often a noticeable switch where the child recognizes that decreasing anger and aggression leads to specific and appreciable outcomes.

Neuropsychiatric Disease and Treatment.

dmdd case study

Higher rates have been reported in clinical samples. Post-Treatment Assessments All outcome data are presented in Table 1.

Stability of disruptive mood dysregulation disorder symptoms irritable-angry mood and temper outbursts throughout childhood and adolescence in a general population sample.

J Abnorm Child Psychol. See other articles in PMC that cite the published article. Disruptive mood dysregulation disorder DMDD is a newcomer to psychiatric nosology. The relationship to tantrums in a community and clinical sample. Sessions 7 to 9 addressed social skills for preventing and resolving conflicts or anger-provoking situations with siblings, peers, teachers, and family.

Children and adolescents with DMDD may benefit from behavioral interventions for anger and aggression. This flexibility in implementation may be particularly relevant for treatment of children with DMDD who may present with psychiatry referrals.

We include a case study to illustrate key points, including diagnostic issues that clinicians may encounter when considering a DMDD diagnosis. Completion of anger logs is rewarded at the next session with enthusiastic praise from the therapist and small prizes when developmentally appropriate. Published 24 August Volume Pediatric onset mania was theorized to present as severe nonepisodic irritability with extended periods of very rapid mood cycling within the day 1 — 3 versus discrete mood cycles.

Cognitive-Behavioral Therapy for a 9-Year-Old Girl With Disruptive Mood Dysregulation Disorder

dmvd The NIMH research group led by Ellen Leibenluft, PhD, has conducted a wide range of studies examining the pathophysiology underlying episodic and nonepisodic irritability utilizing behavioral, neurocognitive, and physiologic measures including functional magnetic resonance imaging fMRIevent-related potentials ERPand magnetoencephalography.


An experimental test of differential susceptibility to parenting among emotionally-dysregulated children in a randomized controlled trial for oppositional behavior. These combinations of symptoms led to the provision of a school plan that afforded Bella intensive math support, extra time on tests, and classroom breaks, as needed. Stjdy U, Dellasega C. Additional follow-up of the same sample revealed that chronic irritability in adolescence predicted dysthymia, generalized anxiety disorders, and major depressive disorder at 20 years follow-up mean age The publisher’s final edited version of this article is dmds at Am J Psychiatry.

Journal of Autism and Developmental Disorders. Increased rates of bipolar disorder diagnoses among U.

[Full text] Disruptive mood dysregulation disorder: current insights | NDT

Journal of Abnormal Child Psychology. Despite this, it was added to DSM-5 to preclude assigning bipolar disorder to children with chronic, irritable mood. Parental diagnoses in youth with narrow phenotype bipolar disorder or severe mood dysregulation. Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling.

Disruptive behaviors were shown to significantly decrease in the experimental treatment versus an active control, whereas effects on the measured mood symptoms were not significant. Ultimately, it is ideal for the child to recognize how their behavioral change will benefit them in their day-to-day stud, which usually leads to them feeling proud about their efforts and accomplishments.