Comorbidity and correlates of disruptive mood dysregulation disorder in 6–8-year-old children with ADHD

Abstract

This study aimed to characterize the nature and impact of disruptive mood dysregulation disorder (DMDD) in children with attention-deficit/hyperactivity disorder (ADHD) including its co-occurrence with other comorbidities and its independent influence on daily functioning. Children with ADHD (6-8 years) were recruited through 43 Melbourne schools, using a 2-stage screening (parent and teacher Conners 3 ADHD index) and case-confirmation (Diagnostic Interview Schedule for Children, Version IV; [DISC-IV]) procedure. Proxy DMDD diagnosis was confirmed via items from the oppositional defiant disorder (ODD) and major depressive disorder modules of the DISC-IV. Outcome domains included comorbid mental health disorders, academic functioning, social functioning, child and family quality of life, parent mental health, and parenting behaviors. Unadjusted and adjusted linear and logistic regression were used to compare children with comorbid ADHD and DMDD and children with ADHD without DMDD. Thirty-nine out of 179 children (21.8 %) with ADHD had comorbid DMDD. Children with ADHD and DMDD had a high prevalence of ODD (89.7 %) and any anxiety disorder (41.0 %). Children with ADHD and DMDD had poorer self-control and elevated bullying behaviors than children with ADHD without DMDD. Children with ADHD and DMDD were similar to children with ADHD in the other domains measured when taking into account other comorbidities including ODD. One in five children with ADHD in their second year of formal schooling met criteria for DMDD. There was a very high diagnostic overlap with ODD; however, the use of a proxy DMDD diagnosis containing items from the ODD module of the DISC-IV may have artificially inflated the comorbidity rates. DMDD added to the burden of ADHD particularly in the area of social functioning.

ADHD and DMDD Comorbidities, Similarities and Distinctions

“…In Mulrany's study [21], 20% of children with ADHD met the criteria for DMDD and it was found that males were at a greater risk of developing ADHD with DMDD which is consistent with previous data. Those results also demonstrated that DMDD exacerbates social difficulties in children with ADHD and has a stronger impact on family functioning.…”

Interpersonal Psychotherapy for Adolescents With Mood and Behavior Dysregulation: Evidence-Based Case Study

“…Studies demonstrate that having a diagnosis of DMDD in childhood is associated with high levels of social impairment (Copeland, Angold, Costello, & Egger, 2013; Mulraney et al, 2016). Youth with SMD/DMDD frequently present to treatment for outbursts at school resulting in suspensions and for outbursts at home, which can include verbal rages, destruction of property, or physical aggression.…”

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

“…For Bella, however, her prolonged instances of angry and irritable mood in between temper outbursts indicated a diagnosis of DMDD. It is also important to note that early onset of ADHD and co-occurring symptoms of anxiety are also consistent with the diagnosis of DMDD (Dougherty et al, 2014; Mulraney et al, 2015; Uran & Kılıç, 2015). …”