Executive function in children with disruptive mood dysregulation disorder compared to attention-deficit/hyperactivity disorder and oppositional defiant disorder, and in children with different irritability levels

Abstract

Addressing current challenges in research on disruptive mood dysregulation disorder (DMDD), this study aims to compare executive function in children with DMDD, children with attention-deficit/hyperactivity disorder (ADHD), and children with oppositional defiant disorder (ODD). We also explore associations between irritability, a key DMDD characteristic, and executive function in a clinical sample regardless of diagnosis. Our sample include children (6–12 years) referred to child psychiatric clinics. Measures of daily-life (parent-reported questionnaire) and performance-based (neuropsychological tasks) executive function were applied. Identifying diagnoses, clinicians administered a standardized semi-structured diagnostic interview with parents. Irritability was assessed by parent-report. First, we compared executive function in DMDD (without ADHD/ODD), ADHD (without DMDD/ODD), ODD (without DMDD/ADHD) and DMDD + ADHD (without ODD). Second, we analyzed associations between executive function and irritability using the total sample. In daily life, children with DMDD showed clinically elevated and significantly worse emotion control scores compared to children with ADHD, and clinically elevated scores on cognitive flexibility compared to norm scores. Children with DMDD had significantly less working memory problems than those with ADHD. No differences were found between DMDD and ODD. Increased irritability was positively associated with emotional dyscontrol and cognitive inflexibility. For performance-based executive function, no diagnostic differences or associations with irritability were observed. We discuss how, in daily life, children with high irritability-levels get overwhelmed by feelings without accompanying regulatory capacities.

Challenges in Diagnosing Oppositional Defiant Disorder in Children and Adolescents: A Comprehensive Review

“…One example is disruptive mood dysregulation disorder (DMDD), which is characterized by irritability and reactive aggressive behaviors. These behaviors, although also present in ODD, tend to be less intentional compared to DMDD, requiring a careful analysis of aggressive attitudes in different social and psychological contexts (Braenden et al, 2024).…”

Differential Effects of Disruptive Mood Dysregulation Disorder Comorbidity in Attention Deficit Hyperactivity Disorder on Social Cognition and Empathy

“…This effect may be explained, at least in part, hyperactive/impulsive and inattentive symptoms which may be linked to dysfunctions of the fronto-striatal brain networks, functionally related to empathic processing and executive functioning. Those hypotheses should be tested by future studies employing various imaging modalities (Arioli et al, 2021; Brænden et al, 2023).…”

“…Various correlates of DMDD and ADHD comorbidity have been studied previously (Brænden et al, 2023; Haller et al, 2022; Mulraney et al, 2016; Pagliaccio et al, 2017; Tufan et al, 2016; Uran & Kılıç, 2020). However, the literature on DMDD comorbid with ADHD and its effects on ToM and empathy are limited (Whitney et al, 2013).…”

An Expanded Conceptual Framework for Understanding Irritability in Childhood: The Role of Cognitive Control Processes

“…Such differences were posited to arise in emotion-neutral situations in which children with DMDD have the capacity to problem solve and reason more flexibly. However, in emotionally demanding situations, children with DMDD may not have the regulatory capacity to cope (Brænden et al, 2023 ). Thus, although further research is required to characterise the unique relationships between irritability and neuropsychological functioning, these findings highlight potential differences in setting factors (i.e., task demands) and evaluation of tasks as intrinsically rewarding, and thus influencing preferential employment of cognitive control processes, such as increased ability of irritable youth to flexibly recruit proactive control where tasks may be less cognitively demanding.…”