Underlying mechanisms of disruptive mood dysregulation disorder in children: A systematic review by means of research domain criteria

Abstract

Background A systematic overview of underlying mechanisms in the new disruptive mood dysregulation disorder (DMDD) diagnosis is needed. The Research Domain Criteria (RDoC) represent a system of six domains of human functioning, which aims to structure the understanding of the nature of mental illnesses. By means of the RDoC framework, the objective of this systematic review is to synthesize available data on children and youths <18 years suffering from DMDD as reported in peer reviewed papers. Methods A literature search guided by PRISMA was conducted using Medline, PsychInfo, and Embase, while the RDoC domains were employed to systematize research findings. Risk of bias in the included studies was examined. Results We identified 319 studies. After study selection, we included 29 studies. Twenty‐one of these had findings relating to >1 RDoC domain. The risk of bias assessment shows limitations in the research foundation of current knowledge on mechanisms of DMDD. Discussion Reviewing self‐report, behavior and neurocircuit findings by means of RDoC domains, we suggest that DMDD youths have a negative interpretation bias in social processes and valence systems. In occurrence of a negative stimuli interpretation, aberrant cognitive processing may arise. However, current knowledge of DMDD is influenced by lack of sample diversity and open science practices. Conclusion We found the six RDoC domains useful in structuring current evidence of the underlying mechanisms of DMDD. Important opportunities for future studies in this field of research are suggested. In clinical practice, this comprehensive summary on DMDD mechanisms can be used in psychoeducation and treatment plans.

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

“…These findings are in accordance with existing research showing no or ambiguous evidence of difficulties in these skills as measured by neuropsychological tasks in children with DMDD [ 31 , 33 ]. Overall, by demonstrating problems with emotion control and cognitive flexibility in daily life, without executive difficulties in organized, relatively emotion-neutral situations, our results substantiate the hypothesis that children with DMDD might primarily have difficulties in EF related to emotion regulation, and not decontextualized problem-solving difficulties [ 14 ]. Instead, in daily life, they might get overwhelmed by feelings without accompanying regulatory capacities.…”

“…Importantly, even though research shows that most children with DMDD have ADHD, this is not true for all children with DMDD. A new systematic review hypothesizes that children with DMDD primarily have difficulties in executive functions (EF) related to emotion regulation, whereas children with ADHD struggle with EF more broadly, i.e., also in less emotionally aroused situations [ 14 ].…”

“…However, the results from SMD research concerning EF are inconsistent and ambiguous [ 11 , 15 , 31 – 33 ]. A considerable problem in current SMD and DMDD research is the high ADHD comorbidity, making it difficult to identify specific DMDD mechanisms [ 14 ].…”

Disruptive Mood Dysregulation Disorder in a Norwegian Clinical Child Population

“…High overlap with other established diagnoses could indicate that the severe irritability characterizing DMDD can be better explained by other diagnoses. On the other hand, irritability is a general sign of distress, with perhaps a variety of different underlying mechanisms (Braenden et al, 2022), which explains the high comorbidity rates (Leibenluft & Kircanski, 2021). Or, the overlap could be explained by the fact that the diagnosis is new, and few clinicians are trained or accustomed to evaluating externalizing behavior as an internalizing problem (mood disorder).…”

Disruptive mood dysregulation disorder: the relationship between cardiac vagal tone, emotion recognition, and expressive prosody

“…Children with SMD also experience difficulties in determining the correct emotional tone of verbal speech (Deveney et al, 2012) and difficulties with vocal emotion labelling (Brænden et al, 2022). No studies have investigated possible difficulties in expressive prosody in children with DMDD, a focus of the current study.…”