Will disruptive mood dysregulation disorder reduce false diagnosis of bipolar disorder in children?

Margulies, David M.; Weintraub, Sheldon; Basile, Joann; Grover, Paul J; Carlson, Gabrielle A.

doi:10.1111/j.1399-5618.2012.01029.x

Cited by 76 publications

(49 citation statements)

References 37 publications

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“…This attests to variable parental responses depending upon how the question was asked and how the question was understood. We have reported elsewhere that it is more difficult to obtain reliability on irritability (j = 0.72) than on subsequent explosive response (j = 1.0) even between professionals observing the child in the same setting (Margulies et al 2012). These data suggest that in exploring the important concept of irritability, we may need to do more basic work in measurement of responses.…”

Section: Discussionmentioning

confidence: 90%

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Loss of Temper and Irritability: The Relationship to Tantrums in a Community and Clinical Sample

Carlson

Danzig

Dougherty

et al. 2016

Journal of Child and Adolescent Psychopharmacology

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Background: This study explores the relationship of irritability to tantrums and loss of temper in a community and clinical sample. Methods: The community sample, recruited via commercial mailing lists, consisted of 462 6-year-olds whose parents completed the Child Behavior Checklist (CBCL), and Preschool Age Psychiatric Assessment (PAPA). Tantrums were assessed in the oppositional defiant disorder (ODD) section of the PAPA. Irritability was assessed in the depression section to identify persistently irritable and/or angry mood. The clinic sample, drawn from a child psychiatry clinic, included 229 consecutively referred 6-year-olds from 2005 through 2014 whose parents completed the CBCL and Child and Adolescent Symptom Inventory (CASI). Temper loss and irritability items came from the ODD and depression sections of the CASI, and tantrum description was taken from an irritability inventory. Children's Global Assessment Scale (CGAS) and the CBCL Dysregulation Profile were examined in both samples. Logistic and multiple regression were used to compare rates of diagnosis, CBCL subscales, CGAS, and tantrum quality between children with tantrums only and tantrums with irritability. Results: Almost half (45.9%) of clinic children had severe tantrums; only 23.8% of those were said to be irritable. In the community, 11% of children had tantrums, but 78.4% of those were called irritable. However, irritability in the clinic, although less common, was associated with aggressive tantrums and substantial impairment. In contrast, irritability was associated with only a relatively small increase in impairment in the community sample. Conclusions: Irritability may have different implications in community versus clinic samples, and tantrums assessed in the community may be qualitatively different from those seen in clinics.

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Section: Discussionmentioning

confidence: 90%

“…Margulies et al (2012) found that 76.2% of inpatient children with severe outbursts were also rated by the staff as ''irritable'' during hospitalization. However, compiling all available information, DMDD was diagnosed in only 17.4% of these patients.…”

mentioning

confidence: 99%

Loss of Temper and Irritability: The Relationship to Tantrums in a Community and Clinical Sample

Carlson

Danzig

Dougherty

et al. 2016

Journal of Child and Adolescent Psychopharmacology

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“…In clinical practice, children with outbursts typically receive disruptive behavior diagnoses such as oppositional defiant disorder (ODD), attentiondeficit/hyperactivity disorder (ADHD) (Carlson and Dyson 2012;Margulies et al 2012), and conduct disorder ). In recent years, greater focus has been placed on severe tantrums as symptoms of a mood disturbance.…”

mentioning

confidence: 99%

“…(DSM-V) (American Psychiatric Association 2013). However, a recent study showed that only half of inpatient children (ages 5-12 years) with chronic irritability and explosiveness met criteria for DMDD (Margulies et al 2012).…”

mentioning

confidence: 99%

Clinical Features of Young Children Referred for Impairing Temper Outbursts

Roy

Klein

Angelosante

et al. 2013

Journal of Child and Adolescent Psychopharmacology

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Objective: In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. Methods: Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 nonreferred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. Results: No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. Conclusions: Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.

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“…Comorbidity with ADHD and disruptive mood dysregulation disorders (DMDD) is very common in children and adolescents [2]. It is little known how DMDD symptoms affect ADHD treatment.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and adverse effects of methylphenidate treatment in children diagnosed with disruptive mood dysregulation disorder and attention-deficit hyperactivity disorder: a preliminary report

Özyurt

Emiroğlu

Baykara

et al. 2017

Psychiatry and Clinical Psychopharmacology

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Objective: Comorbidity with attention deficit hyperactivity disorder (ADHD) and disruptive mood dysregulation disorders (DMDD) is very common in children and adolescents In this study, we aimed to present a retrospective study of methylphenidate (MPH) treatment in 12 cases who were diagnosed with DMDD and ADHD. Method: All patients were followed-up in our outpatient clinic and the effectiveness and side effects of MPH were explored. Mood Symptom Questionnaire (MSQ-7) and Clinical Global Impression-Severity (CGI-S) were used for assessing the mood symptoms and their severity. Results: The differences between initiation time and the end-point time in CGI-S and MSQ-7 scores were statistically significant. Conclusion: In this present study, the usage of MPH was found to lead to an increase in irritability in children with ADHD and DMDD evidently. ARTICLE HISTORY

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Will disruptive mood dysregulation disorder reduce false diagnosis of bipolar disorder in children?

Abstract: Although DMDD does decrease the rate of diagnosis of bipolar disorder in children, how much depends on whether history or observation is used.

Cited by 76 publications

References 37 publications

Loss of Temper and Irritability: The Relationship to Tantrums in a Community and Clinical Sample

Loss of Temper and Irritability: The Relationship to Tantrums in a Community and Clinical Sample

Clinical Features of Young Children Referred for Impairing Temper Outbursts

Effectiveness and adverse effects of methylphenidate treatment in children diagnosed with disruptive mood dysregulation disorder and attention-deficit hyperactivity disorder: a preliminary report

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