Understanding Unstable Mood in Children: Our Life with DMDD
Living with mood instability, irritability, and unregulated emotions can be difficult when you are an adult. When you are a child the addition of factors such as puberty, social growth, and emotional development can make it nearly impossible to navigate a mood disorder. DMDD is a mood disorder that has had an enormous impact on our lives since my daughter’s diagnosis in 2015. It has caused many sleepless nights worrying about her safety and well-being, and many more up studying a condition that is only recently becoming more known and accepted by the medical community.
DMDD, also known as Dysfunctional Mood Dysregulation Disorder, is sometimes thought of as a precursor of bipolar disorder that is seen in children as early as 6 years of age. It is commonly associated with extreme irritability, angry outbursts, and extreme rage. Although it is often seen in children who have experienced trauma at an early age much like those with RAD ( reactive attachment disorder) it can also be present in children with no history of trauma. My daughter, for example, has no past trauma and has had a relatively “normal” childhood apart from her struggles with mental illness. As a parent, this can sometimes make it more difficult to understand why your child is acting in this way because they haven’t experienced the trauma commonly seen with rage disorders.
Note: I am not a medical professional and cannot give medical advice. All information included in this article is anecdotal and in my opinion as a parent and advocate for a child with disruptive mood dysregulation disorder. For all medical advice please contact your child’s health care team. You can find access to children’s mental health providers in your area through the American Psychological Association or by discussing the issue with your child’s pediatrician.
What are the Symptoms of DMDD?
In order for a child to be given a diagnosis of DMDD, or dysfunctional mood dysregulation disorder, they must experience the following symptoms for at least one year before the age of ten.
- a sad, irritable, or angry mood throughout most of the day. This mood occurs regardless of the situation, time of day, etc.
- severe angry outbursts at least three times per week. (may include verbal aggression, physical aggression, or a combination of both.)
- a bigger than expected reaction to situations in everyday life.
- difficulty functioning due to extreme irritability in more than one situation (ex, at home and school, on outings, etc.)
It is important to note that all children will have angry outbursts from time to time. However, with DMDD it almost becomes the norm rather than the exception for the child to be angry, irritable, and violent. In addition, moods in a child with DMDD can seem to not match up to the situation properly.
How is DMDD Treated?
There are a number of treatments available for DMDD. However, some of the treatments available can do more harm than good so it is always best to go into all appointments with all of the information needed to make an informed decision.
Medications to Treat DMDD
There are a wide variety of medications currently approved to use for DMDD. It is always a good idea to thoroughly research medications prior to use though. Some can cause damage to the body with use. Others can cause issues if there is a potential of other diagnoses.
Always go into appointments with a thorough family history available, including both mental health conditions and any other pertinent diseases that may run in your child’s family (such as diabetes, high cholesterol, or high blood pressure). This will help you and your child’s care provider to come to a decision on the proper medication for your child rather than just the disorder itself.
- Stimulant medications such as those for ADHD are often used to treat inattentiveness in children with DMDD. However, this can be problematic for two reasons. For one, stimulants can cause an increase in aggression and irritability in children with DMDD. Secondly, many times inattentiveness in DMDD can be caused by anxiety. In this case, a stimulant is not a good idea as it does not address the underlying problem.
- Antidepressant medications are commonly used in children with DMDD to combat poor self-image and low mood. There are many antidepressants available to meet your child’s needs. However, if there is a family history of bipolar disorder it is important to watch your child closely as some SSRI’s and SNRI’s can cause mania and hypomania in individuals with this condition.
- Atypical Antipsychotics are medications that are frequently used to treat conditions such as schizophrenia. Many have been used off-label to treat the symptoms of DMDD in children. While they have their merits these medications can also be very problematic as they can cause a drastic increase in weight, blood sugar, cholesterol, and more. It is important to make sure that regular blood work is done to monitor the effects while treating with medications such as Abilify, Risperdal, or Zyprexa.
In the end, the type of medication used will depend on your child’s individual symptoms and their current state of health. Many times it will take quite a bit of trial and error to find a medication or combination of medications that work to improve your child’s quality of life with DMDD. It is important as a parent and advocate to know what to look for with each medication, and to report any unwanted or unexpected side effects as quickly as possible to the prescribing provider.
For children who have tried multiple medications without much change in their mood or irritability, it may be worth looking into genesight genetic testing. This testing will tell you which medications will be the best fit for your child and can take a lot of the guesswork out of finding the proper medication treatment options.
Natural Treatments for DMDD
When my daughter was first diagnosed with DMDD I was adamant that we would not be using medication on her. She was in elementary school at the time and I couldn’t even fathom the idea of medicating her. Of course, as she grew and became stronger than me it was apparent that she was becoming more and more of a danger to herself and others.
We tried several different natural remedies for DMDD, including dietary changes, supplements, and more. Unfortunately, while we did see some changes when she avoided certain foods it wasn’t the type of change that had lasting effects on improving her quality of life. No matter what foods she ate or what supplements she was taking there were still extremely violent outbursts that were putting her and the rest of us in serious danger.
It is also important to note that many supplements and “miracle treatments” are untested, unregulated, and potentially dangerous to our children. Mixing these treatments, including CBD, with psychiatric medication can be potentially dangerous as well.
When you break it down to the basics of it all mood disorders are caused by an alteration in the chemicals of the brain known as neurotransmitters. When we alter these chemicals through medication or supplements we are either blocking receptors from picking them up or causing the neurons to create more than they normally would. An overabundance of any of these chemicals can cause serious, and sometimes deadly side effects.
Often, when using natural treatments and supplements there is no way to tell what dose of these substances you are giving your child. They are not regulated in the way that pharmaceuticals are. The potency may vary from one company to another and even from one bottle to another of the same company.
Psychological Treatments for DMDD
Therapy can be a great way of handling the effects of DMDD on our children. There are a variety of types of therapies available to treat children with DMDD. Each has its merits and focus to help your child improve their quality of life.
Cognitive Behavioral Therapy for DMDD
CBT, or cognitive behavioral therapy, can help children with DMDD to look at the thoughts they are having and to combat negative self-talk, dangerous negative thoughts, and the patterns of behavior that can lead to a child’s irritability and anger. Many times there is a misconception by children with DMDD that the world is out to get them. My daughter suffers from extreme paranoia. In CBT she is able to look at the automatic negative thoughts she is having and use coping skills to change them into healthier, more appropriate thoughts for the situation.
Dialectical Behavioral Therapy for DMDD
DBT or dialectical behavioral therapy is a specific form of CBT originally created to treat those with Borderline Personality Disorder. It helps those suffering from thought distortions to analyze their social interactions with others to determine if their reactions are appropriate or a little different from what is expected in a particular situation.
Applied Behavioral Analysis Therapy for DMDD
ABA or applied behavioral analysis is a therapy originally used for the treatment of individuals on the autism spectrum. It helps parents and children to understand why behaviors are happening in relation to a context and to create guidelines for altering those behaviors to ones that are more expected for the situation.
As she has a dual diagnosis of autism and DMDD my daughter qualified for ABA therapy. Some children with only a DMDD diagnosis may not qualify for ABA. Although there are some who are very strongly against this type of therapy I feel that it has been the most beneficial for my daughter. While CBD gave her skills to use when things get overwhelming ABA therapy has given her the tools to use those skills properly by looking at the reasons behind her behaviors.
What are the Best Strategies for Parenting a Child with DMDD?
If you are living with a child who has DMDD you will quickly find out that many traditional parenting strategies will not be effective. As parents we often find ourselves walking on eggshells to avoid blow-ups or running in circles trying to find discipline that our child won’t just blow off or turn around on us.
Although it may not make sense to those who do not have a child living with DMDD, the best approach is often a gentle one. It is important to understand that these children are not acting this way to be bad. They are not spoiled. They are not being vindictive or purposefully hurtful to parents. In fact, these children are dealing with emotions that are much bigger than they have the capacity to handle at such a young age.
Traditional systems such as corporal punishment or removing privileges generally don’t get far in children with DMDD. One of the most important things to do as a parent is giving them a safe space to go to when their emotions get bigger than they can handle. Ensure the safety of your child, your home, and yourself. Then give them time to cool down.
When you react to their temper or give in to attacks you are only reinforcing their negative behaviors. Therefore, let them know the rules (and make those rules as clear and simple as possible). When rules are broken and the child with DMDD wants to resort to anger to avoid tasks or responsibilities give them time to return to a calm state of mind and try again without anger.
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