MOOD DISORDERS 101: A primer for recognizing and intervening with children with DMDD JULIE T. STECK, PH.D., HSPP CRG/CHILDREN S RESOURCE GROUP
OBJECTIVES Participants will develop an understanding of Disruptive Mood Dysregulation Disorder (DMDD) Participants will be able to identify three triggers for temper outbursts in the identified child Participants will develop three new strategies for intervening with the identified child Participants will identify three coping mechanisms for the family/classroom
NEW ADDITION TO DEPRESSIVE DISORDERS IN DSM-V Inclusion in DSM-V was to address concerns regarding over-diagnosis and treatment of bipolar disorder in children Children with this symptom pattern typically present with depression and/or anxiety as adults
DIAGNOSTIC CRITERIA Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation The temper outbursts are inconsistent with developmental level The temper outbursts occur, on average, three or more times per week
DIAGNOSTIC CRITERIA The mood between temper outbursts is persistently irritable or angry,most of the day, nearly every day, and is observable by others The above criteria have been present for 12 or more months and the individual has not a period of 3 or more months without all of the symptoms The criteria above are present in at least two settings (home, school, peers) and severe in at least one of these
DIAGNOSTIC CRITERIA The diagnosis should not be made prior to age 6 or after age 18 By history or observation the criteria were met prior to age 10 The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder
EXCLUSIONARY FACTORS Symptoms are not attributable to physiological effects of a substance or another medical or neurological condition Cannot co-exist with Oppositional Defiant Disorder (ODD), Intermittent Explosive Disorder, or Bipolar Disorder This diagnosis is not used if individual has ever had a manic or hypomanic episode of more than one day
IN GENERAL... More common in males and school-age children Prevalence probably 2-5% High rates of co-morbidity ADHD, disruptive behaviors, anxiety, learning difficulties, tics Families say they walk on eggshells These children don t have tantrums they have rages
IN DSM-V, THE TERM BIPOLAR DISORDER IN CHILDREN IS USED ONLY WHEN THERE ARE DISTINCT PERIODS OF MANIA OR HYPOMANIA, IN ADDITION TO THE EPISODES OF IRRITABILITY/DEPRESSION
PRIMARY SYMPTOM IS MOOD DYSREGULATION/IRRITABILITY
SECONDARY SYMPTOM OF DMDD IS COGNITIVE DYSREGULATION Working memory Visual-spatial reasoning Planning/organization Attention Most noticeable in math and written language
DISRUPTIVE MOOD REGULATION DISRODER ALSO CAUSES FAMILY Marital conflict Financial strain DYSREGULATOIN Difficulty with parents work schedules Significant impact on siblings Isolation from friends and extended family Shame/fear/reliving old memories Anger towards others
CHILDREN WITH DMDD... Do not suffer in silence Have low tolerance for frustration Tend to have poor working memory and slow speed of processing See the glass as half empty
CHILDREN WITH DMDD... Have trouble putting the needs of others before their own needs Perceive comments and the reactions of others negatively Have low tolerance for frustration Often gravitate to the dark and negative
COMMON CO-MORBID CONDITIONS Anxiety Depression ADHD Specific Learning Disorders ASD Known neurological conditions (cerebral palsy, seizure disorders)
CHILDREN WITH DMDD... Almost always have ADHD Poor impulse control Excessive activity for context Short attention span for activities not of their choice Difficulty with multi-tasking Distractibility Poor time concept
ADDRESSING/TREATING DMDD Appropriate diagnosis of the disorder and coexisting disorders Parent and caregiver/teacher education regarding the issues addressing the student Building in positive parenting and teacher support
ADDRESSING/TREATING DMDD Consideration of medication Individual and family therapy Provision of appropriate services and supports in school programming when emotions impact learning and functioning in school Recognizing and treating anxiety, depression and/or ADHD in the parents
WHAT ARE THE TRIGGERS FOR YOUR The word no CHILD? Stopping something they are enjoying doing Leaving home to go somewhere they don t want to go Homework Putting on clothes they don t like/don t feel good in Being served food they don t like
THE BASKET METHOD Dr. Ross Greene Basket A -- Have to s Basket B -- Want to s Basket C -- Let go of it ( Giving in does not mean giving up )
STRATEGIES Try to have a consistent and predictable schedule make the schedule visible to child Note changes to the schedule on the schedule Don t say maybe or we ll see that means yes Don t say no too quickly
STRATEGIES Minimize transitions to and from home Try to find a way to take the home out of homework Negotiate when feasible but stand by your agreement Think of your child as at least 30% delayed in behavior, selfregulation and emotions
DO Remain calm and help your child think Don t invade your child s space unless someone will be hurt Talk less Allow your child to retreat to a pre-determined safe place to calm before further discussion of the topic
Raise your voice DON T Reach for and approach your child in intimidating manner Over-react Talk too much Make threats Try to win the battle but then lose the war
Remember... There is only room for one hand on the panic button THIS NOT THIS
WORDS OF WISDOM Children do well if they can. Ross Greene, Ph.D. The perfect parent is the best parent for the child they have. Giving in does not mean giving up.
RECOMMENDED READINGS Kids in the Syndrome Mix of ADHD, LD, Asperger s, Tourette s, Bipolar and More! Martin L. Kutscher, M.D. Jessica Kingsley Publishers, 2005. Lost at School: Why Our Kids with Behavioral Challenges are Falling through the Cracks & How We Can Help Them. Ross W. Greene. Scribner, 2009. Treating Explosive Kids: The Collaborative Problem- Solving Approach. Ross Greene & J. Stuart Ablon. Guilford Press, 2006. www.nimh.nih.gov
READINGS (CONT D) The Bipolar Child: The Definitive and Reassuring Guide to Childhood s Most Misunderstood Disorder. Demitri & Janice Papolos. Broadway Books. 3rd Edition, 2007. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know. David J. Miklowitz. Guilford Press, 2002. Child and Adolescent Bipolar Foundation www.bpkids.org Depression and Bipolar Support Alliance www.dbsalliance.org
READINGS (CONT D) Lives in the Balance by Ross Greene http://www.livesinthebalance.org/plan-b-inaction/ The Balanced Mind Network http://www.thebalancedmind.org/
UPCOMING WEBINARS December 7 at 12:00 p.m. EST The Emotional Health of College Students: Challenges and Supports Dr. David Parker and Dr. Dana Lasek December 9 at 12:00 p.m. EST ADHD: More Than an Attention Problem Julie T. Steck, Ph.D.
THANK YOU FOR COMING!! Julie T. Steck, Ph.D., HSPP CRG/Children s Resource Group 9106 North Meridian St., Suite 100 Indianapolis, IN 46260 317-575-9111 fax 317-571-4470 www.childrensresourcegroup.com