How to handle a child with dmdd

DMDD | Kids With Extreme Tantrums and Irritability

Occasional tantrums and irritability are normal parts of childhood, but some kids have frequent, extreme tantrums — at an age when most kids have outgrown them — and are irritable most of the time. Those are signs that they might have what’s called disruptive mood dysregulation disorder, or DMDD. It’s a mouthful of a name, but the key words are “disruptive,” which refers to behavior like tantrums and outbursts, and “dysregulation,” which means that these kids can’t manage their emotions in an age-appropriate way.

Kids who have DMDD have usually had, from infancy, a difficult temperament. They have had a hard time self-soothing, and trouble adapting to changes without getting upset or losing their temper. As toddlers, they’ve been strong-willed and difficult to manage. And by grade school age, they’re still having tantrums that are no longer developmentally appropriate.

As one mother of a 12-year-old boy put it to Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute, “I have an intelligent 12-year-old who tantrums like a five-year-old — severe, full-blown tantrums with slamming doors, crying, making fists and banging on the table. ”

In between tantrums, children with DMDD are usually irritable. They have a short fuse, and low frustration tolerance. Parents often describe feeling like they are walking on eggshells around these kids to avoid setting them off.

“We typically see kids in our center beginning at 8 to 10 years old,” says Stephanie Samar, PsyD, a clinical psychologist at the Child Mind Institute, “but they’ve been having trouble with these symptoms for a while and may have tried therapy in the past. They often come because the parents are at a breaking point — they’re burnt out and they’re not sure how to handle it anymore.”

What causes these tantrums?

Children who have DMDD start with very big emotions that they have poor control over. They experience feelings more powerfully than other kids, and lack self-regulation skills. As Dr. Taskiran puts it, “Too much gas and not enough brakes.”

Another factor that triggers irritability and tantrums is that children with DMDD have difficulty reading facial expressions. They tend to perceive neutral faces more negatively, and slightly negative faces as severely judgmental or even hostile, and they react by acting out.

This is different from kids on the autism spectrum, who often don’t respond to facial expressions. These kids misinterpret them. “If the teacher has a headache or is preoccupied when they greet the child in the morning,” says Dr. Taskiran, “the child with DMDD gets alarmed, thinking, ‘There’s something wrong with me. They’re angry at me. They’re going to reprimand me.’ ”

How is DMDD different from ODD?

DMDD is sometimes confused with oppositional defiant disorder, or ODD, because the behavior of kids with DMDD can look, superficially, like ODD. They may be disrupting the classroom, yelling a lot, not following directions. But the difference is that their behavior is not aimed at defying authority. “Clearly they just can’t handle their mood,” says Dr. Taskiran. “That’s the issue.”

He notes that teachers, parents and psychiatrists will say of a kid with DMDD that “Oh, you know, they’re different, they’re not really spiteful, they’re not really vindictive. They can’t really help it.” And kids with DMDD often apologize for their tantrums. “They’re often shocked after the tantrums, like, ‘Why did I do this?’ ”

If a child’s behavior is a threat to others, Dr. Taskiran notes, it unlikely that it’s a case of DMDD. Kids with DMDD might, in the heat of things, throw something, not looking where it’s going, and someone might get hurt. But it wasn’t their intention.

The tantrums of kids with DMDD are also different than the kind children on the autism spectrum have. A tantrum of an autistic child is more internal, observes Dr. Taskiran. “They are trying to self-soothe, reacting to something that has disrupted their own internal environment. It’s less verbal, or they repeat the same thing over and over.”

In kids with DMDD a tantrum is more external, directed at whatever person or situation has triggered them. Usually it involves yelling at someone or something, in protest of something that’s been, or being, done to them.

How is DMDD diagnosed?

For a diagnosis of DMDD a child must have:

Severe temper outbursts, either verbal (yelling), behavioral (physical aggression) or both
Outbursts are out of proportion to the provocation, and inappropriate for the child’s age
Outbursts occur on average three or more times a week
The mood between temper outbursts is persistently irritable or angry most of the day
These symptoms have been present in at least three settings, for 12 months or more
The child can’t be younger than 6 or older than 18, and the onset of symptoms must have been before 10

The reason DMDD can’t be diagnosed before a child is six — even though parents usually say the behavior was present in toddlers — is that tantrums are still part of normal development at that point. Clinicians don’t want to accidentally include kids who might just be maturing somewhat more slowly than their peers. And the symptoms must have developed before age 10 because if a child suddenly develops this pattern of symptoms in, say, the fifth grade, it’s probably something other than DMDD, such as a response to adversity of some sort, at home, at school, with peers.

Until 2014, kids who exhibited this pattern of extreme tantrums and irritability were diagnosed with pediatric bipolar disorder. Though their symptoms weren’t episodic — mania alternating with depression — as in adult bipolar disorder, they were expected to develop mature bipolar disorder as they aged. But that usually didn’t happen. In fact, kids with DMDD are more likely to develop anxiety or depression as adults.

Kids with DMDD often get an earlier diagnosis of ADHD or anxiety, notes Dr. Samar, since the emotional extremes can read as impulsivity, or fight-or-flight responses.

How does DMDD change over time?

Symptoms of DMDD change as children grow and develop. When they are elementary school age, there are a lot of tantrums, at home and at school. The tantrums may continue in middle school. But as kids become adolescents, the tantrums are less physical outbursts than interpersonal ones, volatility in relationships, Dr. Taskiran says.

By late adolescence, or early adulthood, the lashing out has diminished, but the extreme emotions are still there, and they become internalized as anxiety or depression.

How is DMDD treated?

The goal in treatment of DMDD is to enable kids to regulate their mood and handle their emotions without extreme or prolonged outbursts. Cognitive behavior therapy and parent management training are often used with these kids with some effect. But now clinicians are using dialectical behavior therapy, or DBT, with more success. DBT was created for adults, but has been adapted for adolescents and pre-adolescents. The programs for children include Dialectical Behavioral Therapy for Children, or DBT-C, and a modified program known as Mood Masters®, which was created at the Child Mind Institute.

In DBT, therapists validate the emotions people are experiencing (rather than telling them they shouldn’t be feeling that way) and then help them develop skills to cope when the emotions become too intense to manage. Both DBT-C and Mood Masters teach emotional regulation, mindfulness, distress tolerance and interpersonal effectiveness skills, which are combined with parent management training, which teaches parents skills to help their kids rein in their disruptive behavior.

DBT-C and Mood Masters teach DBT skills to parents as well as kids, so they can help their children practice using them — and use the skills themselves. “When you have an 11-year-old having an angry outburst for 30 minutes, the parents need to be skillful and manage their own emotional response in this situation,” explains Dr. Samar. “We found it to be very helpful for these families.”

For school, kids can be taught skills to defuse situations that upset them, and their 504s or IEPs can be modified to accommodate them — for instance, to allow them to leave the classroom to splash water on their face then come back feeling a bit more regulated.

Medication treatment

If therapy and parent training are not available, or not effective alone, medication can be prescribed. To manage the volatile emotions of kids with DMDD, doctors prefer to use an anti-depressant with mild side-effects, like an SSRI. To help kids with the top-down self-control, Dr. Taskiran says he may prescribe a stimulant medication, which helps kids rein in impulses.

If that combination of medications fails, he adds, he might move on to a low dose of an atypical antipsychotic, such as Risperdal.

When behavioral problems are creating a crisis in the family or in school, it’s not uncommon for clinicians to go directly to prescribing Risperdal for children with DMDD. “Parents come in with a sense of urgency that this needs to be fixed right away,” says Dr. Taskiran. “Otherwise they’re going to be kicked out of school, or they’ll have to be sent to residential treatment.” These decisions should be made carefully, as Risperdal can have serious side-effects.

Dr. Taskiran adds that kids with DMDD can be very difficult for families to deal with, and can result in a lot of conflict between parents. When they’re trying to manage huge tantrums, differences in child-rearing practices are heightened, and it may feel as if the family is falling apart. Sometimes just getting a clear diagnosis can be a big relief.

That’s an important point, says Dr. Taskiran. “Children with DMDD are often not understood well, even by mental health professionals. Parents are at a loss. Once they understand what it is, and what can you do — that they’re not powerless — they see the light at the end of the tunnel.”

And it can be a relief to the children, too, adds Dr. Samar. “These kids are really capable of changing. It can be very intense, but once they know the way to manage themselves and get control back, they can be very motivated and successful.”

And she notes that their emotional sensitivity can, when harnessed a different way, be a strength for them. “I think it’s really a gift,” she notes. “As much as they get this rap for being irritable and angry all the time, they’re actually incredibly strong and talented kids who just need a different way of managing that emotion. They’re great kids and great families.”

Discipline and Interventions for Child with DMDD

Tanya J. Peterson

Discipline for disruptive mood dysregulation disorder (DMDD) is both crucial and challenging. Children and adolescents who live with DMDD have outbursts fueled by frustration. These kids yell and swear and act aggressively toward property, other people, and themselves. They’re also perpetually irritable or angry. Disruptive mood dysregulation disorder severely interferes in kids’ lives now, and it increases their risk of major depression in adulthood. Interventions and discipline for DMDD are clearly in order, but because of the vulnerability and volatility of those with it, discipline must be approached correctly.

How to Discipline a Child with DMDD: Helpful Strategies

Knowing your reason for disciplining your child with DMDD will help you shape your approach. When a child or teen has DMDD, the major goal of discipline is helping them develop emotional regulation. Without this (when they experience emotion dysregulation), they’re unable to manage their response to frustrations, triggers, and emotions. They’ll continue their outbursts and aggression until they’ve learned the proper skills.

Discipline and DMDD need specific skills and strategies. The following approaches have been found to be helpful:

Set clear rules, boundaries, and limits, and ensure that your child knows what they are.
Have logical consequences in place, and make these clearly known to your child, too.
Consistently enforce your rules and limits with your consequences.
Be predictable in your approach to discipline as well as in your daily life in general. To a child with DMDD, inconsistency and unpredictability are highly frustrating and trigger meltdowns.
Reward positive behaviors. This is as important as applying consequences for verbal and physical aggression.
Create and follow routines for all that you do every day.

It’s also necessary to teach kids skills in order to work toward emotion regulation. Help your child identify their moods and changes in their moods. Give them words by listening to them, noticing non-verbal cues, and then reflecting them back to your child. For example, you might say, “I see that it’s hard for you to wait your turn for the TV and that you feel impatient. I promise you’ll have your turn soon. While you wait, do you want to play with your cars or draw pictures?” Then, when they choose an activity to do until it’s their turn, reinforce the positive behavior with a small reward.

Also teach your child to pause before acting on emotions. Have them count backwards from 10 to one (or forward if trying to count in reverse is frustrating for your child). Teach them the useful coping skill of taking deep breaths. Let them know, too, that it’s okay to step away from a frustrating situation to cool down. Working closely with your child’s school will ensure that they know your child needs to do this.

As your child or teen’s parent, having discipline skills and teaching them their own coping skills will help them gradually have more control over their strong, negative emotions. Because DMDD affects lives so profoundly, professional help is recommended.

Professional Interventions for DMDD

Therapy is essential in treating and managing DMDD. Psychologists or mental health therapists use cognitive behavioral therapy (CBT) to help children and teens with DMDD identify and deal with negative thoughts and emotions.

This disorder involves the misinterpretation of other people’s attitudes and intentions, which causes frustration and triggers outbursts. Professional treatment helps children handle this frustration and learn to develop alternative interpretations of people and events.

Interventions for DMDD also involve teaching kids coping skills and anger management. The goal of all interventions is to increase a child’s ability to tolerate frustration as part of the development of emotion regulation.

Parent training is another component of interventions for DMDD. In a training program, parents learn skills and strategies such as the ones above to effectively discipline their child or teen. Parents also develop communication skills so they can interact with their child without triggering them. Parents learn crucial concepts like:

Validation of their child’s emotions
Consistency in rules, consequences, and routines
Predictability so the child always knows what to expect
How to reward positive behaviors

Interventions for DMDD, including discipline and disruptive mood dysregulation disorder, are designed to increase kids’ emotional coping skills, communication abilities, frustration tolerance, and self-awareness. In the case of DMDD, “discipline” fits perfectly. Discipline means teaching, and it’s teaching necessary skills that helps children, teens, and parents.

article references

APA Reference
Peterson, T. (2022, January 11). Discipline and Interventions for Child with DMDD , HealthyPlace. Retrieved on 2022, November 5 from https://www.healthyplace.com/parenting/discipline/discipline-and-interventions-for-child-with-dmdd

Last Updated: January 16, 2022

Medically reviewed by Harry Croft, MD

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A cold in a child: how to treat it correctly

Many parents are ready for the fact that babies will catch common, including seasonal infections, which is typical for childhood. Some parents study the methods of treating ARVI and colds in advance, read about it from experienced mothers in blogs and diaries, consult with doctors they know, and watch medical programs. But even despite the fact that the child's body from birth has a powerful immune system, this protection is imperfect. Therefore, no matter how informed the mother is, when the child becomes ill, she has a lot of questions that require qualified answers.
What is ARI and SARS
Most often, children are faced with acute respiratory diseases, abbreviated as acute respiratory infections or colds. This is especially evident when visiting children's groups, where they come into contact with other kids, and actually exchange various pathogens. The mothers of "kindergarten" children are very familiar with the phrase: "We go for 2 days, then 2 weeks - on sick leave."
A cold can be both viral and bacterial, even fungal and of a different nature, in 70-80% of cases it is of a viral nature. It is impossible to establish the origin of a cold with accuracy on a pediatric examination, as well as “by eye” to distinguish one infection from another. However, there are certain signs that indicate the action of viruses, harmful bacteria and other pathogens. For example, nasal mucosal discharge is indicative of an acute respiratory viral infection, which usually begins with mild malaise, loss of appetite, moodiness, and sleep disturbance in a child. This is a prodromal period, it lasts from several hours to 1-2 days. And such a viral infection as the flu begins acutely, immediately with a very high temperature, intoxication, there is almost no prodromal period, dry cough appears in the late stages of the disease. Often ARVI goes away with catarrhal symptoms: nasal congestion, change in tone of voice, "circles", "blue" under the eyes, runny nose, discharge from the nose, cough, sore throat and swallowing.
What to do?
First of all, you need to remember that parents should not panic if the child has a fever and other unpleasant symptoms of a cold. Any mood of the mother is transmitted to the baby. A cold with a competent approach is simply MUST pass in 5-7 days without complications. And it is important to know that the treatment of a cold is complex, which includes the main drugs - antiviral, antibacterial, etc., as well as symptomatic therapy. You should not rely on just one medicine as a panacea, a magic pill from advertising or the advice of a pharmacy worker.
How to treat?
Antivirals. There is a lot of misinformation about antivirals now. They are credited with mythical side effects and actions. If this comes from a doctor, then he must provide data confirming his point of view in official sources, which are state medical institutions, major scientific journals.

Antibiotics. As for antibiotics, their use is currently limited by very clear indications, contraindications, age of the patient, etc. In addition, antibiotics, especially with uncontrolled, frequent use, contribute to the formation of new strains of harmful bacteria that are difficult to treat. Usually, against the background of antibiotic treatment, it is customary to prescribe biological products - live microbes that make up the human intestinal microflora. But there is an opinion that the antibiotic has a detrimental effect on these bacteria, and such therapy does not bring the desired result.

Auxiliaries . In the treatment of colds of any origin, symptomatic therapy is used, the action of which is directed against the symptoms of the disease. They are called auxiliary, as they help to alleviate the course of a cold. They do not get rid of the cause of ARVI, but the child's own antibodies work against viruses.

How to treat a runny nose? In case of a runny nose, a nasal toilet with saline solutions is performed. The procedure is simple, but requires certain skills and care. To do this, you should seat the child with his back to him, first clean his nose. In babies, this can be done with cotton buds (in children under six months old, only with ordinary cotton turundas), and at an older age, children can already blow their nose. After that, you need to raise the chin, holding the child's face with his palm in a raised position. Using a pipette, drip saline solution into both nasal passages, lower the child's head forward. Part of the medicine may spill out of the nose, but the result of such a procedure will still be achieved. If there are no special recommendations from the pediatrician of the sick child, you can use a pipette and normal saline. But preferably a sterile solution based on sea water. It is a delusion to think that washing a child's nose will be addictive or the snot will flow out on its own. Part, of course, can leak out, but if you do not clean your nose, there is a high risk of infection spreading to the lower respiratory tract, the development of complications such as inflammation of the trachea, bronchi, and lungs.
If the runny nose is profuse, watery, painful, accompanied by nasal congestion, vasoconstrictor drugs (based on oxymetazoline, xylometazoline) are used in the form of drops at bedtime, before walking with the child. This helps the baby to have a good rest in a dream without waking up, and on a walk it is normal to breathe through the nose without taking cold air into the mouth. It should not be instilled into the nose of a child in a supine state, since there is a high probability of a change in pressure during such manipulation and there is a risk of otitis media. All instillations must be done while sitting. The use of special preparations in the form of soft (spray with limited jet pressure) should be carried out with great care, since there is also a risk of promoting the spread of infection under pressure.

Antipyretics . Often there are questions about the use of antipyretics, for children - these are drugs based on paracetamol or ibuprofen, for babies - in syrup, suppositories. It should be noted that if there are no special recommendations in this regard, it is necessary to reduce the temperature above 38.3 - 38.5 ° С. If the child feels well, plays, has an appetite, and, in general, tolerates temperature well, antipyretic drugs can not be used. If the parents see that the child's condition is bad, he refuses to eat and drink, becomes lethargic, vomiting occurs, headache, the temperature rises further, you can start giving antipyretics even at a low temperature.

How to treat a cough? Questions about cough are the most frequent and sometimes the most difficult at pediatric appointments for SARS. It is best if the doctor dynamically observes the coughing child. In this case, the specialist can distinguish changes in the tone of the voice, a barking component, a dry or wet cough, wheezing, localization of wheezing. If the pediatrician recommends taking an x-ray, you should not refuse such an examination, this will help to make the correct diagnosis and prescribe adequate treatment. Currently, in the treatment of cough, inhalation drugs are widely used - through a special device - an inhaler. This tactic reduces the systemic effect of the drug on the child's body, where the drug reaches the point of its application - large and medium bronchi, and even alveoli. Inhalers can be used from the very birth of a child, but it is necessary to pay attention to the type of device, the medicinal substances recommended for it, their dosages and the frequency of use.
Activities before the doctor arrives
Sometimes, especially during the season of high incidence of flu and colds, there are difficulties with a doctor's visit, you have to wait for an appointment, the doctor does not have time to come as quickly as parents would like. There are steps that can be taken before the arrival of a specialist. It is necessary to measure the temperature of the child and write down the data on the thermometry performed in a diary, which is then shown to the doctor. If the temperature is high, do not wrap or even dress the child warmly. At home, you can generally strip to your underwear. Disposable diapers are also recommended to be removed from babies. Do not forget about physical methods of cooling - you can wipe it with cool water, you can put a cloth moistened with water on the head, stomach, places of the main vessels. A sick child should be given plenty of fractional water, even if he refuses to drink, it is necessary to constantly offer from a teaspoon, moisten his lips.
There are no children who do not get sick. Everyone gets sick, only some often, while others not so much. The main thing to remember is that any medicines should be prescribed by a doctor at an internal appointment, after examination.

Treatment of child malaise symptoms

Published: October 20, 2018

Child malaise in most cases is a harbinger of an upcoming illness. Many parents immediately notice that something is wrong with their son or daughter: children become capricious and irritable, refuse food and favorite games, get tired faster. It is especially important to recognize the poor health of a 1-2-year-old baby in time, because he still cannot talk about what worries him.

Due to imperfect immune protection, the disease in a child of the first years of life develops faster than in adolescents and adults. Therefore, notice all the signs of malaise in order to detect the infection in a timely manner, consult a doctor and receive the correct treatment.

Contents of the article

When do you need specialist advice?

A child's malaise may be the result of mental or physical overwork. If it is short-term and not associated with a viral infection, then it quickly passes without treatment. Quite another thing is the lethargy and apathy caused by SARS.

A visit to the doctor should not be postponed if the following symptoms occur:

nausea or vomiting,

liquid stool,

aching muscles and bones,

loss of appetite,

rapid noisy breathing,

sore throat,

rise in temperature,

runny nose.

In the initial stage of acute respiratory viral infections, there may be no pronounced symptoms, so many parents do not pay attention to signs of illness and take the child to kindergarten or school. Doing this is not worth it. If possible, it is better to leave your son or daughter at home and observe their well-being. If the condition worsens, you can quickly take the necessary measures and call a doctor.

How to treat a child?

How to treat an indisposition in a child depends on the causes that caused this condition. When poor health is due to excessive physical exertion or mental overstrain, adequate rest and sleep is enough. This will help restore strength in a short time. If the cause of the ailment lies in a viral infection, the doctor selects drugs for the treatment of acute respiratory viral infections in children. In addition to the prescribed therapy, you can use time-tested folk remedies.

A mixture of carrot and beetroot juices in equal proportions is effective in case of a cold. The resulting composition must be filtered through gauze and instilled into each nasal passage 1-2 drops 2-3 times a day.
With hyperemia of the pharynx and inflammation of the oropharynx, rinsing with saline solutions, infusions of chamomile, string, calendula, sage will help. They have a powerful anti-inflammatory and softening effect, soothe irritated mucous membranes.
Vegetable oil helps to reduce sore throat and eliminate perspiration. You can use any: sunflower, corn, olive, linseed. An important condition is the absence of allergies in the child. For a therapeutic effect, you need to give the child one teaspoon of heated oil.
Cool compresses can help reduce fever. Wet a towel with warm water and place it on your child's forehead, neck, or groin. Large vessels pass in these places, so the effect will appear quickly.
Drink plenty of warm water to improve your general condition. It is better to offer children not plain water, but fortified drinks: tea with lemon and raspberries, milk with honey and butter, rosehip broth, diluted juices, dried fruit compote, jelly or cranberry, currant, cranberry juice.