Challenges and Things to Consider

We often think of temper tantrums as something that kids outgrow after the toddler years. But some kids just…don’t. Having a child or teenager who is prone to emotional outbursts or who considerably has trouble regulating their emotions can be extremely challenging.

When you have a kid who exhibits these symptoms, there’s a lot of guilt, worry, and shame involved. It’s not fun at all, and can really take a toll on your mental health. It’s also common to wonder why this is happening, or if there was anything you did wrong to make your child behave this way.

Over the past few decades, the psychological world is starting to understand kids like these better. In fact, many kids who experience intense mood swings and emotional outbursts—especially if they cause problems at school and home—may be diagnosed with disruptive mood dysregulation disorder. With that diagnosis comes a better understanding of what is going wrong—and most importantly, how to manage and treat the child’s symptoms.

Below, we’ll go over everything parents, teachers, and other caregivers of kids need to know about disruptive mood disorder.

Understanding DMDD

So what is disruptive mood dysregulation disorder, exactly?

Characteristics of DMDD include:

• Outbursts must occur at least three times a week
• The child must have had these symptoms for at least a year
• Even when not having an outburst, the children must show signs of intense moodiness
• These episodes have to occur in more than one setting—for example, at both home and at school

As Jillian Amodio, LMSW, licensed therapist founder of Mom’s for Mental Health emphasizes, when a child has DMDD, their behaviors are a direct result of their mental health condition, and not because they are a “bad” child or because they are intentionally trying to be rude or disruptive.

Common Misconceptions

It’s common for children with DMDD to be misunderstood and unfairly judged because of their behavior, according to Amodio.

Amodio understands these struggles personally, as she’s not only a therapist, but a mother. “I am very passionate about advocating for children with this condition and raising awareness, as a therapist, and as a mother of a child diagnosed with this condition, I see on a daily basis how difficult the condition can be not only for the child, but for the family as well,” she shares. “As a parent, I probably answer on average three calls a day from the school to assist with emotional regulation and de-escalation”

Signs and Symptoms

There are certain defining symptoms of DMDD to be aware of. For instance, a child with DMDD:

• Will have had severe temper tantrums or outbursts several days a week
• Will be consistently very moody—irritable, angry, and sad
• May react to frustrations and disappointments with much more intensity than expected, given the situation
• Will have emotional reactions that are much more intense than their peers and may not align with how you would expect a child their age to react
• Will experience symptoms chronically, for at least a year, and often several years
• Will have symptoms that began before the age of ten
• Will have trouble functioning in more than one setting—at home, with friends, at school, etc.

What Is DMDD Caused By?

DMDD is a relatively new diagnosis and was only added to DSM-5 in 2013. As such, experts are still trying to understand what the precise cause and risk factors are for the disorder. They are also trying to understand how many children experience it. “While the exact causes aren’t fully understood, factors such as genetics, brain chemistry, and environmental stressors can contribute,” says Amodio.

Sandra Kushnir, LMFT, licensed marriage and family therapist and founder and CEO at Meridian Counseling, says that the exact causes of DMDD aren’t fully understood, but “a combination of genetic, environmental, and neurological factors likely plays a role.” Additionally, she says, “children who have a family history of mood disorders or anxiety are more at risk, as well as those who experience chronic stress or trauma.”

Diagnosing DMDD

It’s common to have a lightbulb moment when you see the list of symptoms for DMDD and realize that your child may have it. But while it may be tempting to learn about the symptoms of DMDD and just assume your child has it, you can’t diagnose DMDD on your own. If you suspect your child has DMDD, you need to visit a mental health provider for a proper diagnosis.

In fact, some children have more than one disorder at once, including DMDD. That’s why it’s vital to get a full and comprehensive evaluation done by a mental health professional trained to identify DMDD.

Most kids with DMDD are diagnosed between the ages of six and 10. In order to be diagnosed with DMDD, a child:

• Must be over the age of six but under the age of 18
• Have had symptoms of DMDD for 12 months or more
• Have had severe outbursts that are out of proportion with the trigger
• Have outbursts that don’t match their developmental level
• Experience mood issues most days
• Have behavior issues in at least two settings (home, school, or peers)

Treatment Options

Here’s some good news for parents and other caregivers of kids with DMDD. The condition can be effectively managed—usually with a combination of therapy, other supportive techniques, and in some cases, medication. Let’s look at the most common treatments.

Cognitive Behavioral Therapy (CBT)

Therapists who treat kids with DMDD often use a form of cognitive behavioral therapy (CBT) during treatment. CBT focuses on helping kids become more aware of their thoughts and feelings and how these impact their behaviors. “Cognitive-behavioral therapy (CBT) is often used to help children develop better emotional regulation and coping skills,” Kushnir says. “The focus is on teaching children how to recognize their triggers and manage their responses to frustration or anger.”

Medication

Although not every child will require medication to manage DMDD, it can be helpful for many children. “Medication, such as mood stabilizers or antidepressants, may also be considered for some children, but this is typically done in conjunction with therapy and under close medical supervision,” Kushnir explains. According to the National Institute of Mental Health, there are currently no FDA-approved medications for DMDD, but providers often use medications prescribed for other similar mental health conditions.

Family Strategies

Often, DMDD is a family matter, where members of the child’s family need to learn strategies for dealing with and responding to their child’s outbursts. For instance, parents often need to learn how to disengage when emotions get intense rather than “fuel the fire,” says Amodio.

“In my own family, and in my work with other families, I always encourage people to wait until the lava after the emotional volcanic eruption has cooled to try and have a productive conversation and dissect what happened,” Amodio suggests.

She also says that many parents need to learn how to transition from punishing their children for their behaviors and moving toward a more positive reinforcement model. “Praising the positive behaviors and encouraging positive behavior through rewards and incentives is often more productive than punishing negative behaviors,” Amodio notes.

Living with DMDD

It’s important to keep in mind that DMDD is often a chronic condition, which means support is crucial. “Families of children with DMDD often feel overwhelmed, but with the right support, the disorder can be managed effectively,” Kushnir assures. She also shares that she’s worked with families “who initially felt helpless due to their children’s frequent outbursts, but made significant progress through family therapy and consistent behavioral interventions,” says Kushnir.

Kushnir gave an example of one such family. “One anonymous case involved a family where the child’s emotional outbursts significantly decreased after implementing structured routines and attending weekly CBT sessions,” she says. “With time, the family learned how to recognize the early signs of emotional dysregulation and proactively manage situations before they escalated.”

Research and Future Directions

Since DMDD is a relatively new diagnosis, research is ongoing and psychiatrists are still learning about the most effective treatments and neurological underpinnings of the condition, says Kushnir.

“Some studies suggest that children with DMDD may have an overactive amygdala, which is the part of the brain responsible for emotional processing,” she describes. “In the future, we may see more personalized treatment plans incorporating medication and targeted therapies based on a child’s specific neurodevelopmental profile.”

Amodio says that research is increasingly focusing on early intervention as well as effective treatment options for kids with DMDD. “I believe that as awareness grows, we’ll see more integrated approaches that involve schools, therapists, and families working together,” she says. “The future will likely involve a more personalized understanding of each child’s unique needs.”

Resources and Support

Kushnir shared her top tips for families who are navigating DMDD:

• Establish a consistent daily routine for your child, since structure can help stabilize moods and reduce irritability
• Practice positive reinforcement for good behavior
• Try your best to avoid reacting emotionally to outbursts
• Work closely with a therapist or counselor to learn behavior management techniques
• Educate yourself about DMDD and its various treatment options

Some helpful resources that Kushnir recommends parents consider include:

• The Child Mind Institute, which provides wonderful educational materials and support for parents of children with mood disorders.
• Parent support groups, locally or online, which can offer invaluable emotional support and practical advice from others in similar situations

Bottom Line

Living with and managing DMDD can be difficult, and even harrowing at times. Please remember that you aren’t alone—there are many families who are dealing with this condition. Most of all, know that help is out there for you.

“While DMDD can be challenging, with the right interventions and support, children and families can navigate it successfully,” Kushnir stresses. “Regular therapy, family involvement, and, when necessary, medication can all contribute to better emotional regulation and improved quality of life for the child.”