DISCLAIMER: There is no standard treatment protocol for DMDD. However, most psychiatrists will recommend a multi-faceted approach that contains some or all of the following elements. Please seek professional help to develop an individualized treatment plan.
1. Support at Home
Parents and caregivers are the first line of defense in coping with the behavioral symptoms of DMDD. Learning how to interact with a child in a way that will reduce aggression and irritable behavior and improve the parent-child relationship is an essential part of treatment. Specifically, parent training teaches parents more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to have a temper outburst and working ahead to avert the outburst. Training also focuses on the importance of predictability, being consistent with children, and rewarding positive behavior. You may want to start with some of the resources listed below, which have been recommended by our members.
Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children's Behavioral Challenges by Mona Delahooke, PhD.
Parent Management Training: Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents by Alan E. Kazdin
Parenting a Child Who Has Intense Emotions: Dialectical Behavior Therapy Skills to Help Your Child Regulate Emotional Outbursts and Aggressive Behaviors by Pat Harvey
Self-Reg: How to Help Your Child (and You) Break the Stress Cycle and Successfully Engage with Life by Dr. Stuart Shanker
Transforming the Difficult Child by Howard Glasser
The Explosive Child by Dr. Ross Greene PhD.
Livesinthebalance.org Lives in the Balance is the non-profit organization founded by child psychologist Dr. Ross Greene, author of The Explosive Child. The mission of Lives in the Balance is to provide vital, accessible resources and programs to caregivers of behaviorally challenging kids.
The Mehrit Centre was founded by Dr. Stuart Shanker, author of Self-Reg: How to Help Your Child (and You) Break the Stress Cycle and Successfully Engage with Life. The mission of The Mehrit Centre is to mobilize science-based and practice-informed knowledge about self-regulation to develop learning experiences, strategies and resources that will benefit all children, parents, and teachers.
Psychotherapy is an important part of a holistic DMDD treatment plan. Cognitive-behavioral therapy (CBT), a type of psychotherapy, is commonly used to teach children and teens how to deal with thoughts and feelings that contribute to their irritability. Clinicians can use similar techniques to teach children to more effectively regulate their mood and to increase their tolerance for frustration. The therapy also teaches coping skills for regulating anger and ways to identify and re-label the distorted perceptions that contribute to outbursts.
Various professionals offer psychotherapy, including psychiatrists, psychologists, social workers, counselors, and psychiatric nurses. Your psychiatrist may offer psychotherapy but if not, ask for a recommendation. Keep in mind that not all therapists accept insurance so you may want to start with your insurance provider to get a list of psychotherapists in your area. Look for someone who has experience with pediatric mood disorders.
Click here for more information on finding a therapist.
3. Support at School
Children with DMDD may struggle at school, either academically or behaviorally. Gaining the understanding and support of teachers and administrators ensures your child will get the support they need to be successful in the school environment. The first step is to open the communication channels by sharing information about DMDD in general and how it effects your child's behavior specifically. If you believe your child needs special accommodations in addition to general understanding, you may want to put something more formal in place. This can be either a 504 Plan or an Individualized Education Plan (IEP). These services are provided at no cost to your family.
504 Plan versus an IEP
A 504 Plan or an IEP is appropriate when a child has a disability that interferes with the ability to learn in the general education classroom. Both can provide for special accommodations within the classroom, but an IEP may also provide specialized education services outside the classroom.
Click here to learn more about the difference between a 504 Plan and an IEP.
Click here to see examples of potential accommodations for a DMDD child.
There is no single prescription used to treat DMDD. Patients with DMDD often have concurrent diagnoses such as anxiety, depression or attention deficit hyperactivity disorder (ADHD), which makes finding the right combination of medicine more challenging. Some medications may improve symptoms of one disorder, only to worsen symptoms of another. It is likely that several medications may be used together for the best results. Be patient. It may be a long journey of trial and error before you find the right formula. In finding the right combination of medications, your doctor may prescribe one or more of the following:
Stimulants are medications that are commonly used to treat ADHD. There is evidence that, in children with irritability and ADHD, stimulant medications also decrease irritability. Stimulants should not be used in individuals with serious heart problems. According to the FDA, people on stimulant medications should be periodically monitored for change in heart rate and blood pressure.
Antidepressant medication is sometimes used to treat the irritability and mood problems associated with DMDD. Ongoing studies are testing whether these medicines are effective for this problem. It is important to note that, although antidepressants are safe and effective for many people, they carry a risk of suicidal thoughts and behavior in children and teens. A "black box" warning - the most serious type of warning that a prescription can carry - has been added to the labels of these medications to alert parents and patients to this risk. For this reason, a child taking an
antidepressant should be monitored closely, especially when they first start taking the medication.
An atypical antipsychotic medication may be prescribed for children with very severe temper outbursts that involve physical aggression toward people or property. Risperidone and aripiprazole are FDA-approved for the treatment of irritability associated with autism and are sometimes used to treat DMDD. Atypical antipsychotic medications are associated with many significant side-effects, including suicidal ideation/behaviors, weight gain, metabolic abnormalities, sedation, movement disorders, hormone changes and others.