DMDD a new diagnosis for children

[mamachelle]

Hey all,

I know there are a few here like me with kids that are way too young to get a diagnosis of BPD yet they have many traits and have already been identified as having serious behavioral issues. Also, maybe they don't quite fit in with Bipolar or ODD.

My SS10 is dx as Aspergerer's now with problems with executive function and mood. He has also been called "emerging bipolar" and "emerging psychotic". He is on low doses of Abilify and Lamictal. He responds and interacts to the world much like a pwBPD. His mother is dx with BPD.

So, anyway, a friend of mine's daughter has been dx with DMDD. I thought I would share and wondering how many of you can think back to when your kids were younger and see if this might fit a piece of the puzzle.

www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Disruptive_Mood_Dysregulation_Disorder_DMDD_110.aspx

Symptoms of DMDD

The symptoms of DMDD include:

    Severe temper outbursts at least three times a week

    Sad, irritable or angry mood almost every day

    Reaction is bigger than expected

    Child must be at least six years old

    Symptoms begin before age ten

    Symptoms are present for at least a year

    Child has trouble functioning in more than one place (e.g., home, school and/or with friends)

Some of the symptoms associated with DMDD are also present in other child psychiatric disorders, such as depression, bipolar disorder and oppositional defiant disorder. Some children with DMDD also have a second disorder, such as problems with attention or anxiety. This is why it is particularly important to get a comprehensive evaluation by a trained and qualified mental health professional.



Anyway, hope this helps someone else out. I am going to bring it up to SS10's psychiatrist and his psychologist soon.

mamachelle

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Rapt Reader]

Good information, mamachelle 

I'm reading it, and am finding some behaviors and symptoms there that do fit the way my dBPDs36 was when he was young; not sure if he fits enough of the points to qualify, though. Gotta think some more... . However, my sister's 17 year old son recently has kinda had a meltdown of sorts, and all the old diagnoses for him seem to be obsolete. He's doing stuff that seem very BPDish, and I think I'll give her this information. He is, thank goodness, already in therapy, so maybe she can also show it to his therapist.

Thanks for finding this; I'm sure it will prove helpful to many of us... .

[vivekananda]

thanks mamachelle,

I do wish things were easier to categorise... . the more I study the messier it all seems and the overlays of behaviours can be so different. I wonder if DMDD is more prevalent in boys? What about those quiet children seething with anger... . And then there are the 'cultural differences'... . what is acceptable to some is not to others... .

I do hope this disorder makes it easier for those with young children.

Vivek    

[pallavirajsinghani]

Thank you for posting this.  Previously everything was lumped under ADD/ADHD.

I wonder if DBT specifically tailored towards children will be developed.

[qcarolr]

I get somewhat frustrated with my gd8's care. The clinic available with her state medical benefits does not do formal testing. I had to initiate the brief checklist for the school and I to complete to get the ADHD dx. They just ask behavior related questions.

My DD27 had lots of formal, objective testing over the years. She still fell through the cracks in many ways - and I right along with her. Sure wish I had known about validation and values based boudnaries. Well, the selfcare piece was pretty essential too. There was lots of good counseling along the way that I just was not able to accept or apply. Somehow thought I could think it positive and learn it all by myself. ie. I was always right. As I work on my own 'recovery', I am more able to be calm and consistent with each person in my family.

Finding a mindfulness practice, and then doing it daily by appointment with myself, does work.

I wonder if gd8 fits this dx? It has been hard to sort out what is our home environment and what is internal to her personality and genetics. The meds. help some - to make her available to respond to the validation and boundaries strategies.

DD27 definitely fits the description given above.

My biggest question is how does this dx change the treatment options - meds., therapy, school and home?

qcr  

[mamachelle]

I would love if DBT were adapted to younger kids.

The best I have found for parents is the "Parenting a Child with Intense Emotions: DBT Skills" book.

SS10's new T is aware of DBT because she has worked in a RTC. She did not laugh at me, roll her eyes, or get offended when I mentioned that I liked what I knew of it and I try to incorporate it into my parenting. She specializes in kids like my SS and works with kids like him dealing with issues like trauma, gender identity, mood and she says many of the kids are also on the autism spectrum.

Yes, after spending waaaay too much time the past 3 years searching for some answers I've seen oh so many cross-overs between diagnoses and symptoms. Both my SS10 and SS15 have gained a laundry list of dxs and the lists seem to grow a little with every evaluation.

I think in the end it is truly the way you change your responses and work on yourself that at least will start making change with the kids. Diagnoses/names are more important for treatment, schools, and of course, insurance.

I am not sure really what this will change in the long run but here is a good article on it from the Wall Street Journal which came out prior to the DSMV:

www.online.wsj.com/article/SB10000872396390444273704577633412579112188.html

oh and BTW I mentioned this to my parents last night (a Pdoc and spec ed lawyer) and they said, well, mamachelle you need to make sure the doctor has even gotten a copy of the DSMV first before you even bring it up.  

[qcarolr]

Mamachelle - very interesting article. Have you seen the DSMV? I have not had much time this summer to ponder this. Maybe with gd8 back in school Thursday my life can get back to some kind of routine.

DD27 clearly fits this after reading the article. SHe was a 'little terrorist' - a label given by the servers at a resaturant we went to weekly with her from infancy. We kind of viewed it a humorous at the time    She was just over a year old and walking. She was never helped by any of the meds as a child, though we kept trying them. I ended up taking her off of several on my own. She still has unusual reactions to many medications, along with her allergies and sensitivities, migraines and now MRSA infections. When she is 'managing' her emotions by supressing them, all of this flares up. When she feels safe to rage it all out - she feels better and we all feel awful. There is no balance for her. The need to rage is always there below the surface. As an adult this has led to many legal issues with domestic violence contacts and charges. Hope she can get accepted in the dual dx recovery/probation program when she goes to court on 9/5/13. At least get into the evaluation stage. What a hard life she has.

My best support is to love her, maintain my own calm, be consistent with my boundaries, continue to gently push her to do for herself while doing for her what is just too overwhelming.

Praying I can be an influence to help gd8 gain coping skills to express her emotions in a safe way. See her able to verbalize so much better. Like her stomach aches and headaches then talking about worries with school starting. Help her normalize these fears, talk through strategies to manage choices, etc.  Seems to be working as long as I can take care of myself.

Hope this is all relevant to this thread.

qcr  

[vivekananda]

Hope this is all relevant to this thread.

Very relevant I reckon and so hard for you.   

mamachelle that is a great article - it gives you an inside look at how this stuff is decided, really interesting. I like the final comment too   this is not a bloody science... .

cheers,

Vivek