DMDD VS ODD
Disruptive mood dysregulation disorder (DMDD) and oppositional defiant disorder (ODD) are two childhood mental health disorders that can interfere with a child’s mood, functioning, and relationships. While both conditions are treatable, loved ones must understand the development, risk factors, and recovery options.
Mental health in children is complex and often misunderstood. It’s easy to disregard or label problematic behavior as developmentally appropriate. Likewise, the opposite is also true. Concerned parents or teachers may look at perfectly normal behavior (temper tantrums, defiance, and rebellion) and assume it’s a more serious issue.
Learning the nuances and raising awareness of understanding mental health helps children, families, and society.
Let’s get into it.
What Is DMDD?
DMDD stands for disruptive mood dysregulation disorder, which is a condition that refers to chronic irritability and anger outbursts in children. While all children experience mood swings and frustrations, DMDD extends beyond age-appropriate emotional regulation.
DMDD is a relatively new disorder that was introduced in the DSM-5 in 2013. After examining the phenomenon in children diagnosed with bipolar disorder, psychiatrists hypothesized that there appeared to be a difference between mania and depression and explosive anger. With so many children being diagnosed with bipolar disorder, they postulated that another issue might be at play. Today, research shows that upwards of 0.8-3.3% of the population meets the criteria for DMDD.
Although DMDD and bipolar disorder can look similar, as they can both cause irritability and impulsivity, the irritation is chronic in DMDD. Likewise, children with DMDD do not experience the same intensified euphoria or surges of energy associated with manic episodes.
Symptoms of DMDD
The hallmark symptom of DMDD is the severe and recurrent temper tantrums that occur at least three times a week. These temper tantrums can be verbal (including yelling, screaming, threats) and behavioral (hitting, pushing, throwing). Other symptoms include:
- Disproportionate reactions to everyday stress
- Persistent feelings of anger, irritability, and sadness
- Trouble functioning in more than one place (i.e., at home, with friends, at school)
- Symptoms are present for at least one year
Clinicians do not diagnose DMDD before age six or after age eighteen. While the onset varies from child to child, symptoms usually emerge before age 10. Before six, it is difficult to distinguish whether tantrums are clinically inappropriate or aligned with normal childhood development. That said, while it’s reasonable for a toddler to fall on the ground kicking and screaming, this behavior is certainly not appropriate for a 12-year-old. After 18, people might meet criteria for other mental health conditions.
Risk Factors for DMDD
There isn’t a single cause for DMDD. Like with most illnesses, mental health experts argue that a variety of factors can predispose someone to this condition. It is known that children with DMDD are more likely to experience interpersonal conflicts and difficulty in schools. Other risk factors include:
- Being male – boys have higher rates of being diagnosed with DMDD than girls
- Alternative diagnoses of attention-deficit/hyperactivity disorder (ADHD), depression, or generalized anxiety disorder
- History of chronic irritability and mood instability
- Intergenerational family history of DMDD or DMDD traits
- Living in an environment with poverty or other financial stress
Treatments for DMDD
While there isn’t a cure for DMDD, treatment and recovery options are available. Most children benefit from a combination of behavioral therapy and psychotropic medication.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is an evidence-based model of psychotherapy that operates under the theory that thoughts, feelings, and behaviors are interconnected. This therapy teaches children how to change distorted thoughts into more realistic frameworks. It also teaches healthier coping skills related to mindfulness and distress tolerance. CBT may include homework assignments, where clients are encouraged to the skills they learn in between therapy sessions.
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Dialectical Behavior Therapy for Children
Dialectical behavior therapy for children (DBT-C) is a therapy model that teaches children the core principles of mindfulness, emotional regulation, and distress tolerance. Children learn how to identify and accept their emotions without acting on them inappropriately. They also learn self-soothing behaviors to implement when they feel stressed or overwhelmed.
Parent Management Training
It’s often helpful to involve parents in their child’s treatment. In parent management training, therapists teach parents specific techniques to use when responding to their child’s outbursts. This training focuses on soothing children, implementing rewards for positive behavior, and avoiding accidental reinforcement of unwanted behavior.
Some children benefit from medication. This option may be viable for children already involved in therapy. However, it may also be helpful for more extreme cases, or for children who do not respond well to traditional therapies. Medical professionals typically start with SSRIs, which help with symptoms of irritability, poor concentration, and emotional regulation. In some instances, they may prescribe stimulants like Ritalin or Adderall to control impulsive urges.
What Is ODD?
ODD is short for oppositional defiant disorder, which is one of the most common mental illnesses in children. Research shows that just over 10% of all children develop ODD at some point in their lives, and the rates are fairly equal between boys and girls.
ODD refers to a pattern of defiant, hostile, and disobedient behavior across multiple settings. The onset usually occurs around age eight and peaks in early adolescence. The undesirable behaviors may start in the home, but they transition into other settings, like schools or extra-curricular activities.
Symptoms of ODD
ODD symptoms include:
- Frequent and intense temper tantrums or episodes of rage and anger
- Refusal to comply with authoritative requests (from parents, teachers, coaches, etc.)
- Continuous arguing, bargaining, or disregarding rules
- Blaming others for mistakes or behaviors
- Becoming easily frustrated or annoyed
- Engaging in behaviors intended to frustrate or annoy others, particularly authority figures
- Persistent experience of symptoms for at least six months
None of these symptoms alone pinpoints an ODD diagnosis. Instead, the child needs to exhibit a pattern of clustered behaviors occurring over an extended period. Additionally, many children struggling with ODD report feeling misunderstood, disliked, or rebellious. They may identify as an outcast, and they often have a hard time trusting authority. The DSM-5 also scales the severity of ODD, and children can be diagnosed with a mild, moderate, or severe condition. Clinicians assess the severity based on the intensity of symptoms and their impact on the child’s functioning.
Risk Factors For ODD
ODD is believed to be a combination of various environmental, biological, and psychological factors. Some theories suggest that ODD first emerges when children are toddlers. These theories are rooted in the notion that children and adolescents with ODD generally act like toddlers. Likewise, the child or adolescent faces difficulty in individuating from their caregiver.
Other research suggests that ODD derives from learned behavior via negative reinforcement. Often, parents are unaware of this dynamic. However, if the child finds that he receives tremendous attention from acting out, he may be more inclined to engage in those behaviors.
Other risk factors include:
- Being predisposed to particular personality traits like stubborn and independent thinking
- Significant stress and instability in the family home
- Difficulties with attachment to the primary caregiver
- Family histories of ADHD
Research remains mixed on the prevalence of ODD in adults. Other childhood disorders, like conduct disorder and ADHD, have clear adult counterparts. However, there is not a comparable ODD diagnosis intended for adults at this time. That said, some mental health professionals argue that ODD can and does exist throughout the lifespan.
Treatment For ODD
Early prevention and intervention are key to mitigate the risk of ODD progressing into other problems like substance use, delinquent behavior, depression, and other compulsive issues. There are numerous, evidence-based treatment options that can support children and families struggling with ODD.
Cognitive Behavioral Therapy
CBT for ODD often entails learning new ways to cope with anger, impulse control, and problem-solving skills. Many children with ODD suffer from low self-esteem, usually due to their rigid beliefs that others do not like them. Therapists work with these children to untangle these thoughts and create more realistic ones. Therapists also help teach more adaptive ways to cope with intense feelings of anger, sadness, or irritability.
Family therapy supports everyone in the family. Rather than focus solely on the child and their destructive behavior, this therapy helps all family members improve their emotional regulation skills and strengthen communication. Family therapists believe that all family members hold responsibility for systemic change. Therefore, each member must be willing to grow, adapt, and make changes. In this process, parents often learn how to support their child with ODD without coddling or enabling.
Parent-Child Interaction Therapy (PCIT)
PCIT helps parents learn how to improve their relationships with their children. In this treatment, therapists observe how parents interact and intervene with their children. Based on these observations, they provide feedback for new ways to provide more effective parenting. This process helps empower parents to set boundaries and create limits for their children. It also helps them stay diligent with positive reinforcement.
Children with ODD often exhibit deficiencies in interpersonal relationships. They may not know how to relate to their peers, and they may struggle with profound feelings of insecurity and loneliness. Peer groups help children learn how to use healthy social skills.
While there are no specific medications designed to treat ODD, some children benefit from antidepressants. Antidepressants can help reduce or eliminate feelings related to irritability, sadness, impulse control, and lack of motivation.
What Loved Ones Can Do For Children With DMDD or ODD
Parents may feel dejected, confused, or frustrated when they find out their child has a mental illness. They might try to play detective and find the “cause” for the issue. They might even look inward and blame themselves. While these reactions are common, loved ones need to know that mental illness isn’t their fault.
Learning About The Condition
Loved ones can be valuable assets for children with either DMDD or ODD. The first step is education. Learning about the conditions, risk factors, and treatment options provides a sense of knowledge and empowerment. Loved ones can obtain information through credible sources like the American Academy of Pediatrics or the Child Mind Institute.
After all, mental illness isn’t a choice. As loved ones learn more about these conditions, they can be more compassionate and empathetic towards the child. That’s because they start to truly recognize that the child isn’t consciously choosing to behave inappropriately.
Obtaining Additional Information
It is no surprise that children can act differently in various settings. They often know when they can push boundaries- and when they can’t. That’s why it’s crucial parents discuss their concerns with all relevant authority figures in the child’s life. This may include teachers, pastors, youth counselors, and the parents of other children. What kinds of behavior do these people notice? Have they observed similar patterns of defiance or anger? If the child only displays symptoms in the home, this often indicates inherent problems within the family system.
Consulting With A Professional
Only a qualified and licensed mental health professional can diagnose DMDD or ODD. While parents might be quick to self-diagnose, it’s vital to obtain a thorough assessment from a doctor, psychologist, or therapist. These professionals can also provide crucial information about the severity of the condition and realistic outcomes for treatment.
Finding The Right Treatment
All children respond to mental health treatment differently. What works well for one child might be a disastrous option for someone else. Loved ones should be patient and tolerant during this trial-and-error process. Likewise, some children are more willing to speak about their mental health than others. Resistance in therapy is widespread, but child and adolescent therapists anticipate and accommodate for it.
Integrating New Skills
To ensure the best chances for recovery, loved ones must be willing to incorporate new knowledge, skills, and strategies into their lives. While it’s easy to focus on what the child needs to change, parents must be willing to reflect on their own habits as well. Change can be a slow and gradual process. However, loved ones need to be open-minded during this important process.