Saturday, September 13, 2014

Health Issue Week 3 - DMDD

We have all heard of bipolar disorder. It seems that most children in the recent years have been diagnosed with this. If a child acts out, has a tantrum, he/she could be characterized as bipolar.

An article in the September 2014 issue of the American Journal of Psychiatry brought up a new psychiatric nosology to address the need for improved classification and treatment of children displaying temper tantrums or outbursts. Disruptive mood dysregulation disorder (DMDD) is a new diagnostic for children (age 5-18) with chronic irritability. It was first proposed in October 2013, but it didn’t have sufficient empirical support. Partly because it was studied by a single group who focused only on adolescents temporarily hospitalized. Either way, the study was introduced to prevent erroneous diagnosis of bipolar disorder.
“It is likely that [bipolar disorder] diagnostic approach has contributed to the dramatic rise in the rate of pediatric visits for bipolar disorder in the United States, from an estimated 25 per 100,000 in 1994-95 to 1,003 per 100,000 in 2002-2003” (Moreno C, 2007)
Am J Psychiatry shared a case study of an 8-year-old boy name Dillon who has DMDD. It shares how Dillon’s tantrums would cause impairment at home, in school, at family gatherings, in church and various places, causing the parents to avoid including Dillon on errands and events to avoid the embarrassment.
Since this diagnostic approach to chronic irritability in youth is so new, no controlled trials were conducted in DMDD. Treatment decisions are currently made based on other diagnostics related to psychopathology.
From reading the case study on Dillon, I wonder how art can help him. He punched holes through walls, gave his mother bruises, and appeared agitated, restless and often requested to be left alone. He “expressed the negative thought that no one liked him, that he did not have any friends, and that his parents did not love him.” 
Since I have never worked or seen a child who has outbursts, I really do not have any idea what type of art session I would offer. Most of the time, when my nieces or nephews demonstrate bad manners, I would raise my voice a little and tell them that they are behaving badly and nobody likes a little brat. I let them sit by themselves for a few minutes, then grab some papers and oil pastels. I would ask them who their favorite character was and would draw it on the paper for them to color. This usually helps them to behave better and everyone is happy again.
This may work for spoiled brats, but I am not sure if it will work for children diagnosed with DMDD. 
Would love any input from you.

Roy AK, Lopes V, Klein RG. (2014, Sept. 1)  Am J Psychiatry 171:918-24. Disruptive mood dysregulation disorder: a new diagnostic approach to chronic irritability in youth.
Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M (2007) Arch Gen Psychiatry 64:1032-1039

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