Why is my child irritable all the time?

Disruptive Mood Dysregulation Disorder 

A lot of children are irritable, upset, or moody occasionally. Occasional temper tantrums are a normal part of growing up. However, when they become frequent, intense and start to interfere with daily functioning it may be sign of Disruptive Mood Dysregulation Disorder (DMDD).

DMDD is a condition in which a child is chronically irritable and displays frequent and severe outbursts of anger that seem out of proportion. Children with DMDD have trouble regulating emotions in an age-appropriate way. 

DMDD is a relatively new disorder created in order to accurately diagnose children who were previously diagnosed with paediatric bipolar disorder. Children previously diagnosed with bipolar disorder did not experience the episodic mania or hypomania which is a differentiating characteristic of bipolar disorder. Therefore, DMDD was created as a new diagnosis in 2013 to replace paediatric bipolar disorder.

Causes and risk factors of DMDD

Since it’s a relatively new disorder category researchers are still exploring its exact causes and risk factors. Although there are a number of factors that are believed to play a role in the development of DMDD such as genetics, temperament, co-occurring mental conditions, and childhood experiences. 

  • Family history

Children with family members who have mood disorders are at a greater risk for being similarly affected or experiencing symptoms of depressive disorders.

  • Temperament

A child’s temperament may be a risk factor for developing DMDD. Some commonly seen traits in children with DMDD include moodiness, anxiety, irritability, difficult behaviour etc. Children who struggle to deal with frustration or adapt to change from a very young age without losing their temper are more likely to develop DMDD

  • Environmental factors

A stressful, chaotic, or unstable family relationships and home environment can also make children more prone to experiencing DMDD. Low parental support, parental hostility and substance use, family conflicts, disciplinary problems at school might also act as contributing factors for DMDD

  • Stress/trauma

Sudden changes in life or traumatic events might also contribute to feelings of irritability. 

  • Other mental-illnesses

It is more likely to co-occur with other psychiatric conditions, most commonly depressive disorders and oppositional defiant disorders. Sometimes children with an earlier diagnosis of ADHD or anxiety can get an additional diagnosis of DMDD. 

Signs and symptoms of DMDD

Children with DMDD are diagnosed between the ages of 6 to 10. In order to be diagnosed with DMDD, a child must have experienced symptoms for 12 or more months.

Disruptive mood dysregulation disorder is characterised by:

  • Frequent temper outbursts (these outbursts are inconsistent with the situation at hand and inappropriate to a child’s developmental level)
  • Severe outbursts three or more times per week
  • Experience things more powerfully than their peers
  • Lack age-appropriate self-regulation skills 
  • Chronically irritable or angry mood nearly every day
  • Trouble functioning due to irritability 

Treatment for DMDD 

The treatment for DMDD might include psychotherapy (counselling), medication or a combination of the two depending on the severity of the symptoms and the age of the child. 

Mental-health Counselling

Counselling might help children learn to regulate their emotions and avoid extreme or prolonged outbursts. It gives children the tools to develop skills to cope with their feelings when they become too intense or unmanageable

Medications 

Many medications have proven effective in combating DMDD. The most common antidepressant medication for children increases the level of serotonin in the brain. Serotonin is a chemical that can help increase feelings of happiness and well-being. In addition to that a low dose of an atypical antipsychotic drug can also be prescribed. 

It is recommended to be extra cautious when administering antidepressants to children. Some children might not show any improvement with the medications, or may even end up feeling more depressed. Medication should only be administered if prescribed by a qualified specialist. 




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