Disruptive Mood Dysregulation Disorder Associated with Autism Spectrum Disorder: Literature Review and Case Illustrations

China Parenteau; Robert Hendren

doi:10.33700/jhrs.1.1.45

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Authors

China Parenteau Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA https://orcid.org/0000-0001-6812-9263
Robert Hendren Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA https://orcid.org/0000-0001-8470-4862

https://doi.org/10.33700/jhrs.1.1.45

Keywords:

Autism Spectrum Disorder, Disruptive Mood Dysregulation Disorder, Case Series, Pharmacological Treatment, Comorbidities

Abstract

Introduction: Irritability has become increasingly prevalent over the past few decades and is often seen in both children with autism spectrum disorder (ASD), and disruptive mood dysregulation disorder (DMDD). Despite this overlap, there has been scant research on treatment for irritability experienced by individuals with co-occurring ASD and DMDD.

Objectives: This paper aims to explore the development of DMDD and to shed light on potential treatment regimens that address irritability through case illustrations of individuals who experience co-occurring ASD and DMDD.

Methods: Three patients seen through a specialty clinic were selected based on their co-occurring diagnoses of ASD & DMDD.

Conclusions: The case illustrations showed that ASD and DMDD often also occurred in the presence of other disorders. Antipsychotics and CBT have shown the most benefits, but mood stabilizers are becoming more prominent for certain combinations of ASD and DMDD. More research is needed on treatment for irritability across co-occurring disorders.

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References

American Psychiatric Association. (2013). Diag-nostic and statistical manual of mental disorders (5th ed.).

Benarous, X., Ferrafiat, V., Zammit, J., Consoli, A., Gérardin, P., Guilé, J., & Cohen, D. (2020). Ef-fec-tive use of atomoxetine to treat six inpatient youths with disruptive mood dysregulation dis-order with-out attention deficit disorder. CNS Spec-trums, 25(4), 455-457.

Blader, J. C., & Carlson, G. A. (2007). Increased rates of bipolar disorder diagnoses among US child, adolescent, and adult inpatients, 1996–2004. Biological Psychiatry, 62(2), 107-114.

Breaux, R., Baweja, R., Eadeh, H. M., Shroff, D. M., Cash, A. R., Swanson, C. S., Knehans, A., & Waxmonsky, J. G. (2022). Systematic review and meta-analysis: Pharmacological and non-pharmacological interventions for persistent non-episodic irritability. Journal of the Ameri-can Acad-emy of Child & Adolescent Psychia-try.

Brotman, M. A., Kassem, L., Reising, M. M., Guy-er, A. E., Dickstein, D. P., Rich, B. A., Towbin, K. E., Pine, D. S., McMahon, F. J., & Leibenluft, E. (2007). Parental diagnoses in youth with nar-row phenotype bipolar disorder or severe mood dysreg-ulation. American Journal of Psychiatry, 164(8), 1238-1241.

Brotman, M. A., Schmajuk, M., Rich, B. A., Dick-stein, D. P., Guyer, A. E., Costello, E. J., Egger, H. L., Angold, A., Pine, D. S., & Leibenluft, E. (2006). Prevalence, clinical correlates, and lon-gitudinal course of severe mood dysregulation in chil-dren. Biological Psychiatry, 60(9), 991-997.

Brotman, M. A., Rich, B. A., Guyer, A. E., Luns-ford, J. R., Horsey, S. E., Reising, M. M., Thom-as, L. A., Fromm, S. J., Towbin, K., Pine, D. S., & Leibenluft, E. (2010). Amygdala activation during emotion processing of neutral faces in children with severe mood dysregulation versus ADHD or bipolar disorder. American Journal of Psychia-try, 167(1), 61-69.

Bruno, A., Celebre, L., Torre, G., Pandolfo, G., Mento, C., Cedro, C., Zoccali., R. A., & Musca-tello, M. R. A. (2019). Focus on disruptive mood dysreg-ulation disorder: A review of the litera-ture. Psychiatry Research, 279, 323-330.

Cohen, D., Raffin, M., Canitano, R., Bodeau, N., Bonnot, O., Périsse, D., Consoli, A., & Laurent, C. (2013). Risperidone or aripiprazole in chil-dren and adolescents with autism and/or intel-lectual disabil-ity: A Bayesian meta-analysis of efficacy and sec-ondary effects. Research in Au-tism Spectrum Dis-orders, 7(1), 167-175.

Connor, D. F., Boone, R. T., Steingard, R. J., Lopez, I. D., & Melloni Jr, R. H. (2003). Psychophar-ma-cology and aggression: II. A meta-analysis of non-stimulant medication effects on overt aggression-related behaviors in youth with SED. Journal of Emotional and Behavioral Disorders, 11(3), 157-168.

Connor, D. F., Findling, R. L., Kollins, S. H., Sallee, F., López, F. A., Lyne, A., & Tremblay, G. (2010). Effects of guanfacine extended release on opposi-tional symptoms in children aged 6–12 years with attention-deficit hyperactivity disorder and opposi-tional symptoms. CNS Drugs, 24(9), 755-768.

Copeland, W. E., Shanahan, L., Egger, H., Angold, A., & Costello, E. J. (2014). Adult diagnostic and functional outcomes of DSM-5 disruptive mood dysregulation disorder. American Journal of Psy-chiatry, 171(6), 668-674.

Copeland, W. E., Angold, A., Costello, E. J., & Eg-ger, H. (2013). Prevalence, comorbidity, and corre-lates of DSM-5 proposed disruptive mood dysregu-lation disorder. American Journal of Psychia-try, 170(2), 173-179.

Deveney, C. M., Connolly, M. E., Haring, C. T., Bones, B. L., Reynolds, R. C., Kim, P., Pine, D. S., & Leibenluft, E. (2013). Neural mechanisms of frustration in chronically irritable children. American Journal of Psychiatry, 170(10), 1186-1194.

Dickstein, D. P., Towbin, K. E., Van Der Veen, J. W., Rich, B. A., Brotman, M. A., Knopf, L., Onelio, L., Pine, D. S., & Leibenluft, E. (2009). Random-ized double-blind placebo-controlled trial of lithi-um in youths with severe mood dysregula-tion. Journal of Child and Adolescent Psychophar-macology, 19(1), 61-73.

Dickstein, D. P., Barthelemy, C. M., Jenkins, G. A., DeYoung, L. L., Gilbert, A. C., Radoeva, P., Kim, K. L., & MacPherson, H. A. (2021). This is your brain on irritability: A clinician's guide to under-standing how we know what we know now, and what we need to know in the future, about irritabil-ity in children and adolescents. Child and Adoles-cent Psychiatric Clinics, 30(3), 649-666.

Fallah, M. S., Shaikh, M. R., Neupane, B., Rusiecki, D., Bennett, T. A., & Beyene, J. (2019). Atypical antipsychotics for irritability in pediatric au-tism: a systematic review and network meta-analysis. Journal of Child and Adolescent Psy-cho-pharmacology, 29(3), 168-180.

Findling, R. L., Robb, A., McNamara, N. K., Pavuluri, M. N., Kafantaris, V., Scheffer, R., Fra-zier, J. A., Rynn, M., DelBello, M., Kowatch, R. A., Rowles, B. M., Lingler, J., Martz, K., Anand, R., Clemons, T. E., & Taylor-Zapata, P. (2015). Lithi-um in the acute treat-ment of bipolar I disorder: A double-blind, pla-cebo-controlled study. Pediatrics, 136(5), 885-894.

Findling, R. L., McNamara, N. K., Pavuluri, M., Frazier, J. A., Rynn, M., Scheffer, R., Kafantaris, V., Robb, A., Delbello, M., Kowatch, R. A., Rowles, B. M., Lingler, J., Zhao, J., Clemons, T., Martz, K., Anand, R., & Taylor-Zapata, P. (2019). Lithium for the maintenance treatment of bipolar I disorder: a double-blind, placebo-controlled dis-continuation study. Journal of the American Acad-emy of Child & Adolescent Psychiatry, 58(2), 287-296.

Fristad, M. A., Gavazzi, S. M., & Mackinaw-Koons, B. (2003). Family psychoeducation: An adjunctive intervention for children with bipolar disorder. Biological Psychiatry, 53(11), 1000-1008.

Fristad, M. A., Goldberg‐Arnold, J. S., & Gavazzi, S. M. (2002). Multifamily psychoeducation groups (MFPG) for families of children with bipolar dis-order. Bipolar Disorders, 4(4), 254-262.

Fung, L. K., Mahajan, R., Nozzolillo, A., Bernal, P., Krasner, A., Jo, B., Coury, D., Whitaker, A., Veenstra-Vanderweele, J., & Hardan, A. Y. (2016). Pharmacologic treatment of severe irri-tability and problem behaviors in autism: A sys-tematic review and meta-analysis. Pediatrics, 137 (Supplement 2), S124-S135.

Goldstein, T. R., Axelson, D. A., Birmaher, B., & Brent, D. A. (2007). Dialectical behavior thera-py for adolescents with bipolar disorder: A 1-year open trial. Journal of the American Acad-emy of Child & Adolescent Psychiatry, 46(7), 820-830.

Hazell, P. L., & Stuart, J. E. (2003). A randomized controlled trial of clonidine added to psychost-imu-lant medication for hyperactive and ag-gressive children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(8), 886-894.

Hendrickson, B., Girma, M., & Miller, L. (2020). Review of the clinical approach to the treatment of disruptive mood dysregulation disor-der. In-ternational Review of Psychiatry, 32(3), 202-211.

Hlastala, S. A., Kotler, J. S., McClellan, J. M., & McCauley, E. A. (2010). Interpersonal and so-cial rhythm therapy for adolescents with bipolar disor-der: treatment development and results from an open trial. Depression and Anxiety, 27(5), 457-464.

Jain, U. (2017). The use of guanfacine (Intuniv XR) in the treatment of disruptive mood dysregula-tion disorder – Clinical experience from telepsychia-try. European Psychiatry, 41(S1), S442-S442. doi:10.1016/j.eurpsy.2017.01.449

Jaselskis, C. A., Cook, E. H., Fletcher, K. E., & Le-venthal, B. L. (1992). Clonidine treatment of hy-peractive and impulsive children with autistic dis-order. Journal of Clinical Psychopharmaco-lo-gy, 12(5), 322-327.

Kelly, C., Molcho, M., Doyle, P., & Gabhainn, S. N. (2010). Psychosomatic symptoms among schoolchildren. International Journal of Adoles-cent Medicine and Health, 22(2), 229-236.

Krieger, F. V., Pheula, G. F., Coelho, R., Zeni, T., Tramontina, S., Zeni, C. P., & Rohde, L. A. (2011). An open-label trial of risperidone in children and adolescents with severe mood dysregula-tion. Journal of Child and Adolescent Psychophar-macology, 21(3), 237-243.

Leibenluft, E. (2011). Severe mood dysregulation, irritability, and the diagnostic boundaries of bi-polar disorder in youths. American Journal of Psychia-try, 168(2), 129-142.

Leibenluft, E., Charney, D. S., Towbin, K. E., Bhangoo, R. K., & Pine, D. S. (2003). Defining clinical phenotypes of juvenile mania. Ameri-can Journal of Psychiatry, 160(3), 430-437.

Leibenluft, E., Cohen, P., Gorrindo, T., Brook, J. S., & Pine, D. S. (2006). Chronic versus episodic ir-ri-tability in youth: A community-based, longi-tudinal study of clinical and diagnostic associa-tions. Journal of Child & Adolescent Psycho-phar-macology, 16(4), 456-466.

Leibenluft, E., & Stoddard, J. (2013). The devel-opmental psychopathology of irritabil-ity. De-velopment and psychopathology, 25, 1473-1487.

Lecavalier, L. (2006). Behavioral and emotional problems in young people with pervasive devel-opmental disorders: Relative prevalence, effects of subject characteristics, and empirical classifi-ca-tion. Journal of Autism and Developmental Disor-ders, 36, 1101–1114. doi:10.1007/s10803-006-0147-5

Mattes, J. A. (1986). Psychopharmacology of tem-per outbursts: A review. The Journal of Nervous and Mental Disease, 174(8), 464-470.

Mayes, S. D., Waxmonsky, J., Calhoun, S. L., Ko-kotovich, C., Mathiowetz, C., & Baweja, R. (2015). Disruptive mood dysregulation disorder (DMDD) symptoms in children with autism, ADHD, and neurotypical development and im-pact of co-occurring ODD, depression, and anx-iety. Research in Autism Spectrum Disorders, 18, 64-72.

Mayes, S. D., Kokotovich, C., Mathiowetz, C., Baweja, R., Calhoun, S. L., & Waxmonsky, J. (2017). Disruptive mood dysregulation disorder symptoms by age in autism, ADHD, and gen-eral population samples. Journal of Mental Health Re-search in Intellectual Disabilities, 10(4), 345-359.

McClellan, J., Kowatch, R., & Findling, R. L. (2007). Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. Journal of the American Acad-emy of Child & Adolescent Psychiatry, 46(1), 107-125.

Miklowitz, D. J., Simoneau, T. L., George, E. L., Richards, J. A., Kalbag, A., Sachs-Ericsson, N., & Suddath, R. (2000). Family-focused treat-ment of bipolar disorder: 1-year effects of a psychoeduca-tional program in conjunction with pharmacothera-py. Biological Psychiatry, 48(6), 582-592.

Miklowitz, D. J., Axelson, D. A., Birmaher, B., George, E. L., Taylor, D. O., Schneck, C. D., Ber-esford, C. A., Dickinson, M. L., Craighead, E. W., & Brent, D. A. (2008). Family-focused treatment for adolescents with bipolar disorder: Results of a 2-year randomized trial. Archives of General Psy-chiatry, 65(9), 1053-1061.

Moreno, C., Laje, G., Blanco, C., Jiang, H., Schmidt, A. B., & Olfson, M. (2007). National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of Gen-eral Psy-chiatry, 64(9), 1032-1039.

Osterman, K., & Bjorkqvist, K. (2010). A cross-sectional study of onset, cessation, frequency, and duration of children’s temper tantrums in a non-clinical sample. Psychological Reports, 106, 448–454. doi:10.2466/pr0.106.2.448-454

Owen, R., Sikich, L., Marcus, R. N., Corey-Lisle, P., Manos, G., McQuade, R. D., Carson, W. H., & Findling, R. L. (2009). Aripiprazole in the treat-ment of irritability in children and adoles-cents with autistic disorder. Pediatrics, 124(6), 1533-1540.

Palumbo, D. R., Sallee, F. R., Pelham Jr, W. E., Bukstein, O. G., Daviss, W. B., McDermott, M. P., & CAT Study Team. (2008). Clonidine for atten-tion-deficit/hyperactivity disorder: I. Effi-cacy and tolerability outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 47(2), 180-188.

Pappadopulos, E., Woolston, S., Chait, A., Perkins, M., Connor, D. F., & Jensen, P. S. (2006). Pharma-cotherapy of aggression in children and adoles-cents: Efficacy and effect size. Journal of the Cana-dian Academy of Child and Adoles-cent Psychiatry.

Patino, L. R., Bruns, K. M., Witt, N. M., McCune, N. R., & DelBello, M. P. (2015). Management of bipolar disorder in children and adoles-cents. Focus, 13(1), 25-36.

Pavuluri, M. N., Graczyk, P. A., Henry, D. B., Car-bray, J. A., Heidenreich, J., & Miklowitz, D. J. (2004). Child-and family-focused cognitive-behavioral therapy for pediatric bipolar disor-der: Development and preliminary results. Journal of the American Academy of Child & Adolescent Psychiatry, 43(5), 528-537.

Peterson, B. S., Zhang, H., Santa Lucia, R., King, R. A., & Lewis, M. (1996). Risk factors for pre-senting problems in child psychiatric emergen-cies. Journal of the American Academy of Child & Adolescent Psychiatry, 35(9), 1162-1173.

Pisano, S., Pozzi, M., Catone, G., Scrinzi, G., Clem-enti, E., Coppola, G., Milone, A., Bravaccio, C., Santosh, P., & Masi, G. (2019). Putative Mecha-nisms of Action and Clinical Use of Lithium in Children and Adolescents: A Critical Re-view. Current Neuropharmacology, 17(4), 318–341.

Politte, L. C., & McDougle, C. J. (2014). Atypical antipsychotics in the treatment of children and ado-lescents with pervasive developmental disor-ders. Psychopharmacology, 231(6), 1023-1036.

Rich, B. A., Schmajuk, M., Perez-Edgar, K. E., Fox, N. A., Pine, D. S., & Leibenluft, E. (2007). Dif-fer-ent psychophysiological and behavioral re-sponses elicited by frustration in pediatric bipo-lar disorder and severe mood dysregulation. American Journal of Psychiatry, 164(2), 309-317.

Scahill, L., Chappell, P. B., Kim, Y. S., Schultz, R. T., Katsovich, L., Shepherd, E., Arnsten, A., Co-hen, D. J., & Leckman, J. F. (2001). A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention defi-cit hy-peractivity disorder. American Journal of Psychia-try, 158(7), 1067-1074.

Shea, S., Turgay, A., Carroll, A., Schulz, M., Orlik, H., Smith, I., & Dunbar, F. (2004). Risperidone in the treatment of disruptive behavioral symp-toms in children with autistic and other perva-sive develop-mental disorders. Pediatrics, 114(5), e634-e641.

Stringaris, A. (2011). Irritability in children and adolescents: A challenge for DSM-5. European Child & Adolescent Psychiatry, 20(2), 61-66.

Stringaris, A., Baroni, A., Haimm, C., Brotman, M., Lowe, C. H., Myers, F., Rustgi, E., Wheeler, W., Kayser, R., Towbin, K., & Leibenluft, E. (2010). Pediatric bipolar disorder versus severe mood dysregulation: Risk for manic episodes on fol-low-up. Journal of the American Academy of Child & Adolescent Psychiatry, 49(4), 397-405.

Stringaris, A., Cohen, P., Pine, D. S., & Leibenluft, E. (2009). Adult outcomes of youth irritability: A 20-year prospective community-based study. American Journal of Psychiatry, 166(9), 1048-1054.

Tourian, L., LeBoeuf, A., Breton, J. J., Cohen, D., Gignac, M., Labelle, R., Guile, J. M., & Renaud, J. (2015). Treatment options for the cardinal symp-toms of disruptive mood dysregulation disor-der. Journal of the Canadian Academy of Child and Adolescent Psychia-try, 24(1), 41.

Towbin, K., Vidal-Ribas, P., Brotman, M. A., Pick-les, A., Miller, K. V., Kaiser, A., Vitale, A. D., En-gel, C., Overman, G. P., Davis, M., Lee, B., McNeil, C., Wheeler, W., Yokum, C. H., Har-ing, C. T., Rou-le, A., Wambach, C. G., Sharif-Askary, B., Pine, D. S., Leibenluft, E., & Strin-garis, A. (2020). A dou-ble-blind randomized placebo-controlled trial of citalopram adjunc-tive to stimulant medication in youth with chronic severe irritability. Journal of the Ameri-can Academy of Child and Adolescent Psy-chiatry, 59(3), 350–361. https://doi.org/10.1016/j.jaac.2019.05.015

Vidal-Ribas, P., Brotman, M. A., Valdivieso, I., Leibenluft, E., & Stringaris, A. (2016). The sta-tus of irritability in psychiatry: A conceptual and quan-titative review. Journal of the Ameri-can Academy of Child & Adolescent Psychia-try, 55(7), 556-570.

West, A. E., Jacobs, R. H., Westerholm, R., Lee, A., Carbray, J., Heidenreich, J., & Pavuluri, M. N. (2009). Child and family-focused cognitive-behavioral therapy for pediatric bipolar disor-der: Pilot study of group treatment format. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 18(3), 239.

Wilens, T. E., Bukstein, O., Brams, M., Cutler, A. J., Childress, A., Rugino, T., Lyne, A., Grannis, K., & Youcha, S. (2012). A controlled trial of extend-ed-release guanfacine and psychostimu-lants for attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 74-85.

Young, M. E., & Fristad, M. A. (2007). Evidence based treatments for bipolar disorder in children and adolescents. Journal of Contemporary Psy-cho-therapy, 37(3), 157-164.