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NIMH Twitter Chat on Disruptive Mood Dysregulation Disorder

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In recognition of National Children's Mental Health Awareness Day, NIMH hosted a Twitter chat on disruptive mood dysregulation disorder and severe irritability with expert Dr. Ellen Leibenluft.

 Mental Health NIMH@NIMHgov
Welcome to our Twitter chat today on disruptive mood dysregulation disorder (DMDD) & severe irritability. #NIMHchats

 Mental Health NIMH@NIMHgov
We’re using the hashtag #NIMHchats for today’s discussion. Please include it in all of your tweets.

 Mental Health NIMH@NIMHgov
Please welcome Dr. Ellen Leibenluft, Chief of the Section on Bipolar Spectrum Disorders & expert on severe irritability in kids. #NIMHchats

 Mental Health NIMH@NIMHgov
Learn more about Dr. Leibenluft’s work:  http://1.usa.gov/1SZ9xQ4  #NIMHchats

 

 Mental Health NIMH@NIMHgov
Let’s get started by defining DMDD: a childhood condition of extreme irritability, anger, and frequent, intense temper outbursts. #NIMHchats

 Mental Health NIMH@NIMHgov
DMDD symptoms go beyond being a “moody” child. Children with DMDD experience severe impairment that requires clinical attention. #NIMHchats

 Mental Health NIMH@NIMHgov
DMDD is a fairly new diagnosis, appearing for the first time in the DSM-5 published in 2013.  http://bit.ly/1YGS03w  #NIMHchats

 Mental Health NIMH@NIMHgov
According to the DSM criteria, adults cannot be diagnosed with DMDD. There hasn't been enough research on adults irritability. #NIMHchats

 Washington Parent@washparentmag
@NIMHgov Can you say what some of the impairments are for kids with DMDD. #NIMHchats

 Mental Health NIMH@NIMHgov
. @washparentmag lots of outbursts at home and school when frustrated or when ppl ask them to do things they don't want to. #NIMHchats

 Mental Health NIMH@NIMHgov
. @washparentmag Trouble making and keeping friends because of their outbursts and because they are generally cranky. #NIMHchats

 Mental Health NIMH@NIMHgov
DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18. #NIMHchats

 Mental Health NIMH@NIMHgov
A child with DMDD experiences irritable or angry mood most of the day, nearly every day. #NIMHchats

 Change Matrix@changematrix
Can you discuss some ways we can tell DMDD apart from a temper tantrum #NIMHchats

 

 Mental Health NIMH@NIMHgov
Also, severe temper outbursts about 3 or more times a week that are out of keeping w/the situation & child’s developmental level #NIMHchats

 Mental Health NIMH@NIMHgov
A child with DMDD also experiences trouble functioning due to irritability in more than one place (e.g., home, school, w/peers) #NIMHchats

 Mental Health NIMH@NIMHgov
To be diagnosed with DMDD, a child must have these symptoms steadily for 12 or more months. #NIMHchahts

 Change Matrix@changematrix
Is DMDD more likely to occur in certain races compared to other races? #NIMHchats

 

 Mental Health NIMH@NIMHgov
. @changematrix Not as far as we know at this point. #NIMHchats

 

 Troy Pinkney@Troybpink
Do we know if there is a genetic component to this diagnosis? #NIMHchats

 

 Mental Health NIMH@NIMHgov
. @Troybpink Irritability is moderately heritable. That means it's about as genetic as depression or anxiety. #NIMHchats

 Washington Parent@washparentmag
Good question. Do kids grow out of it? #NIMHchats  https://twitter.com/ALoysiuschOW/status/728255477205737472 …

 Aloysius Chow@ALoysiuschOW
@NIMHgov That doesn't mean adults can't be diagnosed with DMDD right? What happens to children with DMDD when they are adults? #NIMHchats

 Mental Health NIMH@NIMHgov
. @washparentmag Irritable kids are at increased risk for depression and anxiety as they grown up. #NIMHchats

 Mental Health NIMH@NIMHgov
. @washparentmag Also, at risk for less income and for not getting as much education #NIMHchats

 information-book.com@infobookcom
#NIMHchats Could we briefly inquire the notion of "irritability"? What is its cause? It could solve so many problems in everyday situations

 Mental Health NIMH@NIMHgov
. @infobookcom We are trying to understand the brain mechanisms #NIMHchats

 

 ResearchAmerica@ResearchAmerica
.@NIMHgov are other outside factors known to increase child's risk of DMDD at this time? Or is more research needed? #NIMHchats

 Mental Health NIMH@NIMHgov
. @ResearchAmerica Genetics and environment both play a role. Definitely more research is needed. #NIMHchats

 PLMathews@PLMathews
Has there been any progress in identifying medications that help with this diagnosis? #NIMHchats

 Mental Health NIMH@NIMHgov
. @PLMathews In kids who also have ADHD, stimulants probably help with irritability too. We are testing antidepressants now. #NIMHchats

 Mental Health NIMH@NIMHgov
. @PLMathews In kids with irritability and lots of aggression, atypical antipsychotic meds may help. #NIMHchats

 Reet Poudel@reetpoudel
@NIMHgov irritability may be misinterpreted as symptom of ADHD 4 which clinicians have much greater experience i guess #NIMHchats

 Mental Health NIMH@NIMHgov
. @reetpoudel Irritability is very common in kids with ADHD. We're trying to understand why #NIMHchats

 Mental Health NIMH@NIMHgov
We received this question in advance: What is the difference between ADD/HD and DMDD? #NIMHchats

 Mental Health NIMH@NIMHgov
DMDD is characterized by irritability. ADHD is characterized by hyperactivity and inattention. #NIMHchats

 Mental Health NIMH@NIMHgov
However, it’s common for youth with ADHD to also be very irritable, so a child may have both diagnoses #NIMHchats

 Troy Pinkney@Troybpink
Are children with learning disorders more likely to develop DMDD? #NIMHchats

 

 Mental Health NIMH@NIMHgov
. @Troybpink We are not sure. Children with language problems may be at increased risk. #NIMHchats

 Aloysius Chow@ALoysiuschOW
@NIMHgov @PLMathews what about non-pharma methods? #NIMHchats

 

 Mental Health NIMH@NIMHgov
. @ALoysiuschOW Psychological treatments should be considered first, with medication added later if necessary #NIMHchats

 Mental Health NIMH@NIMHgov
. @ALoysiuschOW CBT used to teach children how to deal with thoughts & feelings that contribute to feeling depressed or anxious. #NIMHchats

 Mental Health NIMH@NIMHgov
. @ALoysiuschOW New techniques might help teach children coping skills for handling anger. Learn more:  http://1.usa.gov/23JQKn9  #NIMHchats

 Mental Health NIMH@NIMHgov
. @ALoysiuschOW Irritable youth may misread subtle facial expressions as angry.  http://1.usa.gov/1rk5FDu  #NIMHchats

 Mental Health NIMH@NIMHgov
. @ALoysiuschOW Computer-based training that addresses this problem may help youth w/DMDD or severe irritability #NIMHchats

 Mental Health NIMH@NIMHgov
. @ALoysiuschOW What we are testing now is mostly behavioral therapies and computer-based training:  http://1.usa.gov/24A1LEu  #NIMHchats

 Aloysius Chow@ALoysiuschOW
@NIMHgov But is CBT (even when modified for children) effective? #NIMHchats

 

 Mental Health NIMH@NIMHgov
. @ALoysiuschOW Some evidence for CBT in aggressive kids. Testing it in DMDD now. #NIMHchats

 Nevada PEP@NevadaPEP
#NIMHchats What are the best resources to get help for families about DMDD?

 

 Mental Health NIMH@NIMHgov
. @NevadaPEP A good start is:  http://1.usa.gov/1XSsrw1  #NIMHchats

 

 The BRAIN Beat@TheBRAINBeat
@NIMHgov psychotherapy is 1st-line tx B4 pharma - does shortage of child psychiatrists factor into tx? #NIMHchats  https://twitter.com/ALoysiuschOW/status/728259724643176448 …

 Mental Health NIMH@NIMHgov
. @TheBRAINBeat Psychologists can also provide psychological treatment. #NIMHchats

 

 Al Colvin@algcolvin
@NIMHgov How many children that are being treated w/meds 1st as opposed to any therapy for #ADHD going undiagnosed for #DDMD #NIMHchats

 Mental Health NIMH@NIMHgov
. @algcolvin We don't exactly know, but it's possible that psychological treatments are being underused. #NIMHchats

 Mental Health NIMH@NIMHgov
. @changematrix It is very difficult to parent an irritable child. #NIMHchats

 

 Mental Health NIMH@NIMHgov
. @changematrix Parent training may give parents ways to help a child to reduce aggression and irritable behavior #NIMHchats

 Mental Health NIMH@NIMHgov
Parent training teaches ways to foresee events that might lead to a temper outburst & how to work ahead to prevent the outburst. #NIMHchats

 Mental Health NIMH@NIMHgov
Parent training also focuses on being predictable and consistent with children, and rewarding positive behavior. #NIMHchats

 NNED@nned_net
Is DMDD considered a "mental illness" offically yet? Is it recognized by our gov or the general public as a problem? #NIMHchats

 Mental Health NIMH@NIMHgov
. @nned_net DMDD is a fairly new diagnosis, appearing for the first time in the DSM-5 published in 2013.  http://bit.ly/1YGS03w  #NIMHchats

 Nani@nani17adrit
Irritability is a sx of many adult disorders. From the top of my head, key in BPD and Bipolar2. #NIMHchats  https://twitter.com/nimhgov/status/728254511794552835 …

 Mental Health NIMH@NIMHgov
. @nani17adrit Irritability in bipolar occurs during episodes of mania or depression. In DMDD, it is chronic, not in episodes. #NIMHchats

 Troy Pinkney@Troybpink
Does anything show up on a genetic testing #NIMHchats

 

 Mental Health NIMH@NIMHgov
. @Troybpink no regarding genetic testing #NIMHchats

 

 NNED@nned_net
Can it be likely that if one sibling has DMDD, another sibling may have it also? #NIMHchats

 

 Mental Health NIMH@NIMHgov
. @nned_net Irritability runs in families to the same extent as depressionn and anxiety do. #NIMHchats

 Heidi Keller@Hkkeller1
@NIMHgov @nani17adrit My son is irritable all of the time, but he also has all the symptoms of Bipolar disorder. So which one is it?

 Mental Health NIMH@NIMHgov
. @Hkkeller1 Bipolar I includes distinct manic episodes. DMDD is no episodes, just chronic persistent irritability. #NIMHchats

 Mental Health NIMH@NIMHgov
Join a pediatric research study of irritability. No Cost. Compensation and travel may be provided:  http://1.usa.gov/1E0XGie  #NIMHchats

 Mental Health NIMH@NIMHgov
Thank you for participating in our Twitter chat today! Please continue the conversation & share your thoughts #NIMHchats

 Mental Health NIMH@NIMHgov
An archive of this Twitter chat will be available on our website by next week:  http://1.usa.gov/1cpl5sG  #NIMHchats