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We often think of temper tantrums as something that kids outgrow after the toddler years. But some kids just…don’t. Having a child or teenager who is prone to emotional outbursts or who considerably has trouble regulating their emotions can be extremely challenging.

When you have a kid who exhibits these symptoms, there’s a lot of guilt, worry, and shame involved. It’s not fun at all, and can really take a toll on your mental health. It’s also common to wonder why this is happening, or if there was anything you did wrong to make your child behave this way.

Over the past few decades, the psychological world is starting to understand kids like these better. In fact, many kids who experience intense mood swings and emotional outbursts—especially if they cause problems at school and home—may be diagnosed with disruptive mood dysregulation disorder. With that diagnosis comes a better understanding of what is going wrong—and most importantly, how to manage and treat the child’s symptoms.

Below, we’ll go over everything parents, teachers, and other caregivers of kids need to know about disruptive mood disorder.

Understanding DMDD

So what is disruptive mood dysregulation disorder, exactly?

Characteristics of DMDD include:

• Outbursts must occur at least three times a week
• The child must have had these symptoms for at least a year
• Even when not having an outburst, the children must show signs of intense moodiness
• These episodes have to occur in more than one setting—for example, at both home and at school

As Jillian Amodio, LMSW, licensed therapist founder of Mom’s for Mental Health emphasizes, when a child has DMDD, their behaviors are a direct result of their mental health condition, and not because they are a “bad” child or because they are intentionally trying to be rude or disruptive.

Common Misconceptions

It’s common for children with DMDD to be misunderstood and unfairly judged because of their behavior, according to Amodio.

Amodio understands these struggles personally, as she’s not only a therapist, but a mother. “I am very passionate about advocating for children with this condition and raising awareness, as a therapist, and as a mother of a child diagnosed with this condition, I see on a daily basis how difficult the condition can be not only for the child, but for the family as well,” she shares. “As a parent, I probably answer on average three calls a day from the school to assist with emotional regulation and de-escalation”

Signs and Symptoms

There are certain defining symptoms of DMDD to be aware of. For instance, a child with DMDD:

• Will have had severe temper tantrums or outbursts several days a week
• Will be consistently very moody—irritable, angry, and sad
• May react to frustrations and disappointments with much more intensity than expected, given the situation
• Will have emotional reactions that are much more intense than their peers and may not align with how you would expect a child their age to react
• Will experience symptoms chronically, for at least a year, and often several years
• Will have symptoms that began before the age of ten
• Will have trouble functioning in more than one setting—at home, with friends, at school, etc.

What Is DMDD Caused By?

DMDD is a relatively new diagnosis and was only added to DSM-5 in 2013. As such, experts are still trying to understand what the precise cause and risk factors are for the disorder. They are also trying to understand how many children experience it. “While the exact causes aren’t fully understood, factors such as genetics, brain chemistry, and environmental stressors can contribute,” says Amodio.

Sandra Kushnir, LMFT, licensed marriage and family therapist and founder and CEO at Meridian Counseling, says that the exact causes of DMDD aren’t fully understood, but “a combination of genetic, environmental, and neurological factors likely plays a role.” Additionally, she says, “children who have a family history of mood disorders or anxiety are more at risk, as well as those who experience chronic stress or trauma.”

Diagnosing DMDD

It’s common to have a lightbulb moment when you see the list of symptoms for DMDD and realize that your child may have it. But while it may be tempting to learn about the symptoms of DMDD and just assume your child has it, you can’t diagnose DMDD on your own. If you suspect your child has DMDD, you need to visit a mental health provider for a proper diagnosis.

In fact, some children have more than one disorder at once, including DMDD. That’s why it’s vital to get a full and comprehensive evaluation done by a mental health professional trained to identify DMDD.

Most kids with DMDD are diagnosed between the ages of six and 10. In order to be diagnosed with DMDD, a child:

• Must be over the age of six but under the age of 18
• Have had symptoms of DMDD for 12 months or more
• Have had severe outbursts that are out of proportion with the trigger
• Have outbursts that don’t match their developmental level
• Experience mood issues most days
• Have behavior issues in at least two settings (home, school, or peers)

Treatment Options

Here’s some good news for parents and other caregivers of kids with DMDD. The condition can be effectively managed—usually with a combination of therapy, other supportive techniques, and in some cases, medication. Let’s look at the most common treatments.

Cognitive Behavioral Therapy (CBT)

Therapists who treat kids with DMDD often use a form of cognitive behavioral therapy (CBT) during treatment. CBT focuses on helping kids become more aware of their thoughts and feelings and how these impact their behaviors. “Cognitive-behavioral therapy (CBT) is often used to help children develop better emotional regulation and coping skills,” Kushnir says. “The focus is on teaching children how to recognize their triggers and manage their responses to frustration or anger.”

Medication

Although not every child will require medication to manage DMDD, it can be helpful for many children. “Medication, such as mood stabilizers or antidepressants, may also be considered for some children, but this is typically done in conjunction with therapy and under close medical supervision,” Kushnir explains. According to the National Institute of Mental Health, there are currently no FDA-approved medications for DMDD, but providers often use medications prescribed for other similar mental health conditions.

Family Strategies

Often, DMDD is a family matter, where members of the child’s family need to learn strategies for dealing with and responding to their child’s outbursts. For instance, parents often need to learn how to disengage when emotions get intense rather than “fuel the fire,” says Amodio.

“In my own family, and in my work with other families, I always encourage people to wait until the lava after the emotional volcanic eruption has cooled to try and have a productive conversation and dissect what happened,” Amodio suggests.

She also says that many parents need to learn how to transition from punishing their children for their behaviors and moving toward a more positive reinforcement model. “Praising the positive behaviors and encouraging positive behavior through rewards and incentives is often more productive than punishing negative behaviors,” Amodio notes.

Living with DMDD

It’s important to keep in mind that DMDD is often a chronic condition, which means support is crucial. “Families of children with DMDD often feel overwhelmed, but with the right support, the disorder can be managed effectively,” Kushnir assures. She also shares that she’s worked with families “who initially felt helpless due to their children’s frequent outbursts, but made significant progress through family therapy and consistent behavioral interventions,” says Kushnir.

Kushnir gave an example of one such family. “One anonymous case involved a family where the child’s emotional outbursts significantly decreased after implementing structured routines and attending weekly CBT sessions,” she says. “With time, the family learned how to recognize the early signs of emotional dysregulation and proactively manage situations before they escalated.”

Research and Future Directions

Since DMDD is a relatively new diagnosis, research is ongoing and psychiatrists are still learning about the most effective treatments and neurological underpinnings of the condition, says Kushnir.

“Some studies suggest that children with DMDD may have an overactive amygdala, which is the part of the brain responsible for emotional processing,” she describes. “In the future, we may see more personalized treatment plans incorporating medication and targeted therapies based on a child’s specific neurodevelopmental profile.”

Amodio says that research is increasingly focusing on early intervention as well as effective treatment options for kids with DMDD. “I believe that as awareness grows, we’ll see more integrated approaches that involve schools, therapists, and families working together,” she says. “The future will likely involve a more personalized understanding of each child’s unique needs.”

Resources and Support

Kushnir shared her top tips for families who are navigating DMDD:

• Establish a consistent daily routine for your child, since structure can help stabilize moods and reduce irritability
• Practice positive reinforcement for good behavior
• Try your best to avoid reacting emotionally to outbursts
• Work closely with a therapist or counselor to learn behavior management techniques
• Educate yourself about DMDD and its various treatment options

Some helpful resources that Kushnir recommends parents consider include:

• The Child Mind Institute, which provides wonderful educational materials and support for parents of children with mood disorders.
• Parent support groups, locally or online, which can offer invaluable emotional support and practical advice from others in similar situations

Bottom Line

Living with and managing DMDD can be difficult, and even harrowing at times. Please remember that you aren’t alone—there are many families who are dealing with this condition. Most of all, know that help is out there for you.

“While DMDD can be challenging, with the right interventions and support, children and families can navigate it successfully,” Kushnir stresses. “Regular therapy, family involvement, and, when necessary, medication can all contribute to better emotional regulation and improved quality of life for the child.”

Although some think of ADHD as a childhood issue, children with ADHD become adults with ADHD and may require treatment and support for their symptoms their entire lives.

However, although these medications are proven safe and effective, not everyone diagnosed with ADHD can take medication for their symptoms. Some have another medical condition that contraindicates—or negatively interacts—with the ADHD medication, have adverse reactions to these medications, or simply don’t want to take medication. For example, Steffen Hermann, 37, who was diagnosed with ADHD at age 14, was prescribed Ritalin in adolescence. The medication interfered with his sleep to the point that he had to discontinue it.

Additionally, many who take medication for ADHD also use other remedies and treatments to cope with and address their symptoms. Medication can be effective but is not a magical cure-all, so even those who take medication for their ADHD symptoms can benefit from other interventions that might help them.

Everyone deserves support for their symptoms, and they have the right to determine what treatment options are the best fit for them. These decisions must always be made under the supervision of a qualified professional. Learn more about alternative approaches for managing ADHD.

What Is a “Natural” Remedy?

Sometimes, alternatives to medication are referred to as “natural” remedies. This term is misleading because many medications are developed through the use of plants, minerals, and other naturally occurring resources. Additionally, many so-called treatments that are described as “natural” are not actually studied for effectiveness or safety, putting users at risk for adverse side effects and even death.

Also, classifying pharmaceutical treatment options as “unnatural” perpetuates stigma around the decision to take medication for a diagnosis. Those with ADHD whose treatment plan involves medication are sometimes shamed for their decision to use “unnatural” treatments, and sometimes this stigma even prevents someone from even considering medication as a treatment option.

We can explore various methods and treatment approaches to support ADHDers without stigmatizing or vilifying other safe and effective options.

Self-Accommodation

Because ADHD brains operate differently from non-ADHD brains, self-accommodations like scheduling modifications and environmental shifts can greatly help difficulties associated with ADHD. For instance, if you naturally focus better later in the day, that might be the best time to schedule certain tasks rather than forcing yourself to do them in the morning.

Additionally, alarms, visual schedules, and multiple calendar reminders can address deficits from executive dysfunction.

Ari S., an adult with ADHD, shares: “I use a lot of calendar reminders and phone alarms. Everything goes into my calendar immediately. I know if I wait, I’ll forget something, so I always do it immediately. If I can’t do it immediately, I set a date and time to do it. That activates the ‘deadline fear’ ADHD hack so I end up doing the thing.”

Luna Corbden, an adult with ADHD, shares that various executive function tools can be helpful, and cycling through various tools can maintain novelty, making different tools more helpful. They state, “I develop them as I go, often cycling through them.”

Mind-Body Practices

A mind-body practice combines body movements, cognitive focus, and control of body processes like breathing to relax the mind and improve self-regulation. Regular mind-body practice can improve skills like focus, problem-solving, emotional regulation, and impulse control by improving one’s awareness of the body and control over one’s nervous system responses.

The peer-reviewed research on mind-body practices for ADHD symptoms shows that it can be a beneficial tool, but the overall effect of these practices on ADHD symptoms is inconclusive. With that said, if you find these practices beneficial, you can use them to build skills to alleviate ADHD symptoms.

Mind-body practices include:

Steffen Hermann shares that daily physical activity helps him manage his energy levels and sleep cycle. He also reported the benefit of a meditation practice but finds this challenging: “I struggle to keep it up. Thirteen minutes are sufficient to increase focus for the entire day, but sitting for 13 minutes takes a lot of energy as well.”

However, this is not the right fit for everyone. Aroop Roelofs, an adult with ADHD, states that these practices “generally only made things worse for me” because it was not a good fit for how his brain operates. Ari S. shares that mindfulness exercises “did absolutely nothing except stress me out.”

Neurofeedback

Neurofeedback involves monitoring your body’s voluntary and involuntary functions to better tend to your needs, regulate emotions, and learn to control these functions to relieve stress. Interoception refers to our awareness of our body’s internal sensations. Many ADHDers struggle with interoception, which can make it difficult to regulate emotions and monitor what they need.

If I am not attending to my body’s experience, I might not realize I am becoming frustrated until I am at a bursting point, and I might forget to eat, drink water, or perform other self-care tasks needed to survive.

Neurofeedback often involves being connected to a machine that displays the body’s functions, such as heart rate, blood pressure, and breath. When using the biofeedback machine, we can directly observe what’s going on in our bodies and practice skills to regulate and affect how these processes are happening. For those with ADHD, neurofeedback can help with emotional regulation, cognitive processes like sustained attention, sleep quality, and alleviating symptoms of anxiety and depression.

Psychotherapy

ADHD has a high rate of co-occurrence with many other diagnoses, including anxiety, depression, and substance dependence. This is due in part to the stress caused by existing in a world that is not designed for ADHD brains and in part because the genes that can predispose someone to develop ADHD also increase risk for these other diagnoses. Psychotherapy can help both develop skills to alleviate symptoms of ADHD and treat these co-occurring diagnoses.

Some therapies that have been shown to help those with ADHD include:

• Cognitive behavioral therapy (CBT) is an approach to therapy treatment that involves challenging unhelpful or untrue thought processes to improve the emotional state and change behavior. Research has shown that CBT is very effective in helping build skills to alleviate ADHD symptoms, and when combined with medication, clients show more improvement than when treated with medication alone. CBT can also improve impulse control, emotional regulation, and attention span.
• Mindfulness-based therapy: Mindfulness therapy aims to teach individuals to notice their current environment and internal experiences without judgment. For ADHDers, it can help regulate impulses and emotions and help bring the individual’s attention to the present moment, increasing attention span. Some research has shown that mindfulness-based therapy yields comparable symptom improvement for ADHDers to medication treatment.
• Solution-focused therapy: Solution-focused therapy is a short-term therapy that targets specific goals and symptoms. Because it is time-limited, it can be an affordable treatment option for those who cannot afford long-term therapy. Solution-focused therapy can improve attention span and reduce distractibility in those with ADHD.

Aroop Roelofs shares that he found therapy beneficial once he found a provider who was a good fit because he had space for “learning to deal with the problem itself rather than the symptoms.” He says that therapy would “make me observe things myself more and make decisions based on those observations, rather than trying to meet expectations that I did not understand.”

Ari S. says that he found a therapist who understands his brain and helps him manage by “flowing with the current” rather than fighting against his ADHD. At the same time, he notes that some providers list ADHD as a “speciality” but then give “basic platitudes and unhelpful exercises.”

Therapeutic Video Games

Sometimes, children with ADHD struggle to engage in treatment. This can occur for many reasons. The child might struggle to engage in non-preferred activities (which is extra challenging for someone with ADHD!) or might be reluctant to acknowledge their ADHD due to stigma.

In the spirit of meeting clients where they are and offering interventions tailored to their needs, some companies have worked to develop video games designed to engage specific cognitive skills and alleviate ADHD symptoms. Various therapeutic video games exist, and in 2020, the Food and Drug Administration approved EndeavorRX to treat ADHD in children ages eight to 17. Guardians can get a prescription from the child’s doctor, and the child follows a protocol of playing the game for 25 minutes per day.

Bottom Line

There are many non-pharmaceutical options to alleviate symptoms of ADHD and improve the quality of life for those with the diagnosis. While there is no shame in receiving medication treatment for ADHD, many want to pursue other options, and even those who take medication often benefit from a multi-pronged approach to their treatment.