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Pediatric Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder: Analyzing National

Raman Baweja1, Daniel A Waschbusch2, Lan Kong3

  • 1Department of Psychiatry and Behavioral Health, Pennsylvania State College of Medicine, Hershey, PA; Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA.

The Journal of Pediatrics
|January 19, 2025
PubMed

Insights

A disruptive mood dysregulation disorder (DMDD) diagnosis in children with ADHD leads to broader treatment, including more medications like antipsychotics and mood stabilizers. Treatment patterns vary by race and ethnicity, often before optimizing ADHD care.

Area of Science:

  • Child and Adolescent Psychiatry
  • Neurodevelopmental Disorders
  • Pharmacological Treatments

Background:

  • Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
  • Disruptive mood dysregulation disorder (DMDD) is a condition characterized by persistent irritability and frequent temper outbursts.
  • The co-occurrence of ADHD and DMDD presents complex treatment challenges.

Purpose of the Study:

  • To investigate the impact of a disruptive mood dysregulation disorder (DMDD) diagnosis on treatment selection and sequencing in youth with attention-deficit/hyperactivity disorder (ADHD).
  • To compare treatment patterns between youth with ADHD and those with comorbid ADHD and DMDD.
  • To analyze racial and ethnic variations in treatment approaches for ADHD with DMDD.

Main Methods:

  • A multicenter, population-based, retrospective cohort study utilizing the TriNetX Research Network (June 2013–July 2024).
  • Two cohorts were analyzed: youth with ADHD (control, n=631,295) and youth with ADHD + DMDD (study, n=24,723).
  • Statistical analyses included odds ratios (ORs) and relative risks to determine associations.

Main Results:

  • The ADHD + DMDD cohort showed higher rates of non-Hispanic ethnicity, psychiatric comorbidities, inpatient/emergency service use, and psychotherapy.
  • Youth with ADHD + DMDD were more likely to receive ADHD medications, antidepressants, mood stabilizers, and antipsychotics.
  • Treatment patterns differed by race/ethnicity; Hispanic youth with DMDD used more psychotropics but less psychotherapy, while White youth used all services more. Antipsychotic and mood stabilizer prescriptions increased significantly, often preceding psychotherapy or ADHD medication optimization.

Conclusions:

  • A DMDD diagnosis in youth with ADHD is linked to an expanded range of pharmacological and non-pharmacological treatments.
  • Treatment patterns for ADHD + DMDD vary considerably based on race and ethnicity.
  • Antipsychotics and mood stabilizers were prescribed more frequently, often before psychotherapy or ADHD medication optimization, highlighting a need for research into optimal treatment sequences and disparities.
Abstract

Keywords:
ADHDCNS stimulantsDMDDantipsychoticspsychotherapy

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