Characterizing Early Childhood Disruptive Mood Dysregulation Disorder

In DSM-5, disruptive mood dysregulation disorder (DMDD) is defined as chronic irritability with intense temper outbursts in children aged 6 and older. However, these problems often emerge before age 6. This study aimed to characterize early childhood DMDD (EC-DMDD) in a preschool sample enriched for depression and disruptive behaviors.

Children 3 to 5 years old (N = 302) received comprehensive assessments, including the Preschool Age Psychiatric Assessment, MacArthur Health and Behavior Questionnaire-Parent Version 1.0, and Preschool and Early Childhood Functional Assessment Scale. Latent class analysis was used to identify classes varying in intensity and frequency of irritability and temper tantrums. Children with EC-DMDD were compared with children with oppositional defiant disorder (ODD) and children with major depressive disorder (MDD). Regression analysis examined independent associations between EC-DMDD and functional impairment.

Latent class analysis identified 3 classes: regulated, EC-DMDD, and transient irritability. Compared with the other classes, the EC-DMDD class was characterized by higher frequency of co-occurring mental disorders and symptoms and more functional impairment. Compared with the ODD group, the EC-DMDD group exhibited more frequent irritability and temper tantrums and more impairment. The EC-DMDD group was characterized by more externalizing symptoms, whereas the MDD group was characterized by more internalizing symptoms; the EC-DMDD + MDD group was associated with increased risk of multiple comorbidities and functional impairments. In regression analysis, EC-DMDD was associated with functional impairment after controlling for covariates.

This study systematically investigated the latent class of EC-DMDD and the association between EC-DMDD, ODD, and MDD in preschoolers, demonstrating that EC-DMDD can be detected in preschoolers and may be distinctly related to elevated risk of impairment. Future studies should investigate larger samples with longitudinal follow-up.

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science.