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Articles   |    
Adult Diagnostic and Functional Outcomes of DSM-5 Disruptive Mood Dysregulation Disorder
William E. Copeland, Ph.D.; Lilly Shanahan, Ph.D.; Helen Egger, M.D.; Adrian Angold, M.R.C.Psych.; E. Jane Costello, Ph.D.
Am J Psychiatry 2014;171:668-674. doi:10.1176/appi.ajp.2014.13091213
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Dr. Shanahan has received grant support from NIMH (MH094605 and MH058144). Dr. Angold has received support from NIMH and the National Institute on Drug Abuse. Dr. Costello has received NIH funding as well as data collection and salary support from 1993 to present. The research presented here was supported by NIMH (MH080230, MH63970, MH63671, MH48085, MH075766), the National Institute on Drug Abuse (DA/MH11301, DA011301, DA016977, DA011301), NARSAD (early career award to Dr. Copeland), and the William T. Grant Foundation.

The authors report no financial relationships with commercial interests.

From the Center for Developmental Epidemiology, Duke University Medical Center, Durham, N.C.; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham; and the University of North Carolina at Chapel Hill.

Address correspondence to Dr. Copeland (william.copeland@duke.edu).

Copyright © 2014 by the American Psychiatric Association

Received September 14, 2013; Revised November 25, 2013; January 09, 2014; Accepted January 16, 2014.


Objective  Disruptive mood dysregulation disorder (DMDD) is a new disorder for DSM-5 that is uncommon and frequently co-occurs with other psychiatric disorders. Here, the authors test whether meeting diagnostic criteria for this disorder in childhood predicts adult diagnostic and functional outcomes.

Method  In a prospective, population-based study, individuals were assessed with structured interviews up to six times in childhood and adolescence (ages 10 to 16 years; 5,336 observations of 1,420 youths) for symptoms of DMDD and three times in young adulthood (ages 19, 21, and 24–26 years; 3,215 observations of 1,273 young adults) for psychiatric and functional outcomes (health, risky/illegal behavior, financial/educational functioning, and social functioning).

Results  Young adults with a history of childhood DMDD had elevated rates of anxiety and depression and were more likely to meet criteria for more than one adult disorder relative to comparison subjects with no history of childhood psychiatric disorders (noncases) or individuals meeting criteria for psychiatric disorders other than DMDD in childhood or adolescence (psychiatric comparison subjects). Participants with a history of DMDD were more likely to have adverse health outcomes, be impoverished, have reported police contact, and have low educational attainment as adults compared with either psychiatric or noncase comparison subjects.

Conclusions  The long-term prognosis of children with DMDD is one of pervasive impaired functioning that in many cases is worse than that of other childhood psychiatric disorders.

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FIGURE 1. Means Values for Adult Standardized Outcome Scales by Childhood Diagnostic Statusa

a Negative scores indicate more problems than the mean for the total sample. Asterisks indicate whether the comparison group was statistically different from the disruptive mood dysregulation disorder (DMDD) group (p<0.05). Children with DMDD had worse health outcomes than noncase comparison subjects (means ratio=2.8; 95% CI=1.8–2.1, p<0.001) and psychiatric comparison subjects (means ratio=1.6; 95% CI=1.0–2.5, p=0.04). DMDD case subjects had higher levels of all other outcomes compared with noncase comparison subjects (risky/illegal means ratio=2.0; 95% CI=1.1–3.6, p=0.02; financial/educational means ratio=2.3; 95% CI=1.6–3.3, p<0.001; and social means ratio=2.2; 95% CI=1.5–3.3, p<0.001). Relative to psychiatric comparison subjects, DMDD case subjects did not have worse risky/illegal behavior outcomes (means ratio=1.2; 95% CI=0.7–2.3, p=0.45) or financial/educational outcomes (means ratio=1.2; 95% CI=0.8–1.8, p=0.34), but had marginally worse social outcomes (means ratio=1.5; 95% CI=1.0–2.3, p=0.06).

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TABLE 1.Descriptive Statistics and Childhood Family Characteristics in a Study of Adult Outcomes of Disruptive Mood Dysregulation Disorder (DMDD)a
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a Total N=1,420. All reported N values are unweighted and all percentages are weighted. p values are significant at p<0.05.

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TABLE 2.Associations of Childhood/Adolescent Diagnostic Groups With Young Adult Diagnostic Categoriesa
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a N=1,273. All reported N values are unweighted and all percentages are weighted. DMDD=disruptive mood dysregulation disorder; ASPD=antisocial personality disorder; THC=marijuana-related disorders. p values are significant at p<0.05.

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TABLE 3.Associations Between Disruptive Mood Dysregulation Disorder (DMDD) in Childhood and Young Adult Health Functioning and Risky/Illegal Behaviorsa
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a N=1,273. All reported N values are unweighted and all percentages are weighted. Odds ratios significant at p<0.05.

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TABLE 4.Associations Between Disruptive Mood Dysregulation Disorder (DMDD) in Childhood and Young Adult Financial and Social Functioninga
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a N=1,273. All reported N values are unweighted and all percentages are weighted. Odds ratios significant at p<0.05.



Leibenluft  E;  Charney  DS;  Towbin  KE;  Bhangoo  RK;  Pine  DS:  Defining clinical phenotypes of juvenile mania.  Am J Psychiatry 2003; 160:430–437
Brotman  MA;  Schmajuk  M;  Rich  BA;  Dickstein  DP;  Guyer  AE;  Costello  EJ;  Egger  HL;  Angold  A;  Pine  DS;  Leibenluft  E:  Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children.  Biol Psychiatry 2006; 60:991–997
Stringaris  A;  Cohen  P;  Pine  DS;  Leibenluft  E:  Adult outcomes of youth irritability: a 20-year prospective community-based study.  Am J Psychiatry 2009; 166:1048–1054
Leibenluft  E;  Cohen  P;  Gorrindo  T;  Brook  JS;  Pine  DS:  Chronic versus episodic irritability in youth: a community-based, longitudinal study of clinical and diagnostic associations.  J Child Adolesc Psychopharmacol 2006; 16:456–466
Caspi  A;  Elder  G  Jr;  Bern  D:  Moving against the world: life-course patterns of explosive children.  Dev Psychol 1987; 23:308–313
Costello  EJ;  Mustillo  S;  Erkanli  A;  Keeler  G;  Angold  A:  Prevalence and development of psychiatric disorders in childhood and adolescence.  Arch Gen Psychiatry 2003; 60:837–844
Angold  A;  Prendergast  M;  Cox  A;  Harrington  R;  Simonoff  E;  Rutter  M:  The Child and Adolescent Psychiatric Assessment (CAPA).  Psychol Med 1995; 25:739–753
Angold  A;  Costello  EJ:  The Child and Adolescent Psychiatric Assessment (CAPA).  J Am Acad Child Adolesc Psychiatry 2000; 39:39–48
Copeland  WE;  Angold  A;  Costello  EJ;  Egger  H:  Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder.  Am J Psychiatry 2013; 170:173–179
Egger  HL;  Erkanli  A;  Keeler  G;  Potts  E;  Walter  BK;  Angold  A:  Test-retest reliability of the Preschool Age Psychiatric Assessment (PAPA).  J Am Acad Child Adolesc Psychiatry 2006; 45:538–549
Angold  A;  Erkanli  A;  Copeland  W;  Goodman  R;  Fisher  PW;  Costello  EJ:  Psychiatric diagnostic interviews for children and adolescents: a comparative study.  J Am Acad Child Adolesc Psychiatry 2012; 51:506–517
SAS Institute:  SAS/STAT Software, version 9 .  Cary, NC,  SAS Institute, 2004
Angold  A;  Costello  EJ:  A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C).  Psychol Med 1995; 25:755–762
Dalaker  J;  Naifah  M:  Poverty in the United States: 1997.  Washington, DC,  US Department of Commerce, 1993, pp 60–201
Parens  E;  Johnston  J;  Carlson  GA:  Pediatric mental health care dysfunction disorder? N Engl J Med 2010; 362:1853–1855
Axelson  D;  Birmahe  B;  Findling  R;  Fristad  M;  Kowatch  R;  Youngstrom  E;  Arnold  E;  Goldstein  B;  Goldstein  T;  Chang  K;  Delbello  M;  Ryan  N;  Diler  R:  Concerns regarding the inclusion of temper dysregulation disorder with dysphoria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.  J Clin Psychiatry 2011; 72:1257–1262
Stringaris  A:  Irritability in children and adolescents: a challenge for DSM-5.  Eur Child Adolesc Psychiatry 2011; 20:61–66
Taylor  E:  Child Psychology and Psychiatry, in  Diagnostic Classification: Current Dilemmas and Possible Solutions .  Oxford, UK,  John Wiley & Sons, 2011, pp 223–228
Stringaris  A;  Zavos  H;  Leibenluft  E;  Maughan  B;  Eley  TC:  Adolescent irritability: phenotypic associations and genetic links with depressed mood.  Am J Psychiatry 2012; 169:47–54
Leibenluft  E:  Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths.  Am J Psychiatry 2011; 168:129–142
Jaffee  SR;  Harrington  H;  Cohen  P;  Moffitt  TE:  Cumulative prevalence of psychiatric disorder in youths.  J Am Acad Child Adolesc Psychiatry 2005; 44:406–407
Bernstein  DP;  Cohen  P;  Velez  CN;  Schwab-Stone  M;  Siever  LJ;  Shinsato  L:  Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents.  Am J Psychiatry 1993; 150:1237–1243
Cohen  P;  Cohen  J;  Kasen  S;  Velez  CN;  Hartmark  C;  Johnson  J;  Rojas  M;  Brook  J;  Streuning  EL:  An epidemiological study of disorders in late childhood and adolescence I: age- and gender-specific prevalence.  J Child Psychol Psychiatry 1993; 34:851–867
Rutter  M;  Lebovici  S;  Eisenberg  L;  Sneznevskij  AV;  Sadoun  R;  Brooke  E;  Lin  TY:  A tri-axial classification of mental disorders in childhood: an international study.  J Child Psychol Psychiatry 1969; 10:41–61
Copeland  W;  Shanahan  L;  Miller  S;  Costello  EJ;  Angold  A;  Maughan  B:  Outcomes of early pubertal timing in young women: a prospective population-based study.  Am J Psychiatry 2010; 167:1218–1225
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Which of the following best describes the evidence to date about the 3-month prevalence and comorbidity profile of disruptive mood dysregulation disorder (DMDD) in childhood?
How does the risk for adult anxiety or depression in children with DMDD compare with psychiatric comparison subjects?
The adult social functioning profile of individuals with a history of DMDD shows a greater likelihood of which of the following features compared to noncase subjects?
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