Disruptive Mood Dysregulation Disorder: Symptomatic and Syndromic Thresholds and Diagnostic Operationalization - 26/01/21
, Alicia Matijasevich, MD, PhD d, e, Tiago N. Munhoz, DClinPsy, PhD d, f, Iná S. Santos, MD, PhD d, Aluísio J.D. Barros, MD, PhD d, Daniel S. Pine, MD g, Luis Augusto Rohde, MD a, b, c, Ellen Leibenluft, MD g, Giovanni Abrahão Salum, MD, PhD a, b, cAbstract |
Objective |
To identify the most appropriate threshold for disruptive mood dysregulation disorder (DMDD) diagnosis and the impact of potential changes in diagnostic rules on prevalence levels in the community.
Method |
Trained psychologists evaluated 3,562 preadolescents/early adolescents from the 2004 Pelotas Birth Cohort with the Development and Well-Being Behavior Assessment (DAWBA). The clinical threshold was assessed in 3 stages: symptomatic, syndromic, and clinical operationalization. The symptomatic threshold identified the response category in each DAWBA item, which separates normative misbehavior from a clinical indicator. The syndromic threshold identified the number of irritable mood and outbursts needed to capture preadolescents/early adolescents with high symptom levels. Clinical operationalization compared the impact of AND/OR rules for combining irritable mood and outbursts on impairment and levels of psychopathology.
Results |
At the symptomatic threshold, most irritable mood items were normative in their lowest response categories and clinically significant in their highest response categories. For outbursts, some indicated a symptom even when present at only a mild level, while others did not indicate symptoms at any level. At the syndromic level, a combination of 2 out of 7 irritable mood and 3 out of 8 outburst indicators accurately captured a cluster of individuals with high level of symptoms. Analysis combining irritable mood and outbursts delineated nonoverlapping aspects of DMDD, providing support for the OR rule in clinical operationalization. The best DMDD criteria resulted in a prevalence of 3%.
Conclusion |
Results provide information for initiatives aiming to provide data-driven and clinically oriented operationalized criteria for DMDD.
Le texte complet de cet article est disponible en PDF.Key words : child/adolescent, developmental psychopathology, disruptive mood dysregulation disorder, irritability, temper outbursts
Plan
| The Pelotas 2004 Birth Cohort is conducted by the Graduate Program in Epidemiology of Universidade Federal de Pelotas, supported by Associação Brasileira de Saúde Coletiva (ABRASCO–Brazilian Association of Public Health). From 2009 to 2013, the 2004 birth cohort was funded by the Wellcome Trust (United Kingdom). The 11-year follow-up was funded by the Sao Paulo Research Foundation–FAPESP (grant number 2014/13864-6). Previous phases of the study were funded by the World Health Organization, Programa de Apoio a Núcleos de Excelência (PRONEX–Support Program for Excellence Centers), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq–National Council for Scientific and Technological Development), the Brazilian Ministry of Health, and Pastoral da Criança (Child’s Pastoral). |
|
| This work has been previously posted on a preprint server: 19002436. |
|
| Author Contributions |
|
| Conceptualization: Laporte, Matijasevich, Munhoz, Santos, Barros, Pine, Leibenluft, Salum |
|
| Data curation: Laporte, Matijasevich, Munhoz, Santos, Salum |
|
| Formal analysis: Laporte, Santos, Barros, Pine, Rohde, Leibenluft, Salum |
|
| Investigation: Laporte |
|
| Methodology: Laporte, Matijasevich, Munhoz, Santos, Barros, Pine, Rohde, Leibenluft, Salum |
|
| Supervision: Matijasevich, Leibenluft, Salum |
|
| Visualization: Barros |
|
| Writing: original draft: Laporte, Matijasevich, Pine, Rohde, Leibenluft, Salum |
|
| Writing – original draft: Laporte, Matijasevich, Pine, Rohde, Leibenluft, Salum |
|
| Writing – review & editing: Laporte, Matijasevich, Munhoz, Santos, Barros, Pine, Rohde, Leibenluft, Salum |
|
| ORCID |
|
| Paola Paganella Laporte, MD, PhD: 0000-0001-8481-2230 |
|
| Tiago N. Munhoz, DClinPsy, PhD: 0000-0003-1281-9542 |
|
| Daniel S. Pine, MD: 0000-0002-4301-9516 |
|
| Giovanni Abrahão Salum, MD, PhD: 0000-0002-7537-7289 |
|
| The authors thank the children and families for their participation, which made this research possible. The authors also thank the research team from the Pelotas 2004 Birth Cohort. |
|
| Disclosure: Drs. Laporte, Santos, Barros, and Salum have received support from the National Council for Scientific and Technological Development (CNPq). Dr. Rohde has received support from the CNPq. He has served on the speakers’ bureau/advisory board and/or acted as consultant for Eli Lilly and Company, Janssen-Cilag, Novartis, Medice, and Shire (a Takeda company) in the last 3 years. He has received authorship royalties from Oxford Press and ArtMed. He has received travel award for taking part in 2017 WFADHD and 2018 APA meetings from Novartis and Shire, respectively. The ADHD Disorder Outpatient Program chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Janssen-Cilag, Novartis, and Shire. Drs. Matijasevich, Munhoz, Pine, and Leibenluft have reported no biomedical financial interests or potential conflicts of interest. |
Vol 60 - N° 2
P. 286-295 - février 2021 Retour au numéro
Article précédent
- Underconnectivity Between Visual and Salience Networks and Links With Sensory Abnormalities in Autism Spectrum Disorders
- R. Joanne Jao Keehn, Ellyn B. Pueschel, Yangfeifei Gao, Afrooz Jahedi, Kalekirstos Alemu, Ruth Carper, Inna Fishman, Ralph-Axel Müller
- Physical Discipline, Deprivation, and Differential Risk of Developmental Delay Across 17 Countries
- Carmel Salhi, Elizabeth Beatriz, Ryan McBain, Dana McCoy, Margaret Sheridan, Günther Fink
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?