This study investigated how a disruptive mood dysregulation disorder (DMDD) diagnosis influences treatment selection and sequencing in children with attention-deficit/hyperactivity disorder (ADHD).

This multicenter, population-based, retrospective cohort study analyzed data from TriNetX Research Network (June 2013 through July 2024). Youth with ADHD (without DMDD) formed the control cohort (n = 631 295). Youth with ADHD + DMDD (n = 24 723) formed the study cohort. Odds ratios (ORs) and relative risks were calculated to analyze associations.

Compared with controls, ADHD + DMDD cohort was more likely to be composed of non-Hispanic ethnicity and exhibited higher rates of psychiatric comorbidities, inpatient and emergency service utilization, and billed psychotherapy (ORs range 1.25-6.95). Youth with ADHD + DMDD were more likely to receive ADHD medications (ORs range 1.55-4.80), as well as antidepressants, mood stabilizers, and antipsychotics (ORs range 5.05-13.16). Hispanic youth with DMDD utilized more psychotropics but less psychotherapy, while White youth used all services more. Before the use of non-ADHD medications for aggression, only 25% of ADHD + DMDD youth had a therapy code, and around 11% showed evidence of optimization of ADHD medication. After a DMDD diagnosis, treatment rates for other psychotropics increased more than those for central nervous system stimulants.

In youth with ADHD, a DMDD diagnosis is associated with increases in the spectrum of pharmacological and nonpharmacological treatments deployed with patterns varying by race and ethnicity. Antipsychotic and mood stabilizer prescriptions increased most prominently, often before receiving psychotherapy services or efforts to optimize ADHD medication. Future research should address disparities in DMDD treatment patterns and identify the optimal treatment sequences for DMDD.