Mood disorders in the pediatric population? 

A frequent referral to our practice is to diagnosis and differentiate complex neuropsychological presentations. A common example is to differentiate different types of conditions, such as, Bipolar Disorder, Oppositional Defiance, Disruptive Mood Dysregulation Disorder, Conduct Disorder, ADHD, OCD, etc.  This blog post focuses on mood related conditions.

Bipolar disorder, intermittent explosive disorder, and disruptive mood dysregulation disorder (DMDD) are three main mood disorders that may be difficult to differentiate between.

In bipolar disorder, children present with symptoms of both major depressive disorder and mania. In children, depressive episodes may present as a decrease in interest in life, agitation, inconsistent sleep (too much or too little), appetite changes, lower energy and activity levels, inability to concentrate, sadness, feelings of worthlessness or guilt, and thoughts of self-harm, etc. Manic episodes would include an elevated, euphoric mood inflated self-esteem, increased energy levels, decreased need for sleep, increased talkativeness, racing thoughts, distractibility, and increased impulsivity. Children can cycle through these states significantly faster than adults with bipolar disorder, but they still have distinct depressive and manic episodes.

Intermittent explosive disorder is classified by repeated, sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts, which are too extreme for the situation. The outbursts are short and not premeditated, examples of this can include road rage with adults. The onset of recurrent, problematic, impulsive aggressive behavior is most common in late childhood or adolescence and rarely begins for the first time after age 40 years. This condition cannot be diagnosed before 6 years of age.

If the child’s irritability is persistent and particularly severe, they may, instead be disruptive mood dysregulation disorder (DMDD). Outbursts characteristic of DMDD are more frequent, and the child’s mood between the outbursts is persistently irritable or angry most of the day, nearly every day. The outbursts start before the age of 10 and can be diagnosed only between the ages of 6 and 18 years old.

Children experiencing sudden outbursts or irritability and aggression may have intermittent explosive disorder rather than bipolar disorder.  Sudden outbursts of irritability and aggression could be mistaken for Bipolar Disorder; however they are more consistent with Intermittent condition.  As a result, a thorough assessment of the child including collateral information is necessary.

At NRS|LS we employ a comprehensive approach to assessing mood disorders. Our data is collected from parents, teachers, other significant family members, medical team providers of the child’s care, objective data pertaining to the child, etc. Treatment recommendations will vary depending upon accurate diagnostic procedures and outcomes.

Please call our office if you have any questions or would like a consultation with our neuropsychologist.