As noted in my first post on this topic, one of the challenges facing the Mood Disorders and Childhood Disorders work groups stems from the fact that although some children do show the same type of clear cyclicity or episodes as adults with Bipolar Disorder, many children do not seem to have clearly defined mood episodes. So is Bipolar Disorder being overdiagnosed in children? Are children being given a Bipolar diagnosis and treatment when what ails them is not really Bipolar Disorder? To address this problem, the work groups proposed:
- refining the diagnostic criteria for mood episodes to clarify that an episode requires the presence of the symptoms "almost all day, every day," and the symptoms represent a change from baseline for the individual; and
- introducing a new diagnosis that may be more consistent with what we see in many children, Temper Dysregulation Disorder with Dysphoria (TDD).
The diagnostic criteria proposed for TDD are provided here for reference and discussion purposes. In this post, I’ll try to summarize some of the research that led up to the proposal. As part of its consideration and work, a new (temporary) diagnosis was proposed and defined, called Severe Mood Dysregulation (SMD). The criteria for SMD included severe but non-episodic irritability with anger outbursts and hyperarousal/ADHD-like symptoms. The name SMD would subsequently be changed to TDD and the hyperarousal criterion dropped. Read more
Mood disorders, including Depression and Bipolar Disorder, are tentatively slated for a number of changes in the DSM-V. You can read an overview of the proposed changes on the DSM-V web site, and follow the links to specific disorders to see the proposed diagnostic criteria and the rationale for any changes. One of the most contentious proposals involves an attempt to decrease what is perceived to be over-diagnosis (or misdiagnosis) of Bipolar Disorder in young children. Over the past few years, a number of studies have looked at severe mood dysregulation (SMD) in children and what happens to these children as they mature — do they develop depression or Bipolar Disorder, or neither? As a result of the studies, two DSM-V work groups collaborated and proposed a new diagnosis called "Temper Dysregulation Disorder with Dysphoria" (TDD). You can read the proposed diagnostic criteria on the DSM-V web site or here. If you are interested in this condition or the issue of childhood-onset mood disorders, you may find it helpful to read two articles that the work groups produced to explain the research and their rationale for proposing TDD as a new diagnosis: Issues Pertinent to a Developmental Approach to Bipolar Disorder and Justification for Temper Dysregulation Disorder with Dysphoria. In subsequent posts, I will try to summarize more of the controversy and provide statements by different groups of stakeholders who are pro and con the proposal.