(Some of the below was gleaned from the lectures of the late Dr. Larry Fisher, Ph.D, formerly of Clarity Child Guidance Center in San Antonio, Texas)
This diagnostic label was introduced in the DSM-5™ Manual of Psychiatric Disorders as a pediatric or adult diagnostic label. The condition is first diagnosable for a child who is between 6 and 10 years of age. Previously, children with the characteristics of this disorder were diagnosed with Bipolar Disorder with symptoms of ADHD and Oppositional Defiance Disorder.
In a nutshell, it is a brain disorder that is characterized by too much emotion and too little control in too little time. The primary emotions are rage and/or terror. Dr. Fisher compared it to an emotional seizure. It is when the Amygdala, an almond-sized structure in the limbic (non-thinking but emotional) part of the brain, is in control of the body and of the thinking part of the brain where the braking system is. It is when a child, who should be developmentally capable of self-control, completely loses it emotionally and melts down in a violent (fight) or panic (flee) manner, and the provoking circumstance does not fit the response. For example, the child could have been refused a second cookie because supper would be served soon, or the child was asked to turn the television off and go to bed.
The child frequently doesn’t remember what they said or did during their outburst and the loss of control and anti-social behavior is explosive and non-pre-meditated. In other words, their response wasn’t planned out ahead of time. Plus, the child has trouble turning off the outburst because their response isn’t a fake attempt for power or attention. Cause-effect thinking and impulse control are not operating because the smart, or thinking part of the brain is shut down. The child is typically regretful after an episode and may even remark: “I don’t know why I do what I do.”
If the non-pre-planned explosions are frequent (perhaps 3 days a week?), and they are not a result of a serious medical condition or a medication issue, then DMDD could be a diagnosis to consider.
Under no circumstances should Class 2 stimulants be used to medicate an anxiety condition and DMDD is an anxiety condition. Class 2 stimulants are drugs like Vivance, Ritalin, Adderall, Concerta, etc. They irritate the emotional or Limbic part of the brain eventually making meltdowns, aggressiveness, depression, anxiety, and anti-social behaviors worse. The pharmaceuticals which have been most helpful in treating DMDD have been blood pressure medications such as Clonidine which calm the arousal (flight-flight-freeze) centers of the brain, so that the higher, thinking part of the brain where the braking system is can do its job. Other successful pharmaceutical options have been anti-convulsants such as Amantadine or Lamictal which help to create a compensatory braking system, so to speak.
The genetic testing that functional medicine doctors do can pinpoint which nutrients are not being absorbed and processed properly by the body and the neurotransmitters that are not being transmitted and utilized efficiently by the brain. Genetic testing is indicating that the important neuro-transmitter, Dopamine, may not be transmitting properly to the Limbic System in instances of DMDD. So, in a nutshell, functional medicine evaluation and treatment would be the preferred bio-medical course of action: Locate and treat the sources of the symptoms, so that permanent changes, rather than compensatory procedures can take place.
A neuro-behavioral accompaniment to the bio-medical interventions for DMDD would be a treatment protocol of certain, targeted physical movements and activities intended to help habilitate and strengthen the parts of the brain responsible for starting and stopping the cascade of uncontrolled, irrational emotions and behaviors that this brain condition causes. As well, the input of slow, consistent rhythm (about 60 beats a minute) and the practice of rhythmic activities to the same consistent beat help balance the brain and calm the nervous system. This, in turn, supports the brain in doing a better job of managing stress, controlling impulses and containing emotions.
Some examples of brain-training activities to strengthen the braking system, reduce the intensity of emotions, and overall develop better rhythmic synchronicity in the brain, body and relationships:
--Swinging and rocking
--Hatha Yoga that focuses on breath, thought, control of position of body parts and self-awareness
--Trauma-sensitive yogas, such as Kundalini Yoga as taught by 3HO, which focus on rhythmic synchronicity of the breath with physical movement and mantra (song, or prayerful chant)
--No-tech play that targets the brain’s sub-processing modality of differentiation (the gateway to the brain’s braking and impulse control system) and enhances rhythmic synchronicity.
--Music or sound, to be aurally absorbed while asleep or awake, of approximately 55-60 beats a minute to bathe the limbic system in calm, sweet tranquility and to help reduce the reactivity of the Amgdala. Think in terms of ocean waves, a mother’s slow, relaxed, resting heartbeat, or Mozart, and other forms of calming, meditative music.
Note: Please see Beth’s book: Fun Games and Physical Activities to Help Heal Children Who Hurt: Get on Your Feet! for the “hows” and the “whys” behind the development and rehabilitation of children’s brains and bonds through targeted no-tech physical movements and activities. Or make an appointment with her at her office in Conroe, Texas, so she can help you help the children in your care: https://infamilyservices.com/