Attention Deficit Hyperactivity Disorder (ADHD) Overlap With Disruptive Mood Disregulation Disorder (DMDD): Implications Toward Treatment

Rationale There are overlaps between ADHD and DMDD and yet either can exist without the other but more often they occur together. Both seem to have impulsiveness as a common thread. This is not new. But when they occur together, the order of treatment seems relevant. Objective When DMDD and ADHD occur together, are there differences in outcome if one starts with an atypical antipsychotic first or with a stimulant first? Methods Referrals to a telepsychiatry program and 64 newly diagnosed children between 5-12 with DMDD + ADHD were given drug therapy. Patients were excluded if they were on previous medications. Half the patients were started on an atypical antipsychotic (Group 1) and the other half on a psychostimulant (Group 2). SNAP-IV rating scales were done from baseline by the schools and a 1-5 Likert Scale was used to asses their rage episodes in both frequency and intensity. A signifcant result would be a reduction from 5 to lower than 3. Results In 5 cases of stimulant lead treatment, patients became signficantly more aggressive. In only 14/32 cases in Group 1 show a significant improvement (paired t test) compared to 30/32 cases in Group 2 with a reduction in score that was consistently below 2 (p <.05). Conclusion DMDD + ADHD may be related to hyperarousal effects defining it`s etiology as opposed to ADHD as the core disorder. While circular in reasoning, the differences in drug therapies suggest that the combination is not related to ADHD as the driving force.