Dmdd Questionnaire Pdf

[Shari Alvine]

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Objectives: Disruptive mood dysregulation disorder (DMDD) is a new DSM-5 diagnosis. It is observed in youths and is characterized by chronic irritability and temper outbursts. This study aimed (i) to develop a brief questionnaire administered during a semi-structured interview and (ii) to assess its psychometric properties with adolescents 12-15 years old by estimating its internal consistency and its concurrent association with measures of depressive symptoms and borderline personality traits.

Methods: A 10-item questionnaire was developed based on the DSM-5 criteria and input from mental health professionals. The questionnaire was administered to 192 adolescents from youth centres, inpatient units and specialized outpatient clinics in Montreal, as were the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-PL), the Abbreviated version of the Diagnostic Interview for Borderlines revised (Ab-DIB), and the Dominic Interactive for Adolescents-Revised (DIA-R).

Results: A DMDD Questionnaire among adolescents from clinic settings is obtained. The content of the instrument's items was initially developed based on DSM-5 criteria and expert judgment to ensure that this new instrument covered the theoretical concepts of DMDD in English and French. Twelve participants (6.3%) met nine or more criteria and 11 youths (5.7%) met the three main criteria of DMDD (A, C, and D), which suggested the likely presence of DMDD. The total Cronbach's alpha was 0.90. In addition, the DMDD Questionnaire was significantly associated with depressive symptoms and borderline personality traits.

Conclusion: The reliability and concurrent validity indices suggest that the questionnaire as a decision-support tool may be used with adolescents in clinical settings. It highlights that the DSM-5 DMDD criteria seem associated with depressive symptoms and borderline personality traits. Finally, future studies will be necessary to establish more robust calculations in relation to the validity and reliability of this questionnaire.

"Explosive anger outbursts and persistent irritability are among the most problematic symptoms in child and adolescent mental health. They can present as a feature of many different psychiatric disorders. There have been increasing concerns over the past thirty years that youth with chronic irritability and anger outbursts are being increasingly misdiagnosed as having bi-polar disorder. These concerns led to the creation of a new diagnosis for DSM-5, Disruptive Mood Dysregulation Disorder (DMDD) in 2013. " - writes Dr. Sam Goldstein in his article Disruptive Mood Dysregulation Disorder (DMDD): A New Diagnosis, But Not a New Problem.

Since then, Dr. Goldstein worked with Giunti Psychometrics on the first standardized questionnaire for the evaluation of mood, behavior problems, and protective behaviors associated with DMDD.

The diagnostic challenges may, at least in part, be due to difficulties in its assessment [17]. As such, symptoms of DMDD are not unique to children referred for psychiatric services. Hence, many existing measures provide questions which assess symptoms relevant to DMDD (e.g. irritability is measured but considered a nonspecific indicator and is related to several other psychiatric disorders) [12]. Moreover, structured interviews or questionnaires specifically developed to diagnose DMDD are still in their infancy. Consequently, there is currently no gold standard or broad consensus regarding the clinical assessment of DMDD.

In this systematic review of the literature, we aimed to provide a synopsis of all measures that have been used in diagnosing DMDD since the advent of the diagnosis in 2013. Study characteristics of the included studies, quantities of used diagnostic measures, and psychometric properties, where applicable, are reported and discussed. The results of this systematic review of the literature might guide future research in the selection of appropriate tools to diagnose DMDD in the clinical and research setting.

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist [18]. The protocol was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO) and may be accessed under the registration number CRD 42020165496.

The goal of the literature search was to identify any studies assessing DMDD. Therefore, a broad search strategy was formulated. The full electronic search strategy of the systematic literature search in the PubMed database ( ) was: ("Disruptive Mood Dysregulation*") OR ("DMDD"). No limits or filters were added to this search. PubMed, Embase, PsycINFO, and Web of Science databases were scrutinized for relevant literature published from 2013 to 31st March 2020. We used identical search terms in all databases. Further, reference lists of publications identified through database search were screened for potentially pertinent studies not identified in the initial search. To reflect the broadest use of tools to diagnose DMDD, in research as well as in the clinic, we included any regular article, case report, or conference abstract published in any of the searched databases.

Studies were excluded if they (a) did not include patients with diagnosed DMDD; or (b) a full text was not available. Prior to a full-text review, the titles, abstracts, and methods sections of the articles identified through database searches were screened for the eligibility criteria outlined above by two independent reviewers until consensus was reached.

A digital data extraction sheet was developed and refined during the data extraction process. The following data were extracted if available: general information and identifying features of the study, i.e., full reference, year of publication, and country of study origin. Additionally, the article type was identified, comprising regular articles, conference abstracts, or case reports. All article types were included to cover the full breadth of tools available for research and clinical purposes. Magnitudes and percentages of all outcome variables were given for all study types included as well as for abstracts only. Further data extracted comprised details on the study design, study population, sample size, and age range. The main outcome was the tool used to diagnose DMDD, including the rater (clinician, parent, self) and whether psychometric properties had been assessed. Where possible, information about the number of items, administration time, and availability of the tool (licensed vs. free of cost) in different languages was obtained. Authors were contacted to provide details if any of the information of interest was not provided in the study.

Evidence from this systematic review points to a variety of different measures used for the evaluation and diagnosis of DMDD. The majority of studies used clinician-rated structured interviews in combination with DMDD specific symptom checklists. Few studies employed questionnaires or interviews specifically designed to measure DMDD or its severity. In the following, some of the most used measures are presented in more detail, before practical aspects, such as available languages and cost as well as diagnostic challenges and future directions are discussed.

K-SADS-PL DMDD module. Each of the questions are evaluated with 0, 1 or 2 for current and/or past episodes. The diagnostic criteria of DMDD are listed below the questions in the module (see supplementary material for the DSM-5 diagnostic criteria). Reprint authorized by Joan Kaufman, owner of the copyright of the K-SADS-PL

Given the aim of the present systematic review, to provide an overview of existing instruments for the assessment of DMDD and their use in the diagnostic process, we refrained from conducting a formal risk of bias assessment of included studies. The potential risk of bias does not interfere with the aim of the present review and was thus deemed irrelevant.

Since the advent of DMDD, clinicians and researchers have noted various challenges and the diagnosis is not without controversy [17]. The characteristic symptoms of DMDD, namely irritable mood and temper outbursts are observed across multiple disruptive behavior and mood disorders and the validity of DMDD as a distinct diagnosis has been questioned [13, 42, 43]. Further, DMDD could not be distinguished from ODD based on symptomatology alone in a population-based study [44]. It has further been criticized that alternative thresholds for defining DMDD, as well as a closer investigation of clinically relevant thresholds, have so far only partly been considered in the existing literature [45]. The lack of precision in diagnosing DMDD might in part account for the criticism voiced about the clinical entity of DMDD. Similarly, the heterogeneity in measurement of DMDD up to date, as found in the present systematic review of the literature, might account for variations in current prevalence and comorbidity rates as well as findings on associations with risk factors or functional outcomes in individuals with DMDD. Studies designed a priori with appropriate instruments to capture DMDD are therefore necessary [46].

While the diagnostic entity of DMDD may be a useful clinical heuristic, many researcher-clinicians focus their efforts on broader transdiagnostic constructs, such as irritability [8]. Irritability has been defined as a heightened proneness to anger relative to peers [47, 48] which can be seen as a personality trait with a continuous distribution across the population. In children and adolescents with DMDD, by definition, irritability is severe and expressed stably across time. In the last decade, there has been a marked increase in irritability research and there have been neuroscientific as well as treatment-related approaches to understanding pathophysiological mechanisms [41, 49]. Until now, whether persistent irritability between temper outbursts and the outbursts themselves are independent of each other, or whether the mood between outbursts is rather a concatenation of less severe tantrums, remains unknown.

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