Disruptive mood dysregulation disorder (DMDD) symptoms in children with autism, ADHD, and neurotypical development and impact of co-occurring ODD, depression, and anxiety

• Disruptive mood dysregulation disorder (DMDD) is a controversial new DSM-5 diagnosis.
• Mothers rated irritable-angry mood and temper outbursts in 1593 children.
• DMDD frequency was 45% autism, 39% ADHD-Combined, 12% ADHD-Inattentive, 3% typical.
• DMDD most common in autism, even controlling for oppositional behavior.
• Only 5% who did not have ODD had DMDD symptoms, and most of these children had autism.

Disruptive mood dysregulation disorder (DMDD) is a controversial diagnosis introduced in the DSM-5 that is particularly relevant to autism and other disorders in which DMDD symptoms (irritable-angry mood and temper outbursts) are common. Mothers rated DMDD symptoms in 1593 children with autism, ADHD, and neurotypical development (6–16 years, IQ ≥ 80). Percentages with DMDD symptoms (often or very often) were autism 45%, ADHD-Combined type 39%, ADHD-Inattentive type 12%, and neurotypical 3%. Almost all (91%) with DMDD symptoms met DSM-5 criteria for ODD, and 79% with ODD had DMDD symptoms. Only 5% without ODD had DMDD symptoms, and most of these had autism. Children with autism had significantly higher DMDD scores than all other groups, even when the oppositional behavior score (excluding the two DMDD symptoms) was controlled. The findings suggest that DMDD and ODD are not meaningfully differentiated based on their symptoms and that DMDD symptoms are particularly common in autism, more so than expected by comorbid ODD alone.