Kids' tantrums as disorder concern doctors

Some doctors are concerned about new guidelines allowing children who frequently throw tantrums to be diagnosed with a mental health disorder, arguing that normal kids can act this way, but also cautioning that such behavior could signal several other mental health conditions.

The new diagnosis of "disruptive mood dysregulation disorder" will appear in the updated version of the psychiatric handbook the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to be published in May. The American Psychiatric Association (APA) approved the final version of the manual on Saturday (Dec. 1).

Although detailed criteria for the diagnosis have not been released, an APA statement said the condition could apply to "children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year." The addition is intended in part to reduce the number of kids misdiagnosed as having bipolar disorder, who may be treated with powerful drugs.

But some experts say the new condition was added to the manual too soon.

"I think it's premature to put it in as a full diagnosis," said Dr. David Axelson, an associate professor of psychiatry at University of Pittsburgh School of Medicine, referring the condition's inclusion in the front of the manual with other well-accepted diagnoses, rather than in the appendix, which includes provisional diagnoses requiring further research.

Overdiagnosis

Some are concerned that a label of disruptive mood dysregulation disorder would turn normal kid behavior into a medical condition. [ See Typical Toddler Behavior, or ADHD? 10 Ways to Tell.]

But Axelson said the diagnosis requires severe and frequent behavior problems, and if properly applied, kids without a true mental condition would be unlikely to be diagnosed. In addition to frequent outbursts for more than a year, children need to be at least 6, but younger than teenagers, to be given the diagnosis, according to early versions of the criteria.

However, parents might overestimate how often their child behaves badly, because they focus on recent outbursts, and inaccurately reporting behavior to a mental health professional may lead to mislabeling, Axelson said.

And although the diagnosis is intended to reduce misdiagnoses of childhood bipolar disorder and subsequent overtreatment, it could end up putting more kids on medication, Axelson said. That's because there are no treatments for the new condition, so doctors will likely prescribe medications for explosive anger — which are the same medications for bipolar disorder.

Missing real problems

Research suggests the new disorder could become common among kids already diagnosed with other mental conditions. A study by Axelson and colleagues, published in October, found that more than half of children with oppositional defiant disorder or conduct disorder met criteria for the condition, and it was hard to distinguish the disorders from each other.

Also, the diagnosis was not particularly stable, meaning it was not repeatedly diagnosed in the same children over multiple evaluations. This counters the idea that the new condition is chronic, Axelson said.

Some are concerned doctors will diagnose children with disruptive mood dysregulation disorder without checking for other mental problems.

"Explosive behavior is like a high fever," said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook University School of Medicine in New York. "If you have it, you know there's something wrong, but it doesn't tell you what's wrong."

The focus could be taken off other conditions that can lead to explosive behavior, including attention deficit hyperactivity disorder, obsessive compulsive disorder and autism, Carlson said.

But others see the move as positive. Lauren Wakschlag, a clinical psychologist at Northwestern University Feinberg School of Medicine who studies children's tantrums, said there are advantages to having this diagnosis for children's mood problems.

Traditionally, these children may have been given any of several diagnoses, because tantrum behaviors overlap with those of other conditions.

"Here, you have a unifying way to diagnose symptoms," Wakschlag said.

However, because children's behavior can vary substantially between ages 6 and the teen years, more research is needed to determine how to diagnose children of particular ages, Wakschlag said.

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