Coping with Your Child's DMDD Outbursts and the Aftermath
Disruptive mood dysregulation disorder (DMDD) outbursts erupt multiple times a week because a child with DMDD is persistently angry and irritable. DMDD outbursts are tantrums that are way out of proportion to the situation. As parents, they are tough to watch, but preventing them seems impossible. Keeping everyone in the family safe is a priority, and when it's all over, DMDD outbursts leave your family emotionally exhausted.
Early Signs of a Disruptive Mood Dysregulation Disorder Outburst
DMDD outbursts are not always predictable, but I have started to notice early warning signs in my son. For instance, his symptoms of attention-deficit/hyperactivity disorder (ADHD) ramp up. He paces, talks more loudly, and becomes more disruptive. He doesn't like being touched and sounds are too loud for him. Most of all, his irritability goes through the roof. Everything we do sets him on edge. He may have mini-outbursts where he'll shout or threaten, but in those early moments, he's still able to stop himself before it gets worse.
Preventing the Full DMDD Outburst
Once I notice these early signs, there are a few things I try. First and foremost, is using distraction. Sometimes, if I throw him off track with video games or a positive conversation, I can get my son to forget what he was mad about. At his summer program, they talk about the dog we're fostering because he's passionate about this. Fidgets work at school, too, to get him to focus elsewhere.
If that doesn't work, the next step is to remove him from the area. Sadly, one of my son's biggest triggers is his sister, so we're separating them a lot (Siblings of Children with Mental Illness). Other times, he just needs a quiet space because he's overstimulated. At school, he'll go to the nurse's office for a snack, to the sensory room, or he'll take a walk with an available support person.
In the Midst of a DMDD Outburst
There are only two options for my son when the full DMDD outburst hits: isolation and calling in help.
We immediately get my son to a safe place (usually his bedroom) and let him ride it out. He can scream, swear, throw things, etc., without hurting anyone else. We remove dangerous objects and, sometimes, whole pieces of furniture. In general, we keep his room sparse. He has some toys and books in there, but everything else is in other areas so that his room is a safe place no matter when the outburst happens.
Usually, with DMDD, outbursts last for 20 minutes or longer. If my son goes for an hour, that's when we call our local crisis line. (How to Find Mental Health Services in Your Area can help, but you'll want the right number before the next DMDD outburst.) In the past, we drove him to the hospital because he was small enough to contain in the car. He's too big for that now. If he were to have another hospital-level DMDD outburst, we would have to call 9-1-1. (That's a troubling idea, and a topic for another post.)
Coping with the Aftermath of a DMDD Outburst
In the aftermath, you don't know whether to punish or comfort your child (Children with Psychiatric Illness Require Thoughtful Discipline). After all, an outburst involves everything you'd usually punish (swearing, damaging property, etc.). Kids with DMDD often feel remorse once they calm down, though. As a parent, outbursts cause a mixed bag of feelings. I know it's a mental illness and not entirely in my son's control, so what good does it do to punish him if he's not doing it on purpose? What does it teach him, though, if he's not punished for destructive behavior? Will he learn the behavior is okay?
My son is old enough now that we can talk about his diagnoses and what is or is not in his control. We discuss options for preventing DMDD outbursts and the behavior leading up to it. I tell him I can forgive the behavior but that I expect him to work on learning how to manage it in the future. As he gets older, and impulse control improves, he is better able to stop a behavior about one in 10 times--which is one more than it used to be. So here's hoping that gets better and better as we go.
David, M. (2017, June 26). Coping with Your Child's DMDD Outbursts and the Aftermath, HealthyPlace. Retrieved on 2020, September 30 from https://www.healthyplace.com/blogs/parentingchildwithmentalillness/2017/06/coping-with-outbursts-and-their-aftermath
Author: Melissa David
I have a boyfriend that has a son that has been diagnosis with DMDD. I've been reading a lot of these post on people situation and it is hard and I understand what you all are going though. My boyfriend and I have two kids of our own and then he has two other kids from a pervious marriage. The mother herself has mental disabilities but doesn't do anything to help herself but tries to help her son out. And I am sorry but to me just because a child has a disability doesn't mean they don't deserve consequences. To me allowing your child to sit there and have outburst and hitting you and nothing is done because of the disability is ridiculous. All that is going to do it teach that child that they can use that disability as an excuse when they do something wrong, and reading about this mental disorder sound very dangerous. I understand that they can't help it because its a chemical imbalance in the brain but there still has to be some type of punishment for these kids or else they could really hurt someone and unfortunately the law will not care about that disability.
I totally agree with you that there needs to be some kind of discipline library action for their aggressive outbursts. I can’t stand that in society today we let these children get away with physical abuse to their parents and their siblings. Honestly they get away with too much and use manipulation to do so because they think that Cps and police will believe them that it is their parents doing the abuse to them. Unfortunately we can’t hit them unless it is on the ass and even then the government thinks we are wrong for corporal punishment. I just take away privileges and let my daughter have nothing to play with besides utilizing pencils and paper to draw. I give things back to her as she earns them for good behavior and it seems to work because she has less outbursts this way. She also seeks counseling and takes medication for her issues.
If one more person tells me I need to discipline my child better or that I should be ashamed........
I am crying reading this. My son just turned 12 and was evaluated by his child psychologist as having ADHD, ODD and DMDD. I am in the middle of a struggle with the school because I am told that I am enabling him and making excuses for him. I am fortunate enough to have a strong relationship with him. I am really the only one that can calm him down. My real struggle is that I also work for the school district and I am really starting to feel the effects of trying to advocate for him. Everything is about discipline and he doesnt feel that he will ever be given a fair chance. He is extremely smart and absolutely refuses to do school work in or out of school. As a final straw he was placed in the 7th grade to finish off his 6th grade school year with talk of skipping into 8th grade next year. He started doing homework and was excited every day about what he was learning. I celebrated his success and was reminded that this was a disciplunary action and other parents are asking if that is going to be an option for other students also. So no less than 2 weeks into the new placement he feels defeated and I have to struggle to get anything completed. He still does it which would have never happened before but the fight is back. He wants to prove to them that he is more than a discipline problem. As a single mom I struggle with support at the meetings, what line am I willing to push to support my child without affecting my job. Well...I seem to have crossed all of them and now Im not sure what is going to happen. Rant over, sort of, I find it so reassuring to know he and I are not the only ones struggling but terrifying to see how much worse it could get.
Stacy, my son was recently diagnosed with ODD, ADHD, and DMDD as well. I have felt very alone in all of this. How early did you see signs in your son? Has it improved at all over time? Do you have any advice for parenting? I am also a teacher and I feel like I too am struggling to advocate for my son be it in the school, with doctors or in a CBAT. Any help
I’m so sorry you are going through this. My son (14) has been struggling for a few years with adhd, anxiety, depression and recently after a horrible episode where he had to be hospitalized, now has another diagnosis of DMDD. He’s refusing high school this year and any therapy. I do not know how to help him and I want my happy boy back.
This may make some of you mad. One day this abuser showed up and beat the snot out of me! I spent DAYS in intensive care and pleaded for help against my abuser. The hero’s come to save the day but alas the laws aren’t in my favor. Fast forward about a year, my abuser moves into my home disguised so sweetly. Within a short time things go from gross to grotesque... ahh but the many logical calls for help go by the wayside. Passed around the agencies like a card no one wanted to play. After being treated like I was the criminal abusing her I felt defeated and was FORCED to sign her into a temporary group home placement to be able to access appropriate mental health care agencies!! They make $9K a month-/+ to house feed and supervise kids and she came out in 3 weeks not their problem anymore cause she graduated from their program??
Counselor for 1 on 1 every week and a behavior modifier 2x week who have diagnosed her with DMDD after a few short visits!! The worst part is this abuser who permanently dislocated my finger and broke my ribs, this wildcard of sporadic violence, this triggered by the slightest thing yet protected by its professional label (DMDD) is ......
My 13 year old daughter!!! That’s right after losing my job over this behavior and being called to the school constantly I put my foot down!! I’ve had to call the cops on her and invite cps into our life. I’ve had to shuttle her around to helpers within the system for her to not remember anything or pretend she is the victim. She has even gone so far as to sit quietly for almost the whole hour! I’ve been labeled her trigger, treated like a poor parent and subjected to such negative judgments I could fill a notebook and yet I still trudge along hoping my efforts will inspire some sense of investment from others. That the skills and strategies needed for all of us to cope will be delivered soon. Im open to any and all out of the box suggestions! Note at age 12 kids no longer qualify as children and therefore can’t access services AND can’t be taken to any type of juvenile detention center for abuse against a family member until after age 14.... there lies part of the issue so be forewarned
there is DMDD support group on facebook
Where is the group Melvin? What did your
search to find it?
This is our life to a "T".... our son is almost 17 and weighs approx. 300 lbs. with ADHD/ODD & DMDD. We have court intervention... mental health commital... many different services in place, but nothing seems to have an effect. We've tried to get residential placement, but they say he isn't severe enough... what is severe enough? He has already caused his father to go to the ER and have stitches. School seems impossible for him. We have not allowed him to get a license as that would be too risky. It is so difficult to deal with these issues as parents because your child looks perfectly "normal". It is a huge mental health issue - not the parenting aspect. I fear he won't graduate, be able to hold any type of job or live independently.
Wow to know I'm not alone my daughter is twelve and has ADHD and dmdd she gets very aggressive cusses at me she hits me pushes me and. Says she doesn't have to listen to me it's very exhausting dealing with this every day
Thank so much for this post and comments. My daughter (7) has always been aggressive and has had violent outbursts for as long as I can remember. Just recently it's become more frequent and more destructive. Still not really seeing a change away from home (school, church, etc) so we still have a lot of questions. Is it a disorder? Just an angry kid? Maybe a little spoiled? All the questions send us into a tailspin and we are constantly second guessing out choices where she's concerned. to get assessed or not? etc. I hate that other people are going through what we are and worse but a little glad that we aren't alone... if only we could all get together and chat over coffee... or maybe wine. All the wine...
Wow. Knowing I am not alone...wow.
This is so my 10yr old. ADHD combined, severe anxiety, and DMDD. Its been bad. He's been hospitalized twice and currently waiting to be sent to residential, but in the meantime, he is so out of control. He threatens to kill both myself and his step dad in our sleep, threatens suicide, slams and breaks things, swears up a storm, etc.... he has coping skills, but in rages, can't calm down enough to use them. It doesn't help his step dad has anger issues to, so they both butt heads and Im the one in the middle trying to keep the piece. Once he calms down tho, he is the best kid in the world....just so tired of this and he's on meds too... maybe someday...
I’m right there with you! Just had my son today scream that he was gonna snap my daughter’s neck before running off into the neighborhood while shouting swear words. Sometimes I wonder what the neighbors think, but you know what? It doesn’t matter what they think. Do what you need to do to be safe. I’m glad to hear residential is an option for your son. It seems safer for the family but also more intensive so maybe more helpful for your son. It does get somewhat easier as they get older, I think. Even if it’s because other people can help them and it’s not just on our shoulders. I hope your family gets support, including you! Parents need support, too.
Im haveing the same problems i have my son has ADHD and ODD and my daughter ADHD,ODD, and DMDD they where always getting kick out of school for fighting with the teachers and destroying property I'm going to court for them because it became an every day thing and the courts and CPS got involved from the school called them and now my kids are in place ment to get help to control their anger and my son gets bored really fast but it's because he knows the material of the work that they're teaching him and he feels like he doesn't have to learn it over again because he already knows it he is really Advanced for his age I told them to challenge him to make it as a game but they want to do it my son has run away from the school and have the police find him two blocks away from the school
I’m sorry to hear it’s been such an ordeal! How stressful to have the courts involved. We almost had to involve the police today, so I know how it is. I hope there’s an IEP in place for both your kids. If you don’t already, children’s mental health case management can be super helpful too. CPS can probably get you connected if you have a worker through them. I’m always a proponent for using as many resources as are available. I hope your kids get the support they need!
I am in the same position my son has been diagnosed and he does not listen the doctors have put him on medicine it does not work I constantly have neighbors at my house because he runs out the door from me I am a single mom of 4 and I don’t know what else to do do I have tried I feel like everything he says the most hurtful things and is so defiant he gets sent home from school constantly kicked off the bus. He is in a special class. Nothing I mean nothing is working so please if anyone has any advice I’m listening
I have just found your blogs and you are so describing our life. Thank you for writing.
Emotional exhaustion is a perfect description. As a family, we live life on the edge of our seats, always alert to signs that things are going off the rails - knowing there will be minimal, if any, time to intervene once that happens. It is hard to describe to anyone outside -- until they witness it -- and it's hard for people not to apply their various past experiences to our situation. I haven't run into many folks with the situation of such outbursts with a kid who can seem pretty 'normal' and capable at other times -- and I am in health care too -- no surprise it throws others (family, friends, acquaintances) so off kilter.
A thought for others with kids with DMDD - we did not have much success (or really any) with token systems when our child was younger - he would just get upset by not getting the 'star' and would be so defeatist about earning his 'reward.' When we accepted that he wasn't having these issues because he wanted to defy or be a problem, nor even that he didn't care about being on track, and accepted that he, at the moment of an outburst, did not have skills to make another choice, we stopped trying tokens. Now that he's older, they are a little more possible, still not great, but sometimes they are one more thing to remind him when he could use his strategies to settle as he is ramping up. We still have to choose wisely our reward - something that isn't time constrained (For example, when you get 10 checkmatks this good thing happens) seems to be less anxiety provoking (i.e. Less outburst-provoking) than earning a certain number of stars in a week does for him.
We tried this system as well and did not have success with it. He would get really angry when he did not get them as well. He is 6
I have recently noticed that my son gets "bored" eventually. We have to switch up the token economy in our house. He'll do super well on it for a few weeks, and then he doesn't care anymore. It's baffling.
I have tried everything for my 9 year old son brayden rewarding him for good behavior doesn't work there is no discipling him he throws kicks bites cusses breaks stuff for years now they just now said he has dmdd he already takes 5 medications which dont help
It's so tough. I don't think anybody can know just how scary those outbursts are unless they've seen them in person! Reach out to the school, your son's doctors, any social workers who work with him, and see if they have more resources. I don't know what's in your area, but maybe there are other options worth trying like residential treatment or in-home supports like PCA or skills workers. I hope something is out there that finally gets to whatever's causing the outbursts. Good luck!