Effective Medications for Treating Mood Dysregulation Disorders in School-Aged Youth

  • Elizabeth C. GrierEmail author
  • Elizabeth H. Jeffords
  • Kristen E. Dewey
Part of the Pediatric School Psychology book series (PSP)


Disruptive mood dysregulation disorders, which encompass Bipolar 1 and Bipolar 2 disorders, and are a challenge to both diagnose and treat in the school-age population. The purpose of this chapter is to highlight the efficacy and effectiveness of psychotropic medications used in the treatment of children and adolescents presenting with manic and hypomanic symptoms. Both the intended and side effects of medication treatments (mood stabilizers, antipsychotics, anticonvulsants, antidepressants, and stimulants) commonly used to treat mood dysregulation are reviewed. A set of references and web-based materials are provided to readers for additional information.


  1. Aman, M. G., Bukstein, O. G., Gadow, K. D., Arnold, L. E., Molina, B. S., McNamara, N. K., … Butter, E. M. (2014). What does risperidone add to parent training and stimulant for severe aggression in child attention-deficit/hyperactivity disorder? Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 47–60.CrossRefGoogle Scholar
  2. American Academy of Child and Adolescent Psychiatry. (2007). Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. American Academy of Child and Adolescent Psychiatry, 46, 107–125.CrossRefGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: APA.Google Scholar
  4. Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). New York: The Guilford Press.Google Scholar
  5. Baweja, R., Belin, P. J., Humphrey, H. H., Babocsai, L., Pariseau, M. E., Waschbusch, D. A., … Waxmonsky, J. G. (2016a). The effectiveness and tolerability of central nervous system stimulants in school-age children with attention-deficit/hyperactivity disorder and disruptive mood dysregulation disorder across home and school. Journal of child and adolescent psychopharmacology26(2), 154–163.PubMedPubMedCentralCrossRefGoogle Scholar
  6. Baweja, R., Mayes, S. D., Hameed, U., & Waxmonsky, J. G. (2016b). Disruptive mood dysregulation disorder: Current insights. Neuropsychiatric Disease and Treatment, 12, 2115.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Benarous, X., Consoli, A., Guile, J. M., Garny de La Riviere, S., Cohen, D., & Olliac, B. (2017). Evidence-based treatments for youths with severely dysregulated mood: a qualitative systematic review of trials for SMD and DMDD. European Child and Adolescent Psychiatry, 26, 5–23.Google Scholar
  8. Birmaher, B., & Axelson, D. (2006). Course and outcome of bipolar spectrum disorder in children and adolescents: A review of the existing literature. Development and Psychopathology, 18(4), 1023–1035.PubMedCrossRefGoogle Scholar
  9. Chen, J., Wang, Z., & Fang, Y. (2016). The history, diagnosis and treatment of disruptive mood dysregulation disorder. Shanghai Archives of Psychiatry, 28(5), 289–292.Google Scholar
  10. Copeland, W. E., Angold, A., Costello, E. J., & Egger, H. (2013). Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder. The American Journal of Psychiatry, 170(2), 173–179.Google Scholar
  11. Cullins, L. M., Call, D. C., & Joshi, P. T. (2016). Pediatric bipolar disorders: Current understanding and management. In S. Malhotra & P. Santosh (Eds.), Child and adolescent psychiatry (pp. 3–17). New Delhi, India: Springer.CrossRefGoogle Scholar
  12. DelBello, M. P., Goldman, R., Phillips, D., Deng, L., Cucchiaro, J., & Loebel, A. (2017). Efficacy and safety of larasidone in children and adolescents with bipolar I depression: A double blind, placebo-controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 56(12), 1015–1025.PubMedCrossRefGoogle Scholar
  13. Dougherty, L. R., Smith, V. C., Bufferd, S. J., Carlson, G. A., Stringaris, A., Leibenluft, E., et al. (2014). DSM-5 disruptive mood dysregulation disorder: Correlates and predictors in young children. Psychological Medicine, 44(11), 2339–2350.PubMedPubMedCentralCrossRefGoogle Scholar
  14. Goldstein, B. I., Birmaher, B., Carlson, G. A., Delbello, M. P., Findling, R. L., Fristad, M., et al. (2017). The international society for bipolar disorders task force report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disorders, 19(7), 524–543.PubMedPubMedCentralCrossRefGoogle Scholar
  15. Grau, K., Plener, P. L., Hohmann, S., Fegert, J. M., Brähler, E., & Straub, J. (2017). Prevalence rate and course of symptoms of disruptive mood dysregulation disorder (DMDD). Zeitschrift fur Kinder-und Jugendpsychiatriie und Psychotherapie, 1–8.Google Scholar
  16. Faheem, S., Petti, V., & Mellos, G. (2017). Disruptive mood dysregulation disorder and its effect on bipolar disorder. Annals of Clinical Psychiatry, 29(2), 84–91.PubMedGoogle Scholar
  17. Findling, R. L., Chang, K., Robb, A., Foster, V. J., Horrigan, J., Krishen, A., et al. (2015). Adjunctive maintenance lamotrigine for pediatric bipolar I disorder: A placebo-controlled, randomized withdrawal study. Journal of the American Academy of Child and Adolescent Psychiatry, 54(12), 1020–1021.PubMedCrossRefGoogle Scholar
  18. Findling, R. L., Correll, C. U., Nyilas, M., Forbes, R. A., McQuade, R. D., Jin, N., … Carlson, G. A. (2013a). Aripiprazole for the treatment of pediatric bipolar I disorder: A 30-week, randomized placebo-controlled study. Bipolar Disorders, 15(2), 138–149.PubMedCrossRefGoogle Scholar
  19. Findling, R. L., Kafantaris, V., Pavuluri, M., McNamara, N. K., Frazier, J. A., Sikich, L., … & Taylor-Zapata, P. (2013b). Post-acute effectiveness of lithium in pediatric bipolar I disorder. Journal of child and adolescent psychopharmacology23(2), 80–90.Google Scholar
  20. Habibi, N., Dodangi, N., & Nazeri, A. (2017). Comparison of the effect of lithium plus quetiapine with lithium plus risperidone in children and adolescents with bipolar I disorder: A randomized clinical trial. Medical Journal of the Islamic Republic of Iran, 1–7.Google Scholar
  21. Joshi, G., Petty, C., Wozniak, J., Faraone, S., Spencer, A., Woodworth, K., et al. (2013). A prospective open-label trail of paliperidone monotherapy for the treatment of bipolar spectrum disorders in children and adolescents. Psychopharmacology (Berl), 227(3), 449–458.CrossRefGoogle Scholar
  22. Kowatch, R. A., Fristad, M., Birmaher, B., Wagner, K. D., Findling, R. L., & Hellander, M. (2005). Treatment guidelines for children and adolescents with bipolar disorder: Child psychiatric workgroup on bipolar disorder. Journal of American Academy of Children and Adolescent Psychiatry, 4, 213–235.Google Scholar
  23. Krieger, F. V., & Stringaris, A. (2013). Bipolar disorder and disruptive mood dysregulation in children and adolescents: Assessment, diagnosis and treatment. Evidenced Based Mental Health, 16, 93–94.CrossRefGoogle Scholar
  24. Lochman, J. E., Evans, S. C., Burke, J. D., Roberts, M. C., Fite, P. J., Reed, G. M., et al. (2015). An empirically based alternative to DSM-5’s disruptive mood dysregulation disorder for ICD-11. World Psychiatry, 14(1), 30–33.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Lytle, S. M., Moratschek, S. K., & Findling, R. L. (2015). Medical treatment strategies for young people with bipolar disorder. In S. M. Strakowski, M. P. DelBello, & C. M. Adler (Eds.), Bipolar disorder in youth: Presentation, treatment, and neurobiology (pp. 156–188). Oxford: Oxford University Press.Google Scholar
  26. Margulies, D. M., Weintraub, S., Basile, J., Grover, P. J., & Carson, G. A. (2012). Will disruptive mood dysregulation disorder reduce false diagnosis of bipolar disorder in children? Bipolar Disorders, 14, 488–496.PubMedCrossRefGoogle Scholar
  27. Masi, G., Milone, A., Madfredi, A., Brovedi, P., Pisano, S., & Muratori, P. (2016). Combined pharmacotherapy-multimodal psychotherapy in children with disruptive behavior disorders. Psychiatric Research, 238, 8–13.CrossRefGoogle Scholar
  28. Miklowitz, D. J. (2015). Psychotherapeutic strategies for treating youth with or at risk for bipolar disorder. In S. M. Strakowski, M. P. DelBello, & C. M. Adler (Eds.), Bipolar disorder in youth: Presentation, treatment, and neurobiology (pp. 189–204). Oxford: Oxford University Press.Google Scholar
  29. Nandagopal, J. J., Delbello, M. P., & Kowatch, R. (2009). Pharmacologic treatment of pediatric bipolar disorder. Child and Adolescent Psychiatric Clinic, 18, 455–469.CrossRefGoogle Scholar
  30. Parry, P. I., & Levin, E. C. (2012). Pediatric bipolar disorder in an era of “mindless psychiatry.” Journal of Trauma & Dissociation, 13, 51–68.Google Scholar
  31. Rao, U. (2014). DSM-5: Disruptive mood dysregulation disorder. Asian Journal of Psychiatry, 11, 119–123.PubMedCrossRefGoogle Scholar
  32. Rappaport, N., Kulick, D., & Phelps, L. (2013). Psychotropic medications: An update for school psychologists. Psychology in the Schools, 50(6), 589–600.Google Scholar
  33. Schneck, C. D., Chang, K. D., Singh, M. K., Delbello, M. P., & Miklowitz, D. J. (2017). A pharmacologic algorithm for youth who are at high risk for bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 27(9), 1–10.CrossRefGoogle Scholar
  34. Strakowski, S. M., DelBello, M. P., & Adler, C. M. (Eds.). (2015). Bipolar disorder in youth: Presentation, treatment, and neurobiology. Oxford: Oxford University Press.Google Scholar
  35. Stringaris, A., Vidal-Ribas, P., Brotman, M. A., & Leibenluft, E. (2017). Practitioner review: Definition, recognition, and treatment challenges of irritability in young people. Journal of Child Psychology & Psychiatry, 1–19.Google Scholar
  36. Tourian, L., LeBoeuf, A., Breton, J., Cohen, D., Gignac, M., Labelle, R., et al. (2014). Treatment options for the cardinal symptoms of disruptive mood dysregulation disorder. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 24(1), 41–54.Google Scholar
  37. Towbin, K. E., & Leibenluft, E. (2015). Differential diagnosis of bipolar disorder in children and youth. In S. M. Strakowski, M. P. DelBello, & C. M. Adler (Eds.), Bipolar disorder in youth: Presentation, treatment, and neurobiology (pp. 34–55). Oxford: Oxford University Press.Google Scholar
  38. Walkup, J. T., Wagner, K. D., Miller, L., Yenokyan, G., Luby, J. L., Joshi, P. T., … Sanyal, A. (2015). Treatment of early-age mania: outcomes for partial and nonresponders to initial treatment. Journal of the American Academy of Child & Adolescent Psychiatry54(12), 1008–1019.CrossRefGoogle Scholar
  39. Waxmonsky, J. G., Waschbusch, D. A., Belin, P., Li, T., Babocsai, L., Humphery, H., … & Mazzant, J. R. (2016). A randomized clinical trial of an integrative group therapy for children with severe mood dysregulation. Journal of the American Academy of Child & Adolescent Psychiatry55(3), 196–207.Google Scholar
  40. Waxmonsky, J. G., Wymbs, F. A., Pariseau, M. E., Belin, P. J., Waschbusch, D. A., Babocsai, L., … Pelham, W. E. (2013). A novel group therapy for children with ADHD and severe mood dysregulation. Journal of attention disorders17(6), 527–541.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Elizabeth C. Grier
    • 1
    Email author
  • Elizabeth H. Jeffords
    • 1
  • Kristen E. Dewey
    • 2
  1. 1.Independent Private PracticeColumbiaUSA
  2. 2.The Ohio State UniversityColumbusUSA

Personalised recommendations