Disruptive behavioral disorders are the most common preadolescent disorders in child psychiatry and behavioral pediatrics. Dr. Parry discusses the landscape, diagnosis, and treatment of disruptive mood dysregulation disorder (DMDD).
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Many clinicians are still unclear about how bipolar disorder got to be such a common diagnosis, most specifically in the United States. Dr. Carlson describes a historical perspective on bipolar disorder as a diagnosis in children.
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Atomoxetine was not originally included in that rogue’s gallery of medications, but since the drug was originally developed as an antidepressant, the FDA later reviewed its safety data. A post-hoc meta-analysis of placebo-controlled trials revealed an increased risk of suicidal thinking, and so atomoxetine was also slapped with a black box warning.
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Stimulants are fairly effective but tend to cause more side effects in autistic ADHD kids than in children with pure ADHD. Atomoxetine was only equivocally effective in one trial, and the immediate-release version of guanfacine was tested in a small open-label trial, resulting in improvement in about half the subjects.
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Chronically irritable children are not at increased risk to develop manic episodes as they age; instead, they are at increased risk for anxiety and unipolar depression later in life. Moreover, unlike children with bipolar disorder (BD), chronically irritable children do not tend to have unusually strong family histories of BD. Rather, there are both genetic and familial links between chronic irritability and unipolar depression.
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Dr. Joshua Feder studied mathematics and medicine at Boston University, Psychiatry at Naval Regional Medical Center San Diego, serving the first Gulf War in child and adolescent psychiatry fellowship at Tripler Army Medical Center in Honolulu, and eventually became Chief of Child Psychiatry at the National Naval Medical Center in Bethesda, MD. Dr. Feder now practices in Solana Beach, California, and serves as Executive Medical Director at Positive Development, providing relationship-based support for families, with research at UCSD, SDSU, Fielding Graduate University, An Najah National University, Quicksilver Software, Autism Is inclusion program, and Programmatic Lead for the International Networking Group on Peace Building with Young Children, with projects in the US, Northern Ireland, and the Middle East. Dr. Feder co-authored the first American Academy of Child & Adolescent Psychiatry Practice Parameter on Autism and serves as Co-Chair of the Disaster & Trauma Committee at AACAP. Dr Feder was founding policy chair for the California Association for Infant Mental Health and advocates worldwide on access to care, climate policy, and peacebuilding. His recent books include Child Medication Fact Book for Psychiatric Practice, Second Edition (2023) and Prescribing Psychotropics (2021).
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