Prevalence, Clinical Correlates, and Longitudinal Course of Severe Mood Dysregulation in Children

Brotman, Melissa A.; Schmajuk, Mariana; Rich, Brendan A.; Dickstein, Daniel P.; Guyer, Amanda E.; Costello, E. Jane; Egger, Helen L.; Angold, Adrian; Pine, Daniel S.; Leibenluft, Ellen

doi:10.1016/j.biopsych.2006.08.042

« Previous Next »Biological Psychiatry
Volume 60, Issue 9 , Pages 991-997, 1 November 2006

Prevalence, Clinical Correlates, and Longitudinal Course of Severe Mood Dysregulation in Children

Melissa A. Brotman
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
- Address reprint requests to Melissa A. Brotman, PhD, National Institute of Mental Health, Mood and Anxiety Disorders Program, 15K North Drive, Room 208, Bethesda, MD 20892
Mariana Schmajuk
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
Brendan A. Rich
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
Daniel P. Dickstein
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
Amanda E. Guyer
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
E. Jane Costello
- Developmental Epidemiology Program, Duke University Medical Center, Durham, North Carolina.
Helen L. Egger
- Developmental Epidemiology Program, Duke University Medical Center, Durham, North Carolina.
Adrian Angold
- Developmental Epidemiology Program, Duke University Medical Center, Durham, North Carolina.
Daniel S. Pine
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
Ellen Leibenluft
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland

Received 20 December 2005; received in revised form 9 June 2006; accepted 31 August 2006.

Background

Controversy concerning the diagnosis of pediatric bipolar disorder (BD) has focused attention on children with chronic irritability and hyperarousal. This syndrome has been called the “broad BD phenotype” or severe mood dysregulation (SMD). This study examines prevalence, concurrent Axis I diagnoses, and longitudinal outcome of SMD in an epidemiologic sample.

Methods

Data were drawn from the Great Smoky Mountains Study, a longitudinal epidemiological study. Items from the Child and Adolescent Psychiatric Assessment were used to generate SMD criteria.

Results

Among 1420 children, the lifetime prevalence of SMD in children ages 9–19 was 3.3%. Most (67.7%) SMD youth had an Axis I diagnosis, most commonly attention-deficit/hyperactivity disorder (26.9%), conduct disorder (25.9%), and/or oppositional defiant disorder (24.5%). In young adulthood (mean age 18.3 ± 2.1 years), youth who met criteria for SMD in the first wave (mean age 10.6 ± 1.4 years) were significantly more likely to be diagnosed with a depressive disorder (odds ratio 7.2, confidence interval 1.3–38.8, p = .02) than youth who never met criteria for SMD.

Conclusions

Severe mood dysregulation is relatively common in childhood and predicts risk for early adulthood depressive disorders. Research should continue to explore the course of illness in children with SMD.

Key Words: Bipolar disorder, children, prevalence, depression, irritability, ADHD