Photo Credit: Marco VDM

The following is a summary of “Pediatric Attention-Deficit/Hypearativity Disorder and Disruptive Mood Dysregulation Disorder: Analyzing National Treatment Trends,” published in the January 2025 issue of Pediatrics by Baweja et al.

This study examines how a diagnosis of disruptive mood dysregulation disorder (DMDD) influences treatment selection and sequencing in children with attention-deficit/hyperactivity disorder (ADHD). Using a multicenter, population-based, retrospective cohort design, data were analyzed from the TriNetX Research Network spanning June 2013 through July 2024. The study cohort comprised 24,723 youth diagnosed with both ADHD and DMDD, while 6,31,295 youth with ADHD alone formed the control group. Associations were evaluated using ORs and relative risks.

Results indicate that children with ADHD and DMDD were more likely to identify as non-Hispanic and exhibited significantly higher rates of psychiatric comorbidities, inpatient admissions, emergency service utilization, and psychotherapy billing (ORs ranging from 1.25 to 6.95). The ADHD+DMDD cohort demonstrated an increased likelihood of receiving ADHD medications (ORs 1.55–4.80), as well as antidepressants, mood stabilizers, and antipsychotics (ORs 5.05–13.16). Racial and ethnic differences emerged in treatment utilization: Hispanic children with DMDD were more likely to receive psychotropic medications but less likely to access psychotherapy, while White children showed higher usage of both services.

Notably, prior to initiating non-ADHD medications for aggression, only 25% of ADHD+DMDD youth had documented psychotherapy, and merely 11% showed evidence of optimized ADHD medication regimens. Following a DMDD diagnosis, treatment rates for non-stimulant psychotropics, including antipsychotics and mood stabilizers, increased more significantly than those for central nervous system stimulants.

These findings suggest that a DMDD diagnosis in youth with ADHD is associated with broader and more intensive pharmacological and nonpharmacological treatment approaches, though patterns vary by race and ethnicity. Antipsychotics and mood stabilizers were frequently prescribed before psychotherapy or optimization of ADHD medications, highlighting potential gaps in care sequencing. Future research should explore these disparities and develop evidence-based strategies to identify optimal treatment pathways for youth with ADHD and DMDD, ensuring equitable and effective care.

Source: sciencedirect.com/science/article/abs/pii/S0022347625000113