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Tantrums and Meltdowns – but the child is not a toddler! (DMDD)

We all know that tantrums and meltdowns are normal development in children’s behaviour. However, we don’t expect our children to be having them at 8, 9, 10 years old or, more do we? So, what causes this sort of behaviour? It can be a sign of DMDD (Disruptive Mood Dysregulation Disorder.) It means that the child cannot manage their emotions and their behaviour and behave like a much younger child.

Children who are struggling with DMDD have usually had difficulty from infancy – not being able to regulate their emotions or to “self soothe”. As toddlers and young children, they may have been really strong-willed and quite difficult to manage.

One of my clients, the mum of an 11 year- old said: “My daughter is 11 years old but has full-blown tantrums and meltdowns that I would expect from a two or three- year old! She slams doors, shouts, screams, cries and lays on the floor at times and bangs her head! Not only is it frightening for us as parents to watch but we feel like we cant ever tell her off or say “ NO” to her for fear of setting her off so it has become a vicious circle!”

So, What Causes it?

These children have huge emotions, but they can’t control them. They are sensitive so they feel these emotions much more than normal. Sadly, they have no self -regulating skills so when it starts, they don’t know how to slow it down or stop the explosion! One of the other reasons is that these children sometimes have great difficulty in reading other people’s facial expressions. They tend to read faces in quite a negative way so they may be thinking that that person is judgemental, so they react by playing up and then it turns into a meltdown.

This is NOT Autistic Spectrum Disorder

Children on the Autistic Spectrum often don’t respond to facial expressions at all, but children with DMDD respond, but they misinterpret them. For example, a child with DMDD may think that his teacher is angry with him because she didn’t have a big smile on her face when she said good morning to him. So, he will start to feel uncomfortable.

What’s the Difference between ODD and DMDD?

Occasionally people confuse DMDD with ODD (Oppositional Defiant Disorder) usually because some of the symptoms are very similar. However, a child with DMDD is NOT being oppositional and defiant – he simply just cannot regulate his emotions. A child with DMDD will very often apologise after his meltdown whereas a child with ODD won’t see that he has done anything out of the ordinary! That’s the difference!

The Diagnosis

When the Psychiatrist diagnoses a child with DMDD he will look for:

  • Outbursts or meltdowns that are occurring at least 2 or 3 times a week

  • The mood in-between the outbursts is usually irritable and there is a lot of moodiness

  • Symptoms have been going on for a good 12 months

  • The onset of symptoms would

  • Severe temper tantrums, both verbal and physical

  • The meltdowns are inappropriate to the child’s age

  • The child must be over 6 years old and under 18

Children under the age of 6 are still likely to have tantrums and outbursts – it’s a normal part of a child’s natural development, however the parent may well have noticed that their child’s behaviour is not “ normal” especially if this is not their firstborn child.

Children with DMDD are often initially diagnosed with ADHD or an anxiety disorder but its only when a medical professional looks at all aspects of the child’s behaviour that they can see that perhaps they have been misdiagnosed.

So, What Happens When the Child Becomes an Adult?

Usually, the symptoms of DMDD change over time, a lot depending on the child’s upbringing and environment. The tantrums may continue into secondary school but as the child grows up the outbursts will become less physical and aggressive.

What is the Treatment for DMDD?

The idea is really to teach the child how to regulate their emotions and mood. Cognitive behaviour and Hypnotherapy are excellent therapies for DMDD.


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