Elsevier

Biological Psychiatry

Volume 60, Issue 9, 1 November 2006, Pages 991-997
Biological Psychiatry

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

https://doi.org/10.1016/j.biopsych.2006.08.042Get rights and content

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.

Section snippets

Subjects and Procedures

The GSMS is an ongoing, 15-year longitudinal population study of psychiatric disorders. Procedures were approved by the Institutional Review Board of the Duke University Medical Center. As reviewed by Costello et al (1996), a multistep probability sampling procedure was used. First, a representative sample of three cohorts of children ages 9, 11, and 13 was identified in 11 counties in western North Carolina. Then, a screening questionnaire, derived from the “externalizing” scale of the Child

Question 1: Prevalence of SMD

In the sample of 1420 youth, 96 met criteria for SMD at one or more waves, indicating a weighted lifetime prevalence of 3.3% in children ages 9–19 years old. Of the entire SMD sample (n = 96), most children were Caucasian (93.3%) and male (77.6%), with a mean age of 11.7 ± 2.1 when first meeting SMD criteria (Table 2). Approximately one-half (n = 54, weighted 49.1%) with SMD met criteria in the first wave (mean age 10.6 ± 1.4 years). Most SMD youth (82.5%) met SMD criteria in only one wave;

Discussion

A syndrome of severe, chronic irritability and hyperarousal (severe mood dysregulation, or SMD) has been recognized as a common problem in clinical settings. However, it remains unclear how to categorize children with this presentation. Specifically, the prevalence, clinical characteristics, and relationship to later psychiatric disorders have not received systematic study. Whereas most research on pediatric bipolar phenotypes relies on clinical samples, it is vital to extend this work to

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