Temper Dysregulation Disorder: Bad Temper, or Mental Illness?

Temper Tantrums Pushed as a New Disorder Called “Temper Dysregulation Disorder”

Severe outbursts grossly out of proportion to the situation, in the form of verbal rages or physical aggression, several times a week -- to moms and dads, these would seem the most common elements of childhood temper tantrums. They are also the proposed criteria for a new childhood mental disorder called Temper Dysregulation Disorder (TDD) with Dysphoria.

TDD is being recommended for inclusion in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, a massive catalogue of brain dysfunction now undergoing its first major revision in 16 years. It is considered the psychiatrists' bible of mental disorders. If accepted, TDD could soon become as entrenched in our vernacular as ADD.

TDD is being proposed as an alternative to the runaway diagnosis of childhood bipolar disorder. The number of kids being diagnosed with -- and medicated for -- bipolar disorder has shot up dramatically in the past decade, despite concerns that many don't meet the official criteria, but are getting the lifelong label nonetheless because of their explosive temper outbursts. The idea behind TDD is to create a less-severe diagnostic "home" for these kids.

The fear is that TDD could open the door to the diagnosis of any youngster with a bad temper, that it risks pathologizing a normal part of a youngster's development and could lead to wider prescribing of antipsychotics, antidepressants and mood stabilizers to kids, including preschoolers barely out of training pants.

It's an extremely significant move, and it's a very alarming. Infants and kids have meltdowns, regularly and routinely. It's a healthy expression of frustration. It's a very serious move to contemplate that as a bona fide mental illness, which is what they're very seriously proposing.

The over-diagnosis of bipolar has been a colossal embarrassment to the field. So they've tried to come up with another diagnosis that will somehow let you diagnose unruly kids. But maybe they're unruly, full stop.... To give them a psychiatric diagnosis and treat them with antipsychotics is insane.

But the research director for the task force writing the new edition of the DSM says the following:

“TDD isn't run-of-the mill temper tantrums. We're not talking about the temper tantrum of a two-year-old or a three-year-old who's not getting his way. We're talking about kids of age six or above who kind of have a hair-trigger, and really quite violent temper tantrums totally out of proportion to any kind of provocation that might have brought them on. Something out of the norm of what you would call a normal temper tantrum. And these are the kids who were receiving a diagnosis of bipolar disorder."

Here are the proposed criteria for TDD:

A. The disorder is characterized by severe recurrent temper outbursts in response to common stressors.
1. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.
2. The reaction is grossly out of proportion in intensity or duration to the situation or provocation.
3. The responses are inconsistent with developmental level.

B. Frequency: The temper outbursts occur, on average, three or more times per week.

C. Mood between temper outbursts:
1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).
2. The negative mood is observable by others (e.g., parents, teachers, peers).

D. Duration: Criteria A-C have been present for at least 12 months. Throughout that time, the person has never been without the symptoms of Criteria A-C for more than 3 months at a time.

E. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting.

F. Chronological age is at least 6 years (or equivalent developmental level).

G. The onset is before age 10 years.

H. In the past year, there has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day for most days, and the abnormally elevated or expansive mood was accompanied by the onset, or worsening, of three of the “B” criteria of mania (i.e., grandiosity or inflated self esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal directed activity, or excessive involvement in activities with a high potential for painful consequences). Abnormally elevated mood should be differentiated from developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation.

I. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder). (Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.) The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.

The syndrome captured by section A-C (frequent and intense temper outbursts, happening several times per week in the context of negative emotionality) is the core of the symptoms that has been incorrectly interpreted as indicative of childhood bipolar disorder. Section H is very interesting. It states that this diagnosis is not appropriate if the person has experienced classic mania (e.g., abnormally elevated or expansive mood), as in such a case the diagnosis of bipolar is likely more accurate.

Why did the DSM-V decide that this syndrome is not simply bipolar disorder of childhood?

1. Lack of continuity to bipolar. If TDD is simply the expression of bipolar disorder during childhood, then children diagnosed with this condition would eventually develop symptoms of classic bipolar disorder as they reach adulthood. The data do not support this hypothesis. That is, children who display the TDD syndrome in childhood (and are often incorrectly diagnosed as bipolar) are not more likely to develop classic bipolar disorder later in life as their peer. Instead, these children are more likely to develop depression, not bipolar!

2. Different Biological Markets. Youth who are diagnosed with classic bipolar differ significantly from those who have a TDD-like syndrome. If TDD is simply bipolar, then the biomarkers of TDD should be similar to those of bipolar, but this is not the case.

3. Different Demographic Factors. If TDD is simply bipolar, then the gender distribution of TDD should be similar to that of bipolar. This does not appear to be the case. Specifically, there is no gender differences in the rate of classic bipolar; male and females are equally likely to develop the condition. However, the TDD-like syndrome is disproportionately observed in boys rather than girls.

4. A need for a new category that would impact treatment and research. In theory, the presence of TDD will educate clinicians, researchers, and the public that this syndrome is not simply a version of bipolar disorder. This would facilitate research on the causes, features, and treatments for this condition. This has major implications for treatment. For example, the standard treatment for bipolar disorder does NOT seem to work in children that have the TDD syndrome. By explicitly stating that TDD is not bipolar, researchers would be less likely to approach the search for treatments from a “bipolar framework”, which would potentially facilitate the discovery of more effective interventions.

Of course there is no way to predict what practical effects creating the TDD category might have. Even if they are successful at changing the label that clinicians use, it could be that the children all get the same medications as before. But the difference is going to be that they won't have to take the medicine for the rest of their life.

TDD is a new term, but its characteristics are not new to research. In scientific papers, the disorder is referred to as “severe mood dysregulation” (SMD).

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Teens and Presciption Pills

Alcohol, tobacco and illegal drug use among adolescents may have declined over the past decade, but at least one abuse risk is on the rise: the prescription pill bottle. That’s because more children are using painkillers, drugs for ADHA (attention-deficit/hyperactivity disorder), antidepressants, and tranquilizers and sleep aids to get high.

One in five adolescents in grades 7 to 12 intentionally abused prescription drugs, according to a Partnership for a Drug-Free America study. Children assume pharmaceuticals are safe because they’re medicine. But prescription drugs can be just as addictive and deadly as street drugs and are easier to obtain.

The top three ways teenagers report getting pills are through parents’ and friends’ medicine cabinets, someone else’ medications and online sites that don’t require a doctor’s prescription.

Signs of abuse include extreme changes in behavior and a dramatic decline in grades.

So be sure to limit access to medicines by disposing of drugs you’re not using, keeping prescriptions out of easily accessible areas, and monitoring the Web sites your adolescent visits.

My Out-of-Control Teen

Texting Teens and Sleep Deprivation

"My teenage son is not getting up on time for school due to being up most of the night texting his g-friend. Any advice?"

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=> My Out-of-Control Teen: Help for Parents

15-Year-Old Daughter Having Sex with 20-Year-Old Man

My youngest daughter just turned 15 today. While having lunch with my older daughter, who is 23 and living outside of our home, she told us that our 15 year-old had confessed to her that she lost her virginity to a 20 year-old man who often goes to a library activity that she attends each Thursday.

Her dad and I have not liked the library situation for a long time, but have continued to allow her to go (with an attempt to monitor her by having 1 of us there most of the time for the 3 hours that she's there) because older kids hang out around there plus there have been fights and other things that we have not liked. The reason we've continued to allow her to go is because she seems to love it so much. She's homeschooled, so she doesn't think she gets enough socialization and has gone out of her way to "fit in" with the other kids/young adults by giving up a lot of the stuff that she used to love, but will do just about anything to go each Thursday.

Obviously, we want her to be happy, but, especially with this latest revelation from our older daughter, it's time for us to take some kind of action. What would you advise about this? Our older daughter swore us to secrecy and I want her to have a friend to talk to (who better than a sister?), but we need to protect her from these older kids who are bad influences. This guy that she was with before contacted her on Facebook today, saying he wants her back.

She has violent mood swings, which makes her difficult to deal with and I want to handle things properly so that she doesn't hurt herself or run away or anything. This girl is so smart and so capable and has so much potential and we love her dearly. My older daughter offered to take her to Planned Parenthood for birth control pills, but that certainly doesn't take care of diseases or our other concerns plus I'm not sure how I could pretend that I didn't know about the birth control if she leaves it out like she does just about everything else. How should I react in such a situation or should I take her myself? She's already talked about taking the pills for clearing her complexion, so what would be better?

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==> My Out-of-Control Teen: Help for Parents

Son's Phone Messages Reveal Disturbing Behavior

Hi Mark, Need some help… was scrolling through my son’s phone messages… he left his phone unlocked… I know it’s a breach of privacy, but see he has been smoking, not cigarettes, and he and friends arranging between themselves… not sure how to handle it and what to do say. If raise the issue - he will know I’ve been through his phone. If I ignore - he is getting away with it… am in a quandary. ~ A.

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Why do some adolescents hate Math and Science?

It is a known fact that, as kids grow into teens, they gradually lose their natural curiosity and inquisitiveness. Their diminishing love for the unknown coupled with the much harder high school curriculum, can then be attributed to their subsequent hatred for Mathematics and Science.

Although most of these adolescents haven't realized it yet, this is a very alarming situation. It is important for these young people to understand that Mathematics and Science form the very foundation which holds this world together. Therefore it is imperative to point out what the main reasons are behind the continued dislike for these analytical subjects and then provide solutions for such:

(1) They are boring subjects.

Mathematics and Science, with all its formulas and theories can easily alienate young minds. It's wrong to believe that Mathematics and Science don't promote creativity/stimulate the imagination as much as the other subjects like English and Social Studies. In fact, that's the core of these subjects, Science more than anything: Imagination. They are only bounded by what the teenager can fathom.

It is therefore necessary for educators to make these subjects less boring for the teens. If a teacher is armed only with bland Powerpoint presentations and yawn-inducing lectures, there's no surprise that teens will hate the teacher as well as the subject. There should always be room for "fun" even if the subject matter isn't fun in the first place. Most twenty-somethings would usually remember the educators who make a mark on their lives. It would be really nice to hear about successful men and women who can associate their success with their high school Mathematics/Science teacher.

(2) They are attributed with nerds/geeks.

This crude teenage social system is pretty much still common even at this day and age. Look at it this way, the cooler kids with their cars and their pool parties will never dare to be seen with the Science nerds and the Mathematics geeks. Such primitive conduct is simply atrocious!

As an old bumper sticker said: "Mathematics is radical!"

The false belief of being un-cool when you excel in such subjects as Mathematics and Science needs to stop right now. Sure, they may be looked upon as "pariahs" in the teenage society, but these nerds and geeks are the future multi-millionaires of their generation. Moms and dads as well as educators should promote such advocacy – that teens should stand up with their head held high and be proud if they love Mathematics and Science. Wouldn't it be like Millhouse's Utopia if there were Jocks who are also Calculus geniuses or Homecoming Queens who dabble in Organic Chemistry? Or maybe this geek is just stuck in a daydream.

(3) They are difficult to understand.

The thing that separates Mathematics and Science from the rest of the subjects in school is their difficulty. The inability to master the equation for a certain chemical reaction or the formula for a multi-step problem can take a toll on even the brightest minds. You can seldom spot a teenager who flunks English or History, except if they find the tedious task of submitting long essays/reports.

One can easily combat this difficulty with constant practice. It may sound like an old record, but just like sports, Mathematics and Science is no different: Practice indeed makes perfect. When a hard Mathematics problem is encountered, the teenager should always see to it that he/she can understand the theory behind the problem and then solve it step-by-step. Provided that the "boring factor" is already eliminated, then the teenager, whether he is not equipped with the analytic brain required for such subjects, can tough it out just through practice, sheer determination, practice, drive to succeed, and even more practice.

I leave you with a quote by John Louis von Neumann: "If people do not believe that Mathematics is simple, it is only because they do not realize how complicated life is."

(4) Some of these subjects can't be used in day-to-day life.

This statement is completely and utterly FALSE! Even the most minor area of the Sciences is used in everyday living.

As stated earlier, Mathematics and Science comprises the very foundation the world in general is standing on. Business, social structures, even politics has their roots on Mathematics and Science. To completely disregard its importance as a core subject taught in schools is a big no-no. Teens, as young as they are, should come to the realization that they will need these subjects as they go on with their lives, whether they apply to university or not. To understand such concept, one must again rely on the creativity and passion of the teenager's Mathematics/Science teacher. If they can make their teens understand, then such false statements will never enter their heads.

As a conclusion allow me to say that Mathematics and Science should never be looked upon as subjects that make your life difficult. For what it's worth, they're the ones who will make your life simpler and easier.

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Parents' Troubleshooting Guide for Teen Behavior Issues

Is your adolescent rebelling, defying your curfew, or hanging out with questionable kids? Here's how to nip behavior problems in the bud:

To be fair, no one has ever pretended that parenting an adolescent was going to be easy. Still, until your own kids reach that stage, it's tempting to believe your family will be immune to teen behavior problems. No, you tell yourself, your adolescent will never talk back, stay out too late or pierce her eyebrow. Dream on...

Adolescents are basically hard-wired to butt heads with their moms and dads. Adolescence is a time of rapid change for kids both physically and cognitively. It's the task of the adolescent to fire their moms and dads and then re-hire them years later, but as consultants rather than managers. But that doesn't mean you have to take it lying down. With the right approach, you can troubleshoot the following teen behavior problems in a relatively civilized fashion.

Behavior Problem 1:

Your Teen Seems To Hate You—

One minute your sweet youngster is begging you to come on the class trip or to lie down with her while she falls asleep. Then, seemingly overnight, she starts treating you like dirt, discounting everything you say and snickering at your suggestions. If you look closely, you'll see that you've been through this before, when she was a toddler -- only instead of shouting "no!" like a two-year-old would, an adolescent simply rolls her eyes in disgust.

It's so hard for moms and dads when this happens. But part of adolescence is about separating and individuating, and many kids need to reject their moms and dads in order to find their own identities. Teens focus on their friends more than on their families, which is normal too.

Your Solution—

Sometimes moms and dads feel so hurt by their teens' treatment that they respond by returning the rejection -- which is a mistake. Adolescents know that they still need their moms and dads even if they can't admit it. The roller-coaster they put you on is also the one they're feeling internally. As the parent, you need to stay calm and try to weather this teenage rebellion phase, which usually passes by the time a youngster is 16 or 17.

But no one's saying your teen should be allowed to be truly nasty or to curse at you. When this happens, you have to enforce basic behavior standards. One solution is the good, old-fashioned approach of: "If you can't say something nice, don't say anything at all." By letting your adolescent know that you're here for him no matter what, you make it more likely that he'll let down his guard and confide in you once in a while, which is a rare treat.

Behavior Problem 2:

Communication Devices Rule Their Lives—

It's ironic that teenage forms of communication like IM-ing, text-messaging and talking on cell phones make them less communicative, at least with the people they live with. In today's world, though, forbidding all use of electronic devices is not only unrealistic, but unkind. Being networked with their friends is critical to most teens.

Your Solution—

Look at the big picture. If your youngster is functioning well in school, doing his chores at home and not completely retreating from family life, it's probably best to "lay off." It's also OK to set reasonable limits, such as no "texting" or cell phone calls during dinner. Some moms and dads prefer not to let teens have computers in their rooms, since it makes it harder to supervise computer usage, and this is perfectly reasonable. Many experts also suggest establishing a rule that the computer has to be off at least one hour before bedtime, as a way to ensure that teens get more sleep.

One good way to limit how many minutes your teen spends talking on his cell and texting: Require him to pay his own cell phone bills. And do your best to monitor what your youngster does when he's online, particularly if he is using networking sites like Facebook. You still own the home and computer -- so check into parental Internet controls and software to monitor use of any questionable web sites.

Behavior Problem 3:

Staying Out Too Late—

It's 10:30 p.m. and you told your daughter to be home by 10 p.m. Why does she ignore your curfew again and again? Part of what teens do is test limits. But the fact is that they actually want limits, so moms and dads need to keep setting them.

Your Solution—

Do some research before insisting that your youngster respect your curfew because it's possible that yours is unreasonable. Call a few parents of your teen's friends and find out when they expect their kids home. I suggest giving kids a 10-minute grace period, and if they defy that, to set consequences -- such as no going out at night for a week.

If it seems like your youngster is staying out late because she's up to no good, or doesn't feel happy at home, then you need to talk with her and figure out what might be going on. However, if your curfew is in line with what what's typical in your teen's crowd, then it's time to set consequences and then enforce them if your teen continues to break your rules. When you make a rule, you have to mean it. You can't bluff adolescents -- they will always call you on it.

Behavior Problem 4:

Hanging Out with Kids You Don't Like—

You wince every time your son blasts through the front door with his greasy-haired, noisy buddies. Should you suck it up, or say something?

Your Solution—

Kids can wear weird clothes, pierce their lips, act rudely and still be decent kids. Moms and dads should hold off on criticizing something as superficial as fashion in their kids' friends. Adolescents are so attached to their friends that it's like criticizing them directly.

On the other hand, if you know that your youngster has taken up with a group of troubled teens who skip school and do drugs, a talk is in order. Without putting him on the defensive, tell your youngster you're concerned about who he's hanging out with and that you're worried he's doing drugs. While you can't forbid your youngster to hang around with certain kids, you can intervene and try to nip dangerous behaviors in the bud. Don't be afraid to ask for professional help about hanging out with a crowd engaged in negative behavior. Counseling or family therapy can help.

Behavior Problem 5:

Everything's a Drama—

Every little thing seems to set your daughter off lately, and the more you try to help, the more she sobs or shouts or slams the door. Part of being an adolescent is feeling things intensely, so what may seem like no big deal to you is hugely important to her.

Your Solution—

Moms and dads tend to trivialize the importance of things in adolescents' lives. What happens is that kids feel misunderstood, and eventually they will stop telling you anything. Right now it is the most important thing in the world that her best friend is flirting with her boyfriend, and you need to take it seriously.

Don't offer advice, disparage her friends or try to minimize it by saying that one day she'll see how silly high school romances are. Just listen and sympathize. And put yourself in her position -- because, after all, you were once there yourself.

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How do I get my over-achieving daughter to slow down?

"I have taken the quiz and surprisingly found that I was a severely over indulgent parent. This angers me because I didn't think...