Beyond Autism: What Is DMDD?
It’s Not Just “Part of the Autism”
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When our son, L, was first diagnosed with autism, I thought I had the roadmap. I already had a child with autism. It couldn’t be that different, could it? I thought I knew what having two kids with autism would look like.
But as L grew, something else started to emerge, something that didn’t fit the autism I was familiar with. It wasn’t just social confusion or repetitive behaviors; it was a level of chronic, explosive irritability that felt like living in the path of a constant storm.
For a long time, we just assumed it was part of his more “severe” type of autism. We were wrong. We eventually learned that L was fighting a second battle: Disruptive Mood Dysregulation Disorder (DMDD).
So, What Is DMDD?
If you’ve never heard of it, you aren’t alone. DMDD is a relatively new diagnosis, and it’s often the “missing piece” for parents who feel like their child is perpetually angry or “on edge.”
Unlike the meltdowns we see in autism (which are often about sensory overload or communication frustration), DMDD is about mood.
- The Hallmark: Severe, frequent temper outbursts (verbal or physical) that are way out of proportion to the situation.
- The “In-Between”: This is the part that exhausts parents. Between the big explosions, the child’s “baseline” isn’t calm. It’s irritable or angry nearly every day. You’re just waiting for the next outburst.
DMDD vs. Bipolar: The Big Difference
When we first took L to a psychiatrist at age 6, they initially suspected Bipolar Disorder. It makes sense—the moods are so intense. But he was very young, so they did not finalize his diagnosis for two years. After many appointments and different medication therapies, he ultimately was diagnosed with DMDD.
Bipolar involves “episodes”—high highs (mania) and low lows (depression). DMDD is persistent. There are no “high” periods. It is a steady, chronic state of irritability. Knowing this distinction changed everything for us because the way you treat Bipolar is very different from how you help a child with DMDD.
The “Medication Rollercoaster” (And why we stopped judging)
If you read my last post, you know I used to be the “I’ll never medicate” parent. DMDD changed that. I still remember the day I walked into L’s pediatrician office crying because he had spit his yogurt at me. Such a little thing, but it was only the tipping point. It had been a very long day of screams and defiance. He was barely six, and I finally had to admit to myself that he needed more help than we could give naturally. That was a hard day.
Navigating medications for a child who has autism, insomnia, and DMDD feels like trying to solve a Rubik’s cube in the dark. One pill helps the rage but makes him a zombie. Another helps him sleep but makes the irritability skyrocket. When you finally get the combo right, he goes through a growth spurt, and the meds need adjusting again. It is a trial-and-error process even now, 10 years later, as we navigate the changes that come with puberty and hormones.
But we’ve learned that medication isn’t a failure—it’s a tool for survival. It’s about giving L’s brain enough quiet so that he can actually learn the coping skills we’re trying to teach him.
Parenting From the Trenches
Parenting a child with DMDD requires a “thick skin” and a very specific set of skills. You have to become a detective, looking for triggers before the storm hits. We started keeping a detailed mood tracker and planner to bring to doctor appointments, which helped us answer questions about the frequency and reason behind mood shifts.
We also made sure his “calm down corner” was stocked with weighted blankets and noise canceling headphones to help him regulate. When we begin to notice he is escalating, we try to direct him there. Does it work every time? No. But it’s another tool that helps.
As a teacher, I see these kids in my classroom, too. I see the “difficult” student who is actually just a child whose brain is stuck in a state of high alert. It has made me a better educator, and it’s one of the reasons why I created Our Autism Village.
You Aren’t Alone in the Storm
If your child’s rage feels “different” than typical autism meltdowns—if you feel like you’re walking on eggshells in your own home—please know that you aren’t “bad” at this. You might just be dealing with a diagnosis you didn’t know existed.
We are still learning. We still have bad nights. But understanding that L isn’t trying to be difficult—that his brain is literally struggling to regulate his mood—allows us to respond with a little more grace (and a lot more caffeine).
Disclaimer: I am a mother and an educator sharing our personal journey and what has worked for our family. I am not a doctor, psychiatrist, or licensed therapist. The content on Our Autism Village is for informational and educational purposes only and should not be taken as medical advice. Always consult with a qualified healthcare professional regarding any medical condition or treatment plan for your child.
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