February 7th, 2007
Posted By:
Categories: Disorders, Psychiatry

Not that any of us confused parents need another addition to the alphabet soup of potential diagnoses for our “combo platter” kids…but, the National Institute of Mental Health (NIMH) released a most interesting report last week of a study that may be the start of distinguishing pediatric Bipolar Disorder (BD) from another, similar disorder – Severe Mood Dysregulation (SMD).

Researchers at NIMH compared the EEGs of children with BD and those believed to have SMD, and found that they have surprisingly different electrical patterns. This leads researchers to believe that these two disorders may need to be treated very differently.

If you’re like me, SMD is a new one. I searched and found little information out there, except that is was only recently defined and is often treated like BD. This caught my attention, because five years ago LuLu had her first QEEG. I took it, along with another done the following year, to our psychiatrist when we finally acquiesced and began to explore medication options. Our psychiatrist very clearly told me that LuLu had a severely dysregulated electrical pattern, BUT, that she did not have Bipolar Disorder. However, much of her medication regime is similar to that of people with BD.


So what is SMD? It shares many of the same symptoms as BD, except the clear-cut manic episodes are not there. Irritability, hyperactivity, low tolerance of frustration are hallmark symptoms of SMD. Inability to sleep is another symptom. It’s that “frustration provoked by goal-oriented tasks” that has my attention. Rages and temper tantrums in more than one setting (i.e. home and school) was also mentioned. Hmmm…

The interesting thing is that researchers believe that SMD occurs at a higher rate in children than BD. They estimate that 3% of the population has SMD. Violent outbursts (both physical and verbal) are common, as are chronic negative moods and rages. The hereditary factors of BD don’t seem to be there in SMD. I found another research paper saying that the vast majority of children with SMD have been diagnosed as the ADHD/ODD. Hmmm…

The NIMH study involved children doing a task in which they lost money if they were unable to do it – increasing their frustration. The EEGs found that different parts of the brain were activated during the frustration in children with BD vs. SMD. This may lead to different treatments and medications being used for each disorder.

I gotta tell you that I’m easily frustrated (probably you are too) that no professional has a handle on what our “combo platter” children truly have — or what to do about it. As a mom, I want answers and I want them NOW!

But, I’m encouraged by studies such as this one. Here’s why:

The new study shows that clinicians some day could use biological measurements, such as EEGs, to help make psychiatric diagnoses, in combination with clinical symptoms. Currently, clinicians diagnose
mental illnesses based on symptoms alone. The difficulty of diagnosing BD in children is compounded by the frequent co-occurrence of one or more other mental disorders.

“We’re approaching the day when we’ll be able to use neuroscience techniques to improve psychiatric diagnoses. Pediatric BD has some of the most pressing needs in this regard, because of its severity and
because of questions about how to best make the diagnosis,” said senior author Ellen Leibenluft, M.D., Chief of the Unit on Bipolar Spectrum Disorders in the Emotion and Development Branch of the NIMH Mood and
Anxiety Disorders Research Program.

This confirms my theory that someday all psychiatric disorders will have an identifiable neurological “pattern” that can be seen on EEGs or other type of brain mapping tools. And that neurologists and psychiatrists will figure out how to intervene biochemically or neurodevelopmentally to help change these patterns.

But the science isn’t there yet. So, parents of “combo platter” kids do the best we can. I talk to parents all the time who are trying to figure out if their child has BD or not. They have all the diagnoses – ADHD, ODD, CD, BD, and in our adoptive/foster world PTSD/RAD. Their doctors are trying to figure out if they have BD or not. I bristle when people (professionals or parents) make absolute statements – ones like all our kids really have BD because RAD doesn’t exist or ADHD isn’t real or certain diagnoses can’t co-exist with others. The truth is that NOBODY KNOWS – not definitively. Diagnosis of mental illnesses are based on symptoms. Sadly, observation of symptoms and trial and error of treatments is really are the only way – for now….

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16 Responses to “Severe Mood Dysregulation (SMD)”

  1. Kelly says:

    Wow, this fits my kiddo much better than Bi-Polar. His “manic” episodes have always been violent. We’ve never had a truly happy, upbeat, euphoric kid.

    It will be interesting to see where this goes.

  2. vivianjean says:

    Same here. This is fascinating.

  3. very interesting, thank you so much for sharing this!

  4. Heidi says:

    Thanks for sharing this. I find it fascinating and wonder if my child has this instead of BD. His mania starts out giggly and silly sometimes, but for the most part his mania is just angry and irritable any time he isn’t regulated well by meds. I’ll have to chat with his psych. about this.

  5. Heidi says:

    I just thought of something else. I love your “combo platter” description as it fits my son to a T. What I would like to know is how on earth we ended up with the combo platter when all I originally ordered for him was the Happy Meal?

  6. Julie says:

    Heidi –

    I LOVE IT!!!! May I quote it?????

  7. Heidi says:

    Yes, you may quote me on that. It hit me while my son was having a miserable day the other day and I all I could think of was “what would it take for you to be happy?”

  8. magimkmom says:

    Hey, I ran across this blog in my search to find out more about SMD. My 12 year old son was just diagnosed with this, yesterday. I have been convinced a a couple of years now that he struggled with RAD type problems but in my research discovered that a kiddo could be suffering from more than one disorder. Anyhow, the way the I understood the Psychiatrist to explain SMD as opposed BD is that it is like Bipolar only there is no good periods. This definately explains my son who has never been happy. I had already come to terms with the fact that I could never love my son to being a whole and happy person. If I may convey to you, please never stop looking for help and answers for your kiddos. The Doc told us that without treatment, he will most likely continue to get worse. My son has not just treatened myself and our two younger children, he has also been arrested for hurting a female classmate. Get help and never give up!

  9. yelorose says:

    At the request of my 14 yr olds psychiatrist I searched for SMD and found this blog. I too like many pre diagnosed her with BD along with several other people and was to say the least shocked to hear about SMD. She has never really had “manic” episodes, more anxiety and mood swings. Also, there has been for several years a strong sexual obsession, ie: sneaking on the computer and searching for pornography, sexting, etc. In what little reading I’ve done since her appt with the psychiatrist I’ve not seen anything mentioned about the sexual obsession (which as a mother, really concerns me). I recognize a lot of the other signs and symptoms mentioned here but was wondering if anyone else has the sexual issue with their children? By the way, Magimkmom I agree with you…NEVER GIVE UP….

  10. momad says:

    My son is in this NIMH study. It’s been very helpful for us to be on the cutting edge of this science. Hasn’t made it easier, but has helped in subtle ways.

  11. missm says:

    I am so happy to have found this blog of fellow SMD parents. I have read all the comments but don’t see any mention of medications. Does anyone have experience with meds for SMD? What about improvement from any other form of treatment?

    My daughter has just started on medication, but it hasn’t been long enough to take effect yet. I am hoping so hard…

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