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Missing the forest for the trees? A high rate of motor and language impairments in Disruptive Mood Dysregulation Disorder in a chart review of inpatient adolescents

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Abstract

Youths with severe and persistent irritability have a particularly high rate of school failures and learning difficulties. The aim of this study was to determine whether inpatient adolescents with Disruptive Mood Dysregulation Disorder (DMDD) have more motor and/or language impairments compared to patients with other psychiatric disorders. A retrospective chart review of all consecutive cases admitted in two adolescent inpatient units between January 2017 and December 2018 was conducted (N = 191). All patients received multi-disciplinary clinical and developmental assessments. For a subtest of subjects, additional standardized tests were used to document motor and language impairments. In this clinical chart 53 adolescents with a DMDD (mean age 13.6 ± 1.5, min 12, max 16, 70% males) were compared to patients with a major depressive disorder (MDD, n = 64, mean age 15.3 ± 1.6, 52% males) and patients with a non-mood disorder (NMD, n = 61, mean age 14.4 ± 1.55, 59% males). Among inpatients with DMDD, 71% had an associated motor and/or language disorder, with combined forms in around two-thirds of cases. Compared to youths with MDD, participants with DMDD were more likely to have an associated developmental coordination disorder (67% vs. 22%, OR = 4.7) and a written language disorder (35% vs. 10%, OR = 4.6). While 31% of inpatients with DMDD had an associated communication/oral language disorder, this rate was not statistically different from those observed in the MDD group (11%, OR = 3.2). The frequencies of motor and language impairments were not statistically different between participants in the DMDD group and in the NMD group. The high rate of motor and written language disorders found in DMDD patients may partly account for their academic difficulties. Such finding, if confirmed, supports systematic screening of motor and written language impairments in youths with chronic irritability and suggests remediation potential.

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Abbreviations

DMDD:

Disruptive mood dysregulation disorder

BD:

Bipolar disorder

AD:

Adjustment disorder

PTSD:

Post-traumatic stress disorder

ADHD:

Attention deficit hyperactivity disorder

DBD:

Disruptive behavioral disorder

TS:

Tourette syndrome

BPD:

Brief psychotic disorder

ID:

Intellectual disability

ASD:

Autistic spectrum disorder

CGAS:

Children-global assessment scale

CGI-S:

Clinical global impressions–severity

CGI-I:

Clinical global impressions–improvement

WISC-IV:

Wechsler Intelligence Scale for Children—Fourth Edition

WISC-V:

Wechsler Intelligence Scale for Children—Fifth Edition

MABC-2:

Movement Assessment Battery for Children 2nd edition

EMG:

Manual and digital gnosopraxia test

DTVP-2:

Developmental test of visual perception 2nd edition

BHK-ado:

Brief assessment of writing skill in adolescent

EMA:

Evaluation des Fonctions cognitives et des Apprentissages

PPVT:

Peabody picture vocabulary test

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Acknowledgements

I thank Mr. Pierre Morales, Dr. Cora Cravero and all medical secretaries who kindly helped to provide the necessary data for this analysis.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054, Amiens, France

    Xavier Benarous & Jean-Marc Guilé

  2. Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France

    Xavier Benarous, Cosmin Iancu, Angèle Consoli & David Cohen

  3. INSERM U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardie- Jules Verne (UPJV), Amiens, France

    Xavier Benarous & Jean-Marc Guilé

  4. Department of Psychiatry, McGill University, Montreal, Canada

    Jean-Marc Guilé

  5. Group of Clinical Research-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Sorbonne University, Paris, France

    Angèle Consoli

  6. UMR 7222, Institute for Intelligent Systems and Robotics, CNRS, Sorbonnes Université, Paris, France

    David Cohen

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  1. Xavier Benarous
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Correspondence to Xavier Benarous.

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Benarous, X., Iancu, C., Guilé, JM. et al. Missing the forest for the trees? A high rate of motor and language impairments in Disruptive Mood Dysregulation Disorder in a chart review of inpatient adolescents. Eur Child Adolesc Psychiatry 30, 1579–1590 (2021). https://doi.org/10.1007/s00787-020-01636-y

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