Table 1.

Criteria for Severe Mood Dysregulation

A. Inclusion criteria: Current age 7–17 years, with onset of the syndrome before age 12. Abnormal mood (specifically, anger or sadness), present at least half of the day most days, and of sufficient severity to be noticeable by people in the child’s environment (e.g., parents, teachers, peers). Hyperarousal, defined by at least three of the following: insomnia, agitation, distractibility, racing thoughts or flight of ideas, pressured speech, intrusiveness. Compared to his or her peers, the child exhibits markedly increased reactivity to negative emotional stimuli that is manifest verbally or behaviorally. For example, the child responds to frustration with extended temper tantrums (inappropriate for age and/or precipitating event), verbal rages, and/or aggression toward people or property. Such events occur, on average, at least three times a week. The symptoms in 2, 3, and 4 are currently present and have been present for at least 12 months without any symptom-free periods exceeding two months. The symptoms are severely impairing in at least one setting (home, school, or with peers) and are at least mildly impairing in a second setting.

B. Exclusion criteria: Exhibits any of these cardinal manic symptoms: Elevated or expansive mood Grandiosity or inflated self-esteem Episodically decreased need for sleep The symptoms occur in distinct periods lasting more than one day. Meets criteria for schizophrenia, schizoaffective disorder, pervasive developmental disorder, or posttraumatic stress disorder. Meets criteria for substance abuse disorder in the past three months. IQ < 70. The symptoms are due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.