Pharmacologic Treatment of Severe Mood Dysregulation in Children

Presented by:
Oscar Bukstein, MD, MPH
Boston Children’s Hospital
Medical Director, Outpatient Psychiatry Service
Professor of Psychiatry
Harvard Medical School

Faculty Disclosure:

Dr. Bukstein has disclosed that he has no relevant financial relationship(s). No one else in a position to control content has any financial relationships to disclose. Conflict of interest information for the CME Advisory Committee members can be found on the following website: All relevant financial relationships have been mitigated.

Release Date: March 1, 2024
Expiration Date:  February 28, 2026

Target Audience: All physicians

Learning Objectives:

As a result of participation in this activity, participants should be able to:

  1. Identify the pharmacologic agents with effectiveness toward the reduction of aggression and mood dysregulation in children.
  2. Describe an algorithm for the use of pharmacologic agents for aggression and mood dysregulation considering effectiveness and adverse events in children.
  3. Develop a comprehensive, multi-modal treatment plan for the treatment of aggression and mood dysregulation in children.

Requirements for successful completion: Certificates are awarded upon successful completion (80% proficiency) of the post-test.

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Resource(s) for further study:

  1. Stattin H & Magnusson D. 1989. The role of early aggressive behavior in the frequency, seriousness, and types of later crime. Journal of Consulting and Clinical Psychology, 57(6), 710-718.
  2. Leibenluft E. Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. Am J Psychiatry. 2011; 168(2):129-42. doi: 10.1176/appi.ajp.2010.10050766. Epub 2010 Dec 1. PMID: 21123313.
  4. Freeman A, Youngstrom E, Youngstrom J, Findling RL. Disruptive Mood Dysregulation Disorder in a Community Mental Health Clinic: Prevalence, Comorbidity, and Correlates. J Child Adolesc Psychopharmacol. 2016; 26(2):123-30. doi: 10.1089/cap.2015.0061. Epub 2016. PMID: 26745325.
  5. Copeland W, Angold A, Costello EJ, Egger H. Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder. Am J Psychiatry. 2013; 170(2):173-9. doi: 10.1176/appi.ajp.2012.12010132. PMID: 23377638.
  6. Mayes SD, Waxmonsky JD, Calhoun SL, Bixler EO. Disruptive Mood Dysregulation Disorder Symptoms and Association with Oppositional Defiant and Other Disorders in a General Population Child Sample. J Child Adolesc Psychopharmacol. 2016; 26(2):101-6. doi: 10.1089/cap.2015.0074. Epub 2016 Jan 8. PMID: 26745442.
  7. Spoelma MJ, Sicouri GL, Francis DA, et al. Estimated Prevalence of Depressive Disorders in Children from 2004 to 2019: A Systematic Review and Meta-Analysis. JAMA Pediatr. 2023; 177(10):1017-1027. doi:10.1001/jamapediatrics.2023.3221.
  8. Greenhill LL, Solomon M, Pleak R, Ambrosini P. Molindone hydrochloride treatment of hospitalized children with conduct disorder. Journal of Clinical Psychiatry. 1985; 46(8 Pt 2):20-25. PMID: 3894338.
  9. Campbell M, Small AM, Green WH, et al. Behavioral Efficacy of Haloperidol and Lithium Carbonate: A Comparison in Hospitalized Aggressive Children with Conduct Disorder. Arch Gen Psychiatry. 1984;41(7):650-656. doi:10.1001/archpsyc.1984.01790180020002.
  10. Ceresoli-Borroni G, Nasser A, Findling R, et al. A Double-Blind, Randomized Study of Extended-Release Molindone for Impulsive Aggression in ADHD. Journal of Attention Disorders. 2020; 25(11).
  11. Malone RP, Delaney MA, Luebbert JF, et al. A Double-Blind Placebo-Controlled Study of Lithium in Hospitalized Aggressive Children and Adolescents with Conduct Disorder. Arch Gen Psychiatry. 2000;57(7):649-654. doi:10.1001/archpsyc.57.7.649.
  12. Steiner H, Petersen ML, Saxena K, Ford S, Matthews Z. Divalproex Sodium for the Treatment of Conduct Disorder: A Randomized Controlled Clinical Trial. J Clin Psychiatry. 2003;64(10):1183-1191.
  13. Donovan SJ, Stewart JW, Nunes EV, Quitkin FM, Parides M, Daniel W, Susser E, Klein DF. Divalproex Treatment for Youth with Explosive Temper and Mood Lability: A Double-Blind, Placebo-Controlled Crossover Design. Am J Psychiatry. 2000;157(5):818-820.
  14. Blader JC, Pliszka SR, Jensen PS, Schooler NR, Kafantaris V. Stimulant-Responsive and Stimulant-Refractory Aggressive Behavior Among Children with ADHD. Pediatrics. 2010;126(4):e796-e806.
  15. Kemph JP, Devane CL, Levin GM, Jarecke R, Miller RL. Treatment of Aggressive Children with Clonidine: Results of an Open Pilot Study. Journal of the American Academy of Child & Adolescent Psychiatry. 1993;32(3):577-581.
  16. Pringsheim T, Hirsch L, Gorman DA, et al. The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 2: Antipsychotics and Traditional Mood Stabilizers. The Canadian Journal of Psychiatry. 2015;60(2).
  17. Pillay J, Boylan K, Carrey N, Newton A, et al. First- and Second-Generation Antipsychotics in Children and Young Adults: Systematic Review Update. Agency for Healthcare Research and Quality (US), Rockville (MD); 2017. PMID: 28749632.
  18. Towbin K, et al. A Double-Blind Randomized Placebo-Controlled Trial of Citalopram Adjunctive to Stimulant Medication in Youth With Chronic Severe Irritability. Journal of the American Academy of Child & Adolescent Psychiatry. 2020;59(3):350-361.

If you have any questions please feel free to contact Nancy Boyd at (352) 594-4298 or at