Dr. Angela Hanford
Sarina is eight years old. She enjoys gymnastics and dance and loves playing with her friends. She also tends to become angry very quickly – not just angry, but full on rage at times. Her parents have tried everything they can think of, but it seems like the only way to stop the anger is to give in. They also know that this does not actually work in the long run. The family experiences chaos and stress associated with Sarina’s mood swings.
Daniel is nine and loves playing with friends, both in sports and through video games. He also experiences a lot of stomach aches and often breaks down in tears at the slightest perceived offense. Other times he is super excited and has trouble controlling his excitement. He becomes impulsive and says things to his peers that he later regrets. The doctors have ruled out any physical problems, and are now recommending that Daniel’s parents seek the help of a therapist.
Do either of these examples sound familiar? Each example shows a child who experiences frequent changes in mood. Maybe you know a child who displays extreme highs and extreme lows or frequently has outbursts of rage. Severe behavioral outbursts may accompany these shifts in mood. Mood swings can be caused by a variety of factors, both emotional and physical.
Diagnoses Associated with Mood Swings in Children
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5) (APA, 2013) outlines several diagnoses that are associated with mood changes.
Depression in children may manifest as irritability or anger, as opposed to sadness. Symptoms of depression include (APA, 2013):
- Depressed mood, such as feeling sad, hopeless, empty
- Irritable mood may be present in children and teenagers
- Decreased concentration
- Difficulty making decisions
- Losing interest in activities
- Appetite changes: increased appetite or loss of appetite.
- Sleep disturbances, such as sleeping too much or difficulty sleeping
- Feeling worthless or extreme guilt
- Fatigue and/or decrease in energy
- Changes in psychomotor activity, such as agitation or decrease in activity
- Suicidal thinking or thoughts of death
For a diagnosis of depression, someone must experience symptoms for at least two weeks.
Disruptive Mood Dysregulation Disorder (DMDD)
This is a newer diagnosis that was added to the most recent addition of the DSM (APA, 2013). The symptoms of DMDD include (APA, 2013):
- Severe outbursts of temper that are recurrent. These outbursts could be verbal (e.g., rage) or behavioral (e.g., punching someone).
- The outburst is also an overreaction to the situation.
- These outbursts are not age (or developmental level) appropriate. For example, a 12 year old yelling and kicking at a parent in the middle of the supermarket is not expected behavior for that age group.
- These outbursts occur at least three times per week.
- Along with the outbursts, the individual’s mood is angry or irritable most of the time on most days.
- The angry/irritable mood is seen by others.
The symptoms for DMDD are persistent and must be present in more than one setting for at least a year. This particular diagnosis can only be given for the first time for individuals ages 6 and 18, and symptoms must be present before age 10.
Bipolar DisorderMood swings are a hallmark of bipolar disorder. There are several bipolar disorders, such as bipolar I disorder and bipolar II disorder. The main characteristic of bipolar disorder is the presence of manic or hypomanic symptoms. Symptoms of a manic episode include (APA, 2013):
- An elevated, euphoric, or irritable mood
- Increased self-esteem, which could reach a delusional-level of grandiosity
- Speaking more rapidly or loudly, becoming more talkative (this could even include an angry rant)
- Racing thoughts
- Feeling rested after little sleep (e.g., 3 hours of sleep or even staying up all night).
- An increase in activities (e.g., working all night on a new project).
- Engaging in activities that are risky.
If a manic episode occurs, bipolar I disorder is diagnosed. Someone with bipolar I disorder may or may not experience a major depressive episode at some time during his or her lifetime. Bipolar II disorder is when a hypomanic episode occurs, with a hypomanic episode having similar symptoms to a manic episode but is does not last as long or have signifiant consequences, psychotic symptoms, or hospitalization.
Attention Deficit Hyperactivity Disorder (ADHD)
The three main forms of ADHD include: ADHD predominately inattentive presentation (previously known as ADD), ADHD predominately hyperactive/impulsive presentation, and ADHD combined presentation (APA, 2013). Symptoms, which must be present prior to age 12, include (APA, 2013):
- Lacks attention to details, tends to make careless mistakes
- Does not seem to listen to when directly addressed (not defiance)
- Does not follow through on tasks, is easily sidetracked
- Difficulty with organization (e.g., time management problems, backpack is a mess of papers)
- Avoidance or extreme dislike of tasks that requires sustained cognitive effort
- Forgetful (e.g., turning in homework)
- Loses objects (e.g., phone, books)
- Easily distracted, even by one’s own thoughts
- Leaves seat when remaining in seat is expected
- Runs/climbs excessively at inappropriate times, for teens this could be feeling restless
- Difficulty with doing things quietly
- Seems as though “driven by a motor”/“on the go”
- Talks excessively
- Blurts out answers
- Difficulty waiting for one’s turn
- Interrupts others
Although mood swings are not specific criteria, a child or teenager with ADHD often experiences intense moods. These moods are sometimes due to the individual also having an additional diagnosis (e.g., depression).
Autism Spectrum Disorder (ASD)ASD is characterized by deficits in the social arena, such as social skills, communication, and difficulty reading nonverbal communication. There are a host of additional symptoms for ASD, such as engaging in repetitive movements, extreme difficulty with change, and sensitivity to sensory inputs. It is not uncommon for individuals with ASD to have emotional outbursts and mood swings.
Children with anxiety may have severe anger outbursts when they feel anxious. Remember the fight, flight, freeze, or faint response? Sometimes people tend to go with the “fight” part and, thus, when a threat is present they “fight”. Therefore, it is important when a child presents with extreme emotional outbursts or mood swings to determine if anxiety is the trigger.
Examples of anxiety disorders include:
Generalized Anxiety Disorder (GAD)
Symptoms include (APA, 2013):
- Feeling signifiant worry and anxiety on most days
- A feeling of restlessness or being “on edge”
- Feels as though one’s mind going blank
- Difficulty with concentration
- Feeling irritable
- Tension in muscles
- Difficulty with sleep
Social Anxiety Disorder
As the name suggests, social anxiety disorder is characterized by anxiety surrounding social situations.
Symptoms include (APA, 2013):
- Intense anxiety or fear regarding social situations.
- Fear of being negatively evaluated by others.
- For children: the anxiety must be present with peers, not only when interacting with adults.
- Fear that the anxiety symptoms will be noticed by others and then lead to rejection or embarrassment.
- Due to anxiety, the situations are either avoided or the individual participates while feeling extreme distress.
This is a broad sample of possible diagnoses that are associated with frequent shifts in mood. A mental health professional can help you to determine if a specific diagnosis is present.
Helping Your Child to Cope
There are ways in which you can help your child to learn to cope with emotions.
1. Educate yourself on emotional development: Daniel Siegel and Tina Payne Bryson have several books that teach about parenting within the context of brain development, such as No Drama Discipline (2014) and The Yes Brain (2018).
For example, Siegel and Bryson discuss how it is important to examine what is underlying a child’s meltdown. Is it fear? Does the child not have the resources to cope with the situation? After determining what is actually going on you can step in and help your child regulate (Siegel & Bryson, 2014).
2. Create space at home where your child feels safe expressing his or her emotions. This would include making sure not to shame emotions, but to help soothe and create understanding surrounding emotional reactions. Siegel and Bryson educate on how important it is to connect with your child before redirecting, due to the fact that when someone is an emotionally charged state of mind logical redirection will actually inflame the emotions (2014). It is after the brain is soothed that logical instruction can occur.3. Teach and model healthy boundary setting. A lack of boundaries can lead to a variety of intense emotions, such as anxiety and anger.
4. Make sure you have communicated realistic expectations for your child (e.g., grades, extracurricular activities). Know your child and make sure he or she has the skills necessary to handle stress and know when he or she is overworked.
5. Set and maintain consistent boundaries and rules so that your child knows what to expect. Structure is important. This includes chores, consequences, and other household expectations.
6. Self-care, such as eating, sleep, and time management: Not only do you need to be at your emotional best to effectively parent, but your own self care is a model for your child. In addition, you also need a place where you can process your own feelings regarding your child’s strong emotional reactions.
7. Monitor video game/technology use: Constant technology usage will not help your child with emotional or social development, Help then to learn boundaries with technology.
8. Communicate with teachers and other prominent adults in your chid’s life. This communication not only helps you to have a broader context but also allows others to know how to best help your child.
Coping Skills for Children
1. Try different strategies aimed at soothing emotions, such as creating a kit of soothing objects (e.g., crayons and tablet, bubbles, a calming scent, a stress ball) to help when feelings become strong. Each child is different, so experimentation is necessary.
2. Mindfulness: This practice, which focuses on being present in the moment, can help someone be more in tune with thoughts, emotions and body sensations. This attunement is helpful when learning to recognize feelings before meltdowns occur.
3. Relaxation exercises: Examples include guided mediation, yoga, paced breathing, progressive muscle relaxation
4. Maintaining a healthy lifestyle, such as engaging in physical activity, attending to nutrition needs, and making sure to abstain adequate sleep
5. Journaling: This practice provides a place for emotional expression and can be done through writing or art.
6. Learning about emotions: This includes how to label different feelings, how emotions feel in one’s body, and how to express and soothe emotions in a healthy manner. There are many books that can aid in teaching, such as Understanding Myself: A Kid’s Guide to Intense Emotions and Strong Feelings (Lamia, 2010).
Diagnosis and Treatment of Mood Swings in Children
If your child is struggling with mood swings, a mental health professional can help determine the diagnosis and treatment options. In addition, a physical exam may be recommended to determine if any medical conditions are present that may be contributing to the moods swings.
There are a variety of treatment strategies that may be recommended, depending on the diagnosis and specific circumstances of your child. For example, play therapy can be useful to allow your child to express and work though difficult emotions in the context of play.
Cognitive behavior therapy and behavior therapy may also be recommended in order to teach your child about emotions, skills to regulate emotions, and strategies to change ineffective thinking and behavior patterns.
The bottom line is that there is help. Mood swings can feel overwhelming for both the child and his or her caregivers. We are here to help guide you and your child toward understanding and healing!
ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Lamia, M.C. (2010). Understanding Myself: A kid’s guide to intense emotions and strong feelings. Washington, DC: Magination Press.
Siegel, D. J., & Bryson, T. P. (2014). No-drama discipline: The whole-brain way to calm the chaos and nurture your child’s developing mind (First edition.). New York: Bantam.
Siegel, D. J., & Bryson, T. P. (2018). The yes brain: How to cultivate courage, curiosity, and resilience in your child. New York: Bantam
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