tantrumOur series of free practice questions to help you ready yourself for the social work licensing exam continues. The recurrent temper outbursts in the title don't refer to the ones you may be having as you study for the test, they're a key symptom in the following vignette:

A father brings his eight-year-old son to a social worker for help managing the son's repeated temper tantrums. The father reports that the tantrums, which can be set off by "the tiniest thing" have been happening every few days since the boy was six. The boy is otherwise bright, though often "a grouch." During tantrums, he throws himself on the floor, screaming and crying, inconsolable. Given the limited information offered, which of the following is the MOST likely diagnosis for the boy?

A .Disruptive Mood Dysregulation Disorder

B. Major Depressive Disorder

C. Intermittent Explosive Disorder

D. Childhood Bipolar Disorder

Know the answer? Hint: We've written about the diagnosis on the SWTP blog before (just not in question form). The diagnosis is new in DSM-5. Here are the full criteria:

A. Severe recurrent temper outbursts that are grossly out of proportion in intensity of duration to the situation or provocation.

B. The temper outbursts are inconsistent with developmental level.

C. The outbursts occur, on average, three or more times per week.

D. The mood between outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (parents, teachers, peers).

E. The above criteria have been present for 12 months or more (with no break lasting 3 months or more).

F. Criteria A-D are present in at last two settings (home, school, with peers).

G. The diagnosis should not be made before 6 years or after age 18.

H. Onset of A-E began before age 10.

I. There has never been a distinct period, lasting more than 1 day, that meets full criteria for a hypomanic or manic episode.

J. Behaviors do not occur during a major depressive episode.

Now can you name it? Let's narrow it down, starting at the bottom. Childhood bipolar disorder is not a diagnosis in DSM-5. Scratch it out. Intermittent explosive disorder is closer, but it is characterized by "recurrent behavioral outbursts representing a failure to control aggressive impulses." With IED, tantrums are rage-filled, involving verbal and physical aggression toward people, property, and animals. What's described in the vignette sounds more a like typical toddler tantrums (though in an eight year old). MDD is worth considering. Given the focus here on tantrums, it's not the most precise of the offered diagnoses. Yes, the boy is apparently sad and acting out, but the frequency and duration of the acting out (over three times a week for more than a year) point to the last diagnosis standing. The answer is A) Disruptive Mood Dysregulation Disorder.

Did you get it?

For more about DMDD, try the SWTP post on the topic, which also links out to these sites:

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August 15, 2016
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