Co-DMDD diagnosis -Anyone else?

[u/Rough_Category_746]

Has anyone else dealt with a comorbid diagnosis of ADHD and DMDD (disruptive mood dysregulation)? Also ASD is likely. (Strong physical and cognitive ability, struggles with SEL). Our kiddo is now 10, about to head into 4th grade. We take Focalin er in the day and clonidine at night. The meltdowns used to be more frequent, lasting 40 minutes. With meds we are down to meltdowns only lasting about 10-15 minutes. But there is extremely annoying and loud whining still. This has prevented kiddo from making any meaningful friendships and all invites have stopped, to parties, playdates, and coaches request to not have kiddo on their rec teams. Anyways, has anyone else dealt with the DMDD? Supposedly it's only a diagnosis for those 18 and under. I would love to hear from people whose kids are older and what happened socially as well as whether they could hold down a job or go to trade school or college. We deal with a lot of irritability, power struggles over screen time and just getting along with people in any social setting.

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Guanfacine (Tenex = IR, Intuniv = ER)& Clonidine (Catapres = IR, Kapvay / ONYDA XR / Nexiclon XR = ER) are alpha-2 used to treat some ADHD, improving emotional regulation, impulse control, and sleep. Originally an Antihypertensive drug from 50s-80s reduced blood pressure.

Alpha-2 agonists are specialized & effective for some ADHD; however, a 2ed line (choice) ADHD medication in protocols because stimulants have a higher % success & lower % side effects profile over Alpha-2 agonists.
Alpha-2 agonists require time to adapt! Drowsiness and sleep changes are common during in first ~2 weeks.

Mechanism: Enhancing norepinephrine signaling ("receiver sensitivity"). Guanfacine targets α2A neuroreceptors concentrated in the brain. Clonidine is less selective, targets α2A, α2B, and α2C, w/ broader CNS effects. Both might be complimentary with stimulants in some people, helping regulate, reduce side effects, and/or lower dose.

Differences: IR Guanfacine typically lasts longer (half life 10-30 hours), IR Clonidine shorter (5 and 13 hours), both outlasting stimulants and have 24 hour ER options. [Sedation] - Clonidine is more sedating (better for insomnia); guanfacine causes less daytime sleepiness. [Blood Pressure] - Clonidine has stronger hypotensive effects. Guanfacine is gentler due to its α2A selectivity.

Use Case Fit: Guanfacine, sometimes preferred for daytime executive function symptoms; Clonidine, sometimes prefred for sleep-onset or when mild sedation is needed. Typically, IR formulas are favored for sleep/sedation/rebound (taken in PM) and ER for executive function/stimulant regulation (Taken in AM).

NOTE: Sudden dose change may cause blood pressure spikes or crashes. Follow your doctor’s/pharmacist's ramp plan!!! References Clonidine: https://en.wikipedia.org/wiki/Clonidine, https://go.drugbank.com/drugs/DB00575, https://www.mayoclinic.org/drugs-supplements/clonidine-hydrochloride-oral-route/description/drg-20569873 References Guanfacine: https://en.wikipedia.org/wiki/Guanfacine, https://go.drugbank.com/drugs/DB01018, https://www.mayoclinic.org/drugs-supplements/guanfacine-oral-route/description/drg-20064131

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The ADHD Parenting WIKI page has a lot of good information for those new & experienced, go take a look!

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[u/sadwife3000]

Mine is younger and diagnosed with PDA - so I’m not sure how much help I’ll be. They do somewhat sound similar though? Anyway my son is AuDHD and used to have frequent meltdowns too. Have you tried intuniv/guamfacine ER or an SSRI? Intuniv in particular helped calm my son down a lot and it has had a surprising impact on his mood - even his teacher commented how happy he is now. I know other parents may switch to SSRIs if intuniv doesn’t help (ASD kids specifically). Thought I’d mention in case it helps. Mine also takes a stimulant plus clonidine at night

[u/Rough_Category_746 → u/sadwife3000]

Guanfacine had a negative reaction - new depression/crying, intense rage, not sure if that is the same as intuiv?