{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:29:12Z","timestamp":1786663752204,"version":"build-2736575974"},"reference-count":46,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","award":["UL1 TR002014 and UL1 TR00045"],"award-info":[{"award-number":["UL1 TR002014 and UL1 TR00045"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Child and Adolescent Psychopharmacology"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Disruptive mood dysregulation disorder (DMDD), along with other internalizing disorders, is associated with greater impairment in youth with attention-deficit\/hyperactivity disorder (ADHD). However, it remains unclear whether DMDD is associated with differences in treatment course and outcomes among youth with ADHD and comorbid internalizing disorders. Using real-world data, this study compared treatment patterns and clinical outcomes among youth with ADHD and internalizing disorders with and without comorbid DMDD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective cohort study analyzed electronic health records from the TriNetX U.S. Collaborative Network, including 340,225 youth aged 6\u201318 years with ADHD and at least one internalizing disorder (major depressive disorders or anxiety disorder), of whom 25,580 (7.5%) had comorbid DMDD. Outcomes included treatment patterns and clinical outcomes. Propensity score matching and Cox proportional hazards models adjusted for confounding were used to estimate relative risks (RR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI) over 1 year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Youth with ADHD, internalizing disorders, and DMDD exhibited greater psychiatric comorbidity and higher healthcare utilization than those without DMDD. They received more ADHD medications, with a marked shift toward nonstimulants (RR 1.73, 95% CI 1.69\u20131.77), and other psychotropic medications, including antidepressants, antipsychotics, and mood stabilizers (RR range 1.36\u20133.02). New central nervous system (CNS) stimulant prescriptions did not differ between youth with and without DMDD. Compared with nonstimulants, CNS stimulants were associated with lower risks of all adverse outcomes\u2014including suicidal ideation\/attempts, inpatient hospitalization, emergency visits, and subsequent antipsychotic or mood stabilizer initiation\u2014in youth both with and without DMDD (aHR range 0.33\u20130.73).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Comorbid DMDD adds clinical complexity among youth with ADHD and internalizing disorders, influencing treatment patterns toward nonstimulants and other psychotropics. Despite this shift, CNS stimulants were associated with the most favorable outcomes across cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10445463261428442","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T16:50:02Z","timestamp":1773247802000},"page":"473-482","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Disruptive Mood Dysregulation Disorder and Its Association with Treatment Trajectories and Outcomes in Youth with Attention-Deficit\/Hyperactivity Disorder and Internalizing Disorders"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0492-0643","authenticated-orcid":false,"given":"Raman","family":"Baweja","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8115-1286","authenticated-orcid":false,"given":"Daniel A.","family":"Waschbusch","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle A.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G.","family":"Waxmonsky","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2013.09.022"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10578-014-0515-x"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6004"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2012.12111434"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/DBP.0000000000000770"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2015.0053"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S100312"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.5498\/wjp.v11.i12.1206"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2025.114471"},{"key":"e_1_3_2_11_1","first-page":"S0890","article-title":"Attention-Deficit\/Hyperactivity disorder treatment patterns and association with clinical outcomes in adolescents and young adults with co-occurring attention-deficit\/hyperactivity disorder and substance use disorder: A retrospective analysis","author":"Baweja R","year":"2025","unstructured":"Baweja R, , Waschbusch DA, , Padilla FM, et al. Attention-Deficit\/Hyperactivity disorder treatment patterns and association with clinical outcomes in adolescents and young adults with co-occurring attention-deficit\/hyperactivity disorder and substance use disorder: A retrospective analysis. J Am Acad Child Adolesc Psychiatry 2025b:S0890.","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.699687"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40501-018-0135-3"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2022.02.003"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2024.1813"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2019.12.009"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2022.05.012"},{"issue":"9","key":"e_1_3_2_18_1","first-page":"755","article-title":"Effects of guanfacine extended release on oppositional symptoms in children aged 6\u201312 years with attention-deficit hyperactivity disorder and oppositional symptoms","volume":"24","author":"Connor DF","year":"2010","unstructured":"Connor DF, , Findling RL, , Kollins SH, et al. Effects of guanfacine extended release on oppositional symptoms in children aged 6\u201312 years with attention-deficit hyperactivity disorder and oppositional symptoms. CNS Drugs 2010;24(9):755\u2013768.","journal-title":"CNS Drugs"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30269-4"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/1087054715613437"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2021.01.022"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2013.0103"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2021.05.016"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2019.0125"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/chi.0b013e3180ca8385"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2017.10.012"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.6118"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.chi.0000169012.81536.38"},{"key":"e_1_3_2_29_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-0165"},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/DBP.0000000000000822"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2007.05091676"},{"key":"e_1_3_2_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2025.102571"},{"key":"e_1_3_2_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.9492"},{"key":"e_1_3_2_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/chi.0b013e318054e724"},{"key":"e_1_3_2_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/jcp.0000000000001058"},{"key":"e_1_3_2_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.05.021"},{"key":"e_1_3_2_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20765"},{"key":"e_1_3_2_38_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0132"},{"key":"e_1_3_2_39_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.15r10601"},{"key":"e_1_3_2_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.2209"},{"key":"e_1_3_2_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.2859"},{"key":"e_1_3_2_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2019.05.015"},{"key":"e_1_3_2_43_1","doi-asserted-by":"publisher","DOI":"10.1177\/10870547251353392"},{"key":"e_1_3_2_44_1","doi-asserted-by":"publisher","DOI":"10.1177\/10870547251341597"},{"key":"e_1_3_2_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2021.04.008"},{"key":"e_1_3_2_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2215-0366(19)30096-3"},{"key":"e_1_3_2_47_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-083658"}],"container-title":["Journal of Child and Adolescent Psychopharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10445463261428442","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10445463261428442","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10445463261428442","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:17:11Z","timestamp":1786663031000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10445463261428442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":46,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,10,1]]}},"alternative-id":["10.1177\/10445463261428442"],"URL":"https:\/\/doi.org\/10.1177\/10445463261428442","relation":{},"ISSN":["1044-5463","1557-8992"],"issn-type":[{"value":"1044-5463","type":"print"},{"value":"1557-8992","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]}}}