158 Depressive Disorders
common, typically manifesting be fore full criteria for the syndrome are met. Such predi-
agnostic presentations may have qualified for a diagnosis of oppositional defiant disorder.
Many children with disruptive mood dysregulation disorder have symptoms that also
meet criteria for atte ntion-deficit/hyperactivity disorder  (ADHD) and for an anxiety dis-
order, with such diagnoses often being presen t from a relatively early age. For some chil-
dren, the criteria for major depres sive disorder may also be met. 
Genetic and physiological. In terms of familial aggregat ion and genetics, it has been
suggested that children presenting with chronic, non-episodic irritability can be differen-
tiated from children with bipolar disorder in  their family-based risk. However, these two
groups do not differ in familial rates of anxi ety disorders, unipolar  depressive disorders,
or substance abuse. Compared with children with pediatric bipolar disorder or other men-
tal illnesses, those with disruptive mood dy sregulation disorder exhibit both commonal-
ities and differences in information-proce ssing deficits. For example, face-emotion
labeling deficits, as well as perturbed decision  making and cognitive control, are present in
children with bipolar disorder and chronica lly irritable children, as well as in children
with some other psychiatric conditions. There is also evidence for disorder-specific dys-
function, such as during tasks assessing atte ntion deployment in response to emotional
stimuli, which has demonstrated unique signs of dysfunction in children with chronic ir-
ritability. 
Gender-Related Diagnostic Issues
Children presenting to clinics with features of  disruptive mood dysr egulation disorder are
predominantly male. Among co mmunity samples, a male pr eponderance appears to be