Tribute to Dan Matthews, M.D.
Dr. Matthews was working at Duke in the 1970s when he and other providers were given the challenge to develop methods to treat children and teens with impulsive, disruptive and sometimes aggressive behavior that worked better than the treatments commonly being used at the time. Over the years, those exhibiting these symptoms have been given different diagnoses. According to most recent conventions, disruptive mood dysregulation disorder is now the diagnosis used.
Over the years, children and teenagers with this spectrum of behaviors have quite often been treated with anti-psychotic medications. These children have been, and still are, at high risk of being removed from their homes and placed into residential care. Dr. Matthews recognized that anti-psychotic medications could do more harm than good for patients like these. They work to block dopamine, which can have a very negative impact on brain function. They have a host of other very serious side effects including weight gain, elevated blood sugars and elevated triglycerides. Long-term use can result in a condition known as tardive dyskinesia (uncontrollable abnormal movements).
Using a specialized form of EEG, Dr. Matthews found there is abnormal activity in brain regions responsible for the fear response, the limbic region. The protocol he developed relies upon using medications used to treat seizure activity. Medications like these gently slow activity in those areas that are prone to having excessive firing which would typically result in an outburst. The patient who responds to these medications becomes more able to tolerate frustration without becoming irritable or upset as often. They are also able to calm more quickly when their buttons are pushed.
Many patients with DMDD also have difficulty with impulse control and hyperactivity. They are often diagnosed with ADHD. If given a stimulant medication before their mood is more stable, these patients often become much more irritable and explosive. Even with medications that promote mood stability, some patients do not do well with traditional ADHD medications. Dr. Matthews explored the use of a different medication, amantadine. This can sometimes be the missing link for those patients with DMDD combined with ADHD.
The amazing thing about Dr. Matthew’s protocol is that it allows the patient to develop new ways of responding to life’s challenges. Their behavior improves over time, and many patients grow out of their need for medication support.
To learn more about this protocol, follow this link which takes you to a recording of Dr. Matthews describing his work at a presentation in 2016, shortly before his retirement.