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Adjustment Disorders

  • An adjustment disorder is defined as an emotional or behavioral reaction to an identifiable stressful event or change in a person's life that is considered maladaptive or somehow not an expected healthy response to the event or change. The reaction must occur within three months of the identified stressful event or change happening. The identifiable stressful event or change in the life of a child or adolescent may be a family move, parental divorce or separation, the loss of a pet, birth of a brother or sister, to name a few. 

    Who is affected by adjustment disorders?    

    Adjustment disorders are quite common in children and adolescents. They occur equally in males and females. While adjustment disorders occur in all cultures, the stressors and the signs may vary based on cultural influences. Adjustment disorders occur at all ages, however, it is believed that characteristics of the disorder are different in children and adolescents than they are in adults. Differences are noted in the symptoms experienced, severity and duration of symptoms, and in the outcome. Adolescent symptoms of adjustment disorders are more behavioral such as acting out, while adults experience more depressive symptoms. 

    Did you know?

    • 1 out of 5, or 15 million kids nationwide, have a diagnosable mental health concern
    • 100,000 Massachusetts children with mental illness don't receive necessary care
    • 90 percent of children who commit suicide have diagnosable, treatable mental disorders
    • 85 state legislators have signed on as supporters of a new bill to improve mental healthcare for children

    Contact Us

    Psychiatry

    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115

     617-355-6680


  • What causes adjustment disorders? 

    Adjustment disorders are a reaction to stress. There is not a single direct cause between the stressful event and the reaction. Children and adolescents vary in their temperament, past experiences, vulnerability, and coping skills. Their developmental stage and the capacity of their support system to meet their specific needs related to the stress are factors that may contribute to their reaction to a particular stress. Stressors also vary in duration, intensity, and effect. No evidence is available to suggest a specific biological factor that causes adjustment disorders. 

    What are the symptoms of an adjustment disorder?    

    In all adjustment disorders, the reaction to the stressor seems to be in excess of a normal reaction, or the reaction significantly interferes with social or occupational (educational) functioning. There are six subtypes of adjustment disorder that are based on the type of the major symptoms experienced. The following are the most common symptoms of each of the subtypes of adjustment disorder. However, each adolescent may experience symptoms differently.

    Adjustment disorder with depressed mood

    • depressed mood
    • tearfulness
    • feelings of hopelessness

    Adjustment disorder with anxiety

    • nervousness
    • worry
    • jitteriness
    • fear of separation from major attachment figures

    Adjustment disorder with anxiety and depressed mood

    • nervousness
    • worry
    • jitteriness
    • fear of separation from major attachment figures
    • depressed mood
    • tearfulness
    • feelings of hopelessness

    Adjustment disorder with disturbance of conduct

    • violation of the rights of others
    • violation of societal norms and rules (truancy, destruction of property, reckless driving, fighting)

    Adjustment disorder with mixed disturbance of emotions and conduct

    • fear of separation from major attachment figures
    • violation of the rights of others
    • violation of societal norms and rules (truancy, destruction of property, reckless driving, fighting)
    • depressed mood
    • tearfulness
    • feelings of hopelessness
    • nervousness
    • worry
    • jitteriness
    • fear of separation from major attachment figures
    • depressed mood
    • tearfulness
    • feelings of hopelessness
    • nervousness
    • worry
    • jitteriness

    Adjustment disorder unspecified

    • Reactions to stressful events that do not fit in one of the above subtypes are present.
    • Behaviors such as social withdrawal or inhibitions to normally expected activities (i.e., school or work).

    The symptoms of adjustment disorders may resemble other medical problems or psychiatric conditions. Always consult your adolescent's physician for a diagnosis. 

    Prevention of adjustment disorders: 

    Preventive measures to reduce the incidence of adjustment disorders in children are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the adolescent's normal growth and development, and improve the quality of life experienced by adolescents with adjustment disorders.

  • How are adjustment disorders diagnosed?    

    A child and adolescent psychiatrist or a qualified mental health professional usually makes the diagnosis of an adjustment disorder in adolescents following a comprehensive psychiatric evaluation and interview with the adolescent and the parents. A detailed personal history of development, life events, emotions, behaviors, and the identified stressful event is obtained during the interview.

  • Specific treatment for adjustment disorders will be determined by your adolescent's physician based on:   

    • your adolescent's age, overall health, and medical history

    • extent of your adolescent's symptoms

    • subtype of the adjustment disorder

    • your adolescent's tolerance for specific medications, procedures, or therapies

    • expectations for the course of the stressful event

    • your opinion or preference

    Treatment may include: 

    • individual psychotherapy using cognitive-behavioral approaches - Cognitive-behavioral approaches are used to improve age-appropriate problem solving skills, communication skills, impulse control, anger management skills, and stress management skills.

    • family therapy - Family therapy is often focused on making needed changes within the family system such as improving communication skills and family interactions, as well as increasing family support among family members.

    • peer group therapy - Peer group therapy is often focused on developing and using social skills and interpersonal skills.

    • medication - While medications have very limited value in the treatment of adjustment disorders, medication may be considered on a short term basis if a specific symptom is severe and known to be responsive to medication.

    Helping your child with medical experiences

    If it has been recommended or you have decided that your child is in need of a significant medical procedure or hospitalization, this Guide is for you. It was created with the help of parents and professionals to help prepare you for what will happen during your child's hospitalization, and to give you information about specific ways to help you and your child cope with medical procedures and with the hospital stay.

Request an Appointment

If this is a medical emergency, please dial 9-1-1. This form should not be used in an emergency.

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