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 an unexpected healthy response to the event or change. The reaction must occur within three months of the identified stressful event or change happening. Examples of stressful event or change in the life of a child or adolescent include a family move, parental divorce or separation, the loss of a pet, birth of a brother or sister.

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, characteristics of the disorder are often 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.

It is unclear why some children and adolescents may develop an adjustment disorder and others do not. However, developing and practicing coping skills, engaging with social supports, healthy eating habits, ensuring adequate sleep, and daily exercise will likely help your child to deal with stressful life events. Furthermore, early detection and intervention can reduce the severity of symptoms, enhance the child’s normal growth and development, and improve the quality of life experienced by those with adjustment disorders.

In all adjustment disorders, the reaction to the stressful event seems to be in excess of a normal reaction, or the reaction significantly interferes with social or educational functioning. There are several 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 child and adolescent may experience symptoms differently. The symptoms of adjustment disorders may resemble other medical problems or psychiatric conditions. Always consult your adolescent's physician or mental health professional for an accurate diagnosis.

Adjustment disorder with depressed mood

• Low mood
• Tearfulness
• Feelings of hopelessness

Adjustment disorder with anxiety

• Nervousness
• Worry
• Jitteriness
• Fear of separation from a caregivers

Adjustment disorder with anxiety and depressed mood

• Nervousness
• Worry
• Jitteriness
• Fear of separation from a caregivers
• Low mood
• Tearfulness
• Feelings of hopelessness

Adjustment disorder with disturbance of conduct

• Violating the rights of others
• Truancy, destruction of property, reckless driving, fighting

Adjustment disorder with mixed disturbance of emotions and conduct

• Fear of separation from a caregivers
• Violation of the rights of others
• Truancy, destruction of property, reckless driving, fighting
• Low mood
• Tearfulness
• Feelings of hopelessness
• Nervousness
• Worry
• Jitteriness

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.

A psychiatrist, licensed clinical social worker, or psychologist makes the diagnosis of an adjustment disorder in children and adolescents following a comprehensive psychiatric evaluation and interview with the child and the parents. A detailed personal history of development, life events, emotions, behaviors, and the identified stressful event is obtained during the interview. If your child is diagnosed with adjustment disorder and would benefit from therapy, your mental health professional will recommend the appropriate treatment.

Treatment may include:

• Individual psychotherapy using cognitive-behavioral approaches: A psychologist or licensed clinical social worker may use cognitive-behavioral therapy 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, usually facilitated by a licensed clinical social worker, is often focused on developing and using social skills and interpersonal skills. Each member of the group will work with the group facilitator to identify an achievable goal to work on within the group.
• Medication: While medications have very limited value in the treatment of adjustment disorders, your child’s psychiatrist may recommend medication on a short term basis if a specific symptom is severe and known to be responsive to medication.