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 3 months of the identified stressful event or change happening but can last for an extended period of time beyond this time frame if the stressor continues. The identifiable stressful event or change in the life of a child or adolescent may be a response to a family move, a parental divorce or separation, the loss of a pet, or the birth of a brother or sister. A sudden illness, or restriction to a child's life because of chronic illness may also provoke an adjustment response. 

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, in the 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.

Causes and Risk Factors

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 0reaction 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.

Symptoms and Types

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, occupational, or educational functioning. There are 6 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/adolescent may experience symptoms differently:

1. Adjustment disorder with depressed mood. Symptoms may include:

• Depressed mood
• Tearfulness
• Feelings of hopelessness

2. Adjustment disorder with anxiety. Symptoms may include:

• Nervousness
• Worry
• Jitteriness
• Fear of separation from major attachment figures

3. Adjustment disorder with anxiety and depressed mood. A combination of symptoms from both of the above subtypes (depressed mood and anxiety) is present.

4. Adjustment disorder with disturbance of conduct.  Only behavioral symptoms are present.

5. Adjustment disorder with mixed disturbance of emotions and conduct. A combination of symptoms from all of the above subtypes are present (depressed mood, anxiety, and conduct).

6. Adjustment disorder unspecified. Reactions to stressful events that do not fit in one of the above subtypes are present. Reactions may include behaviors such as social withdrawal or inhibitions to normally expected activities (for example, school or work).

The symptoms of adjustment disorders may resemble other medical problems or psychiatric conditions. Always consult your child/adolescent's health care provider for a diagnosis.

Diagnosis and Tests

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

Treatment

Specific treatment for adjustment disorders will be determined by your child or adolescent's health care provider based on:

• Your child or adolescent's age, overall health, and medical history
• Extent of your child or adolescent's symptoms
• Subtype of the adjustment disorder
• Your child or adolescent's tolerance for specific medications 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 skill. Intervention can also include normalization of child or adolescent adjustment to specific stressor, including adjustment to illness. Attendance at camp for children or adolescents with a specific illness may also be a form of group intervention.
• 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, and if the symptoms are interfering with overall functioning (e.g., daily care, school attendance).

Prevention of adjustment disorders

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