01.Adjustment Disorders

01.1.What is an Adjustment Disorder?

An adjustment disorder is an emotional or behavioral reaction to an identifiable stressful event or change in a person's life that is more intense than expected, or negatively impacting the child’s life. This reaction occurs within three months of the identified stressful event or change happening. The identifiable stressful event or change in the life of a child or teen may be a family move, parental divorce or separation, the loss of a pet, birth of a brother or sister, to name a few.

01.2.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 teens vary in their temperament, past experiences, vulnerability and coping skills, and as such some are more likely to struggle than others. Their developmental stage and the ability 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.

01.3.Who Is Affected by Adjustment Disorders?

Adjustment disorders are quite common in children and teens. 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 teens than they are in adults. Differences are noted in the symptoms experienced, seriousness and length of time of symptoms, and in the outcome.

Teen symptoms of adjustment disorders are usually behavioral, such as acting out, while adults usually experience more anxiety and depressive symptoms.

01.4.What Are Symptoms of an Adjustment Disorder?

In all adjustment disorders, the reaction to the stressor seems to be a greater than 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 teen may experience symptoms differently.

01.5.Adjustment Disorder with Depressed Mood

Symptoms may include:

Depressed mood

Tearfulness

Feelings of hopelessness

Adjustment Disorder with Anxiety

Symptoms may include:

Nervousness

Excessive worry

Jitteriness

Fear of separation from major attachment figures

Adjustment Disorder with Anxiety and Depressed Mood

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

Adjustment Disorder with Disturbance of Conduct

Symptoms may include:

Violation of the rights of others

Violation of acceptable behaviors and rules (truancy, destruction of property, reckless driving, fighting)

Adjustment Disorder with Mixed Disturbance of Emotions and Conduct

A combination of symptoms from all of the above subtypes is present (depressed mood, anxiety and conduct).

Adjustment Disorder Not Otherwise Specified

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 disinterest in normally expected activities (i.e., school or work).

The symptoms of adjustment disorders may look like other medical problems or psychiatric conditions. Always consult your adolescent's physician or mental health provider for a diagnosis.

01.6.How Are Adjustment Disorders Diagnosed?

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

01.7.Treatment for Adjustment Disorders

Specific treatment for adjustment disorders will be decided by your child / teen’s doctor based on:

Your child's age, overall health and medical history

Extent of your child / teen’s symptoms

Type of the adjustment disorder

Your child / teen’s tolerance for specific medicines, procedures or therapies

Expectations for the course of the stressful event

01.8.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.

01.9.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.

01.10.Medication

While medicines have very limited value in the treatment of adjustment disorders, medicine may be considered on a short-term basis if it is known to help with a specific severe symptom.

01.11.Prevention of Adjustment Disorders

Developing healthy coping skills and resilience, and strong family support can help to prevent adjustment disorders at this time. Early testing and intervention can reduce the intensity of symptoms, enhance the teen’s normal growth and development, and improve the quality of life experienced by teens with adjustment disorders.