What is an adjustment disorder? 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.
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.
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.
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 child may experience
symptoms differently. Symptoms may include:
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 A combination of symptoms from both of the above
subtypes (depressed mood and anxiety) is present. 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 A combination of symptoms from all of the above
subtypes are present (depressed mood, anxiety, and conduct).
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 (i.e., school or
work). The symptoms of adjustment disorders may resemble other
medical problems or psychiatric conditions. Always consult your
child's (adolescent's) physician for a diagnosis.
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 children and
adolescents following a comprehensive psychiatric 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 for adjustment disorders: Specific treatment for
adjustment disorders will be determined by your child's
(adolescent's) physician based on:
your child's (adolescent's) age, overall health, and medical
history extent of your child's (adolescent's) symptoms subtype
of the adjustment disorder your child's (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. 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 child's normal growth and development, and improve
the quality of life experienced by children or adolescents with
adjustment disorders.
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