Adjustment disorders are quite common in children and adolescents.

An adjustment disorder is defined as a maladaptive or unhealthy emotional or behavioral reaction to an identifiable stressful event or change in a person’s life. This reaction occurs within three months of the occurrence of the identified stressful event or change. A family move, parental divorce or separation, the loss of a pet, birth of a brother or sister, are some events that can cause children and adolescents to develop 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.

Children At Risk

Adjustment disorders 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.

Symptoms

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

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. Symptoms may include:

1. Adjustment Disorder with Depressed Mood:

  • depressed mood
  • tearfulness
  • feelings of hopelessness

2. Adjustment Disorder with Anxiety

  • nervousness
  • excessive 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

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

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 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 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 or mental health provider for a diagnosis.

Diagnosis

A qualified physician, 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 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.

Causes

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, and as such some are more susceptible than others. 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.

Prevention

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.

Treatment

Specific treatment for adjustment disorders will be determined by your child / adolescent’s physician based on:

  • your child’s age, overall health, and medical history
  • extent of your child / adolescent’s symptoms
  • subtype of the adjustment disorder
  • your child / adolescent’s tolerance for specific medications, procedures, or therapies
  • expectations for the course of the stressful event

Treatment may include:

  • Individual Psychotherapy Using Cognitive-Behavioral Approaches
  • Family Therapy
  • Peer Group Therapy
  • 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.