What is an Adjustment Disorder?
An adjustment disorder is an emotional or behavioral reaction to a stressful event or change in a person's life. The change or event is more intense than expected. It negatively impacts the child’s life. This reaction occurs within three months of the stressful event or change that happened. The event or change may be things like a family move, parental divorce or separation, the loss of a pet or the, birth of a sibling.
What Causes Adjustment Disorders?
Adjustment disorders are a reaction to stress. There is not a direct cause between the event and the reaction.
Children and teens vary in their temperament, past experiences, vulnerability, and coping skills. Some children or teens are more likely to struggle than others. Their developmental stage and the support of people around them to meet their needs may make a difference in their reaction to the stress.
Stressors also vary in length , how strong they are, and effect. No evidence is available to suggest a biological factor causes adjustment disorders.
Who Is Affected by Adjustment Disorders?
Adjustment disorders are common in children and teens. They occur in both males and females. Adjustment disorders occur in all cultures. The stressors and the signs may vary based on cultural influences.
Adjustment disorders occur at all ages. 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. Adults have more anxiety and depressive symptoms.
What Are Symptoms of an Adjustment Disorder?
In all adjustment disorders, the reaction to the stressor seems to be a greater than normal reaction. The reaction gets in the way of social or occupational (educational) functioning.
There are six subtypes of adjustment disorders based on the type of the symptoms experienced. The following are the most common symptoms of each of the subtypes of adjustment disorder. However, each child or teen may have different symptoms.
Adjustment Disorder with Depressed Mood
Symptoms may include:
- Depressed mood
- Tearfulness
- Feeling hopeless
Adjustment Disorder with Anxiety
Symptoms may include:
- Nervousness
- Excessive worry
- Jitteriness
- Fear of being separated from important people in their lives
Adjustment Disorder with Anxiety and Depressed Mood
A combination of symptoms from 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 the above subtypes is present (depressed mood, anxiety and conduct).
Adjustment Disorder Not Otherwise Specified
Reactions to stressful events may not fit into one of the above subtypes. Reactions may include behaviors such as social withdrawal or disinterest in normally expected activities (like school or work).
The symptoms of adjustment disorders may look like other medical problems or psychiatric conditions. Always talk to your child or teen’s doctor or mental health provider for a diagnosis.
How Are Adjustment Disorders Diagnosed?
A doctor, a child and teen psychiatrist, or a mental health professional makes the diagnosis of an adjustment disorder after a full evaluation and interview with the child or teen and the parents or guardians. A detailed personal history of development, life events, emotions, behaviors, and the stressful event is talked about during the interview.
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
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 focused on making needed changes within the family system. This includes things like improving communication skills and family interactions, and increasing family support among family members.
Peer Group Therapy
Peer group therapy is focused on developing and using social skills.
Medication
Medicine may be considered on a short-term basis if it is known to help with a specific severe symptom. Medication is not often helpful for treatment of adjustment disorders.
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 child/teen’s normal growth and development, and improve the quality of life of children/teens with adjustment disorders.
