Diseases & Conditions
A maladaptive emotional or behavioral reaction to a stressful event or change in a child’s life, such as a family move, divorce, loss of a pet, or birth of a sibling. The reaction must occur within three months of the stressful event to be considered an adjustment disorder. Because 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 needs may contribute to their reaction to a particular stress.
Adjustment disorders are quite common in children and adolescents, but the characteristics of the disorder in those groups are different than they are in adults. Youthful symptoms of adjustment disorders are more behavioral—children are more likely to act out, while adults experience more depressive symptoms.
In all adjustment disorders, the reaction to the stress seems to be abnormally severe and signiﬁcantly interferes with friends or school function. There are six subtypes of adjustment disorder based on symptoms:
adjustment disorder with depressed mood is characterized by depression, crying, and feelings of hopelessness.
adjustment disorder with anxiety may cause nervousness, worry, jitteriness, and fear of separation.
adjustment disorder with anxiety and depressed mood is a combination of symptoms from both of the above subtypes.
adjustment disorder with disturbance of conduct may be characterized by violating the rights of others, truancy, destruction of property, reckless driving, or ﬁghting.
adjustment disorder with mixed disturbance of emotions and conduct involves a combination of all of the subtype symptoms (depressed mood, anxiety, and conduct).
adjustment disorder unspeciﬁed Reactions to stressful events that do not ﬁt in one of the above subtypes is referred to as “unspeciﬁed” and may include behavior such as social withdrawal or reluctance to do homework or after-school chores.
Because the symptoms of adjustment disorders may resemble other medical problems or psychiatric conditions, the child’s physician should always be consulted for a correct diagnosis. A child psychiatrist or CHILD PSYCHOLOGIST usually makes the diagnosis after a comprehensive psychiatric evaluation and interview with the child and parents, including a detailed personal history describing development, life events, emotions, behaviors, and the identiﬁed stress. Early diagnosis and treatment can reduce the severity of symptoms, enhance the child’s growth and development, and improve the quality of life.
Individual psychotherapy uses cognitive-behav-ioral approaches to improve problem-solving skills, communication skills, impulse control, anger management skills, and stress management skills. Family therapy is often focused on making 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 is often focused on developing and using social skills and interpersonal skills.
While medication has very little value in the treatment of adjustment disorders, it may be considered on a short-term basis if a specific symptom is severe and known to be responsive to medication.