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 not an expected healthy response to the event or change.

The reaction must occur within three months of the identified stressful event or change. Such changes can include:

• A family move
• Parental divorce or separation
• Loss of a pet
• Birth of a brother or sister
• A sudden illness

Adjustment disorder causes

Adjustment disorders are a reaction to stress. There is no 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. There is no evidence of a biological cause for adjustment disorders.

Who is affected by adjustment disorders?

Adjustment disorders are common in children and adolescents, and occur in males and females equally.

While adjustment disorders occur in all cultures, the stressors and the signs may vary based on cultural influences. Adjustment disorders occur at all ages, though the characteristics of the disorder are different in children and adolescents than they are in adults.

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

Adjustment disorder symptoms

In all adjustment disorders, the reaction to the stressor can either be in excess of a normal reaction, or the reaction can significantly impair social, occupational or educational function.

There are six subtypes of adjustment disorder that are based on the type of the major symptoms experienced:

• Adjustment disorder with depressed mood. Symptoms may include tearfulness and feelings of hopelessness.

• Adjustment disorder with anxiety. Symptoms may include nervousness, worry, jitteriness or fear of separation.

• Adjustment disorder with anxiety and depressed mood. A combination of both anxiety and depressive symptoms may be present.

• Adjustment disorder with disturbance of conduct. Symptoms may include violating the rights of others or violation of social norms.

• Adjustment disorder with mixed disturbance of emotions and conduct. A combination of symptoms from all of the above subtypes are present, including 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 (for example, school or work).

The symptoms of adjustment disorders may resemble other medical problems or psychiatric conditions. Always consult your adolescent's healthcare provider for a diagnosis.

Diagnosis

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

Specific treatment for adjustment disorders will be determined by your adolescent's health care provider based on:

• Your adolescent's age, overall health, and medical history

• Extent of your adolescent's symptoms

• Subtype of the adjustment disorder

• Your adolescent's tolerance for specific medications 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

Preventive measures to reduce the incidence of adjustment disorders in adolescents are not known.

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 children or adolescents with adjustment disorders.