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Adjustment Disorders

What is an adjustment disorder?

An adjustment disorder is an unhealthy emotional or behavioral reaction to a stressful event or change in a person's life. The response happens within 3 months of the stressful event. Some events that may lead to an adjustment disorder in a child or teen include:

  • A family move

  • Parents' divorce or separation

  • The death of a pet

  • A new brother or sister

  • A sudden illness

  • A long-lasting (chronic) illness

What causes adjustment disorders?

Adjustment disorders are a reaction to stress. There is not one direct cause between the stressful event and the reaction. Children and teens vary in their personality, past experiences, vulnerability, and coping skills. Where they are in their development and ability to deal with specific needs related to the stress may contribute to their reaction. Stressors also vary in how long they last, how strong they are, and what effect they have.

Who is affected by adjustment disorders?

Adjustment disorders are quite common in children and teens. They happen equally in males and females. These disorders happen in all cultures. But the stressors and signs may vary based on cultural influences. Adjustment disorders happen at all ages. But children and teens have different symptoms than adults. Teen symptoms are more behavioral, such as acting out. Adults have more depressive symptoms. Differences between teens and adults also include how long symptoms last, how strong they are, and what effect they have.

What are the symptoms of an adjustment disorder?

In all adjustment disorders, the reaction to the stressor seems to be more than a normal reaction. Or the reaction significantly interferes with social, occupational, or educational functioning. There are 6 subtypes of adjustment disorder that are based on the type of the major symptoms experienced. Each teen’s symptoms may vary. The following are the most common symptoms of each subtype of adjustment disorder:

Adjustment disorder with depressed mood

Symptoms may include:

  • Depressed mood

  • Tearfulness

  • Feeling hopeless

Adjustment disorder with anxiety

Symptoms may include:

  • Nervousness

  • Worry

  • Jitteriness

  • Fear of separation from important people in the child’s life  

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

Symptoms may include:

  • Violating other people’s rights

  • Violating social norms and rules (not going to school, destroying property, reckless driving, or fighting)

Adjustment disorder with mixed disturbance of emotions and conduct

A combination of symptoms from all of the above subtypes is present (depressed mood, anxiety, and conduct).

Adjustment disorder unspecified

Reactions to stressful events that don’t fit in one of the above subtypes are present. Reactions may include behaviors such as withdrawing from friends and activities such as school or work.

The symptoms of adjustment disorders can look like other health problems or psychiatric conditions. Always talk with your child’s healthcare provider for a diagnosis.

How are adjustment disorders diagnosed?

A child and teen psychiatrist or a qualified mental health professional usually makes the diagnosis. This occurs after a full psychiatric evaluation and interview with the child or teen and the parents. The provider will ask for a detailed personal history of development, life events, emotions, behaviors, and the stressful event.

Treatment for adjustment disorders

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

  • Individual psychotherapy using cognitive behavioral methods. Cognitive behavioral methods 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 in the family. This may include improving communication skills and family interactions. It may also include increasing support among family members.

  • Peer group therapy. Peer group therapy is often focused on developing and using social skills and interpersonal skills.

  • Medicine. Medicines are not often used to treat adjustment disorders. But medicine may be used on a short-term basis if a certain symptom is severe and medicine can help.

Prevention of adjustment disorders

It’s not known how to reduce or prevent adjustment disorders in teens. But diagnosing the disorder early and getting professional help for your child can reduce severe symptoms. Taking these steps can enhance a teen’s normal growth and development. This can improve your child’s quality of life.