River Oak Center for Children: Adjustment Disorders

What is an 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 somehow not an
expected healthy response to the event or change. The reaction must occur within three
months of the identified stressful event or change happening. The identifiable stressful event or
change in the life of a child or adolescent may be a family move, parental divorce or
separation, the loss of a pet, birth of a brother or sister, to name a few.

What causes adjustment disorders?

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 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.

Who is affected by adjustment disorders?

Adjustment disorders are quite common in children and adolescents. They 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. Adolescent symptoms of adjustment disorders are more
behavioral such as acting out, while adults experience more depressive symptoms.

What are the symptoms of 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, occupational or educational
functioning. 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 child may experience symptoms differently.
Symptoms may include:

How are adjustment disorders diagnosed?

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 for adjustment disorders 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   adjustmentdisorders, medication may be considered on a short term basis if a specific   symptom is severe and known to be responsive to medication.

• Adjustment disorder with depressed mood.
     • Depressed mood; tearfulness; feelings of hopelessness.

• Adjustment disorder with anxiety.
     • Nervousness; worry; jitteriness; fear of separation from major attachment
       figures.

• 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.
     • Violation of the rights of others; violation of societal norms and rules (truancy,
       destruction of property, reckless driving, fighting).

•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).

•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 (i.e., school or work).

Prevention of adjustment disorders:

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 child's normal growth and development and improve the quality of
life experienced by children or adolescents with adjustment disorders.

How does River Oak help children and adolescents with adjustment disorders?

Treatment begins with helping the child and adolescent understand the situation that
created the adjustment disorder. This can be something within the family, such as divorce,
or outside of the family, such as changing schools. Treatment can include working on how
the person thinks, understands, and responds to the situation, such as through cognitive
behavioral therapy. Family therapy can be used to help the family communicate in healthier
ways about situations that may create adjustment disorders. Social skills and coping skills
may be taught in treatment to help the individual better cope with stressors and
communicate about her or his needs.

Important messages about children's and adolescents' mental health:

Mental health problems affect one in every five young people at any given time. "Serious
emotional disturbances" for children and adolescents refers to the above disorders when they
severely disrupt daily functioning in home, school, or community. Serious emotional
disturbances affect one in every ten young people at any given time.

For assistance/information call:

1-800-789-2647 National Mental Health Information Center
1-800-969-6642 (press 1) Mental Health America
1-800-273-8255 24 Hour Crisis Line (Mental Health America)
1-240-403-1901 National Federation of Families for Children's Mental Health
1-800-950-6264 National Alliance on Mental Illness (NAMI) www.nami.org