Adjustment Disorders

Key Features

• Pprecipitating event or circumstance is identifiable

• Symptoms have appeared within 3 months after the occurrence of the stressful event

• Although the child experiences distress or some functional impairment, the reaction is not severe or disabling

• Reaction does not persist more than 6 months after the stressor has terminated

• Most common and most disturbing stressors in the lives of children and adolescents include

  • Death of a loved one

  • Marital discord

  • Separation and divorce

  • Family illness

  • Change of residence or school setting

  • Experiencing a traumatic event

  • Peer-relationship problems

Clinical Findings

• Changes in mood

• Changes in behavior

• Anxiety symptoms

• Physical complaints

Diagnosis

• When the reaction is significantly out of proportion to the stressor and a decline in functioning is noted, a diagnosis of adjustment disorder is highly suspected

Treatment

• The mainstay of treatment involves genuine empathy and assurance to the parents and the patient that the emotional or behavioral change is a predictable consequence of the stressful event

• Parents are encouraged to help the child with appropriate expression of feelings, while defining boundaries for behavior that prevent the child from feeling out of control and ensure safety of self and others

• Maintaining or reestablishing routines can also alleviate distress and help children and adolescents adjust to changing circumstances by increasing predictability and decreasing distress about the unknown