Adjustment Disorders in Children

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 this problem in a child or teen are:

• A family move
• Death of a parent, sibling, grandparent, or other significant person
• Parents’ divorce or separation
• Death of a pet
• A new brother or sister
• A sudden sickness in the child or a family member
• A long-lasting (chronic) illness in the child or a family member

Causes

Adjustment disorders are a reaction to stress. There is not one direct cause. Children and teens differ in their personalities, past experiences, vulnerability, and coping skills. Where they are in their development and ability to deal with a stressor may also play a part in how they react. Stressors also vary in how long they last, how strong they are, and what effect they have.

Risk Factors

Adjustment disorders happen at all ages and are quite common in children and teens. They happen equally in boys and girls. They happen in all cultures. But the stressors and signs may vary based on cultural influences.

Symptoms

Children and teens have different symptoms of an adjustment disorder than adults. Children tend to have more behavioral symptoms, such as acting out. Adults have more depressive symptoms. Age differences also affect how long symptoms last, how strong they are, and what effect they have.

In all adjustment disorders, the reaction to the stressor seems to be more than what is thought to be normal. Or the reaction greatly interferes with how the child functions day to day.

There are six subtypes of adjustment disorder. They are based on the type of major symptoms a child may feel. Each child’s symptoms may vary. These are the most common symptoms of each subtype:

• Adjustment disorder with depressed mood. A child may feel depressed, tearful, and hopeless.
• Adjustment disorder with anxiety. Symptoms may include nervousness, worry, and jitteriness. A child may also fear losing important people in their life.
• Adjustment disorder with anxiety and depressed mood. A child has a mix of symptoms from both of the above subtypes (depressed mood and anxiety).
• Adjustment disorder with disturbance of conduct. A child may violate other people’s rights or violate social norms and rules. Examples include not going to school, destroying property, driving recklessly, or fist fighting.
• Adjustment disorder with mixed disturbance of emotions and conduct. A child has a mix of symptoms from all of the above subtypes.
• Adjustment disorder unspecified. A child has reactions to stressful events that don’t fit in one of the above subtypes. These may include behaviors such as withdrawing from friends and school.

Symptoms of an adjustment disorder can look like other health problems or mental illnesses. Have your child see their healthcare provider for a diagnosis.

Diagnosis

A mental health expert such as a psychiatrist often makes the diagnosis after an evaluation. They talk with you, your partner, and your child. They will ask for a full history of your child’s development, life events, emotions, behaviors, school performance, and the stressful event.

Treatment

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

Treatment may include:

• Psychotherapy using cognitive behavioral methods. A child learns how to better solve problems, communicate, and handle stress. They will also learn how to control impulses and anger.
• Family therapy. This therapy is often focused on making needed changes in the family. It may include improving communication skills and family interactions. It may also boost support among family members.
• Peer group therapy. This therapy develops social and interpersonal skills.
• Medicines. These are not often used. But a child may need them for a short time if a certain symptom is severe.

Prevention

It’s not known how to prevent an adjustment disorder in a child. But spotting it early and getting expert help for your child can ease severe symptoms. Taking these steps can enhance a child’s normal growth and development. It can improve your child’s quality of life.

Living with

You can do these things to help your child:

• Keep all appointments with your child’s healthcare provider.
• Talk with your child’s healthcare provider about other providers who will be included in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your child’s care team will depend on your child’s needs and how serious the adjustment disorder is.
• Work closely with school staff. Your child's adjustment disorder may significantly interfere with their ability to learn. If this is the case, the Americans with Disabilities Act (ADA) or Section 504 of the Civil Rights Act may allow the school to offer reasonable accommodations in the school setting.
• Tell others about your child’s adjustment disorder. Work with your child’s healthcare provider and school to create a treatment plan.
• Reach out for support from local community services. Being in touch with other parents who have a child with an adjustment disorder may be helpful.

When to Call a Healthcare Provider

Call your child’s healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms

Key Points

• An adjustment disorder is an unhealthy emotional or behavioral reaction to a stressful event or change in a child’s life.
• Adjustment disorders happen equally in boys and girls and in all cultures. But the stressors and signs of the disorder may vary based on cultural influences.
• Symptoms happen within 3 months of the stressful event.
• There are six subtypes. They are based on the major symptoms a child may feel, such as depression or anxiety.
• Psychiatric evaluation can help diagnose it.
• Personal, family, and group therapy can help.

Next Steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.