Adjustment Disorder

An adjustment disorder is an unusually strong or long-lasting reaction to an upsetting event. The triggering event might be a divorce, a death in the family, moving to a new home, starting a different school, a break up, or a big life disappointment. If your child has an adjustment disorder, he will have a hard time coping with his emotions and may become depressed or anxious, exhibit hostility, pick fights, or refuse to go to school, among many other possible responses. The disorder is a reaction to an event of great importance to the child—whether or not that event appears significant to others. It can occur in young children, adolescents, and even adults.

If your child has experienced a stressful event and hasn’t been the same since then, he may have an adjustment disorder. You might begin to worry if you notice that he is abnormally anxious or depressed, has trouble sleeping, or experiences regular crying spells. Other signs include avoiding school, being isolated from family and friends, irritability, vandalism, and fighting. Common stressful events that trigger adjustment disorders include divorce, moving to a new home, or starting a new school, breaking up with a romantic partner, or, for a perfectionist student, doing poorly in school. In particular, be on the lookout for a reaction that lasts much longer than you would usually expect and significantly interferes with daily life.

Researchers are still unsure of the root causes of adjustment disorder. Your child might be more at risk of developing an adjustment disorder if he lacks a strong social support system, lives in a chaotic environment, or regularly experiences stressful life events. Still, many people without any apparent risk factors develop the disorder. Boys and girls are equally affected.

To be diagnosed with adjustment disorder your child will have experienced a stressful event that leaves him abnormally upset and unable to cope. His distress will be more severe than would normally be expected from such an event, and cause significant impairment in academic or social activities. If these symptoms have lasted more than six months after the stressful event, however, it would not be considered adjustment disorder.

Adjustment disorder is primarily treated with supportive psychotherapy, although in some cases medication may also be prescribed to alleviate symptoms.

Psychotherapeutic: Talk therapy is extremely effective in treating adjustment disorder. A therapist might encourage your child to express emotions in a supportive environment and in a constructive fashion, or suggest that a typical reaction to stress has gotten out of hand but is within his power to control. Another goal of the therapy is to teach him healthier ways of dealing with future stressful situations. Since adjustment disorders often affect the whole family, some sessions might include you. Group therapy can also be helpful. A few sessions are usually sufficient for treatment, though occasionally it might take months.

Pharmacological: Your child’s doctor may prescribe low doses of anti-anxiety or even neurolepticmedication to help with anxiety and behavior problems. Antidepressants may also be prescribed to treat depressive or suicidal thoughts. In most cases pharmacological treatment is short-lived.

Teenagers with untreated adjustment disorder are at a heightened risk for developing depression, chronic anxiety, and substance abuse problems.

What causes adjustment disorder?
Adjustment disorder is, by definition, triggered by an event the child perceives to be traumatic, but it’s unknown why some kids are vulnerable while others are much more resilient. Some suggest that the disorder may be a “pathological extreme” of what is otherwise a quite normal coping process in other people.

Will my child grow out of it?
Yes. If the symptoms your child is manifesting have lasted longer than 6 months, it’s not considered adjustment disorder. But since the anxiety, depression and acting out can disrupt their lives, as well as your family’s, treatment is preferable than waiting it out. And without treatment a child is more likely to have the same kind of unhealthy response to future painful events, rather than developing a better approach to dealing with stress.

Is it dangerous?
It can be. Adolescents with adjustment disorder can be prone to risky behaviors, including violence, alcohol and substance abuse, and even suicide.

Does medication help?Medication may be prescribed to alleviate some severe symptoms of anxiety or depression, but psychotherapy is generally considered the most effective way of treating adjustment disorder.