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An adjustment disorder is defined as an emotional or behavioral reaction to a stressful event or change in a person's life. The reaction is considered an unhealthy response to the event or change within 3 months of the stressful event or change happening. This stressful event or change in the life of a child or adolescent may be a family move, the parents' divorce or separation, the loss of a pet, or the birth of a brother or sister. A sudden illness or restriction to a child's life because of chronic illness may also result in an adjustment response.
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. 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. No evidence is available to suggest a specific factor that causes adjustment disorders.
Adjustment disorders are quite common in children and adolescents. They happen equally in males and females. While adjustment disorders happen in all cultures, the stressors and signs may vary based on cultural influences. Adjustment disorders happen 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 found in the symptoms experienced, in how long they last, how strong they are, and what effect they have. Adolescent symptoms of adjustment disorders are more behavioral like acting out. Adults experience more depressive symptoms.
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. The following are the most common symptoms of each of the subtypes of adjustment disorder. However, each adolescent may experience symptoms differently:
Adjustment disorder with depressed mood. Symptoms may include:
Feelings of hopelessness
Adjustment disorder with anxiety. Symptoms may include:
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. Symptoms may include:
Violation of the rights of others
Violation of society's norms and rules (truancy, destruction of 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 do not fit in 1 of the above subtypes are present. Reactions may include behaviors like social withdrawal or inhibitions to normally expected activities, like school or work.
The symptoms of adjustment disorders may resemble other medical problems or psychiatric conditions. Always talk with your adolescent's health care provider for a diagnosis.
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.
Specific treatment for adjustment disorders will be decided by your adolescent's health care provider based on:
Your adolescent's age, overall health, and medical history
Extent of your adolescent's symptoms
Subtype of the adjustment disorder
Your adolescent's tolerance for specific medicines or therapies
Expectations for the course of the stressful event
Your opinion or preference
Treatment 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, like improving communication skills and family interactions. Also, increasing family support among family members.
Peer group therapy. Peer group therapy is often focused on developing and using social skills and interpersonal skills.
Medicine. While medicines have very limited value in the treatment of adjustment disorders, medicine may be considered on a short-term basis if a specific symptom is severe and it is known that medicine can help.
Preventive measures to reduce adjustment disorders in adolescents are not known at this time. However, early discovery and getting professional help for your adolescent can reduce the severity of symptoms. Taking these steps can enhance the adolescent's normal growth and development, and improve the quality of life experienced by children or adolescents with adjustment disorders.
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