Signs of Adjustment Disorders in Children

DSM-IV defines Adjustment Disorder as the emergence of clinically significant emotional and behavioral symptoms in response to an identifiable stressor(s) within three months of the onset of the stressor(s), and the emotional/behavioral response is not merely an exacerbation of an existing Axis I or Axis II disorder.

Furthermore, the individual's reaction appears to be greater than what would be expected given the nature of the stressor) Moreover, it is characterized by significant impairment in social or academic/occupational functioning. Symptoms are expected to disappear once the stressor(s) and its repercussions are removed. Although there is no typical clinical presentation of Adjustment illness in children and adolescents, recent developments in formal diagnostic schemes (e.g., DSM-IV) have helped to provide a more complete picture of the illness.

Classification of Adjustment Disorders

Adjustment illness is classified into six subtypes, which allow doctors to categorize the illness based on major symptom clusters, more specifically −

  • Adjustment Disorder with Depressed Mood Subtype is similar to "reactive depression" in that depressed mood is the primary presenting problem, and a specific stressor can be identified as the precipitant;

  • Significant symptoms of worry and nervousness characterize Adjustment Disorder with Anxiety Subtype. It is not to be confused with Axis I Anxiety Disorders, which include panic attacks, generalized anxiety, and muscle tension in the absence of an identified antecedent stressor.

  • Adjustment Disorder with Mixed Anxiety and DepreSSion is used when it is difficult to determine the significant emotional disturbance linked with the disorder and when patients present with anxiety and depression.

  • The Adjustment Disorder with Disturbance of Conduct subtype is widespread in adolescence. It entails behavior that violates others' rights or age-appropriate social norms and standards (e.g., truancy, fighting, vandalism, reckless driving). The main difference between this subtype and Axis I Conduct Disorder is that Adjustment Disorder with Disturbance of Conduct is much shorter in duration and can be linked to identifiable environmental stressors;

  • Adjustment Disorder with Mixed Disturbance of Emotions and Conduct subtype is used when the predominant symptoms represent a combination of both emotional difficulties (i.e., anxiety and depression) and conduct problems; and

Adjustment Disorder, Disturbance of Emotions and Conduct One of the mixed Subtypes is the most typical manifestation of Adjustment Disorders in children and adolescents. Females are more likely to be categorized as having Adjustment Disorder with Depressed Mood. At the same time, males are more likely to be classed as having Adjustment Disorder with Mixed Disturbance of Emotions and Conduct.

Despite advances in diagnostic taxonomy, Adjustment Disorder remains a contentious diagnostic category, owing to a perceived lack of clarity in its criteria and all-encompassing character. Furthermore, there is insufficient data to imply that subtyping based on the primary symptom complex has therapeutic predictive value.

Incidence of Adjustment Disorders in Children

Adjustment Disorder is one of the most common diagnoses among children and adolescents. Indeed, some have claimed that the high prevalence of Adjustment Disorder diagnosis in this community is partly attributable to the disorder's inclusive character. Trends in the incidence rates of Adjustment Disorder diagnosis appropriately reflect these concerns. Early estimates of the condition from the 1970s and 1980s.

For example, using less sophisticated diagnostic criteria, revealed incidence rates ranging from 16 to 42 percent, depending on the demographic investigated (e.g., general population, inpatients, etc.). According to more recent estimates, the general population of children and adolescents has an incidence rate of approximately 243 percent. However, rates as high as 34 percent have been found in particular groups, such as mental emergency care admissions.

Correlates of Adjustment Disorders in Children

Even though Adjustment Disorder is typically considered a subthreshold diagnosis, it can be associated with severe morbidity. Suicidal behavior is one of the most dangerous consequences of Adjustment Disorder. Estimates vary, but data suggests that roughly 25% of adolescents with Adjustment Disorder attempt suicide, mainly when impulsivity is included in the clinical presentation. It should be emphasized that significant life stresses such as hospitalization, mourning after the death of a family member, chronic sickness, and divorce frequently precede Adjustment Disorder.

However, abundant evidence shows that Adjustment Disorder and suicidal behavior frequently emerge due to minor occurrences. School troubles, conflicts with parents, peer rejection, substance usage, and problems with boyfriends/girlfriends are the most prevalent precipitants related to the appearance of Adjustment Disorder (and even suicidal behavior). Furthermore, studies show that a significant minority of teenagers with Adjustment Disorder develop more severe diagnoses such as antisocial personality disorder, bipolar illness, and substance dependence. The chronicity of behavioral symptoms associated with an Adjustment Disorder diagnosis has been established as a consistent predictor of more severe difficulties later in life.

Assessment of Adjustment Disorders

Clinical interviews and interview checklists that follow the DSM-/V diagnostic taxonomy are commonly used to diagnose Adjustment Disorders. Others have used structured and semistructured interview schedules created for research objectives with children and adolescents. The identification of a perceived proximal stressor in the environment that precipitates the appearance of behavioral! Emotional symptoms are the fundamental differential diagnostic factor in clinical evaluation. Notably, various evaluation methods hinder the development of more solid diagnostic criteria and accurate incidence estimates of Adjustment Disorder.

Prognosis of Adjustment Disorders in Children

Prognostic projections vary widely, as in most aspects of Adjustment Disorder. Children and adolescents with Adjustment disease fare worse than adults with the disease in general. This might be due to the sheer quantity of traumatic situations that young people must deal with as they grow up. It is also possible that adolescents have evolved fewer sufficient coping strategies to deal with the enormous pressures in their ever-changing environment. In any case, Adjustment Disorder recovery rates range from 30 to 97 percent, depending on the nature of the stressors faced (severity, chronicity) and the group studied.

There is some evidence that children and adolescents who are older at the time of symptom start and have predominately the depressive subtype recover faster and have fewer hospital readmissions. As previously stated, the chronicity of behavioral symptoms, rather than the quantity and kind of symptoms, is the strongest predictor of future success. According to several writers, while recovery rates from Adjustment Disorders are encouraging, recovery sometimes takes longer than six months, which exceeds the 6-month length limit stated in the diagnostic criteria.

Treatment of Adjustment Disorders

Treatment of Adjustment Disorder, like other stress-related responses, is best treated from a therapeutic standpoint that first aims to eliminate or minimize the precipitant stresses. If this is not feasible, cognitive behavioral techniques that aid children and adolescents in recognizing and altering the precipitant stressor(s) should be used in an attempt to reinterpret and neutralize the influence of the stressor on the child's life should be used. Encouraging youngsters to express their anxieties or apprehensions about the stresses can significantly reduce their impact.

Systematic relaxation and guided visualization techniques have also been shown to reduce fear and anxiety in response to stress. Attempts should also be made to include parents in therapy to create a supportive home environment. In the case of older teens, writing assignments that allow for expressing emotions related to the acute stressor might be helpful in a matter of weeks. Medication (antidepressants/anxiolytics) and hospitalization may be needed in the case of Adjustment Disorders that entail high levels of emotional impairments (i.e., depression) and impulsivity.


DSM-IV defines Adjustment Disorders in Children as the emergence of clinically significant emotional and behavioral symptoms in response to an identifiable stressor within three months of the onset. It is classified into six subtypes based on major symptom clusters.

Adjustment Disorder is a contentious diagnostic category due to lack of clarity and all-encompassing character. It is one of the most common diagnoses among children and adolescents, with an incidence rate of 243 percent. Suicidal behavior is one of the most dangerous consequences.

Updated on: 09-May-2023


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