Adjustment Disorders in Children

What is an adjustment disorder?

An adjustment disorder is a reaction to stress that lasts less than 6 months. The stress may be a change in the family, such as a move, divorce, or birth. It may be a very stressful event such as abuse, tornado, rape, severe car accident, or a national tragedy. If a child has an adjustment disorder, the child's reaction seems to be out of proportion to what happened and gets in the way of relationships, school, and daily life.

What is the cause?

It is not known why one child develops an adjustment disorder while another does not. Adjustment disorders are not thought to be caused by anything biological. Children and teens vary in their temperament, past experiences, vulnerability, and coping skills. Their maturity and support system are factors that also have something to do with how they react. Stressors also vary in how severe the experience is, whether it happens again, and how parents react to the event.

What are the symptoms?

Your child may:

• cry easily
• be very irritable or have angry outbursts
• destroy property or get in fights
• fear being separated from parents
• have physical symptoms such as headaches or stomachaches
• have trouble concentrating and perform poorly in school
• have trouble falling or staying asleep, or have nightmares
• have changes in appetite
• lose interest in activities he or she once enjoyed
• show sudden and extreme emotional reactions such as anxiety, panic, anger, or guilt
• worry all the time and startle easily.

How is it diagnosed?

If your child's symptoms last for more than 3 months after the event and interfere with daily life, see your child's healthcare provider. Your child's healthcare provider will ask about the child's symptoms, medical and family history, and any medicines the child is taking. Your child may have some lab tests to rule out medical problems such as chemical imbalances. If your child's symptoms do not have a physical cause, you may be referred to a mental health specialist. The mental health specialist will ask about your child's development, emotions, behaviors, and the stressful event.

How is it treated?

Treatment is based on your child's age, overall health, medical history, and symptoms. Therapy (individual, group, or family) may help reduce fears and worries. Cognitive behavioral therapy (CBT) is very helpful for adjustment disorders. Art therapy can also help young children draw pictures about what happened or play out their feelings. Support groups can help your child understand that he or she is not alone. Groups also provide a safe place to share feelings.

A mental health specialist might also recommend medicines. These medicines can help reduce depression and anxiety and help your child cope with school and other daily activities. Medicine is often used as a temporary measure to help until your child feels better.

What can I do to help my child?

• If you suspect that your child is suicidal, get professional help immediately. Thoughts of suicide are serious at any age and require prompt attention.
• Let your child talk about the stressful event or change when and if he or she feels ready. Do not force the issue if your child does not feel like sharing her thoughts.
• Reassure your child that his or her feelings are okay and that he or she is not "going crazy." The support and understanding that you provide can help your child accept frightening emotions.
• Let your child make simple decisions when appropriate. Because stress often makes a child feel powerless, you can help children by showing them that they have control over certain parts of life. For example, you might consider letting your child decide what to have for dinner or how to spend the day.
• Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.
• Take care of yourself so that you are well equipped to help your child. You can't be supportive if you're neglecting your own emotional or physical health.