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Adjustment



What is adjustment disorder?
An adjustment disorder is a short-term emotional or behavioral reaction to a known stressful event or change in a child’s life that is considered maladaptive or an unhealthy, unexpected response to the change or event. Adjustment disorder is often called “situational depression” as children who have an adjustment disorder may be fearful, hopeless, and lose interest in school or friends. However, unlike major depression, adjustment disorder is triggered by an external stimuli and remits once the child has processed and adapted to the situation. The response must occur within three months of the identified stressful change or event in a child’s life and tends to resolve within six months following the event. These events may be anything from the birth of a sibling to parental divorce. Other changes include adjusting to a diagnosis of a chronic illness, loss of a pet, or change of schools.  If symptoms continue to persist after 6 months of the stressor, other diagnoses must be considered. 

What causes adjustment disorder?
Children who experience frequent and severe stress are more likely to develop an adjustment disorder.  When there is a change to the child's sense of safety, whether it is real or perceived, we must address and treat it the same.  

What is the typical approach to treating adjustment disorder?
The first step to successful treatment is a comprehensive and thorough assessment 
of functioning.  The assessment includes:
  • Review of current symptoms, concerns, duration and intensity
  • A thorough review of child development and past medical history
  • Review of family systems
  • Additional important family background information including history of mental health issues
Then the best course of treatment is decided together with the caregivers.  Treatment helps because the child's brain can learn to connect the event to a specific coping skill, which becomes the life skill of resilience.  Resilience is what combats tendency to develop mental health disorders in adulthood.  Treatment may include a combination of the following:
  • Play therapy to assist child in expressing what is troubling them when they do not have the verbal language to express thoughts and feelings.
  • Family therapy including play to explore and/or challenge existing family dynamics 
  • Cognitive behavioral therapy to replace negative thought patterns
  • Sandtray therapy to allow child to develop sense of self and process concerns non-verbally
  • Bibliotherapy to help normalize child's concerns
  • Psycho-education with family to learn causes, symptoms, and treatment of anxiety

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