What Are Adjustment Disorders?

It’s normal for kids to get upset when they go through a big change. A move, a divorce, a new sibling — any stressful event in a child’s life can affect their mood or behavior.

But sometimes kids under stress have very strong emotional or behavioral reactions that seem to be out of proportion to the events they’re experiencing. When the distress begins to interfere with the child’s daily life, they may have an adjustment disorder. Adjustment disorders are some of the more common mental health disorders in children.

Adjustment disorders always occur in response to a stressful event of some kind, followed by an unusually strong reaction to the event. Children who have an adjustment disorder will act or feel noticeably different than they did before, and their symptoms cause them serious problems in their day-to-day lives.

The symptoms themselves can vary a lot from child to child. “It can skew in the direction of more anxiety-related symptoms, or toward depressive symptoms, or centered around disruptive behavior and conduct problems, or some combination of the three,” says Erika Rooney, PsyD, a clinical psychologist at the Child Mind Institute.

Because of the variety of reactions that kids might have, there are six distinct subtypes of adjustment disorder to help better guide diagnosis and treatment:

• With depressed mood: Feeling extremely sad or hopeless, low energy, crying frequently.
• With anxiety: Feeling very worried or jittery, separation anxiety, physical symptoms like stomachaches.
• With mixed depressed mood and anxiety: Some symptoms of both depression and anxiety.
• With disturbance of conduct: Disruptive behavior, anger, getting into fights.
• With mixed disturbance of emotions and conduct: Some emotional symptoms (like depression or anxiety) as well as some behavioral ones.
• Unspecified: Reactions that don’t quite fit the other subtypes but that nonetheless interfere significantly with the child’s life.

These symptoms start within the first three months of the stressful event, and they usually don’t last for more than six months afterward.

Kids with previous mental health diagnoses can also be diagnosed with an adjustment disorder, but only when the symptoms that show up after the event are much different than the symptoms they experienced before. For example, a child with ADHD who has previously had behavior problems might be diagnosed with an adjustment disorder if they develop anxiety after moving to a new town.

Adjustment disorders can be diagnosed at any age (including in adults), and they are common in both children and adolescents. Boys and girls are diagnosed with adjustment disorders at about equal rates.

Any event that a child experiences as particularly stressful or upsetting can be a cause of adjustment disorder. These events are not generally dangerous or life-threatening. Common examples include:

• Moving
• Changing schools
• Parents divorcing or remarrying
• A new sibling or other change in family composition
• Being diagnosed with a health condition or having a family member be diagnosed
• Social stresses (like falling out with a friend or a breakup)
• School or extracurricular struggles (like failing a class or being cut from a sports team)

Different kids find different events stressful, and individual differences and cultural norms also play a role in shaping kids’ experiences of life changes. “It’s not a prescribed set of circumstances that can cause an adjustment disorder,” says Dr. Rooney. “Sometimes it might not be something that’s obvious to the parent.” The key factor is that a child with adjustment disorder is more upset about what they’ve experienced than would normally be expected for a child of their age and circumstances.

Regardless of the specific stress the child is dealing with, it usually makes sense to reevaluate kids with an adjustment disorder whose symptoms last longer than six months. A clinician can determine whether the child’s symptoms are still mainly a reaction to a stressor or if a different diagnosis, like an anxiety disorder or a mood disorder, would make more sense.

Adjustment disorders are related to post-traumatic stress disorder (PTSD), but there are a few key differences between the two. Timing, type of event, and severity of symptoms are key factors in determining the diagnosis.

One big distinguishing feature is the kind of event that the child is reacting to. PTSD develops in response to a real or perceived threat of harm or death to oneself, or by seeing or hearing about a loved one going through that kind of event. Examples include violence, abuse, natural disasters, sexual assault, abrupt separation from a caregiver, serious accident or illness, or the unexpected or violent death of someone the child is close to. The same is true of acute stress disorder, which may be a precursor to PTSD if left untreated

Adjustment disorders, on the other hand, are unusually strong reactions to non-threatening, relatively normal life stressors and circumstances.

The symptoms are also different between the two disorders. “Adjustment disorder shares some of the symptoms you might see with PTSD, but not all and they might be less severe,” says Dr. Rooney. For example, a child with PTSD or acute stress disorder might experience flashbacks or intrusive thoughts about the traumatic event and be completely overwhelmed with fear, while a child with adjustment disorder might be more preoccupied with worry or sadness.

Additionally, the child’s symptoms need to continue for at least a month before being diagnosed with PTSD, because it’s normal to be very upset right after a life-threatening event. Adjustment disorders can be diagnosed sooner, but they don’t continue for as long after the event.

“If a clinician is unable to collect enough information about the child’s symptoms or life history, or if they don’t have time to do a full evaluation, for example in an emergency room, it may be unclear whether or not the child is experiencing PTSD,” Dr. Rooney notes. In those cases, adjustment disorders are sometimes used as temporary diagnoses that might be updated once the clinician has more information.

Even though adjustment disorders don’t usually last for long, professional support can be very helpful for kids who are experiencing them. In treatment, kids can learn to handle difficult feelings and manage life stress, which makes it less likely that they’ll continue to experience mental health challenges going forward. Treatment for adjustments disorders is often brief, lasting only a few weeks or months.

Because the symptoms of adjustment disorders vary so much, treatment also looks different for the different subtypes. “Treatment is tailored to the primary symptoms that the child is presenting with,” says Dr. Rooney. “If it’s more of a disruptive behavior problem, for example, then it would be geared toward collaborating with parents on effective limit-setting, and helping the child with perspective-taking or impulse control, those kinds of things. If it’s anxiety, then you’d focus it differently. It’s really specific to how they present.”

In many cases, the appropriate treatment is cognitive behavioral therapy (CBT), which helps kids understand the connections between their thoughts, feelings, and behavior. “Most kids with adjustment disorders respond well to the core components of CBT, which involves building up a set of effective coping skills, such as managing intense emotions, reframing unhelpful thoughts, and learning relaxation skills” Dr. Rooney says.

If a child with adjustment disorder is experiencing especially intense anxiety or depression, a doctor might prescribe them a low dose of an antidepressant medication. The medication can help ease the child’s symptoms enough for them to engage in therapy and get through the most challenging phase of coping with the stressful event.

If your child has been diagnosed with an adjustment disorder, it’s important to take their symptoms seriously, even though they’re reacting to what might seem like ordinary life stress.

“The diagnosis is telling you that their symptoms are impairing enough to impede their functioning and quality of life, and as such, worth clinical attention,” says Dr. Rooney. “Moreover, the symptoms could get more intense if the child doesn’t get therapeutic support.” At the same time, it can help keep things in perspective to remember that their condition is likely to be temporary and may not be related to any longer-term diagnosis. “If someone says your child has adjustment disorder with depressed mood, for example, it doesn’t mean that they actually have major depressive disorder,” she adds.

Validation often goes a long way in helping kids through challenging times, whether or not their symptoms reach the level of a clinical diagnosis. Even if your child’s reaction seems out of proportion to you, knowing that you see their pain and are there to help them navigate it can help kids cope more effectively. For instance, you might say: “I see how hard this change is for you. It’s okay to be upset, and we’re going to get through this together.”

Dr. Rooney also notes that parents who use effective coping skills themselves give kids a model for how to do the same. A lot of the events that might cause adjustment disorder for kids are hard for the whole family — if you’ve recently moved, lost a job, or had a new baby, for instance, chances are that you’re dealing with plenty of stress of your own. By finding ways to relax as a family and talking openly about feelings at home, you can let kids know that it’s normal to feel overwhelmed sometimes and that there are things they can do to feel better.

“It’s always good to make it a family activity, if one can,” says Dr. Rooney. “You can have regular check-ins to see how everyone is coping, to model open communication and reinforce the skills that your child is learning in treatment, which will ultimately help them and the family.”