Adjustment Disorderby Deane G. Baldwin, MD

Frequently overlooked in evaluating children for a behavior problem is a common condition termed Adjustment Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The essential feature is the development of clinically significant emotional or behavioral symptoms by an individual in response to an identifiable psychosocial stressor. The manual published by the American Psychiatric Association states that symptoms must develop within three months of the onset of the stressor causing the symptoms and must resolve within six months after the termination of the stressor. The manual also instructs that some symptoms may be prolonged if the stressor is chronic or has protracted consequences. For example, chronic school failure associated with unsympathetic or inadequate authority figures (parent and/or teachers).

An Adjustment Disorder is divided into subtypes that best characterize the predominant symptoms present in an individual with the disorder. Subtypes are listed as follows:

Adjustment Disorder with Anxiety
Adjustment Disorder with Anxiety and Depressed Mood
Adjustment Disorder with Depressed Mood
Adjustment Disorder with Conduct Problems

Adjustment Disorder with Emotional and Conduct Problems Adjustment Disorder of an Unspecified Type (Symptoms are usually associated with reduction in productivity, physical complaints and social maladaptation.

The duration of an Adjustment Disorder is designated as acute if the symptoms are present for less than 6 months and chronic if for more than 6 months.

One should always consider an Adjustment Disorder when a child has problems that include the tentative diagnosis of Anxiety Disorder, Mood Disorder or Conduct Disorder. An Adjustment Disorder can be serious and can lead to delinquency and self-abuse.

On a positive side, an Adjustment Disorder can be remedied in a short time and without medication if the causative stress factor is identified and removed. The key to the diagnosis and treatment is to interview and inventory the common stressors or risk factors that lead to behaviors associated with an Adjustment Disorder.

The ABLE Inventory (www.abledev.com) incorporates many questions relating to common psychosocial stressors that have been shown to cause the symptoms of an Adjustment Disorder. The Inventory addresses the adverse familial, health, behavioral, educational, emotional and environmental issues that can be very stressful to a child, especially one with poor coping skills.

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