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Adjustment disorders – When bad things happen to good kids


By definition, no one likes it when bad things happen to them.  [Alternate first line:  No one likes it when bad things happen to them – thank you, Captain Obvious.]  In fact, any kind of change can be difficult for most of us.  We’re creatures of habit.  But life is full of changes, unexpected events and disappointments.  We can’t avoid them, but some people cope better with those “bumps in the road” than others.

At one end of the spectrum are those people who are unusually resilient.  By nature or through practice, they are able to weather those storms and take obstacles in stride.  Most of us struggle a bit more with set-backs, bad news, and big life changes.  But each time we’ve faced these challenges over the course of our lives, we (hopefully!) learn to cope better.

Most children haven’t yet had to deal with many life stressors, and each one is part of a learning experience.  As parents, it’s hard to watch our children struggle to overcome disappointment, deal with grief, experience hostility, and go through other crises.  But usually, with loving support, most children work through their reactions to life events and are able to move on.

However, in some cases, this doesn’t happen.  If you see your child experiencing an intense reaction to a negative event that doesn’t get better with time, it may be a cause for concern.  Your child may be exhibiting an adjustment disorder.  If so, he or she needs help to keep from getting overwhelmed.

Adjustment disorder – what is it?

Adjustment disorder is an unusually strong or long-lasting reaction to an upsetting event.   This may be something big and obvious, like a divorce, a death in the family, changing schools or moving to a new home.  Less dramatic but painful disappointments, like not making a team or getting a coveted role, can also be a trigger.  Social setbacks can be equally devastating, and are often invisible to parents.

All these events hit kids hard.  How do you know when you should be concerned?  If your child is expressing his or her feelings, turning to friends and family, continuing with regular activities and seems to be feeling better with time, he or she is working through the process successfully.  But if your child seems stuck, then you should look closely.  If your child seems depressed, anxious, lashes out with hostility, closes out friends and resists going to school, these are signals that he or she is struggling with adjustment disorder.

As a parent, you may not always see the trigger that leads to such a reaction, and even if you do, you may not recognize it.  Events that seem trivial to an adult can be excruciating to a child.  The triggering event itself is not important – it’s your child’s reaction to it.  For example, if your child is an over-achiever, getting a bad grade may be enough to be a huge event.


You should be concerned if, after a few weeks, your child:

  • Hasn’t seemed to “bounce back”
  •     Has trouble sleeping
  •  Often has crying spells
  •  Is reluctant to go to school
  •  Becomes withdrawn
  •  Appears sad, listless or apathetic
  •  Doesn’t seem to take pleasure in activities they once enjoyed, or stops doing those activities

You should be concerned if you notice these changes in your child:

  •     Personality changes (i.e., used to be sociable but now seeks isolation)
  •     Sudden irritability
  •     Tendency toward anger
  •     Getting into fights
  •     Getting into trouble at school
  •     Sudden changes in grades
  •     Dropping favorite afterschool activities

Simply put, any reaction that is interfering with your child’s daily life for more than a brief time is cause for concern.

Who is at risk?

Unfortunately, those children who have experienced repeated stressful events are more likely to have difficulty coping, not less.  If you know that your child has had to endure emotional hardships, whether because of external events or bouts of depression, be particularly mindful if and when new stressful life events occur.

Adults sometimes think that enduring these challenges makes us stronger, but that kind of resilience grows from a solid base of childhood security.  When such challenges are faced by children of any age, the exact opposite may occur.

If your child shows signs of adjustment disorder, it does not mean that you, as a parent, have not been supportive enough.  However, if you notice your child exhibiting several of the signs listed above, don’t assume that it will get better on its own.  A proactive response can help your child cope now, and can teach him or her the skills to cope with such setbacks for the rest of his/her life.

How to tell the difference between adjustment disorder and clinical depression

If you see signs in your child’s behavior and emotions that make you wonder about this, it’s clear that your child needs help.  You don’t need to know the diagnosis; you only need to recognize that your child is in distress.  Find therapeutic and psychiatric help for your child first, and let the clinician do the diagnosis.


How treatment helps

Recognizing that there is a problem and getting help for your child is paramount.

Although it may be alarming to hear that your child has adjustment disorder, once you have found a mental health professional, you have already taken the first, important step.  The most dangerous aspect of this disorder is not recognizing it and leaving it untreated.  For younger children, it could lead to more and more intense reactions in the future.  Older children and teens left untreated are at a heightened risk for developing depression, chronic anxiety, violent behavior, and substance abuse problems.  Luckily, adjustment disorder responds very well to psychotherapy.

Psychotherapy, or “talk therapy,” is a process that may take time but shows remarkable results.  A good therapist will create a warm yet neutral environment, away from complex family dynamics, where your child will feel safe and supported.  He or she will encourage your child to express emotions that may be frightening in their intensity.  The therapist will work with your child in many ways:  suggesting constructive ways of expressing strong feelings; providing a neutral point-of-view to balance extreme reactions; and most importantly, teaching your child skills that will help him or her deal better with stress in the future.  Although we can’t control what happens to us, we can learn to react to it in a more positive and constructive way that doesn’t wound us further.  Your child may be more sensitive to stress, but learning that there are ways to respond to it is often a huge relief.  Stress is something your child – everyone – has the power to control.  Realizing that they are not powerless but powerful in these situations is a momentous and lifelong change.  These are skills that anyone should learn.

In fact, the therapy process will usually at some point include family members, too.  Group therapy may also be helpful, as it shows your child that others are going through this, too.  It can be helpful to realize that you are not the only person experiencing this frightening feeling of loss of control, especially for children.

Therapy sessions may take only a few weeks, or months.  Each person reacts differently, and you need to be patient with the process.  Sometimes, therapy may be combined with low doses of anti-anxiety, antidepressant or neuroleptic medication to help with the anxiety and behavior problems.  It is important to note that medicating your child should never be the first step, and never prescribed without accompanying therapy.  Usually, if medication is needed, it is only for a short while.  Medication is a band-aide, but the therapy provides the real solution.

A good therapist will connect with your child and teach them incredibly valuable skills that will last a lifetime.  If the process doesn’t seem to be working, don’t give up!  You can expect resistance at first.  Therapists are trained to work through this.  Occasionally, a therapist may not be the right fit for your child.  If so, find another.  It’s worth it.

It’s hard to watch your child struggle.  But adjustment disorder, once recognized, can be treated, and your child will gain important life skills.  But it’s up to you to begin the process.