Adjustment disorder is an abnormal reaction to an identifiable stressor that results in emotional or behavioral symptoms and impairment. It is commonly seen in children who experience depressed mood, irritability, impaired concentration and sleep issues after stressful events. Treatment involves psychotherapy and sometimes medication to alleviate symptoms. Prevention focuses on building coping skills, conflict resolution training and supportive relationships.

1. Adjustment Disorder
Shehryar Alam Khan
Kinza Tehseen

2. Introduction to Adjustment Disorder
Shehryar Alam Khan

3. Introduction
• Adjustment disorder is an abnormal and excessive reaction to an
identifiable life stressor. The reaction is more severe than would
normally be expected and can result in significant impairment in
social, occupational, or academic functioning.
• Adjustment disorder is sometimes referred to as Situational
Depression.
• This low level of adaptation then leads to the development of
emotional or behavioral symptoms.
• If a child experienced a stressful event and hasn’t been the same
since then, he may have adjustment disorder.

4. Symptoms in SchoolSettings
• Children suffering from depressed mood.
• Crying frequently in class or at school.
• Irritability and impaired social functioning with friends and teachers.
• Expressing feelings of sadness, hopelessness, worry, nervousness, fear, or anger.
• Complaining of body aches and pains in class.
• Being abnormally sleepy in class.
• Not eating their lunch, and showing poor appetite.
• Problems with completing school work and paying attention.
• Getting into fights with other children.
• Reckless behaviors such as destroying school property.

5. Assessment ofAdjustment Disorder
• It is important to collect clinically relevant information through interview
and collateral informant reports.
• Adjustment Disorder module of the Mini- International Neuropsychiatric
Interview (Sheehan et al., 1998)
• Schedules for Clinical Assessment in Neuropsychiatry (Wing et al., 1990)
• Adjustment Disorder module of the Structured Clinical Interview for DSM-
IV-TR (First et al., 1994)
• Development and validation of the Diagnostic Interview Adjustment
Disorder (DIAD) L. R. Cornelius, S. Brouwer, M. R. De Boer, J. W. Groothoff
& J. J. L. Vanderklink

6. TreatmentOptions
• Adjustment disorder is primarily treated with psychotherapy.
• In some cases medication may alleviate symptoms.
• Talk therapy is extremely effective, showing the child that her
reaction to stress is within her power to control and allowing her to
express her emotions in a supportive environment.
• Adjustment disorders often affect the whole family, so counseling
might include parents and caregivers.
• Treatment may take months. Low doses of anti-anxiety medication
may help anxiety and behavior problems; antidepressants may help
alleviate depression or suicidal thoughts.

7. Managementin SchoolSetting
forSleep Disturbances
• Allowing the student to arrive at school late.
• Shortening the student’s school day.
• Scheduling less demanding academic subjects for the first and second
periods of the day.
• Testing accommodations that extend time and that allow the student to
take the test at a time of day where they are better able to function.
• You can explore having the student stand up and move around or walk
during class or during the school day to see if that helps him or her
overcome the sleepiness.
• Keep the student in a brightly lit area and use lots of natural light, if
possible – particularly morning sun.

8. Managementin SchoolSetting
for ImpairedConcentration,Focus,andMemory
• Provision of hard copies of all notes and board work.
• Discreet assistance focusing or remaining on-task.
• Monitoring to see that all assignments are recorded and materials for
assignments are packed.
• Assisting the student by helping them break large projects down into
smaller pieces and conferencing with them on a regular basis to help them
stay on schedule.
• Word banks or other devices to assist with retrieval of information from
memory.
• Testing accommodations that include extended time, allowing the student
to demonstrate what they know in alternative ways, use of multiple-choice
formats as opposed to open-ended format.

9. Managementin SchoolSetting
for In-SchoolCounselling
• Students with significant symptoms may require in-school counseling
on a regular or as-needed basis.
• The in-school counselor (and it should generally be the school
psychologist or social worker and not a guidance counselor).
• Goals for in-school counseling may address helping the student
recognize how their condition is impacting their ability to deal
• with academics and
• peer relationships,
• developing self-advocacy skills,
• developing strategies to work around or manage the impact of their
symptoms in school, etc.

10. Managementin SchoolSetting
for In-SchoolCounselling
• Goals may also include having the student seek adult assistance or
support when they feel that they are having difficulty coping with
feelings or frustration or communicating it.
• In some cases, learning anger management skills may be part of the
school counseling goals.
• Another area of functioning that school personnel may need to
reconsider is whether the student has the communication skills to
communicate when they are frustrated or depressed.

11. Prevention, Etiology of Adjustment
Disorder
Kinza Tehseen

12. Epidemiology
• Adjustment Disorder in pregnant women are more likely to develop AD in
their children (according to research in Mexico).
• Adjustment disorders are common.
• Prevalence has been estimated at 2% to 8% in children and adolescents.
• There is no gender difference in the incidence of adjustment disorders.
• Adjustment disorders are more common in disadvantaged circumstances.
• Study also found a higher rate of adjustment disorder among persons
exhibiting suicidal behavior in children.
• Adjustment disorders are more common in disadvantaged circumstances.

13. Etiology
• The factors that contribute to the development of adjustment
disorder in children and adolescents are similar to those found in
adults, adjusted for stage of development.
• In 1996, Tomb identified the following 4 factors that may contribute
to the development of adjustment disorders in children:
• Nature of the stressor
• Vulnerabilities of the child

14. Etiology
• Intrinsic factors - Age; sex; intellectual, emotional, and ego
development; coping skills; temperament; and past experiences
• Extrinsic factors - Parents and support systems; expectations,
understanding, skills, maturity, and support available from the child’s
larger environment
• Family conflict/parental separation
• School problems/changing schools
• Sexuality issues
• Death/illness/trauma in the family
• Responses may be familial (genetic and learned) and situational.

15. Prevention
• Altering ongoing predisposing factors may prevent recurrent
episodes.
• Respectful, Supportive Relationships.
• Opportunities for Collaboration.
• Conflict resolution.
• Skills training.

16. Prevention
• Character building.
• School environment modifications.
• Empathy training.
• Impulse control.
• Parent training and support.

17. References
• Cornelius, L. R., Brouwer, S., de Boer, M. R., Groothoff, J. W. and van der Klink,J. J. L. (2014),
Development and validation of the Diagnostic Interview Adjustment Disorder (DIAD). Int. J.
Methods Psychiatr. Res., 23: 192–207. doi:10.1002/mpr.1418
• School Mental Health Project, D. o. (n.d.). Common Psychosocial Problems of School Aged
Youth: Developmental Variations, Problems, Disorders and Perspectives for Prevention and
Treatment. Los Angeles, California, United States of America.
• School Mental Health Project, D. o. (n.d.). Mental Health andSchool-Based Health Centers.
Los Angeles, California,United States of America.

18. References
• KaplanandSadock’sComprehensiveTextbookofPsychiatry
• Adjustmentdisorders:thestateoftheart:PatriciaCasey,SusanBailey
• AdjustmentDisorder:epidemiology,diagnosisandtreatment:MauroGiovanniCarta, Matteo
Balestrieri,AndreaMurruandMaria CarolinaHardoy
• Interventionstofacilitatereturntowork inadultswithadjustmentdisorders(Review)ArendsI,
BruinvelsDJ,RebergenDS,NieuwenhuijsenK,MadanI Neumeyer-GromenA,BültmannU,Verbeek
JH
• DevelopmentandvalidationoftheDiagnosticInterviewAdjustmentDisorder(DIAD)L.R.
Cornelius,S.Brouwer, M.R. DeBoer,J.W. Groothoff& j.J. L.Vanderklink

19. References
• SchoolMentalHealthProject,D.o.(n.d.).ConductandBehavior Problems:Interventionand
ResourcesforSchoolAgedYouth.LosAngeles,California,UnitedStatesofAmerica.
• Jager, A;Carlson,B; Larsen,C;Petersen,C;Card,J; Fortuny,J; Sorkin,J;Ozer, K;Smith,T.(2016).
Behavioral healthdepartment–primarycare center andfireweedtreatmentguidelinesfor
adjustmentdisorders.
• AdjustmentDisorder:Treatment.(n.d.).RetrievedApril25,2017,from
https://childmind.org/guide/guide-adjustment-disorder/treatment/
• AdjustmentDisorder:Parent'sGuidetoSymptoms,Diagnosis&Treatment.(n.d.).RetrievedApril25,
2017,fromhttp://www.childrensneuropsych.com/parents-guide/disorder-guide/adjustment-
disorder/

20. References
• Angelino, Andrew F. and Glenn J. Treisman. "Major Depression and Demoralization in Cancer
Patients: Diagnostic and Treatment Considerations." Supportive CancerCare 9 (November
2000): 344-349.
• Jones, Rick,and others. "Outcome for Adjustment Disorder with Depressed Mood:
Comparison with Other Mood Disorders." JournalofAffectiveDisorders 1999, 55.
• Strain, James J., and others. "Adjustment Disorder: A Multisite Study of its Utilization and
Interventions in the Consultation-LiaisonPsychiatry Setting." GeneralHospital
Psychiatry1998, 20.

21. References
• American PsychiatricAssociation.DiagnosticandStatisticalManualofMentalDisorders.4th
edition,textrevised.Washington,DC:AmericanPsychiatricAssociation,2000.
• Araoz, DanielL.,andMarie Carrese.Solution-OrientedBriefTherapyforAdjustmentDisorders:A
GuideforProvidersUnderManagedCare.New York: Brunner/Mazel,Inc,1996.
• Gabbard,GlenO.,M.D."AdjustmentDisorders."In TreatmentofPsychiatricDisorders,writtenby
James. J. Strain,M.D.,AnwarulKarim, M.D.andAngelaCartagena Rochas,M.A.3rd ed,Volume2.
Washington,D.C.:AmericanPsychiatricPress,2001.
• Nicholi,Armand,ed.TheNewHarvardGuidetoPsychiatry. Cambridge,MA:Harvard
UniversityPress,1988