Adjustment disorders in childhood
- In adjustment disorders the patient has difficulties in adapting to a certain identified psychosocial stress factor and, as a result, he/she begins to experience psychological symptoms. In other words it is a reactive disorder associated with the patient's life situation.
- Anxiety caused by an emotional disturbance and a normal state alternate.
- The individual predisposition and vulnerability of the child plays an important role in the aetiology of the disorder.
- Changes in life circumstances, losses, separation from family, bullying at school or illness can lead to an adjustment disorder.
- The prevalence of adjustment disorders is not clear but according to some studies it is about 4%.
- Substantial number of adolescents (about 40%) referred to emergency units for psychiatric evaluation suffer from adjustment disorders.
Symptoms and clinical picture
- Symptoms appear within 1–3 months after the stressful situation or traumatic event.
- If the symptoms are present longer than 6 months after the stress factor has disappeared, it is likely that there is some other psychiatric disturbance in question.
- Symptoms are similar to many other mental disorders. Clinical picture is strongly dependent on the child's age and development.
- The reactions of parents and other individuals close to the child as well as their abilities and possibilities to support the child probably play a role in the occurence of the disorder.
- When making the diagnosis other mental disorders must be excluded.
- Brief depressive reaction
- Prolonged depressive reaction
- Mixed anxiety and depressive reaction
- With predominant disturbance of other emotions (for instance, regressive behaviour)
- With predominant disturbance of conduct
- With mixed disturbance of emotions and conduct
- Little scientific information is available.
- Changing the child's environment and giving support and guidance to both the child and the family is helpful. Mild adjustment disorders can be treated in primary health care using the principles mentioned.
- Cognitive therapies have been reported to be effective in the treatment of more severe forms of adjustment disorders.
- According to the current knowledge, children recover from the adjustment disorder well. Early diagnosis and treatment are considered to be important in respect of the recovery.
- Especially, if the traumatic event is also experienced to be difficult to handle by the parents of the child and taxes their emotional resources as guardians, the need for individual psychological support and treatment has to be assessed carefully.
- Children can also have acute reactions to stress and post-traumatic stress disorders (PTSD) (adults', see 1). These disorders must be treated because children do not forget the traumas they experience. Instead they often need help in handling them . The debriefing technique has been applied also to children, but it is often not enough, especially for children under school age.
- Cochrane reviews1
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