Adjustment disorder in children and adolescents – When everyday life suddenly becomes too much.

Eva Tam -Systemische Kinderpsychotherapie
May 30
3 min read

The diagnosis sounds harmless – but the effects are not: An adjustment disorder describes a psychological reaction to a stressful event that noticeably disrupts the emotional balance of a child or adolescent. It is classified as a reactive mental disorder – meaning it does not arise out of nowhere, but rather as a result of specific external stressors.

Typical triggers can be:

Separation or divorce of parents
Changing schools, bullying, pressure to perform
Illness, accident or death in the environment
family conflicts, mental illnesses of caregivers
Moving, escape or other life changes

How does an adjustment disorder manifest itself?

The symptoms usually begin within a few weeks after the stressful event – they can be mild or very pronounced:

Sadness, irritability, withdrawal
Sleep problems, anxiety, difficulty concentrating
physical complaints without organic cause
sudden drop in performance or school refusal
social withdrawal , self-doubt, occasional aggressive behavior

In contrast to short mood swings, the symptoms usually last for several weeks and have a noticeable impact on social or school functioning.

Diagnostic criteria for adjustment disorder in children ICD-11 / DSM-5

An adjustment disorder is diagnosed when:

a triggering stress is identifiable,
the reaction goes well beyond the usual level ,
the symptoms limit function (e.g. school, family),
and no other mental disorder explains the symptoms better.

Current findings

Neurobiologically, affected children often show increased stress sensitivity, including in the HPA axis (hypothalamic-pituitary-adrenal axis).
Studies suggest that early childhood attachment experiences, resilience factors, and family protective factors are crucial for coping.
Genetics and temperament also play a role – sensitive, introverted or neurodivergent children often react more quickly by becoming overwhelmed.
In the ICD-11, adjustment disorder is increasingly recognized as an independent disorder with potential for chronicity – no longer a transitional condition, but a serious psychological burden.

Comorbidities – what often occurs in addition

It is not uncommon for an adjustment disorder to occur together with other mental health problems, such as:

Anxiety disorders (e.g. separation anxiety, social phobia)
Depression or depressive episodes
ADHD or emotional regulation disorders
Eating disorders , obsessive-compulsive symptoms
dissociative states , especially with traumatic triggers

The transitions are fluid – the longer an adjustment disorder remains untreated, the higher the risk of chronic complications.

What helps? – Therapeutic options

Not every child needs lengthy therapy – but every affected child needs serious attention and stabilization.

Helpful are, among others:

Systemic short-term therapy or talk therapy
Trauma-educational support (for more serious triggers)
Resource-oriented methods , e.g. creative or body-oriented methods
Family discussions and parent work to involve the environment
If necessary: cooperation with schools, youth welfare services or pediatricians

The aim is to help the child process what has happened, feel safe again and develop their own coping strategies.

Conclusion

An adjustment disorder is not hypersensitivity, but a serious signal from the child's psyche: "I am overwhelmed." If it is recognized and treated early, a lot of suffering can be prevented – if it is ignored, the risk of long-term psychological problems increases.

Parents, teachers, and professionals are called upon to pay close attention. Behind the quiet withdrawal or sudden outburst of anger, there may be a child who has just lost their footing.

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