Adjustment disorder is a short-term emotional or behavioural response to a stressful life event (e.g. parental separation, illness, financial struggles, academic stress etc.) that feels too overwhelming to manage alone. The symptoms are strong and disrupt daily life at home, school and in relationships.
Key facts of adjustment disorder:
- Recognised diagnosis in the DSM-5 and ICD-11
- Symptoms begin within 3 months of the stressor or life change
- Symptoms typically resolve within 6 months once the stressor has passed
- Not a character flaw, bad parenting, or personality problem
Anyone can face difficulties adjusting to life's changes. Like adults, children can sometimes develop physical symptoms. These range from stomach pains to headaches.
Behavioural changes are also normal reactions to stress. They may also cry, have temper outbursts, become more clingy, or lack motivation for work or play.
Nevertheless, parents sometimes find their children's behaviour confusing. They may misunderstand these to be deliberate attempts at skipping school or family events.
"Because youths may not have fully developed the ability to express their difficulties, it can be harder for them to address their challenges without support from a trusted adult," explains Daniel Ho, a senior clinical psychologist at IMH's Department of Developmental Psychiatry.
If your child's reaction affects school, friendships, or home life, it may help to talk to a professional.
Citing an example of a person who migrates to another country, Dr Lee Yu Wei, a senior consultant at the Department of Mood and Anxiety at IMH explains, "The individual may be worried about adapting to a new environment and how people would view him. These are natural reactions to starting afresh in a new place."
Such a reaction is normal and what one would expect to have when faced with changes. These do not have lasting impact and are more common.
"However, if he were to become extremely worried about the move and begin to feel anxious or have panic attacks and is unable to cope, this might eventually be diagnosed as an adjustment disorder," Dr Lee adds.
Despite how minor some events may feel, the emotional weight felt by someone with adjustment disorder is real.
Youths go through a demanding period of development. Their brains are still growing, particularly in the areas responsible for managing emotions and making decisions. This can make it harder for them to handle intense emotions or bounce back from setbacks.
They are also in a stage of life where they are still forming their identity while managing academics at the same time. Significant disruptions to these processes can lead a young person to need more support. This is more likely if they lack strong coping skills.
Common triggers of adjustment issues in adolescents
The triggers for adjustment issues in adolescents can include:
- Changing school or moving - Starting at a new school or moving homes can end friendships and familiar routines. Rebuilding this social world from scratch feels impossible to some.
- Parental separation and family conflict - Divorce, conflict at home, or a parent moving out can disrupt safety and stability. Despite the parents' best efforts, young people often carry more of the emotional weight than parents realise.
- Death of someone close - Losing someone close can be a young person's first real encounter with grief. Without the tools to process loss, bereavement can be overwhelming.
- Academic stress - Fear of failing an exam or repeating a school year can feel suffocating. This is especially true for young people who link self-worth to academic performance.
- Bullying and rejection - Being left out can hurt a young person's self-esteem. A growing child can feel humiliated when friends ostracise them.
- Chronic illness - Falling ill or becoming a young caregiver can bring fear and uncertainty. Many young people are not ready to handle this, especially when their needs are unnoticed.
Teens who are struggling with adjusting to changes may not share what's troubling them. This can be easy to mistake as normal behaviour. What to watch out for is not one symptom alone, but a group of changes that happen after a major stressor. Symptoms include:
Emotional signs
- Sadness, crying, low mood
- Anxiousness, worry, constantly on edge
- Irritability, emotional outbursts that seem out of proportion
- Difficulty concentrating
- Suicidal thoughts
Behavioural signs
- Withdrawing from friends, family or hobbies
- Refusing school or a sharp drop in performance
- Recklessness or risky behaviour
- Getting into more trouble
Physical signs
- Trouble sleeping, or sleeping more than usual
- Constant tiredness and low energy
- Unexplained headaches, stomach aches and appetite changes
Not all adolescents show distress in the same way. While some may stay silent, think over and over about things, some become anxious and clingy. Others may act out through bursts of anger.
But when caregivers stay calm and model health responses to stress, it can help a young person learn how to manage their own responses.
You do not need to be a therapist to make a difference. Consistent support from a trusted adult can help in their recovery. Here are some tips:
Keep communication open
While keen to help, jumping into problem-solving mode immediately may appear dismissive.
Instead, allow and encourage them to express how they feel. Most importantly, check in with them and let them know you care. Have open and honest conversations with your child about the changes they are experiencing. Car rides, preparing a meal or going for a long walk can create relaxed moments to chat about feelings.
Dismissive: "It's not that bad. Just push through it!"
Open and validating: "That sounds tough to face. Tell me more."
Create routine and structure
Routine helps people feel stable and provides a sense of safety. Create a schedule for yourself and your child, leaving time for planned activities and free time. Involving them in the planning process helps them feel included.
Examples to try: Regular mealtimes together, consistent bedtime routine, predictable check-ins throughout the week.
Model healthy coping methods
Youths learn how to handle stress largely by watching the adults closest to them. When parents handle difficulty with calm and purpose, it teaches them that hard situations can be survived.
Discussing change can also be an opportunity to learn coping strategies and practise them with your loved one. This give parents and children a chance to spend quality time together, accept change, and learn helpful ways to handle stress. Showing that you recover after struggling is more important than appearing unshakeable.
In practice, this can mean narrating your own coping out loud:
- "I've had a really stressful day, so I'm going for a walk before doing anything else."
- "That conversation was frustrating. I'm going to take a few minutes before I respond."
- "I'm feeling anxious about this. I'll write down what's worrying me and take it step by step."
- "I need support with this. I'm going to call my sister."
Adjust expectations
It makes sense to reduce pressure during a tough time. But if you remove all expectations, it may appear as if you do not trust your child to overcome their difficulties. Instead, speak calmly and firmly about realistic expectations regarding their behaviour.
Don't forget to praise them for things they've done well to build resilience and self-esteem.
Stay calm and care for yourself
Adults who are overwhelmed about ongoing changes may find their children copying similar patterns. Give yourself some time and space to do things you enjoy. Connected with family and friends to seek support during times of stress and uncertainty.
Conclusion:
While adjustment disorder is time-limited, that doesn't mean it goes away completely on its own without support. If not addressed, symptoms can worsen, continue, or develop into other mental health conditions like depression and anxiety.
Therefore, early and consistent support from caregivers make the biggest difference. They plan an important role in shaping how a young person learns how to bounce back from stress.
