Adjustment Disorder

The pandemic changed everything. Previously, we tried to separate our work life from our home life. Today, there is hardly a distinction between home and the office. Home is now the office making work-life balance a more exciting proposition.

During this unprecedented time, homeschooling became a thing for many families. The changes have driven us to take actions that require a fresh mindset about our health, safety, and future. The activities we once enjoyed now look and feel different. For example, some promoters urge their patrons to take a COVID-19 test to enter a concert venue.


As we emerge from the extraordinary restrictions to our lives due to the pandemic, psychological adjustment is crucial to our activities of daily living.


Many children will return to the classroom after an eighteen-month hiatus. Undoubtedly, there will be a period of adjustment. One adjustment will be the transition from online learning back to face-to-face instruction. Some students may revel in the opportunity to return and enjoy the face-to-face interaction and fellowship they enjoyed before the start of the pandemic.


Others are likely to experience emotional or behavioral reactions to the changes in the school community. As such, the students may experience one or more stressors upon their return to school. The stressors may include the practice of social distancing, wearing masks, and other restrictions to their movements. In some instances, new student orientations were canceled or done virtually. So incoming students lost out on the opportunity to visit and tour the school campus before starting the academic year.


There are also parental concerns about the efficacy of vaccines. These concerns extend to whether vaccines will become mandatory and whether there will be exemptions to compulsory vaccinations. The abundance of views expressed by experts and nonexperts about vaccines further complicates whether or not to vaccinate children.


Some of the literature is laden with jargon unfamiliar to the readers, leading to further confusion about the virus and vaccines. In some cases, parents themselves have adapted to the idea of homeschooling their children but are faced with the challenge of what happens when their employers reopen office buildings and set a return date.


Although wearing masks, social distancing, and the other COVID-19 guidances should be normalized by now, many children were not necessarily leaving their homes. Consequently, they were not wearing masks and social distancing in their homes, so the changes to the school community "requiring" or "strongly suggesting or recommending" they wear masks in buildings may be a stressor. Some students may complain about difficulty breathing from wearing the mask. At some institutions, students can be maskless outside of buildings but are required to wear them inside.

What is adjustment disorder? According to the diagnostic and statistical manual of mental disorders, It is a "psychological response to an identifiable stressor or stressors that result in the development of clinically significant emotional or behavioral symptoms."


Predominantly children and adolescents are diagnosed with adjustment disorders. Adults can also be diagnosed with the condition.


Prolonged exposure to a stressor(s) is a risk factor for developing adjustment disorder. The individual struggles to adjust to an environmental stressor(s) intensifies the risk of developing emotional and behavioral problems.


Symptoms:

  • The emotional or behavioral symptoms associated with an identified stressor(s) start within 3 months of the stressful event.

  • The symptoms are clinically significant, with marked distress exceeding the expected response to the identified stressor(s). For example, the child experiences heart palpitations from the stress and anxiety of being in school. Leading to impairment in the child's social or academic functioning.

  • The child or adolescents culture may influence the severity and presentation of the emotional or behavioral symptoms.

  • The emotional or behavioral symptoms do not result from grief (loss of a loved one, parental divorce, pet loss, family move, ongoing acute or chronic medical issues, relationships, or interpersonal problems).

  • When the stressor(s) no longer affect the child's functioning, the symptoms do not continue for more than 6 months after the start of the stressful event.

Subtypes:


Adjustment disorder, as quoted above, is a psychological response to an identified stressor(s). Consequently, the symptoms may be different for each person. The adjustment issues may be associated with 1 of 6 subtypes:

  • Depressed mood – feelings of hopelessness, withdrawal from social supports, trouble sleeping, loss of appetite

  • Anxiety – worry, nervousness, fear, inability to relax, feeling of choking, muscle tension

  • A combination of anxiety and depressed mood

  • Disturbance of conduct - inappropriate behaviors outside of behavioral norms and rules

  • Disturbance of emotions and conduct – depression, anxiety, and maladaptive behaviors

  • Unspecified - the inappropriate behaviors associated with adjustment are not classifiable as one of the first 5 subtypes listed.

Treatment


The treatment modality selected by the mental/behavioral health professional is to improve adaptive coping skills. The more adaptive coping skills the child or adolescent develops and practices, the better they cope with stressful events. Sometimes, the stressful event may not be totally terminated for the environment. Therefore, the child or adolescent uses their adaptive coping skills to manage the environmental change. The adaptive coping skills may be applicable to deal with new stressful events.

  • Individual therapy

  • Group therapy

  • Psychoeducational groups

  • Cognitive Behavior Therapy

  • Rational Emotive Behavior Therapy

A child or adolescent may display signs of adjustment disorder but may not meet the diagnostic criteria for diagnosis. Diagnosing the illness would be dependent on the duration and onset of the symptoms. A trained professional will assess if the child meets diagnostic criteria for the condition.


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References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders 5th edition.

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders 4th edition.

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