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7 - Adjustment disorders

Published online by Cambridge University Press:  06 August 2009

Peter Hill
Affiliation:
Department of Psychological Medicine, Great Ormond Street Hospital for Children, London, UK
Christopher Gillberg
Affiliation:
Göteborgs Universitet, Sweden
Richard Harrington
Affiliation:
University of Manchester
Hans-Christoph Steinhausen
Affiliation:
Universität Zürich
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Summary

Introduction

The concept of adjustment disorder (or a group of adjustment disorders) has a long history, though what is actually meant by the term has changed over time. Originally, as ‘adjustment reaction’, it was one of a very few disorder categories included in major psychiatric classification schemes specifically for use in children and adolescents. In DSM-I, for instance, adjustment reaction and childhood schizophrenia were the only two categories of childhood psychiatric disorder. The intention was to indicate that some instances of disordered behaviour or emotions arose specifically because of an identified stressor rather than, say, a process of mental illness. The source of stress was originally thought of as including both external events (such as bereavement) or an internal developmental process, which might require significant adaptation of mental functioning (such as maturational changes during adolescence). There was an implicit idea that adjustment to adversity or intra-psychic conflict could be either adaptive or maladaptive. If it was maladaptive, then personal dysfunction was to be seen as a psychiatric condition.

Historically, the most widespread way of understanding a psychological response to adversity or conflict was initially through psychoanalytic theory and a concept of trauma or intrapsychic conflict secondary to external events or developmental challenges. Subsequently, the development of a model of social influences led to a rather different way of thinking which emphasized processes rather more than events.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2006

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References

P. Hill, Adjustment disorders. Chap 31 in Rutter, M. & Taylor, E. (eds.), Child and Adolescent Psychiatry. 4th edn. (Oxford: Blackwell Scientific Publications, 2002).
, F. Almqvist, , K. Puura, , K. Kumpulainenet al., Psychiatric disorders in 8–9 year-old children based on a diagnostic interview with the parents. European Child and Adolescent Psychiatry, 8 (1999) suppl. 4, 17–28.Google Scholar
, A. Angold, , E. J. Costello, Farmer, E. M. Z., , B. J. Burns & , A. Erkanli, Impaired but undiagnosed. Journal of the American Academy of Child and Adolescent Psychiatry, 38 (1999), 129–37.Google Scholar
S. Sandberg & M. Rutter, The role of acute life stresses. Chap 17 in Rutter, M. & Taylor, E. (eds.) Child and Adolescent Psychiatry. 4th edn. (Oxford: Blackwell Scientific Publications, 2002).
, E. Frydenberg, Adolescent Coping: Theoretical and Research Perspectives. (London: Routledge, 1997).
, I. Seiffge-Kranke, Stress, Coping and Relationships in Adolescence. (Hove, UK: Lawrence Erlbaum Associates, 1995).
, M. Kovacs, , C. Gatsonis, , M. Pollock & , P. L. Parrone, A controlled prospective study of DSM-III adjustment disorder in childhood: short-term prognosis and long-term predictive validity. Archives of General Psychiatry, 51 (1994), 535–41.Google Scholar
, M. Kovacs, , V. Ho & , M. H. Pollock, Criterion and predictive validity of the diagnosis of adjustment disorder: a prospective study of youths with new-onset insulin-dependent diabetes mellitus. American Journal of Psychiatry, 152 (1995), 523–8.Google Scholar
, D. Shaffer, , M. S. Gould, , J. Brasic, et al., A Children's Global Assessment Scale (CGAS)Archives of General Psychiatry, 40 (1983), 1228–31.Google Scholar

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