Adjustment Disorder (DC: 0-3R and Associated CHADIS Criteria)

Normal text quoted directly from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition (DC: 0-3R; Zero to Three, 2005, pp. 28). Italisized text conveys information about the CHADIS items assessing the DC: 0-3R criteria.

The diagnosis of Adjustment Disorder should be considered for any transient situational disturbances that (1) do not meet the criteria for other Axis I diagnoses (such as Posttraumatic Stress Disorder or Prolonged Bereavement/Grief Reaction), (2) are not merely an exacerbation of another preexisting disorder, and (3) do not represent developmentally appropriate reactions to changes in the environment.

The diagnosis of Adjustment Disorder requires that ALL FOUR of the following criteria be met:

1. An environmental stressor event or events is present
   For the above, CHADIS requires one or more of the following:
   • "In a typical day, how many hours does your child spend in out of home care?" (Twelve or more)
   • "Has there been a change in your child's daycare, childcare, or preschool during the past 6 months (including starting for the first time)?" (Yes)
   • "In the past year, has your child been hospitalized?" (Yes, more than a week)
   • "Did your child have a medical procedure in the past year?" (Yes, and it made him/her very upset)
   • "In the past year, has your child been seriously injured by any of the following?" (Bad fall; Animal bite; Accidental poisoning; Burning; Near-drowning; Serious vehicle accident; or Other)
   • "Have any family members been suffering from any of these conditions during the past year?" (Health problems, emotional problems, substance abuse problems, severe stress, lack of social support, immigration problems, other
   • "Please indicate any employment or financial difficulties that your family may be experiencing" (Major financial problems or unemployment, trouble paying for food; difficult working conditions, parent(s) deployed with the military; problems getting healthcare or insurance; other)
   • "Please indicate any challenges that your family may be facing related to your living situation" (Housing problems, moving, neighborhood safety problems, other)
   • "Has your family had to deal with any of the following this year?" (A person who has been helping take care of your child moved or became unavailable; Death of a parent; Death of another family member or a non-family member your child was close to; Parent separated from child; New child in your family; Parent remarried or new adult in house; Problems getting along with spouse/boyfriend/girlfriend/partner; Separation or divorce of parents; Domestic violence; Legal problems, Custody battle; Other)
   • "Over the past year, which of the following difficulties with your child have occurred?" (Shouting at your child more than once per month; Becoming less able to care for your child, Neglect or abuse of your child by anyone; Protective services involvement or child removed from the home; Spanking your child more than once per month; Shaking your child; Brothers or sisters having physical fights; Child placement in foster care; or Other)
   • "Has your child been exposed to any of the following stressful situations?" (Immediate family member being arrested and/or incarcerated; Child or immediate family member was abducted or held captive; Witnessing violence or being the victim of a crime; Witnessing or being involved in a natural disaster (fire, hurricane, terrible storm, tornado, earthquake, flood); Affected by war or terrorism; Child caused an event that resulted in someone being seriously injured or killed; Experiencing, witnessing, or being affected by a serious car accident; or Experiencing or witnessing some other traumatic event)
2. A disturbance of affect or behavior appears WITHIN 1 MONTH of the environmental stressor event(s). The infant or young child may exhibit affective symptoms (appearing, for example, subdued, irritable, sober, anxious, or withdrawn) or behavioral symptoms (for example, oppositionality, resistance to going to sleep, frequent tantrums, or regression in toilet training) or both
   For the above, CHADIS requires both of the following:
   • "You said that your child or someone else in your immediate family has been experiencing a problem or stressor in the past year. Since that problem or stressor started, are any of the following true of your child?" (Doesn't show feelings as strongly as he/she used to; Seems irritable; Doesn't seem as happy or energetic as he/she used to; Seems anxious; Seems more withdrawn than he/she used to; Seems more difficult to handle; Has been more difficult to get to sleep at night or at naptime; Has been having temper tantrums; Seems to be doing worse with toilet training; Seems too serious)
   • "You said that your child has been having some trouble since someone in your immediate family started experiencing a problem or stressor. How long after the stressful change did you notice that he/she was having trouble?" (Less than a month)
3. Symptoms do not meet criteria for Posttraumatic Stress Disorder, Disorders of Affect, or Disorders of Relating and Communicating
4. Symptoms must be present for MORE THAN 2 WEEKS ("You said that your child has been having some trouble since someone in your immediate family started experiencing a problem or stressor. How long has your child been having this trouble?" -Two weeks or more)