CRITERION AND PREDICTIVE-VALIDITY OF THE DIAGNOSIS OF ADJUSTMENT DISORDER - A PROSPECTIVE-STUDY OF YOUTHS WITH NEW-ONSET INSULIN-DEPENDENT DIABETES-MELLITUS

Objective: The authors examined the criterion and predictive validity of the diagnosis of adjustment disorder in a pediatric study group. Me thod: Ninety-two school-age children with new-onset insulin-dependent diabetes mellitus were evaluated repeatedly and were diagnosed by usin g DSM-III. The criteria for adjustment disorder were further operation alized by requiring four clinically significant symptoms or signs; the time frame for its onset was extended to 6 months after the diagnosis of insulin-dependent diabetes. Predictive validity was assessed in te rms of new psychiatric disorders other than adjustment disorder during the next 5 years. Results: Of the 92 children, 33 developed adjustmen t disorder and five developed other psychiatric disorders in response to the diagnosis of insulin-dependent diabetes mellitus. Mean time fro m diabetes diagnosis to onset of adjustment disorder was 29 days, the average episode length was 3 months, and the recovery rate was 100%. A mong youths with adjustment disorder in response to the medical diagno sis, the 5-year cumulative probability of a new psychiatric disorder w as 0.48, compared to 0.16 among the other youths. Conclusions: The fin dings generally support the criterion validity of the diagnosis of adj ustment disorder. However, episode duration and the predictive validit y of the diagnosis appear to be functions of the study group being exa mined. In nonpsychiatrically referred pediatric patients, early proble ms in adaptation to the stress of changed health status, as evidenced by adjustment disorder, appear to signal vulnerability to later psycho pathology.