A CONTROLLED PROSPECTIVE-STUDY OF DSM-III ADJUSTMENT DISORDER IN CHILDHOOD - SHORT-TERM PROGNOSIS AND LONG-TERM, PREDICTIVE-VALIDITY

Objectives: Using DSM-III criteria for adjustment disorder (AD), furth er operationalized by requiring at least three clinically significant symptoms, we sought to characterize this diagnosis in terms of present ing features, recovery, and predictive validity among juveniles. Desig n: The samples included clinically referred, 8- to 13-year-old patient s with the research diagnosis of AD (N=30) and a high rate of comorbid disorders and age- and comorbid disorder-matched psychopathologic con trols (N=26). As part of a naturalistic, longitudinal, nosologic study , patients were repeatedly examined during an average follow-up interv al of 7 to 8 years. Results: Adjustment disorder was associated with s ix symptoms, on average, and 60% of the patients had other, specific p sychiatric disorders. Adjustment disorder had a median episode length of 7 months and a 97% recovery rate. Comorbidity had no appreciable ef fect on recovery. Patients with adjustment disorder and controls had s imilar rates of new psychiatric disorders and other dysfunctional outc omes during the follow-up. Conclusions: Among psychiatrically referred youths, the diagnosis of AD has clinical information value and identi fies a syndromatic presentation that can be the focus of concern or tr eatment. It has a reasonably good shortterm prognosis, in spite of the fact that patients with this diagnosis typically present with comorbi d specific psychiatric disorders. Controlling for the effects of comor bidity, AD does not predict later dysfunction. To achieve a convergenc e of findings from research and clinical practice, it would be importa nt to ensure a uniform application of specific, operational diagnostic criteria for AD.