Judith a Ifeagwu (2009), Research Assistant and Coordinator, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, explains that due to insufficient behavioral criteria for individuals with AD, validating this disorder proves problematic. AD, a subthreshold disorder, shares characteristics a number of other diagnostic groups as it falls "between defined disorders and problem level (V Code) diagnoses" (Benton & Ifeagwu, ¶ 4). In a number of studies, adjustment disorder with depressed mood depicts the most prevalent subtype of AD assigned. In adult medical settings, general hospitals report 70% of patients with AD experience comorbidity with other psychiatric diagnoses like affective disorders, anxiety disorders, personality disorder, and psychoactive substance abuse disorder. Differential Diagnosis III

Patricia Casey (2009), University Department of Psychiatry, University Hospital, Dublin, Ireland, explains in the journal article, "Adjustment Disorder," that as one element of the AD diagnosis comprises whether the response to the stressor constitutes a manifestation of appropriate distress, the illness differs from other psychiatric disorders. Casey stresses: "The failure to differentiate appropriate, non-pathological reactions to stressful events from those that are pathological could lead to normal sadness being misdiagnosed as adjustment disorder or depression, simply by the presence of symptoms" (Differential Diagnosis Section, ¶ 1). With the absence of criteria to discern normal from abnormal responses, the clinician's judgment proves critical to characterize the individual's responses as proportionate or excessive. Fink (2010) assets that adjustment disorders must be differentiated from a normal reaction to stress to as well as from other psychiatric disorders that transpire following a stress. According to Fink:

1. In acute stress disorder and posttraumatic stress disorder, the stress needs to be severe and it is more clearly specified. The stressors are psychologically...

Both acute stress disorder and posttraumatic stress are characterized by a specific constellation of affective and autonomic symptoms, which is not encountered in adjustment disorders.
2. In normal bereavement, despite difficulties in social and occupational functioning, the person's impairment remains with the expectable bounds of a reaction to a loss of a loved one.

3. Other disorders include major depressive disorder, brief psychotic disorder, generalized anxiety disorder, somatization disorder, conduct disorder, drug abuse, academic problem, occupational problem, or identity problem.

4. If the criteria for any of the above disorders [#3] are met, that diagnosis should

Be used instead of adjustment and disorder, even if the stressor was present.

(Fink, 2010, p. 180)

The individual's personal circumstances as well as the ways individuals within a particular culture express symptoms also prove to be significant considerations when diagnosing AD. "With regard to symptoms and functioning, it is recommended that these should only be regarded as excessive if they are 'clinically significant'" (Casey, 2009, Differential Diagnosis Section, ¶ 3). The meaning of "clinically significant," however, reportedly remains inadequate and tautological as it has not been officially, universally defined.

Pharmacological Treatment

Casey (2009) asserts that for the pharmacological management of adjustment disorder, some professionals advocate antidepressants, particularly when the individual does not appear to benefit from psychotherapy. Little solid evidence, albeit, supports the premise that antidepressants produce an effect on depressive symptoms in those experiencing AD. Nevertheless, treatment of symptoms of adjustment disorders includes treating "insomnia, anxiety and panic attacks and the use of