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Short-term Prognosis and Long-term Predictive Validity

Maria Kovacs, PhD; Constantine Gatsonis, PhD; Myrna Pollock, MSW; Phoebe Lucy Parrone, MS

Arch Gen Psychiatry. 1994;51(7):535-541.

Abstract
Objectives
Using DSM-III criteria for adjustment disorder (AD), further operationalized by requiring at least three clinically significant symptoms, we sought to characterize this diagnosis in terms of presenting features, recovery, and predictive validity among juveniles.

Design
The samples included clinically referred, 8- to 13-year-old patients with the research diagnosis of AD (N=30) and a high rate of comorbid disorders and ageand comorbid disorder—matched psychopathologic controls (N=26). As part of a naturalistic, longitudinal, nosologic study, patients were repeatedly examined during an average follow-up interval of 7 to 8 years.

Results
Adjustment disorder was associated with six symptoms, on average, and 60% of the patients had other, specific psychiatric disorders. Adjustment disorder had a median episode length of 7 months and a 97% recovery rate. Comorbidity had no appreciable effect on recovery. Patients with adjustment disorder and controls had similar rates of new psychiatric disorders and other dysfunctional outcomes during the follow-up.

Conclusions
Among psychiatrically referred youths, the diagnosis of AD has clinical information value and identifies a syndromatic presentation that can be the focus of concern or treatment. It has a reasonably good shortterm prognosis, in spite of the fact that patients with this diagnosis typically present with comorbid specific psychiatric disorders. Controlling for the effects of comorbidity, AD does not predict later dysfunction. To achieve a convergence of findings from research and clinical practice, it would be important to ensure a uniform application of specific, operational diagnostic criteria for AD.

Author Affiliations
From the Department of Psychiatry, University of Pittsburgh (Pa) School of Medicine (Dr Kovacs); the Western Psychiatric Institute and Clinic, Pittsburgh (Dr Kovacs and Mss Pollock and Parrone); and the Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Gatsonis).

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