The Zero‐to‐Three diagnostic classification in an infant mental health clinic: Its usefulness and challenges

Abstract

ABSTRACT:The clinical and practical experiences of a multidisciplinary infant mental health team using the DC: 0-3 Diagnostic Classification system are presented. Using data obtained from clinical in-depth evaluations of 167 consecutive referred infants, the characteristics and clinical features of this sample of children and parents are examined. The principal issues are children and families' socioeconomic status, number and types of stressors, as well as the symptoms or difficulties exhibited by the infants themselves. A significant proportion of infants come from a deprived socioeconomic background, and many are exposed to violence in the home. The diagnoses given to infants and to the kind of relationship they have with the primary caregiver (Axes I and II) are presented, as well as data as to their physical status (Axis III) and stressors (Axis IV). Many children are diagnosed as having regulatory disturbances, predomiDirect correspondence to: Martín Maldonado, Family Service and Guidance Center, 325 SW Frazier, Topeka, KS 66604; phone; 785-232-5005; fax: 785-232-0160; e-mail: Maldo2000mor@aol.com. DC: 0-3 and Infant Clinic • 379nantly of the hypersensitive and motorically disorganized type. A significant proportion of mothers exhibited depression. About a third of the babies and primary caregivers had a relationship disorder, the predominant category being the underinvolved type. The implications of these findings are discussed, emphasizing the usefulness and frequency of some categories, while questioning the usefulness of other diagnostic categories. The experience of the group contributes to a dialogue and database regarding the clinical usefulness and applicability of this diagnostic classification system. RESUMEN: Se presentan en este estudio las experiencias clínicas y prácticas de un equipo de salud mental infantil multidisciplinario que utilizó la clasificación de diagnóstico DC: 0-3. Usando la información obtenida de una evaluación clínica profunda de 167 infantes que consecutivamente nos fueron enviados, este estudio examina las características y rasgos clínicos de dicho grupo muestra compuesto de infantes y sus padres. Los asuntos principales son: la condición socioeconómica de los niños y sus familias, el número y el tipo de las causas de estrés, así como los síntomas o dificultades presentadas por los mismos infantes. Una proporción significativa de los niños procede de niveles socioeconómicos bajos, y muchos están expuestos a violencia en sus hogares. Se presentan los diagnósticos que se les dieron a los infantes y a los tipos de relación que tales infantes tienen con quien les prestan el cuidado inmediato (Ejes I y II). También se presenta la información sobre la condición física de los infantes (Eje III) y de estrés (Eje IV). Muchos niños reciben el diagnóstico que los describe con trastornos regulatorios, predominantemente del tipo de hipersensibilidad y de desorganización motora. Una proporción significativa de madres presentó de depresión. Cerca de un tercio de los bebés y quienes les cu...

Diagnostik und Klassifikation von Verhaltensauffälligkeiten bei Säuglingen und Kleinkindern von 0-5 Jahren

“…Es soll die bestehenden Klassifikationssysteme DSM-IV und ICD-10 nicht ersetzen, sondern ergänzen. Es ist in seiner ersten Version inzwischen in mehrere Sprachen übersetzt und wird derzeit weltweit evaluiert (Dunitz et al 1996;Frankel et al 2004;Keren et al 2001Keren et al , 2003Maestro et al 2002;Maldonado-Durán et al 2003;Wiefel et al 2005 Vandenhoeck&Ruprecht (2007) standardisierte und videodokumentierte Interaktionsdiagnostik. Eine vollständige Untersuchung erfordert in der Regel drei bis fünf Sitzungen von je 45 Minuten Dauer.…”

“…In einem special issue "DC: 0-3" des Infant Mental Health Journals und in einer eigenen empirischen Arbeit sind von verschiedenen internationalen Arbeitsgruppen evaluative Vergleiche zwischen den Systemen vorgenommen worden Cesari et al 2003;Maldonado-Durán et al 2003;Wiefel et al 2005).…”

Infant mental health: classification and relevance for clinicians

“…One clinical study noticed that the majority of referrals from a high-risk, socioeconomically deprived population fell within the third year of life, and speculated that clinicians tend not to refer before the age of 1 year. 15 They noticed a higher rate of classified infant mental health disorders such as post-traumatic stress disorder (PTSD), regulatory disorder and multisystem developmental disorder 16 from 25 to 36 months compared with earlier -perhaps related to the fact that symptoms of these disorders may only be unmasked when the infant moves through the developmental changes during this time. 15 The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Summary Infant mental health is a growing research area, but findings have not generally translated into new service developments.…”

“…15 They noticed a higher rate of classified infant mental health disorders such as post-traumatic stress disorder (PTSD), regulatory disorder and multisystem developmental disorder 16 from 25 to 36 months compared with earlier -perhaps related to the fact that symptoms of these disorders may only be unmasked when the infant moves through the developmental changes during this time. 15 The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Summary Infant mental health is a growing research area, but findings have not generally translated into new service developments. Recognising mental health problems in young infants is relevant for clinicians in all mental health specialties, but it can be a particular challenge to make diagnoses in very young children.…”

“…15,24,27 It widens the thinking beyond the child, concentrating somewhere between the 'child with the problem' and the caregiver potentially as the 'cause' of the problem, and guides clinicians to investigate this complex relationship in a standardised and purposeful way. 15 There already exist many ways to consider the infant-caregiver relationship, and it can be hard to distinguish the phenomenology in terms of relationship qualities, attachment and other descriptive concepts such as temperament. With regard to the attachment relationship, maternal sensitivity has been traditionally seen as a focus of importance:…”