Diagnostic Classification in Infancy and Early Childhood

Diagnostic Classification in Infancy and Early Childhood

Knowledge about the mental health and development of infants has grown exponentially in the past two decades. Through sys-tematic observation, research and clinical intervention a more sophisticated understanding has emerged of the factors that con-tribute to adaptive and maladaptive patterns of development and of the meaning of individual differences in infancy. This knowl-edge has led to an increasing awareness of the importance of prevention and early treatment in creating or restoring favorable conditions for the young child’s development and mental health. Timely assessment and accurate diagnosis can provide the foun-dation for effective intervention before early deviations become consolidated into maladaptive patterns of functioning.

As a result of this growing knowledge base, a new diag-nostic framework was formulated through an 8-year effort of ZERO TO THREE: National Center for Infants, Toddlers, and Families. This framework is presented in detail in Diagnostic Classifi cation of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–3) (1994). It seeks to address the need for a systematic, developmentally based approach to the classification of mental health and developmental difficulties in the first 3 years of life. It is designed to complement existing medical and developmental frameworks for understanding men-tal health and developmental problems in the earliest years.

DC:0–3 categorizes emotional and behavioral patterns that represent significant deviations from normative development in the earliest years of life. Some of the categories presented repre-sent new formulations of mental health and developmental dif-ficulties. Other categories describe the earliest manifestations of mental health problems that have been identified among older chil-dren and adults but have not been fully described in infants and young children. In infancy and early childhood, these problems may have different characteristics, and prognosis may be more optimistic if effective early intervention can occur.

Discussions of diagnostic categories can be most help-ful if they identify challenges to be overcome in the context of an understanding of adaptive coping and development. Understanding both adaptive capacities and challenges is part of the essential foundation for planning and implementing effec-tive interventions. A detailed discussion of the principles of as-sessment, diagnosis and intervention, along with case studies, is presented in Infancy and Early Childhood (Greenspan, 1992).

Reflecting our current state of knowledge, the diagnostic categories, that is, they record presenting patterns of symptoms and behaviors. Some of the categories (e.g., those involving trauma) imply potential etiological factors; some (e.g., regulatory disorders) imply pathophysiological processes. However, at the moment, all that can be stated is that as-sociations have been observed between some of these symptoms and processes (e.g., between a traumatic event and a group of symptoms, or between a sensory or motor pattern and a group of symptoms). Only further research will establish possible pathophysiological or etiological links among these observed phenomena.

As an evolving framework, this conceptualization is not in-tended to include all possible conditions or disorders. It is an initial guide for mental health professionals and researchers to facilitate clinical diagnosis and planning as well as communication and further research. It is not intended to have legal or nonclinical applications.