Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: DC: 0-5

224 Pages·2016·7.767 MB·English

by  Zero to Three

:
DC 0-5
™
Diagnostic Classification
of Mental Health and
Developmental Disorders of
Infancy and Early Childhood
ZERO TO THREE
Washington, DC
Published by
ZERO TO THREE
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Copyedited by Tyler Krupa
Library of Congress Cataloging-in-Publication Data
Names: Zero to Three (Organization), issuing body.
Title: DC: 0-5 : diagnostic classification of mental health and developmental
disorders of infancy and early childhood.
Other titles: Diagnostic classification, 0-5.
Description: Washington, DC : Zero to Three, [2016] | Includes
bibliographical references and index.
Identifiers: LCCN 2016034587 (print) | LCCN 2016042248 (ebook) | ISBN
9781938558573 | ISBN 9781938558580 ()
Subjects: LCSH: Child psychopathology--Classification. | Infant
psychiatry--Classification. | Child psychopathology--Diagnosis. | Infant
psychiatry--Diagnosis. | Child psychopathology--Case studies. | Infant
psychiatry--Case studies.
Classification: LCC RJ500.5 .D53 2016 (print) | LCC RJ500.5 (ebook) | DDC
618.92/89075--dc23
LC record available at https://lccn.loc.gov/2016034587
10 9 8 7 6 5 4 3 2 1
ISBN 978-1-938558-57-3
Printed in the United States of America
Suggested citation: ZERO TO THREE. (2016). DC:0–5™: Diagnostic classification of mental health and developmental
disorders of infancy and early childhood. Washington, DC: Author.
Table of Contents
Preface vii
Acknowledgments ix
Introduction 1
Axis I: Clinical Disorders 15
NEURODEVELOPMENTAL DISORDERS 15
Autism Spectrum Disorder 16
Early Atypical Autism Spectrum Disorder 20
Attention Deficit Hyperactivity Disorder 25
Overactivity Disorder of Toddlerhood 30
Global Developmental Delay 35
Developmental Language Disorder 36
Developmental Coordination Disorder 38
Other Neurodevelopmental Disorder of Infancy/Early Childhood 40
SENSORY PROCESSING DISORDERS 41
Sensory Over-Responsivity Disorder 41
Sensory Under-Responsivity Disorder 45
Other Sensory Processing Disorder 48
ANXIETY DISORDERS 50
Separation Anxiety Disorder 51
Social Anxiety Disorder (Social Phobia) 52
Generalized Anxiety Disorder 53
Selective Mutism 58
Inhibition to Novelty Disorder 61
Other Anxiety Disorder of Infancy/Early Childhood 63
iii
MOOD DISORDERS 65
Depressive Disorder of Early Childhood 65
Disorder of Dysregulated Anger and Aggression of Early Childhood 69
Other Mood Disorder of Early Childhood 76
OBSESSIVE COMPULSIVE AND RELATED DISORDERS 77
Obsessive Compulsive Disorder 77
Tourette’s Disorder 81
Motor or Vocal Tic Disorder 84
Trichotillomania 85
Skin Picking Disorder of Infancy/Early Childhood 87
Other Obsessive Compulsive and Related Disorder 89
SLEEP, EATING, AND CRYING DISORDERS 90
Sleep Disorders 91
Sleep Onset Disorder 92
Night Waking Disorder 92
Partial Arousal Sleep Disorder 93
Nightmare Disorder of Early Childhood 94
Eating Disorders of Infancy/Early Childhood 99
Overeating Disorder 99
Undereating Disorder 102
Atypical Eating Disorder 106
Crying Disorder of Infancy/Early Childhood 110
Excessive Crying Disorder 110
Other Sleep, Eating, and Excessive Crying Disorder
of Infancy/Early Childhood 112
TRAUMA, STRESS, AND DEPRIVATION DISORDERS 114
Posttraumatic Stress Disorder 115
Adjustment Disorder 119
Complicated Grief Disorder of Infancy/Early Childhood 122
Reactive Attachment Disorder 126
Disinhibited Social Engagement Disorder 129
Other Trauma, Stress, and Deprivation Disorder of
Infancy/Early Childhood 133
RELATIONSHIP DISORDERS 134
Relationship Specific Disorder of Infancy/Early Childhood 135
iv DC:0–5™
Axis II: Relational Context 139
Axis III: Physical Health Conditions and Considerations 149
Axis IV: Psychosocial Stressors 153
Axis V: Developmental Competence 159
Appendix A: Developmental Milestones and
Competency Ratings 161
Appendix B: The Process of Revising and Updating DC:0–3R 189
Appendix C: ZERO TO THREE Diagnostic Classification
Task Force (DC:0–3) and Revision Task Force (DC:0–3R) 193
Glossary 195
References 197
Index 199
v

Preface
DC:0–5: Diagnostic Classification of Mental Health and Developmental Disorders of In-
fancy and Early Childhood (DC:0–5™) is a welcome and much-awaited guide for
diagnosing mental disorders in early childhood. Users will find it incorporates
the best available general knowledge from research, clinical practice, and early
child development. Why “much-awaited”? As the Chair of the former DC:0-
3R system which this supersedes, I can say that phrase with conviction because
our general knowledge about identifying and intervening with early childhood
disorders has been growing at a fast pace, and major change has been needed.
In this light, the Introduction to DC:0–5 is a must-read for users, explaining
how the Diagnostic Classification system has evolved in response to needs, and
continues to evolve.
The reader will find that major changes include not only the identification of
new evidence-based syndromes, but also a needed inclusion of the 3–5 year age
period. Further, there is as an increased emphasis on users appreciating and
documenting contexts for diagnostic classification, which is so important for
early childhood development. The latter fact leads the designers of DC:0–5 to
retain the multi-axial system, in order to supplement the clinical diagnoses of
Axis I. In addition to the relational context of Axis II, these include the contexts
of physical health conditions, psychosocial stressors, and developmental com-
petence (in Axes II–V).
Another major change worth mentioning at the outset has to do with the im-
portance of early caregiving relationships. Compelling recent evidence from
research indicates that infant and early child attachments and their disorders are
relationship specific; a fact that justifies the inclusion of a relationship specific
disorder among the Clinical Disorders of Axis I. Additionally, a much-expanded
section on Relational Context in Axis II is included that states “understand-
ing the relationship context should be included in every assessment of infants
and young children.” Accordingly, users are provided with a rating scheme of
“strength,” “not a concern,” or “concern” for dimensions of relationship func-
tioning for one or more primary caregiver relationships (in Part A) and for the
broader caregiving environment (in Part B). The latter is designed to include
the understanding of co-parenting, sibling, and other important relationships
in the child’s development.
vii
In this preface, it seems important to remember what diagnostic classification is
and what it is not. Diagnostic classification is for professional communications,
linking to general knowledge about disorders, derived from research and clinical
practice. It is descriptive of syndromes and symptoms involving distress and
the impairment of functioning over time. A system of diagnostic classification
is not a “textbook,” or worse yet a “bible” for clinicians or others to use, as has
sometimes been portrayed. And as clinicians know, they are classifying disor-
ders, not individuals. For individuals, it is a major task of the clinician to use a
system of diagnostic classification as one significant step in the further process
of diagnostic formulation. This involves applying the general knowledge of disor-
der classification to a developing individual in the particulars of living, with the
formulation of an opinion about the needs for further assessment (or not) and
plans for further intervention (or not). It involves careful history taking in care-
taker interviews, direct observations, clinical empathy, and holistic judgments in
which patterns of child behavior and experience are taken into account. Again,
although DC:0–5 may provide more general information about the assessment
of context in its Axes of II–V than other classification systems, it does not pro-
vide a guide or a manual for clinical formulation.
DC:0–5 is not intended to compete with the diagnostic classifications of the
Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM; American
Psychiatric Association, 2013) or the International Classification of Diseases
(ICD; 10th ed.; World Health Organization, 1992). It arises because current
versions of the latter do not adequately cover syndromes in the earliest postnatal
years—syndromes that clinicians encounter and may require urgent attention
and preventative interventions. While it is the case that some early child-
hood syndromes may link to knowledge about pathways of etiology, in other
instances, where there is insufficient evidence, they may not and yet may still
point to needed interventions as well as research. And it is important to keep
in mind that this is during a time in development when accumulating evidence
shows that early adaptive experience and its disruptions and adversities have
profound influences on development throughout the lifespan. Additionally, non-
competition is emphasized by the provision within DC:0–5 for suggested pos-
sible “crosswalks” for classifications of DC:0–5 to current DSM-5 and ICD-10
classifications of disorder, and by the stated intention that in the future infancy
and early childhood disorders be included within the DSM and ICD systems.
As noted, general knowledge about diagnostic classification in infancy and ear-
ly childhood is evolving and DC:0–5 has made substantial changes that reflect
that. Accordingly, there are new complexities, new criteria, new terms, and new
issues. Current users of DC:0–3R may wonder about what resources are avail-
able beyond the current publication for help in questions about understanding
and implementation. It is helpful to know that the ZERO TO THREE website,
www.zerotothree.org, is a significant resource that may be consulted for addi-
tional information about usage.
Robert N. Emde, MD
Professor of Psychiatry, Emeritus, University of Colorado School of Medicine
viii DC:0–5™
Acknowledgments
The Diagnostic Classification Revision Task Force gratefully acknowledges the
help given to us by the global community of infant and early childhood mental
health professionals who responded to our requests for information and feed-
back during the many stages of the revision process. More than 10 years after
the publication of the Diagnostic Classification of Mental Health and Developmental
Disorders of Infancy and Early Childhood, Revised Edition (DC:0–3R; ZERO TO
THREE, 2005), hundreds of individuals and many groups gave us valuable
advice that reflected the wisdom of their experience. These respondents are
obviously committed to advancing clinical work with infants/young children
and their families by updating diagnostic classification through specifying crite-
ria that are based on up-to-date knowledge and evidence. We have hope for the
future because of this community’s compassion and commitment to the most
vulnerable infants/young children and their families worldwide.
We are extremely grateful to the individuals (890 professionals from six continents)
who responded to the DC:0–3R Revision Survey in 2013. Respondents included
clinicians from a range of disciplines as well as those involved in research and
administration in the infant mental health field. In May 2015, and again in
October 2015, we posted proposed revisions in the diagnostic criteria for public
comment. We also hosted public input forums at the ZERO TO THREE
National Training Institutes in 2013 and 2015, and at the World Association
of Infant Mental Health Congress in Edinburgh, Scotland, in 2014. We are
grateful to the many individuals who provided expert feedback.
Special thanks are due to the individuals who served as consultants to the Di-
agnostic Classification Revision Task Force. They conducted literature reviews
and provided crucial feedback. We are grateful to Kimberly Carpenter, Lauren
Franz, Sherika Hill, Kathryn Humphreys, Ivy Giserman Kiss, Shirley Poyau,
and Timothy Soto.
Several individuals deserve special acknowledgment for their constructive con-
tributions throughout the process. Their invaluable feedback guided our efforts.
We are grateful to Thomas Anders, Marianne Barton, Zeynep Biringen, Karen
Burstein, Irene Chatoor, Roseanne Clark, Annette Copa, Robert Emde, Gil
Foley, Janna Hack, Kathleen Hipke, Barbara Howard, Lucy Hudson, Maria
Kroupina, Julie Larrieu, Claire Lerner, Connie Lillas, Karlen Lyons-Ruth,
James McHale, Lucy Miller, Pia Risholm Mothander, Angela Narayan,
ix