Children birth to three are assessed using the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3R). The DC 0-3R is a multi-axial classification system and includes the following 5 axis:
Axis I: Clinical Disorders
Axis II: Relationship Classification
Axis III: Medical and Developmental Disorders and Conditions
Axis IV: Psychosocial Stressors
Axis V: Emotional and Social Functioning
Axis I: Clinical Disorders Axis I of the DC 0-3R provides diagnostic classifications for the most primary symptoms of the presenting difficulties. These diagnoses focus on the infant or child’s functioning. The primary diagnoses include:
Posttraumatic Stress Disorder: This refers to children who may be experiencing or have experienced a single traumatic event (e.g. an earthquake), a series of traumatic events (e.g. air raids), or chronic stress (e.g. abuse). Furthermore, the nature of the trauma and its effect on the child must be understood in the context of the child. Specifically, attention must be paid to factors such as social context, personality factors, and the caregivers’ ability to assist with coping.
Disorders of Affect: This classification of disorders is related to the infant or child’s affective and behavioural experiences. This group of disorders includes mood disorders and deprivation/maltreatment disorder. This classification focuses on the infant or child’s functioning in its entirety rather than a specific event or situation.
Adjustment Disorder: When considering a diagnosis of adjustment disorder, one has to examine the situational factors to determine if it is a mild disruption in the child’s usual functioning (e.g. switching schools). These difficulties must also not meet the criteria for other disorders included in the categories.
Regulation Disorders of Sensory Processing: The child manifests difficulties in regulating behavioural, motor, attention, physiological, sensory, and affective processes. These difficulties can affect the child’s daily functioning and relationships.
Sleep Behavior Disorder: To diagnose a sleep disorder, the child should be showing a sleep disturbance and not be demonstrating sensory reactive or processing difficulties. This diagnosis should not be used when sleep problems are related to issues of anxiety or traumatic events.
Eating Behavior Disorder: This diagnosis may become evident in infancy and young childhood as the child may show difficulties in regular eating patterns. The child may not be regulating feeding with physiological reactions of hunger. This diagnosis is a primary diagnosis in the absence of traumatic, affective, and regulatory difficulties.
Disorders of Relating and Communicating: These disorders involve difficulties in communication, in conjunction with difficulties in regulation of physiological, motor, cognitive, and many other processes.
Axis II: Relationship Classification Axis II focuses on children and infants developing in the context of emotional relationships. Specifically, the quality of caregiving can have a strong impact in nurturance and steering a child on a particular developmental course, either adaptive or maladaptive. This particular axis concentrates on the diagnosis of a clinical issue in the relationship between the child and the caregiver. The presence of a disorder indicates difficulties in relationships. These disorders include various patterns that highlight behavior affective, and psychological factors between the child and the caregiver.
Mixed Relationship Disorder
Axis III: Medical and Developmental Disorders and Conditions Axis III focuses on physical, mental, or developmental classification using other diagnosis methods. These disorders and conditions are not treated as a single diagnosis, but as a problem that may co-exist with others, as it may involve developmental difficulties.
Axis IV: Psychosocial Stressors This axis allows clinicians to focus on the intensity of psychosocial stress, which may act as influencing agents in infant and childhood difficulties/disorders. Psychosocial stress can have direct and indirect influences on infants and children, and depends on various factors.
Axis V: Emotional and Social Functioning Emotional and social functioning capacities can be assessed using observations of the child with primary caregivers. The essential domains of functioning can be used in these observations on a 5-point scale, that describes overall functional emotional level.