The zero-to-three diagnostic classification in an infant mental health clinic: Its usefulness and challenges

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, predominantly 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. ©2003 Michigan Association for Infant Mental Health.