B O O K R E V I E W
DC:0–5: DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND
DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD
Reviewed by Robert L.P. Klaehn
The Diagnostic Classification: Zero to Five (DC:0–5) repre-
sents a significant step forward in bringing the treatment of the
mental health needs of infants, toddlers, and young children into
the mainstream of child psychiatric practice. As both a practitioner
and an advocate for evidence-based treatment of this age group, I
am very pleased with the changes made to the diagnostic manual,
which better positions the DC:0–5 as a companion text to the Di-
agnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5); American Psychiatric Association, 2013).
The decision to change the focus of the manual to children
birth to 5 years was overdue and now provides a seamless transi-
tion to the diagnostic formulations for older children and adoles-
cents. The inclusion of such DSM-5 diagnoses as Attention Deficit
Hyperactivity Disorder and Autism Spectrum Disorder, but with
diagnostic criteria adapted for this age group, provides continuity
of diagnoses across age groups.
When compared to the earlier versions of the DC:0–3, the
authors have added much “meat” to the “bones” of each diagnosis.
The description of each diagnosis is far more detailed than in
previous versions, bringing each to the level detail provided for
each diagnosis in the DSM-5. For example, the DC:0–5 includes
language describing the clinical presentation and course for most
diagnoses. The addition of functional impairment criteria to each
disorder is another welcome addition.
In my own clinical practice, which included many infants and
toddlers who were exposed to methamphetamine in utero, I have
found the Regulation Disorder of Sensory Processing diagnosis
most helpful, as it allowed for a useful treatment focus and an
ability to describe the travails of these children to others in a
meaningful way. With the DC:0–5 updates to the diagnosis, now
divided into Sensory Over-Responsivity Disorder, Sensory Under-
Responsivity Disorder, and Other Sensory Processing Disorder,
there is a maturity to the descriptions that allows for even wider
application of this diagnostic construct in our field and beyond.
I have no relevant conflicts of interest. No human subjects’ approvals were
needed. I received no funding for the development of this book review.
Direct correspondence to: Robert L.P. Klaehn, 1325 N. Entrada Street,
Chandler, AZ 85226; e-mail: rlklaehn@gmail.com.
INFANT MENTAL HEALTH JOURNAL, Vol. 0(0), 1–2 (2018)
C 2018 Michigan Association for Infant Mental Health
View this article online at wileyonlinelibrary.com.
DOI: 10.1002/imhj.21714
1
Another strength of the original DC:0–3 was the choice to
emphasize the importance of the child–caregiver dyad in the Axis II
Relationship Classification. Though the DSM – 5 focuses on solely
on the individual for making diagnoses, being able to accurately
identify disorders in dyadic relationships is essential to the work
of infant and toddler mental health clinicians and has been retained
in the DC:0–5. There is now a Relationship Specific Disorder of
Infancy/Early Childhood diagnosis in Axis I, which is described
as “symptomatic behavior in the infant/young child that is limited
to one caregiving relationship.”
There also has been significant improvements to the formu-
lation of Axis II, which is now titled “Relational Context.” The
DC:0–5 description of Axis II now calls for a thorough assessment
of both the Caregiver and the Caregiving Environment. Although
this is a more complex formulation than in the DC:0–3 and DC:0–
3R, I believe these changes allow for more specificity in the iden-
tification of strengths and weaknessesin both categories. Multiple
dimensions of the Caregiver and the Caregiving Environment that
may be assessed are identified. In addition, four different Levels
of Adaptive Functioning for each category are described: Well-
Adopted to Good-Enough, Strained to Concerning, Compromised
to Disturbed, and Disordered to Dangerous. This new formulation
may be quite helpful in the development of a comprehensive and
individualized treatment plan for the Child and Caregiver as well as
identifying areas for improvement in the Caregiving Environment.
There are many other strengths of the DC:0–5. The manual’s
introduction includes a cogent discussion of incorporating cultural
factors into the diagnosis of infants and toddlers. With ethnic and
religious beliefs playing a major role in child-rearing practices in
many families, standardized language for developing a cultural-
formulation is quite welcome. The DC:0–5 manual also includes
crosswalks to both the DSM-5 and the International Classification
of Diseases, Tenth Revision (ICD-10; World Health Organization,
1992). This is important for two reasons: (a) It provides increased
continuity with the other major diagnostic frameworks, and (b) the
inclusion of these crosswalks will increase the use of DC:0–5 diag-
noses for reimbursement as the Center for Medicaid and Medicare
services began requiring the use of ICD-10 codes in October 2015.
2 • Book Review
The publication of the DC:0–5 is a giant step forward for the
field of infant and toddler mental health. I strongly recommend it
as an essential part of every child-focused professional’s library.
REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders, Fifth Edition (DSM-5). Arlington, VA:
Author.
Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.
World Health Organization. (1992). International classification of diseases
(10th rev.). Geneva, Switzerland: Author.
ZERO TO THREE. (2005). Diagnostic classification of mental health and
developmental disorders of infancy and early childhood: Revised
edition (DC:0–3R). Washington, DC: Author.
ZERO TO THREE. (2016). DC:0–5: Diagnostic classification of mental
health and developmental disorders of infancy and early childhood.
Washington, DC: Author.