ASPEN, COLO. -- In response to what they say are severe limitations to the DSM-IV, pediatric mental health professionals have developed DC 0-3--a novel classification system for diagnosing mental disorders in infancy and early childhood, Dr. Robert N. Emde reported at a psychiatry conference sponsored by the University of Colorado.
DSM-IV doesn't devote adequate attention to early development, said Dr. Emde, professor of psychiatry and director of the program for early studies at the University of Colorado, Denver. It fails to provide enough diagnostic choices for this early age group. Among its worst shortcomings is its failure to recognize the central importance of the parent-child relationship in abnormalities occurring in the early years.
"We say that much of the [burden of mental and development all disorder during infancy is primarily a disorder of the caregiving environment; it cannot even be described outside the context of the caregiving environment, "explained Dr. Emde a coauthor of the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood," commonly nown as DC 0-3.
DC 0-3 was intended to complement, rather than to replace, DSM-V (see table). In cases where a DSM-IV diagnosis best describes a child's primary difficulty, it's coded under Axis I of DC 0""3.
Validated in its first field trial, the new diagnostic scheme was intended to inspire developers of the forthcoming DSM-V to create a richer, more dimensional diagnostic system than DSM-IV.
Dr. Jay Scully, professor and chairman of psychiatry at the Upiversity of South Carolina, Columbia, and a member of the American Psychiatric Association tas force charged with creating DSM-V, commented that there is broad agreement among APA members that child psychiatry is the topic most in need of a major overhaul.
The field trial too place in Israel, where a national well-baby care system provides preventive medicine and developmental follow-up to all infants in their immediate neighborhoods. Investigators from. TelAviv University applied DC 0-3 to 113 children up to age 3 years referred to a community-based mental health clinic.
DC 0-3 diagnoses were made by a child and adolescent psychiatrist trained in the system. A clinical psychologist separately examined 15 of the children to assess the system's reliability. The two diagnosticians agreed on 100% of the DC 0-3 Axis I and 92% of Axis II diagnoses (J. …