Using the diagnostic classification system DC 0-3 as an integrative multidimensional formulation of psychopathology in infancy

Since its creation, the Zero-to-Three Diagnostic Classification (DC 0-3, 1994) has been used by many clinicians involved in early childhood because of its adavantages over the existing classification systems (DSM IV, ICD 10). Indeed, the equal importance given to all the five axes reflects the need to take into account the development and the relationships in infant psychiatry. The clinical use of the DC 0-3 diagnoses is described in the context of our routine assessment process and basic theoretical approach. It is then illustrated by a clinical vignette. Finally, reasons for referral and distribution of DC 0-3 diagnoses of 414 infants and parents, assessed at the unit between the years 1996 and 2000, are shown. 25% had no diagnosis on any of the 4 axes, 29.5% of the infants had both a primary and a relational diagnosis, and only 5.6% had a diagnosis on each of the 4 axes. Less than half (45%) of the infants received a primary diagnosis, and 52% had a relational diagnosis. Possible explanations are given, and problems we faced with the use of the classification are described. In our view, the DC 0-3 attempts to reflect the diagnostic complexity of the clinical situation, where the infant, by definition, is totally dependent on his environment, and also has characteristics of his own that affect the parenting behavior. Hence, the understanding of infant mental processes and phenomena is integrated into a bio-/psychosocial and developmental approach.