DEFINING RELATIONAL PATHOLOGY IN EARLY CHILDHOOD: THE DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD DC:0–5 APPROACH

Abstract

Infant mental health is explicitly relational in its focus, and therefore a diagnostic classification system for early childhood disorders should include attention not only to within-the-child psychopathology but also between child and caregiver psychopathology. In this article, we begin by providing a review of previous efforts to introduce this approach that date back more than 30 years. Next, we introduce changes proposed in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood DC:0-5 (ZERO TO THREE, in press). In a major change from previous attempts, the DC:0-5 includes an Axis I "Relationship Specific Disorder of Early Childhood." This disorder intends to capture disordered behavior that is limited to one caregiver relationship rather than cross contextually. An axial characterization is continued from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood DC:0-3R (ZERO TO THREE, 2005), but two major changes are introduced. First, the DC:0-5 proposes to simplify ratings of relationship adaptation/maladaptation, and to expand what is rated so that in addition to characterizing the child's relationship with his or her primary caregiver, there also is a characterization of the network of family relationships in which the child develops. This includes coparenting relationships and the entire network of close relationships that impinge on the young child's development and adaptation.

Child Abuse and Neglect

“…From a clinical perspective, we know that young children may be markedly symptomatic with one caregiver and asymptomatic with another caregiver. 35 This is especially likely in the context of young children seen with foster parents and biological parents. In addition to the usual history and developmentally modified mental status examination, a relationship assessment between the young child and all important caregivers is recommended for young children who have been maltreated.…”

The early biopsychosocial development of boys and the origins of violence in males

“…This broad sense of self might be seen as an unconscious agent internal to the individual, controlling and directing one's affective relations with others and with the world, supplying one with a sense of one's own subjectivity and intersubjectivity (Ammaniti & Gallese, ; Fonagy, Gergely, & Target, ; Mizen, ; Reber & Reber, ). Concomitantly, there also has been a significant growth in knowledge about the importance of relationship with caregivers very early in life in shaping this psychological entity of the individual self along healthy—or otherwise—pathways (Beebe & Lachmann, ; Stern, ; Tronick, ; Zeanah & Lieberman, ).…”

Disorganized attachment and defense: exploring John Bowlby’s unpublished reflections

“…This provided a technical definition of the term, though with the very unfortunate ambiguity between process and product that attends any word in English ending in “-ization.” This is another example of terminology obscuring meaning, as this wording would later lead to ambiguity regarding whether disorganization meant either or both (1) the result of not being able to assemble and consolidate an organized goal-corrected system and (2) having an organized goal-corrected system that is then put into a state of disorganization. This question has continued to be an issue in attachment research and links into the larger psychological question of state versus trait, which has quietly plagued discussions of disorganized attachment (Zeanah & Lieberman, 2016). …”