07 August 2009

The DC: 0-3: Enabling Healthcare Practitioners to Diagnose and Treat Infant Mental Health Disorders

Infants and toddlers establish their social/emotional foundational skills during their earliest years through interacting with their adult caregivers. Child development workers and psychiatrists refer to infant and toddler social/emotional development as infant mental health (Cohen et al, 2005). When a child’s earliest experiences are marked by poverty, family violence, child abuse and maternal depression, the physical regions of their brains that allow them to learn do not develop properly (National Scientific Council on the Developing Child, December 2008). Luckily, it is possible to assess and treat children’s mental health disorders early on in their lives so that they have the social/emotional skills they need before they enter kindergarten.

Babies need at least one stable adult relationship in order to develop the ability to form relationships with others and have the confidence to explore the world around them and learn. Adults also support babies in their social/emotional development by modeling and teaching them how to understand and manage their emotions, thoughts and actions. Developing social/emotional skills is necessary for a child’s successful transition into school because children are not capable of developing their cognitive skills in kindergarten if they do not know how to successfully engage in relationships and learning from the first day of school forward (Cohen et al, 2005).

The DC: 0-3 is the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. It was developed to supplement the DSM: V since many young children’s mental health disorders are not diagnosable using traditional instruments that focus on assessing the mental health of the individual. As one of the DC:0-3’s authors explains, “We say that much of the burden of mental and developmental disorder during infancy is primarily a disorder of the caregiver environment; it cannot even be described outside the context of the caregiving environment (Jancin 2001)”. In other words, the mental health of infants and toddlers is dependent upon and mediated through their relationships with their caregivers.

There are many children in Memphis who are at-risk for poor social/emotional development in their earliest years because of their exposure to poverty, family and neighborhood violence and child abuse. Currently, 47% of children in the city under 5 are growing up in poverty (ACS, 2007). One study of children in Early Head Start revealed that nearly half (48%) of the children participating had mothers who reported enough depressive symptoms to be considered clinically depressed (EHS Evaluation and Research Project, 2003). If these numbers hold true for Memphis, we would estimate that roughly a quarter of the children in the city under 5 have a mother suffering from clinical depression. Every year, roughly one third of the children who are victims of child abuse and neglect in Shelby County are between birth and age 3 (DCS Foster Care Data, 2008).

The key to effectively improving children’s social/emotional development in Memphis is to begin to identify young children who have mental health disorders and treat them before they enter kindergarten. Increasing the number of children who are assessed using the DC: 0-3 for disorders could improve our ability to target interventions to children and families who would benefit from them. These types of services could be targeted to the at-risk population via established DHS child care providers, Early Head Start and Head Start providers since they already care for the children who have the greatest exposure to risk factors.

Children’s social/emotional development could also be improved by increased screening and treatment for maternal depression. Many women seek mental health care services form their primary physician and so physicians need to be trained to perform maternal depression screenings. Physicians also need access to information on treatment programs for mothers who are depressed and reimbursement for screening and diagnosis.

In Illinois, multiple state agencies have worked together to create a funding stream for physicians to screen, diagnose and refer mothers for treatment for maternal depression. They have also provided training to physicians and access to psychiatrists to provide consultation on maternal depression for physicians as they see patients (Onunaku, July 2005). With these measures in place, depressed mothers have more resources for diagnosis and treatment. Effective treatment of depression enables mothers to provide nurturing, responsive care that supports their children social/emotional development.

In Shelby County, black churches have partnered with the mental health care system to create Emotional Fitness Centers. Through this partnership, peer advocates are being trained to do initial mental health screenings and then refer parishioners in need of care on to the mental health care system. Thus far, the program is being piloted in 6 Memphis churches with a budget of $250,000. They have a goal of serving 3,000 clients in their first several months of existence (Powers 2008). Hopefully, the Emotional Fitness Centers will provide more avenues for screening, diagnosis and treatment for mothers and children struggling with depression and other issues that hamper children’s social/emotional development.


American Factfinder (2007). Table B17001. POVERTY STATUS IN THE PAST 12 MONTHS BY SEX BY AGE. Washington D.C.: U.S. Census Bureau.

Cohen, Julie, Ngozi Onunaku, Steffanie Clothier and Julie Poppe (September 2005). Helping Young Children Succeed: Strategies to Promote Early Childhood Social and Emotional Development. Washington D.C.: Zero to Three and the National Conference of State Legislatures. Accessed 29th July 2009.

Early Head Start Evaluation and Research Project (January 2003). Research to Practice: Depression in the Lives of Early Head Start Families. Washington D.C.: U.S. Department of Health and Human Services, Administration for Children and Families.

National Scientific Council on the Developing Child (December 2008). Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life: Working Paper #6. Accessed 29th July 2009.

Jancin, Bruce (November 2001). "DC 0-3 Enhances Diagnosis of Mental Illness in Children: The Central Importance of the Parent-Child Relationship Needs to Be Recognized," Clinical Psychiatry News. Accessed May 21, 2009

Onunaku, Ngozi (July 2005). Improving Maternal and Infant Mental Health: Focus on Maternal Depression. Washington D.C.: Zero to Three. Accessed July 29, 2009.

Powers, Mary (13th March, 2008). "Six Churches Tapped for Emotional Fitness Campaign," The Commercial Appeal. Accessed 30 July, 2009. <http://www.commercialappeal.com/news/2008/mar/13/six-churches-tapped-for-emotional-fitness/>

Tennessee Department of Children's Services (2008). Child Abuse Data for Shelby County 2008. Available from TN: DCS. Estimates are the work of the author.

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