Background:

The last decade has witnessed major advances in classification of infant mental health problems. The development of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3; Zero to Three, 1994) has resulted in more serious attention being given to the specific mental health needs of infants and toddlers, where previously they were simply subsumed under the broader umbrella of child, adolescent, and even adult psychiatry.

To date, the Zero to Three system has not been widely used outside the relatively small circle of clinical experts in infant mental health. This is due, in part, to understandable reluctance to allow for widespread use of criteria to diagnose disorders that are presumably rare. However, other problems compound this concern. For example, there are no data on the prevalence of these categories of infant mental health disorder in the general population. In addition, there have been limitations in how well DC: 0-3 definitions are operationalized to the point of clear criteria, which has been corrected to some degree by the revised DC:0-3R made available in 2004 will allow for greater operationalization. The revised and expanded form we propose here will draw upon these revisions, giving our proposed system the potential for widespread utility in preventive care.

Noted scholars of developmental intervention argue that evidence points to greater utility in thinking about emotional and behavioral disorders as part of "continua of adaptation rather than as present-or-absent categories" (e. g., Emde & Robinson, 2000, p. 169). We have developed a conceptual framework that builds upon this concept of "continua of adaptation" in order to promote primary care clinicians'; acceptance and use of infant mental health information in the context of a new paradigm for child health supervision. In contrast to the current categorical, pathology-oriented approach to primary care, this new paradigm (Sturner, et. al., 2007) supports assessment of the full continuum of child/family functional adaptations, including strengths, to facilitate individualized anticipatory guidance or intervention. Individualized attention to infant and toddler mental health by primary care clinicians is expected to yield more effective prevention of serious mental health problems in childhood.

Current research and development:

In conjunction with authors of the DC: 0-3R (Thomas Emde, Helen Egger, Brian Wise, Jean Thomas, Irene Chatoor, and Alice Carter) we have developed algorithms that operationalize the DC:0-3 R criteria into a parent questionnaire. This new computerized questionnaire is organized to represent, not just DC:0-3R disorders but the continuum of lesser severe forms designated by problem and variation categories following similar logic of the DSM-PC. This questionnaire begins with collection of data that is generally required for routine pediatric care, such as a review of eating and sleeping and only goes on to asks questions related to infant mental health classification when parents report unusual difficulties. Since infant mental health disorders are rare in most instances primary care clinicians using the tool will not be need to address these conditions. We call this tool CHADIS: 0-3

Currently validation studies are in progress comparing CHADIS: 0-3 mental health diagnoses with the following standard measures depending on the age of the child: Infants (2 – 12 months: Parenting Stress Index (PSI; Abidin, 1995); Carey Infant Temperament Questionnaire (ITQ; Carey & McDevitt, 1995); Brief Infant-Toddler Social and Emotional Assessment-Revised (BITSEA; Briggs-Gowan, & Carter, 2001); Child Behavior Checklist 1 ½ - 5 (CBCL/1 ½ - 5; Achenbach & Rescorla, 2000); Preschool Age Psychiatric Assessment (PAPA; Egger et al., 1999). Sampling is occurring both in primary care pediatric practices and in special at risk populations such as NICU follow-up clinics, early intervention programs and a homeless shelter.

Sturner, R. A., Albus, K., Thomas, J., & Howard, B. (2007). A Proposed Adaptation of DC: 0-3 for Primary Care, Developmental Research and Prevention of Mental Disorders. Infant Mental Health Journal 28 (1) 1-11

Funding:

NIMH SBIR award (1)