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What is the the DC:0–5™?

Mental Health in Early Childhood

When we think about mental health diagnoses, we often think of older children, teens, or adults. But infants, toddlers, and preschoolers can also experience mental health and developmental challenges. Because early childhood is a time of rapid growth, standard diagnostic tools don't always capture the unique experiences of very young children. The are geared toward disorders in school-age children, adolescents and adults, and they do not adequately reflect mental health disorders that are typically first diagnosed in infancy and early childhood.

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-5) is an age-appropriate approach for assessing infants, toddlers and preschool children. This tool classifies mental health and developmental disorders in children from birth through five years old considered in relationship to their families, culture and communities. DC: 0-5 also can help to establish whether a child qualifies for early childhood intervention services. Since children go through different developmental stages and life experiences, it is necessary to periodically reassess diagnoses.

How the DC:0–5 Works: A Holistic Approach

When a clinician at Introspect Mental Health uses the DC:0–5, they don't just look at the child in isolation. They evaluate the child across five distinct areas, known as "Axes," to get a complete picture of their well-being:

• Axis I: Clinical Disorders. This looks at the primary symptoms the child is experiencing, such as anxiety, mood disorders, sleep/eating challenges, or trauma responses.

• Axis II: Relational Context. Because young children rely entirely on caregivers, this axis assesses the caregiving environment and the quality of the child’s primary relationships.

• Axis III: Physical Health Conditions. This considers any medical, genetic, or environmental health issues that might be impacting the child's emotional or behavioral development.

• Axis IV: Psychosocial Stressors. This looks at environmental stressors, such as housing instability, a new baby in the home, parental stress, or traumatic events.

• Axis V: Developmental Competence. This assesses how the child is progressing across emotional, social, language, cognitive, and physical milestones compared to their peers.

What Tests and Scales Are Used in a DC:0–5 Evaluation?

The DC:0–5 is a comprehensive picture, not a single test. To build a complete understanding of your child across all five "Axes," clinicians use a combination of clinical interviews, structured play observations, and standardized assessment tools.

Because young children communicate differently than adults, we rely heavily on your insights as a caregiver. You are the expert on your child, and your input is a vital part of the testing process.

Depending on your child's specific needs, an evaluation may include some of the following standard tools:

1. Social-Emotional and Behavioral Scales

These tools help us understand your child's mood, behavior, and emotional regulation compared to other children their age.

• Ages and Stages Questionnaires: Social-Emotional (ASQ:SE-2): A parent-completed survey that highlights a child's strengths and areas where they might need more support in self-regulation and social interactions.

• Child Behavior Checklist (CBCL for Ages 1.5–5): A widely used questionnaire that asks caregivers to rate how often their child exhibits certain behaviors, helping to identify things like anxiety, withdrawal, or other behaviors.

• Brief Infant-Toddler Social and Emotional Assessment (BITSEA): A short screener used to identify potential social-emotional problems and delays in competence.

2. Developmental Assessments (For Axis V)

These tests measure how your child is progressing in core areas like speech, motor skills, and problem-solving.

• Ages and Stages Questionnaires (ASQ-3): A developmental screener tracking communication, gross and fine motor skills, problem-solving, and personal-social skills.

• Bayley Scales of Infant and Toddler Development: A more comprehensive, play-based assessment where a clinician interacts directly with your child to evaluate their cognitive, language, and motor development.

3. Relational and Caregiving Tools (For Axis II)

Because a child’s environment is key to their well-being, we also look at family dynamics and parenting support.

• Parenting Stress Index (PSI-4): A questionnaire designed to identify the sources and levels of stress within the parent-child system. This helps us figure out how to best support you so you can support your child.

• Observational Play (e.g., The Crowell Procedure): Rather than a paper test, this involves a clinician observing you and your child playing together in a room. We look at how you interact, solve problems together, and comfort one another.

Once an assessment is completed we provide the results, and recommendations. This information to the parent and any party who might need it (with your permission).

If you are in need of an assessment reach out to us. Our provider Chloe Kieser, MS LPC conducts the assessments at our Cambridge location. Read more about her here.