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Little Kids, Big Questions
is a series of 12 podcasts that translates the research of early childhood development into parenting practices that mothers, fathers and other caregivers can tailor to the needs of their own child and family. Click here to listen to or download the podcasts. This podcast series is generously funded by MetLife Foundation.

Clinical Formulation In Infancy and Early Childhood

The following is reproduced from the Introduction to DC:0-3R:

Clinical Formulation In Infancy and Early Childhood

In discussing clinical formulation with respect to infants, toddlers, and young children, the authors of DC:0-3 made two key observations:

  • Assessment and diagnostic classification are guided by the awareness that all infants have their own developmental progression and show individual differences in their motor, sensory, language, cognitive, affective and interactive patterns.
  •  
    All infants and young children are participants in relationships. Children's most significant relationships are usually those within the family. Families, in turn, participate in relationships within the larger community and culture.

Any intervention or treatment program should be based on as complete an understanding of the child and the child's relationships as it is possible to achieve. Pressed for time, clinicians may be tempted to focus attention on a limited number of variables while giving only cursory regard to other influences on development.

Clinicians may also be tempted to avoid assessing those areas of a child's functioning where the constructs or research tools are not fully developed or where gaps in their own training exist. Although these temptations are understandable, any clinician who is responsible for making a complete diagnostic assessment of an infant or young child and planning an appropriate intervention program must take into account relevant areas of the child's functioning. Independently or with a team of colleagues, the clinician is obliged to apply state-of-the-art knowledge to each area of functioning and to evaluate both strengths and weaknesses in the child.

A clinician or team needs a number of sessions to understand how an infant, toddler, or young child is developing in each area of functioning. A few questions to parents or caregivers about each area may be appropriate for screening, but not for a full evaluation. A full evaluation usually requires a minimum of three to five sessions of 45 or more minutes each. A complete evaluation will typically involve:

  • Interviewing the parent(s) about the child's developmental history;
    Direct observation of family functioning-for example, family and parental dynamics, the caregiver-child relationship, and interaction patterns;
  • Gaining information, through direct observation and report, about the child's individual characteristics, language, cognition, and affective expression; and
  • Assessment of sensory reactivity and processing, motor tone, and motor planning capacities.

Findings from a comprehensive evaluation should lead to preliminary notions about:

  • The nature of the child's pattern of strengths and difficulties, including the level of overall adaptive capacity and functioning in the major areas of development (i.e., social-emotional, relational, cognitive, language, sensory, and motor abilities) in comparison to age-expected developmental patterns.

  • The relative contribution to the child's competencies and difficulties of the different areas assessed (e.g., family relationships, interactive patterns, stress, and constitutional-maturational patterns).
    A comprehensive treatment or preventive intervention plan to deal with 1 and 2 above.

Provided that well-trained clinicians have sufficient time and resources to conduct them, comprehensive diagnostic assessments may take place in many different settings. A clinician who conducts a diagnostic evaluation and formulates an intervention plan should have experience in assessing the areas of functioning described above and in integrating the assessment findings into a cohesive formulation.

Settings that are strong in only some areas of assessment and intervention should obtain additional expertise through engaging additional staff or through consultation with colleagues who have the expertise to assess specific areas of functioning. For example, the assessment of regulation disorders of sensory processing may require the expertise of an occupational therapist who is trained to evaluate sensory processing and integration capacities in infants and young children.

Suggested citation:
ZERO TO THREE. (2005). Diagnostic classification of mental health and developmental disorders of infancy and early childhood (rev.). Washington, DC: Author.  

 

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