DC:0–5 turns 5! Reflections on This Special Anniversary

As with any big anniversary, a look back at the journey can inspire gratitude. Beginning in March 2013, we had the privilege to serve for 3 years on the Diagnostic Classification Revision Task Force, led by Dr. Charles Zeanah, to revise our former diagnostic classification system DC:0–3R and to develop D*C:0-–5™: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood* (DC:0–5). Imagine what it was like to be working shoulder-to-shoulder with some of the field’s world-renowned leaders: Charley Zeanah, Alice Carter, Helen Egger, Mary Margaret Gleason, Miri Keren, and Alicia Lieberman!

DC:0–5 was published in 2016, and in the 5 years since its publication ZERO TO THREE has trained thousands of clinicians and allied professionals not only across the United States, but worldwide in Canada, Africa, Asia, Australia, Europe, and the Middle East. The ZERO TO THREE Policy Center has engaged in important efforts with states to not only advocate for the use of DC:0–5 as the developmentally appropriate diagnostic classification system, but to provide technical assistance to states in developing policies and procedures to adopt DC:0–5 as a standard of practice, to crosswalk DC:0–5 disorders with acceptable coding for reimbursement through Medicaid and third party payors, and to advocate for workforce development efforts focused on DC:0–5 training and post training supports.

In recognition of this 5th anniversary and the incredible journey of DC:0–5 efforts worldwide, the December 2021 issue of the ZERO TO THREE Journal has been designated as a special issue primarily focused on DC:0–5. As guest editors for this issue, we were charged with working with Stefanie Powers in structuring the table of contents and in reaching out to clinicians, researchers, and policymakers for contributions of articles. There are a total of nine articles dedicated to different aspects and uses of DC:0–5 and three additional articles related to infant and early childhood mental health (IECMH). The issue opens with an article authored by members of the Task Force, sharing our reflections about DC:0–5 over the past 5 years. Dr. Alice Carter and her colleagues provide an informative and compelling look at using DC:0–5 to diagnose and understand autism spectrum disorder and early atypical autism spectrum disorder. Dr. Charles Zeanah and Dr. Julie Larrieu include a case that illustrates a new clinical disorder of relationship specific disorder and details the importance of DC:0–5’s focus on the relational context in diagnosis. Other authors highlight reflective consultation and diversity-informed supervision and use of the DC:0–5 Cultural Formulation. Dr. Mary Margaret Gleason and Dr. Jennifer Moran illustrate how physical health conditions and considerations are critical in understanding direct and indirect implications for a young child’s mental health. They provide a useful and systematic approach to extracting relevant physical health information from an electronic health record and mapping these elements into the DC:0–5 diagnostic approach. The issue touches on international use of DC:0–5 in an article from authors in Nordic countries. Members of the IECMH Policy Team highlight how states are integrating DC:0–5 into state policy and systems. Another article featuring ZERO TO THREE’s training and support efforts in Los Angeles County, CA, provides a striking example of a multiyear collaborative effort to deliver intense training and support to clinicians throughout Los Angeles County in the use of DC:0–5, as well as other IECMH topics, to support and strengthen the knowledge and skill base of professionals supporting babies and young children.

You do not need to be a mental health clinician to enjoy and benefit from these articles! This issue will prove to be an invaluable resource to professionals from multiple disciplines who work with infants, toddlers, preschool-aged children, and their families. We hope everyone at ZERO TO THREE will read this issue and consider how we address issues of IECMH assessment, diagnosis, and treatment within and across our different programs and divisions. We believe this issue will contribute to the existing literature about diagnosis in infancy and early childhood and will spur much needed research in this area. Finally, we hope this issue will provide information and examples to drive additional policy and systems change at the state and federal levels.