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Physical Health Conditions and Considerations in the DC:0–5 Diagnostic Approach and Clinical Formulation
Jennifer M. Moran and Mary Margaret Gleason, Eastern Virginia Medical School and Children’s Hospital of The King’s Daughters, Norfolk, Virginia
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The expanded scope of Axis III in DC:0–5 Diagnostic Classification offers opportunities to consider the influence of children’s physical health status on their mental health clinical presentation. Physical health conditions may influence children’s mental health through direct physiologic processes or indirectly by affecting a child’s experiences or the caregiver’s perceptions of the child. Health conditions may also provide information about the child’s caregiving environment. Many infant and early childhood mental health clinicians have limited training in a systematic approach to the review of a child’s physical health history and of the review of a health record. Electronic health records contain immense volumes of information about young children’s health. As a complement to history from caregivers, strategic review of the health record can yield valuable information that can inform the diagnosis and clinical formulation. This article provides a systematic approach to extracting relevant physical health information from an electronic health record and mapping these elements into the DC:0–5 diagnostic approach.
All children seeking mental health evaluation present with emotions, bodies, and relationships, all of which occur within the context of a child’s caregiving and cultural context, life experiences, and developmental status. A strength of the DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5; ZERO TO THREE, 2016) is the inclusion of a multiaxial system (see Jargon Buster, page 99), which includes explicit attention to health conditions and other physical health factors (Axis III) that may influence a child’s clinical mental health status. The importance of Axis III conditions are particularly relevant in early childhood mental health. First, emotional and behavioral changes and symptoms may reflect an infant or young child’s physical discomfort or distress, and attention to this possibility allows for the development of a treatment plan to address the underlying cause(s). In addition, infants and young children with mental health conditions experience physical health conditions at higher rates than others (Gleason et al. 2011). Older children with mental health concerns have higher rates of unmet physical health needs compared to other children, highlighting the importance of mental health professionals’ being attuned to ensuring that physical health concerns are recognized and treated (Bell et al., 2010).
In the field of infant and early childhood mental health (IECMH), the majority of clinicians have limited training in the physical health factors that influence mental health. Consideration of Axis III diagnoses does not require that an IECMH clinician becomes a physical health clinician or expand the scope of their practice. However, use of Axis III does require an IECMH clinician to consider the whole child, take a history that includes physical health factors, and collaborate with physical health providers to confirm the impact of the Axis III diagnoses on IECMH as needed.