Das DC: 0 – 5 Klassifikationssystem zur Diagnose von psychischen Störungen bei Säuglingen, Klein- und Vorschulkindern
Eine Übersicht
Abstract
Zusammenfassung. Psychische Störungen sind bei jungen Kindern häufig und weisen eine entwicklungsbezogene Symptomatik auf. Die DC: 0 – 5 wurde als ein multiaxiales Klassifikationssystem psychischer Störungen für das Alter von 0 bis 5 Jahren entwickelt. Das Ziel dieser Übersicht ist es, den Aufbau und die Anwendung der DC: 0 – 5 darzustellen. Sie umfasst die fünf Achsen: klinische Störungen, Beziehungskontext, medizinische Diagnosen, psychosoziale Stressoren und Entwicklungskompetenzen. Die erste Achse ist die wichtigste und hat viele neue Störungsbilder definiert. Als neue Angststörung bezeichnet z. B. die Störung mit Inhibition gegenüber Neuem eine Furcht gegenüber neuen Stimuli. Ein Novum ist die Spezifische Beziehungsstörung der frühen Kindheit, die das Auftreten von einer kindlichen Symptomatik speziell in einer Beziehung definiert und eine akute Gefährdung des Kindes signalisiert. Die DC: 0 – 5 ist das derzeitig beste System zur Erfassung psychischer Störungen bei jungen Kindern. Eine weitere empirische Überprüfung und Validierung gerade der neuen Kategorien ist notwendig.
Abstract. Mental disorders are common among young children, undergo rapid developmental changes, and have specific age-dependent symptoms. In addition, the relationship to caregivers plays an important role in this age group. Therefore, a multiaxial classification system for mental and developmental disorders specifically for the ages of 0 to 5 years was developed: the DC: 0 – 5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Zero to Three (DC: 0 – 5). The aim of this review is to present the development of the DC: 0 – 5, its structure, new aspects of the first axis, its strengths and limitations, and its application in clinical practice. The DC: 0 – 5 is based on the previous versions (DC: 0 – 3 and DC: 0 – 3R). Its aim is to develop descriptive and empirical criteria for categorical diagnoses of clinically relevant and incapacitating disorders. The DC: 0 – 5 should be used together with the DSM-5 and ICD-10. The DC: 0 – 5 comprises five axes: clinical disorders, relational context, physical health conditions and considerations, psychosocial stressors, and developmental competence. The first axis is the most important and contains many new disorders in young children. Recognition of any precursors of autism spectrum disorder and attention-deficit/hyperactivity disorder is essential, as they enable early diagnosis and treatment. The old term regulatory or regulation disorder has been replaced by sensory processing disorder. In addition to the classic anxiety disorders, the new category of inhibition to novelty disorder has been introduced, designating fear toward unfamiliar stimuli and not just toward strangers as in social anxiety. In externalizing disorders, the focus has shifted from oppositional and conduct behaviors to problems of the regulation of emotions in the disorder of dysregulated anger and aggression of early childhood. Crying disorder of infancy/early childhood has been defined as a separate and distressful disorder. The criteria for eating disorders have been revised. The relationship-specific disorder of infancy/early childhood is a novel concept, defined by clinically relevant symptoms of the child with one caregiver and not toward others. It is included as a disorder of the first axis and is an indicator of a failure of caretaking and poses an acute threat to the child’s safety. To date, the DC: 0 – 5 is the best and most specific classification system to assess and diagnose mental disorders in young children. Validation and other clinical studies are needed, however, especially of the newly introduced disorders.
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