DIAGNOSTIC CLASSIFICATION 0-3: DECISION TREE - AXIS I (PRIMARY DIAGNOSIS) Answer all the questions on this tree (1 to 9).

Two primary conditions are possible, but rare. Use Rule Out when you need more information in making a differential diagnosis.
1. Is there a trauma? -chronic enduring stress -life threatening event(s) for child or caregiver

Yes

100 Traumatic Stress Disorder (19)

Type I: Hypersensitive (34) Type II: Under-reactive (36) Type III: Motorically Disorganized, Impulsive (37)

9. Remember to consider these: Do not use if problem is due to other Axis I, II, III Disorders 500 Sleep Behavior Disorder (38) 600 Eating Behavior Disorder (39)

No
2. Are there clear constitutional/maturational difficulties associated with the maladaptive behavior?

Yes

400 Regulatory Disorders (31) Type IV: Other (38)

No
3. Are the presenting problems mild, of short duration (< 4 months) and associated with a clear environmental event or person?

Yes

300 Adjustment Disorder (30) [If difficulties are related to a certain person, consider Axis II]

Anxiety Disorders of Infancy & Early Childhood (23) Mood Disorder: Prolonged Bereavement/Grief Reaction (24) Mood Disorder: Depression of Infancy and Early Childhood (25) Mixed Disorder of Emotional Expressiveness (25)

No
4. If all of the answers are No, then consider Disorders of Affect

Yes

200 Disorders of Affect (22)

No
5. Are there severe difficulties in relating and communicating that involve a chronic pattern of maladaptation?

Yes

*700 Disorders of Relating and Communicating (40) Multisystem Developmental Disorder (43) 300 Adjustment Disorder (30) [If difficulties are related to a certain person, consider Axis II] -Do not use Axis I -Use Axis II

Childhood Gender Identity Disorder (26) Pattern A (44) -aimless behavior, socially unrelated most of the time and severe problems in motor planning Pattern B (45) -intermittently related and capable of simple intentional gestures some of the time Pattern C (45) -more consistent sense of relatedness and use simple social gestures

No
6. Does the difficulty occur only in a certain situation or in relation to a particular person?

Yes

No
7. Is the only difficulty the relationship?

Yes

No
8. Is there evidence of an acute pattern of deprivation or maltreatment?

Yes

*206 Yes Reactive Attachment Deprivation/ Maltreatment Disorder of Infancy (28)

* Diagnosis 700 and 206 take precedence over diagnosis 100 and 400. [Number(s) in parentheses is the source page number(s) in the manual.]

Adapted from ZERO TO THREE /National Center for Clinical Infant Programs. Diagnostic Classification: 0-3; Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. 1994 (pp. 16-17). [Wright & Northcutt (2002) Funding for Dr. Northcutt provided by First Five Sacramento Commission]