Fall 1998
Articles
Reviews
1998 Award Recipients
1997 Award Recipients
Special Presentation
|
Book Review: DC: 0-3 Casebook
by Henry L. Shapiro, M.D. FAAP,
St. Petersburg, FL
DC: 0-3 Casebook. Alicia Lieberman, Serena
Wieder, and Emily Fenichel editors. Foreword by Stanley I. Greenspan. Zero to Three:
National Center for Infants, Toddlers, and Families, Washington, DC, 1997. Paperback, 393
pages. Available from the Zero to Three Web Site http://www.zerotothree.org/
or by calling 1-800-899-4301
This book is tellingly subtitled: "A Guide to the Use of Zero to Three's Diagnostic
Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood
in Assessment and Treatment Planning." While the editors intend readers to use this
book in concert with the diagnostic manual, it is a valuable reference in its own right.
Its in depth studies of a variety of presenting problems in early childhood set a high
standard for systematic evaluation and treatment of problems. A strong functional focus
and emphasis on in depth study rather than standardized testing is especially appropriate
for the social, emotional, and temperamental issues described in the Casebook.
The primary topic areas include: Traumatic Stress Disorder; Disorders of Affect;
Adjustment Disorder; Regulatory Disorders; Sleep Behavior Disorder; Eating Behavior
Disorder; Disorders of Relating and Communicating; and Relationship Disorders. Many of
these topic areas include subtypes, such as Hypersensitive and Underactive variants of
Regulatory Disorders. Often, several in-depth case studies illustrate both ways of
discriminating these sub-types as well as the inherent difficulty in sub-typing in
general. The lack of external validation of many of these diagnoses genetically, or in
terms of natural history or response to intervention, continues to be challenge, but the
Casebook presents the reader with enough detail to form their own opinion of the cases. As
such, the Casebook is a rich source of material for teaching and discussion. While
appearing to mimic the multi-axial, categorical framework of the DSM, the Casebook
actually takes more of a holistic and dimensional view of child development and behavior,
with a strong ecological focus.
The section on Disorders of Relating and Communicating, for example, is an excellent
resource for understanding the proposed Multisystem Developmental Disorder (MSDD). Many
"lumpers" will wonder whether the four types of MSDD shed any new light on the
Pervasive Developmental Disorder category. However, by defining an evaluation/diagnostic
approach, the Casebook at least provides a starting point for discussion.
I continue to be bothered by prognostic speculation common in many evaluation reports,
and the Casebook is an offender in this regard. For example, one case study states:
"It seems likely that Simon will move into preadolescence as a popular, energetic,
ambitious, and attractive, if somewhat self centered boy…" (page 357). Also,
there are frequent references to concepts from Sensory Integration (SI) theory and
practice. I still do not understand how we can know what a child "craves."
We still do not have satisfactory, testable, theories of the development of children
who have severe difficulties relating, interacting, and communicating. Many of the
examples in the Casebook could be reformulated from several different perspectives. By
providing explicit criteria for diagnoses, emphasizing the need to tie evaluation data
with treatment, and the need for longitudinal re-evaluation, makes the Casebook a
priceless resource.
I strongly recommend the DC: 0–3 Casebook. It bears
careful reading, with or without the classification manual. It adds a great deal to the
routine developmental evaluations done in early intervention programs.
|
