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The current study examined the mental health diagnostic profiles of infants and young children prenatally exposed to substances using the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0-3R) diagnostic system. Participants were 46 biological mother-infant dyads who were engaged in a clinical program for mothers with substance-use problems and their young children (aged 10-41 months). Diagnostic information was reported for each of the five axes listed in the DC:0-3R diagnostic system based on file reviews. In addition, the children's socioemotional and adaptive behaviors were assessed using the Child Behavior Checklist, Infant-Toddler Social Emotional Assessment, the Social-Emotional Scale, and the Adaptive Behavior Assessment System (2nd ed.). In this sample of young children with prenatal substance exposure, a broad range of socioemotional symptoms were evident, with almost one third of the children meeting criteria for at least one Axis I mental health diagnosis. In addition, the majority of dyads demonstrated features of a disordered relationship. Children in more problematic relationships demonstrated higher levels of socioemotional and adaptive functioning difficulties and were more likely to have an Axis I diagnosis than were children in adapted relationships. The importance of early intervention efforts aimed at infants with prenatal substance exposure and their biological mothers is highlighted, with a particular focus on enhancing the quality of the mother-child relationship. [ABSTRACT FROM AUTHOR]