infant and early childhood mental health what it is and why it matters lisa mennet, phd
TRANSCRIPT
Infant and Early Childhood Mental
Health
What It Is and Why It Matters
Lisa Mennet, PhD
The Amazing Social Infantborn ready to interact
Infants are an open system
Infants are an open system
Born to learn and ready to adapt to any human culture, babies absorb the range of their experiences, good and bad.
What is IECMH?
Infant mental health is the developing capacity of the child from birth to three to: • Experience, regulate, and express emotions; • Form close and secure interpersonal relationships; • And explore the environment and learn
all in the context of family, community, and cultural expectations for young children. Infant mental health is synonymous with healthy social and emotional development.
Zero to Three, the National Center on Infants and Toddlers, 2001
What is IECMH?
Expressing and Regulating Emotions – Forming Relationships -- Exploring
Child characteristics
Caregiver characteristics
Experiences in relationships
Elements of Infant and Early Childhood Mental Health
Child characteristics
• temperament• genetic endowment• medical issues, including
prematurity• birth order• appearance
Caregiver characteristics
• temperament• family of origin • environmental safety• resources and supports
(or lack thereof)• trauma history• mental health issues
(including post-partum depression)
Post-Partum Depression
• 20% of mothers experience depressive symptoms in the first 3 months following childbirth, 7% experiencing major depression
• one in 25 fathers • young children: language skills, physical and
cognitive development• older children: poor self-control, aggression, poor
peer relationships, and difficulty in school• biggest impact when depression combines with
other factors http://zerotothree.org/
Experiences within Relationships
nurturing, sensitive adult-child interactions• are crucial for the development of
trust, empathy, generosity, and conscience
• support the development of curiosity, self-direction, persistence, cooperation (Greenough, et. al., 2001)
• are a precursor of school readiness (Kaplan-Sanoff, 2000)
Learning through Close Relationships
Adverse Childhood Experiences
Abuse• emotional, physical, sexual
Neglect• emotional, physical
Household dysfunction• household substance abuse, household mental
illness, mother treated violentlySeparation or divorceIncarceration of a family member
sources of toxic stress
Outcomes
• heart disease• liver disease• autoimmune disease• diabetes• obesity• drug use• incarceration• depression• smoking• suicide attempts• domestic violence• teen pregnancy
• and more, including early death
Outcomes
• heart disease• liver disease• autoimmune disease• diabetes• obesity• drug use• incarceration• depression• smoking• suicide attempts• domestic violence• teen pregnancy
• and more, including early death
Outcomes
• heart disease• liver disease• autoimmune disease• diabetes• obesity• drug use• incarceration• depression• smoking• suicide attempts• domestic violence• teen pregnancy
• and more, including early death
Stress Impacts the Developing Brain
• sustained or frequent activation of stress hormones (cortisol, adrenalin) can have serious developmental consequences
• learning, memory, and emotional regulation all compromised
• lack of an integrated sense of self• undermines ability to learn from
environment: prediction = safety
http://developingchild.harvard.edu/
Stress Impacts the Developing Brain
• brain is “primed” for danger, NOT for learning• problems with executive function (frontal lobes)– impulse control– planning– accurate interpretation of other’s behavior
The Scope of the Problem
• 26% of population in child welfare is under 4 y/o*• 34% of abused and neglected children are 0-36
months old, making them the most vulnerable age group**
• 26% of children 0-2 and 32% of children 3-5 have emotional or behavioral problems***
Infants and Toddlers are Especially Vulnerable
National Survey of Child & Adolescent Well Being, 1997-2013**Child Abuse & Neglect Fatality Victims by Age, 2010
***National Center for Children in Poverty
Symptoms
• physical symptoms (poor weight gain, slow growth, difficulties with toileting, somatic complaints)
• overall delayed development • inconsolable crying, irritability
in infants and toddlers
Symptoms
• sleep and feeding problems• aggressive or impulsive behavior • anxious and withdrawn behavior• danger-seeking behavior
in infants and toddlers
Attachment Theory
• evolutionary advantage• activated by fear and distress• protection by caregiver, including co-regulation of
fear, is gradually internalized
Attachment Theory
• children maintain their attachment relationships at all costs
• children will distort expression of needs to accommodate caregiver
• distortions are stabilized because they work = some comfort is received
• insecure attachment is an important adaptation to danger because it increases survival
• distortions affect child’s developing structures for regulation, memory, thought and sense of self
Attachment Theory:Security Across the Lifespan
• free expression of needs: confidence they will be met• flexibility of attention• internalization of regulatory capacity• safety with a wide range of affects• free access to memory
Attachment Theory – Infancy
Secure (B) Open protest, greet or approach, return to play
Sensitive to cues, comfortable with dependency and individuation
Avoidant (A) Appears unmoved by parent’s absence or return, engaged with environment
Insensitive, uncomfortable with dependency harsh, punitive and rejecting
Resistent/Ambivalent(C)
Upset throughout, difficult to soothe, angry, does not return to play
Insensitive, unpredictable, uncomfortable with individuation, enmeshed
Disorganized(D)
Confusing behaviors: freezing, falling, contradictory strategies
Frightening or frightened abuse & neglect, hostile/helpless, dissociation
child parent
Attachment Theory – Infancy
• internal working models• secure: The world is safe. I am effective at getting my
needs met. Mom is there when I need her.• avoidant: The world is dangerous. Relationships can’t
help. I have to manage on my own. • resistant: The world is dangerous. I can’t cope alone.
I must keep mom focused on me.• disorganized: The world is very dangerous. I don’t
know what to do! Nothing I try makes me feel safer.
Attachment Theory – Infancy
• Distribution – approximate
15% 62% 9% 15%
25% 33% 12% 30%
General population
High-risk population
A B C D
D attachment ranges from 20-78%, depending upon source of risk.
Source: van IJzendoorn, M., Schuengel, C., Bakermans-Kranenburg, M. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11(2) 225-249.
Attachment Theory - Toddlers
• increased complexity due to developmental change• “goal-corrected partnership”• caregiver changing expectations about child’s new
abilities• what activates attachment system is different• language and behavior can both be used to mis-cue
Attachment –Toddlers and Preschoolers
• focus on function of behavior, not behaviors themselves.
• distorted behavior comes from attempts to create more predictability = safety
• what conditions cause the behavior to start and to stop?
Attachment - Toddlers and Preschoolers
• secure (B)• use caregivers as a secure base – connections are
more distal• negotiate separations, exploration• share responsibility for contact-maintenance• growing capacities for self-soothing (regulation)
Attachment – Toddlers and Preschoolers
• avoidant (A)• avoid focus on relationship• take responsibility for contact maintenance,
emotional regulation• actively monitor attachment figure• coy, cheerful or solicitous• anger – inhibited and displaced• focus on environment
Attachment – Toddlers and Preschoolers
• resistant (C)• coercive and angry• helpless• disarming• punitive• threatening• responsibility for contact maintenance and emotional
regulation rests with caregiver
Attachment – Toddlers and Preschoolers
• disorganized (D)• representational models that are incoherent, do not
allow for prediction• highly coercive– punitive– solicitous
Attachment – Toddlers and Preschoolers
• disorders of attachment in the second year of life (Lieberman and Pawl)
• behaviors are distortions of secure base behaviors
• reckless and accident-prone• inhibition of exploration• precocious competence
Dynamic Maturational Model
– Treatment should take current sources of perceived danger seriously, and work to remove them
– Uncover triggers that promote distortion of affect or cognition
– Parents need to understand their own and child’s patterns of distorting thoughts and feelings as ways of dealing with fear
– See passivity, coyness as warning signs of accommodation to danger
Healing through Relationships
• risk and resilience• supporting caregivers, supporting children
“How you are is as important as what you do.”
- Jeree Pawl
“Don't just do something—stand there and pay attention.”
-Sally Provence
How you are is as important as what you do
– does this feeling belong? here? now?– strong feelings: impediments or important
information?– mindful self-regulation– empathic inquiry and collaborative exploration:
over-looked but powerful interventions– reflective supervision or consultation: critical for
those who work with infants
Common Stories
Paula, Nick and Mateo, 6 months• fussy and inconsolable• PPD, isolation, lack of support
Debra and Ellie, 2 years• withdrawn, fearful• domestic violence
Jimmy, 4 years• aggressive and risk-taking• wetting • in foster care
and how we can help
Thank You!
What are your questions?