Infant and Early Childhood Mental Health - PowerPoint Presentation

Slide1

Infant and Early Childhood Mental Health

What It

Is and Why It Matters

Lisa Mennet, PhD Slide2

The Amazing Social Infant

born ready to interactSlide3

Infants

are an open systemSlide4

Infants are an open systemBorn to learn and ready to adapt to any human culture, babies absorb the range of their experiences, good and bad.Slide5

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 Slide6

What is IECMH?Expressing and Regulating Emotions – Forming Relationships -- ExploringSlide7

Child characteristics

Caregiver characteristics

Experiences in relationships

Elements of Infant and Early Childhood Mental HealthSlide8

Child characteristics

t

emperamentgenetic endowmentmedical issues, including prematurity

birth order

appearanceSlide9

Caregiver

characteristics

temperamentfamily of origin environmental safety

resources

and supports

(

or lack thereof

)

trauma history

mental

health issues

(

including

post-partum depression)Slide10

Post-Partum Depression20% 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 developmentolder children: poor self-control, aggression, poor peer relationships, and difficulty in schoolbiggest

impact when depression combines with other factors

http://zerotothree.org/Slide11

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

)Slide12

Learning through Close RelationshipsSlide13

Adverse Childhood ExperiencesAbuseemotional, physical,

sexualNeglectemotional,

physicalHousehold dysfunctionhousehold substance abuse, household mental illness, mother treated violentlySeparation or divorce

Incarceration

of a family member

sources of toxic stressSlide14

Outcomesheart diseaseliver diseaseautoimmune diseasediabetesobesitydrug use

incarcerationdepressionsmokingsuicide attemptsdomestic violenceteen pregnancy

and more, including early deathSlide15

Outcomesheart diseaseliver diseaseautoimmune diseasediabetesobesitydrug use

incarcerationdepressionsmokingsuicide attemptsdomestic violenceteen pregnancy

and more, including early deathSlide16

Outcomesheart diseaseliver diseaseautoimmune disease

diabetesobesitydrug useincarceration

depressionsmokingsuicide attemptsdomestic violenceteen pregnancyand more, including early deathSlide17

Stress Impacts the Developing Brain

sustained or frequent activation of stress hormones (cortisol, adrenalin) can have serious developmental consequenceslearning, memory,

and emotional regulation all compromisedlack of an integrated sense of selfundermines ability to learn from environment: prediction = safety

http://developingchild.harvard.edu

/Slide18

Stress Impacts the Developing Brainbrain is “primed” for danger,

NOT for learningproblems with executive function (frontal lobes)

impulse controlplanningaccurate interpretation of other’s behavior Slide19

The Scope of the Problem26% 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 PovertySlide20

Symptomsphysical symptoms (poor weight gain, slow growth, difficulties with toileting, somatic complaints)

overall delayed development

inconsolable crying, irritabilityin infants

and

toddlersSlide21

Symptoms

sleep and feeding problems

aggressive or impulsive behavior anxious and withdrawn behaviordanger-seeking behavior

in infants

and

toddlersSlide22

Attachment Theoryevolutionary

advantageactivated by fear and distress

protection by caregiver, including co-regulation of fear, is gradually internalizedSlide23

Attachment Theorychildren 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 receivedinsecure attachment is an important adaptation to danger because it increases survival

distortions

affect child’s developing structures for regulation, memory, thought and sense of selfSlide24

Attachment Theory:Security Across the Lifespanfree expression of needs: confidence they will be met

flexibility of attentioninternalization of regulatory capacity

safety with a wide range of affectsfree access to memorySlide25

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

parentSlide26
Slide27

Attachment Theory – Infancyinternal 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.Slide28

Attachment Theory – InfancyDistribution – 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.Slide29

Attachment Theory - Toddlersincreased complexity due to developmental change

“goal-corrected partnership”caregiver changing expectations about child’s new abilities

what activates attachment system is differentlanguage and behavior can both be used to mis-cueSlide30

Attachment –Toddlers and Preschoolersfocus on function

of behavior, not behaviors themselves.distorted behavior comes from attempts to create more predictability = safetywhat conditions cause the behavior to start and to stop?Slide31

Attachment - Toddlers and Preschoolerssecure (B)

use caregivers as a secure base – connections are more distalnegotiate separations, exploration

share responsibility for contact-maintenancegrowing capacities for self-soothing (regulation)Slide32

Attachment – Toddlers and Preschoolersavoidant (A)

avoid focus on relationshiptake responsibility for contact maintenance, emotional regulation

actively monitor attachment figurecoy, cheerful or solicitousanger – inhibited and displaced

focus

on environmentSlide33

Attachment – Toddlers and Preschoolersresistant (C)

coercive and angryhelpless

disarmingpunitivethreatening

responsibility

for contact maintenance and emotional regulation

rests with caregiverSlide34

Attachment – Toddlers and Preschoolersdisorganized (D)

representational models that are incoherent, do not allow for predictionhighly

coercivepunitivesolicitousSlide35

Attachment – Toddlers and Preschoolersdisorders of attachment in the second year of life (Lieberman and Pawl)

behaviors are distortions of secure base behaviorsreckless and accident-prone

inhibition of explorationprecocious competenceSlide36
Slide37

Dynamic Maturational Model

Treatment should take current sources of perceived danger seriously, and work to remove themUncover 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 fearSee passivity, coyness as warning signs of accommodation to dangerSlide38

Healing through Relationshipsrisk and resiliencesupporting caregivers, supporting childrenSlide39

“How you are is as important as what you do.”

- Jeree Pawl

“Don't just do something—

stand

there and pay attention.”

-

Sally ProvenceSlide40

How you are is as important as what you dodoes this feeling belong?

here? now?strong feelings: impediments or important information

?mindful self-regulationempathic inquiry and collaborative exploration: over-looked but powerful interventionsreflective supervision or consultation: critical for those who work with infantsSlide41

Common StoriesPaula, Nick and Mateo, 6 monthsfussy

and inconsolablePPD, isolation, lack of support

Debra and Ellie, 2 yearswithdrawn, fearfuldomestic violence

Jimmy

, 4

years

aggressive

and

risk-taking

wetting

in

foster care

a

nd how we can helpSlide42

Thank You!

What are your questions?