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?