A/Prof Frances Thomson Salo Dept of Psychiatry, Uinversity of Melbourne 24.1.11 Recognition of need for cultural sensitivity to importance of local cultural beliefs about infants  What is infant mental health?  Some newborn capacities  Negative factors impacting on development  How to intervene with parents and babies when there are difficulties  Trauma – signs of Post Traumatic Stress  Intervention and treatment principles  Treatment for infants and carers  Attachment trauma       The emotional, social and psychological wellbeing of a baby – years Secure attachment is important for good self esteem, relationships, cognitive capacities, work Concept of ‘baby as subject’ in his or her own right Assessment: “Diagnostic Classification 0-3” Increasing number of interventions available eg Dr Giang’s Floortime with autistic infants and book about playing with infants Infants are born primed to communicate  Before birth they are aware of mother’s voice, feelings, also father and family  At birth they can recognise mother’s face and voice, and father’s voice  Within the first hour they can turn to track parents on the other side of room, and imitate  They need to attach, be kept in mind and enjoyed  They are very sensitive to physical and emotional feelings of other people  They are aware of anger and fear in intimate partner violence in utero      The situation is urgent for the infant experience organises the brain to filter future experiences Infant vulnerabilities: weak cues, difficulty regulating themselves, extreme prematurity Parents’ depression, teenage pregnancy, mental illness, substance use, family violence Mazelko et al, 2010 Mother’s affection at months predicts adult attachment difficulties JECH, 1-5    Feeding difficulties may be problems of emotional communication Less attunement with feeding linked with less attunement with grandmother (Henry 2004) - link with force feeding? Irritability (RCT: 25% mental health diagnosis at yrs)     Gaze avoidance and attachment difficulties Infant depression Neglect Trauma including transgenerational transmission: ‘ghosts in the nursery’ include hunger and poverty in the past  Many group and individual interventions, and programs  Re-present infant differently to parent: as an interactive person  Encourage:  -time spent with baby  -gaze in en-face communication  -touch  -and play  With feeding difficulties, encourage pleasure and autonomy  Clinicians communicate with baby as a person, with expressive gaze, gesture and vocalisation  To understand baby’s experience  To re-present to his or her parents  As witness to and direct victims of violence  Co-existing risks eg poverty, chaotic life style, substance use, serious mental illness  Cumulative trauma -6 months: hypervigilance  6-12 months: increased anxiety in strange situations  12–8 months: unusual clinginess with caregiver  Disorganised attachment: cortisol elevated but anxiety is not outwardly shown  Infants become frazzled and ‘snap’ as their switch point has been shifted by trauma  Infants’ internal representations are frightening  They may feel anger with parents (in part anxiety  driven)  Restore safety and routines  Maintain sensitivity to re-traumatisation  Provide help for depressed or traumatised carers to be available to child  Helpful for carers to be in sessions with infants when traumatic feelings are revived  Especially if carer is reluctant to explore their own trauma  Enable re-experience of trauma in tolerable doses: help child master the trauma by play  Which setting? Whatever is most useful  Treatment should be specific to the case video, or encourage touch and massage eg 3 month old infant can show in behaviour what happened A child from months has symbolic play Talk to pre-verbal child as if they understand in ageappropriate words Intervention may be single or need to be repeated Infants may need intervention to recover fully    Under months: desensitisation approaches to emphasise interactional encounters involving specific distress situation, with caregiver or therapist as primary stimulus Eg 4-month-old abused by father during feeding - focussed on feeding in treatment (Gaensbauer, 2004) + months: desensitisation with techniques to recreate trauma emphasising specifics of traumatic stimulus or context  Asking children about the trauma and how it affected them often has a positive effect  Open discussion of the trauma to master anxiety and grief produces relief Allow 2–3 y o child to recreate trauma through appropriate play   eg give dolls and encourage to ‘make a story’, with carers present for sessions  Developmentally sensitive play therapy to work through, with parent, grandparent, foster carer  Perhaps with separate counselling and developmental guidance for carers Attachment trauma is the most destructive kind of trauma Abused infants become attached to the abuser and cling to them They later choose relationships that re-traumatise It needs a therapeutic attachment relationship to work through it  Infant mental health  Zeanah, C H, (ed) (2010) Handbook of infant mental health New York, NY: Guilford Press, 3rd edn  Diagnostic Classification 0-3 R (2005) Washington, D.C.: Zero to Three  Henry, L (2004) Is my baby still hungry? A study of Vietnamese mothers feeding interaction with their month old babies Masters theses, University of Melbourne unpubd  Maselko, J, Kubzansky L, Lipsitt L, Buka SL, (2010) Mother’s affection at months predicts emotional distress in adulthood J Epidemiol Community Health, 1-5  Trauma  Gaensbauer, T J., (2004) Telling their stories: representation and re enactment of traumatic experiences occurring in the first year of life, Zero to Three, 25 -31  Scheeringa, M & Gaensbauer,T (2000) Post-traumatic stress disorder In: Handbook of infant mental health, second edition, Zeanah C H (ed.) New York: Guildford Press [...]... separate counselling and developmental guidance for carers Attachment trauma is the most destructive kind of trauma Abused infants become attached to the abuser and cling to them They later choose relationships that re-traumatise It needs a therapeutic attachment relationship to work through it  Infant mental health  Zeanah, C H, (ed) (2010) Handbook of infant mental health New York, NY: Guilford... and routines  Maintain sensitivity to re-traumatisation  Provide help for depressed or traumatised carers to be available to child  Helpful for carers to be in sessions with infants when traumatic feelings are revived  Especially if carer is reluctant to explore their own trauma  Enable re-experience of trauma in tolerable doses: help child master the trauma by play  Which setting? Whatever is... predicts emotional distress in adulthood J Epidemiol Community Health, 1-5  Trauma  Gaensbauer, T J., (2004) Telling their stories: representation and re enactment of traumatic experiences occurring in the first year of life, Zero to Three, 25 -31  Scheeringa, M & Gaensbauer,T (2000) Post-traumatic stress disorder In: Handbook of infant mental health, second edition, Zeanah C H (ed.) New York: Guildford... recreate trauma emphasising specifics of traumatic stimulus or context  Asking children about the trauma and how it affected them often has a positive effect  Open discussion of the trauma to master anxiety and grief produces relief Allow 2–3 y o child to recreate trauma through appropriate play   eg give dolls and encourage to ‘make a story’, with carers present for sessions  Developmentally...  Treatment should be specific to the case video, or encourage touch and massage eg 3 month old infant can show in behaviour what happened A child from 6 months has symbolic play Talk to pre-verbal child as if they understand in ageappropriate words Intervention may be single or need to be repeated Infants may need intervention to recover fully    Under 6 months: desensitisation approaches to ... interventions, and programs  Re-present infant differently to parent: as an interactive person  Encourage:  -time spent with baby  -gaze in en-face communication  -touch  -and play  With feeding... to work through it  Infant mental health  Zeanah, C H, (ed) (2010) Handbook of infant mental health New York, NY: Guilford Press, 3rd edn  Diagnostic Classification 0-3 R (2005) Washington,... about infants  What is infant mental health?  Some newborn capacities  Negative factors impacting on development  How to intervene with parents and babies when there are difficulties  Trauma