Healthy Skepticism Library item: 7026

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Publication type: news

Bernstein E.
Sending the Baby To a Shrink: Expanding Field of Infant Mental Health Aims To Head Off Depression and Other Disorders
Wall Street Journal 2006 Oct 24

Abstract:

Jean M. Thomas, a Washington, D.C., psychiatrist, recently saw a patient who
was struggling with her emotions. She was agitated and couldn’t stop crying.
She was recovering from an eating problem and had trouble forming
relationships.

She was 11 months old.

Therapists are increasingly moving their treatments from the couch to the
crib. While the field of infant mental health — which encompasses the study
of children from birth through age three — has been around for decades, new
research on everything from brain development to maternal depression is
giving it a boost. A widely used mental health and development diagnostic
manual for infants was revised last year for the first time since 1994 to
include two new subsets of depression, five new subsets of anxiety disorders
(including separation anxiety and social anxiety disorders) and six new
subsets of feeding behavior disorders (including sensory food aversions and
infantile anorexia).

By starting treatment as soon as possible — even before their patients are
out of diapers — doctors feel they are helping kids become better adjusted.
But the field is also getting a push from anxious parents, who are
increasingly eager to catch serious problems, such as autism or anxiety
disorders, in their children as early as possible. Indeed, doctors are
finding that they can recognize the signs of some of these problems earlier
— sometimes in infants as young as one.

“Early intervention can make a difference,” says Dr. Thomas, who practices
at Children’s National Medical Center in Washington, D.C.

The growing understanding of the baby’s mind is leading to new therapies
that address a variety of issues, including sleep and eating problems and
excessive crying. What they all have in common is that they focus on the
relationship between the baby and the primary caregiver — usually the
mother, but sometimes also the father and even the nanny. “It’s very
important to meet with who the baby is in love with,” says Christine
Anzieu-Premmereur, a psychiatrist and director of the Parent-Infant Program
at Columbia University College of Physicians and Surgeons.

While many of these therapies were initially designed to help kids with
early signs of emotional problems, more and more they’re being utilized by
parents of healthy babies seeking assistance with common parent-infant
issues, such as toilet training and separation anxiety.

Psychologists at the Marycliff Institute in Spokane, Wash., and the
University of Virginia have developed a specific course of group therapy
called “Circle of Security,” to help new parents understand their attachment
to their own parents and how it affects their developing relationship with
their baby. Parents and their babies meet once a week for 20 weeks, and each
family is videotaped interacting for a half hour, with the parent
periodically leaving the child and returning. The group watches the
videotape from a different family each week, studying how the child
expresses its needs and how the parents react.

“If parents can reflect on where the struggles are, they will do a better
job of parenting,” says Kent Hoffman, one of the therapy’s creators.
Currently, Circle of Security — which is practiced at approximately 10
universities in the U.S., as well as an additional six abroad — has been
used by a variety of clients, from doctors and their families to mothers in
prison.

The growing demand from parents for infant mental-health services is, in
turn, driving a rapid expansion in the field. While no one tracks the number
of infant mental health professionals, the World Association for Infant
Mental Health, an organization that seeks to educate early-childhood
professionals, currently has 44 affiliate organizations around the world,
more than double the number it had in 1996. This year alone, new groups
formed in Nebraska, New Zealand, Portugal and Latvia.

In the U.S., there are new graduate programs that aim to train professionals
in the field — including one that started last month at Seton Hall
University, in South Orange, N.J. — and new academic journals, such as the
Journal of Early Childhood and Infant Psychology and the Journal of
Developmental Processes. Two years ago, the Michigan Association for Infant
Mental Health created a system to give accreditation to professionals who
have completed specific coursework in the field and passed other
requirements. Currently, the system is in the process of being adopted by
four other state infant mental-health associations: Texas, New Mexico,
Oklahoma and Arizona.

The growth in the field comes as experts increasingly demonstrate that the
emotional and social development of young children is every bit as important
as their motor and cognitive development. “Those first few years are
unprecedented in the life cycle for how rapidly the changes occur, as well
as for the complexity of the changes,” says Charles Zeanah, a professor of
psychiatry at Tulane University, and author of the “Handbook of Infant
Mental Health.” “The experiences that young children have are very
important.”

Doctors, of course, have been studying the cognitive development of children
for many decades. In the late 1960s, Selma Fraiberg, a researcher at the
University of Michigan, began examining the infant-caregiver relationship.
She coined the phrase “ghosts in the nursery” to denote emotional patterns
that parents bring with them from their own childhood, and created services
for vulnerable babies and their families as well as one of the first
training programs for professionals in the field.

Since then, research has shown that a baby’s environment affects both its
psychology and its neurobiology. If a mother is depressed, for example, her
baby may become listless and nonresponsive. Additionally, studies show that
negative experiences during infancy can alter brain chemistry. Experts
understand that many adult disorders — such as depression, anxiety or
attention-deficit hyperactivity disorder — start in childhood, and
increasingly can recognize them as early as late infanthood or early
toddlerhood.

Doctors have developed an integrated roadmap of what an infant’s healthy
emotional, social and cognitive development should look like. “By
understanding the building blocks of healthy development, we can see when a
baby is going off the healthy pathway,” says Stanley Greenspan, a clinical
professor of psychiatry, behavioral sciences and pediatrics at George
Washington University’s medical school and author of “Infant and Early
Childhood Mental Health,” which lays out risk factors for specific disorders
as well as explicit interventions for each one.

Next month, the Interdisciplinary Council on Developmental and Learning
Disorders, a nonprofit organization of which Dr. Greenspan is the chairman,
will release a report in conjunction with the U.S. Centers for Disease
Control that will offer guidance on early identification and preventive
therapies.

Many babies who show up at a therapist’s office have no serious issues. “The
parents got the message that these are the critical years, and it’s caused a
lot of anxiety,” says Claire Lerner, director of parenting resources at Zero
to Three, a Washington-based infancy educational group that published the
newly revised diagnostic manual. “They’re watching for every marker.” She
says that good therapy can still help a healthy child: “It’s an opportunity
for parents to tune into their child, understand what makes him tick and to
develop strategies to help him thrive.”

In Washington, Dr. Thomas sees babies who have physical or psychological
problems as well as babies with parents whose expectations are out of sync
with the child’s abilities. “What if the parent expects the child to sit at
six months and the child is not sitting?” she says. “The parent might worry
that the child is delayed or retarded. They might pressure the child and
then the child gets frustrated.”

Dr. Thomas practices “early childhood family-based therapy” in which she
observes the parents with their baby — both while she is in the room as
well as through a one-way mirror — and points out what pleases and what
frustrates the child. Often, she gives the parents a daily homework
assignment, such as setting a timer for every 20 minutes while the baby is
awake and then, when it rings, finding some small activity that both baby
and parent can enjoy, such as following the child’s lead in play. “This is
about helping the parent and the child have good experiences together that
are going to be driving healthy development,” says Dr. Thomas.

The cost of infant mental-health therapy varies, but generally runs between
about $85 to $250 per session. Typically, insurance will not cover it unless
one of the participants — either parent or child — is given a diagnosis.
But some therapists say they are reluctant to give the baby a diagnosis.

For Elizabeth Thomason, the price was worth it. After her son Peter was
born, she had trouble bonding with him — the labor had been difficult, he
had an intestinal problem that required surgery and refused to sleep, and
the overwhelmed new mom fell into a post-partum depression. “He was not
getting a lot from me — I just fed him, changed his diaper, put him to
bed,” says Ms. Thomason, 32, who worried that her depression would
permanently affect her baby. “There was no joy.”

When her therapist suggested she see a clinical social worker who
specializes in infant mental health, she quickly agreed. Once a week for
about five months, the infant specialist came to Ms. Thomason’s home and the
two women discussed the baby’s issues, how Ms. Thomason was feeling about
her baby and different techniques to soothe him. “She helped us get the
dialogue going between us,” says Ms. Thomason. “Just having someone there to
listen was huge.”