Ebook ĐỘC QUYỀN (C) Tâm lý học Sức khỏe - Chấn thương sức khỏe tinh thần cho trẻ sơ sinh (Anh ngữ)

 Recognition of need for cultural sensitivity to importance of local cultural beliefs about infants  What is infant mental health?.  Some newborn capacities  Negative factors impacti

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 0 – 3 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 8 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 5 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

differently to parent: as

an interactive person

 -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

baby’s experience

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

trauma

 0 -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 eg video, or encourage touch and massage

 3 month old infant can show in behaviour what happened

symbolic play

they understand in

age-appropriate words

need to be repeated

to recover fully

 Under 6 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)

 6 + 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

master anxiety and grief

produces relief

trauma through appropriate play

 eg give dolls and encourage to ‘make

a story’, with carers present for

sessions

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

to the abuser and cling to them

that re-traumatise

attachment relationship to work through it

 Infant mental health

Guilford Press, 3rd edn.

interaction with their 2 month old babies Masters theses, University of Melbourne unpubd.

predicts emotional distress in adulthood J Epidemiol Community Health, 1-5.

traumatic experiences occurring in the first year of life, Zero to Three, 25 -31.

of infant mental health, second edition, Zeanah C H (ed.) New York: Guildford

Press.