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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments
Showing posts with label communication. Show all posts
Showing posts with label communication. Show all posts

Thursday, October 13, 2011

How Does Maternal Depression Affect Young Babies?

When I’ve mentioned maternal depression on this blog, I’ve sometimes been quite surprised to have readers respond as if the condition was a moral failure rather than a mental illness. That attitude was especially common when the reference was to depression in adoptive mothers-- some seemed to think that such women were simply spoiled brats who changed their minds about what they wanted after they discovered that baby care was a challenge. I don’t think there’s much point to arguing about that belief. Depression is more common in women than in men, and is especially common during the child-bearing years. Although some women who are depressed while caring for young babies have been depressed earlier in their lives, it is also true that life-changing events-- even much-wanted ones-- can trigger depressive reactions, however counter-intuitive that may be.

Mood disorders in young mothers can exist for a variety of reasons. But it doesn’t really matter whether they occur because of moral turpitude or because of a genetically-determined emotional disturbance. In all cases, effective treatment is desirable, because a depressed caregiver cannot provide the foundation for a baby’s good cognitive and emotional development.

Why is this? How can a very young baby even know what a caregiver’s mood is? And as long as it’s fed, warm, and clean, why would the baby care?

To answer these questions, it’s important to look very closely at communications between caregivers and young babies-- communications that are quite subtle and occur very quickly, so a casual observer can notice only a few, if any, of them. Understanding such communications requires a microanalysis of videotaped movements and facial expressions. These can be examined in the order in which they occurred, so it’s possible to see how each member of the pair responded to changes in the other. (As an example of this, I’m going to summarize an article by Reck, Noe, Stefenelli, Fuchs, and others, “Interactive coordination of currently depressed inpatient mothers and their infants during the postpartum period”, Infant Mental Health Journal, 2011, Vol. 32, pp. 542-562.)

Ideally, we’d expect the baby and the caregiver to be coordinated in their behavior and mood, and to respond to each other by matching a communicated mood (what Edward Tronick calls mutual regulation). But we’d also expect that the two will occasionally make mistakes or “mismatches” and respond with a smile to a frown, or vice-versa. Normally, baby and caregiver fairly quickly notice their mistakes and “repair” the communication by moving to match the other’s mood more closely. Those repair events seem to be even more important than frequent accurate matches, because they teach the baby that moods can be changed and regulated, and that mistaken communications can be corrected with effort.

Reck and her co-authors looked at a group of mothers who were hospitalized together with their babies for treatment of serious depression, and compared them to a group of healthy mothers and their infants. They observed the frequency of positive matches (when both partners showed positive emotion) and negative matches (when both showed negative emotion such as crying, withdrawal, hostility, or intrusiveness). Because it has been reported that maternal depression interferes with the development of joint attention (looking at an object and then back at each other), shared looking at objects was also studied. There was particular interest in the pairs’ abilities to repair mismatches and come to similar positive states. The babies ranged from 1 to 8 months in age.

In order to encourage mothers and babies to show their social interactions, the researchers used the “face-to-face still-face” method. In this, mother and baby were seated opposite each other, with one video camera recording each face’s expressions and a single microphone between them. The mothers were instructed to begin just with a normal interaction, to get the babies’ attention and play with them without using toys or a pacifier. After two minutes of this play, the mothers were to do two minutes of an unresponsive “still face”, in which they simply stare into space toward the baby without responding to the baby’s bids for communication. For the final two minutes (the “reunion” phase), the mothers were to return to normal responsiveness and engage with the baby again.

Depressed mothers and their babies did behave somewhat differently from healthy mothers with their babies. When the mother was depressed, repair of mismatches took longer. Healthy mothers were quicker to repair mismatches in the reunion phase than in the initial play phase, as if they were “trying harder” after the difficult period of the still-face episode, but when mothers were depressed the difference was the opposite. There were also differences in the time it took the mother-baby pairs to come to a match. For the healthy mother-baby pairs, half of them got to a positive match in 3 seconds after they began, whereas in half of the cases with depressed mothers they needed 12 seconds to get to a positive match in the play episode and 18 seconds in the reunion episode.

The babies of depressed mothers thus had quite different experiences of social interactions than did those of healthy mothers-- and experiences of this kind would be repeated many thousands of times in the early months of life in ordinary caregiving. Slower development of communication skills would certainly be expectable for babies of depressed mothers. This would be only one of several reasons why treatment of maternal depression is important with respect to infant development. Babies don’t have to know their mothers’ moods, or to care about them-- they are affected by depression in their caregivers in ways that do not support the best development.

Thursday, October 6, 2011

Bring On the Taties, Bring on the Bread: Feeding, Eye Contact, and All That

“Bring on the taties, bring on the bread-- Won’t somebody get this baby fed!” Feeding hungry babies is a universal task of childrearing. Before they reach the toddler period, babies get frantically hungry and seem to think that only desperate crying will bring them anything to eat. Parents and other caregivers sometimes feel that they spend most of their time in feeding, and sympathize with mother and father birds confronted with wide-open beaks every time they return to the nest.

Obviously, feeding enough of the right things, in the right amounts and at the right times, is essentially to babies’ very survival, as well as to normal physical growth and development. The physical effects of feeding are so important and so obvious that it’s easy to forget that much happens during feeding other than transferring food from the outside of the baby to the inside. Studies of preterm infants have shown a number of factors that affect feeding and digestion even in very tiny babies who cannot suck and must be tube-fed-- these include the experience of smelling the mother’s milk, the experience of sucking a pacifier while being tube-fed, and the experience of being fed during a period of activity rather than when deeply asleep (all of these increase growth rate).

Even the youngest babies are actively engaged in the experience of feeding and are paying attention to events that they connect with being fed. This is a simple but powerful type of learning-- the kind Pavlov called classical conditioning-- in which the babies learn to expect one event to follow another one. More and more complicated learning builds on these early feeding experiences, until the hungry one-month-old who quieted when Mother began to undo her blouse becomes the one-year-old who tries to unbutton those buttons herself.

All those moments of learning are closely connected with social and emotional development. Except for the unlucky baby who has to make do with a propped bottle or pureed food in a bottle with a big hole in the nipple, infants almost always experience feeding as an interaction with another person. It’s an interactive experience of communication with a caregiver who does a lot of the physical work of providing food-- but who ideally does this in response to the baby’s communications of wanting to eat or wanting to stop. Both parent and baby use their best communicative skills to do this job. They both use their eyes to gaze at or look away from the other person or the food being offered, as well as putting out their hands to control a spoon or a bottle and their voices to show approval or protest. The baby wants food but may like some foods better than others, and prefers certain feeding rhythms; as he or she experiences a more satisfied appetite, there may be changes toward slower consumption or stronger preferences or avoidances.

These facts mean that ideally babies and caregivers have many sessions of practicing communicating with each other about a topic that is of great interest to both of them. It’s fun to eat when you’re hungry, and it’s fun to see your healthy baby consuming the food you’ve offered, so both of them are likely to find feeding time pleasurable and to associate that pleasure with their communication and social interaction. However, if a baby is sick or developmentally delayed, and if the caregiver is worried, depressed, afraid of wasting food, frightened, or exhausted, neither of them will have much fun in the feeding situation, and they will miss a major chance to learn to enjoy their interactions. They may not advance well in their abilities to communicate with each other, either about feeding or about other important things.

When parents and babies are not doing well together, they need support that pays attention to both adult and child needs and abilities, but they do not always get this even when intentions are good. A few years ago, I observed a program for adolescent mothers and their babies. There had been some concerns about neglect in the case of each participant, and the babies were receiving intervention in the form of supportive day care, while the mothers attended classes and discussion groups. The highlight of the day was supposed to be lunch, with each mother feeding her baby. The babies had high chairs and plenty of food provided. BUT--- nobody had remembered that it was important for the mothers and babies to be able to look at each other’s faces in order to communicate. There were no chairs for the mothers! Each young woman stood in front of her baby and bent over awkwardly to spoon the food into the baby’s mouth. The babies had to look up and away from the spoon to see their mothers’ faces, and even then saw only a tense-looking expression on a face held at an odd angle. What appeared to be a tiny detail actually caused a major impediment to the social and emotional interaction that’s a critical part of feeding.

It’s popular nowadays to emphasize early interactions, “skin-to-skin” experience, and so on, and I don’t dismiss those. But if we want to see how relationships, communication, and understanding of other people develop, I suggest we look at the thousands of feeding experiences that occur in the first year or so of a baby’s life. If someone invented feeding as a brand-new intervention, parents would rush to take workshops and learn how to do it. It doesn’t need to be invented, but parents need to understand its importance, and so do those who “coach” or support parents in other ways.

Monday, August 22, 2011

When Will My Baby Understand....?

Concerned parents (and what other kind is there, really?) pore over lists of developmental milestones, checking out the average age for the first independent step, first word, and so on. Even more important-- but much harder to establish-- would be developmental milestones for ways of understanding and communicating with other people.

As it happens, an American developmental psychologist who has contributed much to our understanding of infant understanding, Michael Tomasello, has just received the 2011 Wiley-Blackwell/British Academy prize for contributions to psychology. I’ve been going through some of his research articles (kindly posted for free by Wiley-Blackwell), and I put together some “milestones” that I think will be of interest to parents. Some of these developmental achievements may seem pretty ordinary at a casual glance, but if you think it over you’ll see that they’re very significant steps in understanding other people.

12-month-olds:

How do 12-month-olds understand pointing? Do they just look where you point, as they look where you look, or do they understand that a pointing person means to communicate some information? When an adult pointed at a hidden toy, 12-month-olds could usually find the toy. Those who had understood the pointing could also point correctly themselves when an adult asked them where a toy was. This suggests that 12-month-olds know that a gesture like pointing means that another person knows something and wants them to know it too.
[Behne, T., Liszkowski, U., Carpenter, M., & Tomasello, M. (2011). Twelve-month-olds’ comprehension and production of pointin. British Journal of Developmental Psychology, 29, 1-17.]

Do 12-month-olds point just because they are interested in a toy or an entertaining sight? No, they point for various reasons. One is to call a person’s attention to something she does not know about or isn’t looking at; one is to share a positive or negative attitude about things they are both looking at; and one is in reference to things that are mentioned but are not there--- for example, a puppet that is no longer in a window the baby can see. These different purposes seem to be related to the 12-month-old’s developing understanding of other people’s mental states.
[Liszowski, U., Carpenter, M., & Tomasello, M. (2007). Pointing out new news, old news, and absent referents at 12 months of age. Developmental Science, 10, F1-F7.]

14-month-olds:

Do 14-month-olds just remember things like toys, or do they pay attention to the toy experiences they have shared with other people? In this study an adult and a baby played with three toys. The adult acted excited and encouraged the baby to be excited about one toy but was bland about the others. Later, the baby was shown all three toys on a tray, and the adult excitedly said “give it to me!” (leaving it unclear which toy was meant). 14-month-olds most often chose the toy they had been excited about--- but they did not make the same choice if they had only watched the adult acting excited without being involved. The babies could use the past history of playing together to figure out which toy the adult meant.
[Moll, H., Richter, N., Carpenter, M., & Tomasello,M. (2008). Fourteen-month-olds know what “we” have shared in a special way. Infancy, 13, 90-101.)

Do 14-month-olds understand when someone else is having trouble, and do they want to help? In one study, an adult pretended not to be able to reach a dropped clothespin. 14-month-olds spontaneously tried to help. When the adult was struggling with a more complicated task like opening a box, though, 14-month-olds did not always try to help. The toddlers could understand that the adult had a problem, and wanted to help, but they could apparently also figure out whether they could do the task or not.
[Warneken, F., & Tomasello, M. (2009). The roots of human altruism. British Journal of Psychology, 100, 455-471.]

18-month-olds:

Will 18-month-olds work hard to give help when they see it’s needed? When older toddlers saw an adult “struggling” to reach a dropped object, 18-month-olds would walk around obstacles to help, and they did this without being rewarded. They not only understood what another person might want, but they were eager to help and would do something difficult for them to manage while they were still amateur walkers.
[Warneken & Tomasello, above]

Do 18-month-olds understand that different people can know and mean different things, even if they say or do the same things? In one study, when 18-month-olds played with a toy one way with the first adult and another way with a second adult, they started the first activity when the first adult pointed at the toy, and the second activity when the second adult pointed at the toy.
[Liebal, K., Behne, T., Carpenter, M., & Tomasello,M. (2009). Infants use shared experience to interpret pointing gestures. Developmental Science, 12, 264-271.]

20-month-0lds:

Will 20-month-olds put helping someone above their immediate play interests? In one study, 20-month-olds would stop playing and leave an attractive group of toys to help someone who seemed to be having trouble. They would not only do this without reward-- if they were rewarded they became less likely to help on another occasion! Their understanding of the need for help and their motivation to help were both apparently very high.
[Warneken & Tomasello, above.]

Can 20-month-olds use other information to figure out the meaning of words they don’t know? In one study, 20-22-month-olds were shown pictures of puppets doing odd things that were described with nonsense words like “tamming”. If they were shown a picture and just told “this is tamming”, they did not seem to learn the meaning of the word. But if they were helped to practice by seeing pictures and hearing about one thing doing something to another thing, they were later able to use that kind of information to choose the right meaning for a word. If they saw a picture of a frog “tamming” a monkey, and heard it described with a complete transitive sentence, they would later look toward the correct picture -- for example, they would look at a frog doing something to a monkey, not at a picture of a monkey doing something to a frog. They used the relationship between the two animals to help decide what the unknown word probably meant; they did not need to be “taught” every word.
[Dittmar, M., Abbot-Smith, K., Lieven, E., & Tomasello, M. (2008). Young German children's early syntactic competence: A preferential looking study. Developmental Science, 11, 575-582.]

24-month-olds:

Children of 24 months know that if someone leaves the room before an event occurs, that person does not know about the event. But in one study, when an adult stayed in the room but could not see a new object because of a barrier that was above her eye level, 24-month-olds did not act as if the adult knew more about the hidden object than about two other objects she had seen. Just being together when the child saw the object was a factor that confused the children about what the adult might know—suggesting that for all the social and cognitive skills described here, there was still a lot of development ahead.

[Moll, H., Carpenter, M., & Tomasello, M. (2011). Social engagement leads 2-year-olds to overestimate others’ knowledge. Infancy, 16, 248-265.]

36-month-olds:

Do three-year-olds understand enough about what others can see or hear to be able to be “sneaky” in disobedience? Even though this might be something we don’t want them to do, we have to give credit for understanding to anyone who is able to manage this task. In one study, 3-year-olds were told not to peek in a box that had a very nice toy in it, and told they could play with it when the adult said it was all right. They were more likely to peek when they could tell that the adult could not see what they were doing. Given a box with two doors, one decorated with bells and one that would not make noise, they chose the silent door to peek through. To manage this “sneakiness”, they had to be able to think about what the adult could see or hear and whether they could do what they wanted to without being “caught”. (This is one of many cases in child development where being “bad” is evidence of good development.)

[Melis, A.P., Call, J., & Tomasello, M. (2010). 36-month-olds conceal visual and auditory information from others. Developmental Science, 13, 479-489.]

Can 3-year-olds really pretend, by playing that an object is one thing at one time, another thing at another time? In one study, they were able to switch back and forth from one pretend identity of an object to another and could talk about whether a wooden block “was a car” or “was an apple” at different times. This advance in pretend play may be associated with the earlier understanding that different people may mean the same thing by different gestures.
[Wyman, E., Rakoczy, H., & Tomasello, M. (2009). Young children understand multiple pretend identities in their object play. British Journal of Developmental Psychology, 27, 385-404.]

Do 3-year-olds mind if bad things are done to other people? Does their earlier “helping” tendency extend to social problems? In one study, each child and each of two hand puppets made a picture or a paper sculpture. One hand puppet “left”. For half of the children, the remaining hand puppet then destroyed the other one’s work; for the other half, the puppet destroyed some extra materials that had not been used. The children seeing the departed puppet’s work destroyed were more likely to protest, tell the puppet not to do that, and tattle on the destructive puppet; they also comforted or helped the second puppet on its return. The children’s concern extended to situations where another person was hurt, even though the child had no problems of his or her own. “Tattling” in this situation seemed to be a natural part of the child’s attempt to help.
[Vaish, A., Missana, M., & Tomasello, M. (2011). Three-year-old children intervene in third-party moral transgressions. British Journal of Developmental Psychology, 29, 124-130.]

Tomasello’s work shows that young children already know a lot about how to learn from other people and how to communicate with and act toward them. But what if your child can’t do all these things at the “right age”? Should you be worried? Parents usually ARE worried, but there are a lot of reasons not to panic here. One is that even in these studies there were some children of a given age who did not manage to do the task. They may have been having a bad day, or maybe the successful children were having good days. (Some of the children didn’t complete the tasks at all.) Also, the researchers did not just march up to each child and try to get him or her to do a task. They spent a long time with “warm-up” tasks and with getting the child ready. In addition, they were in a specially-designed lab, without a lot of familiar objects and people to distract the child from the job at hand. You may try this at home-- but results will vary!

Sunday, May 10, 2009

Eye contact with babies-- how important is it?

People have believed for centuries that the human gaze had remarkable powers. In the distant past, most people thought that rays came out of the eyes and explored the world, carrying information about objects back to the brain. (Some still believe this-- even college freshmen.)

One of the important abilities attributed to gazing involved the mutual gaze, or "eye contact", where two people look into each other's eyes and feel as if they are communicating powerful emotions. "Eye contact" is often said to play a critical role in interactions between adults and babies, and even to help create emotional attachment in early life. A related idea is that breastfeeding mothers and babies gaze intently into each other's eyes and thus establish an emotional connection.

Let's examine some of these ideas. Do babies see well when very young, and do they spend time in mutual gaze with their caregivers?

Newborn babies have vision, but it still has to develop for quite a while before it's as good as an older child's. Newborns (infants in the first month of life) can only see clearly at certain limited distances. They are well adapted to looking at a face from about 10-18 inches from their eyes, which would be a typical distance if an adult held the baby in his or her arms. Babies are more interested in some things they can look at than in others. They like things that are shiny, that move around, and that have patterns rather than just a blank surface. Of course, this set of characteristics describes human eyes-- they are moist and reflect light, they move as we examine something we're looking at, and they have white, colored, and dark parts, as well as eyelashes and lids that move. So, babies with normal vision do look at eyes when they get a chance. What this means to the baby, we can't tell, but it is very exciting and gratifying for the adult when "eye contact" is made.

A curious thing about young babies' eye contact is that blind babies do it too. How? They listen to the adult voice, then move their gaze so they are "looking" in the right direction. It appears to the adult that the baby is looking at him or her, and the adult may not even realize that the baby can't see.

What about the breastfeeding baby? Does he or she gaze into the mother's eyes while nursing? Actually, no; young babies, especially, usually squeeze their eyes tight shut while they nurse. In any case, because the baby has to turn its face toward the breast to take the nipple, it would have to work hard to be able to look up at the face at the same time. Older babies (8 months or so) may have figured out how to hold the nipple in their mouths while turning to look up at the mother or at someone else in the room, and they may let go the nipple and play or babble to the mother for a little while before nursing again. But an intense mutual gaze during breastfeeding is pretty infrequent. (And remember, breastfeeding mothers are not necessarily gazing at the infant. They may be eating, drinking, talking on the phone, or reading to an older child.)

As babies get a few months older, they can see better, and they also begin to use their eyes in a way that gives signals to an adult. For example, suppose you are playing with a baby and the baby gets tired, or maybe you have just come on a little too strong and been too stimulating. The baby turns the gaze away from your face, gets quiet for a moment, and just withdraws to have a little rest. The averted gaze works to tell a sensitive adult that the baby needs to back off for a bit. Then, rested up, the baby looks back at your eyes, smiles, and shows readiness to play some more. This slightly older baby gazes at the adult sometimes, but has the mature capacity to be able to stop looking. A baby who gazed at its caregiver's eyes a great deal of the time would not be showing the level of development we would expect by 3-6 months of age.

In the second half of the first year, babies begin to show a new use of the gaze for communication. They develop the ability for an important skill called "joint attention." The baby sees something interesting like puppies playing-- watches intently-- then turns to "catch the eye" of an adult, and looks back at the puppies again. Babies will do this several times until they get the adult to look at the puppies. Just like an adult, the older baby can use the gaze to point, as a pointing finger would be used. Also like an adult, the older baby wants to share the fun with a loved person, and wants to look at the puppies together with someone else. At the end of the sequence, the two look at each other and smile. (Notice that the baby does not do this in order to get the adult to do anything other than share the interesting sight. This is not a way to get fed, or picked up, or even carried over to see the puppies.) Again, mutual gaze or "eye contact" is only a part of the communication the adult and baby carry out with their eyes.

*** Readers, if you have found this post in your search for current material about eye contact and autism, please look at my post for Nov. 7, 2013,which discusses the Nature article by Warren Jones and Ami Klin.