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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 nannies. Show all posts
Showing posts with label nannies. Show all posts

Wednesday, November 23, 2011

Disrespect or Disobedience? A Matter of Perspective

This morning I received an e-mail from someone who writes about nannying. She very nicely sent along some of her work, and hoped I might mention it on this blog. I am going to talk about it, but I won’t cite my source, because I can’t agree with most of what she said.

The material I was sent discussed problematic child behavior that nannies might have to deal with and listed a number of issues like disobedience, tantrum-throwing, and lying. I certainly agree that these can be problems if they occur frequently (but breathes there a child who has never done any of these things?). My concern is not that my correspondent pointed out these problems, but that she classed them as matters of disrespect to the nanny.

From early life, children behave toward others with what would be appalling disrespect if it were done by an adult. (I don’t know about you, but if one of my friends stuck a finger up my nose, I would definitely take umbrage.) One of the jobs of adult caregivers is to guide children toward empathic responses that will lead them to be respectful of others’ feelings.

This is a job that is better done by adults who see it as the job it is, rather than focusing on whether they have personally been disrespected. One of my real concerns with the nanny material I was sent is that by using the term disrespect to categorize disobedience and other problematic behaviors, it encourages child care providers to perceive child behaviors as personally significant, rather than as goals in the task of child guidance. When we see ourselves as being disrespected, we are likely to be angry and resentful; when we are angry and resentful, we don’t think clearly; when we don’t think clearly, we can’t bring all our knowledge and ability to bear on what we want to accomplish.

Don’t misunderstand me. Although I know that disobedience and so on are common foibles of childhood, I would not for a moment say they are unimportant or suggest that they may all be ignored. On the contrary, it’s because I think child guidance is so important that I don’t want it to be confused with separate issues like a nanny’s sense that she gets the respect she deserves.

Disobedience and other problem behaviors are significant issues in several ways. One is that they are strongly related to health and safety concerns. Children who frequently disobey home rules (“don’t jump on the bed”) can’t be trusted to stop at the corner before crossing a street, or to keep their hands away from sharp knives in the kitchen. We owe it to children to train them in reasonable obedience to reasonable rules, for their safety as well as for our adult convenience (our needs do count in this equation sometimes, too). However, a sensible approach to obedience recognizes that young children may forget or misunderstand directions, and some older children may act on impulse or take risks when they need attention. Their disobedience, although it needs to be worked on, should be understood in terms of their developmental stage or individual characteristics, not in terms of their wish to annoy a particular adult, or their lack of esteem for that adult.

My correspondent included lying and tantrum-throwing among “disrespectful” behaviors, and of course if our adult friends do these things to us we rightly interpret their attitudes toward us as less than respectful. With reference to children’s lying, let me suggest several interpretations that may be more fruitful than assuming they are disrespectful. Depending on the child’s age and situation, here are some possibilities: the child may be frightened of some consequences of his own or other people’s actions; the child may have misunderstood events or information; the child may be telling a story about imagined events; the child may not remember events or understand the question. If the child has reasons to be frightened, those reasons need to be explored for the child’s own sake. If none of these possibilities seems to apply, but the child is persistently untruthful, it’s important to investigate whether the behavior is an aspect of emotional disturbance.

Interpreting tantrum behavior also needs to be done in the context of the child’s developmental age. Toddlers who do not yet talk well are likely to have tantrums as a result of frustration about unsuccessful communication. Punishing them for this behavior simply increases the frustration level and decreases their ability to handle problems in a more mature way (which will not be very mature in the best of circumstances). Older children may have learned to have tantrums to “get their own way” when adults have rushed to placate them when they make a scene-- but they may also behave in this way when overwhelmed by frustration. When older children have tantrums, it might be useful to explore whether marital problems are leading the parents to be less responsive or positive than usual; whether the child is overscheduled with school, lessons, and sports; whether divorced parents are scheduling visits that are too long or too unpredictable for the child’s comfort; whether the relationship with the nanny feels tenuous to the child (e.g., parent threatens to fire nanny, nanny mutters about quitting). In none of these cases is the tantrum an expression of personal disrespect for the nanny.

In high-quality child care settings, staff are provided with what is called “reflective supervision” to help them focus on problematic interactions with children as tasks to be done, rather than personal wars to be won. Ideally, nannies too would be provided with that kind of help, but very few of them, if any, are supported in this way. We certainly don’t need for nannies to be told that childhood problems are personal disrespect—potentially making matters worse rather than better.

Tuesday, April 19, 2011

Why Should We Worry About Maternal Depression?

It seems as if I’ve had a lot of discussions of maternal depression lately-- both the perinatal mood disorders of birth mothers and post-adoption depression. When these topics come up, there are a lot of different responses. Some deny that there could be post-adoption depression, because they’re convinced that the hormones of pregnancy cause perinatal mood disorders (although if this were the case, it’s not too clear why all women don’t have the same problems). Others feel that the women are just suffering from “buyer’s remorse” and could do perfectly well if they just pulled their socks up. Still others feel that such mood disorders are excuses given by people who don’t like the hard work of early motherhood.

In most cases, people focus on the mother as the significant person, the one who’s influenced by depression. They forget the fact that the impact of maternal depression on a baby’s development can be quite negative. They also forget that this is an issue that has significance not just for mothers but for all major caregivers. Depression in nannies, day care providers, or grandmothers who “watch” the child while the mother works all have the potential for interfering with optimum development. (You notice I don’t say “normal development”. Things have to get pretty bad before development gets below the bottom of the normal range-- but long before that there may be a deviation from a baby’s best developmental trajectory, the one that will result in the best developmental outcome.)

So, what do depressed mothers and caregivers do that’s so different from what better-functioning people manage?

Imagine your own experiences with depression-- whether they involved an afternoon of low interest in life, or a long, serious problem with thoughts of suicide. Think how you feel when you’re depressed, what you feel like doing, and how you respond to other people. You’ll probably realize that you feel not only sad, but slow, tired, unresponsive, hard to please, pessimistic, and perhaps guilty or even worthless. You’d like people either to leave you alone completely or to nurture you without thought of themselves. You don’t want to talk or listen to others, you don’t want to make eye contact, you don’t smile or show expression in your posture or gestures.

Then, imagine how you feel when you’re with someone else who is depressed (and you aren’t). You may feel and act sympathetic at first, but that might not last long in the face of their negative mood. You interpret the other person’s mood as anger or hostility or rejection, and soon you respond to that perceived mood by being angry yourself. You don’t want to be with that person, and if you have to be (you live together, for instance), you may end up picking a fight just to get some acknowledgement of your existence.

Now, I don’t want to act as if I think babies have the same interpretations of other people’s behavior as adults do. I’m positive they do not. But when you consider how you feel when you’re depressed, and how you react to other depressed people, I think you can catch something of the flavor of a baby’s reaction to a depressed caregiver. In addition to that “flavor”, though, it might be good to consider some things depressed caregivers do or don’t do, and how those things relate to a baby’s needs.

1.Depressed caregivers don’t talk much.

Babies need to hear speech from the earliest months. Initially, hearing speech helps babies learn which noises adults make as part of speech, and which are not part of speech. To understand a language, you have to learn that particular sounds determine the meaning of speech, and others, like humming, coughing, or saying “ummm” do not. Different languages have different proportions of certain speech sounds and sometimes don’t use a particular sound at all. Babies who hear little speech are delayed in their understanding of the way their native language works and which sounds they need to pay attention to in order to understand.

2.Depressed caregivers make the “still face” often.

By a few months of age, certainly by 4-6 months, babies have normally learned to expect adult facial expressions to change in response to baby communications. When an adult makes the “still face”-- gazing blankly and unresponsively as if he or she can’t see the baby-- it’s very disturbing to the baby, who will begin to cry quite soon, will avert his or her gaze and become disorganized, sometimes hiccupping or spitting up. Adults can make still faces under perfectly normal situations like trying to remember where the car keys are or trying to talk to the plumber on the phone while the baby makes a bid for attention. Ordinarily, though, the non-depressed adult quickly comes back and re-engages with the baby, repairing their temporarily troubled communication. Depressed caregivers, on the contrary, may not only do the still face more often, but may lack the energy or interest to help the baby later understand that everything is okay and resolve the disorganization and anxiety the baby feels.

3.Depressed caregivers do only the basics.

Fatigue and slowing of responses are part of depression and interfere with normal infant care routines. Ordinarily, caregivers do a lot more than just the physical jobs of caring for a baby. The non-depressed caregiver who is changing a diaper talks to the baby in an interesting, voice that catches the baby’s attention. She plays with the baby at the same time, making eye contact, smiling, tickling or blowing on the tummy, perhaps giving the baby a toy to hold (not entirely play, of course, this is a good strategy for keeping the little hands out of the dirty diaper). When feeding the baby, she talks and jokes, perhaps pretending to eat some of the food herself (for some reason, this is a wow with the high-chair set), or helping the baby pick up some finger food. The depressed caregiver goes through these routines without any of the usual grace notes, doing the minimum and missing out the actions that pique the baby’s interest and foster communication, as well as those that encourage learning.

4.Depressed caregivers may not be very careful or attentive.

When babies can roll over, or pull to stand in their cribs, or later on crawl and so on, caregivers need “eyes in the back of their heads” to ensure safety. Even so, most babies experience a few scary tumbles as their caregivers fail to anticipate their doing something for the first time. The depressed caregiver moves slowly and has trouble paying attention to more than the troubles in her own thoughts and feelings. She may be so preoccupied that the baby might as well be at the top of the stairs or in the bathtub alone. Paradoxically, the depressed caregiver’s sense of guilt or worthlessness may concern her so much that she fails to prevent accidents and thus really does become guilty.

These are only a few of the caregiving problems that can be associated with depression. It may well be that the best thing we could do to foster good early development would be to attend to and treat the depression of mothers and other infant caregivers, so they can do the optimum job of bringing up young children.