Tag Archives: Ed Tronick

Preschool, Day Care: Attachment and Separation

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I have promised to discuss interventions for childhood constipation and soiling, but I received a great comment that I would like to address first.

A reader of the blog commented:

As the director of a Montessori school in Colorado, I have a few questions:
1) What are your thoughts about early child care and its effects on attachment? I am aware of Belsky’s study and the NIHCD studies. Do you believe that early child care (before 3) undermines security of attachment? Do you believe this is irrespective of the type or quality of care? Is there other research on this issue that you would recommend?

2) I know there have been a lot of studies (some even specific to child care) which show that infants/young children separated from their parents show abnormally high cortisol levels and lower growth hormone levels. Given these studies, do you have a recommendation as to an optimal way to transition a young child into a child care setting (to minimize their distress)? Is there an optimal way for children to separate from their parents each day (we have tried many things over the years- parents walking their child into the school, children leaving their parents in a car line- a teacher comes out to get the child, etc)? If a child appeared to be highly stressed (how would you quantify this?), what would you recommend? Is there any research as to how specific practices might increase or decrease a child’s experience of separation?

In response to this important comment, I contacted recent graduates of the Infant Parent Mental Health course in Boston and Napa, of which I am on the faculty – http://www.umb.edu/academics/cla/psychology/professional_development/infant-parent-mental-health. I value the knowledge and expertise of this group of clinicians and wanted to start a discussion about the issues of childcare, security of attachment, and separation from parents. I will also request comments from another group of valued colleagues – preschool teachers.

My first response came from an IPMH graduate who also has extensive experience directing and administrating early child care programs, Alayne Stieglitz. Here is her thoughtful response:

When I read these questions I thought of Ed Tronick on the first day of the IPMH Program introducing us to the caregiving practices of several cultures around the world: The village in the Andes where infants are bundled in blankets and strapped upside down on their mothers backs for the first year of their lives and the tribal group in Africa where children have an average of seven caregivers before their first birthday. These are not what we would consider ” best practices” but the children there are reaching their developmental milestones, forming healthy, robust attachments, and thriving in their societies. He said, “Different patterns of care taking and parenting may violate norms we hold as vital, yet children are still developing and learning. Those differences work for their culture. The point is to raise a child who can be competent and successful in the culture they live in.”

In this day and age, the culture that an increasing number of families are living in includes childcare. Single parent households and households where both parents work in order to provide what’s needed for their family do not have the option of whether or not to put their children in someone else’s care. There are many choices; in home care by a relative, in home care by a nanny, small family day care, and center based care. I think the question to ask is not, “Which type of care is best?” But, “Which type of care will be best for my child and my family?” And, of course, “Which is the highest quality of care that I can afford?” This last question limits the options for many families. Continue reading

“Ghosts in the Nursery”

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For this mothers’ group meeting the mothers chose the topic of the relationship with their own mothers. This is a very important subject and one that has been central to thinking in psychology for about half a century now. I will organize my thoughts about it into three categories. The first is psychoanalytic or psychodynamic thinking about the subject. The second is Attachment Theory, and the third is the developmental perspective introduced by Tronick in his Mutual Regulation Model (Tronick, 2007).

First of all, Sigmund Freud didn’t pay much attention to the mother’s relationship to her own mother in his theorizing. In fact, he didn’t blame the mother much at all. In his famous case of a child with a horse phobia, “Little Hans” – although there was plenty of evidence of Little Hans’ mother’s emotional difficulties and of his parents’ marital conflict at the time (this was revealed rather recently when the Sigmund Freud Archives revealed information gained from interviews of the father and of Little Hans himself as an adult) – Freud attributed most of Little Hans’ problems to Hans’ own inner conflicts generated by his developmental stage and position in the family – his “Oedipal Conflict” (Freud, 1909), (Chused, 2007).

The early child analysts who studied with Sigmund Freud’s daughter, Anna Freud, gave more thought to the influence of parenting. Anna Freud and Dorothy Burlingham created “Hampstead War Nurseries” in which the impact of children’s separation from their mothers was observed and the recommendation was made to keep children with their families whenever possible, even during the bombings (Midgely, 2007). One of the circle of early child analysts around Anna Freud, Berta Bornstein, wrote a classical paper describing her analytic treatment of the little boy she called “Frankie” (Bornstein, 1949). In this paper she hypothesized that Frankie’s mother’s relationship with her own mother – and to her preferred older brother – affected her own difficulty bonding to newborn Frankie and influenced her continuing relationship with her son.

Another follower of Anna Freud was Selma Fraiberg, who became famous for her book about early child development called “The Magic Years”. Fraiberg made an important contribution in our understanding of early development through clinical her work with the mother-child relationship. She wrote a classic paper called “Ghosts in the Nursery” about the influence of a woman’s experience with her mother on her relationship with her own child (Fraiberg, Adelson, & Shapiro, 1975). In this paper, Fraiberg states, “In every nursery there are ghosts. They are visitors from the unremembered past of the parents; the uninvited guests at the christening” (p. 387). One of Fraiberg’s followers, Alicia Lieberman, has written about a counteracting influence that she calls, “The Angels in the Nursery” (Lieberman et al, 2005).   Continue reading

How to Talk to Your Child About Complex Subjects

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At a gathering of family and close friends recently, a young couple asked me a question about their almost 3-year old son. I had observed the child and had found him to be intelligent, charming, and warmly connected to his parents. He also seemed sensitive, perhaps one of Kagan’s “inhibited” children (Kagan & Moss, 1983). The child, whom I will call “David” (not his real name), had been anxiously asking his parents about whether he might be put in jail, about whether he was a “bad guy”. He seemed to associate these fears to bible stories he was hearing in Sunday school, particularly the stories of Daniel and the Lion’s Den, and the story of Jesus being arrested. This was confusing to his parents, because in their understanding of these narratives, it was the “good guys” who were arrested. His parents told me that they constantly reassure him that he is a good boy, that they love him, and that he is safe. David’s parents further explained that he seems to ask these questions about being thrown in jail whenever a stranger is in the house, asking whether that person is going to throw him in jail. His parents decided to avoid stories about jail and to limit the bible stories since many of the concepts seemed too complex for him to process at this age. They asked me what I thought.

This question is fascinating from several points of view. First of all, it highlights the difference between the meanings an adult makes of certain narratives and those made by a preschool child. Second, it underscores the often discrepant levels of maturation of different developmental capacities in the same child. Third, it reveals aspects of a crucial cultural context that forms the way narratives transmit important beliefs and values in a society. Consideration of these factors may help parents in their efforts to talk to their children about complex subjects. 

What about what Tronick calls the “age possible” meanings that two people of different developmental ages make of the same story (Tronick, 2007)? An example is offered by the 4-year old whose mother was trying to explain to her the generational relationship of people at a family reunion. The mother explained, “Your nana is your daddy’s mommy.” The little girl thought for a moment and then asked in wonder, “But how did she get him into the car seat?” I am also reminded of a little patient, a 3-year old who witnessed people jumping from the World Trade Towers on television and in a play session suggested to me that children could “jump big” in a playground because it is “softer” (Harrison & Tronick, 2007). I took her to be referring to a “soft landing”, though I knew that no number of soft mattresses at the foot of the WTT could have cushioned the fall of the jumpers. In David’s case, the meaning he derived from “being put in jail” was that you were a bad guy, period. He was not able to consider a nuanced meaning in which a good guy was unjustly jailed. It is clear that good guys and bad guys are on his mind these days. Remember the “terrible two’s”?. His age-typical anxiety about the result of noncompliance to parental demands (whether real acts of noncompliance or imagined ones) led him to fear that his “bad guy” feelings and thoughts would brand him as a bad guy and cause someone to throw him in jail. A “stranger” is a preferable enforcer of that terrible punishment, because a stranger can be seen as “all bad”.  If it were one of his beloved parents who threatened him with jail, how could he manage the stress of fearing one that he also loved and depended on? 

The second issue is that of discrepant developmental capacities. Human development is not a smooth, linear process. It occurs in a messy process of hits and misses, halts and bumps forward, and reiterative efforts to master. In many children, this messy process occurs at very different rates and in different ways in different domains of competency. For example, some children have precocious motor coordination but are slow to speak. Others speak sophisticated sentences early but struggle to do one rung of the monkey bars or are insecure about climbing and jumping. If you have significant discrepancies in your developmental capacities, you are left with a subjective sense of inner imbalance, sometimes even of incipient chaos, in the background. It does not always bother you, but when you experience a threat, it can emerge. This could be called “anxiety”, but that is a rather crude description of a complicated subjective experience. I do not know David well enough to guess about whether he has a discrepant developmental profile. The inheritance of “inhibited” genes is another possibility. However, I do know many children who fit this picture of uneven development.

Finally, there is the interesting factor of culture. In an earlier posting, I wrote about how another 3-year old sat through a 6-hour wedding dinner with a minimum of fuss. I described what I saw his French parents do in order to teach him to sit at the table for long stretches. In any culture many core beliefs are transmitted by narratives. Children hear these narratives repeated over and over from early on and learn the culturally shared meanings that their parents convey to them. However, the meaning is not transmitted by language alone. Peter Fonagy talks about this process. He says, “Human communication is specifically adapted to allow the transmission of cognitively opaque cultural knowledge, kind-generalizable generic knowledge, and shared cultural knowledge” (Fonagy, lecture IPMH, May, 2012). This knowledge is transmitted by what he calls “ostensive communication cues” such as eye contact, turn taking with contingent reactivity, and special vocal tones. In a study Fonagy cited, infants of 18 months old were asked by the researcher to pass an object, a doll. In the control group, the researcher gave no cues directed to the infant, but in the study group, the researcher first smiled and said hello to the infant. Then in both groups, the researcher smiled at one doll and made a disgust face at the other. At that point, another researcher came into the room and the baby was asked to give the second person a doll. Only in the group in which the experimenter had smiled and said hello, did the babies give the second person the doll the first experimenter had smiled at, the doll designated as desirable . In other words, the researcher had initiated a relationship with the baby and in that context, the baby attended to the “ostensive cues” (smiling or disgust face) she then gave him. The infant trusted the researcher who smiled and said hello and then judged the information she gave him to be reliable.  

So, in response to my young friends’ question, I would say that I support their decision to protect David from anxiety provoking bible stories for the present. In avoiding certain bible stories they are acknowledging a dysynchrony between the dominant contemporary middle class U.S. culture and a culture in which bible stories are a primary means of transmitting beliefs. In the latter culture, bible stories would not just be read but from early on would be told as stories, with accompanying “ostensive cues”. In that culture, the parent would communicate – with eye contact, turn taking rhythms, and tone of voice – who the bad guys and who the good guys are in every story, over and over.  In that way, David would learn the salient meanings – with associated values – of his culture. Of course, he might still have fears of being a bad guy, because of his age-typical struggles with his aggression and negativity. It is less likely, though, that his fears would focus on bible stories.

Harrison, Alexandra & Tronick, Ed (2007). Now we have a playground: Emerging new ideas of therapeutic action”, J Amer Psychoanal Assoc., 55/3: 853-874.

 Kagan, Jerome & Moss, Howard A (1983) From Birth to Maturity: A Study in Psychological Development, Yale University Press. 

Tronick, Ed (2007). The Neurobehavioral and Social-Emotional of Infants and Children, WW Norton.

 

photograph by Joshua Sparrow

 

 

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Infant Parent Mental Health Weekend: Murray and Cooper

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Part I

The last weekend in the IPMH fellowship, we were treated to researchers on postnatal depression (PND) from the U.K., Lynne Murray  and Peter Cooper. In this summary, I cannot do justice to the rich presentation and discussions that followed. What I will do instead is to note some of the main points and then illustrate them with descriptions of some of the wonderful film examples Lynne and Peter showed us. At the end I will include references to some of the studies so that those who are interested may read about the research in greater detail. http://www.reading.ac.uk/pcls/people/lynne-murray.aspx

On Friday, Lynne Murray lectured on the effects of PND on the child. She pointed out that PND occurs at a time when the infant is maximally dependent on the mother and also highly sensitive to the caregiver’s communications. Depression influences the communications that the caregiver gives the baby. The baby picks up for example whether the caregiver’s eyes are open or closed, whether her gaze is direct or indirect. By 8 weeks old, the baby is ready for “proto-conversations” – a variety of gestures and expressions that indicate the baby’s affect and intention and that demand contingent responses to maintain engagement. 

When a mother is clinically depressed, she may fall into two broad patterns of insensitivity, either remoteness and disengagement, or hostility and intrusiveness, and in turn the infants may avoid contact and become depressed themselves. Boys are more vulnerable, perhaps because they intrinsically tend to need more support. 

Murray showed a film of the first pattern of interaction with a depressed mother and her 12-week old baby. The mother says to her baby, “Oh, poor baby! I feel so sorry for you sitting there (in an infant seat) all by yourself! You’re struggling to get out!” In this example, the mother seems to perceive her baby as feeling as trapped as she herself might feel. Perhaps because she is weighted down by her own negative affect state, the mother cannot respond to the baby’s cues of widening eyes and open mouth, and so the baby gives up and withdraws. Naturally, the mother gets discouraged. A cycle gets going in which mother and baby both feel helpless. 

In a film exemplifying the second pattern, the mother seems a little speeded up and anxious. She behaves in an pushy manner and cannot seem to sit back and attend to the baby’s cues. As the baby pulls away, the mother pushes forward. The mother changes the play agenda all the time; she decides the baby is fed up with a toy without any evidence from the baby’s behavior, and she takes it away, abruptly substituting another. This interaction also ends up in a discouraging experience for both mother and baby.

Two experimental paradigms demonstrate the effect on the baby of an interruption of maternal responsiveness. The first is Ed Tronick’s still face procedure in which the mother is instructed to interrupt her play with her baby and become unresponsive for a period of 1-2 minutes; the babies in these experiments are powerfully affected by the loss of their mother’s responsiveness. The second is a study by Lynne Murray that illuminated the refinement of the contingency response pattern between young infants and their mothers (Murray & Trevarthen, 1985). When babies were shown their mothers’ images on a television screen as the mothers were reacting to them in real time, the babies responded to them as if they were their interactive partners. Then when the mothers’ images were played back to them with the timing manipulated so that there was no contingency with the babies’ gestures (same mother, same baby, but gestures played back a little later than they were made), the babies’ gaze dropped off, the smiling stopped, and the baby became confused and distressed. 

What are the ways that non-depressed mothers behave that support their babies’ psychological growth and development? The mother of a 3-month old facilitates the baby’s attention by closely monitoring the baby’s expressions to maintain the baby’s attention on an object, varying the experience enough to keep the baby’s interest. This is difficult for a depressed mother to do because she has difficulty picking up the baby’s cues. The non-depressed mother will also facilitate the baby’s potential by holding the toy at the right distance and keep the baby in the right position so that the baby can get the maximum benefit out of the toy. The non-depressed mother of a 12-month old will for example pick up toys to make them available to the child – indicating what the baby can do with it without taking over, steadying the toy so that the baby can achieve his own goals. In an example of a non-depressed mother sharing a book with her baby, the mother put her thumb under the page so that the baby could more easily turn the page himself. 

Both the general patterns displayed by PND mothers – without intervention – can end up in persisting interaction difficulties, and in different kinds of negative outcomes in the developing child. Examples of these outcomes are a depression in IQ and school achievement, behavior regulation problems in childhood, and depressive disorders in childhood (Murray et al, 2010).

References:

Murray L & Trevarthen C (1985). Emotional regulation of interactions between two-month olds and their mothers, In T A Field & N A Fox, Social Perception in Infants, Norwood, N.J., Ablex Publishers, pp. 177-197.

Murray J (2010). The effects of maternal postnatal depression and child sex on academic performance at age 16 years: A developmental approach, Child Psychol & Psychiat, 51(10):1150-1159.

 Photo – Joshua Sparrow, M.D., Nov. 2012 

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March IPMH Meeting: Epigenetics II

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(Continuation of Barry Lester’s presentation with discussion)

What are some long-term prenatal stressors that affect placental genes? These risk factors may play a role in future problems but do not predict the future. What they can do is alter the HPA system set points and affect the way the newborn responds to stress. This in turn could influence the baby’s regulation.  One could hypothesize that potentially this could lead to dis-inhibition, psychopathology, cognitive problems, and adolescent substance abuse. Of course, there are many steps along the way and many forks in the road. We are only talking about risk factors in a very complex set of processes. We don’t know what these pathways are that lead to problems down the road. We only see correlations. 

Let’s look at cocaine using mothers. It becomes difficult to isolate a particular risk factor in the lives of these women. But the cocaine exposed babies showed higher reactivity to stress. What are the other stressors in the picture? In addition to cocaine use, there is also a relationship of the babies’ high reactivity to the number of caregiver changes. The important point is that you are looking at how the drug interacts with adversity in the postnatal environment, not just the effect of the drug itself.

Which epigenetic changes will be passed on?  Ed (Tonick) says that nutritional studies show that it takes two more generations after the parent generation to clear out some of the nutritional effects in the generation of the grandparents. Do these pass through the mother’s line only? (There are also those who dispute the intergenerational transmission.) If the changes that are passed on represent a guess about the environment, then that is important. How stable are these epigenetic changes anyway? It is possible that they are short lived but that the environment reinstates them. Suppose you are a 2-yo and you are neglected and so you methylate your GR receptors (stress regulatory system). Then you get neglected again, so you methylate them again. There then may be changes in your hippocampus that in effect become a damaged part of your stress regulatory system. Is it causality or association? It seems unlikely that methylation of one gene is going to cause the changes we are talking about. 

It is essential to keep in mind that the connections we are talking about do not represent the actual events of the real world. Ed says that “simple” and “sovereign” is always wrong. We tend to find a new paradigm, and the situation always becomes more complicated the more you look at it. We always find a new paradigm and it gets more complicated the more you look at it. If you look at the Dutch famine study, think about the mothers who were pregnant during a war in which the whole country was starving. The famine ends, but people have died, fetuses have been aborted, the babies who are born are smaller and more irritable. The women who mother them are traumatized. We talk about the famine but do not seriously take into consideration all the other horrible factors that were involved. These amplifying and reinforcing factors were still going on even after the war.

The magnitude of effects – the effect size of all these factors – is small.  It is interesting that you get this variability in the relationship between methylation and behavior in healthy babies, and it makes you wonder what would happen if you look at “at risk” populations; in that case, do you magnify the effects? Within the normal range you can find the same relationship between birth rate and behavior in a study done by Ed Tronick and Barry Lester. You need to consider the whole range – babies who weigh 8 pounds and those who weigh 6 pounds – will the bigger babies have a little better organized behavior? 

There is a new NICU at Brown with single rooms. The changes taking place include more breast feeding, more kangaroo care, etc. An Italian colleague of Ed’s, Rosario, did a study in which he looked at the quality of care in 24 different NICU’s in Italy. He categorized them and gave them assessments, and the babies in the better NICU’s had better scores than those in the least good ones. You are then discharging a baby who is medically in better shape and also neurobehaviorally in better shape. Also, the higher the level of neurodevelopmental care, the lower the incidence of depression in the mothers. All of these NICU’s ascribe to a particular care policy, but in fact they vary. Some of the things that are done in developmental care are thought of as “neuro-protective”. Ideas of developmental care have shifted. 

Schizophrenia – what is the epigenetic issue? There are people who are studying epigenetic changes related to schizophrenia and autism. There is not a lot published yet, but it seems there are prenatal effects that are related to schizophrenia. We also need to look at the relationship between epigenetic changes and genotype. 

Steve Suomi  has done cross fostering studies of rhesus monkeys. He took inhibited and uninhibited babies and cross fostered them, and found that there was evidence of temperament coming through in addition to the environment. Barry Lester thinks of temperament as a protective factor. Nancy Snidman asked about individual differences in the pups – not all the pups get licked, do they? Everyone agreed that there are probably individual differences among the pups that influence how much they get licked. Ed pointed out that just because these models have to do with stress, it doesn’t mean that stress is all bad. We don’t know what appropriate levels of stress are. What about the stress and temperament interaction – is it possible that stress for a highly reactive kid can lead to a blow out, whereas stress for a low reactor can be facilitating? Yes, but it also depends on what you mean by stress. These kids have different thresholds for reactivity. Some people get a rush that is positive, and others feel a negative reaction immediately.

If you have an acute stressful event and it finishes and is done, and yet you ruminate about it, that self-amplifies the stress.  This is where a psychodynamic factor plays an important role. In the case that the individual makes a harmful, self-critical meaning of the stress, then when stress happens, things deteriorate. Stress reactivity by itself, the cortisol effect, is a nonspecific model that could go many different ways. The Kagan model is more specific – it is reaction to novelty – across the lifespan. Stress reactivity and care is a different model. There are many paths that fussiness in a baby can take. Nancy and Kagan were looking at reaction to novelty, and they wanted to get the system aroused to see the physiological systems respond. There were a lot of things they could not include that have to do with caretaking. The amygdala approach-withdrawal reaction – is specific in its relation to novelty. They started with older children. How could they bring that reaction down to infancy and what was going on in the brain? They do see SES differences. Nancy reminds us that most kids are a mix of the temperamental features they are talking about. They were studying mainly the extremes. 

This kind of research is also constrained by the use of checklists. Remember that it is not only parental translation to what these words like “seldom” and “often” mean; it is also what we mean. In the checklist we have to interpret the answers, and what was “trouble” when the checklist was developed and what it is now sometimes has changed. The reason you use CBCL is that the parent has a thick relationship with the child and you may not see all these things for 15 min in the lab. It is also true that the more extreme anything is, the greater effect you will see from it. So that you will see a greater effect the more abnormal the caretaking is. In the case of the relationship between temperament and training in dogs, it is harder to train certain breeds to be aggressive than others, but you can do it. You could probably override most traits. 

In the discussion, one fellow talked about a home placement program in which a child who has not been able to develop certain skills is put into a supportive foster home. Then, when he is better, he is sent back into the home, and they cannot manage. It is typical for kids to do well in structured environments but do poorly at home, and the school says. There is a tendency to dismiss the fact that the child does better in one context because of the regulatory support context.

In the next blog, I will report on the presentation about Attachment Theory. 

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