Monthly Archives: April 2015

Avoiding Struggles: Strategizing

One of the biggest challenges a parent or other caregiver faces is avoiding struggles with the child. Struggles are a no-win situation. Many children, like junior lawyers, are great at arguing. Caregivers (CG) often cannot resist getting pulled into a lengthy argument, in which the child usually gets the upper hand. Although some parents tell me about their child’s arguing skills with pride, I know that parents letting children litigate is making a fool’s bargain.

The argument usually starts with the CG setting a limit. For example, the teenager comes home from school, drops his back pack on the floor, and lunges for the couch and the t.v. remote. The CG asks, “How much homework do you have tonight?” Child responds, “Not much. I did most of it in study hall.” The CG represses her skepticism and asks, “What about that English paper that is due Friday?” The child says, “Why are you always always acting like that? My teacher says that kids need to relax when they get home from school! I’ve had a hard day, and I need to chill a little bit before I do anything like homework!” CG: “I’m sorry. What was hard about your day?” Child: “None of your business. Don’t be so nosy. I wish you were like Jason’s parents. They leave him alone when he needs his space!”

One can empathize with the CG. By now she has three people aligned against her – her child, the teacher, and (maybe 4) Jason’s parents! Also, she hears the stress in his voice and she agrees that he needs time to relax. At the same time, she replays in her mind the past few weeks, when he has stayed up until midnight struggling with homework with diminishing returns, or given up, after “relaxing” in front of t.v. or texting with friends for hours after coming home from school. What should she do?

Before giving suggestions, let me point out that this problem most likely started long ago. It is a pattern that has old roots. Consider this situation. Preschool child is in a bad mood when she wakes up. First, she wants her red pants that are in the wash, and nothing else can satisfy her. Then she decides that she will make do with her silver Cinderella sandals, but it is 10 degrees outside and there is snow everywhere. Her mother has left for work and her father (CG) is trying to get her ready for school, where she has pronounced she is not going.He is thinking of a difficult client he has an appointment with first thing, and he is feeling stretched to the limit. Finally he gets his princess downstairs to the kitchen, and she demands coffee cake for breakfast, remembering the special treat they served to a guest the morning before. He thinks for a moment about what her mother will say if he gives in, but he says, “OK, coffee cake and then eggs (pointing to the eggs he has already prepared). She says “OK” but after the coffee cake, she touches the eggs with a fork and proclaims, “These are not the kind of eggs Mommy makes. I don’t want them.” Sound familiar?

The solution to both of these situations (and one does indeed follow the other) is strategy. When you are on the front lines of the battle, you can’t make strategy; you can only shoot or surrender. It is the generals who make strategy, and they don’t make strategy on the front lines but in the “war room”, protected and far away from the storm of battle. Strategy is also best made with at least two collaborators. They can bounce ideas off each other, balance each other’s extremes, recall data that the other has missed. They can make a plan. After they make a plan, they have to execute it, and then they have to practice it over and over again until it becomes a habit. When it is a habit, the old bad habit – the struggle pattern – starts to unravel and make way for the new pattern, a more secure and potentially collaborative one not just between generals but between generals and soldiers.

Let’s look at how strategy works in our two examples. With out teenager, CG says, “Well, I totally sympathize with you for needing to relax, but we agreed that there were no screens except computer for homework until homework is done. That lets you relax afterwards and get to bed in time for you to be rested. Can I get you a snack before you begin? I got you your favorite popcorn and a new vitamin drink of the kind you like.” If the child protests, the CG responds, “I’m so sorry, but you know that is what we (she and other CG) decided, and we all agreed that was best. I know it is hard.” Then she leaves the room. This last part is crucial, because if she stays, he may persuade her to give in or get into a struggle with him that takes up his homework time and drains her of all her emotional energy.

Now the preschooler: The CG says, “You know we said no coffee cake. You can have eggs or an energy bar in the car (he and his partner agreed on this beforehand). Which will it be? And, by the way, you can wear your Cinderella slippers in the car but your boots are going with you, and I am putting them in your cubby when we get there.” If she has a total meltdown, he can carry her to the car. CG’s of preschoolers, remember the example of the teenager when you feel tempted to give in. You can’t carry teenagers to the car, or anywhere. Start building healthy habits early. It is hard in the beginning, but it pays off.

Helping Your Child Learn Self Regulation: The “3 R’s”

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What is regulation? Regulation refers to the integration of the various functions of the body and mind in order to achieve a sense of wellbeing. Regulatory processes are organized into rhythms. The body has many rhythms that are repeated over and over again mostly out of our awareness, creating micro patterns that then coordinate to create macro patterns, that help to organize and integrate our human body and mind. For example, we don’t usually pay attention to our heart rate or respiratory rate unless something is going wrong, such as the rapid heart rate associated with anxiety or panic. But our sense of well being emerges from among other things the signals these rhythms send us. An example of the coordination of these rhythms is the coordination of respiratory rate with walking. If walking at a comfortable pace, many people tend to take two strides for one inhalation and between two and three strides for one exhalation. Walking is a self-regulating activity, as well as dancing and drumming, and many other repetitive rhythmic patterned activities. In fact, music and dance often provide refined regulatory procedures that make one feel good – calm (“music soothes the savage beast”) or invigorated.

A child develops regulatory capacity through a process of mutual regulation with a caregiver, beginning in infancy (Tronick, 2007). This helps to explain why regulatory activities done with another person are often even more effective than done alone, for example, taking walk with another person (or a dog). Even having a conversation with another person involves rich processes of turn taking that create coordinated rhythms between the two people and also within each individual. The capacities for mutual regulation are developed over time, and some children develop them more easily and earlier than others. That is because some children are born with better functioning capacities for self-regulation and coordinating with others than other children, and because some caregiving environments are better “regulators” for children than others. Mutual regulation is intimately tied to self-regulation, so that if someone is not good at mutual regulation, he is also not so good at self-regulation.

In order to better understand regulatory processes, it is important to understand something about brain development. No one describes the connection between brain development and stress regulation than Bruce Perry. Perry explains, 1. The brain develops sequentially from the brainstem to the cortex; in the first year of life, the cerebral cortex is not yet “on line”, and the lower and mid brain are what the infant makes use of to make sense of his world. 2. The brain is use dependent – “use it or lose it”, “Neurons that fire together, wire together.” 3. The stress response systems originate in the lower parts of the brain and help regulate and organize higher parts of the brain – or if poorly organized or poorly regulated themselves, they dysregulate or disorganize higher parts of the brain.

Interventions that support regulation can target various parts of the brain. Thinking through a challenge (“Use your words!”) targets the cerebral cortex that is involved in functions of language and thinking. Thinking things through or “understanding” is highly regulating. However, if an individual is stressed, or if certain of his thinking functions are not well developed due to an inherited learning challenge or immaturity, intervening at these higher-level brain functions will be insufficient.

In fact, all of us from time to time need more basic regulatory means than “thinking things through”, at least to settle ourselves enough to actually do the thinking. We benefit from building up our stress regulatory system in the lower part of our brain. How do you do that? We do that through – Rhythmic, repetitive, patterned activity. 3 R’s – rhythm, repetition, relaxation. Walking; dancing; meditation; rhythmic music; drumming. Although dancing and making or listening to rhythmic music is highly regulating, most of us do not have the habit of doing this regularly. However, taking a walk is easy to do. It may have the added advantage of taking you physically away from a stressful situation.

There is another set of 3 R’s – routine, ritual, rendering (articulating). Daily routines and rituals (the parents’ best friends); rendering means articulating transitions – creating multiple steps to organize the transitional space (first we get out of bed, then we go to the bathroom, then we brush out teeth, then we wash our face, then ….). For more information on routines, follow the tag “routines” on the blog.

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

Second Posting on Lynne Murray at IPMH

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Part II of Lynne Murray at IPMH

Cognitive Development: IQ and School Achievement

The overall findings for poor outcome in cognitive development in Murray’s Cambridge longitudinal study and other recent studies show that PND is associated with a significant risk for poor outcome, but mainly in the context of high risk (families with multiple risk factors such as poverty and social disadvantage), persistent depression, and possibly being a male child.

What are the maternal behaviors that are associated with poor outcome in PND? Multiple studies suggest general reduced responsiveness (Murray et al, 1993, Milgrom et al, 2004), lack of contingency and learning (Tronick & Weinberg, 1997), and modulation of input to sustain attention (Kaplan et al, 2011).

What do these behaviors look like and how do they exert a negative effect?

It is not hard to imagine that depressed mothers would have a generally reduced responsiveness to their children. However, in the newborn period the child is particularly sensitive to communications – particularly emotional communication – from the caregiver, so that reduced responsiveness exerts a powerful influence at this time in life. Nothing demonstrates this fact more than Tronick’s still face experiment. We have described this research in earlier blog postings. In essence, the mother is instructed to play with her baby in a face-to-face situation with the baby in a baby seat and the mother facing him or her. At a signal, the mother is supposed to assume a nonresponsive pose and hold it (for 1-2 min) until another signal alerts her to resume playing. The infant’s response is powerful. She will usually begin with various bids for the mother’s attention – gazing at the mother, giving her an inviting facial expression, smiling, gesturing, or vocalizing. When persistent bids for connection are unsuccessful, the infant looks increasingly distressed, attempts to self-soothe in various ways, and finally may become acutely dysregulated; some infants even lose postural tone and slump down in their seats.
This experiment does not actually simulate the situation with a depressed mother, but corresponds in terms of the reduction in general responsiveness.

Depressed mothers tend to fall into two different patterns (although these are rough generalizations). Some tend to primarily withdraw, and others tend to be intrusive and controlling (Tronick & Weinberg, 1997). The particular style a depressed mother takes will depend at least in part on her own history of caregiving experiences with her own mother and on her personality style. Both of these problem patterns interfere with the way a mother a mother wants to be with her infant. What are some ways that the PND mother can correct some problem patterns and give her baby what she wants to give him or her?

The first step is to find a supportive family member, friend, or therapist. This is important not only to combat depressive thoughts that pull the mother down further into unhappiness – such as, “I am a failure”, “I can’t do anything right” – but also to gain assistance in reading the baby’s cues. A mother who feels like a failure may easily misinterpret her infant’s gaze aversion as a rejection of her, rather than the communication, “I need a break; I will be right back.” Videotapes of mother and infant interacting can be particularly helpful. Often the videotape will reveal missed opportunities for positive engagement, when for example, the infant is gazing at the mother’s face and she is looking away. After viewing the videotape with a friend or therapist, the mother is more likely to be on the lookout for her baby’s invitations to “be together”. It is important to note that whereas medication may relieve the mother’s depressive symptoms, it does not seem to change problematic interactional patterns in PND mothers. In addition, therapy with the mother alone does not seem to be as effective as therapy that includes mother and infant together. In my opinion, videotape intervention therapy is the most effective for PND of all the alternatives.

Beebe B, jaffe J, Markese S, Buck K, Chen H, Cohen P, Bahrick L, Andress H, Feldstein S (2010). The origins of 12-month attachment: A microanalysis of 4-month mother-infant interaction, Attach Hum Dev. 12(0):3-141.

Kaplan PS, Danko CM, Diaz A, Kalinka CJ (2011). An associative learning deficit in 1-year old infants of depressed mothers: Role of depression in duration, Infant Behavior and Development, 34(1):35-44.

Milgrom J, Westley D, Gemmill AW (2004). The mediating role of maternal responsiveness in some longer-term effects of postnatal depression on infant development. Infant Behavior & Development, 27:443-454.

Murray L, Kempton C, Woolgar M, Hooper R (1993). Depressed mothers’ speech to their infants and its relations to infant gender and cognitive development, Journal of Child Psychology and Psychiatry 34(7):1083-1101.

Tronick EZ & Weinberg MK (1997). Depressed mothers and infants: Failure to form dyadic states of consciousness. In L Murray and PJ Cooper (Eds.), Postpartum depression and child development (pp. 54-81). New York: Guilford Press.