Tag Archives: amygdala

More About Orchids

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I am interrupting my blog progression again to talk about a recent infant parent mental health weekend, while it is still on my mind. We heard two terrific lectures last month about temperament and attachment, both subjects of particular interest to me.

The lecture on temperament was again given by Nancy Snidman, the temperament researcher. Nancy defines temperament as “predisposition to respond to the environment in certain ways”. There are many terms to describe temperamental characteristics – for example, introversion and extraversion, fearfulness, sociability, rhythmicity, thrill and adventure seeking, thoughtfulness or empathy, and many more.

One of the most important dialectics is the relationship between temperament and environment. In this case, temperament refers to inherited characteristics and the environment refers to experiences with family, friends, school, and life events. Nancy pointed out that there has been a long history of ways of thinking about temperament. In classical times, the Greeks and Romans thought of temperament in terms of the “humors”. In the 18th century, John Locke deemphasized temperament in favor of the influence of the environment, but then in the 19th century, Darwin focused on the importance of heritable factors in his evolutionary theory. The post World War II period again attributed the most powerful influence to the environment, for example in Freudian theory that gained widespread popularity. However, current research, such as in genetics and neuroimaging, has brought us back to a focus on temperament. Luckily, contemporary theories generally maintain a complex perspective by also including the important influence of the environment.

Some of the variables used by Nancy in studies of temperament deriving from Rothbart infant behavior questionnaire include approach, sadness, activity, perceptual sensitivity, fear, soothability. For example, does the baby get excited when given a new toy (approach), or how sad does the baby get when the caregiver goes away, is the baby easily soothed, does the baby enjoy cuddling?
Nancy reported on a longitudinal study of two styles of temperament – behaviorally inhibited (shy, wary of novelty, slow to approach), and behaviorally uninhibited (sociable, comfortable with novelty). They measured the time it took 31-month old children to accommodate to various novel situations, such as the time it took for them to enter a toy cloth tunnel, the time it took them to approach a robot. Some children behaved in relatively “inhibited” ways, and others were significantly less inhibited. The researchers wondered where this “shy” and “outgoing” behavior was coming from.
Starting with the hypothesis that people have different thresholds of excitability in the amygdala that create different sympathetic nervous system responses, resulting in different kinds of behavioral reaction to uncertainty, Nancy’s research team designed various kinds of auditory, visual, and olfactory stimuli to activate their amygdalas and test their hypothesis. In the lecture, Nancy showed films of 4-month old babies in the experimental situation. The babies were seated in a baby seat, and first one mobile figure was waved in front of him and then another, and then three at once. The first baby sat, attentively watching the moving figures, moving his fingers slightly, calm. The second baby started to fuss as the level of stimulation increased until he arched his back and began to scream. The experimenters studied the frequency and direction of every arm and leg movement, negative vocalization, arched back, etc. The babies sorted themselves out into high reactive babies with “high motor/high cry” and low reactive babies with “low motor/low cry”. Then they studied a group of children from 9-months to 15 years, to see what happened to them.
They were thinking of reactivity in terms of biology. If the amygdala fires, there is sympathetic nervous system activity – arousal, heart rate, respiratory rate. They believe that the biology of the children has a direct effect on their behaviors. If the amygdala is firing and the sympathetic nervous system is “Go!” it will produce behavioral responses. The hypothesis was that the babies who at 4 months were high reactive (high motor/high cry) by 2 ½ years became shy children, and that was because they had inherited a temperament associated with a low threshold of reactivity in the amygdala. These children were what I have referred to previously in the blog as “orchids”.
Across the years, they measured the children’s behavioral and physiological responses – at home at school, and in the lab – to situations that challenged them with different types of novelty or uncertainty. They found that the children moved from simple high reactivity in the youngest babies to a mixture of reactivity and shyness, or inhibition, in the older babies. This shift from high motor activity and high vocalization, to inhibition in the older infants reflects what we know about adults. In some high reactive older infants, when the experimenter changed the tone of her voice from pleasant to harsh as she invited the child to touch a toy, the child withdrew. Over the years, the researchers found remarkable consistency in the reactive style of the children. Some of the high reactive children became less shy, but the uninhibited children did not change. Interestingly, when the high reactive children became comfortable in their environments, they did OK. It was the transitions that are the problem. The high reactive children had more trouble with transitions.
The researchers concluded that there is “strong evidence that infant reactivity is related to a predisposition to have an excitable limbic system” and that this kind of reactivity is a “stable quality over time and situation” (Snidman, 2014). In addition, the research suggests that though these biological factors do not determine anything about the child’s future, and that environment can have an important influence on the child’s behavior and personality characteristics, these biological constraints remain as part of the child’s inherited predisposition.
From my point of view as a clinician, I would stress the value in helping parents understand their children, and teachers understand their pupils, so that they can take the children’s temperament into account when they make expectations of them. Children of all temperaments may be able to achieve the same accomplishments, but they may require different degrees and different types of support in order to achieve them. Earlier blog postings include information related to this subject.

photograph by Ginger Gregory

Snidman, Nancy, “Temperament: Importance, Influence, Impact”, Lecture given at Infant-Parent Mental Health Program, U Mass Boston, Sept. 19, 2014.

 

Being the Parent of an Anxious Child

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Recently I heard an author and editor of The Atlantic magazine, Scott Stossel, talk about his severe anxiety ( Stossel, 2014). What struck me about his story were two things – his description of having had serious problems with anxiety since he was two years old, and also how terrible his anxiety was. He said that the feeling of dread was sometimes so intense that he didn’t think he could go on living. In response to an interviewer asking him what he had found that helped, Scott spoke compellingly about how the first step was accepting the fact that there is no cure, that one has to develop a repertoire of coping skills to deal with the issue and recognize that sometimes you will be OK and other times you suddenly and drastically will not. He even referred to his condition as “temperament”. This rang so true to me.

I pondered on the sweet children I have seen over the years who have had severe anxiety. Some of them have gotten better, and some of them – “stubbornly”! – have not, or at least, are still up and down. Scott Stossel correctly described the problem as a spectrum. All of us have anxiety, but whereas for some it is typical nervousness related to environmental stressors, for others the anxiety is debilitating. I will discuss the treatment of these conditions in another blog posting, since I disagree somewhat with his sense of the limitations of treatment. Right now, I want to talk about the role and the experience of parents with an anxious child.

First of all, I agree with Scott that this problem – barring cases of posttraumatic stress – is largely an issue of temperament. Jerome Kagan and Nancy Snidman talk about how the newly recognized “sensory reactivity disorder” can be seen as a feature of temperament, since both the sensory disorder and also high reactive temperament, have significant heritable features. I don’t say, “inherited”, since we know that the matter isn’t as simple as that. Environmental (and epigenetic) factors have an important role even in the womb, and certainly after birth, when anxious caregivers have a powerful effect on the developing capacity for self-regulation in the infant (Nelson, 2013) (Beebe & Lachmann, 2013). Individual differences tend to be a “blend of temperament and environment” (Snidman, 2011). It appears that the part of the brain that registers threat in response to environmental stimuli – the amygdala – has a lower threshold of reactivity in these children. It is well known that high reactive temperament and the related insufficient development regulatory competencies may complicate a child’s attempts to cope with adverse life circumstances and even everyday transitions (Kagan et al, 2007, Kagan, 1989).

What I would like to focus on here is the effect of an anxious child on his parents. I am not referring to parents just getting anxious when their child is anxious. I am referring to complex patterns of emotional communication that are initiated in infancy and become established and then have a continuing influence on future development – both of the child and of the parents – so that over time, the trajectory of development and associated behaviors become increasingly distorted (Beebe & Lachmann, 2013) . And the people involved don’t even notice it, because they are so intent on staying connected. Many parents of super anxious children tell me that they “walk on eggshells”. What they then explain is that they are afraid of triggering an explosion in their child. But, what I think they really mean is that they are afraid of losing the connection, afraid of losing the child.

Also, they get worn down. When you “lose energy”, as in all living systems (which humans are) you tend to retreat to a simpler but less complex and effective level of functioning.  I don’t use the word “regress” because that could imply a global move to a previous level of functioning, whereas when I use the term “retreat” I mean that the idea that the higher level of functioning remains in the individual’s repertoire but he/she does not at that point have enough energy to attain and maintain it. In my practice, I sometimes talk to parents about “being on the front lines” in an attack. If things are not going well and you are in the front lines, you may tend to just shoot rather than – from the more protected position of the generals – plot new strategy.

So from the beginning, when the child cannot sleep or has trouble with feeding, the parents bend over backwards to help the child sleep – such as sleeping with the child – or eat – such as accommodating severely restrictive diets. These parents are trying to protect their child’s survival. However, what they can’t allow themselves to realize at the time is that they are contributing to the distortions that are developing. The child who will explode if you don’t accommodate his demands does not learn to tolerate frustration. The child who “only eats chicken nuggets” doesn’t learn to like other foods.

Before you begin to blame the parents, though, consider what it means to have a child who “will” not eat, “will” not sleep. Sooner or later, you give up and accommodate the child’s demands. That is, unless the parents have support in changing these pernicious patterns.

The support the parents need is in the form of relationships. There are many therapeutic techniques that are recommended, but I am skeptical of all of them that follow manuals and are short term. The children who get better from these techniques – and there are some that do – are on an “easy part of the spectrum”. The parents of children on the hard part of the spectrum need ongoing support to change their responses to their children. They need the support of a long-term therapeutic relationship that encompasses them and their child. I will continue with this subject in a future blog.

References

Beebe B, Lachmann F (2013). Origins of Attachment, New York: Taylor & Francis, pp. 95-139.

Nelson C A (2013). Biological embedding of early life adversity, jamapediatrics.com JAMA Pediatrics Published online October 28, 2013 E1

Kagan J (1989). The concept of behavioral inhibition to the unfamiliar, In Reznick, J, Ed., Perspectives on Behavioral Inhibition, University of Chicago Press, pp. 1-25.

Kagan J, Snidman N, Kahn V, Towsley S ( 2007). The Preservation of Two Infant Temperaments into Adolescence, Monographs for the Society of the Research in Child Development, 72 (2).

Snidman N (2011). Lecture on Temperament, U Mass Bos Infant Parent Mental Health Post Grad Certificate Program.

Stossel S (2014). My Age of Anxiety – Fear, hope, dread, and the search for peace of mind. New York, Random House.