By Wenda Reed
Although mental health problems are usually diagnosed well into childhood, or more commonly in adolescence and adulthood, the road to optimal mental health begins in infancy. Its basis is the attachment between the baby and his or her parents and caregivers.
Kathryn Barnard, Ph.D., R.N., director of the Center on Infant Mental Health & Development at the University of Washington in Seattle, has been a leader in the field for more than 30 years and her Feeding and Teaching Scales are used to assess parent-child interactions all over the world.
"It's as simple and as complex as being able to make an emotional connection, a quality relationship," Barnard says.
A child who feels secure in his attachment to his parent or caregiver is then free to explore his world and relate to the people in it without anxiety or fear.
In their outreach to at-risk parents, Barnard and her staff encourage a lot of physical contact between babies and caregivers. Barnard cites a recent study in which some parents were given a carseat for their baby to sit in while the parent went about her daily business. Others were given a Snugli®, in which they kept their babies close to their bodies while they went about daily activities. After three months, the babies in Snuglies® were more attached to their caregivers and showed more signs of feeling secure.
However, a parent who is close to a baby without responding to or understanding her cues may be seen as "smothering," according to literature published by Attachment Parenting International, a national organization that helps establish local support groups and publishes materials for parents and professionals. If a parent continues to try to interact with a baby after she's overstimulated, the baby learns that her responses do not matter.
"A lot of babies are hyper- or hypo-sensitive, so they have difficulty processing stimuli. They look like they're rejecting the parent," Barnard explains. "Parents should see what their sensory preferences are and go with that."
Nature or Nurture?
Many mental health disorders, including depression, bipolar disorder and schizophrenia, are known to have a genetic component. However, in their groundbreaking book, Parenting from the Inside Out, Daniel Siegel, M.D., and Mary Hartzell, M.Ed., cite research showing that nurturing experiences directly affect how - and even whether - genes become expressed.
"In the presence of an unhealthy variant, lack of proper nurture can lead to its activation," they write. In other words, genes and the child's experience interact.
"The way a child is nurtured changes the wiring of the brain," Barnard summarizes.
Siegel and Hartzell cite brain imaging studies showing that abused children have smaller brains, inhibited growth in the connections between the right and left sides of the brain and deceased growth of a neurotransmitter that serves to calm excitable and emotional limbic structures. They live in a state of heightened anxiety, which gets in the way of their learning and healthy development.
A 2000 report by the National Institute of Mental Health shows that maltreated children are 25 percent more likely to suffer from mental illness. Recent brain imaging surveys and other experiments show that child abuse can cause permanent damage to the neural structure and function of the developing brain. On the other hand, healthy bonding between a child and his or her parents and caregivers creates a chemical buffer in the brain that protects the child from shutting down in reaction to stress.
There is also evidence that disengaged parents, who do not pick up on or respond to their babies' cues, can have a harmful effect; the baby has no sense of security or knowledge that the world can meet his needs. In Children of Depressed Mothers, Marian Radke-Yarrow and her fellow writers at the U.S. Department of Health and Human Services point out how depression can be "passed on" from mothers to children. The degree depends on the developmental stage, gender and temperament of the child and the interactions and daily functioning of the mother. By age 2, many of the children begin to show symptoms of their own mental problems.
A Birth to Three Research Study, conducted by the Center on Infant Mental Health & Development, is evaluating mothers with and without postpartum depression in their interaction with their babies during play and feeding. Researchers will follow the children until age 3 or 4 to see how disruptions and disturbances affect early attachment and social and emotional growth and how helpful it is to have intervention by specialists in attachment.
More Support in the Early Years
"The quality of childcare makes such a difference," Barnard says. "It doesn't have to be the biological parents, but it does have to be an adult who will emotionally invest in the child."
Barnard notes that many experts feel it is important for a child to have one primary caregiver for the first three years. Others see that in some cultures there are many caregivers and the children do just as well. In China, for example, aunts and grandmothers often give early care, as most mothers are in the workforce (and have been longer than American mothers have). The incidence of mental disorders is no higher, Barnard points out.
"The child, in her mind, has to establish that someone is the source of security," Barnard says.
"Overall, we do not give a lot of support to families and parents," she adds. "This is especially true of the increasing number of kids born to single parents, where one parent has to meet all those needs without support."
Barnard encourages parents to become involved in new parent support groups and infant and toddler classes. Some hospitals and many houses of worship have programs where young parents can be mentored by more experienced parents.
"The key to infant mental health is working with the parents," Barnard says. "If you have concerns about how you feel or how you feel toward your baby, get some help."
- The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Baby, by Martha Sears, R.N., and William Sears, M.D., Little, Brown, 2001.
- Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive, by Daniel Siegel, M.D., and Mary Hartzell, M.Ed., Jeremy P. Tarcher/Putnam Books, 2003.
Wenda Reed is a freelance writer and former editor for United Parenting Publications.