Infant Mental Health

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Infant Mental Health
LETS START FROM THE VERY BEGINNING
Weatherston/Hofmans, 2001
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Do infants have mental health problems?
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A recent HSE study of the mental health needs of
children and adolescents in Irelands SE,
estimated that 14.98 of under 5s meet the
criteria for at least one psychological disorder
(Martin Carr, 2006)
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2006 Census Figures
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The first few years are crucial they set a
strong or fragile stage for what follows J
Shonkoff D. Phillips, 2000 From Neurons to
Neighbourhoods The Science of Early Childhood
Development
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DC0-3R

• Diagnostic Classification of Mental Health and
  Developmental Disorders of Infancy and Early
  Childhood.
• Published in 1994, revised in 2004.
• Provides a systematic, developmentally based
  approach to classification of mental health and
  developmental difficulties in first 4 years of
  life.
• Helps with clinical formulation, research and
  professional communication.
• Compliments DSM-IV.

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DC0-3R
Axis I Clinical Disorders e.g.
disorders of affect Axis II Relationship
Classification e.g.
over-involved Axis III Medical and
Developmental Disorders and
Conditions e.g diseases of nervous system Axis
IV Psychosocial Stressors e.g.
housing challenges Axis V Social and Emotional
Functioning e.g. functions immaturely
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Infant Mental Health
Is a field dedicated to understanding and
treating children from 0 - 3 years within the
context of family, care giving and community
relationships World Association of Infant
Mental Health, 2002
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• Core concepts include
• Promoting secure and healthy relationships
• Early Intervention
• Assessment and treatment of developmental, social
  and emotional concerns in infancy

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• Fraiberg 1970
• shift in focus on the infant, the parent and
• their developing attachment relationship
• Kitchen Psychotherapy

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IMH practitioner goes to the home to observe
first hand, the infant or toddler within the
context of the emerging parent-child
relationship, sitting beside the parent and
infant at the kitchen table or on the floor the
practitioner watches and listens carefully to
understand the capacities of the child and
family, the risks they face and the ways in which
the practitioner might be helpful to the infant
and family Deborah Weatherston
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Active Participant Vs Passive Recepient


Infant
Caregiver
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Attachment theorists and researchers such as John
Bowlby and Mary Ainsworth have long contended
that the primary caregivers sensitive response
to the infants signals is the critical element
influencing the development of a secure
attachment.
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• According to Ainsworth parental sensitivity has 4
  
• components
• An awareness of the signals
• An accurate interpretation of them
• An appropriate response to them
• A prompt response to them

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• What would get in the way?
• (Freud, Fraiberg, Bowlby)
• Unresolved issues from a parents own childhood
  that cloud her ability to sense and respond to
  the emotional needs of her infant.
• The parents inner working model of attachment
  relationships, rooted in her own childhood
  experiences, that guide her interactions with her
  infant.
• Parents who have not yet confronted and worked
  through painful memories from their own
  childhoods remain defensively cut off from
  emotionally open relationships with their
  children, because such openness would elicit
  memories of the parents past experiences with
  hurt and rejection.

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3 Levels of Intervention in IMH

• PROMOTION (no to low risk)
• PREVENTION (moderate risk)
• INTENSIVE INTERVENTION (high risk)

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Promotion

• Infant
• Attentive, well-regulated, engaging, responsive,
• curious, able to interact and relate well to
  others.
• Parent
• comfort, offer interesting playthings, relate
  well, warm,
• nurturing.
• Relationship
• Safe, secure, responsive, mutually rewarding.
  
• Environment
• Safe, stable, secure, a place for learning.

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Prevention

• Infant
• Premature, underweight, failing to gain, fussy,
• unresponsive, difficult to comfort, unable to
  communicate
• wants/needs.
• Parent
• Unprepared for the care of a baby, few resources,
  
• isolated,emotionally unavailable, unresponsive to
  
• babys cues, unable to comfort, insensitive.
• Relationship
• Inconsistent, inattentive, absence of affection,
  insecure.
• Environment
• Impoverished.

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Intensive Intervention

• Infant
• Evidence of delay, disturbance or disorder of
  infancy e.g. traumatic stress disorder,
  regulatory disorder, restricted range of
  emotional expression, head banging, defiant,
  biting, diagnosis of non-organic failure to
  thrive, regression of a skill.
• Parent
• Consistently emotionally unavailable, angry,
  unresponsive, intrusive, controlling, punitive,
  harsh, abrupt, neglectful, abandoning, abusive,
  diagnosis of mental illness or developmental
  delay.
• Relationship Non-attached, disorganized,
  inattentive, unresponsive.
• Environment Lacks basic resources (food,
  shelter), unstable home, chaotic, unsafe,
  exposure to violence or drugs.

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Do infants have mental health problems?
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Contact Details susann.keating_at_hse.ie paula.lod
ola_at_hse.ie rosarii.odonnell_at_hse.ie