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Overcoming developmental risk:

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Overcoming developmental risk: A biopsychosocial foundation for early interventions Oslo RBUP June, 2009 Arnold Sameroff sameroff_at_umich.edu – PowerPoint PPT presentation

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Title: Overcoming developmental risk:


1
Overcoming developmental risk   A
biopsychosocial foundation for early
interventions
  • OsloRBUPJune, 2009
  • Arnold Sameroff sameroff_at_umich.edu

2
Agendas for Intervention Professionals
  • Academic
  • 2. Social
  • 3. Political
  • How do we understand children?
  • How do we improve children?
  • Who is responsible for children?

3
Agendas for Intervention Professionals
  • 2. Social Agenda
  • How can we improve childrens lives?

4
Opportunities for Prevention or Intervention
OTHER
SELF
INFANCY CHILDHOOD ADOLESCENCE ADULTHOOD
5
Improving Developmental Success
  • 1) Make Children More Resilient
  • 2) Make Environments Less Risky

6
Infant Competence
  • Obstetrical Problems
  • Newborn Pediatric Problems
  • Newborn Brazelton Scores
  • 4-Month Temperament
  • 4-Month Development Scores
  • 12-Month Development Scores

7
Infant Competence Predicting to 4-Year Mental
Health
Infant Competence
8
4-Year Mental Health Predicting to 18-Year
Mental Health
4-Year
9
13-Year Mental Health Predicting to 18-Year
Mental Health
13-Year (Y) Mental Health
10
18-Year Mental Health Predicting to 30-Year
Mental Health (PIRS)
4
18-Year MH
High
Low
3
30-Yr. Mental Health
2
0
1
2
3
4
18-Year Social Risk
11
18-Year Mental Health Predicting to 30-Year
Physical Health
18-Year Mental Health
12
Philadelphia Adolescent Development Study
  • Todd Bartko, Jacque Eccles
  • Frank Furstenberg, Tom Cook, Glen Elder

500 11- to 14-year olds Urban Setting Examine
Multiple Competencies Examine Multiple Risks
13
Social Ecological Model
14
20 Negative Environmental Influences
  • Proximal
  • Parent-Child Interaction
  • Parent Characteristics
  • Family Structure Economy
  • Family Management
  • Peers
  • School
  • Community
  • Distal

15
Indicators of Adolescent Success
  • Psychological Adjustment
  • Few Problem Behaviors
  • Academic Competence
  • Depression Anger Self-Esteem
  • Substance Use Early Sexuality Delinquency Violen
    ce
  • Grades

16
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17
Resourcefulness
High
Low
Psychological Adjustment
Academic Performance
Problem Behavior
1.0
1.0
1.0
.8
.6
.5
.5
.4
.2
.0
0.0
0.0
-.2
-.4
-.5
-.5
-.6
-.8
-1.0
-1.0
-1.0
HIGH
MED
LOW
HIGH
MED
LOW
HIGH
MED
LOW
Multiple Risk
Multiple Risk
Multiple Risk
Lines indicate means and 95 confidence intervals
18
Question Can Personal Resilience Overcome
Environmental Adversity?
  • Answer
  • Not for most people,
  • For most of the time!

19
Improving Developmental Success
  • 1) Make Children More Resilient
  • 2) Make Environments Less Risky

20
Political Strategies for Social Intervention
  • Conservatives-----Preserve the Family
  • Liberals------------Eliminate Poverty

21
Preserve the Family
Single Parent
Two Parents
22
Eliminate Poverty
Below Poverty Level
1 to 2 Times Poverty Level
gt 2 Times Poverty Level
23
Percent of Families in High and Low Risk Groups
Family Structure
Income
Risk Group
Two Parents
Single Parent
gt30,000
10-30,000
gt10,000
54
34
60
35
13
Low (0-3)
7
22
6
15
44
High (8)
24
If single factors (money, parents) dont change
childrens lives, What about multiple factors?
25
  • Promotive Factors
  • Changing Many Settings

26
Making Big Changes
  • From Risk Factors to Promotive Factors

27
20 Positive Environmental Influences
  • Proximal
  • Parent-Child Interaction
  • Parent Characteristics
  • Family Structure Economy
  • Family Management
  • Peers
  • School
  • Community
  • Distal

28
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29
Social Agenda
  • What can be done to increase developmental
    success?
  • Need to improve many settings

30
Making Small Changes
  • Early Interventions
  • and the
  • Transactional Model

31
Social Ecological Model
32
Family Setting
FAMILY
PARENT
CHILD
CHILD
33
Regulation Model
Other-Regulation
Self-Regulation
34
Whos Suffering?
  • Infant
  • Parents
  • Professionals
  • Sleep, Feeding, Crying
  • Stress, Depression
  • Abuse and Neglect

35
Whos the Patient?
  • Infant
  • Parents
  • The Relationship

36
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37
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38
  • Themes
  • Structural Model
  • Motherhood Constellation
  • Daniel Stern
  • Nadia Bruschweiler-Stern
  • Process Model
  • Transactional Diagnosis
  • Arnold Sameroff
  • Barbara Fiese

39
Motherhood Constellation
Bact Mact
40
Motherhood Constellation
Bact Mact
Brep
Mrep
41
Motherhood Constellation
Trep
Tact
Bact Mact
Brep
Mrep
42
Motherhood Constellation
43
Transactional Diagnosis
Parent
Child
time
44
3-Rs of Intervention
  • Remediation
  • Redefinition
  • Reeducation

45
3-Rs of Intervention
Redefine
Parent
Parent
Reeducate
Remediate
Child
Child
time 1
time 2
46
Remediation
  • Indicated Child Conditions
  • Low Birth Weight
  • Malnourishment
  • Behavior/Emotional Problems

47
Remediation Low Birth Weight Babies
  • Problem
  • Small, fragile appearance
  • Weak responses
  • Interventions
  • Gentle Stimulation
  • Deep Massage
  • Passive Limb Movement
  • Increases Activity/Alertness
  • Non-nutritive sucking
  • Accompanies Tube Feeding
  • Increases Weight Gain
  • Earlier Discharges

48
Remediation Malnourished Infants
  • Problem
  • Unresponsive
  • Inactive
  • Feeding Intervention
  • Greater Responsiveness
  • Increased Energy Level
  • Provide Stronger Cues

49
Remediation
  • Medical Interventions
  • Surgery
  • Cleft Palate
  • Down Syndrome
  • Medication
  • Mood
  • Colic

50
Redefinition
  • Indicated Parent Conditions
  • Failure to adapt to exceptional child
  • Failure to distinguish mother perception from
    child behavior
  • Ghosts in the Nursery
  • Negative attributions

51
Redefinition
  • Failure to Adapt to Exceptional Child
  • Problem
  • Disability, Low Birth Weight
  • Parent feels unqualified to care for child
  • Only professionals competent
  • Intervention
  • Emphasize Typical within Atypical
  • Sleeping, Eating, Plays, Attends
  • Demonstrate Responsiveness
  • Brazelton Demonstrations

52
Redefinition
  • Failure to Distinguish Mother Perception from
    Child Behavior
  • Problem
  • Poor fit between parent beliefs and infant
    behavior
  • Crying interpreted as opposition or bad
  • Intervention
  • Relabeling
  • Reinterpreting age-appropriate behaviorintentiona
    lity

53
Redefinition
  • Ghosts in the Nursery
  • Problem
  • Carryover from own experience of being cared for
  • Own mothers voice
  • Insecure attachment experience (AAI)
  • Inconsistent, unreliable, abusive
  • Carried forward into new attachment relationship
  • Intervention
  • Infant-Parent and Infant Toddler Psychotherapy
  • Parent Treatment

54
Redefinition
  • Negative Attributions
  • Problem
  • Parents negative view of others (self?)
  • Intervention
  • Positive Adjective-Bugental

55
Reeducation
  • Indicated Parent Conditions
  • High Risk Parents
  • Teenage Parents
  • Low Birth Weight Infant
  • Developmental Disabilities
  • Overachieving Parents

56
Reeducation
  • High Risk Parents
  • Problem
  • Low Resource Parents
  • Retarded Parents
  • Maltreating Parents
  • Intervention
  • Interaction GuidanceMcDonough
  • Project STEEPErickson Egeland
  • Infant TeamZeanah Larrieu

57
Reeducation
  • Interventions
  • Teenagers
  • School Programs
  • Teenage Fathers Involvement
  • Low Birth Weight Infant
  • Vermont Program
  • Infant Health Development Program
  • Developmental Disabilities
  • OT, PT, ET
  • Overachieving Parents
  • Integrating Parenting and Teaching Roles

58
3-Rs of Intervention
Redefine
Parent
Parent
Reeducate
Remediate
Child
Child
time 1
time 2
59
Relationships Affecting Relationships
Intervener
Intervener
Redefine
Parent
Parent
Reeducate
Remediate
Child
Child
Intervener
time 1
time 2
60
Motherhood Constellation
Trep
Tact
Bact Mact
Brep
Mrep
Dynamic System
61
Relationships Affecting Relationships
62
Transactional Diagnosis Over-Simplified Decision
Tree
Is Child Treatable?
YES
Remediation
NO
Do Parents Have Child Rearing Skills?
YES
Redefinition
NO
Reeducation
63
Agendas for Infant Mental Health Professionals
  • 3. Political Agenda
  • Whos responsible for children?

64
Unlocking Doors
  • Identifying who controls resources
  • Changing allocation of resources
  • Understanding what motivates funding decisions

65
H.M.S. Titanic
66
Locking Doors Fatality Rate for Women on the
Titanic
67
Unlocking Doors
  • Identifying who controls resources
  • Changing allocation of resources
  • Understanding what motivates funding decisions

68
Opportunities for Prevention or Intervention
OTHER
SELF
INFANCY CHILDHOOD ADOLESCENCE ADULTHOOD
69
Unlocking Doors
  • Identifying who controls resources
  • Changing allocation of resources
  • Understanding what motivates funding decisions

70
Motivation for Political Funding
  • Conservatives vs. Liberals
  • Family vs. Government Control
  • Personal Responsibility
  • Medical Disease vs. Psychological Problem
  • Toxic Brain
  • Prevention vs. Treatment
  • Public HealthSomething for nothing
  • Cost-Benefit Analysis

71
?
Y
X
Successful Adulthood
Babies

72
X
Adult Mental Health
Children
73
Everything should be as simple as possible

. . . but not simpler. "
Albert Einstein
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