Emerging Issues in Infant Mental Health

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Linda Mayes, Helena Rutherford, Nancy Suchman, and Nancy Close, Yale Child Study Center .... McMahon, Rounsaville, & Mayes, 2011 ). Offered in ...
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November 2012 Volume 33 No.2

Journal of ZERO TO THREE: National Center for Infants, Toddlers, and Families

Emerging Issues in Infant Mental Health From the Irving Harris Foundation Professional Development Network Diversity-Informed Infant Mental Health Tenets

Strategies for Influencing Public Policy

Topics in Infant Mental Health Research

Clinical Child Psychology, 25,341-363. 0ZER, E. M., & BAN DURA, A. (1990 ). Mechanisms governing empowerment effects: A selfefficacy analysis. Journal ofPersonality & Social Psychology, 58(3), 472-486. PROVENCE, S. (1983). Infants and parents: Clinical case reports, No.2, New York, NY: International Universities Press. ST. JOHN, M.s., THOMAS, K., & NORONA, c. R., WITH THE IRVING HARRIS FoUNDATION

PROFESSIONAL DEVELOPMENT NETWORK TENETS WORKING GROUP. (2012). Infant mental health professional development: Together in the struggle for social justice. Zero to Three, 33(2), 13-22. TETI, D., & GELFAND, D. (1991 ). Behavioral competence among mothers of infants in the first year: The mediational role of maternal self-efficacy. Child Development, 62,918-929. WELLS-PARKER, E., MILLER, D.!., & TOPPING, J. s.

(1990). Development of control-of-outcome scales and self-efficacy scales for women in four life roles. Journal of Personality Assessment, 54(3-4). s64-S75· WENZEL, A.) HAUGEN,

E., ]ACKSO~, L., &

RoBINSON, K. (2003). Prevalence of generalized anxiety at eight weeks postpartum. Archives ofWomen 's Mental Health, 6(1),43-49.

THE NEURAL AND PSYCHOLOGICAL DYNAMICS OF ADULTS' TRANSITION TO PARENTHOOD Linda Mayes, Helena Rutherford, Nancy Suchman, and Nancy Close, Yale Child Study Center OR DECADES, CLINICIANS and developmental scholars have focused on how individual differences in parental care impact infant and child development. This accumulated work has shown that early relationships and parental care play a critical role on a child's developing brain architecture, social and cognitive development, and life-long health outcomes (Center on the Developing Child at Harvard University, 2010; National Scientific Council on the Developing Child, 2007; Shonkoff, Boyce, & McEwen, 2009;). Within the parent-child dyad however, the adult as a parent is also developing. The parents' development is a reflection of their own early experiences as well as their neurobiology, and parental development at all levels of analysis is facilitated by the act of caring for another-the adult side of the "serve and return" interactions so critical for infant and child development. How adults transition into parenthood has become a key question and area of focus for many developmentalists. Specifically, what are the neural and psychological changes that occur (and must occur) as both women and men assume the care of their infant? What an(the sources of individual variation in that psychological and neuropsychological transition? How can prevention and intervention efforts impact that adult transition before or in the presence of a new infant when needed? Converging studies from the clinical and preclinical worlds are shedding light on how there are significant neurobiological and neurophysiological changes subserving the transition to parenthood. These include a host of structural and neurochemical changes indicating plasticity at the neural regions, synaptic, and transcriptional regulation levels of control (Rutherford, Williams, Moy, Mayes, & Johns, 2on; Rutherford,

F

Potenza, & Mayes, 2012a) suggesting the dynamic nature of neural systems in adulthood, especially under the influence of attachment related experiences. Central to the transition to parenthood (although mothers are, to date, more often studied than fathers) are significant changes in the function of key brain regions involved in reward and motivation, as well as stress and emotion regulation and the production of the oxytocin (OT), a neuropeptide involved in the regulation of uterine contractions, milk release, and affiliative behavior. For example, Strathearn and colleagues (Strathearn, Fonagy, Amico, & Montague, 2009) have shown that mothers recruited regions of the brain that are regulated by dopamine (a neurotransmitter key to reward and motivation regulation) when viewing photographs of their own smiling infants but did not do so when viewing unfamiliar infants. Further, individual differences in maternal attachment (based on mother's own parenting) predicted divergence in regions of brain activity in response to viewing infant faces. Specifically, securely attached mothers show heightened activity in reward regions while insecurely attached mothers show a stronger response in the right insula, an area associated with anticipated loss. Further, changes in peripheral levels of OT following mother-child play correlated with brain activation in hypothalamicpituitary regions when mothers view photographs of their own infant compared to an unknown infant, and this OT response was stronger in securely attached mothers compared to insecurely attached mothers. Findings such as these are being replicated in ours and others' laboratories in which it also appears that with increasing exposure to the infant, there is consolidation of specific neural circuits around response to salient infant cues.

Additional lines of work highlighting the neurophysiological changes accompanying parenting point to heightened perceptual sensitivity to infant cues (auditory or visual) as measured by electrophysiological studies as well as alterations in neurophysiological markers of emotion regulation in mothers compared to non-mothers (Rutherford eta!., in press). Finally, preclinical models of parenting suggest that early parenting experiences set response thresholds in key neural and perhaps genetic transcriptional systems such that individual differences in parenting are transmitted intergenerationally (Rutherford eta!., 2011). How this apparent neural and physiological reorganization and adaptation is impacted by a host of adversities including depression, addiction, and anxiety in adults who are parents is also a topic of ongoing study in our research group using both functional brain imaging and neurophysiology methods while mothers respond to infant faces and infant cries. How does this emerging literature on the social neuroscience of parenting influence prevention and intervention programs with parents and their infants? For one, thinking of adult brain and psychological development as occurring simultaneouslywith infant brain and mind development focuses as much on helping adults understand the changes in their own psychology as those of their infant. It requires clinicians and investigators to think about parenting interventions as more than providing education on what the infant needs. It is important to understand how parents' own feelings and expectations of their role impacts their behavior and understanding of their infant-and how their infant impacts them as much as what their infant needs from them. These kinds of parenting

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intervention efforts may be broadly described as parental reflectiveness or mindfulness approaches. The goal is first to engage parents in thinking about and reflecting on their own development as a parent. The approach also engages parents in learning and enhancing skills from reflectiveness to a range of executive control capacities (e.g., planning, attentional focus, distress tolerance) in the service of their parenting role. Minding the Baby is one such program that, through intensive home-based work wit4 ~rst -time parents and their infants, focuses on how adults develop an awareness of their own needs and skills as a parent just as they learn about their infant and their relationship (Sadler, Slade, & Mayes, 2006; Slade, Sadler, & Mayes, 2005). The core aims of the program are to promote positive physical and mental health, life course, and attachment outcomes in high-risk babies, mothers, and their families living in urban poverty. Distinct features of the program include 1.

2.

Intensive services are provided by an interdisciplinary team that includes a licensed clinical social worker and a pediatric nurse practitioner, The enhancement of parental reflective functioning is an essential focus of both the infant mental health and health aspects ofthe intervention, and

3· The program is embedded within wellestablished community health centers in the inner city.

toward their children, in their approach to their own self-care and management of their own needs, and their overall ability to think about their own and their infants' feelings, desires, and ways of understanding the world. These programs also represent an example of how clinical science and clinical interventions inform one another inasmuch as much of our basic research focuses on how mothers think about and respond to infant cues at both a behavioral and neural level, the same area of focus for these two intervention efforts. Further, in both the clinical research and clinical interventions, we are focusing on how adults transition to parenthood and how the individual differences in that transition impact both maternal and child health. Translating these efforts to understand the development of the parental brain and mind into effective prevention and intervention programs for parents and their families also expands the mandate of effective policies for services for young children by calling attention to a very open, dynamic adult developmental phase initiated by the demands of caring for an infant. When seen in this light, it is clear that services for young children must include services facilitating adults' development and capacity building for their roles as parents. A multilevel approach that bundles services for adults with services for infants and families stands to impact not only the infant's health and development but also the next generation. i

Study Center. She is also associate director of research on substance abuse and the family and a practicing licensed clinical psychologist with extensive experience providing and supervising psychotherapy in the PIO programs at Yale. Her research interests include attachmentbased intervention development for parents with substance abuse and psychiatric problems, and she has extensive expertise in substance abuse, personality disorders, adult psychotherapy development and evaluation, and qualitative methods. NANCY CLOSE, PhD, is assistant clinical professor, Yale Child Study Center. Dr. Close specializes in the assessment and treatment ofchildrenless than syears old. She teaches Yale College students and fellows in training at the Child Study Center. She conducts developmental assessments ofyoung children and does dynamically oriented psychotherapy with children. In addition she provides mental health consultation to early childhood education programs in the community.

CENTER ON THE DEVELOPING CHILD AT HARVARD UNIVERSITY. (2010). The foundations oflifelong health are built in early childhood. Retrieved from www.developingchild.harvard.edu NATIONAL SciENTIFIC CouNciL oN THE DEVELOPING CHILD. (2007). The timing and

quality of early experiences combine to shape brain architecture: Working Paper#s. Retrieved from www.developingchild.net RUTHERFORD, H. J. V., CROWLEY, M.J., GREGER-MOSER, M., McCRORY, E., PROVERBIO,A. M., & MAYES, L. C. (in press).

The neural correlates ofemotion regulation.

A second model, Mothering from the Inside Out, applies similar ideas to center-based services for substanceusing mothers struggling to manage or overcome their addiction as they also try to parent their children (Suchman, DeCoste, McMahon, Rounsaville, & Mayes, 2011 ). Offered in conjunction with outpatient substance abuse treatment, mothers participate in weekly individual therapy focusing on problem solving and coping emotionally with the everyday stresses of being a mother. A developmentally trained child care team supports the growing communication capacities of the young children. As a whole, the clinic functions as a milieu that supports the dyad's regulatory functions by simultaneously supporting mother's reflective and the child's communicative capacities. The results of focusing more directly on parental development in either model reveal promising changes in parents' behavior

84 Zero to Three November 2012

LINDA C. MAYES,

MD, is Arnold Gesell

Professor ofChild Psychiatry, Pediatrics, and Psychology, Yale Child Study Center. Dr. Mayes coordinates early childhood services in the Yale Child Study Center. Her research focuses on the impact ofearly adversity on stress regulatory mechanisms and on the neural changes and correlates as adults transition to parenthood.

RuTHERFORD, H. J. V., PoTENZA, M. N., & MAYES, L. C. (2012a). The neurobiology of addiction and attachment. InN. E. Suchman, M. Pajulo, & L. C. Mayes (Eds.). Parents and

substance addiction: DiYelopmental approaches to intervention. New York: Oxford University Press. RUTHERFORD, H. J. V., WILLIAMS, S. K., MoY, S., MAYES, L. C., &JOHNS,]. M. (20ll). Disruption

PhD, is associate research scientist, Yale Child Study Center. Dr. Rutherford's research focuses on understanding how brain and behavior change when adults become parents. She uses neuroscience and behavioral experiments to explore how mothers respond to infant signals ofemotion (e.g., crying) and how mothers regulate their emotional response to those infant signals. HELENA RUTHERFORD,

NANCY SUCHMAN, PhD, is associate professor in the Yale University School ofMedicine Department of Psychiatry and the Yale Child

of maternal parenting circuitty by addictive process: rewiring of reward and stress systems. [Review]. Frontiers in Psychiatry, 2. SADLER, L.S., SLADE, A., & MAYES, L. C. (2006). Minding the Baby: A mentalization based parenting program. In J. G. Allen, & P. Fonagy, (Eds.), Handbook ofmentalization based treatment. New York: John Wiley and Sons. SHONKOFF, J.P., BoYcE, W. T., & McEWEN, B.S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. JAMA, 301, 2252-2259·