Ebook ĐỘC QUYỀN (C) Tâm lý học Sức khỏe - Chấn thương sức khỏe tinh thần cho trẻ sơ sinh (Anh ngữ)

A/Prof. Frances Thomson Salo
Dept of Psychiatry, Uinversity of Melbourne 24.1.11


Recognition of need for cultural sensitivity to
importance of local cultural beliefs about infants
 What is infant mental health?
 Some newborn capacities
 Negative factors impacting on development
 How to intervene with parents and babies when
there are difficulties
 Trauma – signs of Post Traumatic Stress
 Intervention and treatment principles
 Treatment for infants and carers
 Attachment trauma
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The emotional, social and
psychological wellbeing of a
baby 0 – 3 years
Secure attachment is
important for good self

esteem, relationships,
cognitive capacities, work
Concept of ‘baby as subject’
in his or her own right
Assessment: “Diagnostic
Classification 0-3”
Increasing number of
interventions available eg.
Dr Giang’s Floortime with
autistic infants and book
about playing with infants


Infants are born primed to communicate
 Before birth they are aware of mother’s voice,
feelings, also father and family
 At birth they can recognise mother’s face and
voice, and father’s voice
 Within the first hour they can turn to track
parents on the other side of room, and imitate
 They need to attach, be kept in mind and
enjoyed
 They are very sensitive to physical and emotional
feelings of other people
 They are aware of anger and fear in intimate
partner violence in utero
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The situation is urgent
for the infant experience organises
the brain to filter
future experiences
Infant vulnerabilities:
weak cues, difficulty
regulating themselves,
extreme prematurity
Parents’ depression,
teenage pregnancy,
mental illness,
substance use, family
violence
Mazelko et al, 2010. Mother’s
affection at 8 months predicts adult
attachment difficulties. JECH, 1-5.


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Feeding difficulties may be
problems of emotional
communication
Less attunement with feeding
linked with less attunement
with grandmother (Henry 2004)
- link with force feeding?
Irritability (RCT: 25% mental health
diagnosis at 5 yrs)

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Gaze avoidance and attachment
difficulties
Infant depression
Neglect
Trauma including
transgenerational transmission:
‘ghosts in the nursery’ include
hunger and poverty in the past


 Many

group and individual
interventions, and

programs
 Re-present infant
differently to parent: as
an interactive person
 Encourage:
 -time spent with baby
 -gaze in en-face communication
 -touch
 -and play
 With feeding difficulties,

encourage pleasure and
autonomy


 Clinicians

communicate
with baby as a
person, with
expressive gaze,
gesture and
vocalisation
 To understand
baby’s experience
 To re-present to
his or her parents


 As

witness to and
direct victims of
violence
 Co-existing risks
eg poverty,
chaotic life style,
substance use,
serious mental
illness
 Cumulative
trauma


0 -6 months: hypervigilance
 6-12 months: increased anxiety in
strange situations
 12–8 months: unusual clinginess with
caregiver
 Disorganised attachment: cortisol elevated but
anxiety is not outwardly shown
 Infants become frazzled and ‘snap’ as their
switch point has been shifted by trauma
 Infants’ internal representations are
frightening
 They may feel anger with parents (in part anxiety
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driven)

 Restore

safety and routines
 Maintain sensitivity to re-traumatisation
 Provide help for depressed or traumatised
carers to be available to child
 Helpful for carers to be in sessions with
infants when traumatic feelings are revived
 Especially if carer is reluctant to explore
their own trauma
 Enable re-experience of trauma in tolerable
doses: help child master the trauma by play
 Which setting? Whatever is most useful
 Treatment should be specific to the case

video, or encourage touch and massage

eg


3

month old infant can show in
behaviour what happened
A child from 6 months has
symbolic play
Talk to pre-verbal child as if
they understand in ageappropriate words
Intervention may be single or

need to be repeated
Infants may need intervention
to recover fully


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Under 6 months: desensitisation
approaches to emphasise
interactional encounters involving
specific distress situation, with
caregiver or therapist as primary
stimulus
Eg 4-month-old abused by father
during feeding - focussed on
feeding in treatment (Gaensbauer,
2004)
6 + months: desensitisation with
techniques to recreate trauma
emphasising specifics of traumatic
stimulus or context


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Asking children about the

trauma and how it affected
them often has a positive effect

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Open discussion of the trauma
to master anxiety and grief
produces relief
Allow 2–3 y o child to recreate
trauma through appropriate
play

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eg give dolls and encourage to
‘make a story’, with carers present
for sessions

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Developmentally sensitive play
therapy to work through, with
parent, grandparent, foster
carer

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Perhaps with separate counselling

and developmental guidance for
carers


Attachment

trauma is the most
destructive kind of trauma
Abused infants become attached
to the abuser and cling to them
They later choose relationships
that re-traumatise
It needs a therapeutic
attachment relationship to work
through it


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Infant mental health

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Zeanah, C. H, (ed). (2010). Handbook of infant mental health. New York, NY:
Guilford Press, 3rd edn.

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Diagnostic Classification 0-3 R. (2005). Washington, D.C.: Zero to Three.

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Henry, L (2004) Is my baby still hungry? A study of Vietnamese mothers feeding
interaction with their 2 month old babies. Masters theses, University of Melbourne
unpubd.

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Maselko, J, Kubzansky L, Lipsitt L, Buka SL, (2010). Mother’s affection at 8 months
predicts emotional distress in adulthood. J Epidemiol Community Health, 1-5.

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Trauma

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Gaensbauer, T. J., (2004). Telling their stories: representation and re enactment of
traumatic experiences occurring in the first year of life, Zero to Three, 25 -31.

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Scheeringa, M & Gaensbauer,T. (2000). Post-traumatic stress disorder. In:
Handbook of infant mental health, second edition, Zeanah C. H. (ed.) New York:
Guildford Press.