Attachment and Infant
Mental Health
Dipti Aistrop
22 September 2010
 Definitions
of mental health
 Importance of early years
 Mental health needs of babies
 Attachment and sensitive care giving
 Brain development in formative years
 Practice overview
Health is the basis for a good quality of life
and mental health is of over riding
importance in this
(UN Convention – Rights of the Child; Article24)
Children who are mentally healthy will
have the ability to develop psychologically,
emotionally, creatively intellectually and
spiritually.(Bright futures,Mental health foundation 1999)
The Significance of infancy for mental health
“Good parenting is fundamental for the development of a
child's mental health and well being. As children's
primary carers, all parents need to be supported and
helped, but especially when they are parenting in difficult
circumstances or facing uncertainty about the way they
are bringing up their children. Interventions focused
during pregnancy and at the time around the birth are
likely to be the most effective in preventing mental health
problems of a child. ……….”
The Mental Health of Children and Young People: A Framework for
Promotion, Prevention and Care, Scottish Executive, 2005. (1)
Pre-natal / Early Years
Babies
thrive when they
receive warm, responsive early
care
Early
care has a decisive, long
lasting impact on how people
develop, their ability to learn,
and their capacity to regulate
their own emotions
Babies need:
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To be nurtured
Security
Predictability
Support
Encouragement
Development through expansion
To feel loved

Babies are born ready to communicate and
relate to another human.
 They are ready to learn and to develop a
relationship
 Attachment is the deep and long lasting
connection that is established between a child
and the primary care giver in the early years of a
child’s life
 Quality of maternal sensitivity = determinant of
baby’s attachment pattern
Sensitive care giving
(Video clip).
When parents understand their baby’s
communication, it enables them to
reciprocate positively.
‘Attachment’ is the deep and long lasting
emotional connection established between
a child and care giver in the first years of
life - a dyadic process
Attachment is developed through reciprocity

Reciprocity is a two way communication which
enables the infant to form a concept of his own
affect on his environment and on other people

Babies are active in engaging their mother in a
relationship, and through sensitive care giving,
the mother and baby become attuned to each
other.
Secure attachment pattern enables a child to:
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Trust and reciprocate
Learn to self regulate
Develop self esteem and self worth
Have a sense of right and wrong
Develop empathy and compassion
Develop resilience
Have healthy brain development –
achieve academic success
Develop an ability to make and sustain relationships
Insecure Attachment types:
Attachment Disorder
Insecure ambivalent
Insecure avoidant
Insecure anxious
Disorganised
Insecure attachment is more likely to lead to
A negative internal working model
Self perception:
Unlovable
Uninteresting
Unvalued
Ineffective
The World:
Others are unavailable
Neglectful. rejecting
Unresponsive
Hostile
Potential effects of insecure attachment:
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Feeding problems
Sleep disturbance
Toileting/gastric problems
Aggression
Poor concentration / attention span
Lack of co-operation
Longer term: fears and phobias associated with anxiety,
emotional disorders, anti social behaviours, relationship
difficulties……
Is attention seeking behaviour a
manifestation of attachment seeking?
Brain Development

All behavioral development has to do with the
brain
 Brain development is dependent upon both
experience and genetics
 The brain has a great deal of plasticity and can
recover over time.
5 Days
2
Months
1 Year
28 Years
Early Experiences are Crucial
By
age 3, 80% of
synaptic connections
are already made
By
the second
decade of life growth
levels off and
pruning begins
Increased
experiences define
the wiring of an
infant’s brain
Brain development is not automatic but is
'experience dependent'. During the first three years
of life, the brain makes trillions of new connections
between nerve cells – known as synaptic growth.
These connections govern the development of
language, emotional, physical, social and cognitive
abilities.
Connections that have been repeatedly used
grow stronger, form well-trodden pathways and
are retained.
Those connections that have not been used are
'pruned' and shed by the age of three, resulting
in literally a smaller, less developed brain with
fewer connections across which messages can
be passed between nerve cells
6 Years Old
14 Years Old
Nature vs. Nurture
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During the first 10 years of life the brain is twice
as active as that of an adult’s

60% of nutrition is used by the brain during the
first year of life. This decreases to 30% by age 3

Genetic and environmental factors have a more
dynamic, qualitative interplay that can not be
reduced to a simple equation
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Building Blocks for Secure Attachment &
Positive Mental Health
Reciprocity to infant communication and cues
Resilience
Parental mental health
Temperament
Impact of child on parents
Parental sensitivity
Sensitivity
Responds to cues,
reciprocates
Insensitivity
Intrusiveness – reflects
parents own wishes/needs
Acceptance
Of responsibility with little
or no irritation
Rejection
Displays feelings of anger or
resentment and irritation
Co-operation
Respectful of child’s
autonomy
Interference
Imposes own wishes and
expectations
Accessibility
Familiar with child’s
communication – will be
easily distracted by the
child
Ignoring
Pre occupied with own
thoughts, often miss child’s
communication but notice
behaviour outcomes
Factors that build resilience:
Child
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Temperament
Secure
attachment
Communication
skills
Positivity in
approach
Ability to problem
solve
Family
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Four or fewer
children in
family
At least one
parent
available for
attachment
Democratic
parenting style
Other significant
adults
Environment
• Support networks in
community
• Availability of good
housing
• Easy access to
services
• Lack of poverty
• Parental involvement
with work/educational
services
Observation Criteria in assessing mental
health of young children:

Parent factors
 Child factors

Environmental factors
(video clip)
Parent factors

Poor parental mental health or post natal depression
 Overt family discord or domestic abuse
 Family breakdown/ bereavement
 Inconsistent, unclear boundaries with contradictory
parenting styles
 Hostile or rejecting relationships
 Inability to adapt to child’s changing needs
 Parental substance / alcohol misuse
 Criminality in family
 Hostile or abusive parenting style
Child factors

Genetic make up
 Likelihood of learning difficulties or low IQ
 Chronic physical illness
 Developmental uncertainty or delay
 Communication difficulties
 Temperament
 Low self esteem / resilience
Environmental factors

Homelessness
 Poverty
 Discrimination
 Unemployment
 Difficult to access local services
 Communication between agencies
 Frequent moves to new areas
What is needed to Develop a Seamless
Service to Promote Mental Health
Mid Wives
School Health
Universal Services
Sure Start Child Centres
Education
GP
Health Visitors
Targeted Services
Including Family Nurse Partnership
Social Care
Gaps ????
Family Support
Resources tend to be re-active rather than proactive
All parents wish to succeed at parenting
What services are we to offer in order to
ensure they get it right from the
beginning?
For better outcomes for babies and
young children’s Mental Health,
prevention is necessary - it is certainly
better than cure.
Thank you for listening.
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Attachment and Infant Mental Health