Infant and Early
Childhood Mental
Health
What It Is and
Why It Matters
Lisa Mennet, PhD

born ready to interact

Born to learn and ready to adapt to any human culture, babies absorb the range of their experiences, good and bad.

Infant mental health is the developing capacity of the child from birth to three to:
• Experience, regulate, and express emotions ;
• Form close and secure interpersonal relationships ;
• And explore the environment and learn all in the context of family, community, and cultural expectations for young children. Infant mental health is synonymous with healthy social and emotional development.
Zero to Three, the National Center on Infants and Toddlers, 2001

Expressing and Regulating Emotions – Forming Relationships -- Exploring

Elements of Infant and Early Childhood
Mental Health
Experiences in relationships
Child characteristics
Caregiver characteristics

• temperament
• genetic endowment
• medical issues, including prematurity
• birth order
• appearance

• temperament
• family of origin
• environmental safety
• resources and supports
(or lack thereof)
• trauma history
• mental health issues
(including post-partum depression)

• 20% of mothers experience depressive symptoms in the first 3 months following childbirth, 7% experiencing major depression
• one in 25 fathers
• young children: language skills, physical and cognitive development
• older children: poor self-control, aggression, poor peer relationships, and difficulty in school
• biggest impact when depression combines with other factors http://zerotothree.org/

Experiences within Relationships nurturing, sensitive adult-child interactions
• are crucial for the development of trust, empathy, generosity, and conscience
• support the development of curiosity, self-direction, persistence, cooperation (Greenough, et. al., 2001)
• are a precursor of school readiness
(Kaplan-Sanoff, 2000)

Learning through Close
Relationships

sources of toxic stress
Abuse
• emotional, physical, sexual
Neglect
• emotional, physical
Household dysfunction
• household substance abuse, household mental illness, mother treated violently
Separation or divorce
Incarceration of a family member

• heart disease
• liver disease
• autoimmune disease
• diabetes
• obesity
• drug use
• incarceration
• depression
• smoking
• suicide attempts
• domestic violence
• teen pregnancy
• and more, including early death

• heart disease
• liver disease
• autoimmune disease
• diabetes
• obesity
• drug use
• incarceration
• depression
• smoking
• suicide attempts
• domestic violence
• teen pregnancy
• and more, including early death

• heart disease
• liver disease
• autoimmune disease
• diabetes
• obesity
• drug use
• incarceration
• depression
• smoking
• suicide attempts
• domestic violence
• teen pregnancy
• and more, including early death

Stress Impacts the
Developing Brain
• sustained or frequent activation of stress hormones (cortisol, adrenalin) can have serious developmental consequences
• learning, memory, and emotional regulation all compromised
• lack of an integrated sense of self
• undermines ability to learn from environment: prediction = safety http://developingchild.harvard.edu/

Stress Impacts the
Developing Brain
• brain is “primed” for danger, NOT for learning
• problems with executive function (frontal lobes)
– impulse control
– planning
– accurate interpretation of other’s behavior

Infants and Toddlers are Especially Vulnerable
• 26% of population in child welfare is under 4 y/o*
• 34% of abused and neglected children are 0-36 months old, making them the most vulnerable age group**
• 26% of children 0-2 and 32% of children 3-5 have emotional or behavioral problems***
National Survey of Child & Adolescent Well Being, 1997-2013
**Child Abuse & Neglect Fatality Victims by Age, 2010
***National Center for Children in Poverty

in infants and toddlers
• physical symptoms (poor weight gain, slow growth, difficulties with toileting, somatic complaints)
• overall delayed development
• inconsolable crying, irritability

in infants and toddlers
• sleep and feeding problems
• aggressive or impulsive behavior
• anxious and withdrawn behavior
• danger-seeking behavior

• evolutionary advantage
• activated by fear and distress
• protection by caregiver, including co-regulation of fear, is gradually internalized

• children maintain their attachment relationships at all costs
• children will distort expression of needs to accommodate caregiver
• distortions are stabilized because they work = some comfort is received
• insecure attachment is an important adaptation to danger because it increases survival
• distortions affect child’s developing structures for regulation, memory, thought and sense of self

Attachment Theory:
Security Across the Lifespan
• free expression of needs: confidence they will be met
• flexibility of attention
• internalization of regulatory capacity
• safety with a wide range of affects
• free access to memory

Secure (B) child
Open protest, greet or approach, return to play parent
Sensitive to cues, comfortable with dependency and individuation
Avoidant (A)
Resistent/
Ambivalent
(C)
Disorganized
(D)
Appears unmoved by parent’s absence or return, engaged with environment
Insensitive, uncomfortable with dependency  harsh, punitive and rejecting
Upset throughout, difficult to soothe, angry, does not return to play
Insensitive, unpredictable, uncomfortable with individuation, enmeshed
Confusing behaviors: freezing, falling, contradictory strategies
Frightening or frightened  abuse
& neglect, hostile/helpless, dissociation

• internal working models
• secure: The world is safe. I am effective at getting my needs met. Mom is there when I need her.
• avoidant: The world is dangerous. Relationships can’t help. I have to manage on my own.
• resistant: The world is dangerous. I can’t cope alone.
I must keep mom focused on me.
• disorganized: The world is very dangerous. I don’t know what to do! Nothing I try makes me feel safer.

• Distribution – approximate
A B
General population
High-risk population
15%
25%
62%
33%
C
9%
12%
D
15%
30%
D attachment ranges from 20-78%, depending upon source of risk.
Source: van IJzendoorn, M., Schuengel, C., Bakermans-Kranenburg, M. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae.
Development and Psychopathology , 11(2) 225-249.

• increased complexity due to developmental change
• “goal-corrected partnership”
• caregiver changing expectations about child’s new abilities
• what activates attachment system is different
• language and behavior can both be used to mis-cue

Attachment –Toddlers and
Preschoolers
• focus on function of behavior, not behaviors themselves.
• distorted behavior comes from attempts to create more predictability = safety
• what conditions cause the behavior to start and to stop?

Attachment - Toddlers and
Preschoolers
• secure (B)
• use caregivers as a secure base – connections are more distal
• negotiate separations, exploration
• share responsibility for contact-maintenance
• growing capacities for self-soothing (regulation)

Attachment – Toddlers and
Preschoolers
• avoidant (A)
• avoid focus on relationship
• take responsibility for contact maintenance, emotional regulation
• actively monitor attachment figure
• coy, cheerful or solicitous
• anger – inhibited and displaced
• focus on environment

Attachment – Toddlers and
Preschoolers
• resistant (C)
• coercive and angry
• helpless
• disarming
• punitive
• threatening
• responsibility for contact maintenance and emotional regulation rests with caregiver

Attachment – Toddlers and
Preschoolers
• disorganized (D)
• representational models that are incoherent, do not allow for prediction
• highly coercive
– punitive
– solicitous

Attachment – Toddlers and
Preschoolers
• disorders of attachment in the second year of life (Lieberman and Pawl)
• behaviors are distortions of secure base behaviors
• reckless and accident-prone
• inhibition of exploration
• precocious competence

– Treatment should take current sources of perceived danger seriously, and work to remove them
– Uncover triggers that promote distortion of affect or cognition
– Parents need to understand their own and child’s patterns of distorting thoughts and feelings as ways of dealing with fear
– See passivity, coyness as warning signs of accommodation to danger

• risk and resilience
• supporting caregivers, supporting children

“How you are is as important as what you do.”
- Jeree Pawl
“Don't just do something— stand there and pay attention.”
-Sally Provence

How you are is as important as what you do
– does this feeling belong? here? now?
– strong feelings: impediments or important information?
– mindful self-regulation
– empathic inquiry and collaborative exploration: over-looked but powerful interventions
– reflective supervision or consultation: critical for those who work with infants

and how we can help
Paula, Nick and Mateo, 6 months
• fussy and inconsolable
• PPD, isolation, lack of support
Debra and Ellie, 2 years
• withdrawn, fearful
• domestic violence
Jimmy, 4 years
• aggressive and risk-taking
• wetting
• in foster care

What are your questions?