Monday, January 30, 2012

Early Experiences May Be Linked to ADD?

In the Sunday New York Times (Jan 29, 2012), researcher L. Alan Sroufe wrote on Op-Ed exploring  ADD examining the effectiveness of Ritalin.

Sroufe writes, "Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth."

Sroufe reviews a 2009 well-controlled study of 600 children:  "However brain functioning is measured, these studies tell us nothing about whether the observed anomalies were present at birth or whether they resulted from trauma, chronic stress or other early-childhood experiences. One of the most profound findings in behavioral neuroscience in recent years has been the clear evidence that the developing brain is shaped by experience."

Sroufe goes on to discuss results from his own and other longitudinal studies and concludes, "Putting children on drugs does nothing to change the conditions that derail their development in the first place. Yet those conditions are receiving scant attention."

The conditions that derail development (including exposure to domestic violence, lack of social support, chaotic living environments, and parental intrusiveness) are conditions which are addressed by infant mental health (IMH) home visiting.   

We are eager to hear from those of you working in or on behalf of IMH home visiting programs.

To read the full NY Times Op-Ed, go to 

Wednesday, January 25, 2012

How do you describe infant mental health to others?

Are you asked about infant mental health?  How do you describe it to friends and family?  How do you describe it to new families recently referred for infant mental health home visiting services?  This question came up in a few contexts this week.  The first among the seminar students at Wayne State University Merrill Palmer Institute Graduate Certificate in Infant Mental Health.  The second in preparation for a taping of at Detroit Public Television show looking at children's mental health.  Here are some of the words staff at MI-AIMH and students at Merrill Palmer have used to describe infant mental health (IMH).  We ask you to join the conversation!

  • Infant mental health recognizes both the remarkable opportunities and vulnerabilities that exist in the first three years of life. 
  • IMH professionals aim to partner with the parents and caregivers of infants and toddlers. The professional brings her knowledge of development, specifically the infant's capacity for non-verbal communication. Together with the parent's intimate knowledge of this baby, they can try to better understand what it is the baby wants them to know. 
  • Babies do remember. What happens in their world matters greatly to how they feel about themselves, their ability to relate to others, and their ability to begin Kindergarten ready to learn. 
  • The best way to help an infant is to help her parents. Compassion and support offered to new parents during the adjustment to parenthood can lead to more compassionate and nurturing responses to their baby's needs. 
  • When babies receive sensitive, nurturing care they are more likely to believe they are worthy of love as adults. They have healthier relationships and are at lower risk for engaging in dangerous behaviors such as smoking, drinking, and promiscuity. They are at lower risk for health problems such as obesity and diabetes. (ACE study, American Academy of Pediatrics) 
  • Secure relationships offer a buffer if the infant is exposed to harm or trauma. 
  • IMH is a name that is sometimes confusing or off-putting, but simply means that the very young child has the capacity to love and learn. Because babies are dependent upon the adults responsible for their care, those earliest relationship experiences are where the first schooling takes place. Therefore, the adults' capacities to see and respond to the needs expressed will teach important lessons about what the child can expect from others and himself. It is so much easier & less expensive to build on positive experiences in healthy development than to correct beliefs that come out of negative ones. 
  • Whomever spends many hours in care of an infant or toddler needs to understand that good care involves so much more than the basics (feeding, cleanliness, etc), so child care providers & relatives, in addition to parents might also need compassion and support 
  • Anyone with responsibility for making important decisions on behalf of young children, or providing support to families needs good information about development, early relationships, (etc.). IMH in Michigan - the first professional IMH organization...(you know all the things you can say about the importance of a competent workforce!)
And a quote borrowed from the Infant Massage USA Facebook page:

“It is easier to build strong children than to repair broken men.”
~ Frederick Douglass (1817–1895) 

Thursday, January 12, 2012

Reflecting on NY Times Op-Ed regarding American Academy of Pediatrics Policy Statement

The Op-Ed page that appeared in the NY Times provides a rationale for IMH Home Visiting.  How we take care of our children and their caregivers matters to the health and well-being of society.  What follows is Nicholas Kristof's thought-provoking article about poverty solutions that start with a hug.  We invite a discussion about the role of IMH home visitors in addressing poverty.

A Poverty Solution That Starts With a Hug

PERHAPS the most widespread peril children face isn’t guns, swimming pools or speeding cars. Rather, scientists are suggesting that it may be “toxic stress” early in life, or even before birth.
Damon Winter/The New York Times
Nicholas D. Kristof

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This month, the American Academy of Pediatrics is issuing a landmark warning that this toxic stress can harm children for life. I’m as skeptical as anyone of headlines from new medical studies (Coffee is good for you! Coffee is bad for you!), but that’s not what this is.
Rather, this is a “policy statement” from the premier association of pediatricians, based on two decades of scientific research. This has revolutionary implications for medicine and for how we can more effectively chip away at poverty and crime.
Toxic stress might arise from parental abuse of alcohol or drugs. It could occur in a home where children are threatened and beaten. It might derive from chronic neglect — a child cries without being cuddled. Affection seems to defuse toxic stress — keep those hugs and lullabies coming! — suggesting that the stress emerges when a child senses persistent threats but no protector.
Cues of a hostile or indifferent environment flood an infant, or even a fetus, with stress hormones like cortisol in ways that can disrupt the body’s metabolism or the architecture of the brain.
The upshot is that children are sometimes permanently undermined. Even many years later, as adults, they are more likely to suffer heart disease, obesity, diabetes and other physical ailments. They are also more likely to struggle in school, have short tempers and tangle with the law.
The crucial period seems to be from conception through early childhood. After that, the brain is less pliable and has trouble being remolded.
“You can modify behavior later, but you can’t rewire disrupted brain circuits,” notes Jack P. Shonkoff, a Harvard pediatrician who has been a leader in this field. “We’re beginning to get a pretty compelling biological model of why kids who have experienced adversity have trouble learning.”
This new research addresses an uncomfortable truth: Poverty is difficult to overcome partly because of self-destructive behaviors. Children from poor homes often shine, but others may skip school, abuse narcotics, break the law, and have trouble settling down in a marriage and a job. Then their children may replicate this pattern.
Liberals sometimes ignore these self-destructive pathologies. Conservatives sometimes rely on them to blame poverty on the poor.
The research suggests that the roots of impairment and underachievement are biologically embedded, but preventable. “This is the biology of social class disparities,” Dr. Shonkoff said. “Early experiences are literally built into our bodies.”
The implication is that the most cost-effective window to bring about change isn’t high school or even kindergarten — although much greater efforts are needed in schools as well — but in the early years of life, or even before birth.
“Protecting young children from adversity is a promising, science-based strategy to address many of the most persistent and costly problems facing contemporary society, including limited educational achievement, diminished economic productivity, criminality, and disparities in health,” the pediatrics academy said in its policy statement.
One successful example of early intervention is home visitation by childcare experts, like those from the Nurse-Family Partnership. This organization sends nurses to visit poor, vulnerable women who are pregnant for the first time. The nurse warns against smoking and alcohol and drug abuse, and later encourages breast-feeding and good nutrition, while coaxing mothers to cuddle their children and read to them. This program continues until the child is 2.
At age 6, studies have found, these children are only one-third as likely to have behavioral or intellectual problems as others who weren’t enrolled. At age 15, the children are less than half as likely to have been arrested.
Evidence of the importance of early experiences has been mounting like snowflakes in a blizzard. For example, several studies examined Dutch men and women who had been in utero during a brief famine at the end of World War II. Decades later, those “famine babies” had more trouble concentrating and more heart disease than those born before or after.
Other scholars examined children who had been badly neglected in Romanian orphanages. Those who spent more time in the orphanages had shorter telomeres, a change in chromosomes that’s a marker of accelerated aging. Their brain scans also looked different.
The science is still accumulating. But a compelling message from biology is that if we want to chip away at poverty and improve educational and health outcomes, we have to start earlier. For many children, damage has been suffered before the first day of school.
As Frederick Douglass noted, “It is easier to build strong children than to repair broken men.”

Thursday, December 1, 2011

What do home visitors need to know when working with babies?

To order the Competency Guidelines, please go to

Much interest has been generated in home visiting, particularly to support babies and their families.  Home visitors need knowledge and specialized skills to enter into relationships with families and to support social and emotional well-being in the critical early years.

So, what does a home visitor need to know? Knowledge about pregnancy & early parenthood; infant development & behavior, how family dynamics work, how attachment emerges and can be harmed by prolonged separation, trauma, and loss; and how to be culturally sensitive.  That's just the beginning!

They need to be sensitive to the relevant laws & policies that affect families and that affect home visiting programs, they need to understand how to manage ethical dilemmas, and how to locate appropriate resources like food, diapers, shelter, and pediatric health care.

 What skills do home visitors need to have?  They need to be able to observe & listen carefully, to screen for capacities and risks, to respond sensitively to what they see and hear, to support parents in nurturing and protecting their baby's development.

Above all, home visitors need to know all development unfolds in the context of relationships.  Infants develop best within secure and loving relationships.  Parents develop best when supported by  family and professionals within the community who offer nurturing relationships.  Home visitors need to understand  that their relationship is the most important instrument for positive change.

Go to the MI-AIMH website for more guidance and information in developing a professional work force who has the knowledge and skills to promote better outcomes for babies and families!
MI-AIMH website