Infant s responses to abusive paren1ng implica1ons

Transcription

1 Infant s responses to abusive paren1ng implica1ons Dr Catherine Thomas Child and Adolescent Psychiatrist NSFT

2 Recap on regula1on Content Working model, AFachment strategies Exposure to neglect and abuse infants and children Long term implica1ons

3 Schore (Science of the Art of Psychotherapy, 2012): There is now agreement that the essen'al task of the 1st year of human life is the co-crea'on of a secure a5achment bond of emo'onal communica'on between the infant and his/her primary caregiver. The a5achment rela'onship shapes the ability of the baby to communicate with not just the mother, but ul'mately with other human beings.

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5 Walker-Andrews & Bahrick (Infancy, 2001): Sen'ent being, capable of percep'on, sensa'on and feeling. Emerging subjec'vity (developing mind) created in an intersubjec've context.

6 AFachment AFachment = interac1ve regula1on of emo1ons Right brain of baby to right brain of mother right hemisphere specialises in regula1ng stress - and emo1on-related processes.

7 Mother minimises nega1ve affect (fear, anger) Maximises posi1ve affect (joy, play)

8 Op1mal zone of arousal.

9 Arousal Pain Fear Anger Desire for comfort Comfort Bored Tired Sleep Depression

10 Especially at night! Ac1va1on of afachment system at night Fear of darkness, being alone Sleep disturbance common in 20% -30% infants NB of consistent maternal presence Implica1ons for custody arrangements

11 Schore (1994): Episodes of right brain to right brain emo1onal transac1ons Visual facial Auditory-prosodic Tac1le- gestural Bodily based nonverbal afachment communica1ons

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13 Life began with waking up and loving my mother s face George Eliot

14 WinnicoF (1986): The main thing is a commun-ica'on between the baby and the mother in terms of the anatomy and physiology of live bodies.

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16 Changes in Mothers brain the mother s posi've feelings for her baby may facilitate the increased levels of gray ma5er, especially right brain Right brain more involved in emo'onal regula'on

17 Role of fathers/secondary caregivers Second year of life, when infants leg side of brain (cogni1on) developing S1mula1ng play, regula1on of aggression

18 AFachment styles(strategies) and Informa1on Processing

19 Informa1on Processing The brain processes informa1on and influences behaviour by forming representa1ons, or mental models 2 kinds of informa1on are crucial to safety and reproduc1on: cogni1ve affec1ve

20 Informa1on Processing Cogni1ve (external) informa1on Sequen1al ordering 1me, place, who was involved Tells the brain where and when danger has occurred and therefore where it might happen again

21 Informa1on Processing Affec1ve (internal) informa1on Intensity of the signal that triggers the autonomic nervous system in terms of heart rate, breathing, circula1on, perspira1on, pupil dila1on, muscle tension, feelings

22 Informa1on Processing These 2 sorts of informa1on are processed differently in the brain : Cogni1ve info processed thro leg hemisphere Affec1ve info processed thro right hemisphere

23 Informa1on Processing Posi1ve afachment experiences - integra1on of leg and right hemisphere informa1on Also integrate higher and lower parts of brain Influence our mo1va1ons and behaviour

24 Informa1on Processing AFachment rela1onships influence both the nature or the informa1on that the brain processes and the way the brain process that informa1on

25 Informa1on Processing Neural networks include representa1ons of how rela1onships work and how significant afachment figures are likely to behave Children develop working models of how parents likely to behave and organise afachment behaviours to maximise afen1on, proximity and predictability

26 Mother s childhood rela1onships Maternal IWM A Working Model Maternal sensi'vity and Reflec've func'on Maternal sensi1vity Infant a5achment Infant s IWM Future rela1onships

27 Informa1on Processing Mental models come to guide child s and later the adult s expecta1ons, beliefs and behaviours in all important rela1onships, especially under threat or anxiety Mental representa1ons are not sta1c they revise con1nuously

28 Representa1on of sensory input Balanced equal amount of cogni1ve and imaged Schewed distorted amounts of cogni1ve and imaged Depends on experience with parental figures and exposure to danger

29 A Distancing Cognitively organised B Balanced Integrates True Cognition and Affect C - Preoccupied Affectively organised

30 Dynamic Matura1onal Model (DMM) What are the three afachment strategies? Type B: secure and balanced Type A: Cogni1vely based, minimal affect Type C: Affec1vely based, distorted cogni1on

31 B A C DMM Strategies balanced distancing preoccupied

32 DMM Secure B s : safe and comforting environments, optimal child functioning Anxious types A and C: exposure to danger and lack of comfort Developmental risk

33 Balanced B strategy B A C

34 Normative People pleasing/inhibited (adaptive in safe contexts) Concerning Compulsive Caregiving / compliant Endangering Promiscuous / self reliant (adaptive in dangerous contexts) Distancing A Strategy A B Infant learns to value thinking over feelings: cognitively organised C

35 What is safe? Type A Doing the right thing, from the perspective of powerful people Attending to powerful people

36 Type A Dismiss self Preoccupied with other Exaggerate prediction Omit / dismiss negative affect Minimise problems Distance the past

37 Type A + children By 3 months babies can inhibit nega1ve affect the good baby Rigid, robo1c babies. By 2 years toddlers are able to falsify posi1ve affect i.e. smile and/or say they are happy when then feel sad or worried.

38 Concerning A paferns (compulsively caregiving/compliant) Develop if milder A strategies do not succeed in providing protec1on and comfort More complex Caretaking, role reversal with parent, isola1on, compliance, performing well Child learns ins1nc1vely to imagine what the carer is thinking and makes carers needs and goals more important than their own

39 Compulsive caregiving/compliant A Children appear bright, competent, socially accepted Underneath, fear of not mee1ng parent expecta1ons or risking parental disapproval or anger Compelled to perform well Learn to manage their anxiety about parents responses

40 Consequences: Compulsive A Depression, underlying anxie1es, emo1onal agita1on, soma1c concerns

41 Victoria Climbie

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44 Baby P

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46 The Preoccupied C Strategy A B C Norma1ve Threatening/disarming (adap1ve in safe contexts) Concerning Aggressive/feigned helplessness Endangering Puni1ve/seduc1ve (adap1ve in dangerous contexts )

47 Preoccupied C Strategy Unpredictable and variably afuned/unafuned care Infant learns to value feelings over thinking; becomes affec1vely organised

48 Type C Affectively organised Self perspective Dismiss others Preoccupied with self Omit/dismiss cognition Exaggerate negative affect Emphasise problems Retain past

49 When under threat Type A Inhibits feelings Does what others want Blames self Feels shame Some1mes explodes with anger or desperately wants comfort Has no explana1on for explosive behaviour Type B Exaggerates anger, fear & desire for comfort Behaves vengefully & decep1vely Blames others Considers self innocent Offers elaborate false reasoning to mislead self and others

50 True Cognition A Dynamic-Maturational Model of Information Processing & Strategies Distorted Cognition Omitted Neg. Affect False Positive Affect Socially Facile/ Inhibited A3-4 Integrated True Information True Negative Affect A1-2 Compulsively Caregiving/ Compliant A5-6 Compulsively Promiscuous/ Self-Reliant Reserved B3 Comfortable B1-2 B4-5 A7-8 A/C Delusional Idealization/ Externally Assembled AC Self Psychopathy Reactive C7-8 Menacing/ Paranoid C1-2 Threatening/ Disarming C3-4 Aggressive/ Feigned Helpless C5-6 Punitive/ Seductive Integrated False Information False Cognition Distorted Neg. Affect Omitted Cognition

51 When things go wrong.

52 Vulnerable Parents

53 ! Key factors Domes1c violence; mental health problems; substance/alcohol misuse; unresolved trauma! Infant s emo1onal states trigger profound discomfort in these parents! Triggers their internal working models/ representa1ons! Non- con1ngent responses to infant cues

54 Care Index Assessment of playful interac1on under nonthreatening circumstances Assesses dyadic characteris1cs associated with afachment Assesses development of rela1onship roles

55 Care index Procedure: 3-5 minute video of interac1on with parent and baby Any sesng Start while dyad sefling Birth 15 months

56 Care Index Coding Sensi1vity to infant signals is the central construct Sensi1vity is a dyadic construct

57 Sensi1vity Adult sensi1vity in play is any pafern of behaviour that pleases the infant and increases the infant s comfort and afen1veness and reduces its distress and disengagement

58 Scored 0 14 Sensi1ve Inadequate Risk

59 Seven aspects of interac1onal behaviour! Facial expression! Verbal expression! Posi1on and body contact! Affec1on! Turn taking con1ngencies! Control! Choice of ac1vity (signifier behaviours)

60 Adult scale Sensi1ve Controlling covert/overt Unresponsive covert/overt

61 Co opera1ve Difficult Infant PaFerns Compulsive (afen1on,performance, caregiving, compliant) Passive

62 Conclusion First year of life most cri1cal period in which disrup1on of developmental processes will have long term effects on brain structure and func1on it may also be a period in which therapeu1c interven1ons would have the greatest posi1ve affect.

63 Norfolk Perinatal Infant Mental Health AFachment Service Started as a pilot last year 45 high risk families Funded by Local Authority Intensive mental health and parent infant psychotherapy Interagency, based in childrens centres and parents homes Significant reduc1on in removal of infants

64 References Patricia CriFenden: Raising Parents- AFachment, paren1ng and child safety. Willan publishing (2008) Implica'ons of modern a5achment theory and developmental neuroscience for family law: Schore & McIntosh. (2011). Family law and the neuroscience of afachment, Family Court Review, Vol 49, No 3, July 2011,

65 PrueF, McIntosh, & Kelly. (2014). Parental separa1on and overnight care of young children: Consensus through theore'cal and empirical integra'on: Part l. Family Court Review.