Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Tuesday, August 2, 2011

Infant-Parent Mental Health: Getting the Word Out

I was so enthralled by the movie Page One that I saw it twice in one weekend. It is a behind-the-scenes look at the New York Times. It addresses the question of how people receive information: the relative roles of traditional journalism and new media, and how things are so rapidly changing. While it may seem a bit off topic for my blog, I thought to write a post about it when yesterday I received the latest issue of Zero to Three (not published on line), the journal of the organization Zero to Three National Center for Infants, Toddlers, and Families. It is jam packed with a wealth of important information. There are articles about, among others, healing from postpartum depression, a program designed to strengthen relationships between parents and children, and a case of selective mutism, all from the perspective of the discipline of infant mental health.

Over this past year as a fellow in the U Mass Boston Infant-Parent Mental Health Post-Graduate Certificate Program, the other fellows and I had many conversations about what a treat it was to spend intensive time with like-minded colleagues, but how frustrating it could be when we returned to the "real world" and people didn't know what we were talking about. One woman, who was about to graduate from law school and plans to be a child advocate, told of speaking with judges about how early relationships shape the brain and being looked at like she had three heads. There was no support for her lawyer colleagues to encourage them to address the more complex and often painful issues involved in dealing with suspected abuse and placing children in foster care.

Tying these ideas together, I recently was referred, in my behavioral pediatrics practice, a seven-year-old girl with selective mutism. She had gone through two years at school without talking. Now her parents came to me with the question, "Should we do something or give it another year?" With a full hour to talk with her parents, I heard a story of a girl who had struggled with severe separation anxiety since infancy. The family was dealing with multiple stresses, and there were generations of similar difficulties (selective mutism is now understood as being a manifestation of social anxiety, which often occurs in multiple generations). None of this had ever been discussed until our visit. The school had had a number of meeting with the parents in which they said to give it more time, but now were telling the parents that if she did not start talking, she would have to be placed in a special education class. This is despite the fact that the girl was clearly of normal intelligence and spoke well and frequently at home.

Somehow the wealth of knowledge coming out of the growing discipline of infant mental health must find its way to the larger community. At the back of this issue of Zero to Three, there are reprints in English and Spanish of handouts "designed as tools to spark discussion on important child development topics and to support parents in developing the skills of self-awareness, careful observation, and flexible response." It has a section with the heading "Behavior Has Meaning" stating:
All behavior has a purpose. Babies and toddlers are not able to put their thoughts and feelings into words very well, so they communicate by using actions. A baby may cling and cry because she is fearful of new places. A toddler may bite to keep another child from interrupting her play. Understanding what your child's behavior is telling you helps you find supportive ways to respond to her and teach her better ways to express herself.
I wanted to bring these parents of the girl with selective mutism to place where they would ask not "what can we do to make her talk?" but "why is she behaving this way? and "what does it feel like for her to struggle in this way?" These kinds of questions would naturally lead them to "what to do" to help her and support her with these struggles. Our visit was a start. I introduced a new way to think about the problem. I can only hope that it sunk in. Having the Zero to Three handout might have helped, but certainly seeing her at four, three or even two would have been preferable.

So here I am, writing about what I am doing, namely using social media to bring new knowledge to a larger community. In the very near future (perhaps this week) I will have a direct feed of my blog on the newly designed Boston.com website (the Globe is following the lead of the New York Times in offering a separate free and subscription site) As Page One clearly shows, both traditional journalism and new media have an important role to play!

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