Infant - Toddler Mental Health Coalition of Arizona

Connections

Clinical Disturbances of Attachment in Infancy and Early Childhood

 Neil. W. Boris, MD, and Charles H. Zeanah, MD

(Reprinted with permission from the authors, 2002)

The development of the attachment behavioral system in infancy has been the focus of a wide range of research in the past 30 years. The clinical significance of disturbances in this area of development is currently a major focus for this research. Research on patterns of attachment in infancy has informed understanding f the development of psychopathology in later childhood: insecure-disorganized attachment is recognized as an important risk factor in this regard. The clinical features of reactive attachment disorder in early childhood are also becoming more clear. Finally, knowledge about the intersection between attachment and various risk conditions is growing and should inform clinical judgment about infants and young children requiring intervention. Primary care physicians can use these finding to identify children in need of intervention.

The clinical significance of the development of attachment in early childhood has been a recent focus of research in developmental psychology (1). Attachment is currently conceived of as an innate and homeostatic behavioral and motivational system that is evident in infancy and operative throughout the life span. The driving force behind the development of the attachment system was originally conceptualized by Bowlby (2) as arising from the evolutionary pressure in infancy to balance exploration with the seeking of comfort and protection from a selected group of caregivers.

Data from both human and animal studies suggest that the patterns of interaction between the infant and its primary caregivers serve to regulate the physiology and behavior of the infant (3). This interaction strongly influences the development of the infant’s attachment system. The vast majority of infants develop strong preferences for a limited number of caregivers around the time of a predictable biobehavioral shift at 7 to 9 months of age (4). As the infant develops cognitively, the cumulative interactive experiences contribute to the formation of internal working models of relationships that in turn direct the infant and young child’s strategies for behaving in future relationships (2).

There have been a number of research directions related to the development of the attachment system in infancy and early childhood. After Bowlby’s (2) theoretic work, the first two decades of this research focused primarily on the validation of  the construct and the development of standardized assessments of attachment (1, 5). More recent research has focused on understanding psychiatric disorders related to deviance in the developing attachment system (6) and investigating the neurobiology underlying the mechanisms by which attachment behavior is regulated in the brain (3, 5).

This paper reviews the continuum of clinical disturbances of attachment, from, patterns of attachment that appear to be risk factors for later behavioral problems to markedly disturbed behavior in early childhood signaling already evident disorder. Because the development of the attachment system is related to interaction with responsive caregivers, clinicians must be aware of how factors that negatively impact parenting may affect infants and young children. These factors are also reviewed:

Patterns of attachment    

Much of the research on the development of patterns of attachment behavior in infancy has relied on a standardized laboratory assessment that activates the infant's attachment behavioral system by introducing a novel adult and briefly separating the infant from its caregiver (5). Stable patterns of behavioral response to reunification with the caregiver can be reliably identified from videotapes of this procedure. Three basic classifications were originally identified: secure, in which the infant actively seek proximity or interacts with the caregiver on reunion, using her or him as a source of comfort and seamlessly retuning to active exploration; insecure-avoidant, in which the infant actively avoids the caregiver on reunion and minimized contact, even if physiologically aroused; and insecure-ambivalent, in which the infant actively seeks comfort and proximity with the caregiver but is unable to use that contact to calm herself and return to exploration (5). A fourth more recently identified group are those children who do not exhibit a coherent strategy for obtaining security need s from their caregiver. These infants show anomalous behaviors at the time of reunion with their caregiver, a hallmark of the insecure-disorganized pattern of attachment (8).

Berger (Berger et al, Paper presented at the Biennial Meeting of the Society for Research in Child Development, Washington, DC: April, 1997) has established that the three basic categories of attachment patterns can be reliably coded from videotapes of  pediatric well-child visits. Pediatric visits replicate the essential elements of the laboratory paradigm used in the original samples of infants screened (5). The clinician who is concerned about the interaction between infant and caregiver is likely to be able to get valuable information in this setting about the attachment pattern displayed.

Are patterns of attachment clinically meaningful?                      

There is significant  variability in what percentage of children are classified in each of the four categories from study to study. This variability is accounted for by the number and severity of risk factors impacting the dyads being studied and how these factors effect the caregiver-infant  interaction (9). Typical low-risk samples average approximately 65% to 70% secure and less than 15% insecure-disorganized. Samples with higher levels of risk have fewer secure infants and more who are classified as disorganized: for instance, Carlson et al. (10) found that the extreme risk of verified maltreatment in infancy changed the percentages to approximately 14% secure and approximately 83% insecure-disorganized.  

There is now good evidence that insecure attachment in infancy, particularly of the disorganized type, is a risk factor for later behavioral problems (11,12). For instance, Lyons-Ruth et al. (13) recently found that 83% of a low socioeconomic status sample of children followed up longitudinally to age 7 who were identified by their researchers as disruptive and aggressive had been disorganized in their attachment behavior at 18 months and below the national mean in mental development scores (vs. 13% of those who did not display this type of behavior). These findings were potentiated by the level of maternal depression, such that the higher the maternal depression score, the more likely the child was to be significantly disruptive. On the other hand, “internalizing” symptoms at age 7 (e.g. Anxious withdrawal and sadness) were related to insecure-avoidant attachment at 18 months and also potentiated by level of  maternal depression across the first 5 years of life.

Can disorders of attachment be identified in infancy?                  

Research on clinical disturbances sever enough to warrant intervention because of dysfunction before age 5 is limited. However, reactive attachment disorder (RAD) has been included in the psychiatric nosology since 1980: updated criteria appear in the Diagnostic and Statistical Manual (DSM-IV). The criteria for this disorder requires that the clinical disturbance be evident before 5 years of age, making RAD one of the few psychiatric disorders applicable to infants, toddlers and preschoolers. Although there are considerable problems with diagnosing psychiatric disorders in infancy and early childhood 915) and the current criteria for RAD have specifically been criticized (4), there have been a number of case reports of RAD published (16).  

Criteria for RAD have evolved from a large body of clinical literature on infants and toddlers raised in institutions or otherwise  maltreated (12). These young children exhibit a number of anomalous patterns of social behavior, often in multiple settings. Two basic subtypes have been described: inhibited, in which the child appears fearful, markedly ambivalent and consistently restricted in her interest in caregivers: and disinhibited, in which the child is overly familiar, shallow, and indiscriminate in her interest in caregivers (14).

Until recently, there had been no empirical studies using these criteria to identify groups of children with these patterns of behavior. However, Boris et al. (17) presented data on a clinical sample using multiple clinicians raters to compare DSM-IV criteria with an alternate set of criteria derived from clinical cases reflecting other potential subtypes of RAD (18). This study found that a significant portion of children presenting to an infant behavior clinic between 9 and 36 months of age met criteria for one or another form of RAD: those who met criteria were rated as having more dysfunctional parent-child relationships and were more likely to come from single –parent families. This data supports previous assertions that RAD can be reliably identified and may be an important clinical syndrome (16).

The recent influx to Western countries of children raised in institutions in Romania and Russia has provided an increasing group of children at high risk for RAD. Not surprisingly, research on these children has re-vealed that a significant portion of them show behavior consistent with the patterns of behavior described in RAD criteria (19,20); this behavior is stable enough to be evident even when the children are followed up for many years after adoption (21). 

Attachment and risk                       

A common theme in research on patterns of attachment and disorders of attachment is the link between clinically meaningful disturbances in infant functioning and risk factors impacting the family in which the infant is developing. The recently published DSM for Primary Care  (22) lists a variety of factors linked to the category “challenges to attachment relationship” (22), including death of a parent, maternal depression, maternal substance abuse, marital discord or divorce, poverty, maltreatment, multiple early hospitalizations and placements in foster care. Research on the link between risk conditions and development suggests that these conditions may not be specific in their effects during early childhood: rather the overall burden of risk impacting a given family (i.e. the number of risks) is likely more determinant of outcome than the specific risks involved (23). The “transmission” of the effects from risk conditions to the infant is mediated by the infant-caregiver interaction and it is this interaction, which is the most powerful predictors of infant attachment. (9,23).

Clinical Assessment                      

Because the pediatrician or primary care physician typically has numerous visits with infants and toddlers, they will have the change to make important observations about the caregiver-infant interaction and the developing attachment system (24). Familiarity with the clinical assessment of attachment can sharpen these observations: as noted previously, the pediatric visit is a good setting for making valuable observations about attachment. However, observations should be linked with specific questioning of the parent about their child's socioemotional development (25). Recognizing and assuring the impact of risk conditions on the development of the individual infant is critical and the identification of parents who are overwhelmed should lead to referral for intervention. Thinking in terms of risk conditions and socioemotional development is not typically emphasized in pediatric training programs and may require a paradigmatic shift in the way well-child visits are approached.

One important risk factor to consider when identifying families in need of referral is parental depression. Though risk conditions may not have specific effects, it is clear that maternal depression alone may significantly impact infant development (paternal depression is less well studied) (26). Parental depression is typically responsive to intervention and simple screening instruments are available to assess depression in parents; it would be possible to impact the consistent underdiagnosis of depression in women. Similarly, children in foster care are at particularly high risk for insecure or disorganized attachment because they typically experience early disruption in care often linked with poor parent-child interactions or maltreatment. Some of these children may already meet criteria for RAD, and more frequent health care visits for these children are warranted (24). Finally, children who experience hospitalization in the first 3 years of life may also be at risk for disturbances of attachment (27). Although a number of variables may intersect in determining which children are significantly adversely affected by hospitalization, assessment of attachment after repeated hospitalizations is warranted.

Conclusions                                    

Research pertaining to clinical disturbances of attachment ranges from the investigation of the effects of care-giver-infant  interaction on developing brain pathways to the relationship between early behavior patters, like those associated with insecure-disorganized  attachment, and later psychopathology. A variety of important risk condition s appear to influence the development of attachment patterns, which are associated with later disruptive behaviors. There is also new evidence that one of the few psychiatric disorders diagnosed in infancy, RAD, can be reliably diagnosed and is associated with particular forms of early deprivation. The clinician who regularly evaluates infants and toddlers is in a position to identify those at risk for later problems as well as those who already have RAD.

References and recommended reading:

1.    Rutter M: Clinical implications of attachment concepts: Retrospect and prospect. J. Child Psych of Psychiatry 1995.

2.    Bowlby J: Attachment and loss, vol. 1 edn. 2. New York, 1982.

3.    Schore AN: Early organization of the nonlinear right brain and development of a predisposition to psychiatric disorders. J. of Dev and Psychopathology 1997,  9:595 - 631.

4.    Zeanah CH., Boris NW, Scheeringa MS: Infant development: the first three years of life. In Psychiatry, edn. 1, Edited by Teeman A Kay. Lieberman J. WB Saunders: Philadelphia, 1997, 75-100.

5.    Ainsworth MDS, Fisher M, Waters E, Wall S: Patterns of attachment. Hillsdale, NJ: Erbium, 1978.

6.    Zeanah CH: Beyond insecurity: a conceptualization of clinical disorders of attachment. J. Consult. Clin Psychiatry 1996, 64:42-52.

7.   Insel TR, a neurobiological basis of social attachment. Am J Psychiatry 154:6, June 1997.

8.    Main M. Solomon J: Procedures for identifying infants as disorganized/disoriented during the Ainsworth strange situation. In Attachment during the preschool years. Edited by Greenberg MT Cicchetti D. and Cummings EM, University of Chicago Press: Chicago: 1990:121-160.   

9.     van IJzendoorn, MH., Goldberg, S., Kroonenberg, P. & Frenkel, O. 1992. The relative effects of maternal and child problems on the quality of attachment. Child Development, 63:840-858.

10.  Carlson, V., Cicchetti, D., Barnett, D. and Braunwald, K Disorganized/disoriented attachment relationships in maltreated infants. Child Development 1989, 25:525-53.

11.  Solomon, J., George, C., & DeJong, A: Children classified as controlling at age six: Evidence of disorganized representational strategies and aggression at home and school. Dev. and Psychopathology, 1995, 7:447-464.

12.  Zeanah, CM, Emde RN: Attachment disorders in infancy. In Child and Adolescent Psychiatry: modern approaches. Edited by Rutter M., Hersov L, Taylor L. Blackwell: Oxford, 1994:490-504.

13.  Lyons-Ruth K., Easterbrooks MA, Cibelli, C. Infant attachment strategies: Disorganized attachment strategies and mental lag in infancy: Prediction of externalializing problems at age seven. Developmental Psychology 1997; 33: 681-692.

14.  American Psychiatric Association, Diagnostic and Statistical Manual: IV, APA Press: Washington, DC: 1994.

15.   Zeanah CH, Boris NW, Scheeringa MS: Psychopathology in infanccy. J. Child Psychol  Psychiatry 1997: 38:81-99.

16.   Richters MM, Volkmar  FM: Reactive attachment disorder in infancy or early childhood. J. Amer Acad Child  Adol Psychiatry 1994 33:328-332.

17.   Boris NW, Zeanah CH, Larrieu,JA, Scheeringa MS, Heller SS Reactive attachment disorder of infancy and early childhood: A preliminary investigation of diagnostic criteria, American Journal of Psychiatry, 1998 155: 295-297.

18.   ZeanahCH , Boris NW., Lieberman AF, Attachment disorders of infancy In  Handbook of Developmental Psychopathology . Edited by Lewis, M, Sameroff, A, in  press.

19.   O’Connor TG, Bradenkamp D, Rutter M and the ERA team: Attachment disturbances and disorders in chidlren exposed to early severe deprivation. Infant Menatl Health Journal 1999, in press.

20.  Chisholm K, Carter MC, Ames EW, Morison SJ. Attachment security and indiscriminately friendly behavior in children adopted from Romanian orphanages. Dev and Psychopathology, 7, 283-294, 1995

21.     Hodges, J,  Tizard. IQ and behavioral adjustment of ex-institutional adolescents, J of Child Psychol and Psychiatry 1989, 30:53-75

22.     American Academy of Pediatrics: The Classification of Child and Adolescent Mental Diagnoses in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version. Elk Grove Village, IL 1996.

23.     Zeanah CH,  Boris NW, Larrieu JA: Infant development and developmental risk: a review of the past 10 years. J. Am Acad Child Adolesc Psychiatry. 1997, 38: 165-178

What is Infant Mental Health?

Robert Weigand

Department of Family and Human Development, Arizona State University 

This question can be interpreted in two ways. First, it asks, “What is a ‘mentally healthy’ infant?”  It also asks,  “What is the field or discipline of infant mental health.  What do we as professionals do to promote and ensure mental health in very young children?” Although these are separate questions they are obviously related.  Indeed, I suggest that the second cannot be carefully answered without initially considering the first.  In this two-part article, I’ll attempt to answer each in order. 

I think the beginning of a definition for the “healthy infant” can be attempted by identifying the fundamental principles that, over the past few decades, have guided the emerging professional and scientific consensus about the nature and process of healthy early development.  These principles have their roots in early psychoanalytic thinking and in psychodynamic approaches to child development.  They were given form by John Bowlby’s work on early caregiver–child relationships, and have been refined, by contemporary theorists including Mary Main, Alan Sroufe, Arnold Sameroff, Daniel Stern, and others.  Several decades of research in the area of parent-child attachment and recent research examining the structure, function, and development of the human brain and central nervous system continues to support and affirm the significance of these guiding principles.  The principles have been discussed in numerous books and articles from Bowlby’s initial treatises on mother-infant attachment to the recently published scientific review From Neurons to Neighborhood: the Science of Early Childhood Development.   Rather than a comprehensive list and discussion of these principles, what follows is a synopsis of the specific principles that I think most contribute to defining the practice of infant mental health. 

1.    The business of being human (or what we might call “competence”) involves two primary functions: social engagement or relatedness and learning about the world.

Social relatedness is essential.  Infants need to engage their caregivers in order to survive and learn.  Children and adolescents need to engage peers in order to learn and practice social skills and establish friendships.  Adults need to engage other adults for companionship and emotional support during times of stress. Fully functioning, or “healthy”, human beings need to be socially engaged in age-appropriate ways throughout the course of development.  The interest in, and early capacities for, positively engaging caregivers and peers are hallmarks of healthy infants and young children, and become the foundation for later successful social functioning.   

At the same time, the child’s “business at hand” includes figuring out how to manage and learn about his world.  An infant must learn how to gather and organize information about the world.  He must learn to use this information to effectively solve problems.  All the while he must also learn how to cope with inevitable stresses, both large and small, encountered along the way, and how to take advantage of growth promoting opportunities.  His world is dynamic, ever changing, and he must determine how to manage the constant changes, (some pleasant, some not so pleasant, some in fact painful).  ).  For example, one moment he is content, the next he is consumed by an increasingly uncomfortable feeling of emptiness and hunger.   Later, as he studies a flickering shadow on his bedroom wall, he is startled by the loud slamming of a door.  In both cases he must regulate the tension he feels in order to focus on a specific task:  the  coordinated suck and swallow required to relieve the pangs of hunger, or a systematic visual search to re-locate the fascinating pattern.  Learning to self-regulate is a key component of “learning to learn.”   

The healthy child pursues both of these tasks, social engagement and learning, with vigor and enthusiasm.  Undue worry, fear, or ambivalence about either one does not interfere with the other.  The Infant’s successful exploration and learning enhances his capacity for social relatedness; while positive relationships with adults and peers become an increasingly important tool for successful learning.  In healthy children these two endeavors, relating and learning, proceed hand-in-hand.   

2. The goal of development is to pursue these two functions with increasing complexity, flexibility, and stability. 

3.Complexity is that aspect of development that is most evident, and certainly most draws the attention of parents and professionals.  It is the increase in sophistication, effectiveness, and efficiency in learning and relating to others that we observe as children mature.  Locating, reaching for, and grasping a desired object involves greater complexity than simply turning toward and gazing at an object.  A verbal request is a more complex form of soliciting a caregiver’s assistance than merely crying.  

As the child acquires new skills and abilities he can use them interchangeably in an increasing variety of appropriate ways.  Increasing flexibility means that he uses a particular skill or pattern of behavior in a variety of different social or learning contexts and can apply this behavior to new contexts.  For example, an infant uses a socially directed smile to communicate satisfaction and pleasure to each of his caregivers (mother, father, nanny, etc.); to greet caregivers; to invite caregivers to playful interaction; to imitate and therefore respond to play invitations from caregivers; and to express positive interest in a friendly stranger. Later the child uses this same behavioral pattern, a directed smile, to share discoveries with caregivers and, still later, to initiate play with peers.  Flexibility also refers to the development of a repertoire of behaviors that can be used interchangeably as the situation demands.  When his smile fails to gain the desired attention and response, the infant can persist calling to a caregiver by vocalizing or waving.  An older toddler typically has access to an arsenal of strategies for capturing the attention of and initiating interaction with peers: mimicry, exuberant positive affect such as “fake” laughter, a gentle touch or hug, vocalization, donating a toy, etc.  Each of these skills is flexible to the extent that it can be substituted for another when necessary and appropriate.  Flexibility then is the increasing capacity to apply new skills to new situations in and, when one behavioral strategy fails the ability to try one or more alternatives.  Limited application of behavioral schemes or rigidity of function, on the other hand, suggests developmental deviation.  

Stability can be thought of as the child’s confidence in the effectiveness of a behavioral scheme.  When a toddler is first learning to walk, for example, he might take a few tentative steps toward an attractive toy, but if he really wants to be certain about getting that toy, he drops to his hands and knees and takes off.  Walking in this case is not yet a particularly stable pattern of locomotion.  Stability is evidenced by persistence.  It is as if the child thinks, “I know this will work if I try again or try a little harder.”  Stability also refers to the sustainability of complex behavioral schemes under increasingly challenging or stressful circumstances.  Using language to identify and express negative emotions such as anger and frustration, for example is not an especially stable pattern during early childhood.  A child might be able to say, “No, that’s mine! I’m mad at you [for taking it]!” during relatively mild confrontations, but that verbal ability fails him when he becomes very frustrated or frightened.  As many preschool teachers will attest, verbal expression often looses out to the less complex, but more reliable and stable pattern of physical aggression.  Even adults’ ability to verbally express emotions and intentions occasionally fails during circumstances of extreme arousal! 

Thus, the healthy infant is one who makes consistent and noticeable developmental progress by using increasingly complex behavioral schemes to explore the world and engage with others.  He can apply these skills flexibly to an ever-increasing variety of learning and social situations, and these skills remain available and useful to the child in increasingly challenging circumstances. 

Neither biology (genes) nor experience alone determines the course of a child’s development.   Developmental pathways are determined by transactions between the expression of the child’s genetic makeup and experiences with the environment to which the child’s biology must adapt.  Some of these transactions enhance the child’s competence and resilience, while others drive development toward greater risk of negative outcomes.  The effects of some influences are more powerful than others, and how specific biological and environmental influences impact development is unique for each child.  It is the combined, accumulated effects of these factors that determine whether development is healthy or disturbed. This transactional view of developmental influences has contributed to the increasing attention from developmental scientists on early brain development and neuroplasticity    A transactional view of development suggests that experience impacts development by it’s potential effect on the very structure and physiology of the infant’s central nervous system.  This means that we can no longer consider the state or development of a child’s mental health without considering the quality of the environment, the sources of both potential risk and support, with which the child must interact.  Because the most influential element of the infant’s environmental transactions involve, or are mediated by, his caregivers, developmental scientists and infant mental health professionals alike tend to view the mental health of very young children in terms of the quality of their relationships with caregivers.   It would not be much of an overstatement to suggest that an infant is only as healthy as the caregiving he is receives. Winnicott put this view succinctly when he declared that there is no such thing as an infant. 

4.Development proceeds in an organized and systematic manner. 

This principle suggests that development can be viewed as a sequence of changes that occur in essentially the same order for all individuals.  Developmental theorists have proposed or identified a sequence of “stages” charting the abilities that emerge in several domains.  Piaget’s stages of cognitive development are familiar examples. Most relevant to infant mental health professionals is a closely related view that development proceeds through a series of “developmental issues” of “tasks”.  Freud, and later Erik Erikson, first suggested this approach to thinking about development. For them, successful development of the “self” involved a progression through a series of phases (Freud’s “oral phase” and Erikson’s “trust vs. mistrust” for example).  Problems during one phase inevitably impact development during later ones.  More recently, developmental psychologists such as Robert Emde, Alan Sroufe, Stanley Greenspan, and others have offered frameworks of developmental issues consisting of the emerging tasks related to social and exploratory competence. Although there are some differences in these recent frameworks, they share two features especially relevant to infant-family practice.   

First, all point to the cumulative nature of development. Although early experience alone does not determine outcome, earlier patterns of adaptation always carry some implications for later functioning.  Current behavior, then, can always be understood in terms of what went before, and knowing something of a child’s history can help us to understand the meaning of current patterns - why a child is functioning in a specific manner.  Answers to that why help to focus intervention. 

Second, the earliest phases that involve self-regulation and the formation of early representations of self and relationships with others (attachment) are critically important.  These early phases form the core of the child’s sense of self-worth, and are the foundation on which later regulatory, social, and intellectual abilities are built.  Patterns of behavior that emerge around these early phases are initially flexible, but become increasingly rigid, especially as development proceeds into adulthood. 

Thus the mental health of an infant, according to this view, is conceptualized in terms of successful management of these important early issues involving self-regulation and attachment.  The healthy infant has an age-appropriate capacity for regulating emotions and attention.  He has a sense of self as worthy, competent, and effective.  And he has a positive interest in relationships with others and an expectation that those relationships will be rewarding. 

Conclusion

The four developmental principles identified in this article provide at least a sketch, if not a portrait, of the “mentally healthy infant”.  In doing so they also suggest implications for the nature of the infant mental health profession.  Although I’ll offer a discussion of these implications for defining infant mental health practice in Part II of this article, a few brief conclusions are warranted here.  First, infant mental health is a child development profession.  Because developmental domains are interrelated, the profession must be about the business of supporting all aspects of development.  Second, it is a profession rooted in an ecological perspective.  It’s focus is not simply the child alone, but the child along with the sources of risk and support in which he is embedded.  Third, it is relationship-focused. Children’s early “caregetting” relationships powerfully impact their development.  Ensuring the health of these relationships goes a long way toward ensuring healthy development.  Finally, these developmental principles are the raison d’etre  for the emergence of our profession.  What is clear and indisputable is that mental health intervention early in life, indeed during the first few months and years is advantageous, if not crucial.

 

Southwest Human Development Receives Prestigious Grant from The Harris Foundation Creating Arizona’s First Infant Mental Health Training Institute

Young children in need of mental health services received a boost this summer as Southwest Human Development received a prestigious national three-year grant totaling $375,000 from the Chicago-based Harris Foundation. 

“The Harris Foundation is thrilled to support Southwest Human Development and their new Irving B. Harris Infant Mental Health Training Institute of the Southwest, which  will produce high quality specialists who can support the healthy development of infants and their families.  Babies need nurturing, loving and responsive relationships with their parents and other caregivers from birth in order to develop to their fullest potential.  There is no more critical time to intervene than in the early years to assure that children grow up to be successful in life,” said Irving Harris, Chairman of the Harris Foundation.

The grant will be used to create Arizona’s first Infant Mental Health Training program.  Modeled after several distinguished institutes throughout the country, the Irving B. Harris Infant Mental Health Training Institute will address the severe shortage of professionals qualified to work with the range of problems babies and young children can experience.  Examples include difficulties with sleeping and feeding, severe tantrums, the effects of neglect and abuse, and poor parent-child attachments.   

Services will be provided through Southwest Human Development’s Good Fit Center.  The only center of its kind in the Southwestern United States, the Good Fit Center provides mental health services for very young children and their families. 

“Thanks to this award, we can address the state’s desperate need for trained professionals and ultimately help thousands of Arizona’s young children and families,” said Ginger Ward, Executive Director of Southwest Human Development. 

The Harris Institute involves a close collaboration with faculty and students in the Department of Family and Human Development at Arizona State University.  Professor Richard Fabes, Chair of the Department of Family and Human Development, welcomed the exciting news and noted that “the synergy that will result from the combined efforts of Southwest Human Development’s Good Fit Center and ASU’s Department of Family and Human Development will benefit local children and families who are in need of these services, as well as assuring that the programs and services are scientifically-sound and effective.  It is a good example of ASU’s commitment to being responsive to the needs of the community and to its embeddedness in community action.” 

For some, the concept of infant/toddler mental health care conjures images of a baby on a psychiatrist’s couch talking about his or her problems.  In reality, infant mental health care is about building strong relationships between children and their caregivers. 

Research shows that a strong caregiver-child relationship can build resiliency in children – the single most important predictor of a child’s later success.  For children who have experienced trauma such as the loss of a parent, serious illness, or abuse and neglect, resiliency has proven to be key in overcoming these obstacles.  A strong relationship between children and their parents can enhance resiliency in children. Applications for the Fall 2003 class wil be available January 6, 2003. Please contact Jan Martner or Alison Steier (602) 266-5976 for further information in January.

 

Southwest Human Development, founded in 1981, is a non-profit educational and human services organization.  The agency provides comprehensive services to 30,000 young children and their families throughout Maricopa County who face challenges related to health, child abuse and neglect, mental health, poverty or disabilities.