Giving Troubled Young Children a Voice

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It is hard to believe that just two years ago I was drowning under a pile of prescription refill requests for ADHD medication in a busy pediatric practice. As those who have been reading my blog since its beginning know, I was disturbed by the over-reliance on psychiatric medication to treat complex problems, problems that I increasingly recognized had their origins very early in life. This approach was in effect silencing these children.

I left that practice to devote my time to prevention, both through clinical work with young children and their parents, and teaching. I wanted to bring the wealth of new research at the interface of developmental psychology, neuroscience and genetics, largely coming out of the discipline known as infant mental health, to my colleagues in pediatrics. This research offers opportunity for meaningful intervention in the early years, when the brain is most rapidly growing.

I had a resurgence of that old feeling of despair on Sunday when I read the New York Times Magazine cover story Can You Call a Nine-Year-Old a Psychopath? It was yet another example of over-simplified labeling.  Problems that represent a complex interplay of genetics and environment are placed squarely in the child, adding the letters CU-for "callous-unemotional"- to a long list of letter combinations used to label children. The article speaks of teaching empathy to children, but the approach is decidedly lacking in empathy for the child.

Children like the one described in that article are a tangle of complexity.  Sensory processing problems, which may be genetic in origin, are often associated with colic, sleep and feeding problems in infancy. Marriages are severely strained. There may be generations of mental illness, sometimes untreated and unrecognized. Parents feel overwhelmed with guilt and torn apart by multiple demands on their time and emotional energy. Treatment involves embracing the messiness of the problem at an early age, even before three, with support for the whole family.

Fortunately I have been given many wonderful opportunities to move this preventive model forward. This work keeps me afloat and hopeful in the face of the type of thinking represented in this article.

Michael Jellinek, president of Newton-Wellesley Hospital, hired me to build a program focused on early childhood social-emotional health. Jellinek was chief of Child Psychiatry at Massachusetts General Hospital for 30 years.  He really understands and values this preventive approach to children's mental health.

Most recently I had the honor of being invited by J. Kevin Nugent, director of the Brazelton Institute, to be on the training faculty for the Newborn Behavioral Observation System (NBO). This clinical intervention grew out of the original research of T. Berry Brazelton demonstrating the wide range of  individual behaviors of newborns. The NBO was designed as a relationship-building tool used to demonstrate a baby's unique capacities, with an aim to promote a positive connection between parents and children. I will  join an amazing group of people who give training sessions to a range of professionals who work with young children and families around the world.

In a previous post, I described a talk given by Robert Anda on the ACES study, a study that offers evidence of  the long-term negative effects of stress in early childhood on physical and mental health, and is currently exerting significant influence on social policy.  Anda spoke of the United States as a giant nursery of 4.3 million babies. He called upon us to think creatively to get those babies, especially those in an environment of risk, going in healthy direction. The NBO offers a way to do just that.

Another exciting event on the horizon is a parenting conference July 20-21 in Stockbridge, MA co-sponsored by the Austen Riggs Center and Yale Child Study Center. I will present alongside master clinicians and leading researchers in the field of child development. The conference "will examine how cutting-edge findings drawn from psychological, neurobiological and genetic studies on parenting clarify and deepen our understanding." My piece will focus on the child's contribution to the development of the parent. If any readers are interested in attending, I suggest making reservations ASAP. The Berkshires are a popular summer destination!!!

In another post I described of a great experience traveling to Seattle to speak with a group of pediatricians about this work, and our need to embrace a new paradigm of care in order to make use of our position in the lives of young children and families.

The icing on the cake is that this weekend I will have the great privilege of speaking alongside Peter Fonagy to the current fellows in the UMass Boston Infant Parent Mental Health Post Graduate Certificate program. I recently graduated from this terrific program, in which I had the opportunity to work closely with leaders in the field and a great group of fellows from a wide range of disciplines.

Fonagy, a world-renowned clinician and researcher, has had an enormous influence on my work.  I learned from him to listen to parents from a stance of non-judgmental curiosity about the meaning of behavior, rather than focusing on "behavior management." His ideas form the basis for my book Keeping Your Child in Mind.

Now rather than feeling like I'm drowning, I often feel like I'm walking on air- exhilarated by the opportunity to work alongside an amazing group of people who share a passion for helping young children and their families in meaningful ways.

Relationships are central to promoting children's healthy emotional development, relationships between caregivers and children as well as between clinicians and caregivers. Perhaps equally important are relationships among colleagues. Two years ago I felt alone and discouraged. Joining in this work with a wonderful group of people, including many that I have not mentioned here, I am hopeful that together our voices will be heard, in turn giving voice to young children and their families.

Originally published on the blog Child in Mind.

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