Transcript Infant Mental Health

An Infant Mental Health
Perspective on Sensory Processing
& Autistic Spectrum Diagnoses,
Amy Yun &
Dianne Koontz Lowman
Things you already know…
SEVEN SENSES:
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Vision
Hearing
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Smell
Taste
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Touch
Vestibular
Proprioception
SENSORY INTEGRATION IS…
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Neurological Process
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Organizes sensation
from one’s body & the
environment
Enables one to use
body effectively
within environment
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OT Intervention: (OT-SI)
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Based upon theory
Used to address difficulties
with neurological process
Theoretical framework for understanding brainbehavior relationships based on knowledge &
assumptions about the nervous system
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Ayres, 1972, 1989
SI ASSUMES…
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Children are active agents
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
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Intrinsically motivated to
challenge self
Development is influenced
by unique transactions
with the environment
(Blanche, 1998)
Neuroplasticity
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Nervous system has
capacity to change
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Learning depends upon
the ability to accurately
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Take in sensations from
the environment &
body
Process & integrate this
info within the CNS
Use information to plan
& organize increasingly
complex behaviors
SENSORY INTEGRATION: THE PROCESS
Williamson & Anzalone, 2001
Registration
Execute
Response
Organize
Response
Orient
Interpret
FOUR A’s
Action
(WILLAMSON & ANZALONE, 2001)
Arousal
Sensory
Integration
& Modulation
Affect
Attention
Sensory Processing Disorder(s)
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Exists when
sensory signals
don't get
organized into
appropriate
responses.
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Results in observable problems
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Motor: clumsiness, postural instability
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Cognitive: slower /incomplete
processing
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Behavior: avoidance, rigidity,
aggression, withdrawal…
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Affective: anxiety, depression
Functional:
 Problems participating within &
performing occupations
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ADL, play, school
May impair social relationships
•Parents who suspect their children
have sensory issues should ask
themselves 2 questions:
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"Is the child's problem getting in his way?
And if not, then is it getting in everyone
else's way?“
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C. Kranowitz
Sensory Processing Disorders
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Sensory Based Motor Disorders
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Difficulties with praxis (conceptualize, plan, & execute new movements)
Signs
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SPD Foundation
Reaches motor milestones at later end of “typical” range
Clumsy, difficulties with self care, productive & play activities
Low self-esteem
“Behavior problems” - Rigid, avoids, difficult transitions, manipulates
Sensory Discrimination Disorder
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Inability to distinguish between different stimuli, or organize temporal
& spatial qualities
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If you can not distinguish, you can not learn…
Sensory Modulation Disorder
Sensory Modulation Disorder
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Person is not able to adjust
response in relation to
environment
Neuro-modulation
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Reflects ability of central
nervous system to regulate
arousal in response to
environment
 Frequency of stimulation
 Amplitude –intensity of
stimulation
 Multiple or single sensory
input(s)
 Duration of stimulation
Reflects balance between SNS &
PNS
Evidence for SMD is Growing
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Davies & Gavin (2007)
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Ability to habituate typically develops over time
Children identified as having SMD demonstrate
difficulties habituating to neurological stimuli
compared with controls
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Schaaf, Miller, Seawall, & O’Keefe (2003)
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Priming occurs with difficulties increasing with time &
exposure to stimuli rather than decreasing
Children with SMD demonstrate  vagal tone (PNS)
Children with SMD do not habituate to repeated stimuli
McIntosh, Miller, Shyu, & Hagerman, (1999).
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Electro-dermal responses high amplitude orienting is
associated with poorer performance on the SSP
Sensory Thresholds & Behavioral
Responses (Dunn)
Neurological Thresholds
Behavior Responses
In accordance w/threshold To counteract Threshold
Poor registration
Sensation
Seeking
Sensitivity to
Stimuli
Sensation
Avoiding
High
(habituation)
Low
(sensitization)
Evidence for Sensory Processing
Problems in Children with ASD
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Children with ASD demonstrate
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Atypical auditory processing (Kulesza & Mangunay, 2008; (Zwaigenbaum et al., 2005)
Atypical visual processing
Atypical responses to tactile (touch) (Zwaigenbaum et al., 2005)
Atypical abilities processing sensory information (Belemonte e t al 2004)
Atypical performance on Sensory Profile (Kern et al 2007a)
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Difficulties modulating response to environmental events
Atypical vestibular processing compared to community controls (Kern et
al 2007b)
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Atypical sensory modulation compared with community controls (Kern, et
al 2008)
 Older people with ASD scored closer to community controls than younger
people with ASD
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Children with ASD showed more dys-regulation than children with
intellectual disabilities (Seynhaeve & Nader-Grosbois, 2008).
Sensory Modulation in Individuals
with Autism
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Kern et al (2008)
Children with ASD differed from control group
on all four modulation sections of the Sensory
Profile
 Sensory modulation differences in autism
involves
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Body position & movement;
Movement affecting activity level;
Sensory input affecting emotional responses
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Visual input affecting emotional responses
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Atypical Structure of Elements of Central
Nervous System of People with ASD
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Brain Stem
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Atypical medial superior olive (Kulesza, R. J., &
Mangunay, 2008)
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Function: localize source of sounds
Atypical cell shape & orientation in people with ASD
Cerebellum
Forebrain
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Amygdala enlarged
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Function: emotions & emotional regulation
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Enlargement associated with severe anxiety & decreased
social & communication skills.
Most of the time we think about
challenges associated with Autistic
Spectrum Disorders as simply
existing within the child with the
disorder…

Maybe we need to think about this in a more
sophisticated way…
“There is no such thing as a
baby, there is a baby &
someone…” (Winnacott, 1987)
Transactional Models
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View development & brain
organization as a process of
transaction between
(Fox, Calkins, & Bell, 1994)
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Genetically coded programs for the formation of
structures & connections among structures
Environmental influences
Infant Mental Health
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“is emotional & social competence in young
children who are developing appropriately
according to biology, social relationships, &
culture”.
“Normal paths of development serve as reference
points to assess infant competence”
Charles Zeanah, M.D.
Infant Mental Health Considers
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Individual Client Factors
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Temperament
Development
Body Structures & Body Functions
Meaning
Sensory Processing
Cognition
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Process
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Context
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Relationships
Routines
Risk factors
Attachment
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Client Story
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Client History
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Infant
Caregiver
Dyad
Family
Environment
Critical or Sensitive Periods
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Human brain growth spurt
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Begins in 3rd trimester - 24 mos
(Dobbing & Sands, 1973)
Brain generates genetic
materials
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Programs developmental
processes
Directly influenced by events in
social-affective environment
(Schore, 1994).
Consumes more energy than
at any other stage
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Requires
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Nutrients (fatty acids
(Dobbing, 1997)
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Regulated interpersonal
experiences for optimal
maturation (Levitsky & Strupp,
1995; Schore, 1994).
Critical periods- “specific
critical conditions or stimuli
are necessary for
development & can influence
development only during that
period” (Erzurumlu & Killackey, 1982, p.
207).

Conditions & events
occurring in “critical” or
“sensitive” early periods of
brain development have
long-enduring effects. Brazelton
& Cramer (1990)
Infant brain “is designed to be molded by
the environment it encounters” (Thomas et al.,
1997, p. 209).
Fundamental Biological
Adaptation Strategy
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CNS reacts & modifies itself in
relation to environment. (Schore,
2001)
Cortical & subcortical networks
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Hyper generation of neurons &
synapses
Competitive interaction
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‘environmentally driven process selects connections that most
effectively relay information.’
Activity-dependent (Chechik,
Meilijson, & Ruppin, 1999; Schore,
1994).
Environmental experiences may
enable or constrain structure &
function of the developing brain.
BioEnvironmentalBiosocial Brains (Gibson, 1996)
“Enriched environment” can be
coupled with psychoneurobiological
construct of a “growth-facilitating”
interpersonal environment (Schore,
1994)
 “Biological variables not only
influence behavior & environment
…behavioral & environmental
variables also impact on biology.”
Cairns & Stoff, 1996
Attachment Patterns Shape Brain
Structure & Function for Life
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Attachment interactions allow for the
emergence of a biological control system that
functions in the organisms state of arousal
(Bowlby, 1969)
Attachment theory = Regulatory Theory
(Schore 2000)
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Typically the secure mother intuitively regulates
baby’s shifting arousal levels & emotional states
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Dys-regulated children pose challenges for parents
“the longer an individual continues along
a maladaptive ontogenetic pathway,
the more difficult it is to reclaim a
normal developmental trajectory”
(Cicchetti & Cohen, 1995, p. 7).
Stress
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&
Subjective experience
induced by a novel,
potentially threatening or
distressing situation
Behavioral or
neurochemical reactions
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Stress Response
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Designed to
Promote adaptive responses to
physical & psychological
stimuli
Preserve homeostasis. . . .
Mediated by
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Central Nervous System
Autonomic Nervous
System
SNS Energy-expending
PNS conserves energy
Survival depends upon
ability to maintain
homeostasis in response
to challenges by
stressors (Weinstock 1997)
Critical Periods Stress & Coping
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Pre/post-natal periods are “critical period” of limbic–
autonomic circuit development (Rinaman, Levitt, & Card,
2000)
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Shapes ongoing synapse formation.
 Subcortical SNS & PNS components of ANS
 Cortical limbic components of CNS
 Especially for right hemisphere (Chiron et al., 1997) which matures
earlier than left
Maturation is experience dependent (Schore, 1996, 2000).

Events that influence ANS–limbic circuit development are
embedded in the infant’s ongoing affect regulating attachment
transactions.
Infants, Coping with Stress
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Interactive regulatory transactions that co-create
secure attachment bonds influence development &
expansion of infant’s regulatory systems involved
in appraising & coping with stress (Schore, 2001)
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Subtle differences in care-giving affect infant attachment,
development, & physical well-being (Champoux, Byrne, DeLizio, &
Suomi, 1992)
Variations in care serve as the basis for a non-genomic behavioral
transmission of individual differences in stress reactivity across
generations (Francis, Diorio, Liu, & Meaney, 1999).
Caregivers who can accurately perceive infants stress
signals help the infant develop an increasingly complex
capacity to cope with increasingly challenging situations…
Affect, Synchronicity & Attachment
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Infants & caregivers work to co-create a secure attachment bond &
emotional communication (Papousek & Papousek, 1997)
Baby
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Experience-dependent neuro-maturation allows more complex
responses for coping to emerge
Caregiver works to regulate baby
Affect synchrony
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Infant led, caregiver follows the infant’s lead
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Allows partners to match states & adjust their social attention,
stimulation, & arousal to each other’s responses
Synchronicity - match between caregiver’s & infant’s activities that
promotes positivity & mutuality in play & other functional activities.
Caregiver as Regulator
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To regulate infant’s
arousal,
st
caregivers must 1 be able to
regulate own arousal state.
Must be able to accurately
identify infant’s state
Must be able to respond in a
way that meets the infant’s
needs
This is what “typically”
happens
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What happens when parents
are observing atypical
responses?
Typical Amplification
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Infant’s attachment motivation synergistically
interacts with caregiver’s motivation
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Infant experiences increasing levels of
accelerating, arousal states amplified by caregiver
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If attuned, each partner monitors behaviors of
other
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Results in coupling between output of one partner’s
loop & input of the other’s to form a larger feedback
configuration & amplification of positive state in both.
Atypical Amplification
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Output of one partner’s loop & input to the other’s
do not align
Feedback is provided in an in manner incongruent
with needs/expectations of partners
Amplification of negative state may occur in both
partners.
Increased stress
What is Stressful for an Infant?
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Inability to regain homeostasis
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State changes
Bodily needs-hunger, thirst…
Novelty
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Transitions
Unpredictability
Signs of Autonomic & Behavioral
Distress in Young Children
Autonomic
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Yawning
Sneezing
Hiccupping
Sweating
Gagging
Spitting up
Breathing Irregularly
Changes to Skin Color
Abrupt State Changes
Voiding
Behavioral
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Fussing & Crying
Grimacing
Sighing
Starting
Stiffening
Splaying
Averting Gaze
Pushing Away
Arching Back
Staring into space
Evaluation: Sensory Processing Disorders
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Child
Context
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Physical
Social-Caregiver, family
members…
Cultural
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“Goodness of Fit”
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Child &
Context
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Caregivers
Physical Environment
Cultural Environment
Occupations
Activity Demands
Performance Patterns
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Habits
Roles
Routines
Assessments***
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What we Typically Think
of for EI Assessment
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HELP
E-LAP
Mullen (MELS)
TIME
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Specifically for Sensory
Processing
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Infant Toddler Sensory
Profile
Infant Toddler
Symptom Checklist
Sensory Integration
Observation Guide for
Children from birth –
three
Test of Sensory
Functions in Infants
Early Coping Inventory
Environment/
“goodness of fit”?

Physical
Environmental
Assessment
HOME
Social Environment
Dyadic
Assessment
PSI
Adult Adolescent
Sensory Profile
Evaluation
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Family/Caregiver Report
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Concerns/Comments
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Developmental history
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Pre & post natal
Qualitative Observations
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Structured
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Unstructured
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Multiple environments
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Assess the environment in addition to the child!!!
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Assess performance patterns of child & family
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Formal Assessment
Early Identification of ASD
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What you should look for
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Behavioral Signs
 Failure to respond to name by 8-10 mos (Werner, Dawson,
Osterling, & Dinno, 2000).
 By 12 months, infants with ASD distinguished from typical infants
by
 Failure to respond to name (Baranek, 1999; Osterling &
Dawson, 1994; Osterling et al., 2002)
 Decreased looking at faces of others (Osterling & Dawson,
1994)
 Low rates of showing things to others & pointing to
request/share interest (Adrien et al., 1993; Maestro et al.,
2002; Osterling & Dawson, 1994; Osterling et al., 2002;
Werner & Dawson, 2005).
 Poor eye contact & failure to respond to name distinguishes
children with ASD from infants with developmental delay but
without autism (Baranek, 1999; Osterling et al., 2002
Tools that Look Promising
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Autism Observation Scale for
Infants (Bryson, McDermott,
Rombough, Brian, & Zwaigenbaum,
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Visual attention
Response to name
Response to a brief still face
Anticipatory responses
Imitation
Social babbling
Eye contact
Social smiling,
Reactivity
Affect
Transitioning
Atypical motor & sensory
behaviors
Were not sufficient for diagnostic purposes at
6 mos
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Subset of children later diagnosed
exhibited impairments in
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Responding to name
Unusual sensory behaviors.

By 12 mos could distinguish
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Atypical eye contact
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Visual tracking
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Disengaging visual attention
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Orienting to name
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Imitation
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Social smiling
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Reactivity
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Social interest
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Sensory-oriented behaviors
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Poor gesture use & understanding
of words (Mitchell et al., 2006).
Assessments
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First Year Inventory
(Watson et al., 2007)
 Parent questionnaire
 Assess behavioral
symptoms related to
autism in 12-mos.
 screening instrument
for autism

Autism Observation Scale for Infants
(Bryson, McDermott, Rombough, Brian,
& Zwaigenbaum, 2007)
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Visual attention
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Response to name
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Response to a brief still face
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Anticipatory responses
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Imitation
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Social babbling
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Eye contact
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Social smiling,
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Reactivity
Affect
Transitioning
Atypical motor and sensory behaviors
Intervention
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Help family to understand
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Reframe behavior in terms of sensory processing
Help caregivers identify patterns & anticipate problems
Develop caregivers capacity to
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Read child’s cues
Support reciprocal interactions
Establish an environment that supports the child’s performance
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Developmentally appropriate expectations
Anticipate challenges & problem-solve
Develop routines that will work for entire FAMILY
Facilitate “Goodness of Fit”
Refer to Occupational Therapist skilled in identifying &
treating children with sensory processing disorders
Intervention

Remember you are an important part of the
child’s context…
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How does your ability to process sensory
information influence your ability to work with a
particular child & family?
Now apply this understanding to the child’s
primary social context
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How do caregivers/family members’ abilities
interact with the child’s?
Infant Mental Health Intervention
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Contributes to the development of a healthy,
emotionally responsive parent & child relationship
Promotes the baby’s development by fostering the
parents’ competence in their parental role
Perspective is one of capacity building & strength
rather than one of deficit & weakness (Perez,
Peifer, & Newman, 2002).
For at-risk children

Interventions focused on promoting
caregiver sensitivity were more effective
than the combination of all other types of
interventions (Bakermans-Kranenburg, Van Ijzendoorn, & Juffer,
2003)
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Effective interventions
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Involved < 16 sessions
Used video feedback
Target parental sensitivity & infant
contingent responding

Parents who have appropriate expectations
of their infant develop richer & more
positive interactions & provide enhanced
environments
This is associated with better developmental outcomes for
the child…

Interventions need to take into account the
individual characteristics of both members
of the dyad, and be sensitive to the “dance”
that the dyad performs together
(Poehlmann & Fiese, 2003).
Attachment Patterns Shape Brain
Structure & Function for Life


Attachment interactions allow for the
emergence of a biological control system
that functions in the organisms state of
arousal (Bowlby, 1969)
Attachment theory = Regulatory Theory
(Schore 2000)

Typically secure caregiver “intuitively”
regulates the baby’s shifting arousal levels &
emotional states
Intervention in General
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R-E-S-P-E-C-T
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People first
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Family is the constant
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Children, even young ones
should have a voice & vote
Teach the child to advocate
for self
Avoid placing blame- i.e.
“dysfunctional family”
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Regardless of where
child lives -he/she is
always part of their
family
Parents are the expert on
the child
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Give them the
information they need to
make decisions
You may not always
agree with their choices
Dimensions of Infant Mental Health
Service (Weatherston, 2000).
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Concrete Assistance
Emotional Support
Non-Dydactic
Developmental Guidance
Early Relationship
Assessment & Support
Advocacy
Infant-Parent
Psychotherapy
Concrete Assistance
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Involves clinical reasoning &
case management
Hierarchy of needs

help family meet basic “survival”
needs
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until these are met, other needs
recede into the background
Emotional Support
It means eliciting, listening
to, & thinking about
parents’ descriptions of
their experiences, &
small children’s
expressions of theirs”
(St. John & Pawl, 2000)
It also means observing
behavior, hearing the
message of the behavior
& helping the person ‘use
words’ to explain it
Families Need Support
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Acknowledge that parenting is difficult
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Assist families with identifying & accessing
supports they have/need
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24/7/365
May involve referrals to or be done in conjunction with
other disciplines- social work
Help identify which “supports” are supportive
Non-didactic Developmental
Guidance

By responding to the child’s
needs for care & his/her
specific abilities, the
interventionist helps parents
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Recognize what the baby is
doing
Anticipate the next step of
development or skill that will
emerge.
Encourage positive/playful
interactions through modeling
Early Relationship Assessment &
Support

Observing interactions of parents with their infants
& using “in the moment” comments to
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Reinforce positive interactions
Identify the infant’s responses that the parent might
misinterpret
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Ghosts in the nursery refers to the perspective parents bring to
their role as parents
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Parents are influenced positively & negatively by what they
experienced as children (Fraiberg, Adelson, & Shapiro, 1975).
Assessing Infant Care-Giver Relationships

Infant–caregiver relationships are open systems

Relationships include infant’s & caregiver’s
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Interactive behaviors (external-observable components of relationship)
Internal representations (subjective experiences of infant & caregiver
comprise the internal components)
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Memories
Representations of the history of interactions of the dyad
Interventions aimed at 1 component must have an impact on
other components of the system (Stern-Brushweiler & Stern 1989)
Interactive Behaviors

Insight into the meaning may come from
considering the organization of those
behaviors.

Clinicians account for the goals & contexts of
observed behaviors as a way of evaluating their
meaning.
Caregiver’s Internal Subjective
Experience

Consider how the caregiver represents the infant
& the relationship
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May assess subjective experience of caregivers by
attending to narrative patterns in descriptions of
relationship experiences. (Main, Kaplan, & Cassidy, 1985)
What caregivers say may be less important than how
they say it, (Zeanah, 1993).
Reflect back the meaning of what you hear to clarify…
 You may sometimes be wrong, but if you reflect back you
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Give the caregiver an opportunity to correct you
Likely will assist the parent gain a deeper perspective
Enhance the Caregivers’ Capacities

Improve ability to “read” their child
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Listen
Learn- how the caregiver views their child’s behavior
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“Watch, Wait, & Wonder…”
Educate
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Infant states, cues, behavior, response patterns
Non-verbal communication
State Modulation
Enhance Caregivers’
Capacities

Increase their
understanding of
their child’s
development

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Establish
“developmentall
y appropriate
expectations”
Anticipate what
comes next

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Parents who display higher levels of synchronization &
contingent responses during interaction have children with
ASD who develop superior communication skills over
periods of 1, 10, & 16 years (Siller & Sigman, 2002).
Early nonverbal communication, (esp joint attention)
strongly related to language outcomes for children with
ASD & typical development (Brooks &Meltzoff, 2005; Dawson et al.,
2004; Sigman & Ruskin, 1999; Toth, Munson, Meltzoff, & Dawson, 2006).

Parents find it more difficult to respond sensitively to
infants who have regulatory difficulties and who have less
reciprocal interaction styles (Kelly, Day, & Streissguth, 2000; O’Connor,
Sigman, & Brill, 1987; Tronick & Field, 1986; Yehuda et al., 2005).
Remember

Children with ASD showed more dysregulation than children with intellectual
disabilities (Seynhaeve & Nader-Grosbois, 2008).


Children are less able to follow caregiver’s lead
Consider the impact this has on the
caregiver…
Enhance Caregivers’ Capacities

Orchestrate their child’s
activities in a responsive
manner


Routines
Choice of materials, timing,
people…

Scaffold
children’s
occupations
within their own
occupations

Laundry & play
Enhance Caregivers’ Capacities

To cope effectively & assist the child with
developing effective coping strategies (Williamson &
Szczepansky, 1999)


Develop positive self value & beliefs

Accurately determine meaning of event

Manage challenging event

Evaluates the effectiveness of efforts
Managing stress is easier said than done…
Understanding & Managing
Child’s “Behavior”

Parent needs to “know the child”








What is going to set him/her off?
What are his/her limits?
Communicate with child
Convey clear expectations
Establish routines
Teach self-regulation
Modify environment to meet child’s needs
Address undesirable behaviors
Infant Subjective Experience


What we really want to know about infant
development is neither the infant’s nor the
environment’s contributions, but rather the infant’s
subjective experience of the world. Escalona (1967)
Attend to



Infant & caregiver interactive behaviors
Systematic formal study of caregiver’s subjective
experience
Bio-behavioral cues from infant
Enhance the Child’s Capacities
Structure




Routines vs. Schedules
“Flexible Predictability”
Clear Expectations
Developmentally appropriate expectations




Within child’s ability level & within his learning
style
Give child choices within their ability
Appropriate responsibilities
Time to complete activities & make decisions
Home Organization



Safety
Sensory environment
Make “appropriate” materials accessible to
promote independence




Set up
Exploration
Clean up
Limit access to unsafe/undesirable materials
Enhancing the Child’s Capacities

Self-Regulation







Physiological homeostasis
Ability to modulate environmental
stimulation
Maintain attention
Understand own behavior
Communicate needs
Delay gratification
Understand others’ behaviors
General Principles

When considering Sensory Input,
consider all sensory channels

Think about the stimuli’s




Intensity
Duration
Rhythm
Meaning to the child


Learning happens quickly, what learning has
already occurred?
Think about the child
Alerting




Intense stimulation
Frequent or long lasting
Arrhythmic /unpredictable/irregular
Input may be from different sensory
channels…

Make sure you understand the neurological
habituation principles of receptors you are
stimulating & interactions between channels.


Vest
Wilbarger Protocol
Calming



Often, less intense
May or may not be long lasting…
Rhythmical/Predictable


child anticipates input, has time to plan &
execute a response
Consider different sensory channels
Make sure you understand how this
relates to neuro
Be aware of spatial & temporal summation…
Sensory Diet


Family-centered approach provides sensory input to
meet needs of a specific child within his/her context
Involves specific activities designed to help child
modulate his/her arousal level so he/she can
participate within daily activities


Activities are planned around child & family’s needs &
embedded within their routines.
Should be designed by an OT with specialized training
in sensory integration theory & intervention

May be supervised by parents, or other professionals.
Precautions


Make sure you collaborate with a therapist who has completed the
proper training & supervision in techniques used
Be aware of how stimulation you provide impacts the child’s nervous
system



Habituation
Length of time stimuli reverberates within the system
Interactions with medical conditions &/or medications



Seizures
Medically Fragile Children

Cardiac

Respiratory problems
Allergy medications
Enhancing the Child’s Capacities

Social & Emotional Skills are learned…





Dyad
Later larger groups
Self-awareness
Empathy
Interactions with others
Assistive Technology

Enhance Communication Skills


PECS
Sign Language/Baby Sign
Videos
Enhance ability to explore the environment
Enhance ability to organize behavior







Picture Schedules
Pictures for clean up
Enhance Parental Support
Enhance Parental Understanding of Development

eHealth
Psychosocial Aspects of SelfRegulation



Successful development requires the
ability to identify & control emotions &
arousal levels
Self esteem is gained when children
control their responses & make positive
self-regulatory choices
Relating emotional feelings to arousal
levels increases relevance of choices made
Outcome of self-regulation






Modulates adaptive
responses
Improves social participation
Enhances sensorimotor
abilities & experiences
Positively influences
regulatory independence
Improves psychosocial wellbeing
Facilitates function across
lifespan
Advocacy

Involves



Helping families get their needs met
Giving voice to the baby’s or parents’
perspective.
Helps clarify the parent’s/child’s perspective
Infant–Parent Psychotherapy


“thoughtful exploration about parenthood
& the infant or toddler’s continuing needs
for care” (Weatherston, 2000)
This is completed only by a properly
credentialed psychotherapist

Other team members often relay many
important insights
Remember


“There is no such thing as a baby, there is a
baby & someone…” (Winnacott, 1987)
Werner-DeGrace (2004) suggests we ask
ourselves

Are we creating supports to help the family
participate together in positive health
promoting daily life activities or are the
interventions we provide interfering with
shared family occupations?
Questions/Comments


Email Amy Russell Yun at
[email protected]
References






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