Pediatric Leaders on Health and Resilience: Listen to Parents

"We need to actively engage parents before we jump to invest in pre-K for all," Jack Shonkoff, director of the Center on the Developing Child at Harvard University wisely proclaimed yesterday at the American Academy of Pediatrics (AAP) Symposium on Child Health, Resilience and Toxic Stress in Washington, DC. Promoting a "two generation approach,"  symposium speakers recognized that not only the child, but the parent-child relationship, is the concern of the pediatrician.

One of the speakers addressed the problem of "uncompensated time." This phrase hit the nail on the head. Time and space is the treatment. People need to feel safe to be able talk about what is important.  This includes both the clinician and the parent. When the pediatrician feels stressed by a waiting room full of patients that the current system of care demands he must see, he is not able to be present with a parent in the way that careful listening requires.

It  is like a set of Russian dolls. The society values the clinician's time, offering the opportunity to listen to the parent, who listens to the child. And as many at the symposium recognized, it is not just pediatricians, but also child care workers, teachers, home visitors and others who have the opportunity to support stressed parents. All policy needs to be focused on protecting space and time to listen. Listening is not high tech. But it is this space and time, where parents feel safe and valued, that we have the opportunity to grow healthy brains and minds.

Pediatrician and journalist Perri Klass gave a beautiful talk about Reach Out and Read, a national program that distributes books to parents in pediatrician's offices. She spoke honestly about the growing realization that benefits were not from larger vocabulary or "school readiness." Rather it was the act of reading, the gentle sound of the parent's voice, fully in the moment with the child, that was responsible for positive results.

One audience member asked a wise question about giving a book to a mother who has herself not been read to, and so does not have a model for this kind of intimate interaction. Klass responded that this is true of any advice or guidance we give to a parent. Her response leads back to the notion that rather than giving information, or teaching skills, first we need to listen, to be curious about the experience of the person we are with.

My first book, Keeping Your Child in Mind, whose second chapter is "Listening to Parents, Strengthening the Secure Base"  translates the explosion of contemporary research that Shonkoff referred to in his presentation. The book shows what this approach looks like for a range of everyday parenting concerns from newborn to teenage years.

While the symposium was occurring, a relevant headline,  A Case Study in Maternal Mental Illness, on New York Times front page, told the tragic story of a mother's struggles with her belief that she had caused her baby harm. This conviction eventually led to her jump from a building with her infant strapped to her chest. While one cannot fully understand the treatment she received by reading a newspaper article, it appears that there were multiple interventions along the way, all of which treated the mother and baby separately. Many pediatricians reassured the mother that there was "nothing wrong." Psychiatrists diagnosed depression and prescribed medication.

Knowing the research on the value of treating parent and child together, I can't help but wonder if time with an experienced clinician who could sit on the floor with both parent and baby, might have offered the opportunity to make sense of her suffering and so set the pair on a different path. In the abundance of advice, reassurance and diagnosing of illness, was there time and space for listening?

For when parents, who may be stressed and overwhelmed, feel heard, recognized and understood, they are better able to do the same for their child. When  parents listen to their child, are fully present with their child, they offer the opportunity build resilience and the capacity to manage adversity. It is not about giving information, or even about teaching skills. It is about supporting parents' efforts to connect with their most competent self.

Central to this view is the notion of the good-enough mother, a phrase coined by pediatrician turned psychoanalyst D.W. Winnicott, and demonstrated in the contemporary research of developmental psychologist Ed Tronick. The good-enough mother is not perfect. But it is her very imperfection that drives development forward in a healthy way. Parents make mistakes. It is through these mistakes, and their subsequent recognition and repair, that children learn to manage the inevitable challenges of life.

It was an inspiring symposium, but we may be making this more complicated than it needs to be. All the best science tells us that our single aim should be to protect time and space for listening to parents, and so to children. This is the road to health and resilience.

Quotidian Trauma, Quotidian Resilience: Boston Conference on Contemporary Developmental Neuroscience

When Frank was a young boy, and he committed some typical toddler transgression such as having a meltdown when it was time to leave the playground, his father would slap him across the face, hurting and humiliating him in a very public way.

When I spoke with Frank over 20 years later, in the context of helping him with his own son Leo's frequent tantrums in my behavioral pediatrics practice, he did not describe this experience as "trauma." Rather, he described it in a very matter-of-fact tone.

But when we explored in detail his response to his son's tantrums, we discovered that, flooded by the stress of his own memories, Frank in a sense would shut down. Normally a thoughtful and empathic person, he simply told Leo to "cut it out." As we spoke he recognized how he was emotionally absent during these moments, which were increasing in frequency. It seemed as if Leo was testing Frank, perhaps looking for a more appropriate response that would help him manage this normal behavior. Once this process was brought in to awareness, Frank was able to be present with Leo- to tolerate his tantrums and understand them from his 2-year-old perspective. Soon the frequency and intensity of the tantrums returned to a level typical for Leo's developmental stage. Frank, greatly relieved, once again found himself enjoying his son.

The upcoming Boston conference; Psychological Trauma: Neuroscience, Attachment, and Therapeutic Interventions, promises to offer insight in to the developmental neuroscience behind this story.

What Frank experienced as a young child might be termed "quotidian" or "everyday" trauma. It was not watching a relative get shot, or having his house washed away in an avalanche. It was a daily mismatch with his father- he was looking for reassurance and containment and instead got a slap across the face. It was what leading researcher Ed Tronick would term "unrepaired mismatch." Frank, in a way that is extremely common- termed "intergenerational transmission of trauma" was then repeating this cycle with his own child. When this dynamic was brought in to awareness, was able to "repair the mismatch," setting his relationship with his own son on a healthier path.

Tronick, who runs the Infant Parent Mental Health Postgraduate Certificate Program at UMass Boston, and will be presenting at next week's conference, describes this process in a paper entitled Quotidian resilience: Exploring mechanisms that drive resilience from a perspective of everyday stress and coping. Resilience is a capacity that develops over time through the typical misattunments that inevitably occur between parent and child. D. W. Winnicott, pediatrician turned psychoanalyst, coined the phrase "the good-enough mother" to describe this phenomenon.

Quotidian trauma, on the other hand, occurs when these mismatches are not repaired. Tronick's research as shown that even if they are only repaired 30% of the time, development still proceeds in a healthy direction.

Steven Porges, a professor of psychiatry at University of North Carolina Chapel Hill, another speaker at the conference, has developed through his research, a fascinating theory to explain this process on a neurobiological basis. Tronick dramatically demonstrates the effects on an infant of these misatunement, or mismatches, in his Still Face experiment. In it we see how a young infant becomes highly distressed and disorganized when his mother does not respond to him in the typical way.

Many are familiar with the term "fight-flight" response to describe how when the body is faced with extreme stress, the sympathetic nervous system kicks in. What Porges brilliantly identifies is that in the setting of parenting, the drive to protect one's child may override this response. So what happens when a parent, like Frank, is flooded with stress, but cannot fight or take flight? A more primitive stress response, mediated not by the sympathetic, but by the parasympathetic nervous system, takes over. This is the "freeze response" that leads an animal to play dead in the face of overwhelming threat.

The parasympathetic nervous system innervates the muscles of the face and voice, controlling on a neurobiological basis that attunement that is so important to healthy development. Putting this together with Tronick's research, we can understand what happened to Frank. In a way that was unconscious and so out of his control, flooded with stress but with his fight-flight reaction unavailable, his parasympathetic system took over. The result is a literal still face. Leo's increasing tantrums match the increasing distress seen in the infant in Tronick's experiment.

At this week's conference, organized by Bessel van der Kolk, whose work with psychological trauma is featured in the New York Times Magazine this weekend, there will be much more to learn. This exploding field of study, while often identified with "Trauma" with a capital "T," has much to teach us about prevention. From the research that will be presented, we are able to understand not only how to treat trauma, but also how to intervene in the earliest months and years to break the cycle of transmission of trauma and set development on a healthy path.

Roz Chast on Parent-Child Relationships

Roz Chast's new book Can't we talk about something more pleasant?, a touching, funny, sad, and thought provoking graphic memoir, is primarily about her caregiving role as her elderly parents approach death. She makes her painful subject tolerable with humor. For example, at a point when Chast thinks her mother's death is imminent, she arrives at the "the Place" where her mother is under the care of a new nurse. She finds her sitting up, dressed, and eating lunch. Chast writes, "Where in the five Stages of Death, is EAT TUNA SANDWICH?!?!?"

Chast has a troubled, fraught relationship with both parents, though more so with her mother, right up to the end. Though the focus of the book is the final years, Chast gives some insights in to the origins of these difficulties.  Reading the memoir with an eye to understanding parent-child relationships, I found an interesting example of the way parent and child can dysregulate each other. Of how when things go wrong, the problem is not either exclusively in the parent or the child, but in the relationship.

Chast was born one month premature, delivered by cesarean section as a precaution because her mother's first baby, a girl, had died at 7 and 1/2 months. A family narrative suggested that the death was related to standing on a stool to change a lightbulb, something Chast's meek and fearful father refused to do. But the actual cause was placenta previa. An obstetrician had told Chast's mother that her "uterus would rupture" if she carried to term.

Chast describes herself as "probably not a fun baby." She had low tone, cried a lot, didn't like to eat or sleep. Likely some of these traits were related to her prematurity. Chast writes, "I had one cold after another, and from the time I could speak, one anxiety after another." Temperamentally she was much more like her father than her mother. While as an adult she writes of her mother, "I can sympathize with her desire to leave me in the care of someone else for a while," she follows with," who knows what I thought back then."

Chast's mother came from a history of trauma. Her father, Chast's maternal grandfather, was an engineer in Russia but came to the US, presumably following persecution of the Jews, to a life of extreme poverty that left him "bitter and angry."  It is possible that her mother's experience as a parent was colored not only by this history, but also her history of loss. Even today pregnancy loss may not be recognized as an experience with its own significant grieving process. Certainly in 1940 it is likely that one was expected to just carry on.

The aim of the book, I believe, is to call attention to the inherent challenges of caring for aging parents. But it is a rich and beautiful story, with other lessons as well. Chast, with her sparse details, offers us a picture of a parent-child relationship that got off on the wrong foot. I wonder if Chast's brilliant creativity is in part a result of having to cope with this difficult and painful family story. If so, her struggles become our gift.

On Rising Disability Benefits for Children: Distribute Diapers, Not Drugs

Children who grow up in poverty are at risk for problems of emotional, behavioral and attentional regulation. Today's Globe reports that SSI (Supplemental Security Income) for disabilities has surpassed traditional welfare as a source of support for poor families. The vast majority of these disabilities are mental health problems such as ADHD ( attention deficit hyperactivity disorder.) In her brilliant three part series that led to this current study, Patricia Wen uncovered some complex questions.  What does it mean for children and families that in order to receive financial support, there is incentive to get children diagnosed with psychiatric disorders and medicated with psychiatric drugs?

Current research at the Yale Child Study Center offers a novel look at this problem, literally from the other end. In a study published in Pediatrics in 2013, researcher Megan Smith showed that 30 percent of families living in poverty report diaper need.

Extensive research has  shown that when parents are fully emotionally present with their infants, they support development of emotional regulation, cognitive resourcefulness and social adaptation. But what if her baby is screaming in a dirty diaper, uncomfortable or in pain, and a mother can't reliably have access to a clean one? The stress of this predicament may make emotional regulation, both for parent and child, impossible. Smith concludes:

Although a majority of studies have examined family socioeconomic status as income and educational and employment status, emerging research suggests that indicators of material hardship are increasingly important to child health. This study supports this premise with the suggestion that an adequate supply of diapers may prove a tangible way of reducing parenting stress, a critical factor influencing child health and development. 

Next weekend, Smith will be presenting her research at the Austen Riggs Center, in conjunction with a community diaper drive sponsored by the Berkshire Psychoanalytic Institute. 

Wen's current Globe piece quotes Rebecca Vallas of the Center for American Progress; "Cash is what actually matters for these families, as a baseline, before you can even start talking about supports and services."

The point of juxtaposing these two studies is not that we should distribute diapers in place of cash. Rather it raises the question of whether it makes sense to invest in infants, rather than waiting until problems of emotional and behavioral regulation are so great that children meet diagnostic criteria for a psychiatric disorder. 

The infant brain makes as many as 700 synaptic connections per second. By investing resources in infancy, not only with diapers, but also such things as quality child care, paid maternity and paternity leave, and identification and treatment of perinatal mental health problems such as postpartum depression and anxiety, we literally have the opportunity to grow healthy brains. 

The current SSI system seems to be an investment in illness. In contrast, concrete support with clean diapers, as well as the broader support of parents and young children, is an investment in prevention and health. 

Reflections on the government shutdown: why is health care so threatening?

 I may be putting myself out on a bit of a limb here, but the draw of the blog makes it hard to sit silent while our country heads towards disaster.

As I listen helplessly to a report on NPR  about our country being in the grips of an irrational game of chicken, I found myself being curious about the motivations of the tea party conservatives. Drawing a lesson from psychoanalyst Peter Fonagy, who identifies the ability to attribute motivations to behavior as a uniquely human characteristic, I wonder if taking a stance of curiosity rather than anger might be useful.

This led me to consider another psychoanalytic construct, namely that of transference.  The tea party hardliners refer to Obamacare as an invasion of privacy. This idea is grotesquely depicted in the commercial showing a creepy Uncle Sam invading a gynecologic exam. Before he enters, the patient,  a young woman, is being cared for by what appears to be a kind, motherly doctor.

The notion of transference describes how strong feelings from a past relationship, often with a parent, find there way in to a current relationship. This phenomenon can occur in relationships with spouses, children, co-workers, in addition to the setting where Freud originally identified it, namely in the patient-therapist relationship.

In the intimacy and privacy of the patient-doctor relationship, such as that between a young woman and her female gynecologist, these type of transference feelings naturally occur. That made me wonder if to those who made the commercial, Obamacare, as represented by Uncle Sam, in some way represents a third invading the primary caregiver-child relationship. If so, that might help explain the intransigent behavior of those who are unable to accept that Obamacare, or the Affordable Care Act, is the law, and are willing to hold the country hostage rather than face that fact.

But Obamacare is not a threat to that intimate private relationship. In fact, if it works, and health care costs do go down, and insurance companies lose some of their power, it may in fact strengthen the relationship.  With increased emphasis on prevention, the healing power of the patient-doctor relationship might be brought in to better focus than under the current system, when doctors are forced to see more and more patients in less and less time.

To MA Gubernatorial Candidates on Mental Health: What About Children?

At last night's MSPP ( Massachusetts School for Professional Psychology) sponsored Gubernatorial Forum on Mental Health there was much talk among all of the candidates about how devoting resources to mental health care is a wise investment. But there was virtually not one mention of prevention in the form of children's mental health care. This was striking, as Nobel prize winning economist James Heckman has offered extensive evidence of how devoting resources to prevention in early childhood leads to decreased long-term costs of physical and mental health care.

Investing in early childhood also leads to decreased spending on prisons, a topic all of the candidates addressed in terms of decreasing the number of people in prison for non-violent crimes and first time drug offenses. They all correctly identified the high rate of mental illness in prison and the need to offer treatment, particularly substance abuse treatment.

The whole night I was thinking, "what about the children?" This might have been due to the format, and the fact that moderator Tom Ashbrook did not ask a single question about children.
I was struck by the contrast between this discussion and last week's American Academy of Pediatrics sponsored symposium on Child Health, Resilience and Toxic Stress.

All the best science of our time, in the form of research at the interface of neuroscience, genetics and developmental psychology, tells us that to invest in prevention means to invest in parents and children.

I was disappointed by Martha Coakley in a sense towing the NIMH party line, whose great shortcomings I describe in a previous post, by saying that mental illness is like any physical illness, such as diabetes. I am one hundred percent in favor of parity for mental health care, and decreasing the stigma of mental illness. But the only way to achieve this parity is to recognize that mental illness is not like diabetes.

Resilience and emotional wellbeing develop in the context of relationships. To both prevent and treat mental illness the focus of intervention needs to be on relationships. What makes us human is our historical and relational context. We need to value space and time to listen to each other.

The most important point of the evening, that was made in some form by all three democratic candidates, is that reimbursement for mental health care needs to increase significantly. When we place value, both cultural and monetary, on taking the time to listen, whether to parents of young children, teens struggling with substance abuse, or adults with a range of diagnostic labels, then we will be making meaningful steps not only towards mental health care parity, but also towards promotion of health and resilience.

NYT on mental illness, talk therapy, drugs: what about children?

Last week there was an invitation to dialogue in the New York Times on this subject.  In today's Times there is a fascinating array of responses, but none addresses the issue as it relates to children, for whom there has been an exponential rise in prescribing of psychiatric medication in the last decade. Here is the letter I sent in.

We live in a culture of advice and quick fixes. Increasingly, understanding of human experience is reduced to lists of symptoms, diagnosis and medication. There is less curiosity, less careful listening to one another.

Talk therapy, which perhaps should be called “listening therapy,” offers space and time to create a meaningful narrative, including an opportunity to experience feelings of grief and loss.

This is particularly important in work with children. When symptoms are medicated away, the opportunity to tell stories that give meaning to behavior may be lost. Research has shown that a child’s knowledge of family narrative, both the ups and downs, is highly correlated with self- esteem, resilience and mental health. Giving a parents an opportunity to tell their story to a nonjudgmental listener, to integrate their own narrative,  is critical to treatment of childhood “behavior problems.”

I am not advocating for talk therapy for children. Rather, in order to help children who are struggling with a range of "behavior problems," it is essential to listen to their parents, to give them an opportunity to reflect on the meaning of behavior. The behavior is a symptom, perhaps even an adaptive response, to the underlying problem. There is extensive evidence, that I describe in my book Keeping Your Child in Mind, that when parents reflect on the meaning of behavior in this way, they have the opportunity to promote healthy development at the level of gene expression and structure and biochemistry of the brain.

In my practice, where I see children under the age of five, parents typically present with concerns like, "he never listens" or "she is defiant." But as we take the time to think about how the problem developed, meaningful shifts in understanding occur. For example, parents may recognize the way a child's behavior pushes their buttons because of their own history of abuse. Or serious marital conflict, that often has zeroed in on the child's behavior, comes to the fore.  Or the impact of an easygoing sibling may be recognized. Tantrums and meltdowns at birthday parties may be understood in the context of a child's longstanding difficulty with processing sensory input.

Creating this narrative, this story that makes sense of the problem, may only be the beginning of the treatment. Intensive work with parent and child together, to address the way the child's behavior provokes the parent, is often indicated. Marital counselling, or even working with a couple who are not together, to help them work together to support their child may be necessary. Quality occupational therapy can be invaluable to help a child to feel calm in his body. Parents may benefit from things such as yoga to help them to calm their own reactions.

Here is where the trouble really starts. Quality clinicians who offer these services are in short supply. Insurance is often a huge obstacle. But, creating perhaps an even bigger obstacle, is the cultural norm of the "quick fix" approach of medicating symptoms, even in children as young as 5.  Not only must parents overcome these obstacles of finding a provider, making the time, allocating funds, as well as doing the important but often challenging emotional work of addressing these issues. They must go against pressure from teachers, relatives, friends and  health care providers.

I will continue to offer parents space and time to be heard, to create meaningful narrative, because I am confident that telling stories, and working through the feelings of grief and loss that often accompany them, is the path to meaningful connection and healthy emotional development.  It causes me great heartache when these efforts are thwarted by a system that works in opposition to this approach.

To CDC on childrens mental health: consider office of homeland attachment security

Change is in the air for children's mental health care. The latest CDC (Center for Disease Control) special supplement to the MMWR (morbidity and mortality weekly report) is titled Mental Health Surveilance Among Children-United States 2005-2011. The report overview states:

Approximately $247 billion is spent each year on children’s mental health.  The mental health of children is critical to their overall health as children and as they grow into adults.

The report summary concludes:

More comprehensive surveillance is needed to develop a public health approach that will both help prevent mental disorders and promote mental health among children.

This report coincides with both the release of DSM (Diagnostic and Statistical Manual of Mental Disorders) 5, and a statement by the director of the NIMH (National Institute of Mental Health) that research funding would not be guided by DSM diagnoses, and that a new paradigm of mental health care is needed.

The time has come to recognize the overwhelming evidence regarding the importance of early relationships in healthy emotional development. The answer to the problem posed in the CDC report is in: invest in early childhood -from newborn to three- to prevent mental health disorders and promote mental health.

A huge part of this evidence comes from the CDC itself, with the ACES study, showing long-term negative impact on both physical and emotional health of a range of adverse childhood experiences.  An abundance of research coming from the discipline of infant mental health provides a more nuanced view of this issue. 

 When parents are supported and valued by society, they are able to be fully present with their children, in turn helping to grow healthy brains. Children who grow up in an attuned caregiving environment are flexible, resilient, and empathic.  In contrast, when children experience toxic stress, or stress in the absence of a safe, secure caregiving relationship, the parts of their brains responsible for emotional regulation do not develop normally. What results are symptoms that are then labeled "mental illness." 

I heard this phrase "office of homeland security of attachment" from Gerard Costa, director of the Center for Autism and Early Childhood Mental Health at Montclair State University. I was speaking at the 2nd annual Todd Ouida Children's Foundation Conference with the wonderful title: The Magic in Moments: Patterns of Early Relationships that Create Resilient Individuals and Peaceful Societies. While the phrase is meant to be humorous, the idea behind it is very serious.  

Our country is seriously lagging behind other countries in the care and attention we give to young children and their parents, with potentially devastating effects. A special government organization to take on this task would address this problem with the attention it deserves. This does not mean that the government has a role in parenting, which is a private, individual experience. Rather, such an organization could address such things as:

- parental leave policy

- comprehensive screening and treatment for perinatal emotional complications including 

depression and anxiety

- education of a workforce trained in working with young children and families

-  high quality child care, including supervision for child care workers 

Attending to early caregiving relationships will move us toward the goal of creating peaceful societies. Given that $247 billion is spent a year on children's mental health, focusing on early childhood is not only the right thing to do, it is also a worthwhile investment. 

  

DSM, NIMH on mental illness: both miss relational, historical context of being human

It seems that the National Institute of Mental Health (NIMH) may have dealt a death blow to the recently published Diagnostic and Statistical Manual of Mental Disorders (DSM 5) when the organization declared they would no longer fund research based on the DSM system of diagnosis. The views of NIMH director Thomas Insel were referenced in the recent New York Times article on the subject.

His goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

I am no fan of the DSM system, which reduces complex experience to lists of symptoms; focusing on the "what" rather than the "why."  However, the NIMH model has limits as well. There seems to be a wish to study mental illness in the same way we study cancer or diabetes. While I certainly have great respect for the complexity of the pancreas, or the process of malignant transformation of cells, trying to understand the brain/mind in an analogous way seems to be an unnecessary and even undesirable reduction of  human experience.

What is missing from both paradigms is recognition of the relational and historical context of being human. Fortunately there seems to be awareness that neither paradigm is complete. The Times article goes on to say:

Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders, though neither he nor anyone else knows exactly what it will look like.

The growing discipline of Infant Mental Health offers just such a paradigm. This discipline is characterized by four key components. First and foremost, it is relational, recognizing that humans (and that includes their genes and brains) develop in the context of caregiving relationships. Second, it is multidisciplinary. Experts in infant mental health offer different perspectives.  They come from many fields, including, among many others, developmental psychology, pediatrics, nursing, and occupational therapy.  Third, it encompasses research, clinical work and public policy.  The field looks at mental health within the context of culture and society. And last, it is reflective, looking at the meaning of behavior, not simply the behavior itself. The ability to attribute motivations and intentions to behavior is uniquely human, and research has shown that this capacity is closely linked with mental health.

Unfortunately when people hear the term infant mental health, they imagine babies lying on the couch.  In reality, the field offers a way of understanding all of human experience, well beyond infancy.  I recently taught a course on infant mental health to clinicians at the Austen Riggs Center, a hospital that offers intensive inpatient treatment for severely disturbed patients. None of them are infants- the youngest are in their late teens and most are well into adulthood.  My students found the insights from infant mental health very valuable for understanding and treating their patients.

The Center for Disease Control (CDC) Adverse Childhood Experience (ACES) study provides extensive evidence of the long-term effects of early exposure to a range of negative experience, including parental mental illness, divorce, abuse, and neglect, on mental health. The more severe the mental illness, the earlier in life disruptions to development probably occurred. Knowledge of infant mental health (that spans age 0-5) offers a textured understanding of this early experience.

Looking at an individual brain and/or genes, or listing the behavioral symptoms of an individual person, out of relational and historical context, how can one possibly understand the complexity of human experience? This complexity is represented by such things growing up in the home of a Holocaust survivor, a depressed parent,  in the setting of ongoing war trauma, with a physically and emotionally abusive parent, or some combination of all of these. A recent article on the blog ACES Too High,  "What motivated the Boston bombing suspects?" offers a fascinating look at the Tsarnaev brothers from an ACES perspective. The use of the word"motivation" in the title represents a curiosity about the meaning of behavior that is representative of an infant mental health perspective.

The ongoing research coming from the discipline of infant mental health offers growing knowledge about effective, primarily preventive, interventions. Not only do we need this research to continue, but we also need to grow a workforce trained in infant mental health to offer these interventions on a large scale. When the NIMH looks for a new paradigm towards which to direct funding, I hope they will look to the paradigm of infant mental health.

Sex and alcohol use by high school students on college visits

Recently I received an email alerting me to an important survey conducted by CARE about sex and alcohol use on overnight college visits for high school student applicants. I admit that despite practicing pediatrics for over 20 years, and having a high school senior in the thick of the college application process, I have not previously given this issue a moments thought. Certainly it seemed worthy of a blog post! The email read:

Roughly one in six surveyed teens (16 percent) who had been on an overnight college admissions visit reported drinking alcohol during the visit. Teens also reported engaging in sex or other intimate sexual behavior (17 percent), using drugs other than alcohol (5 percent) or driving while impaired (2 percent) during their overnight college visit. 

The study, conducted for CARE(Center for Adolescent Research and Education) and SADD(Students Against Destructive Decisions) by ORC International Inc. surveyed 1,070 U.S. teens from age 16 to 19, 270 of whom indicated they’d been on an overnight college admissions visit. It includes high school students currently making college visits and current college students reflecting on previous visits. Data was collected online between April 17 and 20, 2012.

Most concerning, in my opinion, is that for half of those kids, it was their first experience with sex or alcohol. This suggests that high schoolers visiting college may a particularly vulnerable group. They may be initiated into the world of college life before they are quite ready for it.  Below is a quote from A Higher Education, the Psychology Today blog post by Stephen Wallace, director of CARE:

New research from the Center for Adolescent Research and Education (CARE) at Susquehanna University and SADD (Students Against Destructive Decisions) reveals that  more than half (51 percent) of high school overnight visitors who reported drinking alcohol on campus (about one in six) report having done so for the first time.  Among those who reported having sexual intercourse (12 percent of those participating in an overnight visit), half (50 percent) said this had been the first time they had done so.

With regards to sexual encounters, it is quite likely, given the circumstances, that these are one time affairs. Such an experience may have negative consequences, particularly in the setting of emerging sexual identity.

The whole college application process challenges teenagers to focus, in what can and should be a healthy way, on their emerging sense of self and unique identity. For parents, offering background support and letting the child, with the help of college advisors, guide the process, is an excellent approach.

This survey, however, has opened my eyes to an issue that warrents parental involvement. Wallace offers some guidelines about addressing this issue, for both parents and teens. Every family has its own unique ways of communicating.  My hope is that in calling attention to the issue, it will help to prevent college bound teenagers from getting themselves into uncomfortable or unhealthy situations. 

Is big pharmas grip on childrens mental health care loosening?

Is it possible that our culture's over-reliance on the quick fix of medication to treat complex problems is waning? That alternative models of care offering meaningful support for early parent-child relationships are gaining increased recognition? My inspiring weekend with the current group of fellows in the UMass Boston Infant-Parent Mental Health Post-Graduate Certificate Program gives me hope that this is in fact the case.

One person in the group, an experienced neonatologist, has in the course of her clinical work increasingly recognized that what makes some premature babies do well and others not lies in the quality of their early caregiving relationships. She sent the group an article as evidence of the above trend, writing: 

I am attaching a very short paper from this month's Journal of Perinatology that describes incorporation of relaxation techniques into perinatal counseling. It uses terms such as "being with," "connections," and "compassionate presence." Ten years ago, this paper would have been flatly rejected by a prestigious journal as being anecdotal and merely descriptive. 

Peter Fonagy, the weekend's featured speaker, a great mind who has been likened to a modern-day Freud in terms of the transformative nature of his ideas, offers an alternative model from that presented by the pharmaceutical industry. Relationships can change the brain in more specific ways than drugs.

Fonagy identifies the quality that makes us uniquely human, different from animals. It is the ability to interpret other's behavior as having meaning. Humans alone understand that behavior is driven by motivations, intentions, desires and beliefs.

But the thing is, babies are not born knowing how to make sense of their own and other's behavior. They learn it from the people who care for them. When a parent is attuned with her baby in such a way that says, "I understand you," that child learns to understand not only his own mind, but also the minds of others. This learning takes place at the level of structure and biochemistry of the brain. This ability to interpret other's behavior in turn allows that child to make sense of the wider social world.

 Attuned early relationships of what Fonagy called "epistemic trust" are critical because they are "the superhighway for transmitting cultural knowledge." They are the means by which we learn about the world: how we learn to engage with others in a healthy and productive way.

Where does the motivation come from to shift from a quick-fix model of disease to one that promotes healthy relationships? The ACE study, which I have written about in previous posts, offers a kind of negative motivation. If we do not do something to change direction, there will be lots of bad outcomes in the form of such things as mental illness, violent crime, diabetes and heart disease. Fonagy offers more positive motivation. If we intervene early to promote secure safe relationships, we give children the tools to go out into the world, think creatively and move our society forward.

Fonagy points to three trends offering hope that things are changing in the way we as a society care for children and families. One is the increasing evidence of the impact of stressed early relationships on such long-term health outcomes as heart disease and obesity. The second is the decreasing influence of big pharma on mental health care, as evidenced by the marked decrease in development of new drugs to treat mental illness.  And third is the role of the Internet in disseminating new information. I am hopeful that this blog is one small part of that trend.

Five for Friday on a Satuday {forgive me}

I'm linking up with Kacey from Doodle Bugs Teaching to bring you my "Five for Friday" on a Saturday! #justcantkeepup

I'm trying to finish up this baby here....I made each sheet for my students last year as we went through the letters. I had to change some of the graphics since some artists have specific terms of uses, so it'll take me a day or two to post...look out for it, I'm going to be giving it away free next week! I have the letter "Aa" sheet up as a free sample...so if you'd like to snag yourself a copy you can find it here.

{Please forgive all the crappy cell phone photos}

I attended a two day conference on lesson plan design this week and BOY was it a whole lot of information!! We worked diligently on designing the perfect lesson, which btw, we all know does not exist! {don't worry, we didn't share our thoughts with the presenters...they were too sweet!}

We even had homework!! YIKES! 

 Here we did some brainstorming 

My word wall needs a little help. I just received my order of laminating film from Amazon so I'm quickly working to laminate my headers and words. I've been putting the words we've learned on a sad little pocket chart so I can't wait to get this up & running...but for now, it looks like this...bleh!  

 

EDUCENTS!! 

I love Educents! It's a flash deal website for educational products. There are many great products constantly being added, but don't blink! It'll end before you know it! What I'm loving now is this First Grade Bundle, ok....I'm a little biased because one of my items is featured in this bundle. But seriously, you get 18 products for only $24.99- that's less than $1.50 per unit!!! Now where else are you going to find a deal like that?! 

My other favorite deal going on right now are these "Writing Poems for Letters & Numbers". 

Perfect for my little ones! 

Pretty Puulleeesssee use my affiliate code if you decide to make a purchase! I will love you forever ;)

http://www.educents.com/#colormekinder

And finally, I gave myself a little treat for surviving one crazy- busy week! 

FRENCH MACARONS! 

Love, love, love these babies!! YUM!

Have a great weekend friends!!

42 Freebies on the 4th from your Kinderland Friends!!!

Happy 4th of July!!! I am so excited to finally be able to reveal the BIG SECRET!!! 

My Kinderland friends & I have some goodies in store for you!! 

42 goodies to be exact!

All you have to go to my FB page and click on this image at the top:

 After clicking on this image on my FB page, you will see this image:

After you grab my freebie, be sure to click on the circle to take you to the next participating member. If you make the full hop you will have grabbed 42 freebies in all!
 

Here is a sneak peak of my freebie!! 

Only available on my FB page & only available for 24 hours!! 

Happy Clicking!

Spinning Babies on the net

A beautiful controversary on breast feeding

New Blog on the Block

I'm so excited to share the new blogs I recently came across. If you have a minute please stop by these blogs and show these new bloggers some bloggy love :) 

Kaci Hoffer is a Kindergarten teacher who has some really awesome center ideas and lots more: 

 

Courtney from Once upon a substitute is a recent graduate with lots of FUN ideas & some cute pins from pinterest:

   

Meagan at Oodles of Teaching Fun is a 5th & 6th grade Reading & Spelling teacher who shares some links to great teacher resources that I can't wait to check out. One link that caught my eye is a website called "giggle poetry" {sorry I had difficulty uploading her button- I think the image was too small}. 

Ms. D over at The Eagle's Nest has taught Kindergarten for 14 years. She has LOTS of awesome ideas on her blog. I love her most recent post about letting her little ones hold their own election.
 

I've always got my eye out for blogs that focus strictly on Reading, since I'm so passionate about it, and when I came across this blog I almost fell off my chair. I love everything about this site and I hope you will too. MJ's got lots of fun & exciting things going on you MUST hop on by: 

And finally, Sarah over at The Eager Teacher {love the blog title} has a fun Dr. Seuss packet, {am I allowed to say that after all the Suessy controversy clip art..lol} some great pins from pinterest, and lots more...won't you hop on over and say hello? 

Hope you enjoy these new blogs I came across....and btw, I'm almost at 200 followers...I can't wait for another excuse to have a giveaway ;0

Happy *almost* FRIDAY!!! 

New Blog on the Block & a Not So New One

Thank- you everyone for your sweet words & well wishes. The wedding was beautiful and I had a BLAST!

Before I mention this week's new blogs I wanted to let you know about an amazing blog I have been following for a while now. 

Shawna is the teacher behind this blog which reviews picture books with the busy teacher in mind. She also offers information on genre, theme, reading level, and reading strategies that work best for that book. There is also a link to Amazon included if your interested in purchasing the book. I wish I had a resource like this when was working towards my M.A. in Reading.

And now for this week's new blogs on the block...

Kristen at Glitter and Glue is a Kindergarten teacher from Florida. She has some really awesome 100th day activities she recently posted.

and 

Sophia at How Cute is this! is a Kindergarten teacher who shares all things "cute" on her blog. 

If you have a minute, stop by these awesome blogs and take a look around ~ enjoy!! 

{we did some valentine's day interactive writing today~ I hope to share some freebies with you tomorrow if its not too late}

Have a Great Day!

New Blog on the Block

Happy Friday!!!!! 

In honor of so many wonderful blogs popping up here & there I wanted to start a weekly post called "New Blog on the Block". (If you'd like to be featured here, 35 followers or less, just send me an email). I started my blog back in November, but didn't really begin posting until December. I'm sure we can all remember the anticipation we had as we watched our number of followers climb. Let's all show these new bloggers some love as we welcome them into the blogging community. Tammy over at Teaching First also has a blogroll specifically for new bloggers. Stop by her blog if you'd like to be added. I know I've said it before and I'll say it again. I am so THANKFUL for this wonderful community. Each and every one of you have impacted my outlook on teaching in more ways than one. I'm extremely proud to be a part of something so positive and so wonderful!! 

{ok, sorry, enough of that}

NOW onto the "New Blog on the Block"

{drum roll please}

GLYPH GIRLS 

{click}

Don't you just love glyphs? I know I sure do. There are so many standards you can target with them, not to mention how much F-U-N the kids have doing them. Angela & Kelley are both 1st grade teachers who both have a lot of experience under their belt, not to mention some amazing glyph ideas {hence, the name}. Take a moment to stop by their blog and look around their tpt store. I'm sure you'll be glad you did!! {wink!}

Walchers on tv!

More on the value of apprenticeship