Overcoming developmental risk: A biopsychosocial foundation for early interventions
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Overcoming developmental risk: A biopsychosocial foundation for early interventions Oslo—RBUP—June, 2009 Arnold Sameroff [email protected]
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Overcoming developmental risk: A biopsychosocial foundation for early interventions. Oslo—RBUP—June, 2009 Arnold Sameroff [email protected]. Academic 2. Social 3. Political. How do we understand children? How do we improve children? Who is responsible for children?. - PowerPoint PPT Presentation
Transcript of Overcoming developmental risk: A biopsychosocial foundation for early interventions
Overcoming developmental risk: A biopsychosocial foundation
for early interventions
Oslo—RBUP—June, 2009
Arnold [email protected]
Agendas for Intervention Professionals
1. Academic
2. Social
3. Political
• How do we understand children?
• How do we improve children?
• Who is responsible for children?
Agendas for Intervention Professionals
2. Social Agenda
How can we improve children’s lives?
Opportunities for Prevention or Intervention
INFANCY CHILDHOOD ADOLESCENCE ADULTHOOD
BIOLOGY
PSYCHOLOGY
SOCIAL
ECOLOGYSOCIAL
ECOLOGY
OTHER
SELFSELF
Improving Developmental SuccessImproving Developmental Success
1) Make Children More Resilient1) Make Children More Resilient
2) Make Environments Less Risky2) Make Environments Less Risky
Infant Competence
• Obstetrical Problems• Newborn Pediatric Problems• Newborn Brazelton Scores• 4-Month Temperament• 4-Month Development Scores• 12-Month Development Scores
3.0
3.2
3.4
3.6
3.8
4.0
4.2
Low Moderate High
Early Social Risk
4-Y
ear M
. H
.
High
Low
Infant Competence
Infant Competence Predicting to 4-Year Mental Health
4-Year Mental Health Predicting to 18-Year Mental Health
50
60
70
80
90
Low Moderate High
4-Year Social Risk
18-Y
ear M
enta
l Hea
lth
High MH
Low MH
4-Year
60
70
80
90
Low Moderate High
13-Year Social Risk
18-Y
ear M
enta
l Health
High
Low
13-Year (Y)Mental Health
13-Year Mental Health Predicting to 18-Year Mental Health
18-Year Mental HealthPredicting to 30-Year Mental Health (PIRS)
18-Year MH
2
3
4
0 1 2 3 4+
18-Year Social Risk
30-Y
r. M
enta
l H
ealt
hHigh
Low
2
3
4
0 1 2 3 4+
18-Year Social Risk
30-Y
r Phy
sica
l Hea
lthHigh
Low
18-YearMental Health
18-Year Mental HealthPredicting to 30-Year Physical Health
PhiladelphiaAdolescent Development Study
Todd Bartko, Jacque Eccles
Frank Furstenberg, Tom Cook, Glen Elder
500 11- to 14-year olds Urban Setting
Examine Multiple CompetenciesExamine Multiple Risks
Social Ecological ModelGEOPOLITICAL
COMMUNITY
FAMILY
PEERSCHILD
PARENT
SCHOOL CHILD
20 Negative20 NegativeEnvironmental InfluencesEnvironmental Influences
20 Negative20 NegativeEnvironmental InfluencesEnvironmental Influences
Proximal• Parent-Child Interaction• Parent Characteristics• Family Structure & Economy
• Family Management• Peers• School• CommunityDistal
Indicators of Adolescent Success
• Psychological Adjustment
• Few Problem Behaviors
• Academic Competence
DepressionAngerSelf-Esteem
Substance UseEarly Sexuality DelinquencyViolence
Grades
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
1
0 1 2 3 4 5 6 7+
Multiple Risk Score
Sta
ndar
dize
d m
eans
Psychological Adjustment
Problem Behavior
Academic Performance
Resourcefulness
High
Low
Psychological AdjustmentProblem Behavior Academic Performance
Multiple Risk
HIGHMEDLOW
1.0
.8
.6
.4
.2
.0
-.2
-.4
-.6
-.8
-1.0
Multiple Risk
HIGHMEDLOW
1.0
.5
0.0
-.5
-1.0
Multiple Risk
HIGHMEDLOW
1.0
.5
0.0
-.5
-1.0
Lines indicate means and 95% confidence intervals
Question:
Can Personal ResilienceOvercome Environmental Adversity?
Answer:
Not for most people,For most of the time!
Improving Developmental SuccessImproving Developmental Success
1) Make Children More Resilient1) Make Children More Resilient
2) Make Environments Less Risky2) Make Environments Less Risky
Political Strategies for Social Intervention
Conservatives-----Preserve the Family
Liberals------------Eliminate Poverty
Psychological Adjustment
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
Low (0-2) Moderate (3-5) High (6+)
Multiple Risk
Stan
dard
ized
mea
ns
Problem Behavior
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
Low (0-2) Moderate (3-5) High (6+)
Multiple Risk
Academic Performance
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
Low (0-2) Moderate (3-5) High (6+)
Multiple Risk
Preserve the Family
Single Parent
Two Parents
Psychological Adjustment
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
Low (0-2) Moderate (3-5) High (6+)
Multiple Risk
Sta
ndar
dize
d m
eans
Problem Behavior
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
Low (0-2) Moderate (3-5) High (6+)
Multiple Risk
Academic Performance
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
Low (0-2) Moderate (3-5) High (6+)
Multiple Risk
Eliminate Poverty
Below Poverty Level
1 to 2 Times Poverty Level
> 2 Times Poverty Level
Percent of Families in High and Low Risk Groups
Percent of Families in High and Low Risk Groups
7%22%6%15%44%High (8+)
54%34%60%35%13%Low (0-3)
TwoParents
Single Parent>$30,00
0
$10-30,000>$10,00
0
Family Structure
IncomeRisk Group
If single factors (money, parents)don’t change children’s lives,
What about multiple factors?
Promotive Factors
Changing Many Settings
Making Big Changes
From Risk Factors to
Promotive Factors
20 Positive 20 Positive Environmental InfluencesEnvironmental Influences
20 Positive 20 Positive Environmental InfluencesEnvironmental Influences
Proximal• Parent-Child Interaction• Parent Characteristics• Family Structure & Economy• Family Management• Peers• School• CommunityDistal
-0.9
-0.6
-0.3
0
0.3
0.6
0.9
1.2
1 2 3 4 5 6 7 8 9 10 11 12 13+
Promotive Factors
Co
mp
eten
ce
Psychological Adjustment
Self-Competence
Problem Behavior
Activity Involvement
Academic Performance
-0.9
-0.6
-0.3
0
0.3
0.6
0.9
1.2
1 2 3 4 5 6 7 8 9 10 11 12 13+
Promotive Factors
Co
mp
eten
ce
Psychological Adjustment
Self-Competence
Problem Behavior
Activity Involvement
Academic Performance
Psychological Adjustment
Self-Competence
Problem Behavior
Activity Involvement
Academic Performance
Self-Competence
Problem Behavior
Activity Involvement
Academic Performance
Social Agenda
What can be done to increase developmental success?
Need to improve many settings
Making Small Changes
Early Interventions
and the
Transactional Model
Social Ecological ModelGEOPOLITICAL
COMMUNITY
FAMILY
PEERSCHILD
PARENT
SCHOOL CHILD
Family Setting
FAMILY
CHILD
PARENT
CHILD
Regulation Model
Development
Other-Regulation
Self-Regulation
Who’s Suffering?
• Infant
• Parents
• Professionals
• Sleep, Feeding, Crying
• Stress, Depression
• Abuse and Neglect
Who’s the Patient?
• Infant
• Parents
• The Relationship
• Themes
Structural ModelMotherhood Constellation
Daniel SternNadia Bruschweiler-Stern
Process ModelTransactional Diagnosis
Arnold SameroffBarbara Fiese
Motherhood Constellation
Bact Mact
Motherhood Constellation
Bact Mact MrepBrep
Motherhood Constellation
Bact Mact MrepBrep
Tact
Trep
Motherhood Constellation
Ba MaMrBr
Ba MaMrBr
Ba MaMrBr
Parent
Child
time
Transactional Diagnosis
P2
P4
C1 C3 C5
3-R’s of Intervention3-R’s of Intervention
Remediation
Redefinition
Reeducation
3-R’s of Intervention
Parent Parent
Child Child
Remediate Reeducate
Redefine
time 1 time 2
Remediation
Indicated Child Conditions Low Birth Weight Malnourishment Behavior/Emotional Problems
Parent
Child
Remediate
Remediation Low Birth Weight Babies
Problem Small, fragile appearance Weak responses
Interventions Gentle Stimulation
Deep Massage Passive Limb Movement Increases Activity/Alertness
Non-nutritive sucking Accompanies Tube Feeding Increases Weight Gain Earlier Discharges
Parent
Child
Remediate
Remediation Malnourished Infants
Problem Unresponsive Inactive
Feeding Intervention Greater Responsiveness Increased Energy Level Provide Stronger Cues
Parent
Child
Remediate
Remediation
Medical Interventions Surgery
Cleft Palate Down Syndrome
Medication Mood Colic
Parent
Child
Remediate
Redefinition
Indicated Parent Conditions Failure to adapt to exceptional child Failure to distinguish mother perception from
child behavior “Ghosts in the Nursery” Negative attributions
Parent Parent
Redefinition
Failure to Adapt to Exceptional Child Problem
Disability, Low Birth Weight Parent feels unqualified to care for child
Only professionals competent
Intervention Emphasize Typical within Atypical
Sleeping, Eating, Plays, Attends Demonstrate Responsiveness
Brazelton Demonstrations
Parent Parent
Redefinition
Failure to Distinguish Mother Perception from Child Behavior
Problem Poor fit between parent beliefs and infant behavior Crying interpreted as opposition or “bad”
Intervention Relabeling Reinterpreting age-appropriate behavior—intentionality
Parent Parent
Redefinition
“Ghosts in the Nursery” Problem
Carryover from own experience of being cared for Own mother’s voice Insecure attachment experience (AAI)
Inconsistent, unreliable, abusive Carried forward into new attachment relationship
Intervention Infant-Parent and Infant Toddler Psychotherapy Parent Treatment
Parent Parent
Redefinition
Negative Attributions Problem
Parent’s negative view of others (self?)
Intervention Positive Adjective-Bugental
Parent Parent
Reeducation
Indicated Parent Conditions High Risk Parents Teenage Parents Low Birth Weight Infant Developmental Disabilities Overachieving Parents
Parent
Child
Reeducate
Reeducation
High Risk Parents Problem
Low Resource Parents Retarded Parents Maltreating Parents
Intervention Interaction Guidance—McDonough Project STEEP—Erickson & Egeland Infant Team—Zeanah & Larrieu
Parent
Child
Reeducate
ReeducationInterventions
Teenagers School Programs Teenage Fathers Involvement
Low Birth Weight Infant Vermont Program Infant Health & Development Program
Developmental Disabilities OT, PT, ET
Overachieving Parents Integrating Parenting and Teaching Roles
Parent
Child
Reeducate
3-R’s of Intervention
Parent Parent
Child Child
Remediate Reeducate
Redefine
time 1 time 2
Relationships Affecting Relationships
Parent Parent
Child Child
Remediate Reeducate
Redefine
time 1 time 2
Intervener
Intervener
Intervener
Motherhood Constellation
Bact Mact MrepBrep
Tact
Trep
Dynamic System
Relationships Affecting Relationships
GEOPOLITICAL
COMMUNITY
FAMILY
PEERSCHILD
PARENT
SCHOOL
Transactional DiagnosisOver-Simplified Decision Tree
Is ChildTreatable?
Do Parents HaveChild Rearing
Skills?
Remediation
Redefinition
Reeducation
YES
YES
NO
NO
Agendas for Infant Mental Health Professionals
3. Political Agenda
Who’s responsible for children?
Unlocking Doors
• Identifying who controls resources
• Changing allocation of resources
• Understanding what motivates funding decisions
H.M.S. Titanic
Locking Doors
Fatality Rate for Women on the Titanic
0%
10%
20%
30%
40%
50%
1st Class 2nd Class 3rd Class
Unlocking Doors
• Identifying who controls resources
• Changing allocation of resources
• Understanding what motivates funding decisions
Opportunities for Prevention or Intervention
INFANCY CHILDHOOD ADOLESCENCE ADULTHOOD
BIOLOGY
PSYCHOLOGY
SOCIAL
ECOLOGYSOCIAL
ECOLOGY
OTHER
SELFSELF
Unlocking Doors
• Identifying who controls resources
• Changing allocation of resources
• Understanding what motivates funding decisions
Motivation for Political Funding
• Conservatives vs. LiberalsFamily vs. Government Control
Personal Responsibility
• Medical Disease vs. Psychological ProblemToxic Brain
• Prevention vs. TreatmentPublic Health—Something for nothing
Cost-Benefit Analysis
YX
SuccessfulAdulthood
Babies
?
YX
Children Adult Mental Health
. . . but not simpler. "
“Everything should be as simple as possible
Albert Einstein
