Mellow Babies: A big help for very little people Dr Christine Puckering Consultant Clinical Psychologist and Research FellowRoyal Hospital for Sick Children, Glasgow.
Babies are designed to communicate – they can’t do much else…• “There is evidence that even newborn infants, with their very immature though elaborate brains, limited cognitions, and weak bodies, are specifically motivated, beyond instinctive behaviours that attract parental care for immediate biological needs, to communicate intricately with the expressive forms and rhythms of interest and feeling displayed by other humans” (Trevarthen, 2001)
Sequence of development• At birth, sensory and motor areas are myelinated and the vegetative functions are working• The frontal lobes do not begin to function until six months and are not fully myelinated until adolescence/early adulthood• The capacity to make judgements and control emotion is not fully organised until the frontal lobes are in action and the types of decision made are formed by experience
Normal diurnal production of cortisolWaking Bed time
Diurnal production of cortisol inabused and neglected children Waking Bed time
Graph of the Yerkes –Dodson Law Performance Low Medium High arousal arousal arousal
When do we learn best?Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: Scotland’s Economic Prospects
THE LONG TERM EFFECTS OF EARLY EXPERIENCE:•1) The wiring of the brain•2) Sensory Integration•3) Emotional Literacy•4) Belief Systems•5) Relationship patterns•6) Empathy, conscience/moraldevelopment
WHAT ARE THE OUTCOMES FOR YOUNG PEOPLE OF POSTNATAL DEPRESSION?• Increased risk of depression especially early onset depression• More social and behavioural problems lasting into adolescence• Poorer language development• Poorer cognitive development especially in boys and in families with other social problems• NB just treating maternal depression does not change risk to child!!
Who needs most support?The parents who are least likely to engage in and benefit from parenting interventions are* • Young • Poor • Poorly educated • Lacking social and partner support • Suffering from psychological disorders themselves *NICE report 2006
What works in targeted services for infant mental health?• Narrow focus on sensitivity alone• Between 5 and 16 sessions• Between 6 and 12 months of age (no advantage in antenatal intervention)• Programmes including fathers showed increased sensitivity in fathers but diluted effects for mothers• The use of video feedback increased effect sizes for sensitivityBakermans-Kranenburg M.J., van IJzendoorn M.H., Juffer F., 2003. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin 129(2), 195-215.
WHY DEVELOP THE BABIES PROGRAMME?The developmental needs of the child and thecorresponding parenting tasks are specific to thisstage i.e lunch-time activities and workshops’ contentEarly intervention: focus on preventing attachmentproblems and increasing parental attunement.
MELLOW BABIES: THE INITIAL DIRECTION• Hard to engage families with a history of significant mental health and relationship difficulties• Significant post-natal depression• Child protection
Components of the Programme• Careful recruitment – Low levels of literacy – History of adverse relationships – Low self-esteem – Low trust• Child care and transport help• Personal group• Parenting workshop using parent’s own video• Hands-on lunchtimes• “Homework” to practice skills at home
Personal Group• A chance to reflect on the mother’s story• A chance to reflect on current relationships• A chance to reflect on mother’s mental health (CBT)
Clouds What I thought What the group thought What the group thought What I feltWhat I did
Mother-baby activitiesAim: to get mothers and babies face to face and attentive to each other and to have fun• Gentle Touch• Book reading• Interactive coaching (mirroring)• Nursery rhymes(see weekly programme)(also good for babies and dads)
Parenting Workshop• Feedback on mother’s videotape• Psycho-educational material• Dimension of parenting – Anticipation – Autonomy – Responsiveness – Cooperation – Distress – Control
Have A Go (homework)• A chance to practice mother-baby interaction• A chance to challenge negative automatic thoughts
Child Protection Outcomes• 2 groups• 10 families• 13 children• Child Protection involvement with 7/13 children
Child Protection OutcomesChild Protection Involvement• 7 children on the Child Protection Register at start of program.• 2/7 children de-registered by 6 month follow up stage. Legal proceedings dropped on 1 case.• 3/7 children returned from care at follow up point but remained on register
Child Protection Outcomes• 2/7 children remained in care. Court report provided by Mellow Parenting supporting the Local Authority’s application for Care Orders and Freeing for Adoption.
Edinburgh Postnatal Depression Scale inMellow Babies Group and Waiting List Controls20 Mellow Babies Waiting list1510 5 0 Before After P=0.035
Positive Interaction Measures in Mellow Babies and Waiting-list Control groups200 Mellow Babies Waiting List15010050 0 B A ef fte o re *P<0.023 r
Negative Interaction Measures in Mellow Babies and Waiting-list Control groups2015 Mellow Babies Waiting List10 5 0 B A ef fte o re r *p<0.025
What Mum’s Gained From Mellow Babies I• I learned to open and share my feelings.• The best thing was being able to sit relaxed, and cry, or say nothing or listen.• The most important thing I learnt was that I am worth it.• The most important thing I learnt was how to be more interactive with babies.• I now put him somewhere safe when he is upset and I cannot stand it.• It felt really good because everybody understands you.
What Mum’s Gained From Mellow Babies II• It was good seeing yourself on video because you see the difference in them and how you and your baby have bonded together.• The video meant you could see how different things were (compared to the beginning).• How did it feel in the group? Totally relaxed and trusting each other.• I don’t get so upset. Think first.• I can go out now. Trying to think positive.• The most important thing was listening to other people’s feelings, and my own