Wednesday, April 8, 2009

Babies with BiPolar? Not quite... (edited)

(The edits are small and probably insignificant for anyone who read it before - I just posted in a big hurry and when I went back found a number of little things that I wanted to adjust/correct. Content stays the same!)
I'm writing this post as a response to another bloggers' post - but I won't give out who. But the gist of her post was about a situation where someone suggested that the 6 months old baby of a depressed mother should have a mental health assessment completed to see if the baby was having mental health problems. Now, the author of the post was agast - and I can see why. Giving a 6 month old a diagnosis?? Has someone lost their mind?? I would have probably thought so too - before about 15 months ago...

See, despite all my talk about foster care - where my true heart is - I am currently a supervisor and therapist at a Community Mental Health Agency. And the children on my caseload and the programs I supervise all focus on children who are 0-7 years old. Thats right, ZERO to 7 years old. Now, most of the kids I see are more in the 3-7 year old range but occasionally I have a toddler or two year old. And I would like to be working with even younger children - we are trying to get the word out in our area. Let me back up a minute and tell you how I even got here:

WAY back (okay, like 10ish years ago) in the day when I was in college, I worked at our University's "Laboratory" preschool - Kindergarten. (I always feel like that term makes it seem like we were experimenting on the kids!) But really, it means that the preschool was located on the university campus and was used to help teach Early Education majors about working in a school. It also meant that all the classrooms were led by Master's level teachers and the "Assistant Teachers" all had bachelor degrees. If you know anything about preschools/daycares you know that most states barely even require an Associates degree for caring for young children - but that is a post all unto its own. Also, the Lab School employed college students to work in the classrooms to improve ratios. For example - state standards for a 3-5 year old classroom was 1 adult to 15 kids. Our ratios were more like 1 adult to 5 kids. I worked primarily in the infant, toddler, and 2's rooms. I worked there all four years of college. Then I got hired as an "Assistant Teacher" for the toddler classroom after I got my bachelors degree and worked there for another 2 years. Let me tell you - the stuff I learned about children, child development, and parents has been PRICELESS in the work I've done since then. So, when I made the tough decision to leave child welfare (another long post) and got offered the chance to combine my two passions - Early Childhood and Social Work - I was raring to go! So, back to it..

One of the main tasks I was given Day One of being a supervisor was to Co-lead a supervision group focusing on working with children 0-7 years old. I was terrified because although I knew a lot about young children and a decent amount about therapy - I had no idea how to DO therapy WITH young children! Lucky for me, the other leader was a contracted consultant who is also a Infant Mental Health Specialist. I was intrigued by this thing called "Infant Mental Health". And boy have I learned a lot!

The thing is, we KNOW that mental health problems start very young! A child can start forming attachment at birth right? So, wouldn't it reason that attachment disorders can start at birth?(read "Ghosts from the Nursery"). I will never forget one of my college professor's experience in adopting a baby girl from Korea. Maya was adopted at 6 months old and started attending the Lab School at 9 months old. I was there the first day she attended. She looked (physically) like a much younger baby. She still couldn't roll over very well, her legs had almost no muscle tone, and the back of her head still showed the flattening that resulted from months of laying unattended in an orphanage crib. But, those physical delays were nothing compared to the social and emotional deficits she suffered from. Maya never cried. She made poor eye contact and she was completely uninterested in the other children or adults in the room for the first year she was with us. Slowly, over time and with a lot of work she began to cry when she needed something, smile when interacted with, and began to show preferences for her favorite caregivers. But she was still far from your "average" little girl. As a pre-schooler, Maya still showed significant signs of disorder in her social interactions. She didn't make her first peer-aged friend until she was in the 2nd grade. Maya is 9 now and I still see her Mom occassionally. Maya is doing well but still struggles at reading other people's emotions, understanding social cues, and interacting appropriately with other kids. Thank God her adoptive mom is a Child Development/Educational Psychology professor! Prior to Maya, I never would have believed that the effects of things that happen to a baby prior to 6 months of age could have such terrible and long lasting effects!

And its not just that severe form of neglect that is so harmful. If a baby experiences trauma, such as a domestically violent household, they can suffer the effects of PTSD. They can become hyper-vigilant, have restless sleep and an over-active startle response. Guess what often happens to a baby with an over-active startle response? They cry - A LOT. And guess what happens to a baby who cries a lot in a household where tempers already run high? Its not good - their risk of being abused goes through the roof.

And if a baby lives with a depressed mother who can not interact, care for and stimulate the baby properly you will begin to see signs of depresson in the baby - lack of eye contact, irritability, flattened affect. Guess what could happen when the baby stops making those connects with their already struggling Mom? Mom can start to feel rejected by her baby, she starts to feel awkward and unconsciously avoids the baby (and the rejection). Before long, what do you have? A toddler who is doing what toddlers do - being difficult, throwing tantrums, trying to assert their independance... Then guess what Mom does when she can't read her child's cues because they haven't developed that kind of secure relationship? She gets frustrated. She yells more. She makes unreasonable demands of her child. And they still aren't bonding appropriately. Still no intervention here? Pretty soon, you've got a Mom bringing her child in to MY agency because at 5 or 7 or 10 years old he is completely out of control. And then what will he end up with? A diagnosis like ADHD, Disruptive Behavior Disorder, ODD, or worse. And look at all the chances we've missed to address Mom's isses AND the effects it is having on the baby!

Yes, young children are resillient - but only if they are in a supportive environment. I get the hesitation to diagnose or "label" a baby with a mental illness. (Trust me, most kids in my office get the diagnosis "Disorder of Childhood, NOS" because I refuse to give them anything much worse.) Diagnosis a very young child is a completely different thing. They are even developing a diagnostic tool to use with children 0-3 years old. Its called the DC0-3 and trust me, you won't find BiPolar disorder in there. You don't even START looking at an "axis I" diagnosis until you've assessed the baby's social-emotional functioning, pre-existing medical conditions, and various life and parent/child relationship stressors. Once you've looked at all of that you can move on to looking at the "axis I" diagnoses (again, they are completely different than ones found in the DSM). And once you are there - they focus on the most obvious first. "Bereavment" and "PTSD" trump everything.

So, most 'Infant Mental Health' does not focus on the baby but on the baby's caregivers and environments. So, its not as if we are giving the baby traditional talk or even really play therapy. But we are providing interventions to alleviate symptoms, which is essentially - therapy. Think about how many preschoolers/elementary/teenagers wouldn't have to have such extreme forms of therapy if someone had seen the signs that something wasn't right in their environment as a baby!

Ok, what started as a comment on someone else's blog turned into this whole LONG post - hope I didn't bore or terrify you all too much. But I'm pretty passionate about this. I truly believe that if we just start reading the signs of distress in our littlest people, we can prevent a lot of the truly horrible diagnoses (Conduct Disorder, Bi-Polar, RAD) for our children later in life.

13 comments:

  1. You are so right. I've seen it as a social worker AND as a foster parent. I saw it a lot in my drug exposed infants who spent time at home with their birth families before coming into foster care. I don't know if it was the probable prenatal exposure, the neglect or a combination of the two. A lot of times the pediatricians would say that drug exposed infants don't like to be touched but what if it wasn't just the drugs? What if it was the neglect that was leading to attachment issues even at such a young age? So sad. Thanks for this post.

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  2. Thanks for the post. I actually found it very interesting and it's not just because I studied psychology, counselling and education. AND it's not just because I am a bit of a nerd....:) Honestly though, I think alot of it makes a whole bunch of sense so I really appreciated it. Good post.

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  3. Whew..... seriously, I was a little scared about posting this! I'm glad my first two comments were positive. But please dont' be afraid to tell me if you still don't agree or have concerns! I'm happy to explain more or just hear another opinion!

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  4. very interesting post, and I agree that so much affects them at a young age.

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  5. Hi there, thanks for reading my blog, and thanks for giving me more insight into the mental health of children. I admit that I hadn't really thought about the bigger picture, as it were, and maybe I did write in haste a little. Having said that, the child I wrote about showed none of the behavioural symptoms you describe, as I said the doctor who saw him felt he was a very healthy, happy baby, and it was the fact that despite him being totally "normal" (if normal really exists...) at this stage that made me wonder why someone would worry about his mental health! Also, I agree that we should be reading the signs from day one, but if you look and the signs aren't there.... Anyway, as I said, thanks for the insight, I really admire your passion. Thanks also for a great blog, I only discovered you recently but when I have some spare time will try & read some of your archived stuff. Keep up the good work :-)

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  6. I completely agree - signs should be watched for, but NOT made up! :) I realize that the baby you posted about didn't seem to have any signs - perhaps the person who recommended the MHA hadn't really been around the baby but was just worried given the circumstances? Either way - my broader point was the that I'd rather be safe than sorry. It won't hurt to have a child assessed and be told they are fine. But it can cause a world of hurt if their are warning signs and everyone just goes along believing "its just a baby". Thanks for reading!

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  7. Excellent post and I concur. A friend sent this to me today and it looks like a really great class and it's a webinar. It goes right along with your post!

    https://www.meds-pdn.com/continuing_education.php?seminar_id=2419

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  8. Ooohh... you've just hit on my newest obsession Lisa! I have recently become absolutely fascinated by the effects of trauma and other stressors on the brain. I may really have to consider doing this!

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  9. As a new MSW my first job is with an early intervention agency. This was the first time I had even heard of the term 'infant mental health.' I agree with you that this is one of THE critical times to look at intevention/'therapy' as a means to prevent future child-focused behavioral/MH diagnoses. It kills me how quickly children get labeled as having problems rather than focusing on the environment and parent-child dyad.

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  10. Attachment is the key! I think many of us who work in mental health are just beginning to realize this, although we studied it all along (those of us in the field). I have a very hard time diagnosing any child I work with as Bipolar. Children are such complicated beings- constantly changing and developing. I think many who are diagnosed with bipolar are often kids with attachment difficulties.

    Enjoyed the post!

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  11. Very fascinating post! Where I work I'm often called in to do assessments of mom shortly after they've given birth if the OB nurses have concerns about PPD and such. Your post makes it even more clear how important early intervention for mom can be, as well as for baby.

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  12. Really interesting stuff. Thanks for sharing.

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  13. I completely agree with this! I've always felt that I could sense something with children as young as a month old at the nursery. Sometimes they feel like they already have this nervous energy around them. I've also seen very young babies definitely show a response of fear when turning the lights out during nap or sleep. Their little bodies just completely tense up and their eyes are so wide and they are on high alert.

    Although we may not consciously remember things from our childhood I feel that they greatly affect us. It's good to know that there are methods out there that can help at a very young age.

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