Pediatric Mental Health Care Must Be Family Mental Health Care [jamanetwork.com]

@Laura Haynes Collector posted:

Dr Prescott says experiencing max bodily physical pleasure  as a baby, epitomized by being held and carried, is the key to later non violence.

We are PRIMATES.  What human would think it's ok to take a baby monkey from its mother? 

Modern humans miss out on so many primals --  then we wonder why we're F'd up! To me the connection is patently obvious.

Consider:  would spending 10 hours a day in a Romanian orphanage be damaging to an otherwise healthy child?   (Wouldn't it feel depressing, at least, to be dropped off each day and begin the 10 hour wait to be picked up again?)

Further, that baby gets 1/3 less sensory input, socializing, modeling; 1/3 less reinforcement of a mind to mind connection with their mother aka attachment.   Even in a primal state, it takes years to develop the capacities and skills to possess decent control over the complexities and powers of our very powerful brains. 

Due to infant's head size and women's pelvic size, our brains are born  semi-formed; "raw" and need to grow further a great deal OUTSIDE the womb.  This takes 3 years.  Babies need more "womb" than they actually get -- so carrying is important to replicate the amount of motion-as-a-sensory-input that we need.   

Infancy and toddlerhood basically 'cure' the brain and make it more sophisticated and nimble by building capacity for interpenetration, trust, self awareness, interpretation of others, relational confidence, playfulness, calmness, stability, and pleasure-- at the time brain growth is TURBOcharged .  It's what our brains REQUIRE to grow properly.  However 'normal' not getting it has become.  This problem goes WAY beyond over abuse and it has massive consequences.  Mental health suffers when MINDS lie fallow at key times of needing INPUT.

James Heckman's work shows enriched input in the very earliest years of life is the game changer -- a dollar invested correctly at that time pays off 13% annually.  Year after year.  

How about a mother primally invested for 3 years?  Every costly social problem dissolves.

Universal Momcare, (or Dadcare) is what we need as a society to become mentally healthier!

 

 

 

Laura - I totally, 100% agree. Parentcare so parents can pour the love and investment in them into their infant. Once we get this going everywhere, all the time? Even for just ONE generation? We could have a generation without ACEs. Imagine the brain power that would be unleashed if all babies had the chance to develop in a loving, stress free, buffered environment. 

The La Leche League could help. There are so many resources. Policy makers just need to understand ACEs Science — especially the science of what you call “Baby ACEs,” and have the COURAGE to invest in babies and moms, not tanks and bombs.

Love you and your whole “take” on the opportunity we have as we create “a Better Normal.”

Carey Sipp

PS 1-2 year olds LOVE roughhousing as long as it feels safe.  The two year old I help watch loves me to throw him on the sofa.  He is however very physical and strong.

99.9% of communication with pre-verbal children is BODY TO BODY... roughhousing,  tickling, stroking, playing, hugging, cuddling.  

Play DEFINES interpenetration!:  Two organisms mutually decide to joke around together.

By 18 months, there begins a shift from solitary to social play with other infants, but this is a slow transition marked by a long period of "parallel play," with each infant playing alone near other infants.  Encounters between infants of 2-3 are likely to turn quickly into struggles and screaming.  Apparently, signals are misinterpreted, and behavior is erratic.  Too much novelty and tension, too much incongruity, and not enough predictability in their behavior make infants of this age incapable of sustaining a play interaction.  Instead, a state change in one or both parties terminates a bout soon after it begins. The next phase, rough and tumble play, begins at about 4-5 years of age in the human, when elements of aggressive, sexual and parental behavior are mixed in with a profusion of rough and tumble gymnastic maneuvers.   

Play provides a multitude of settings in which rapidly changing sensory simulation is repeatedly correlated in time with newly developed patterns of behavior.  Early social play --- such as the rough and tumble variety that characterizes so many mammals, including humans --- presents the sensory patterns of another similar body, together with segments of its own motor behavior.  The reafference resulting from these repeated correlations may provide a necessary organizing process for the establishment of sensory-guided social behavior that is appropriate, integrated and efficient later in life.  

By this conception, the young organism need only have crude approximations of segments of adult behavior to start with.  These segments would then be released in play and would gradually acquire the sensory guidance and the integration of sequences characteristic of adult adaptive behavior.  Without the experience of play and other social interaction s, these behaviors would continue to be elicited only in fragments, unintegrated with each other and lacking directed sensory coordination --- the very characteristics described for monkeys and rat pups deprived of peers.   

Obviously play, particularly in humans, provides many opportunities for ordinary learning, and much of the most successful educational approaches are built on that principle.  Social learning certainly takes place and plays and important role in the fine tuning of every kind of social behavior.  But the groundwork of sensorimotor coordination and behavioral sequence integration may take place at a more elemental level of plasticity, which allows undirected fragments of behavior to become synthesized into the species-typical sequences of sexual, aggressive, and parental behavior.  This  may well be how we seem to "know what to do" (more or less) on our very first try at these roles in adulthood.  The behavior just seems to be there, without having to be learned.  This quality has led us to label these behaviors as "instinctive" or "innate," but experiments with animals have shown that they are far from innate and depend upon experiences occurring a long time after birth.  We are beginning to unravel the nature of these crucial experiences and how they may come to facilitate normal development.  

Role in Development

 Prenatal and some neonatal behavior is made up of small units that do not last very long -----just fractions of a second ---- and involve only a few muscles at a time.  By the time of birth, some of these units which have the longest history of functioning are assembled into the simple goal-directed sequence of nursing.  But this involves only a part of the body and is relatively crude, repetitive, and stereotyped.  Early play behavior involves larger units of behavior, that is, more muscle groups acting in a coordinated fashion over longer periods of time in a relatively consistent pattern.  The movements are formed into short sequences and involve coordination of changing sensory patterns and motor output.  

Although the units of play behavior are longer and more complex than in the prenatal period, they are still shorter than adult behavior.   The sequences are put together in a highly variable order and are not organized toward a common goal.  Behaviors tend to be either exaggerated or perfunctory and occur in unpredictable order.  Gradually, sequences become more ordered, movements more economical and the sequences cluster together into predictable categories.  

Thus, it would appear that the sequences of behavior found in juvenile play may be a later counterpart of the individual movements found in the prenatal period. Their role may also be in promoting neurobiological development, but not the development of neurons, sensory receptors, muscles, and joints, for they are completed by this stage.  Rather, play may act to promote the neural integration of behavior,  the formation of neural systems capable of complex, goal-directed sequences that allow adaptation to the social and inanimate environment.  

In the rat there is much less play between adults and young but a period of vigorous social play with peers occurs from the second postnatal week to just before puberty.  Fragments of sexual, aggressive, predatory, and parental behavior can be identified in these playful interactions.  If male rats are allowed normal mothering until two weeks after birth and then some of them are housed alone, some in a group, and some alone but across a wire mesh from the group, then only the males raised in a group develop normal mating behavior when presented with a receptive female.   A group of males is as effective as a heterosexual group, so that prior experience with females is not involved.  Isolated males show aberrant responses such as climbing over and under, appear hyper-excitable, and direct their mounting and clasping approaches in a fragmented way toward flanks, shoulders, and heads of the females, as well as toward posterior regions.  Even when the female is approached from the rear, clasping, mounting and thrusting are not combined into an effective sequence allowing intromission and ejaculation.  

The control condition allowing proximity but preventing actual interaction by a wire mesh wall, helps to isolate behavioral interaction as the essential element of experience.  These males maintained sensory contact with the others through smell, hearing and sight; they were aware of the groups' interactions and were not subjected to gross sensory deprivation.  Yet their sexual performance in adulthood was not significantly improved over isolated rats.  

The results of this study leave us with the conclusion that without play (or hudding, grooming, or some other behavioral interaction in the juvenile period) the sexual behavior of the male rat develops only in a fragmented, misdirected, and uncoordinated form.

Play: The Cradle of Adult Behavior

By most definitions, play should not be taken seriously.  It is what children are told to do when adults are  tired of having them underfoot.  Nothing seems to be accomplished by it except that it seems to be entertaining and relaxing; something to be done when no other needs are pressing.   In the past, only a few scientists gave the topic serious thought, and for the most part this has been for its role in the develop0ment of cognition and in the creative process.  

Recently, biologists have become aware that play occurs with great frequency in the early development of a wide variety of mammals, particularly those having long periods of parental dependency and complex social behaviors similar to the human.  Its clear presence has demanded some understanding.  The problem that play presents to a biologist is that it lacks a biologically significant goal such as protection or reproduction and indeed does not appear to have any adaptive function.   Since biological thinking about behavior is usually organized around its role in adaptation, this has posed conceptual problems.  Furthermore, play appear to be composed of elements from other behaviors, rather than to have a distinctive pattern of its own, making the category difficult to deal with even at a purely descriptive level.  

With all these difficulties, why bother with it?  The answer is that play occupies the major part of the wakeful behavior of higher mammals during the transition from infancy to adulthood and that it provides the first expression of the behaviors we characterize in adults as exploratory, aggressive, sexual, affiliative, and parental.  In addition, it provides early developmental precursors of motor and sensory skills, language, abstract intelligence and humor.  That is, if you trace any of these adult activities back to its earliest crude approximations in early development, you will find it occurs during play.  

SPECIAL CHARACTERISTICS

The very fact that play behavior is uncoupled from consequences gives it some of its identifying character.  It is often repetitious and seems to lead nowhere.  In fact, if an actual sequence is carefully studied, it resembles adult adaptive behavior except that the elements are scrambled.  For example, a young mammal at play may begin with a pounce on some object or other animal and then run about chasing it.  In addition, the behavior itself is exaggerated, first by the extent of movements, second by repetition, and third by prolongation of certain phases of movements.   These quantitative modifications are very easy for an adult or older child to recognize and allow the proper distinction for an adult or older child to recognize and allow the proper distinction from "serious" (goal-directed) behavior.  This is necessary so that the sexual or aggressive nature of some play behaviors are not misinterpreted.  Apparently, as an additional safeguard of this sort, play signals have evolved:  facial expressions or bodily movements that make clear what is about to follow is "just a game."   These latter features make it possible for play behaviors to become more and more similar to adult goal-directed behaviors in a gradual shading off process, which extends into adulthood and even old age in many mammals.  Under the protection of play signals, movements become more and more economical, sequences become purposefully ordered, and extraneous frills are eliminated.  But, if properly signaled, it is still responded to playfully by other animals.  

Thus, although play behavior resembles many other behaviors, it has distinctive features that allow it to be differentiated.  It occurs in a wide range of mammals during the juvenile period, so that it is not a creation of human cultural evolution.  Rather, it appears to be a general fact about behavior development, a universal stage in the maturation of social animals.   But why does it occur?  What is it's survival value?  What benefits does it provide for evolutionary fitness?  This last question is particularly challenging because of the nonadaptive character of play behavior.   

Dr Prescott says experiencing max bodily physical pleasure  as a baby, epitomized by being held and carried, is the key to later non violence.

We are PRIMATES.  What human would think it's ok to take a baby monkey from its mother? 

Modern humans miss out on so many primals --  then we wonder why we're F'd up! To me the connection is patently obvious.

Consider:  would spending 10 hours a day in a Romanian orphanage be damaging to an otherwise healthy child?   (Wouldn't it feel depressing, at least, to be dropped off each day and begin the 10 hour wait to be picked up again?)

Further, that baby gets 1/3 less sensory input, socializing, modeling; 1/3 less reinforcement of a mind to mind connection with their mother aka attachment.   Even in a primal state, it takes years to develop the capacities and skills to possess decent control over the complexities and powers of our very powerful brains. 

Due to infant's head size and women's pelvic size, our brains are born  semi-formed; "raw" and need to grow further a great deal OUTSIDE the womb.  This takes 3 years.  Babies need more "womb" than they actually get -- so carrying is important to replicate the amount of motion-as-a-sensory-input that we need.   

Infancy and toddlerhood basically 'cure' the brain and make it more sophisticated and nimble by building capacity for interpenetration, trust, self awareness, interpretation of others, relational confidence, playfulness, calmness, stability, and pleasure-- at the time brain growth is TURBOcharged .  It's what our brains REQUIRE to grow properly.  However 'normal' not getting it has become.  This problem goes WAY beyond over abuse and it has massive consequences.  Mental health suffers when MINDS lie fallow at key times of needing INPUT.

James Heckman's work shows enriched input in the very earliest years of life is the game changer -- a dollar invested correctly at that time pays off 13% annually.  Year after year.  

How about a mother primally invested for 3 years?  Every costly social problem dissolves.

Universal Momcare, (or Dadcare) is what we need as a society to become mentally healthier!

I do agree that parent education and breaking the chain of intergenerational transmission of poor mental health is important -- but if we seek to explain the PLUNGE in childhood mental health we see today,  it is much bigger than that.  The plunge is due to a widespread input deficit-- because we also see decent, caring parents with kids who are anxiety ridden.  WHY?  Because they did not have the *sufficient intensity or number* of attachment experiences.  

A really key concept is INTERPENETRATION.  Does the child have a person in their lives who s able to interpenetrate with them?  Being intuited or "read" by your mom -- "oh is that dog scaring you?, let me pick you up..."-- is an interpenetration experience.  A parent making a "joke," and baby "getting" the joke, is interpenetration.   It's the experience of two minds understanding one anther and entering one another's *mental* experience.

Many little kids get waaaay too LITTLE of this.    They have nobody inviting them into this kind of intimate connection.  Whereas an atachment parenting parent would be interacting like this all day long with their baby.

The biggest lie of parenting, that ushered our current MH disaster in,  is "quality time."  It needs to be quantity time, 0-3.  Quantity IS quality -- which is why carrying is so key.

Daycare???  O-3 is when children attach.  Lack of attachment experiences is to mental health  like not eating enough vitamins is to physical health.  We need to wake up!!!