Reframing caring for parents who struggle with substance-use disorders

Nancy Suchman and the colleagues she influenced have produced ground-breaking and attitude-challenging work in understanding how parenting and substance use come together. Dr Suchman and her colleagues make the claim that there is nothing about a substance-use disorder that precludes effective and sensitive caring for children especially with interventions that focus on the parent–child relationship. Suchman's legacy is to highlight how substance use as an illness pulls individuals away from important, caring relationships and limits their giving themselves to those relationships. Restoring the salience of caring relationships and of the individual's ability to care may be as impactful on their substance use as a strict focus on the reduction of drug use and achieving abstinence.     

Early childhood mental health consultation: Care providers’ experiences of the consultative relationship

This article presents findings from a qualitative research study exploring child care teachers’ experiences receiving early childhood mental health consultation (ECMHC). As an emerging intervention in early childhood education, ECMHC is already yielding promising results, namely in helping teachers better address challenging behaviors in their classroom and promote a more nurturing classroom environment. However, there remains a lack of personal testimony from teachers who receive this intervention. Considering that teachers are the primary focus of most ECMHC interventions, the purpose of this study was to examine child care teachers’ personal experiences receiving consultation. Eight child care teachers were interviewed for this study. Results from this study illuminate key interpersonal processes in the development of the consultant–consultee relationship, indicate what teachers consider to be the most helpful components of consultation, and speak to the challenges that teachers experience in consultation. By examining the personal testimony of child care teachers who have received ECMHC services, consultants and researchers can consider ways to expand and improve future implementation of ECMHC.     

EARLY PARENTING SUPPORT AND INFORMATION: A CONSUMER PERSPECTIVE

The transition to parenthood is a period of both joy and challenge for most parents. There is a recognized need to support parents during this period, yet existing interventions have shown limited evidence of efficacy. This study takes a consumer‐focused approach to examine the needs and preferences of parents both prenatally (n = 77) and postnatally (n = 123) for parenting support. The study used a cross‐sectional design with a purpose‐built online survey. Parents were recruited via online forums, Facebook and parenting blogs, childcare centers, and playgroups. In general, all parents were satisfied with their current levels of both formal and informal support, and about one fourth of parents had accessed a parenting intervention. Parents expressed a moderate level of interest in additional parenting information, and parents expecting their first baby indicated preferences for information about basic baby care needs whereas postnatally, parents expressed more interest in topics around self‐care and behavior management. The implications for developing interventions and engaging families are discussed.     

Working in the borderland: early relational trauma and Fordham's analysis of ‘K’

This paper outlines a view of early relational trauma as underlying borderline states of mind, and argues that Knox's 1999 paper on internal working models and the complex provides a basis for understanding such states of mind. The author argues that in addition to internal working models, the complex also embodies and contains primitive defences of the core self. He outlines how these apply on the objective, subjective, transference and archetypal levels, and in direct and reversed forms and applies this to the account of Fordham's analysis of his patient ‘K’, which ended in impasse. The paper explores the dynamic that emerged in that analysis and suggests that it could be helpfully accounted for in terms of the co‐construction and re‐construction of early relational trauma in the analytic relationship.     

IMPACT OF JOINT ATTENTION ON SOCIAL‐COMMUNICATION SKILLS IN INTERNATIONALLY ADOPTED CHILDREN

Internationally adopted (IA) children have often experienced early adversity and are at risk for long‐term deficiencies in multiple developmental domains. This study examined the association between IA children's joint attention (JA) soon after arrival and later cognitive, communicative, and socioemotional competency 6 months’ postadoption. We expected a child's initial JA would positively predict later cognitive, communication, and social ability. IA children (n = 63) adopted from Eastern Europe were seen soon after their arrival into the United States to assess their JA. Their socioemotional competency, social communication, and cognitive abilities were measured at a follow‐up session 6 months’ postadoption. We found that higher order JA was positively associated with measures of social relatedness. Furthermore, individual hierarchical regressions of each measure of JA (higher order JA, initiating JA, responding to JA, and initiating behavior requests [BR]) considered with age‐at‐adoption showed that each measure was an independent and positive predictor of Mullen outcomes in the receptive and expressive language domains. These results suggest that JA may be a sensitive predictor of subsequent functioning in the social, communicative, and cognitive domains. Thus, assessing JA soon after arrival has the potential to identify at‐risk IA children, and interventions targeting JA may support those children in overcoming the negative impacts of early adversity.     

Profils multidimensionnels de jeunes enfants trisomiques bulgares

This study examines links between cognitive, communicative, socioemotional and psychomotor abilities in 20 Bulgarian institutionalised children with Down syndrome. These children were evaluated by means of the Early Cognitive Development Assessment Scales (ECDAS, Nader-Grosbois, 1993), the Early Social Communication Scales (ECSP, Guidetti and Tourrette, 1993), and two grids of socioemotional and psychomotor indicators, inspired by the Trandisciplinary Play-Based Assessment (TPBA, Linder, 1990). Several analyses of developmental patterns were performed in order to identify specificities in the structural organisation of abilities in Bulgarian Down syndrome children in situation of abandonment or negligence: comparison of means of scores in distinct domains, correlations, clusters of variables, analysis of individual profiles by clusters of cases. The results indicate: weakness in vocal imitation and in joint attention; limited relationships between communicative abilities; local homologies between some cognitive and communicative abilities implicating a lack of integration; particular links between specific dimensions of socioemotional and psychomotor adaptation and certain cognitive and communicative abilities in these Down syndrome children.     

MEDIATING ROLE OF MATERNAL SENSITIVITY: ENHANCING LANGUAGE DEVELOPMENT IN AT‐RISK FAMILIES

Home‐visiting programs have gained increasing importance in family‐centered prevention and intervention. However, few studies have examined the mechanisms underlying early intervention treatment effects. The goal of this study is to analyze the mediating role of maternal sensitivity in enhancing language development with the home‐visiting program Parents as Teachers (PAT). Data were collected and analyzed within the ongoing, long‐term ZEPPELIN study, a randomized controlled trial with 251 participating at‐risk families. Via longitudinal mediation analysis, we examined whether effects of the PAT on receptive and expressive language outcomes at 24 and 36 months were mediated by maternal sensitivity at 12 months. Within a moderated mediation framework, we investigated whether the level of family psychosocial stress affects this mediation. Results showed that intervention effects on language outcomes are mediated by maternal sensitivity—weakly and through specific pathways. Moderation and moderated mediation analyses indicated that effects of the PAT and also specific mediation effects increase with the level of psychosocial stress. Implications of the results for practice are discussed.     

Intersubjectivity and the creation of meaning in the analytic process

By means of a clinical illustration, the author describes how the intersubjective exchanges involved in an analytic process facilitate the representation of affects and memories which have been buried in the unconscious or indeed have never been available to consciousness. As a result of projective identificatory processes in the analytic relationship, in this example the analyst falls into a situation of helplessness which connects with his own traumatic experiences. Then he gets into a formal regression of the ego and responds with a so‐to‐speak hallucinatory reaction—an internal image which enables him to keep the analytic process on track and, later on, to construct an early traumatic experience of the analysand.     

“There's more love between us”: The parental experience of attending Mellow Babies,a targeted,early intervention program for parents and their babies

It is recognized that parenthood in the context of psychosocial adversity can have negative implications for infant development. Parenting programs are the first line of intervention to improve outcomes for families; however, evidence for the effectiveness of group-based, targeted early interventions is still scarce. Preliminary findings indicate Mellow Babies (MB) as a promising group-based parenting program for families at risk for parenting difficulties. Using thematic analysis, we aimed to understand: (i) the aspects of the intervention that enabled parents to complete the program and (ii) the relational and behavioral changes perceived as valuable for parents and their babies post-intervention. In total, 68 parents residing in the United Kingdom were interviewed after completing MB (49 mothers and 19 fathers; 88% self-identified as British). Three themes and six subthemes were generated from the data. Parents identified several intervention components as beneficial, including the facilitators' interpersonal skills and multi-dimensional, group-based approach. Participant reflections highlighted three underlying mechanisms that enabled positive change: (i) the sense of community cultivated within the group, (ii) the process of formulating and re-conceptualizing one's difficulties, and (iii) the opportunity to reshape interpersonal interactions. Findings are discussed within the context of perinatal and infant mental health.     

A developmental origins perspective on the emergence of violent behavior in males with prenatal substance exposure

Children with prenatal substance exposure are at increased risk for externalizing behavior problems and violence. However, the contribution of early life experiences for placing these individuals at risk is not well understood. Utilizing a sample of 1,388 children with prenatal substance exposure from the Maternal Lifestyle Study, we attempt to shed light on these contributing factors by examining the impact of infant temperament, maternal sensitivity, and early life stress on the expression of violent behavior at ages 12 through 14 years. Males may be more at risk for increases in violent behavior in early adolescence through a number of early life experiences, such as variability in responses to maternal flexibility and engagement related to individual differences in temperament, as well as exposure to early adversity. Comparing two prevailing developmental theoretical frameworks, deficit models and differential susceptibility, we aim to understand the developmental origins of violent behavior in males by identifying children who may be most susceptible to early caregiving experiences.