A previous article already introduced some of the symptoms and risks of Postpartum Depression (PPD), but I would still like to emphasize the profound effects of this disorder. In this particular stage of life, depression does not only hurt the new mother, but poses threat for the well-being of the baby as well. In other words, It could be an ailment for two. This makes the need for timely and adequate help even more compelling.

Beyond the emotional and psychological suffering experienced by women with PPD, there are multiple negative effects for the infant. Women who experience more severe or prolonged PPD symptoms are more likely to develop insecure attachment to their infants and perceive their baby in a negative way, unable to enjoy the bonding and joy reported by healthy mothers.¹  A body of research shows that children of depressed mothers tend to receive lower scores on measures of intellectual and motor development when compared to children born to non-depressed mothers. These babies also tend to be fussier  and of more difficult temperament.¹  Another unfortunate consequence is that children of depressed mothers typically react poorly to stress, show poorer academic performance, delayed development of self-regulation, low self-esteem, lack of social competence and multiple behavioral problems.²

At least one study³ has shown that infants born to depressed mothers experience significant sleep disturbance in the developmental period between two weeks and the first six months of life. The difference is compelling when compared to infants of non-depressed mothers. This is especially troubling since it is known that this initial phase of life is a critical developmental period for sleep-wake cycles, melatonin and temperature rhythms.³

Depressed mothers tend to be more irritable and hostile towards their child, interacting with either intrusive, controlling and over-stimulating style or with withdrawn, passive and under-stimulating style.⁴ Neither of those extremes is beneficial for infant development. In comparison with healthy mothers, mothers with PPD touch their babies less frequently and more often do it in a negative, harmful way. Depressed mothers also have different vocal behavior, more negative affect and engage in less baby talk. Overall, they spend less time playing with the child or reading, talking, and touching. This contributes to creating an inadequate environment for the developing infant, which is deprived of mother-child bonding, synchrony and enrichment activities. Additionally, depressed mothers are less likely to begin breastfeeding and even when they do, they are more likely to discontinue in around 4 to 16 weeks.⁴

Women with PPD are more likely to start smoking or abuse alcohol and illicit substances which can further exacerbate the severity of their symptoms and the negative effect on the child. Further, these mother are at greater risk for experiencing physical, emotional or sexual abuse.⁵

References:

1. Cho, H. J., Kwon, J. H., & Lee, J. J. (2008). Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study. Yonsei Medical Journal, 49(4), 553-562.   2. Goodman, S. H. & Gotlib, I. H. (1999). Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychological Review, 106(3), 458-490.   3. Armitage, R., Flynn, H., Hoffmann, R., Vazquez, D., Lopez, J., & Marcus, S. (2009). Early developmental changes in sleep in infants: the impact of maternal depression. Sleep, 32(5), 693-696.   4. Field, T. (2010). Postpartum depression effects on early interactions, parenting and safety practices: a review. Infant Behavioral development, 33(1), 1. doi:10.1016/j.infbeh.2009.10.005.   5. Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2011). Treatment of postpartum depression:clinical, psychological and pharmacological options. International Journal of Women’s Health, 3, 1-14.

Reactive Attachment Disorder:

Etiology, Symptoms, Affected Brain Areas and Treatment

Reactive Attachment Disorder (RAD) is characterized by considerably disturbed and inappropriate social interaction, across situations, that is manifested before the age of five (DSM-IV-R). Evidence for the disorder is usually seen in continuous failure to respond appropriately in social situations (being hypervigilant, inhibited, or ambivalent) and/or inability to develop and exhibit selective attachment to primary caregiver(s) (DSM-IV-R). The causes for the disturbed behavior in Reactive Attachment are associated with the developmental stages of Infancy and Early childhood, when pathogenic care can have profound and lasting effects. DSM-IV outlines three aspects of pathogenic care that explain the disturbance in normal development and behavior: persistent disregard for the child’s physical and emotional needs, as well as repeated changes of primary caregiver and/or surroundings. The connection between pathogenic care and disrupted behavior is compelling and reminds of the critical importance of nurture and effective parenting. Many psychologists have studied in depth child development during the first years of life and reveal that this is an extremely sensitive period for both physical and emotional development and maturation. It is a critical time for cultivating attachment, social skills, developing empathy and understanding basic values.

Maltreatment, no matter whether it is abuse, neglect, abandonment, or witnessing violence, can lead to enduring negative changes in the still developing brain of a child. Each time there is some sort of traumatic experience, the brain suffers a particular change. Many of the brain abnormalities that have been studied in abused and neglected children are located in the left hemisphere. Very often, in children, victims of abuse, there were fewer dendritic connections between different areas in the left hemisphere (Gunnar & Vazquez, 2001). Children that had showed such abnormal results demonstrated self-destructive or aggressive behavior, as well as certain disturbances in behavior, thinking and physiology (higher blood pressure, heart rates temperature, hyper vigilance) (Gunnar & Vazquez, 2001). Studies of neglected children found that their cortex was about 20 percent smaller than that of a control group of subjects (children) who have not suffered neglect (Gunnar & Vazquez, 2001). The data is compelling and reveals that providing stable environment of nurture is of utmost importance. About 1% of children who have developed insecure-ambivalent attachment develop RAD (Lehman and Jegtvig, 2004) and without intervention, support and help, many of these children might grow up to develop Antisocial Personality Disorder and live a disruptive life. Eventually, many of these individuals end up in correctional facilities. This compels helping professionals to promote and teach effective parenting and explain the implications of early childhood stress. In addition, the issue has to be considered within the context of adoption and foster care where, very often, children would be moved often and are being exposed to very different/inconsistent treatment and living conditions.

The non-pharmaceutical treatment of RAD appears to be more successful and beneficial than the behavioral medical model (Lehman and Jegtvig, 2004). It utilizes the attachment model as described by Dr. Daniel Hughes in his book “Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children.” The emphasis is on effective parenting - nurturing holding, eye-contact, providing opportunities for enjoyment, encouragement, unconditional love and being a model for self-regulation abilities (Daniel Hughes). Parents and caregivers are to love, nurture, accept and respect the child, so that he/she can grow healthy and happy. Also, professionals in the helping field need to unite their efforts in attempt to educate people and advocate affective parenting and children’s well-being.

Is it really true that our past is so powerful that it can control our future? It has been the chief task for many psychologists and people in the helping professions to identify different environmental factors and their positive or negative impact on human development. Different developmental theories emphasize the huge importance of early childhood experiences and the quality of the relationship with parents (caregivers) to the health and well being of the maturing individual. Both neglect and abuse in the earlier stages of life can lead to chemical imbalance, delay of mental development, depression or even some psychological disorders. It is crucial for optimal development that stable bonding and attachment are effectively developed in the early stages of life, as this has a lasting effect. If parents fail to create a secure environment and provide emotional support for the child, this can cause negative social interactions in the future, or their overall avoidance.

Many psychologists have studied child development during the first years of life in depth. This is an extremely sensitive period for both physical and emotional development and maturation. It is critical time for cultivating attachment, social skills, developing empathy and understanding basic values. During the first year of a baby’s life, in particular, emotional attachment with the primary caregiver(s) is established. In fact, the bond with the mother starts blooming only within hours of childbirth (Kaitz et al., 1995).

Psychologist Mary Ainsworth (1989) investigates different levels of attachment by observing mothers and their infants in an unfamiliar setting. The mother was asked to suddenly leave the room and then the baby’s reactions were being observed, especially upon the mother’s return. This study described three main types of attachment: securely attached children (enjoying a stable and positive emotional bond), insecure-avoidant attachment and insecure-ambivalent attachment (both depicting an anxious emotional bond). Ainsworth studied this cross-culturally, observing the same behavior and making the same conclusions. Children who are securely attached by the age 1 show more social competence, resilience and problem-solving abilities (Collins and Gunnar, 1990). The importance of both the mother and the father is crucial when it comes to meeting the baby’s affectional needs. Generally, a warm and secure family atmosphere with clear rules and expectations promotes secure attachment for the child (Belsky, 1996). On the other side, failure to meet these needs leads to insecure attachment, where anxiety usually characterizes the relationship. Insecure attachment (ambivalent or avoidant) and negative parental representations are positively correlated with depression in adolescents (Milne & Lancaster, 2001; Ollson, Nordstrom, Arinell & Knorring, 1999). Depressed and ill people tend to repel their family and friend instead of using them as a support group (Alferi, Carver, Antoni, Weiss & Duran, 2001; Coyne & Smith, 1991).

Psychologist Erik Erikson (1963) has also focused on the developmental stages, outlining the different developmental challenges. For the first years of life, the struggle is between forming a basic sense of trust or mistrust. This, once again, would have a lasting effect in life. If ‘trust’ is developed, the baby would become a healthy individual, who is equally able to give and receive love and trusts in other people and ‘good in life’. On the contrary, developing a basic sense of ‘mistrust’ might lower self-esteem and increase perceived distress.

Parents are the first and, probably, the most important support group for the growing individual. Social support that is provided from the parents and their role to create a stable and supportive environment has a long-term effect on health and one’s ability to cope with stressful events (Repetti et al., 2002). One study of college students found that students who reported having a lot of support from their parents were more likely to cope effectively with stressful events (Valentiner, Holahan, & Moos, 1994). Parental support also enabled students to cope better emotionally (Maunder & Hunter, 2001). A longitudinal study of undergraduate Harvard male students demonstrated that those who perceived to have had warm and close relationships with their parents were healthier 35 years later (Russek & Schwartz, 1997). On the contrary, males who did not report warm relationships with their parents in childhood were much more likely to be diagnosed with coronary artery disease, hypertensions, ulcers and alcoholism in Middle adulthood (Russek, Schwartz, Bell & Baldwin, 1998). In adult life, emotional support from a significant, intimate others is most important (Benson, Gross, Messer, Kellum & Passmore, 1991), but negative relationships with parent in earlier stages of life can lead to distress in interpersonal relationships later on.

Dear parents, be there for your baby and never forget there is no such thing as “spoiling an infant”.