About 53,000 children pass away each year in the United States and nearly 19% of the adult population has experienced such painful loss¹. The death of a child is a severely traumatic event for parents and represents a major risk for future emotional, psychological and physical problems.^{2, 3, 4} The loss of a child challenges parents’ expectations for the natural order of life events and shatters hopes and beliefs for the future.⁵ Some psychologists suggest that parental grief is more severe that other types of grief and lasts longer, presenting with more serious psychological, physical, behavioral and social issues. ^{1, 6} This may be explained by the special role that a child plays in a person’s life – the child represents a unique amalgam of feelings for parents, as it is both part of themselves and representation of their feelings for each other.⁷ In essence, bereaved parents mourn the loss of self, their hopes and dreams.²

The fact that parents think of their child as a “part of, and the same as themselves” ^{7, p. 234} suggests that the loss of a child is very much the loss of a part of one’s self and represents a unique challenge.

The Shock of Sudden and Unexpected Death

The death of a child has become rare in the Western world, due to improved prenatal and perinatal care, it is considered exceptionally painful and traumatic, with parents not being prepared to face such loss.^{8, 9} Nowadays, pregnancies continuing after the 20th week are usually wanted and anticipated with joy and commitment. In the case where such joyous event ends up being a tragedy, parents face a major challenge. For many young parents, this may be their first experience with death and loss.⁸ When the death occurs unexpectedly and suddenly, as opposed to following a long disease or terminal condition, the shock, guilt and bewilderment experienced by the parents are much more severe and long lasting.^{1, 3} Although a long and debilitating disease is another source of trauma for parents, it provides an opportunity to psychologically prepare for the death and understand the cause of death.^{3, 10} In fact, sudden and unexpected loss is correlated with higher levels of distress and parents are at much higher risk of experiencing complicated grief.⁹

In one study¹ researchers interviewed and assessed bereaved parents about 20 months after the child’s death. Their results showed that mothers who experienced the sudden death of a child had more prolonged grief than those who anticipated the grief. Results from the same study did not support expectations that mothers experience more severe grief than fathers. A Swedish population-based study⁵ by demonstrated that fathers’ opportunity to know about the impending death of a child in advance is correlated with better prognoses of grief processing. These results indicate that medical practitioners need to be honest with parents, when the death of a child is concerned, to allow time for accepting and preparing for the imminent death. However, research finds that physicians are aware of a child’s terminal prognosis 3 months before parents are (Wolfe cited in ⁵).

Findings about the profound negative effects of sudden loss explain why parents who experience Sudden Infant Death Syndrome (SIDS) face especially troublesome complications and adjustment problems. These parents suddenly have to deal with the unexplained and, possibly unpreventable, death, the sudden severing of the the attachment and bonding and the involvement of other agencies in the investigation process.¹¹ Currently, SIDS is identified as “the sudden death of an infant younger than one year that remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene, and review of the clinical history.” ^{12, p. 870} It is the leading cause of death among healthy infants and accounts for about 2,200 deaths each year.¹²

(For additional information about Sudden Infant Death Syndrome, including statistics and risk factors, see here)

References:

Pharmacological Treatment

A number of studies have pointed out that Postpartum Depression (PPD) is essentially the same as Major Depression (MDD) and, therefore, benefits from pharmacological treatment with antidepressant medication, but very few studies have conducted randomized controlled trails comparing different medication and placebos.¹ In general, pharmacological treatment of MDD has proven to be just as effective as psychological interventions.² However, the adverse effects on breastfeeding and infant well-being remain largely unknowns and medication has to be prescribed with caution.^{1, 2} An extensive review by Fitelson and associated¹ outlines several open studies that have established fluoxamine, sertraline, bupropion, nefazodone and venlafaxine as effective pharmacological treatment for PPD. Yet, the validity and generalizability of these studies is limited by small sample sizes (4 to 15 participants) and tainted by pharmacological companies’ sponsorship. In  cases where patients have responded well to a particular antidepressant in the past, experts advise practitioners to choose the same medication for the treatment of PPD.^1,3

Pharmacological Treatment as a Preventative Measure

There is some evidence that pharmacological treatment can have preventative properties as well. A randomized placebo-controlled pilot study by Wisner and colleagues (2004)⁴ has shown that sertraline treatment started shortly after delivery prevented women with history of PPD from experiencing another episode. Yet, these results remain inconclusive and more research is needed to establish the role of antidepressants in PPD prevention.

Pharmacological Treatment’s Effect on the Child

The major concerns surrounding pharmacological treatment of PPD revolve around its effect of lactation, breastfeeding and infant well-being.¹ Infants are particularly vulnerable to the effects of medication, due to their immature blood-brain barrier, hepatic and renal systems and still developing neurological systems and brain structures.⁵ Still, research on the effects of antidepressants on the baby through maternal breastfeeding is very limited and largely contains of small studies with questionable external validity, and isolated case studies.¹ Some researchers have deducted that sertraline and paroxetine, among the Selective Serotonin Reuptake Inhibitors, are least likely to be detected in the infant’s system and adverse effects have rarely been observed.⁵ In comparison, citalopram and fluoxetine, appear to be more readily transmitted through breast milk. Their effects range from sleep changes in the infant to more serious respiratory, gastrointestinal problems and even seizures.⁵ In addition, antidepressants in infants have been correlated with increased plasma levels.¹ Although the observed effects among infants have been of mild to moderate severity and have remitted after the mother discontinued medication use, there are no guarantees there will be no effects in the long run. In addition, research has not determined whether lack of clinically significant amounts of antidepressants in the baby’s system actually means the child is not affected in any way.¹ These concerns suggest the need for further research, including more longitudinal studies.

Why Medication May Not be The Best Option

The benefits of breastfeeding have been extensively studied and firmly established by prominent organizations, such as the World Health Organization, the American Academy of Family Practitioners and the American Academy of Pediatrics, all of which recommend breastfeeding for at least six months after birth.^6,7,8 Considering this, most clinicians recommend non-pharmacological treatment for cases of mild or moderate depression, especially since these can be just as effective, but without the risk of side effects.¹ Yet, if pharmacological treatment is initiated, experts suggest that the baby’s pediatrician is immediately informed and begins to routinely examine for possible exposure and monitor any changes of sleeping and feeding patterns, sedation, irritability and other signs of drug toxicity1.^1,9

Research has demonstrated the effectiveness of psychological and psychosocial treatments of PPT, which also bypass the risk of side effects and infant drug toxicity.^{1, 10}

Interpersonal Therapy

Interpersonal therapy (IPT) has been suggested as effective psychological treatment for PPD and women who received IPT had a significant decrease in PPD symptomatology.¹¹ The typical course of IPT lasts for 12 to 20 weeks and focuses on four main interpersonal problem areas: role transition, role dispute, interpersonal deficits and grief. Clients are encouraged to transform their problematic interpersonal approaches into more healthy and adaptive ones, which is expected to improve the mother-infant and  mother-partner relationships and help the new mother for the upcoming transition back to work.¹¹ It has been further established that a group format of IPT may have benefits compared to individual therapy, as it increases social support, helps new mothers improve their interpersonal skills, allows for realization of the normality of the symptoms and issues and reduces the stigma associated with PPD.¹

Cognitive behavioral Therapy

Cognitive Behavioral Therapy (CBT) is another therapeutic modality that has proven no be beneficial in the treatment of depression, including PPD.^1,12,13 The main focus in CBT is to help clients modify their distorted cognitive patterns and negative thinking and initiate behavioral changes that will enhance their coping and reduce distress.^13,14 Fitelson and associates¹ have reviewed a study where only six sessions of CBT correlated with significant decrease of depressive symptoms in postpartum women. A pilot study by Cho and colleagues (2008)¹³ has examined antenatal CBT as a way of primary prevention. The intervention incorporated classic CBT components for treatment of depression and components aiming at enhancing marital relationship and communication. Their CBT intervention proved effective in reducing automatic negative thoughts, marital dissatisfaction and communication dissatisfaction. This individual CBT intervention not only improved well-being during pregnancy, but also during the postpartum period. The authors’ conclusion is that individually-tailored CBT intervention is more effective than a group format. However, if group sessions are the only option, helping professionals should avoid issues around personal fatigue, the condition of the unborn baby and dissatisfaction from partner.¹³ One key hypothesis in these studies is that interventions  that improve the quality of the marital relationship have great preventative power for PDD, as they increase both actual and perceived support.

Person-Centered Therapy

Person-centered counseling, also referred to as non-directive counseling, has also shown to decrease depressive symptoms in postpartum women in a number of randomized controlled studies.¹

Social Support

Lack of adequate social support is among the first risk factors for PPD, therefore peer and partner support groups have received a lot of attention among researchers.¹ Dennis (2003)¹⁵ has studied the effects of mother-to-mother support over telephone communication and has observed the beneficial effects of this approach. In fact, the severity of depressive symptoms was significantly reduced in eight weeks. Additionally, women who have been identified as high risk for developing PPD were involved in telephone-based peer support over 12 weeks and were later recorded to have lower incidence of PPD when compared to a control group. This gives hope that these noninvasive and cost-effective therapeutic approaches can also serve as preventative measures.

Alternative Therapies

Interesting research by Field and colleagues (1996)¹⁶ has shown that teaching new mothers to massage their infant reduces irritability and sleep problems in the baby, while leading to reduced depression in the mother. This massage therapy is a relatively simplistic techniques with potential to greatly benefit both the mother, child and their interaction. Findings like these increase our hopes that researchers will establish new methods of prevention and treatment which can transform the prevalence rates of PPD among new mothers.

References:

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.

Postpartum Depression (PPD): A Psychological Disorder

Postpartum Depression (PPD) is a fairly common complication of childbirth and often accompanies the postpartum period, leading to psychological suffering for the mother, negative effects on the infant and strained family relationships.¹

Pregnancy, childbirth and the postpartum period involve intense emotional experiences for most women and are characterized by a major developmental transition, physical and psychological demands, body image changes, as well as psychosocial changes, all within a short period of time.² Sadly, psychiatric disorders are the leading cause of maternal deaths, very often through suicide.¹

Women with PPD suffer from depressive mood and profound sadness, frequent crying, insomnia, lack of appetite, fatigue, lack of motivation, low self-esteem, perceived inability to cope, suicidal ideation as well as multiple physical complaints.^3,4

Some researchers attempt to conceptualize PPD as a complicated maternal identity formation, where the new mother is unable to achieve a sense of maternal competence and incorporate her new psychosocial role.³ In other words, there is a dominating American middle-class perspective on mothering, which expects an intense child-centered parenting that is both economically and emotionally demanding. Yet, we often fail to appreciate the largely diverse population of the United States in the context of child rearing. Thus, mothers who may not fit the middle-class American script may feel like a failure and begin to experience growing maternal incompetence, diminished self-efficacy, self-esteem and increased distress. All of these may be contributing to the onset of PPD.³

Why is this Disorder Often Undiagnosed?

Women diagnosed with PPD often describe themselves as “bad mothers” and report intense feelings of guilt and shame.^{3, p.374}  This gives us an idea about the social stigma associated with PPD and would partly explain why most women do not seek professional help and remain undiagnosed and untreated. That is why helping professionals need to put every effort into promoting psycho-education and establishing PPD as a diagnosable, treatable disorder, so that no mother and her child remain in suffering. In fact, researchers point out that some women may experience the diagnosis of PPD as a relief, helping them accept their symptoms and reduce their personal feelings of guilt, self-blame and shame.³

How Common Is The Disorder?

The estimated prevalence rate of PPD is about 13%, with higher incidence among teenage mothers.⁵ A study of women in Sweden has shown depressive symptoms in around 17% of pregnant women during the late stages of pregnancy and in 13% of new mothers.⁶ Other studies have found prevalence rates of 14% in both early pregnancy and during the first year after delivery.^{Rubertsson cited in 6}

Such prevalence rates pinpoint PPD as a serious public health issue that affects not only mothers, but also their children and other family members.

Risk Factors

Many life events and psychological factors have been identified as risk factors for PPD. Among these, anxiety and depression during pregnancy have shown to be strong predictors for the onset of PPD.⁷ Many studies have also established low socioeconomic status as a strong risk factor.^3,6 Obese pregnant women are also at higher risk of developing PPD.⁷

Postpartum depression might be more common than you have imagined. It is not as common as “baby blues” also referred to as “postpartum blues” that affect about 75% of new mothers within the first ten days after delivery.^8,9 PPD’s symptoms are more serious and longer lasting than those of postpartum blues. Still, if your wife, partner, or friend is experiencing such profound sadness, you should not underestimate the possible seriousness of the issue. Pay close attention to the symptoms and provide support and understanding. (An article on prevention and treatment will be posted soon).

References:

1. Bick, D. & Howard, L. (2010). When should women be screened for postnatal depression? Expert Reviews of Neurotherapeutics, 10(2), 151-154.    2. Clark, A., Skouteris, H., Wertheim, E. H., Paxton, S. J., & Milgrom J. (2009). The relationship between depression and body dissatisfaction across pregnancy and the postpartum. Journal of Health Psychology, 14(1), 27-35.   3. Abrams, L. S. & Curran, L. (2011). Maternal identity negotiations among low-income women with symptoms of postpartum depression. Qualitative Health Research, 21(3), 373-385.   4. 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.   5. O’Hara, M. W. & Swain, A. M. (1996). Rates and risks of postpartum depression: a meta-analysis. International Review of Psychiatry, 8, 37-54.   6. Claesson, I., Josefsson, A., & Sydsjo, G. (2010). Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study.  BioMed Central Public Health, 10, 766-776.   8. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

It seems that many of the global problems humanity is facing are due to the fact that our  home, Earth, is being overpopulated. Since the Industrial Revolution, the world population has increased its size dramatically. While longevity is on the rise and the overall quality of life has improved significantly, we are far from eradicating hunger, crime, pollution, abuse and neglect. For a large portion of the world population, one or all of the above are a daily reality.

About 963 million people across the world suffer hunger (The Food Secutity Statistics, 2008), which is recognized as the most severe form of poverty (Hunger Report, 2004). This strikingly big number may sound unreal to those of us who have just enjoyed our delicious Starbucks treat. Even worse, we might have been desensitized to numbers ranging in the millions, or even billions, as we see them in the same sentence with bailout, debt, loan, equity, and so forth. In this case however, the number is as real as can be. 963 million people – each of these lives as important and meaningful as the next one. To begin to understand these statistics better, let’s break the numbers down: each day, about 16,000 children die from hunger-related causes (Black, Robert, Morris, Saul, & Jennifer Bryce. “Where and Why Are 10 Million Children Dying Every Year?” 2003). This means, one child perishes every five seconds, due to hunger. The more specific causes for these deaths might be chronic undernourishment, vitamin or mineral deficiencies, which, in turn, lead to heightened susceptibility to illness (Hunger Report, 2004).

The United Nations Office on Drugs and Crime (UNODC) starts its 2008 Annual Report with the following sentence: “Drugs, crime and terrorism remain three of the greatest threats to the peace, security and well-being of humanity”. Sadly, there is little place to argue the opposite. The number of inmates, in the US alone, is compelling: 2,310,984 (U.S. Department of Justice, Bureau of Justice Statistics, 2008). This is a 0.8% increase from the number of 2007. However, the average annual growth from 2000 until 2007 was 2.4%. This means we have an estimated 509 sentenced prisoners per every 100,000 US residents. The number of female inmates is also rising, with numerous cases of pregnant inmates, whose inborn child never stood a chance of starting a ‘normal’ life.

When issues like these continue to describe our modern reality, i cannot help but wonder: Why do people have children? What is a good reason to have a child?

We addressed these question to students in an Introductory Psychology class. The responses were truly puzzling: “To have someone carry your name”, “To have a part of you stay after you’re gone”, “To keep a guy”, “To make your marriage work” and so on.

I stood there, in disbelief, shocked to hear what these young and smart people identified as the ‘reasons’ to have a child. Are these really good reasons for a commitment of this magnitude? If we are so desperate to have someone carry our name, aren’t we being purely egoistic? If we need to carry our genotype forward, we are certainly guided by evolutionary principles, but is this a good enough reason? If it takes a baby to make any guy stay with you, you might want to wonder if this guy is worth keeping, to begin with. If anything, a baby can be a strain on any happy marriage and is rarely prescribed as a remedial for a bad one. So, are these the right reasons? If college students, who thought about the issue, considered these their reasons, I am petrified to know what other people might say. Or do people even think about it? Has it just become the ‘normal’ thing to do – a routine of sorts – find a relationship, build a home, have children? Is it merely what our society considers appropriate? Is it something we do to feel good about ourselves? I hear parents taking such pride in the fact they have given life to another human being; people who think giving life is enough of itself and fail to look for their flaws when it comes to parenting. Is this mature and is it fair to the little person who is yet to come into this world and become part of the statistics (which statistics, we could not know yet)?

I happen to think that a good reason to have a child is the desire and possibility to raise a person of quality, who will contribute to society and might as well make the world a better place. I don’t find it trendy and I don’t think it’s cute either.  It is a serious matter of life and the greatest of all responsibilities. For this to be a success, one has to have a good game-plan. All of this, of course, has to be backed up by sincere love, commitment and stability. I do not mean to sound grotesque, or oversimplify complicated situations, but I sincerely believe this is an issue that each of us needs to consider very seriously and make a conscious decision. It would be sad, if something wonderful like a child would be something unwanted and unwelcome. As a professor of mine said: Imagine what a different place this world would be, if in order for a woman to conceive, both parents had to hold hands, look each other in the eyes and repeat thee times ‘I want to have a baby. I want to have a baby. I want to have a baby’ (M.J. Grant). What a different place that would be, indeed. Also, I do not think it is simply enough to give life (any living form can do this). More important is what we do to the life we have given. Do we abuse, or empower? Do we nurture, or neglect? Do we practice effective parenting, or do we fail miserably to connect?

Roger McIntire remarks: “We already license pilots, salesmen, scuba divers, plumbers, electricians, teachers, veterinarians, cab drivers, soil testers and television repairmen. … Are our TV sets and toilets more important to us than our children?” We even need marriage licenses! Then, why do we assume that our right to be parents is absolute and why do we take it so lightly? It is not an absolute right, it ought to be a privilege. Roger McIntire suggests further that licensing parents could be as simple as when you turn 18, you get the book and study it or take the course, then you take the written test, and the eye test, and if you pass, you get a beginner’s license, then you do some hands-on child care for maybe six months under the guidance of a licensed parent, and if you pass that part, you get your license, and if you don’t, maybe you try again in a while. We do it for almost anything else, why should this serious matter be any different?

There are millions of people in this world, who suffer starvation, diseases, low quality of life; millions of people who are being killed, abused or otherwise traumatized. If we are going to bring one more such life into the world, we have plenty already – why not try to take care of one of those.

The creation of life is a moral matter and requires serious moral examination, so ask yourself: Why have children?

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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.

The Eight Millennium development goals cont.

Step Four: Reducing Child Mortality

Parents, they say, are responsible for the survival of their babies. Parents teach us attachment, symbolize safety and the closest relationship there can be. Even from evolutionary perspective, one is interested in preserving his or her genes and transmitting them to the next generations. Thus, human beings, collectively, are supposed to care about their children and guarantee their survival in order to preserve our kind. The paradox is that we are able to analyze such complicated biological-psychological issues and we run social organizations that circulate billions of dollars around the world in order to grant children in need a life, and yet, the way almost everything else is degressing, gives little hope for the generations to come. Children, being the most vulnerable part of humanity are highly dependent upon the care they receive and the atmosphere they live in.

On one side, we fear that our children face a lot of daily stress, never to have been imagined before, and are forced to live up the enormous expectations we put on their brittle shoulders. Needless to say, children today are the victims of the 24/7 regime. On the other side, 2.3 million children under age of 15 are the victims of HIV/AIDS related disease. 12 million more lives of people at age from 15 to 24 are claimed by the deadly virus. Poor quality of life in countries like India turns malaria and diarrhea into mortal diseases. A fact we thought was changed for good after the Great Plague in England in 1665. On the contrary, more that 700 000 children under the age of 5 still die from diarrhea in India, alone.

Some people assume it is only uncivilized societies that do not care about a child’s life. Those of us who have heard about the abduction of children in Uganda and the ‘lost boys of Sudan’ view that as the monstrous act of savages that can be annihilated by the hand of civilization and progress.

In Uganda, child soldiers who managed to escape their captors are brought to a rehabilitation center in Gulu, where Anna Karih has photographed their life and spoken to one of the boys. The eighteen-years-old John (not his real name), is one of the ex-soldiers, who personally knows how difficult it is to integrate to the community again and try to lead a normal life. After he has been abducted twice, the boy realizes how much he has changed: Before I was abducted I was a happy school boy, I had five sisters and one brother.” Now John and many other boys are happy in the new Gusco center, where they take part in cleaning and cooking. The children also go to group sessions aiming to erase the memories of the abduction, when children watched their friends and siblings being tortured to death. When compared to such cases, our daily stress does not appear that frightening anymore. John considers himself very lucky to be still alive. He remembers how the rebels used to drag him along and beat him while discussing the best way to kill him. “I could only think about running away again. But now they didn’t trust me and they watched me all the time.” He believes his luck showed when he was shot in the hip during a battle, so that the rebels left him behind. This gave him his second chance to have a life, out of the nightmare of abduction.

These boys did not break a leg during a basketball play, they are soldiers shot during battle.

How do many civilized societies try to protect our children? We decide to make a difference by putting children in the army. Since the release of the eight Millennium Developmental goals, many countries got involved in the so called War against Terrorism, which many consider to be the prelude to a Third World War. There is hardly a military conflict in the history of men that did not rely on the vital energy of young people to fuel its operations. The Statistical Information Analysis Division of the Defense Manpower Data Center shows that for the last three years, when we were supposedly working to reduce child mortality, we have the greatest percentage of military deaths of people younger that 22, in The United States only.

The Eight Millennium Development Goals cont.

Step Two: Achieving universal primary education.

In most parts of Europe and America, education is taken for granted and, even worse, children often consider it a method adults have invented to torture them. And while getting education is considered the normal thing to do, one may go through college without fully appreciating how lucky he or she is. You hear college students say “I wonder what I’m still doing here! I can learn so much more in the real world, without writing papers and reading assignments.” Needless to say, that person does not have second thoughts about the millions of people who have never held a pen in their hand and cannot write their name or express themselves in an essay. Probably, we, the lucky ones, who got a diploma, are responsible for those who cannot write a letter to some social organization and cannot complain in writing to their government. Perhaps, education is supposed to help us better understand the suffering of these people. Perhaps, this is responsibility we have to admit and commit to. In complaining that the computer labs in one’s university are somewhat ‘out of date’ let us spare a thought for the people who will never have the chance to learn what a computer is and let us try to build some understanding. In the year 2001, 115 million children in developing countries were out of school. In sub-Saharan Africa only, the percent of children that do not receive education is 42%. Not surprisingly, children from poorer families are even less likely to ever go to school. This leaves us little place to wonder about what chances for success and progress these children have in this highly-competitive world.

In villages in Tanzania, children are suffering too heavy a burden to be concerned with writing homework assignments. From the age of 10, Joyce walked for about 10 hours every night in order to fetch water for her family’s needs, for the day to come. She leaves her village, Uhambingeto, at midnight and returns at about 10 a.m. on the following morning with her burden of 20 liters bucket of water (nearly 22 fluid quarts). Thus, Joyce covers more than 8000 km every year (about 4 970 miles). However, it is wrong to assume we are talking isolated cases. Villagers in Tanzania may not be representative for peoples all over the world, but they surely mean there is something wrong in the order established. The organization of the United Nations has addressed the same problem and has made schools in Tanzania a fact. A fact that gives children there a lot of joy and a way to escape the hard work of their days and feel a part of something greater than working on the fields, perhaps the only fact that will remind them they should have a childhood. At least Joyce’s children will be able to receive primary education.

Recently, in Venezuela, 1.2 million adults were the students of new schools that taught them how to read and write.

In many countries, Pakistan among them, children are important work force. The 14 year old Jabber is one of the child laborers in Karachi, Pakistan’s largest city. His job is making construction blocks. The boy who gets up at seven in the morning and works from 8 a.m. until 7 in the evening shares “I don’t like school. I went there once, but never again.” Enduring the hard work all their lives, these adults-to-be have no happy memories of careless childhood, no hopes, or opportunities, but only a few hours of sleep until the next working day.

In yet another part of the globe, Romanian orphans complain they have “nothing to do”. The children explain: “We were not allowed out – and most of the time we were not even allowed to play. It was really boring because there was nothing to do. The staff used to beat us a lot. I think they liked it. Sometimes they would get drunk and then they would hit us really hard. We had a shower once a week, but the carers didn’t want to touch us, so we washed each other. Often we didn’t have any hair (it was shaven off periodically to avoid head lice).” And while this may sound as the horrific description of a concentration camp back in World War II, it is part of Today’s reality.

(Pictures: National Geographic Magazine)

The Eight Millennium Development Goals cont.

Step one: Eradicating extreme poverty and hunger.

A 15 year old dog is doing great! Many children in sub-Saharan Africa do not survive to be 15.

While extreme poverty is inconceivable for many parts of the world, reports of the United Nations show that it is the grotesque reality for more that 1 billion people, relying on less that $1 a day to meet their daily needs. In the same time, thoughts about “extreme poverty” are far, far away from the daily concerns of Liza Mobini, 29. The former cheer leader has her cell phone loading pictures of Gigi, her dog, dressed as a princess for Halloween and as an angel for Christmas. And while Gigi spends a “yappy hour” at a boutique, lack of food seriously threatens children’s physical and mental development in many corners of the world.

In this reality of growing socio-economic issues, many people in San Francisco have invented a way to escape boredom and feel useful in the same time by arranging massages for their dogs, worth $75 an hour and taking the cute furry creatures to acupuncturists. Liza confesses something about her favorite Gigi: “Honestly, she has a better wardrobe than I do”. Ambassadors of the goodwill associations confess in their reports that more than a quarter of children under age of 5 in developing countries are malnutritioned.

Recently, communities have discussed a particular point of Darwin’s theory – it appears that, in our reality, survival is not granted to the fittest, but, moreover, to the richest. The tendency is that rich people and countries are becoming even richer while “the very poor are getting pooper.” The latter is part of The United Nations’ report of 2005. Reports of the World Bank for 2005 show that 59 countries have low-income economies and 54 more have low-middle-income economies. 55 countries are said to have high-income economies. The important thing to point out is that 48 countries from sub-Saharan Africa and 8 from South Asia are not among the low-income economies, but are placed in a different category that stands for extreme poverty and total lack of functioning economy. Keeping the statistics in mind might prevent you from getting angry next time you see that your favorite CD or DVD has a huge scratch upon it. We are reminded every day that we need to spare our minds of negativism and that being angry adds a few wrinkles on the skin. And while people are preoccupied with such concerns, we are blinded for the more global picture. The paradox is that in a modern world of Globalization and concern for others, self-help books that teach us how to become our own best friend are best-sellers.

Humanity is waking up to unite and work for achieving a better future for all of us. In the year 2000 the organization of the United Nations came up with “The eight Millennium Developmental Goals” to guide us in out actions in the near future. This blueprint has been agreed to by the world’s leading developmental institutions and all countries. The target date of this Brave Project is the year 2015.

The eight Millennium Development Goals are:

1. To eradicate extreme poverty and hunger.

2. To achieve universal primary education.

3. To promote gender equality and to empower women.

4. To reduce child mortality.

5. To improve maternal health.

6. To combat HIV/AIDS, malaria and other diseases.

7. To ensure environmental sustainability.

8. To develop a global partnership for development.

Kofi Annan, the Secretary-general of the United Nation, prompted people that “we must start now. And we must more than double global development assistance over the next few years. Nothing less will help us achieve the Goals.” Nine years have passed since the goals have been clearly formulated. However, does it happen that we ask ourselves “How much did we achieve?” and “Where will we be in 2015?” The 2005 report of the United Nations states that poverty is falling and progress has been made against hunger. Also, efforts have been made to make sure that children in sub-Saharan Africa, Southern Asia and Oceania are receiving “a high-quality education”. The report reads “the gender gap is closing” and “death rates in children under age 5 are dropping”. Yet another thing we have to be extremely proud of is that “some progress has been made in reducing maternal deaths in developing countries, but not in the countries where giving birth is most risky.” As to Goal 6 in the plan for development, it is stated that yet “there is no cure for AIDS, and prevention efforts must be intensified in every region of the world if the target is to be reached.” In ensuring environmental sustainability we did not have huge success, as “most countries have committed to the principles of sustainable development. But this has not resulted in sufficient progress to reverse the loss of the world’s environmental resources. Achieving the goal will require greater attention”. The mere fact that there is “The United Nations Millennium Declaration” is enough to show we have already developed some global partnership that we can feel proud of. Nine years have passed, and all we have are vague statements that have only one message – we need not lose all hope yet, someone, out there, is working on those issues; someone out there probably cares, so that humanity may eventually face 2015 with pride – we have achieved the Millennium Development Goals.

After all, we have six more years until the onset of the target-date and, we all know, anything may happen in six years. Setting highly challenging goals for oneself is, undoubtedly, motivating, but when the subject of consideration is millions of people all over the world we need to be a little more realistic, rather than romantically-ambitious. Are our good intentions just another paradox in our times?

Let us track our progress…