My earlier posts documented my sense of frustration seeing many patients for "ADHD evaluation." I listened to story after story of mothers alone and depressed with their fussy, "difficult" infant. This infant then became an "explosive" toddler. Child and parents continued to struggle until now at the age of seven, ten or even fifteen, they came to see me in search of a diagnosis and medication. More often than not their symptoms did meet DSM criteria for some diagnosis, usually ADHD. Between imminent failure in school, intense pressure from teachers and a severe shortage of quality mental health services, medication often seemed to be the only option.
It caused me great pain to see a child's life experience reduced in this way, and, as is also documented on this blog, I decided that I needed to focus my efforts on prevention.
Next weekend is my second installment of the Infant-Parent Mental Health Post Graduate Certificate Program I have referred to in the two previous blog posts. As I review the material in advance, I am learning about research providing evidence that postpartum depression, particularly if the depression is chronic, affects a child's cognitive development, and is associated with behavior regulation problems and depression.
Last week, I saw a mother and her 3 month old daughter. A single mother struggling with depression and anxiety, she hadn't slept in a long time. Her baby fussed and squirmed on her lap. I held the baby, walking her around the room to quiet her while her mother talked of feelings of helplessness and frustration. The other doctors in my practice, who had been called almost daily by this mother with problems of feeding, sleep and crying, didn't know what to do for her. Pediatricians, who are seeing these mother-baby pairs on a regular basis, are mostly unaware of this important field of study.
I am well aware that there are many other professionals who have been doing this work for a long time. One social worker in my program does home visits with high risk pregnant women and then together with their newborns for a year after delivery. Sadly, they are paid practically nothing for this critical work.
John Bowlby, the father of attachment theory, in a 1980 lecture said:
Successful parenting is a principal key to the mental health of the next generation. In most societies throughout the world these facts have been and still are, taken for granted and the societies organized accordingly. Paradoxically it has taken the world’s richest societies to ignore these basic facts. Man and woman power devoted to production of material goods counts as a plus in all our economic indices. Man and woman power devoted to the production of happy, healthy, and self-reliant children in their own homes does not count at all. We have created a topsy turvy world.Next weekend I will learn more about effective interventions for these mother-baby pairs. I am very much looking forward to it. For now, sitting in a room with this mother and her young infant, at least I know I am in the right place to start.