Last week I was away in New Jersey speaking at the ICDL conference (Interdisciplinary Council for Learning and Development) In the afternoon, after giving my presentation, I attended another workshop. In the minutes before it started, a woman sitting in front of me turned to me and commented that she had enjoyed my presentation. I asked her what she did.
I learned that that she works at Newark Beth Israel Medical Center where she does massage in the Pediatric Intensive Care Unit and Hematology/Oncology unit. When I commented that this must be a very progressive hospital, she said that if she had come with the program fully formed, it was unlikely they would have used it. But she started out just doing a consult here and there, and when the doctors saw the value of her work, they expanded the program to what it is today.
In addition, she told me, in her program Nurturing Touch she does massage with drug addicted moms and their babies who are being treated for withdrawal symptoms. She explained that at first she just worked with the babies, and held what she soon recognized were incorrect assumptions about the mothers. She observed that "we rip the mothers and babies apart" when there is a positive tox screen (drugs found in the urine.) When she actually met the mothers, she found that they were in deep pain over being separated from their babies and longed to reconnect with them. She began to use her massage techniques on the mothers as well, recognizing that many of them had histories of abuse, and might never have experienced touch in a positive and caring way. She did this simply with gentle hand massage. Her aim was to begin to relax their bodies enough to enable them to hold their own very dysregulated babies; providing comfort both mother and baby so desperately needed.
Earlier that day I had received an email from someone who had been referred to my website by her pediatrician. She wanted to share her work with me. She is a musician and music therapist who began studying clinical psychology after the birth of her first child. But rather than complete her PhD, she produced an album for mothers and babies, Good Morning My Love, that won the Parent's Choice Gold Award. I found the following on her website:
The benefits of music are intuitive to most people. Music is a natural endorphin that bypasses intellectual thought and directly connects you to emotions. It can simultaneously engage both your playful, spontaneous side and your soulful, tender side. For many reasons it is one of the best ways to connect to your baby: Music, with its inherent melody, rhythm, and repetition, is a language that babies can understand from day one. It also has a way of organizing experience and enhancing it. Both you and your baby can use music to create routine, develop reliable patterns of expectations, and foster a sense of security - all of which help to create a familiar and loving environment.As a lover of folk music, I was captivated. One song that is excerpted on her website perfectly captures the ambivalence of toddlerhood with the lyrics, "Mama leave me be but don't leave me." In groups she runs for moms and babies, she uses music to address the anxiety and isolation that new moms often feel.
On my return home, these experiences came together in my mind when I read a study in the current issue of the Journal of the American Academy of Child and Adolescent Psychiatry suggesting that ADHD and Autism Spectrum Disorder (ASD) may actually represent one overarching diagnosis. Interestingly, at the conference I had been speaking with a colleague, an occupational therapist, about the overlap in symptoms not only of of ADHD and ASD, but also anxiety.
Stanley Greenspan, founder of ICDL, eloquently described the very close link between sensory and affective experience. He recognized these "disorders" as variations of ways in which these systems have been derailed, and created the DIR floortime model as a way to help children and their families to address problems of sensory and affective experience.
I suspect that as we learn more about the biology and genetics of these problems, we will find that the diagnostic categories as described in the DSM system represent artificial constructs.
Rather than figuring out what diagnostic category a child fits in to, we need to focus on supporting parents' efforts to understand their child's experience and to help him to manage his unique vulnerabilities. The research that I describe in my book Keeping Your Child in Mind offers evidence for this model as a way to promote healthy emotional development.
At the conference, in collaboration with Dana Johnson, an occupational therapist who reached out to me after reading my work, we advocated for integrating the two models in our presentation: Development of the Parent: the Child's Contribution.
I hope that "alternative" therapies, as represented by music and massage, will someday be considered primary therapies, as they address the primary problem. Even better, offering these kinds of interventions for stressed mother-baby pairs may go a long way in preventing the development of more complex problems of sensory and affective experience, problems that we now label "psychiatric disorders."