I vividly recall the emotional pain of
a new mother in my pediatric practice many years ago as
she described the stress she experienced bringing her infant son to
meet her colleagues in her office. He screamed inconsolably the entire time.
She was similarly unable to take him to social events, observing with deep envy
the easy social interaction of other parents with their children. The low level
depression she had struggled with much of her life returned in full
force. Her son was later diagnosed with autism.
Many parents of children subsequently
diagnosed with autism describe this agonizing absence of the easy give-and-take
they observe between other parents and their infants. A recent article, An Integrative Model of Autism Spectrum Disorder by psychoanalyst William
Singletary explores the latest research in neuroscience, genetics, and
developmental psychology showing how this stressful experience of
disconnection, while originally attributable to neurobiological vulnerabilities
in the infant, itself plays a significant role in development of the disorder.
It makes sense that my little
patient too was stressed, but had limited ways of communicating
his distress. Just as his mother was stressed and even depressed by the
lack of intimacy with her child, so was this little boy likely stressed by the
difficulty connecting. Evidence suggests that this disconnect may be at
least in part due to variations in brain pathways responsible for sensory
processing. Research shows that the stress of the disconnect itself may
continue to exert a negative effect on the developing brain.
Whenever we enter in to the realm of
the infant-parent relationship in discussion of autism, there is a risk of
echoes of the devastating "refrigerator mother" theory that placed blame for the disorder squarely on the
mother. Research into the genetic and neurobiological underpinnings of autism
offers evidence of the fallacy of this theory.
Singletary identifies the
significance of the relationship in a way that is healing rather than
blaming. Evidence of the brain's neuroplasticity shows us that by
focusing on supporting the relationship, thus decreasing the stressful
experience of lack of connection on the part of both parent and child, we may
help to prevent progression and even reverse the genetic and structural brain
abnormalities.
The article addresses in depth a
number of evidence-based treatments of autism that support parent-child
relationship in this way, including the Early Start Denver Model. Singletary also
offers case material from his psychoanalytic practice, explaining that
his intensive treatment offers insight into the inner emotional life of
the child with autism. He finds evidence of the stress these children
experience from the social isolation that results from their biological
vulnerabilities.
Reading his article, I found myself
thinking about that mother and son so many years ago in my pediatric practice,
and what I might have been able to do to help them. Another article about a program in a pediatric practice in the Bronx offers an
answer.
What if we had the opportunity to
support all stressed parents and infants in the early weeks and months of life,
when the brain is most plastic? The central issue is the absence of connection,
made all the more painful with the cultural expectation that this should be a
time of bliss and joy. Autism is but one cause of this loss of
connection.
The Bronx program
integrates the Healthy Steps model in to a pediatric practice.
When a pediatrician identifies a stressed parent-child pair, she asks her
colleague down the hall to come and meet the family. A recent news article
about the program describes a case of a young mother struggling with her
two-year-old daughter around eating. The pediatrician, in her 15-minute visit,
identifies the problem:
It’s time to bring in an expert of
childhood mental health. So Castalnuovo brings in Rahil Briggs, the child
psychologist and introduces her personally to this family. It’s what’s called a
“warm hand off” and makes it more likely they will actually see someone instead
of disappearing down the rabbit hole of outside referrals.
A wide range of troubling
behaviors that we see in young children are both cause and result of stressed
relationships. When these issues can be addressed early we support healthy
development of the rapidly growing brain.
If I had known what I know now, and had
such a person in my office (thanks in part to the UMass Boston
Infant-Parent Mental Health program I could now be that person), I might have said to that young
mother, "I see that you are really struggling. I wonder if it might be
helpful to take some time to make sense of this problem. My colleague down the
the hall knows all about helping young children and their parents. Let me
introduce you to her."
Would I have been able to change this
course of that family's life? I don't know. But all the best science of our
time suggests that the answer might be yes.
The Healthy Steps model is not
specifically about identification and treatment of autism. But it is one
example of taking a broad public health approach to supporting early
parent-child relationships.
If we are going to make a dent in the
exponential rise in autism and other so-called mental health disorders in
children, such a public health perspective is necessary. As I describe in my
new book,The Silenced Child: From Labels, Medications, and Quick-Fix Solutions to Listening, Growth, and Lifelong Resilience, we need to look broadly at the way our culture supports, and
fails to support, parents and children. Paid parental leave
programs and fostering a culture of postpartum care that recognizes the
normal disorganization of the transition to parenthood are other examples of
initiatives that offer opportunity to change the situation in significant
ways.
When we support these early
relationships, intervening in situations of stress before things
begin to derail, we have the opportunity to set development on a healthy path-at
the level of behavior, genes and brains- for all children.
