Social and Emotional Impact after Neonatal Intensive Care

1. Social and Emotional Impact afterNeonatal Intensive Care Penny Glass, Ph.D. Developmental Psychologist Children’s National Medical Center

2. Objectives: • Understand the early pattern of typical social/emotional development • Identify factors which impact social/emotional development during and after the NICU • Understand the role of the professional in supporting social/emotional development

3. NORMAL PATTERN OF SOCIALIZATION • Roots of Attachment – • Development of Trust • Independence/Autonomy • Importance of Peers

4. Attachment: Environmental Predisposition Imprinting in humans??

5. Early Attachment – what the infant brings • Inborn social prediliction • Innate releasers (Bowlby) • Root/suck/cling/cry • Visual regard + Physical dependency + Cute • + own temperament

6. Biologically predisposed for social vs nonsocial • human voice • empathic distress • interactional synchrony

7. Social Predisposition and Sensory Motor Integration Interactional synchrony.. to human voice

8. Social Predisposition mutual exchanges & magic moments

9. Predisposition for social vs nonsocial • searches for facial features (eyes!) • face/voice discrimination • (parent/non-parent) • reciprocal vocal play

10. Attachment, Trust, and Contingency – who the infant chooses • Biological mother facilitates attachment… but is not essential • More important: • sensitivity • contingent responsiveness • emotional involvement Power of the smile

11. Mama? She can’t compete!

12. Attachment takes time…. From initial eye contact… to shared experiences and social reciprocity…… Physical dependence and development of language

13. Temperamental style • Easy • Difficult • Slow to Warm • Match/Mismatch • Chess & Thomas

14. Temperament as emotional reactivity & self regulation • Approach/withdrawal to new situation • Sensitivity to stimulation • Intensity of response • Predominant mood (+ or -)

15. Emotional reactivity & self regulation • Activity level, regularity of biorhythms • Distractibility • Persistence in pursuing a goal • Adaptability to change

16. Stepping toward Independence & Autonomy • Power of walking • Touching base parent as base of emotional support • self-regulation • mastery motivation • Empathy: • From crying to caring • From parent to others 2-year old dilemma!

17. Attachment and Separation Anxiety • response to separation/reunion • Secure • Insecure ambivalent • Insecure avoidant • Disorganized • …and temperament

18. Attachment and Peers Task of the 3 year old Practice with “pair-dates” expands to group play Needs: desire (biology/temperament) skills (lang. dependent 1. art of conversation 2. negotiate a social contract, taking turns 3. compromise and playing pretend

19. Social and Emotional Impact during/after NICU Factors which Impact Parent Child

20. “High Risk” Newborn • physical separation • vulnerable appearance • “6 sticks of butter” • disruption of biological clock • change of itinerary

21. Loss of Identity as Parent • Nurse…Therapist….Teacher • Force feeding and later food refusals • Not doing enough….or doing too much • Later social isolation

22. Parents often try to compensate for NICU experience

23. Prolonged Physical Dependency • parent fatigue • effects our social interaction • parent depression

24. Interference with Play • physical limitations and type of toys • play is a social thing (language!) • teaching vs play time • parents searching for the “magic toy”

25. Sensory Deficits • auditory, visual, tactile • reciprocal interaction • communication

26. Multisensory toys:- heighten arousal, not attention to what is important- delay object relations - increase irritability

27. “Risks” of Therapeutic Interventions • Physical intrusion • personal body space: • physical discomfort • parent’s protective role • Multiple therapists and too many adults • Loss of parenting role • Loss of peers?

28. “Risks”of Therapeutic Intervention • Impact of excess reinforcement • loss of internal motivation • becomes overly dependent on adult • distracting from task goal • Never teach a child to do something that you later must teach him (her) not to do.

29. Problem of Limits in Child with Special Needs • Over-acceptance of inappropriate behavior • Inhibition and brain damage • Who loves a terror and a tyrant? • Not even the parent

30. Beyond the NICU • Family Issues • Financial burden • Siblings • Adult relationships • Facing the future • Community Support • Early Intervention • Neighbors and friends • Cultural Expectations

31. Summary • The social/emotional pathway for a NICU graduate may be different, but it can be just as strong. • The parent’s primary role as protector, a source of safety and comfort in times of distress, is altered in the NICU and beyond. • As professionals, we need to be aware of the potential impact of our therapeutic approaches on social/emotional development of the child and family

32. Selected References • Fetal Development: A Psychobiological Perspective. Jean-Pierre Lecanuet, William Fifer, Normal Krasnegor, & William Smotherman, eds. Hillsdale, NJ: Lawrence Erlbaum, 1995. • Attachment and Loss, J. Bowlby. New York: Basic Books, 1969.