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Children and Young People’s Emotional Wellbeing and Mental Health Conference 10 th October 2012. The Importance of the Early Years in Developing Emotional Resilience Jane Barlow Professor of Public Health in the Early Years. Structure of paper

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Children and young people s emotional wellbeing and mental health conference 10th october 2012

Children and Young People’s

Emotional Wellbeing and Mental Health Conference

10thOctober 2012

Children and young people s emotional wellbeing and mental health conference 10th october 2012

The Importance of the Early Years in Developing Emotional Resilience

Jane Barlow

Professor of Public Health in the Early Years

Children and young people s emotional wellbeing and mental health conference 10th october 2012

Structure of paper

  • The impact of the early parent-infant relationship on the child’s later development

    • neurological development

    • attachment security

  • Implications for practice

The infant brain
The Infant Brain

  • Babies born with immature brains

  • Wiring takes place during prenatal period to school-entry – important first two years in response to the environment

  • Most important aspect of the environment is primary caregiver

  • Rapid proliferation and overproduction of synapses followed by loss (pruning)

  • ‘Use it or lose it’ – lost if not functionally confirmed

The social baby

Looks and smiles help the brain to grow

Baby looks at mother; sees dilated pupils (evidence that sympathetic nervous system aroused and happy); own nervous system is aroused - heart rate increases

Lead to a biochemical response - pleasure neuropeptides (betaendorphin and dopamine) released into brain and helps neurons grow

Family’s doting looks help brain to grow

Negative looks trigger a different biochemical response (cortisol), stopping these hormones and related growth

(Gerhardt, 2004)

The Social Baby

Children and young people s emotional wellbeing and mental health conference 10th october 2012

Babies of depressed mothers:

nearly half show reduced brain activity

much lower levels of left frontal brain activity (joy; interest; anger) (Dawson et al 2006)

Early experiences of persistent neglect and trauma:

overdevelopment of neurophysiology of brainstem and midbrain (anxiety; impulsivity; poor affect regulation, hyperactivity)

deficits in cortical functions (problem-solving) and limbic function (empathy)

The Social Baby

Nurturance emotional and behavioural regulation
Nurturance/ Emotional and Behavioural Regulation

Key aspects of early parenting that promote ‘secure’ attachment organisation:

  • Sensitivity/attunement(Woolf, van Ijzendoorn 1997)

  • Mid-range contingency (Beebe et al 2010)

  • Reflective Function and Marked Mirroring (Fonagy 2002)/ Mind-Mindedness (Meins et al 2001; 2001)

Affect synchrony the dance

By two months the mothers face is the primary source of visuo-affective communication

Face-to-face interactions emerge which are high arousing, affect-laden and expose infants to high levels of cognitive and social information and stimulation

To regulate this, infant and mothers regulate the intensity of these interactions

The dance – synchrony; rupture; repair

Absolutely fundamental to healthy emotional development – prolonged negative states are ‘toxic’ to infants

Adults that are incapable of ‘attunement’ i.e. intrusive; depressed, cannot regulate appropriately

‘Affect Synchrony’ – the dance

Reflective function1
Reflective Function

  • Capacity to understand the infant’s behaviour in terms of internal states/feelings

  • Child’s development of self-organization is dependent on the caregiver's ability to communicate understanding of the child's internal states via ‘marked mirroring’

  • Reflective function in pregnancy and postnatal period predicts infant attachment security (Fonagy & Target, 2005; Grienenberger, Kelly & Slade, 2005; Slade, Grienenberger, Bernback, Levy & Locker, 2005)

Sensitivity or reflective function
Sensitivity or Reflective function

  • A mother who has left her infant to go to another room hears him cry for comfort. She returns to the room and picks him up.

  • Sensitive but ? mind-minded

  • If while comforting the infant she remarks that the baby is crying because he did not want her to leave or felt lonely, this would be classified as ‘appropriate’ mind related comments. If, however, she comments that the baby is crying because she is angry or bored these would be classified as non-attuned’ because they misinterpret the infants likely internal state (Meins, 2010)


  • ‘Attachment’ is an important biobehavioural feedback system that plays a significant role in helping the infant to regulate their emotions particularly when distressed

  • Attachment shapes the child’s adaptive responses, and involves development of ‘internal working models’

Internal working models
Internal Working Models

  • Infants begin ‘mapping’ the world from birth;

  • A key aspect of the environment that is mapped is interactions with primary caregivers;

  • Internal maps (IWMs) - enable a person to anticipate and interpret another's behaviour and plan a response

  • Caregiver is experienced as a source of security and support, infant develops a positive self-image and expect positive reactions from others;

  • Infants with non-attuned or abusive caregivers internalise a negative self-image and generalise negative expectations to other relationships

Children and young people s emotional wellbeing and mental health conference 10th october 2012

Types of attachment

  • Secure (Group B) – able to use caregiver as a secure base in times of stress and to obtain comfort (55-65%)

  • Insecure

  • Anxious/resistant (Group C) – up-regulates in times of stress to maintain closeness (8-10%)

  • Avoidant (Group A) - down-regulates in times of stress to maintain closeness (10-15%)

  • Disorganised (Group D) – unable to establish a regular behavioural strategy (up to 15% in population sample; 80% in abused sample) (Carlson, cicchetti et al 1989)

Parenting predicts attachment security
Parenting predicts attachment security

  • Secure (Group B) – predictable, responsive, sensitive/attuned parenting

  • Insecure

    Anxious/resistant (Group C) – unresponsive, inconsistent

    Avoidant (Group A) – rejecting, punitive

  • Disorganised (Group D) – Fr-behaviour/Atypical parenting behaviours

Fr and atypical parenting behaviours
Fr- and Atypical parenting behaviours

  • Fr-behaviour – frightened AND frightening (Main and Hesse 1990)

  • Atypical/anomalous parenting behaviours (Lyons-Ruth 2003): threatening (looming); dissociative (haunted voice; deferential/timid); disrupted (failure to repair, lack of response), affective communication errors (mother laughing while child distressed)

  • Meta-analysis (12 studies) – strong association between atypical behaviours and disorganised attachment at 12/18months (Madigan et al 2006)

Secure attachment
Secure Attachment

  • Secure (Group B) – (55-65%)

  • Longitudinal studies show that secure attachment in infancy is associated with optimal later functioning across a range of domains including scholastic, emotional, social and behavioural adjustment, as well as peer-rated social status (e.g. Berlin, Cassidy and Appleyard 2008; Granot, Mayseless 2001; Sroufe 2005).

Outcomes of disorganised attachment
Outcomes of Disorganised attachment

  • Follow-up of children disorganised at 1-year at age 6 (Lieberman and Amaya-Jackson 2005);

    • controlling behaviours toward parent;

    • avoidance of the parent;

    • dissociative symptoms;

    • behavioural/oppositional problems;

    • emotional disconnection;

    • aggression toward peers;

    • low social competence in preschool

  • Associated with significant psychopathology in childhood and later (Green and Goldwyn 2002)

Disorganised controlling attachment
Disorganised/Controlling Attachment

  • Caregivers – unpredictable and rejecting; source of comfort also source of distress

  • Self represented as unlovable, unworthy, capable of causing others to become angry, violent and uncaring

  • Others – frightening, dangerous, unavailable

  • Predominant feelings – fear and anger

  • Little time for exploration or social learning

  • Range of ‘coercive’ strategies developed by child e.g. Controlling strategies and compulsive caregiving

Arousal in traumatic disorganised attachments
Arousal in traumatic/disorganised attachments

Hyper-arousal (aggression, impulsive behaviour, children emotional and behavioural problems – ‘Fight or flight’ response)




Hypo-arousal (dissociation, depression, self harm etc)

Children and young people s emotional wellbeing and mental health conference 10th october 2012

Parent-infant Interaction

Disorganised Attachment - Inability to regulate emotions

Normal stresses of childhood

Unbearably painful emotional states



substance abuse

eating disorders

deliberate self-harm

suicidal actions










(Modified Robin Balbernie 2011)

Parent infant relationship in the face of parental problems
Parent-infant relationship in the face of parental problems

  • Key factors – Domestic violence; mental health problems; substance/alcohol misuse; unresolved trauma

  • Infant’s emotional states trigger profound discomfort in these parents

  • Interaction becomes characterized by:

    - withdrawal, distancing or neglect (i.e. omission)

    - intrusion in the form of blaming, shaming, punishing and attacking (i.e. commission)

Parental attachment predicts child s attachment
Parental attachment predicts child’s attachment

  • Studies show that parental attachment status predicts child attachment security (Hesse, 2008; van IJzendoorn, Schuengel & Bakermans, 1999)

  • Mothers classified as ‘unresolved’ more likely to develop disorganised attachment relationships with their children (e.g. Lyons-Ruth and Jacobvitz, 1999; van Ijzendoorn et al 1999).

Key points for intervening to support attachment
Key Points for Interveningto support attachment

Early infancy (4-6 weeks) – Regulation of emotional states


7 – 14 months – Safety and Exploration


15-24 months (toddlerhood) – Developing independence – emerging behaviour problems


Introducing parents to their social baby
Introducing parents to their ‘Social Baby’

  • Promote closeness and sensitive, attuned parenting

    (e.g. Skin-to-skin care and the use of soft baby carriers; infant massage etc)

  • Provide parents with information about the sensory and perceptual capabilities of their baby (e.g. The Social Baby book/video or Baby Express newsletters) or validated tools (e.g. Brazelton or NCAST)

    Underdown A, Barlow J (2011) 'Interventions to support early relationships: mechanisms identified within infant massage programmes.', Community Practitioner, 84 (4),

Supporting the parent infant toddler relationship
Supporting the Parent-Infant/toddler Relationship

  • Invitation to group-based parenting programmes (e.g. Solihull; Triple P; Mellow Babies; Circle of Security)

  • Father–infant groups that promote opportunities for play and guided observation

  • Individualised coaching (by a skilled professional) aimed at stimulating attuned interactions – videotape feedback

  • Referral to attachment-oriented or parent– infant psychotherapy interventions

Anticipating problems
Anticipating Problems

  • Anticipatory guidance:

    - practical guidance on managing crying and healthy sleep practices e.g. bath, book, bed routines, and activities

    - encouragement of parent–infant interaction using a range of media-based interventions

  • Can lead to significant improvements in parents’ routines with children

Promoting early development
Promoting Early Development

  • Encouragement to use books, music and interactive activities to promote parent–baby relationship and thereby development

    Disadvantaged families:

  • Group-based interactive support (e.g. PEEP)

  • Encouragement to use good quality early intervention

Key intervention approaches
Key Intervention Approaches

  • Sensitivity/attachment-based: Interaction Guidance; FNP

  • Psychotherapeutic: Parent-infant psychotherapy

  • Mentalisation: Minding the Baby

  • Parenting programmes– Parents under Pressure

  • Parenting Programmes– Circle of Security; Baby Triple P

Further reading
Further reading

  • Barlow, J. and Underdown, A. (2008) 'Supporting parenting during infancy', in Child and adolescent mental health today: a handbook, Editors: Jackson, C., Hill, K. and Lavis, P. Brighton: Pavilion Publishing/Mental Health Foundation;

  • Barlow, J. and Underdown, A. (2008) 'Attachment and infant development‘ as above.