Strengthening the bond can break the cycle

Strengthening the bond can break the cycle
21 January 2010

The combined force of the evidence from neuroscience and epidemiology is compelling, says the US National Council on the Developing Child. The harmful effects of maternal depression on families and children are severe and far reaching.

Infant brain architecture and stress response systems may suffer long lasting damage. Among households living below the US poverty threshold, one in four mothers of infants will be experiencing moderate to severe levels of depressive symptoms, but only 15 per cent of stricken mothers get any professional care.

So the implications for policy and practice should be clear: there is an irresistible rationale for testing and evaluating promising practices and new intervention strategies that tackle the needs of both partners in the crucial formative relationship – mother and infant together.

The Harvard-based Council collaboration of university scientists translates good science about child development into clear recommendations for public policy. "Maternal Depression Can Undermine the Development of Young Children" is the latest in a series of working papers.

Throughout childhood, the developing brain is in a constant state of elasticity, and early experiences actively shape its architecture, the authors explain. The "serve and return" nature of parent-child interactions is highly significant.

For example, when a toddler babbles and a parent responds with attention and gesturing, the connections in the brain that support social and communications skills are strengthened. "When caregivers are sensitive and responsive to a young child's signals, they provide an environment rich in serve-and-return experiences, like a good game of tennis."

Interactions with depressed mothers are less sensitive and less responsive. Typically, depressed mothers' interactions with their children will be marred by hostility or disengagement. 

"When parents are hostile and/or intrusive, it is as if the parent is 'serving' the ball in ways that make it difficult for the child to 'return' it. Conversely, if a parent is withdrawn or disengaged, the child may serve the ball, but the parent won't return it".

The neuroscientific argument is that flawed interactions impair a child's developing brain. If the depression is chronic, the outlook is worrying. Children of chronically depressed parents tend to perform worse on cognitive tests, develop worse behavior, suffer greater emotional difficulty, experience severer problems at school and run greater risk of mental health problems in adulthood.

The working paper recommends two types of preventive activity. First, that there should be more enthusiasm for replicating practices that show promising initial results. Evidence from small scale studies show that intensive programs of weekly toddler-parent therapy over the course of a year improve cognitive development in children with depressed mothers.

Parenting courses that promote positive interactions between child and parent are known to benefit older children; more evidence is needed of their impact in the context of maternal depression, the authors say. 

Council working papers routinely include sections on the "science-policy gap" and "common misconceptions". In the case of postpartum depression, the authors argue that there has been far too little experiment in the US. Considering the clear time of onset (childbirth), the distinct risk period (up to six months post delivery) and east access to an identifiable population it amounts to a striking opportunity missed.

Among the misconceptions identified, the authors offer the mistaken belief that reducing a mother's depressive symptoms will necessarily lead to better parenting and improved child development. Hence the argument in favor of interventions that focus on the mother-child "dyad" and tackle parenting behavior and interaction.

See: Center on the Developing Child at Harvard University (2009) Maternal Depression Can Undermine the Development of Young Children: Working Paper No. 8 http://www.developingchild.harvard.edu

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