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Referring Infant and Toddlers for Psychological Services
By Lianne Lennert, PsyD
Many people
believe that infants and toddlers are too young to have emotional problems, or,
if they have problems, are too young to treat. This is unfortunate, because
during the first few years of life, appropriate treatment is more effective, and
requires less effort, than at any other time of life.
The reason for
this is that infants and toddlers are (with the help of their caregivers)
creating a foundation for emotional health that will last a lifetime. Addressing
mild problems in parent-child interactions during these formative years can
result in a much stronger foundation that will serve as a resource for
preventing emotional disorders throughout the life span.
In the book,
From
Neurons to Neighborhoods, the researchers from the
National Research Council and Institute of Medicine describe three developmental
tasks during infancy and toddlerhood. These tasks include:
 | Negotiating
the transition from external to self-regulation, including learning to
regulate emotions, behavior, and attention; |
| Acquiring
the capabilities that undergird communication and learning, including early
language development, reasoning, and problem solving skills; |
| Learning to
relate well to other children and form friendships, including the capacity to
trust, love, nurture, and resolve conflict constructively. |
Healthy
parent-child relationships are key to facilitating all of these developmental
tasks, because:
| A parent’s
presence and engagement with the infant to moderate distress, communicate
delight, and allow the infant to “feel felt” help develop the parts of the
brain that will later support regulation of emotions, attention, and behavior |
| Attachment
to parents provides a secure base for exploring the world, and facilitates
language learning |
| Emotional
communication with parents through facial expression, touch, and tone of voice
is the precursor for spoken language and will continue to add depth and nuance
to conversation throughout life |
|
Attachment-based interactions develop the brain regions that later support
empathy, self-regulation, attention skills, intuition, and “mindsight,” all
capacities that are crucial for making friends and resolving interpersonal
conflict |
| Attachment
relationships to parents form the basis for a person’s “working model” of
relationships that guide expectations and behavior when interacting with
others |
There is a wide
variety of problems that can interfere with the development of healthy
parent-child relationships, including:
| Difficult child temperament or mismatch
between parent and child temperament |
| Sensory or regulatory problems |
| Parental depression or other mental
health problems |
| Lack of social and emotional support for
mothers |
| Psychological stressors such as financial
problems, marital discord, or work pressures |
| Poor quality non-parental care
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| Parents have difficulty reading infant
cues |
| Child neglect or maltreatment, or family
violence |
| Parents
themselves had poor parenting models |
A psychologist
familiar with infant-toddler mental health can:
| Evaluate the health of the parent-child
bond |
| Improve the attachment relationship by:
 | Coaching parents to recognize infant
cues |
| Help parents eliminate, reduce, or
modify stressors |
| Help parents change beliefs or
practices, or resolve experiences that interfere with sensitive parenting |
| Treat parental mental health issues
that are affecting the relationship |
| Help parents understand and accommodate
temperament, regulatory, or sensory difficulties |
| Train
parents in behavior management techniques |
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Referral to a
mental health provider for infants and toddlers is appropriate whenever there
are high levels of risk factors for poor attachment or current indicators of
problems in the attachment relationship.
Risk
factors for attachment difficulties:
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Suspected maternal depression (or other mental health problem) |
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Infant is extremely irritable, colicky, or sleeps less than 10
hours out of 24 |
|
Family has high level of social stressors—financial
difficulties, work problems, family discord, frequent moves |
|
Lack of social support such as extended family, friends, church |
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Infant or child is in poor quality nonparental care |
|
Family circumstances interfere with parent-infant interaction
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Indicators of possible mental health or attachment
problems:
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Failure to thrive with no
medical cause |
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Parent handles infant in a way that seems rough, hurried,
withdrawn, disengaged, or unaware of infant needs or signals |
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Infant avoids eye contact, does not cling for comfort, is
difficult to soothe, does not seek out parent when distressed |
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No evidence of stranger anxiety for infants 10-18 months of age |
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Excessive clinginess or unwillingness to move away from parent
to explore the environment in the parent’s presence, especially past the age
of 24 months |
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Parent unable to describe
positive interactions with infant or positive characteristics of infant (“What
I like about my baby is…) |
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Parent expresses unhappiness about relationship with infant |
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Feeding problems, sleep problems, and/or behavior problems may
be related to mental health or attachment issues, especially if there is no
medical cause |
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