Is therapy appropriate for children before they are even five years old? What could be so wrong with someone so young? And how could a therapist begin to help?
These and other questions were asked and answered at January’s SCV-CAMFT South Region Luncheon. Members of the Santa Clara County Infant Mental Health Collaborative discussed the important mental health research increasing our understanding of the significance of early trauma, attachment and brain development (particularly of the cerebral cortex). The panel included Howard Doi, MFT, current Chair for the Infant Family Mental Health Collaborative for Santa Clara County; Julie Kurtz, MFT, Director of Mental Health Services at Kindango; Charlene Canger, MFT, LCSW, BCD, social work consultant at Stanford’s Division of Neonatology; and
Sharla Kibel, MFT, of County Mental Health as part of a First 5 Early Learning Initiative.
Kurtz acknowledged the “whys” and “hows” of therapy with very young children. “How messed up can they be at that age?” she challenged her audience, but it soon became apparent that we were all asking ourselves the wrong question. A better question is “How helpful can therapy be to such young children?” Studies of animals have demonstrated that development in the brain’s cortex is most rapid in young animals that receive generous nurturance, stimulation and are able to exercise some control over their environment. These vital brain-developing elements must be provided to human infants by a loving caregiver. A compassionate, responsive caregiver also helps a very young child develop the key skills needed in self-regulation, arousal and self-calming.
When a parent and baby experience difficulty engaging or “bonding” with each other in the early days of life, parents will find themselves less “tuned in” to their infant, resulting in a cycle of unmet needs and frustration. This lack of attunement between parent and child also results in lost opportunities to develop vital self-regulation skills and cerebral cortex growth. The first three years of life are a critical period of building the “architecture of the brain,” according to neuroscience research presented by Canger. Early development is not merely about “walking by one and talking by two,” she explained, but developing a secure attachment that supports the ability to tolerate stress and sets the stage for the ability to develop empathy later in life. Persistent neglect in the early years potentially can leave children less resilient to setbacks for years to come.
Families at risk for poor attunement and related far-ranging problems include those with parents who are overwhelmed by the circumstances of their own lives, which can include trauma, depression, chaos, and addiction. Such obstacles might stand in the way of effective attunement in some families. Sometimes a child has special needs that overwhelm a parent’s ability, such as severe neurological problems, Down’s syndrome or Autistic Spectrum Disorder.
Not all parents of children with special needs have difficulty meeting the needs of their young children. A heartwarming example of such a case was shared by Doi. A mother was told repeatedly that due to the severity of her child’s disability, institutionalization would be required. She refused. Instead, she worked with her child herself with love and patience, returning a year later and stunning the health care providers with the child’s developmental progress. The power of a mother’s dedication, determination and love, and her ability to sustain hope despite overwhelming circumstances served as a powerful example that love grows the brain, not just in babies, but for the parents, too.
For families at risk early intervention is critical. The next question was, “How does a therapist work with such a young child?” The answer is, of course, to work with the whole family, and on many levels.
Therapy with young children and their families is not a neat and tidy process contained in a fifty-minute hour in an office. Most of the work is done with the children and families in their homes and community, on tables, floors and playgrounds. This form of therapy must meet families’ needs on several levels, one at a time or simultaneously.
Santa Clara County Infant Family Mental Health Collaborative recommends multiple levels of support in therapy with young children’s families:
- Concrete support to relieve stress and meet immediate needs for housing, money, childcare and other specific needs through active use of community resources.
- Strength-based support coupled with non-dydactic parent education: recognizing and appreciating the positive and finding opportunities to support steps to create small changes to help parent and child alike. A therapist must observe, build and join with the family before gaining the credibility to challenge the family to see more possibilities.
- Building parents’ insight into their own background and how life experiences help and hinder effective attunement.
- Emotional support from the therapist, who engages the family in a healthy relationship to support the parents to form stronger bonds with their children. In some cases, this can involve actively and repeatedly reaching out to families to help meet needs and find opportunities to support a stronger connection.
Intervening while a child is very young is vital for developmental and physical growth, and families must be approached on a variety of levels to enable them to meet their own unique set of needs. How can we know where to begin?
Kurtz emphasized the importance of ongoing assessment, as therapy begins and occasionally during the course of therapy, since children can progress so rapidly at such a young age. Valuable tools for effective early childhood assessment, the Ages and Stages Questionnaire (ASQ) and Ages and Stages Questionnaire: Social-Emotional (ASQSE), were recommended for identifying red flags and making appropriate referrals. These questionnaires are designed for parents and childcare providers to answer themselves, in order to determine an appropriate course of action with a therapist’s assistance. These questionnaires, available in English and Spanish, and the ASQ Treatment Planner can be found through Brookes Publishing at www.brookespublishing.com.
The presentation in January challenged the way we, as therapists, think about the mental health care of infants, toddlers and preschoolers. Many organizations in Santa Clara County, through the support of the First 5 Early Learning Initiatives, are working together to expand services to families with young children. Nationally and throughout the state, conferences are being held to get the word out. Zero to Three: National Center for Infants, Toddlers and Families will be holding a certification workshop in Sacramento in March. More information can be obtained at www.zerotothree.org.
Is therapy appropriate before the age of five? Absolutely! According to the Santa Clara County Infant Mental Health Collaborative, the earlier the better!
Review by Marté J. Matthews, M.A.
Marté J. Matthews, M.A. is an MFT Intern at Community Health Awareness Council in Mountain View. She has also been a parent educator since 1995 and a behavioral interventionist for six years.
