Social and Emotional Impact Social and Emotional Impact

afterafter

Neonatal Intensive CareNeonatal Intensive Care

Penny Glass, Ph.D.Penny Glass, Ph.D.Developmental PsychologistDevelopmental Psychologist

Children’s National Medical CenterChildren’s National Medical Center

Objectives:Objectives:

Understand the early pattern of typical Understand the early pattern of typical social/emotional developmentsocial/emotional development

Identify factors which impact Identify factors which impact social/emotional development during and social/emotional development during and after the NICU after the NICU

Understand the role of the professional in Understand the role of the professional in supporting social/emotional developmentsupporting social/emotional development

NORMAL PATTERN OF NORMAL PATTERN OF SOCIALIZATIONSOCIALIZATION

Roots of Attachment – Roots of Attachment – Development of TrustDevelopment of Trust

Independence/AutonomyIndependence/Autonomy

Importance of PeersImportance of Peers

Attachment: Attachment: Environmental PredispositionEnvironmental Predisposition

Imprinting in humans??

Early Attachment – Early Attachment – what the infant bringswhat the infant brings

Inborn social predilictionInborn social prediliction

Innate releasers Innate releasers (Bowlby)(Bowlby) Root/suck/cling/cryRoot/suck/cling/cry Visual regardVisual regard

+ Physical dependency+ Physical dependency

+ Cute+ Cute

++ own temperament own temperament

Biologically predisposed Biologically predisposed for social vs nonsocialfor social vs nonsocial

human voicehuman voice

empathic distressempathic distress

interactional interactional synchronysynchrony

Social Predisposition and Social Predisposition and Sensory Motor IntegrationSensory Motor Integration

Interactional Interactional synchrony..synchrony..

to human voiceto human voice

Social Predisposition Social Predisposition mutual exchanges & magic mutual exchanges & magic

momentsmoments

Predisposition for social vs Predisposition for social vs nonsocialnonsocial

searches for facial features (eyes!)searches for facial features (eyes!)

face/voice discrimination face/voice discrimination (parent/non-parent)(parent/non-parent)

reciprocal vocal playreciprocal vocal play

Attachment, Trust, and Attachment, Trust, and Contingency – Contingency –

who the infant chooseswho the infant chooses Biological mother Biological mother

facilitates facilitates attachment… but is attachment… but is not essentialnot essential

MoreMore important: important: sensitivitysensitivity contingent contingent

responsivenessresponsiveness emotional emotional

involvementinvolvementPower of the smile

Mama? She can’t compete!Mama? She can’t compete!

Attachment takes time….Attachment takes time….

From initial eye contact…From initial eye contact…

to shared experiences to shared experiences and social reciprocity……and social reciprocity……

Physical dependence and Physical dependence and development of languagedevelopment of language

Temperamental styleTemperamental style

EasyEasy

DifficultDifficult

Slow to WarmSlow to Warm

Match/MismatchMatch/Mismatch

Chess & ThomasChess & Thomas

Temperament as Temperament as emotional reactivity & self emotional reactivity & self

regulationregulation Approach/withdrawal to new situationApproach/withdrawal to new situation

Sensitivity to stimulationSensitivity to stimulation

Intensity of responseIntensity of response

Predominant mood (+ or -)Predominant mood (+ or -)

Emotional reactivity & self regulationEmotional reactivity & self regulation

Activity level, regularity of biorhythmsActivity level, regularity of biorhythms

DistractibilityDistractibility

Persistence in pursuing a goalPersistence in pursuing a goal

Adaptability to changeAdaptability to change

Stepping toward Stepping toward Independence & AutonomyIndependence & Autonomy

Power of walkingPower of walking

Touching base parent as Touching base parent as base of emotional supportbase of emotional support

self-regulation self-regulation

mastery motivationmastery motivation

Empathy: Empathy: From crying to caringFrom crying to caring From parent to othersFrom parent to others

2-year old dilemma!

Attachment and Separation Attachment and Separation AnxietyAnxiety

response to response to separation/reunionseparation/reunion SecureSecure Insecure ambivalentInsecure ambivalent Insecure avoidantInsecure avoidant DisorganizedDisorganized

……and temperamentand temperament

Attachment and Peers Attachment and Peers Task of the 3 year oldTask of the 3 year old

Practice with “pair-dates” Practice with “pair-dates” expands to group playexpands to group play

Needs: Needs: desire desire (biology/temperament)(biology/temperament)skills (lang. dependentskills (lang. dependent

1. art of conversation1. art of conversation2. negotiate a social 2. negotiate a social

contract, taking turnscontract, taking turns3. compromise and 3. compromise and

playing pretendplaying pretend

Social and Emotional Impact Social and Emotional Impact during/after NICUduring/after NICU

Factors which ImpactFactors which Impact

Parent Parent Child Child

““High Risk” NewbornHigh Risk” Newborn

physical separationphysical separation

vulnerable vulnerable appearanceappearance

““6 sticks of butter”6 sticks of butter”

disruption of biological disruption of biological clockclock

change of itinerarychange of itinerary

Loss of Identity as ParentLoss of Identity as Parent

Nurse…Nurse…Therapist….TeacherTherapist….Teacher

Force feeding and later Force feeding and later food refusalsfood refusals

Not doing enough….or Not doing enough….or doing too muchdoing too much

Later social isolationLater social isolation

Parents often try to compensate Parents often try to compensate for NICU experiencefor NICU experience

Prolonged Physical DependencyProlonged Physical Dependency

parent fatigueparent fatigue

effects our social effects our social interactioninteraction

parent depressionparent depression

Interference with PlayInterference with Play

physical limitations and physical limitations and type of toystype of toys

play is a social thing play is a social thing (language!)(language!)

teaching vs play timeteaching vs play time

parents searching for the parents searching for the “magic toy”“magic toy”

Sensory DeficitsSensory Deficits

auditory, visual, auditory, visual, tactiletactile

reciprocal reciprocal interaction interaction

communicationcommunication

Multisensory toys:Multisensory toys:- - heighten arousal, heighten arousal, notnot attention to what is attention to what is importantimportant- delay object relations - delay object relations - increase irritability- increase irritability

““Risks” of Therapeutic Risks” of Therapeutic InterventionsInterventions

Physical intrusionPhysical intrusion personal body space: personal body space:

physical discomfortphysical discomfort parent’s protective roleparent’s protective role

Multiple therapists and too many adultsMultiple therapists and too many adults Loss of parenting roleLoss of parenting role Loss of peers?Loss of peers?

““Risks”of Therapeutic Intervention Risks”of Therapeutic Intervention

Impact of excess reinforcementImpact of excess reinforcement loss of internal motivation loss of internal motivation becomes overly dependent on adultbecomes overly dependent on adult distracting from task goaldistracting from task goal

Never teach a child to do something that Never teach a child to do something that you later must teach him (her) not to do.you later must teach him (her) not to do.

Problem of Limits in Problem of Limits in Child with Special NeedsChild with Special Needs

Over-acceptance of Over-acceptance of inappropriate behaviorinappropriate behavior

Inhibition and brain Inhibition and brain damagedamage

Who loves a terror and Who loves a terror and a tyrant?a tyrant? Not even the parentNot even the parent

Beyond the NICUBeyond the NICU Family IssuesFamily Issues

Financial burdenFinancial burden SiblingsSiblings Adult relationshipsAdult relationships Facing the futureFacing the future

Community SupportCommunity Support Early InterventionEarly Intervention Neighbors and friendsNeighbors and friends

Cultural Expectations Cultural Expectations

SummarySummary

The social/emotional pathway for a NICU graduate The social/emotional pathway for a NICU graduate may be different, but it can be just as strong.may be different, but it can be just as strong.

The parent’s primary role as protector, a source of The parent’s primary role as protector, a source of safety and comfort in times of distress, is altered in safety and comfort in times of distress, is altered in the NICU and beyond.the NICU and beyond.

As professionals, we need to be aware of the As professionals, we need to be aware of the potential impact of our therapeutic approaches on potential impact of our therapeutic approaches on social/emotional development of the child and social/emotional development of the child and familyfamily

Selected ReferencesSelected References

Fetal Development: A Fetal Development: A Psychobiological Perspective. Jean-Psychobiological Perspective. Jean-Pierre Lecanuet, William Fifer, Pierre Lecanuet, William Fifer, Normal Krasnegor, & William Normal Krasnegor, & William Smotherman, eds. Hillsdale, NJ: Smotherman, eds. Hillsdale, NJ: Lawrence Erlbaum, 1995. Lawrence Erlbaum, 1995.

Attachment and Loss, J. Bowlby. New Attachment and Loss, J. Bowlby. New York: Basic Books, 1969. York: Basic Books, 1969.