Mellow Babies: A big help for very little

people

Dr Christine Puckering

Consultant Clinical Psychologist

and Research Fellow

Royal Hospital for Sick Children, Glasgow.

Babies are designed to communicate – they can’t do much else…

• “There is evidence that even newborn infants, with their very immature though elaborate brains, limited cognitions, and weak bodies, are specifically motivated, beyond instinctive behaviours that attract parental care for immediate biological needs, to communicate intricately with the expressive forms and rhythms of interest and feeling displayed by other humans” (Trevarthen, 2001)

Some brain basics – the neuron

Sequence of development

• At birth, sensory and motor areas are myelinated and the vegetative functions are working

• The frontal lobes do not begin to function until six months and are not fully myelinated until adolescence/early adulthood

• The capacity to make judgements and control emotion is not fully organised until the frontal lobes are in action and the types of decision made are formed by experience

Normal diurnal production of cortisol

Waking Bed time

Diurnal production of cortisol inabused and neglected children

Waking Bed time

Medium arousal

Low arousal

High arousal

Perf

orm

ance

Graph of the Yerkes –Dodson Law

When do we learn best?When do we learn best?

Source: J Heckman & D Masterov (2005) Ch 6, Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: Scotland’s Economic ProspectsNew Wealth for Old Nations: Scotland’s Economic Prospects

THE LONG TERM EFFECTS OF EARLY EXPERIENCE:

•1) The wiring of the brain

•2) Sensory Integration

•3) Emotional Literacy

•4) Belief Systems

•5) Relationship patterns

•6) Empathy, conscience/moral development

WHAT ARE THE OUTCOMES FOR YOUNG PEOPLE OF POSTNATAL

DEPRESSION?• Increased risk of depression especially early

onset depression• More social and behavioural problems lasting

into adolescence• Poorer language development• Poorer cognitive development especially in

boys and in families with other social problems

• NB just treating maternal depression does not change risk to child!!

Who needs most support?The parents who are least likely to engage in and benefit from parenting interventions are*

• Young• Poor • Poorly educated• Lacking social and partner support• Suffering from psychological disorders

themselves

*NICE report 2006

What works in targeted services for infant mental health?

• Narrow focus on sensitivity alone• Between 5 and 16 sessions

• Between 6 and 12 months of age (no advantage in antenatal intervention)

• Programmes including fathers showed increased sensitivity in fathers but diluted effects for mothers

• The use of video feedback increased effect sizes for sensitivity

Bakermans-Kranenburg M.J., van IJzendoorn M.H., Juffer F., 2003. Less is more: meta-analyses of sensitivity and attachment

interventions in early childhood. Psychological Bulletin 129(2), 195-215.

WHY DEVELOP THE BABIES PROGRAMME?

The developmental needs of the child and the corresponding parenting tasks are specific to this stage i.e lunch-time activities and workshops’ content

Early intervention: focus on preventing attachment problems and increasing parental attunement.

MELLOW BABIES: THE INITIAL DIRECTION

• Hard to engage families with a history of significant mental health and relationship difficulties

• Significant post-natal depression

• Child protection

Components of the Programme

• Careful recruitment– Low levels of literacy – History of adverse relationships– Low self-esteem– Low trust

• Child care and transport help• Personal group• Parenting workshop using parent’s own video• Hands-on lunchtimes• “Homework” to practice skills at home

TYPICAL DAY:

09:30 - Breakfast/Welcome10:00 - Personal Group11:30 - Break11:45 - Lunch12:30 - Activity01:00 - Workshop02:30 - Finish

Personal Group

• A chance to reflect on the mother’s story

• A chance to reflect on current relationships

• A chance to reflect on mother’s mental health (CBT)

What I thought

What I did

What I felt

What the group thought

What the group thought

Clouds

Mother-baby activitiesAim: to get mothers and babies face to face and

attentive to each other and to have fun

• Gentle Touch• Book reading• Interactive coaching (mirroring)• Nursery rhymes

(see weekly programme)(also good for babies and dads)

Parenting Workshop

• Feedback on mother’s videotape• Psycho-educational material• Dimension of parenting

– Anticipation – Autonomy – Responsiveness – Cooperation – Distress – Control

Baby Cues

Have A Go (homework)

• A chance to practice mother-baby interaction

• A chance to challenge negative automatic thoughts

Child Protection Outcomes

• 2 groups

• 10 families

• 13 children

• Child Protection involvement with 7/13 children

Child Protection Outcomes

Child Protection Involvement• 7 children on the Child Protection

Register at start of program.• 2/7 children de-registered by 6 month

follow up stage. Legal proceedings dropped on 1 case.

• 3/7 children returned from care at follow up point but remained on register

Child Protection Outcomes

• 2/7 children remained in care. Court report provided by Mellow Parenting supporting the Local Authority’s application for Care Orders and Freeing for Adoption.

Waiting-list controlled trial(postnatal depression)

• 11 mothers completed trial

• 2 mothers dropped out

• 6 W/L controls

0

5

10

15

20

Before After

Edinburgh Postnatal Depression Scale in Mellow Babies Group and Waiting List Controls

Mellow Babies

Waiting list

P=0.035

0

50

100

150

200

Before

After

Positive Interaction Measures in Mellow Babies and Waiting-list

Control groups

Mellow Babies

Waiting List

*P<0.023

0

5

10

15

20

Before

After

Negative Interaction Measures in Mellow Babies and Waiting-list

Control groups

Mellow Babies

Waiting List

*p<0.025

What Mum’s Gained From Mellow Babies I

• I learned to open and share my feelings.• The best thing was being able to sit relaxed, and

cry, or say nothing or listen.• The most important thing I learnt was that I am

worth it.• The most important thing I learnt was how to be

more interactive with babies.• I now put him somewhere safe when he is upset

and I cannot stand it.• It felt really good because everybody

understands you.

What Mum’s Gained From Mellow Babies II

• It was good seeing yourself on video because you see the difference in them and how you and your baby have bonded together.

• The video meant you could see how different things were (compared to the beginning).

• How did it feel in the group? Totally relaxed and trusting each other.

• I don’t get so upset. Think first.• I can go out now. Trying to think positive.• The most important thing was listening to

other people’s feelings, and my own