The first three years of one’s life are the most important for brain development, in fact what a baby does or learns during that time s/he will not lose. On the other hand, if s/he doesn’t learn through exposure to certain environments, relationships and stimuli s/he may never learn later in life.
Furthermore the ability to build a bond with a caregiver, is the most important factor to ensure that a child, then adolescent and then adult can build secure relationships with others around them. However as Sir Michael Rutter (known as the father of child psychiatry) said: “It is a paradox that, in the 21st century, indicators of social wealth and physical health amongst children worldwide have improved, while mental health indices in young people are deteriorating.”
The early time after childbirth is a period of greater risk for severe mental illness than any other time in a woman’s life.
The perinatal period extends from when pregnancy begins to the first year after the baby is born. Perinatal mental health is related to the bio-psycho-social functioning of pregnant women and their child. Pregnancy does not protect against the onset or continuation of mental illness – 1 in 5 women will experience mental illness during pregnancy or in the first postnatal year. The early time after childbirth is a period of greater risk for severe mental illness than any other time in a woman’s life. Effective treatments are available and in nearly all circumstances the outcome is good.
In recent years, perinatal mental health has been recognised as a major public health concern which impacts on individuals across the lifespan. Researchers, healthcare professionals and individuals in the general community have highlighted the huge impact of mental health problems during the perinatal period and the need for improved care in this area.
Where a woman experiences maternal mental illness, her partner is more vulnerable to ill health. It is essential to address the needs of the partner, family and older children for the woman’s recovery. Attention to an infant’s bond with the father and other caregivers, and the impact of paternal mental ill health on the child’s attachment and development, is core to good family functioning. Therefore if the mother is suffering from a mental illness, supporting the family members to be around for the child and encouraging them to spend time and build a secure attachment with the child, will ensure the child’s development continues to progress and reach their potential, whilst the mother is recovering.
Infant mental health applies to infants until the age of three and investigates their optimal social and emotional development. The transmission of attachment difficulties and mental health problems from one generation to another is well recognised. Therefore, if the family works on breaking its cycle of mistakes, it would stop the trans-generational transmission of attachment difficulties in children.
“One may go as far to say that in the same way that parents take their children to be assessed by a pediatrician, it would be ideal if the stigma with mental health was lost and parents also take their children for mental health checkups.”
It is mediated through wider environmental influences, genetic and biological factors. Social relationships in early life are likely to have a crucial influence on the infant brain. Basic principles of infant mental health evaluation and treatment involve consideration of the parent(s), child, and their relationship, while keeping in mind the rapid and formative development of the brain and mind in the first years of life. One may go as far to say that in the same way that parents take their children to be assessed by a pediatrician, it would be ideal if the stigma with mental health was lost and parents also take their children for mental health checkups. And this applies to everyone, not only children coming from vulnerable families or those who have behavioral problems.
In the words of Gordon Smith – “We take our kids for physical vaccinations, dental exams, eye checkups.
When do we think to take our – our son or daughter for a mental health checkup?”
Brain development is dependent on strong, early bonds with an infant’s main caregiver – most often the mother. Research identifies critical time periods in early life where specific brain pathways develop optimally. Later on it becomes increasingly difficult to bring about change. The interaction with the primary caregiver in the first years of life shapes the infant’s social, emotional, cognitive and language development, facilitating development of good mental health through childhood and into adulthood. Early intervention is therefore essential in ensuring the prevention of future mental health difficulties and is a public health concern, particularly due to increases in mental health difficulties and lack of corresponding funding allocated to services for 0-5s.
There is increasing evidence to favour interventions that improve the mother-infant relationship, where mother and child face additional vulnerability. A number of specific parent child programmes have demonstrated efficacy. Parent-child programmes are implemented through the attachment pathway at the TAASC (the team for assessment of attention and social communication) at Remedies Clinic, Birkirkara. We offer parents and their children this unique opportunity to get assessed following the most recent evidence and to be offered expert advice were needed.
Author: Dr Nigel Camilleri
Dr Nigel Camilleri studied medicine and surgery at the University of Malta and practices as a psychiatrist. He is currently a Consultant Child and Adolescent Psychiatrist at Mount Carmel Hospital and Clinical Lead for the Team for Assessment of Attention and Social Communication (TAASC), Malta. He also chairs the Association of Child Mental Health (ACAMH) – Malta Branch.