THE WORLDWIDE BURDEN OF INFANT MENTAL AND EMOTIONAL DISORDER: REPORT OF THE TASK FORCE OF THE WORLD ASSOCIATION FOR INFANT MENTAL HEALTH.

Children worldwide experience mental and emotional disorders. Mental disorders occurring among young children, especially infants (birth -3 years), often go unrecognized. Prevalence rates are difficult to determine because of lack of awareness and difficulty assessing and diagnosing young children. Existing data, however, suggest that rates of disorders in young children are comparable to those of older children and adolescents (von Klitzing, Dohnert, Kroll, & Grube, ). The lack of widespread recognition of disorders of infancy is particularly concerning due to the unique positioning of infancy as foundational in the developmental process. Both the brain and behavior are in vulnerable states of development across the first 3 years of life, with potential for enduring deviations to occur in response to early trauma and deprivation. Intervention approaches for young children require sensitivity to their developmental needs within their families. The primacy of infancy as a time of unique foundational risks for disorder, the impact of trauma and violence on young children's development, the impact of family disruption on children's attachment, and existing literature on prevalence rates of early disorders are discussed. Finally, global priorities for addressing these disorders of infancy are highlighted to support prevention and intervention actions that may alleviate suffering among our youngest world citizens.

Toddler socioemotional behavior in a northern plains Indian tribe: associations with maternal psychosocial well-being.

M.C. Sarche, C.D. Croy, C. Big Crow, C. Mitchell, and P. Spicer (2009) provided first-ever information relating the socioemotional development of American Indian toddlers to the immediate context of their mothers' lives. The current study sought to replicate and build on their earlier work by examining the impact of additional maternal risk factors, identified in previous research with non-American Indian populations, on the development of American Indian toddlers: maternal depression, negative social influences, and mother's feelings of isolation. At 27 months, American Indian mothers (N = 110) completed the Parent Demographic Questionnaire, which measured maternal psychosocial characteristics (e.g., depressed affect, social support, drug and alcohol use, isolation) and demographics. Mothers also completed the Infant-Toddler Social Emotional Assessment (A.S. Carter & M.J. Briggs-Gowan, 2006) and the Parent-Child Dysfunctional Interaction subscale of the Parenting Stress Index (R.R. Abidin, 1995, 1997). Some results replicated the original study, but others did not. Reports of a dysfunctional mother-child relationship related to externalizing and internalizing problems, replicating the earlier study. This study also found associations between a dysfunctional mother-child relationship and socioemotional competence as well as dysregulation. The previous finding of a relationship between American Indian identity and socioemotional competence was supported. Adding the effects of maternal depressed affect and isolation significantly increased prediction of toddler behavior problems.

Emotional availability: critical questions and research horizons.

Based on attachment theory, the construct of emotional availability and its assessment goes beyond attachment in important ways. Its origins in clinical experience and emotions research are discussed as well as the prospects for continuing advances in knowledge stimulated by the contributions in the Special Section. This is especially so in terms of developmental variations and the biological underpinnings of emotional availability. A major need and opportunity also exists concerning research related to psychopathology, clinical interventions, and training.

Emotional Expression and Language: A Longitudinal Study of Typically Developing Earlier and Later Talkers from 15 to 30 Months.

Children's emotional expression and language both develop during infancy and early childhood, yet these two communication systems have been studied primarily in isolation. This study focuses instead on assessing the relation between them just as productive language emerges during toddlerhood. Seventy-seven typically developing, firstborn toddlers and their families were recruited at 13 months of age. Using an extreme groups design, earlier and later talkers were selected based on their MacArthur Communicative Development Inventory production scores. Laboratory visits occurred at 15, 21, and 30 months; home visits occurred at 3-month intervals from 15 to 30 months. Observational and parent report measures assessed child language, emotional expression, temperament, and overall developmental functioning. Parents also reported on parenting stress and family life events. Overall, results support a significant relation between emotional expression and productive language that varies according to the specific emotion, a finding that may resolve earlier contradictory results in this area. Earlier talkers expressed more joy/pleasure than did later talkers, but later talkers expressed more fear and anger than did earlier talkers. Potential contributions of various child/family factors were explored. Child temperament is proposed as influencing this relation through its effects on the child's transactions with the caregiving environment.

Potentials for infant mental health: Congress themes and moral development.

Themes of the Congress carried forward the pioneering contributions of Rene Spitz and Takeo Doi. Contributions to infant mental health included those dealing with: (a) relatedness, (b) positive rewards of infancy, (c) disruptions of relatedness and rewards, (d) assessments, and (e) interventions. Contributions from infant mental health and bridging to the future included those regarding: (a) prevention, (b) policy, and (c) advances for science and practice. Knowledge from infant mental health is seen to fill a gap in our current moral discourse. Biologically based, universal moral processes of reciprocity and empathy develop in infancy, with regulation from parenting. Parenting, suffering under conditions of deprivation and adversity, can benefit from interventions designed to promote positive outcomes for conduct. Implications stem from a wider awareness of global needs. An expressed resolve of many is to provide consultation for regions needing our help and to formulate a declaration of infant rights for guiding actions.

Facilitating reflective supervision in an early child development center.

Reflective supervision (RS) has not been a tradition in most early child development settings. The infant mental health consultant, in successfully implementing RS, helps to articulate and affirm some basic values necessary for a community of reflective practice. These emphasize (a) participating in an environment of continuous learning and improvement and (b) engaging in an ongoing commitment to professionalism. Sets of dimensions of RS, therefore, include sharing and learning, emotional support and dealing with vulnerability, and systems sensitivity. Issues for RS training involve using yourself as a tool and learning about the science of being with others.

Innovation in child psychoanalytic training: an implementation study.

A five-year evaluative research project regarding an innovation in psychoanalytic training within institutes of the American Psychoanalytic Association (APsaA) was conducted through the Committee on Child and Adolescent Analysis (COCAA) of its Board on Professional Standards, which led to significant policy changes within APsaA's Principles and Standards of Education. Eleven candidates at four different institutes (Columbia, Denver, Houston-Galveston, and St. Louis) entered a pilot training program for child and adolescent analysis without the requirement of adult training. Satisfaction with training and supervision in these programs was rated high by candidates, faculty, and program directors, with additional flexibility for child analytic training seen as an advantage. The limitations and implications of this implementation study are discussed, including its encouragement of educational evaluation and further research.

Development of autonomy: role of walking onset and its timing.

The observations of psychoanalytically oriented clinicians such as Mahler, Pine, and Bergman and Greenacre were descriptive of intriguing aspects of the infant's transition to upright locomotion. Yet, research on how walking creates changes in the infant and in the family have scarcely been studied. In this naturalistic home study, 46 infants were designated "earlier" (13 girls and 10 boys) and "later" (12 girls and 11 boys) walkers based on their relative timing of entry into this developmental transition. Analyses between these two groups were done with age held constant and indicated that the earlier walkers showed a greater rise in autonomous functioning across the transition to self-produced, upright locomotion. Autonomy was assessed as infant proximity-seeking and distancing with respect to mother and "testing of wills" between mother and child. These findings suggested that the timing of beginning to walk crucially affects the development of autonomy. In addition to these clear differences associated with the walking transition, there were differences between the two groups in an aspect of temperament, Distress to Limitations, even prior to walking onset as well as at all time points of measurement.

How do we evaluate learning from the curriculum? Thirty phone interviews with Institutes of the American Psychoanalytic Association.

A telephone survey of curriculum directors of the thirty institutes of the American Psychoanalytic Association revealed that 75 percent of institutes highly value the importance of evaluating what candidates learn from the curriculum. Paradoxically, however, most institutes do not do evaluations in this area. Typically, institutes evaluate candidates' satisfaction with courses, or their attendance and conduct in classes, rather than learning per se. Some institutes have more rigorous evaluation methods, including oral exams. Objections to evaluating what candidates learn included (1) evaluations involve too much work; (2) evaluations of learning are considered inappropriate or invalid; (3) evaluations would hurt candidates, faculty, the learning process, and the institute. Some curriculum directors dismissed these objections, contending that it is the responsibility of psychoanalytic educators to set teaching goals and evaluate learning.

Healing after Columbine: reflections of psychoanalytic responders to community trauma.

Following the shootings at Columbine High School on April 20, 1999, the Denver Psychoanalytic Society provided both immediate and long-term interventions to those closely impacted by the tragedy. In this effort, analytically trained volunteers faced many personal challenges and role adjustments. To address these issues a reflective study group was formed twenty months after the traumatic event. Group discussions revealed a surprising number of residual symptoms from secondary trauma, as well as opportunities for shared coping among analysts. Little has been written about the very human and subjective responses of analysts in such circumstances. These experiences may be helpful to others in today's world of terrorism and unexpected violent events.

Developmentally sensitive diagnostic criteria for mental health disorders in early childhood: the diagnostic and statistical manual of mental disorders-IV, the research diagnostic criteria-preschool age, and the diagnostic classification of mental health and developmental disorders of infancy and early childhood-revised.

As the infant mental health field has turned its focus to the presentation, course, and treatment of clinically significant mental health disorders, the need for reliable and valid criteria for identifying and assessing mental health symptoms and disorders in early childhood has become urgent. In this article we offer a critical perspective on diagnostic classification of mental health disorders in young children. We place the issue of early childhood diagnosis within the context of classification of psychopathology at other ages and describe, in some detail, diagnostic classifications that have been developed specifically for young children, including the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R; ZERO TO THREE, 2005), a diagnostic classification for mental health symptoms and disorders in infants, toddlers, and preschoolers. We briefly outline the role of diagnostic classification in clinical assessment and treatment planning. Last, we review the limitations of current approaches to the diagnostic classification of mental health disorders in young children.

Trajectories of cognitive development among American Indian young children.

Children who begin kindergarten with stronger skills learn faster than do those who enter with lower skills. Minority children tend to enter kindergarten already at a disadvantage, and the gap widens across time. However, little is known about cognitive development among American Indian young children. In this study, 110 American Indian infants from one Northern Plains reservation community were assessed four times between ages 6 months and 36 months, with the Mullen Scales of Early Learning. At 6 months of age, scores were near the national norms; a drop occurred between 6 months and 15 months. Scores then tended to level off below the norms through 36 months. In each domain, we observed a crucial decline over the 1st year of life and relatively little change in the 2nd and 3rd years of life, highlighting the importance of developing culturally syntonic interventions to facilitate cognitive development during the 1st year of life.

Engaging imagination and the future: frontiers for clinical work.

Narrative theory indicates that assessment using narratives is expectant, collaborative, and has the potential to begin a process of change. A shift from thinking exclusively about meaning (subjectivity in the child) to thinking also about shared meaning (intersubjectivity between child and clinician-examiner) seems appropriate in the clinical context. Recent knowledge from the cognitive neurosciences makes a shift of this sort compelling and has further implications. More story stem narrative research at the level of assessing individual children needs to be done so there can be explicit links to treatment.