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Social and Emotional Impact after Neonatal Intensive Care. Penny Glass, Ph.D. Developmental Psychologist Children’s National Medical Center. Objectives:. Understand the early pattern of typical social/emotional development
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Social and Emotional Impact afterNeonatal Intensive Care Penny Glass, Ph.D. Developmental Psychologist Children’s National Medical Center
Objectives: • Understand the early pattern of typical social/emotional development • Identify factors which impact social/emotional development during and after the NICU • Understand the role of the professional in supporting social/emotional development
NORMAL PATTERN OF SOCIALIZATION • Roots of Attachment – • Development of Trust • Independence/Autonomy • Importance of Peers
Attachment: Environmental Predisposition Imprinting in humans??
Early Attachment – what the infant brings • Inborn social prediliction • Innate releasers (Bowlby) • Root/suck/cling/cry • Visual regard + Physical dependency + Cute • + own temperament
Biologically predisposed for social vs nonsocial • human voice • empathic distress • interactional synchrony
Social Predisposition and Sensory Motor Integration Interactional synchrony.. to human voice
Predisposition for social vs nonsocial • searches for facial features (eyes!) • face/voice discrimination • (parent/non-parent) • reciprocal vocal play
Attachment, Trust, and Contingency – who the infant chooses • Biological mother facilitates attachment… but is not essential • More important: • sensitivity • contingent responsiveness • emotional involvement Power of the smile
Attachment takes time…. From initial eye contact… to shared experiences and social reciprocity…… Physical dependence and development of language
Temperamental style • Easy • Difficult • Slow to Warm • Match/Mismatch • Chess & Thomas
Temperament as emotional reactivity & self regulation • Approach/withdrawal to new situation • Sensitivity to stimulation • Intensity of response • Predominant mood (+ or -)
Emotional reactivity & self regulation • Activity level, regularity of biorhythms • Distractibility • Persistence in pursuing a goal • Adaptability to change
Stepping toward Independence & Autonomy • Power of walking • Touching base parent as base of emotional support • self-regulation • mastery motivation • Empathy: • From crying to caring • From parent to others 2-year old dilemma!
Attachment and Separation Anxiety • response to separation/reunion • Secure • Insecure ambivalent • Insecure avoidant • Disorganized • …and temperament
Attachment and Peers Task of the 3 year old Practice with “pair-dates” expands to group play Needs: desire (biology/temperament) skills (lang. dependent 1. art of conversation 2. negotiate a social contract, taking turns 3. compromise and playing pretend
Social and Emotional Impact during/after NICU Factors which Impact Parent Child
“High Risk” Newborn • physical separation • vulnerable appearance • “6 sticks of butter” • disruption of biological clock • change of itinerary
Loss of Identity as Parent • Nurse…Therapist….Teacher • Force feeding and later food refusals • Not doing enough….or doing too much • Later social isolation
Prolonged Physical Dependency • parent fatigue • effects our social interaction • parent depression
Interference with Play • physical limitations and type of toys • play is a social thing (language!) • teaching vs play time • parents searching for the “magic toy”
Sensory Deficits • auditory, visual, tactile • reciprocal interaction • communication
Multisensory toys:- heighten arousal, not attention to what is important- delay object relations - increase irritability
“Risks” of Therapeutic Interventions • Physical intrusion • personal body space: • physical discomfort • parent’s protective role • Multiple therapists and too many adults • Loss of parenting role • Loss of peers?
“Risks”of Therapeutic Intervention • Impact of excess reinforcement • loss of internal motivation • becomes overly dependent on adult • distracting from task goal • Never teach a child to do something that you later must teach him (her) not to do.
Problem of Limits in Child with Special Needs • Over-acceptance of inappropriate behavior • Inhibition and brain damage • Who loves a terror and a tyrant? • Not even the parent
Beyond the NICU • Family Issues • Financial burden • Siblings • Adult relationships • Facing the future • Community Support • Early Intervention • Neighbors and friends • Cultural Expectations
Summary • The social/emotional pathway for a NICU graduate may be different, but it can be just as strong. • The parent’s primary role as protector, a source of safety and comfort in times of distress, is altered in the NICU and beyond. • As professionals, we need to be aware of the potential impact of our therapeutic approaches on social/emotional development of the child and family
Selected References • Fetal Development: A Psychobiological Perspective. Jean-Pierre Lecanuet, William Fifer, Normal Krasnegor, & William Smotherman, eds. Hillsdale, NJ: Lawrence Erlbaum, 1995. • Attachment and Loss, J. Bowlby. New York: Basic Books, 1969.