Emotional Development : Researchers Identify Babies' Milestones

The Washington Post

Some babies, declares one researcher, "seem to be born three drinks ahead." More mellow, that is, than most.

(That's three figurative drinks, of course. Even three drops would be too much--and do no good--for inconsolable newborns.)

Almost any mother of two or more will tell you that no two are alike--from the moment of birth. Along with the laid-back babies, who seem to take to life--to take on life--with zest and equanimity, there are the babies who are born in a state of what the infant psychiatrists call "emotional disorganization," seemingly unable from day one to deal with the stress of being alive.

But experts today are finding that these apparent differences--whether observed by midwife, psychiatrist or modern mom--are genuine manifestations of budding emotional organization on the part of the infant. Some do it better than others. Some can't do it at all without some immediate help. Others may stumble--or be tripped--along the way.

Emotional Milestones

Building on the pioneering work of Swiss psychologist Jean Piaget, who laid out the steps in the cognitive development of the child, today's child psychiatrists, including a team at the National Institute of Mental Health and a spinoff group of clinicians in private practice, have identified similar step-by-step development of emotions.

And they are discovering subtleties of emotional learning, requiring specific parental (or care-giver) participation beginning at birth. Some of the emotional steps, or milestones if they are missed, can retard subsequent development on the intellectual or cognitive, as well as the emotional level. In its most severe form, a child's failure to master increasingly complex emotional milestones can cause him to withdraw from the human world into what appears to some as a kind of autism.

Sometimes, pioneering child psychiatrist S. Reginald Lourie says, these emotional deficits can even be fatal.

Much of the initial work on emotional development was in families where specialists perceived particular risk factors--psychiatric illnesses, lack of support systems and other ongoing and serious problems. But Lourie, who was for 25 years director of psychiatric services at Children's Hospital National Medical Center in Washington, Dr. Stanley I. Greenspan, Dr. Robert Nover and other researchers at the Mental Health Study Center of the National Institute of Mental Health, now have amassed enough evidence to document this conclusion:

Attention to an infant's emotional state, according to specific milestones they have been able to set forth, is as important to any assessment of any baby as is his rate of growth, IQ or physical health, whether or not risk factors exist in the family.

Pinpointing Emotional Patterns

Greenspan, chief of the study center, says that years of study and clinical treatment of multi-risk families, along with observations about the varying temperaments of newborn infants, have now permitted the mapping of "emotional milestones of early development."

"This permits us," he says, "to pinpoint not only when a child sits up, crawls, walks, talks--those kinds of things every parent looks for--but, with growing specificity, the normal or maladaptive emotional patterns in babies and young children."

How critical these milestones may be is demonstrated by results of a recently completed study, Greenspan says, "showing that the more risk factors (likely to interfere with mastering the emotional milestones) a family has, the more probability there is of compromised intellectual and emotional development later on."

The study showed that in families where emotional disturbances in the parent were severe and chronic and no other support existed--such as a grandmother or well father--"there was a 20- to 25-fold greater probability of severe compromise of intellectual development by the age of 4, compared with those in families with only one or two (risk factors)."

These are the most severe cases. But research has also taught the specialists that even when the infant seems to miss the milestones--and the mastery of each is dependent on mastery of the one before--some form of intervention, perhaps only a matter of helping the care-giver read the baby's signals, can be valuable.

"When the child is beginning to go off the road at say, 4 months," Greenspan says, "it's a lot easier to nudge the child and the parents back onto the road than it is at 4 years, when you already have three years of perhaps maladaptive emotional coping strategies being built up."

Major Objective to Communicate

Because so much of this work is so new--much of the knowledge amassed or confirmed only in the past five or six years--a major objective has been to communicate the findings to pediatricians, neonatal nurses and other care-givers. A goal is that emotional assessments become part of the routine so-called "well-baby examinations."

Greenspan has (with his wife, Nancy) written a book for parents, setting forth in lay terms the need and techniques for parental interaction in emotional development. "First Feelings: The Emotional Care of the Infant and Young Child" will be published next winter by Viking.

In a move designed to start providing services to communities, the Regional Center for Infants and Young Children was founded in Silver Spring, Md., an outgrowth of the NIMH program. Lourie is chairman of its board, and Greenspan and such trailblazers as Harvard's Dr. T. Berry Brazelton are among the board members.

A nonprofit agency, the regional center offers emotional development assessments and a whole range of therapeutic and educational interventions for parents who simply want to be better parents or for those where developmental problems seem to exist. There are individual parent consultations and groups, parent-child interaction sessions, a therapeutic nursery and day-care program--the latter just getting under way.

The problem may be as simple as teaching the parent that the emotionally disorganized newborn may be too easily overstimulated, or may find high tones--pleasing to most babies--actually painful. Or may be discomfited--even pained--by stroking or cuddling. (Retrospective studies show, for example, that some adolescents who have trouble forming close relationships have histories of this kind of sensory difficulty.)

Or the problem could be one in which mother and child are temperamentally at odds: a not unusual problem. Or there may be serious illness, either in child or parent, that can throw off the emotional development and therefore some cognitive development. The center staff is trained, as only a handful of hospital or university-based staffs around the country are, to identify the emotional elements, the missing emotional "nutriments" and often the appropriate interventions, either for therapy or prevention.

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