Developmental Problems of Maltreated Children and Early Intervention Options for Maltreated Children. Infant-Focused (Clinic- and Home-Based) Interventions

04/23/2007

Therapies specifically designed for maltreated infants are also available; however, the use of these treatments is limited by the lack of infant mental health training among therapists. Because most of the emotional and behavioral problems in maltreated infants (e.g., problems with eating, sleeping, emotion regulation, and attachment) are seen as relational, infant mental health interventions mainly focus on improving the infant-parent relationship. Interventions using attachment, social learning, object relations theories, or some combination have been created to alter the interaction style of the parent to resemble more sensitive, responsive behaviors and thus remediate infant difficulties (for a description of different theories of attachment, social learning, and object relations, see Ainsworth, 1969). Effectiveness studies usually incorporate pre- and posttest design or case illustration, and this research has suggested that infant-parent psychotherapy may improve poor attachment quality, emotional expression and regulation, and eating and sleeping patterns that are frequently seen in neglected and abused infants (Fraiberg & Adelson, 1976; Fraiberg, Lieberman, Pekarsky, & Pawl, 1981; Green & Meersand, 1994; Hopkins, 1992; Lieberman, Weston, & Pawl, 1991; Slade et al., 2005). In one study, a treatment that acknowledged and then focused on the role of past experience in shaping maternal response to infant's cues and behavior gave positive results (Robert-Tissot et al., 1996). The same study also showed similar positive results for interventions that focus only on altering observable present-day mother-infant interactions and maternal thoughts-positive results that included reducing infant presenting problems, improving dyadic interaction, and improving maternal self-confidence and satisfaction with parenting. More recently, a study conducted by Cohen et al. (1999) compared an infant-led psychotherapy, Wait, Watch, and Wonder, with a more psychodynamic infant-parent therapy that included transference work. The two interventions were compared with respect to attachment behaviors, presenting problems, and infant cognitive development. Although both treatments were effective in decreasing the severity of infant problems (i.e., feeding, sleeping, behavioral regulation problems), more of the Wait, Watch, and Wonder infants moved toward security or organized attachment and had higher cognitive scores at the end of treatment. Nevertheless, 6 months after treatment, the differences between these two interventions disappeared; both intervention groups demonstrated similar levels of improvement in infant symptoms; attachment related behaviors; cognitive development; and maternal depression, stress, and competence (Cohen Lojkasek, Muir, Muir, & Parker, 2002). This study suggests that infant-parent therapies are effective in helping maltreated infants and their families and that these effects are maintained for some time after treatment. Further research and program evaluation on infant-parent therapies for maltreated dyads are currently being investigated by the Infant Parent Program at the University of California-San Francisco (Mahler, Kreader, Godber, Knitzer, & Douglas-Hall, 2002) and by other university-based mental health centers (Cicchetti, Toth, & Rogosch, 1999).

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