Infant Mental Health Even infants can experience trauma. Infant mental health is a multidisciplinary field that examines early childhood development and recognizes the presence of social- emotional processes as early as infancy (Zeanah, 2009). Some people view infants as simply going through the biological motions of survival, without advanced emotional functioning. This misconception often causes traumatic attachment failures or other traumatic experiences to be dismissed as occurring out of an infant’s perceptual awareness (e.g., “They won’t remember”), minimizing the focus on infant intervention needs. Although infants cannot directly report on their trauma symptoms, physiological evidence suggests that the impact of chronic attachment failures mimics that of more overt traumas (Humphreys & Zeanah, 2015). That being said, due to their limited cognitive, motor, and language skills, infants likely cannot actually experience or show many symptoms of PTSD as described in current diagnostic criteria (DeYoung & Landolt, 2018). Researchers have studied socioemotional traumatic stress of infants by experimentally manipulating parental responsiveness and measuring infants’ behavioral and physiological reactions (Braungart-Rieker et al., 2019; Provenzi et al., 2016). Parents were asked to become unresponsive, with flat affect, while interacting with their children. The infants in the experiments responded with emotionally charged attempts to re-engage the parent, decreased their social/communicative behaviors, and averted their gazes from the parents, all while exhibiting increased physiological stress and arousal (Provenzi et al., 2016). These effects have been shown to carry over into continued parent–child interactions, even when the parent shifts back to a more positive interaction style. In other words, traumatic attachment interactions can impart the long-term consequences in mental health and biological functioning commonly observed in response to trauma. However, for children and parents who generally Conclusion This chapter examined the impact of trauma within a developmental context and highlighted the unique ways in which children respond to trauma. The common DSM-5 diagnoses that are used to classify childhood challenges but do so without proper consideration for underlying trauma symptoms were reviewed. Covert, interpersonal traumas commonly observed in children were differentiated from the overt traumas often seen in adults. For instance, attachment failures (e.g., chronic unresponsive or insensitive caregiving) were positioned as developmentally pertinent traumas that alter developmental trajectories with long-term negative outcomes. Various examples highlighted how overlooking trauma as an etiological factor and attending only to surface
display a secure attachment style, there appears to be an increased ability to recover following these periods of unresponsiveness, suggesting that periods of distress can be overcome in the midst of a generally supportive environment (Braungart-Rieker et al., 2019). Clinicians may be in a role to educate parents about the concepts of infant mental health and could potentially mitigate interactions harmful to healthy attachment. When looking for signs of trauma in infants, practitioners should worry less about DSM-5 criteria, as infants do not fit well within symptom domains, and assess for the ways in which trauma may be resulting in developmental shifts—either delays or deviance from normal development (Humphreys & Zeanah, 2015). Case Example Jeff, a young single father struggling with his own depression, entered therapy for help with his 10-month-old infant. His baby would frequently cry, and Jeff felt helpless in his ability to soothe the child. This was Jeff’s first child and he had planned on coparenting with his wife Kristin, who had died from suicide two months earlier, when their infant was 8 months old. Jeff felt unprepared to parent alone and had been experiencing severe grief and depression since Kristin’s death. Jeff reported that Kristin was stifled by her treatment-resistant depression and had not connected emotionally with the baby. Jeff, feeling the same way now, acknowledged that the child had not experience a lot of positive emotion in these first few months of life. Jeff was committed to working on both his depression and his attachment relationship with the baby. While simultaneously focusing on his grief, Jeff was able to improve his ability to help the baby regulate when distressed; engage in shared, positive emotion with the baby; and attune his emotions with the child in a way that eventually reduced the baby’s distress and contributed to improved soothing and regulation. symptoms often result in ineffective trauma treatment. The available child-specific trauma diagnoses were examined and the two primary diagnoses, PTSD for children six years or younger and DTD, were compared and contrasted. Clinicians should be aware of both disorders and use clinical judgment when attempting to classify child trauma. Finally, this chapter considered the role of trauma during infancy, an often-forgotten developmental period, and reviewed the nuanced observations clinicians need to make when assessing for infant mental health. Clinicians must be aware of the complexities of childhood trauma, and they must learn to assess, diagnose, and treat childhood trauma differently from adult trauma.
THE NEUROBIOLOGY OF TRAUMA
Advances in technology have uncovered the biological effects of trauma on underlying physiological mechanisms. Previously reserved only for medical practitioners, at least a minimal knowledge of the biological mechanisms involved in trauma can translate to more effective professional practice for social workers, mental health counselors, psychologists, and marriage and family therapists. Trauma can wreak havoc on biological systems, and providers are not only more informed when they understand all the effects of trauma, they can also better tailor clients’ treatments with this information in mind. This chapter will present basic background information on the neurobiological mechanisms involved with and affected by trauma. For example, the various structures of the brain are presented to help the reader understand which structures are involved
in general memory storage, the encoding of traumatic events, and memory storage of traumatic material. By revealing the connection between brain structure and brain function, neuroscience provides insights into the ways that experiences shape mental processes and create neural network patterns in the brain. Trauma is a psychophysical experience, and clinicians should consider the effect of trauma on the physical encoding of information and see how trauma is encoded and stored within the various parts of the body—how trauma “gets under the skin” (McEwen, 2020, p. 4). This information can then inform the nature of trauma treatment and increase understanding of how various types of intervention can help to move the healing process forward.
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