How do we arrive at our hypotheses about the needs of the family and the baby?
Every domain of development is our concern. Relying too heavily on information from one area underestimates the value of another. We all need each others’ expertise in our work. The more attentive we become in working together, the smarter we are in our own work.
When you watch a baby and parent interact, the lens of your own discipline colors what you see, and how you interpret your observations. If you are a mental health provider, you may be wondering about maternal depression or attachment disorder. If you are an OT or a PT you may be noticing the atonic neck reflex or the infant’s response to vestibular stimulation. If you are a Speech/ language pathologist, you may focus on the absence of vocalizing or the lack of social referencing. Cross-disciplinary information allows us to see how one area of development is influencing another and protects us from misinterpreting a symptom as a cause of the problem.
An example of interdisciplinary intervention
For example, a family came to see me with their 5-month-old. The baby was in distress. The parents were distraught. The fourth child in the family, the parents were trying to take pleasure in a fleeting smile and convince themselves that the baby’s somber face was acceptable. The mental health concerns were obvious to me. This baby and parents were slipping away from each other. Being informed by other disciplines I noticed the asymmetry of his motor system, weakness in his core body and poor stability in his posture. He was working so hard to stablize his body, he was not able to use his visual system to anchor himself to his caregivers. To work effectively with this family, we needed intervention from physical therapy, medicine and mental health. By combining intervention across disciplines, we were able to use emotional cues to engage the baby and mobilize sensory and motor systems into well-orchestrated interactions with his parents. In this case, the baby’s body was fully supported by the mother’s lap and legs. Mom was the object of interaction and play; no toys were needed. Interventions spanned the emotional system, motor system, sensory processes and nonverbal communication. The emotional life of the dyad was addressed by holding Mom’s anxiety so she could wait for her baby to process environmental cues and reciprocate emotionally. The baby was positioned with full physical support so he did not have to use all of his energy attempting to organize his body, enabling him to organize his attention on Mom’s face and voice. With these interventions, Mom and baby were able to maintain a continuous flow of back and forth interaction anchored in mutual visual regard, gesture and facial expression.
↔ ↔ Stay tuned for Section 3:
Principles of Infant Mental Health for all disciplines
Barbara Kalmanson, Ph.D. is a Licensed Psychologist and Special Educator in private practice in the San Francisco Bay Area. She is a National Fellow of Zero-to-Three, Senior Faculty for the Interdisciplinary Council for Developmental and Learning Disorders (ICDL) and Senior Faculty of the Profectum Foundation.
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