Child and family interaction: the setting
The scene shows Eaton Kerr, a toddler, in a happy and playful family photo shoot with other members of his family. These family members are his mother, Kerry; his father, Jonathan; and his doting 8 year old brother, Jordan. The Kerr family lives in Northern Ireland.
Kerry is clearly enamoured of her little boy. In her own words, she “can’t bear to be away from him” and could just “gobble him up”. This is probably intensified by the fact that Eaton had been an unproblematic infant, who slept well, ate well and rarely cried. Kerry and Jonathan apparently had an easy time in the first few months after his birth. This is evident in the casual and relaxed manner that can be seen with the entire family.
However, one and a half years later, Kerry is yearning for a baby girl. Having previously lost two female children, and currently raising two little boys, Kerry hungers for a female child. A scene in which she strokes her dog’s head longingly could perhaps be an indicator of how much she craves another child. Kerry has a tendency for potential fatal blood clots, which is typically increased in pregnancy. Despite past medical complications and a clear understanding of the associated risks, Kerry is determined to pursue her dream. She is booked into the hospital for a medical scan to assess potential risk of cerebrovascular or cardiovascular events during pregnancy. The results are daunting and confirm that a pregnancy could be lifethreatening for the young mother.
Understandably, Kerry is dejected by the prognosis, and four months later, she still has not come to terms with the outcomes of the scan. Her severe levels of unhappiness culminate in clinical depression: she is perpetually unhappy and tired; has lost all motivation to carry out even mundane everyday tasks; and finds no pleasure in things that normally make her happy (anhedonia). The loss of her two baby girls in the past appears to be constantly on her mind and she keeps photo scans of the embryos which would serve as a constant negative reminder. The fact that she has named these two offspring (Jordana and Caitlin) shows the depth of the attachment she feels for them. In addition, it seems she has recently lost her father – all these are textbook triggers for clinical depression. Using the DSM-1 classification of mental health diseases, Kerry’s depression would be classified as severe, as she confesses to having had suicidal thoughts.
It is a well-known fact that depressed mothers find it difficult to respond to their children’s needs. In a poor attempt to discipline her toddler, Kerry tries to implement strict upbringing rules which are often not suitable to Eaton’s developmental phase. This is clearly corroborated by the evidence of Eaton’s corresponding stunted development. However, the little boy is shown as striving to obey his mother, only becoming rebellious at the often-dreaded bedtime etc, thus showing signs of his first battle for independence at eighteen months.
Poor sleep hygiene that is common among depressed patients is also proving to be problematic in the mother-child relationship. In the video, classifying humans according to their sleep patterns, Eaton is categorised as a lark – early to bed and early to wake; while Kerry is a contradicting owl – who is up till late at night and, consequently, stays in bed till late in the afternoon. This means that Eaton is often up, for hours, sometimes for up to three and a half hours, crying for his mother before he gets any attention. He is losing numerous battles for his independence in this ‘power struggle and is learning that he has no control over his environment. Although it is not voiced in the videotape, the constant absence of Eaton’s father, Jonathan, suggests possible family problems. He has to leave for work early as he helps run the family energy business, and appears to be blissfully unaware of the problems in his home. Therefore, Kerry is probably going through these difficult times alone. Without the vital family and social support, her depression is likely to worsen and would essentially adversely impact on her little boy.
As Kerry is unable to motivate herself to do anything, she is also incapable of stimulating the young Eaton. Her apparent insensitivity to his emotional needs is clearly evident and would be detrimental to the child’s development. This is seen with simple tests as outlined below:
Progress testing: carried out by a child development specialist with picture books and block shapes. The results of this showed that Eaton could complete less than one third of his tasks and is behind other children of his chronological age.
Empathy testing: using a scientifically based questionnaire, Kerry scored high on the empathy testing. However, she has been unable to pass this on to Eaton who scored very low on these tests, having a tendency towards blatant aggression towards not just his mother, but also to his eight-year old brother, Jordan. This sort of behaviour could lead to bullying traits in the future.
Interaction experiment: this shows that Kerry is unwilling to allow Eaton grow and learn. By limiting his playtime to toys and games that don’t stimulate him, she is inadvertently limiting his development, probably in an unconscious and failing attempt to foster attachment to her. It seems she doesn’t want him to gain independence, but would rather he remain dependent on her.
Analysis of child-mother interaction: a literature review
John Bowlby’s attachment theory is a psychological and ethological description that helps to explain an infant’s attachment to a parent or caregiver. Infants become attached to adults who are sensitive and responsive in their interactions with them. The way a parent responds to their young infant in different situations is key to the development of patterns of attachment in the child. These patterns are the skeletal framework that guides the child’s feelings, thoughts and expectations in subsequent relationships (Bretherton et al, 1999).
According to Bowlby’s theory, through physical and emotional closeness with a parent or caregiver, the child develops an internal working model, reflecting the parent’s own response to him/her. In Eaton’s case his thought process might mirror the insensitivity that he has experienced from his depressed mother, and could potentially cause problems in the future.
Family dynamics: a secure base
The point of attachment should ideally provide a secure base from which the child can explore the environment and return when he/she feels fearful. If Eaton lacks that secure haven, his mental health would be compromised.
In his book, A Secure Base, John Bowlby (1998) describes the initiation of the mother-infant interaction. He highlights an initial elation and extreme possessiveness immediately after delivery. This phase was probably evident in Kerry, in the first few months when she stated her joy and reluctance to let Eaton out of her sight. However, the well documented lively social interaction alternating with phases of disengagement may have developed a pronounced effect of the latter phase, especially after the disheartening results of her hospital scan.
Peri- and post-natal conditions that could affect (hinder or foster) positive attachment and the effective formation of a secure base, as outlined by Bowlby (1998) are outlined below:
Adequate support for the mother with other aspects of household chores, etc.
A secure base for the mother herself
Length of separation from the baby in the hours and days following delivery
Attitudes and expectations expressed by the mother during her pregnancy
It is not clear from the brief clips of the videotape which, if any, of the above factors are applicable to Kerry’s experience. However, interpreting non-verbal communication and appearances, I think it is possible that Kerry receives little or no support around the house, especially as Jonathan departs for work early and eight-year old Jordan would be if limited help. This proposed lack of support could mean that Kerry does not have her own personal security base and might have been in need of assurances. While we are not privy to Kerry’s birth experience during the delivery of little Eaton, her past medical history, in addition to that statement “I’ve cheated life once alreadyâ€¦”, suggest that she may have had a difficult pregnancy, which, in addition, could have led to prolonged periods of separation from her newborn in the periods immediately following the birth.
The Maternal Deprivation Theory
Revisiting the controversial ‘maternal deprivation’ theory, in the World Health Organization report on Maternal Care and Mental Health, Bowlby (1951) explored the effects of deprivation of maternal care. Maternal deprivation is not limited in definition to mothers who are physically absent from their infant’s lives; it also applies to mothers who are not sensitive or responsive to their child’s needs. In this report, Bowlby concluded that a warm, intimate and continuous child-mother relationship, in which both parties find satisfaction and enjoyment, is essential. Lack of such a satisfactory relationship could lead to significant and irreversible mental health malformations.
The case of Eaton and his mother, Kerry, could be seen as a classic example of the maternal deprivation theory. While Kerry is present physically, her own self-admitted lack of motivation and uninvolved attitude is not adequate to foster that close relationship with her second son. As highlighted by Bowlby and later his close colleague, Mary Ainsworth (1962), Eaton could be at risk of having some mental problems in the future, if a timely and effective intervention is not implemented.
The long-term effects of poor child-family interactions
The consequences of the poor maternal and possibly paternal interaction which Eaton is accustomed to cannot be overemphasised. In a recent study using a conceptual model derived from the attachment theory, it was shown that attachment anxiety and low empathy significantly increases the odds of child molester status (Woods and Riggs, 2008). Furthermore, attachment insecurity in childhood is linked to externalizing behaviour and higher and stable patterns of depressive behaviour at the adolscence stage (Allen et al, 2007).
Also, conversely, avoidance of closeness in depressed mothers is implicated in the development of internalizing symptoms in their children, because individuals who are avoidant of closeness, logically, are poor care givers (Whiffen et al, 2005). Research also shows that infants and toddlers of depressed mothers are at increased risk of developing attachment insecurity and behavioural difficulties than offspring of nondisordered mothers (Cicchetti et al, 1998).
Observing the effects of maternal depression on social cognition and behaviour in parent-child interactions, Lovejoy (2007) depressed mothers, as a group, exhibited more negative behaviour. Furthermore, maternal depression was found to be associated with negative parent-child interactions and more negative, albeit fairly accurate, perceptions of child behaviour. This factor could be a major implicating factor in the apparent poor development that Eaton shows.
An older study by Seiner and Gelfand (1995) showed that enacted maternal withdrawal and depression led to toddlers physically withdrawing from their mothers, making more negative physical bids for attention and generally becoming unfocused and negative, displaying their distress in a developmentally appropriate manner. In addition, the children made no attempt to comfort their mothers; this can be related to Eaton’s unsympathetic reaction to his mother’s apparent distress in the video.
There are numerous other studies in the literature that explore the negative impact of poor interaction between child and mother (or care giver). There is a clear association between attachment and maternal depression, and the development of the recipient child.
Recently, Vieten and Astin (2008) evaluated the effectiveness of an eight-week mindfulness-based intervention during pregnancy on prenatal stress and mood. Their findings demonstrate that mothers who received this intervention showed significantly reduced anxiety and negative effect during the third trimester in comparison to those who did not receive the intervention. It is well-documented that stress and negative mood during pregnancy increase the risk of poor childbirth outcomes and postnatal mood problems and may interfere with mother-infant attachment and child development. Accordingly, such interventions may be pivotal in supporting mothers in preparation for child delivery.
In the course of research for this write-up, I have a gained a greater understanding of the attachment theory and the role of the “secure base” in molding a child’s development. More importantly, I am now aware of the need to provide as much support to the mother as is expected for the newborn. This is especially the case for at-risk mothers. Partners and family members need to be a part of the support programme to ensure that mothers receive the care and security they need in order to effectively carry out their newly acquired duties.