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Vol. 26 No.

2-3 | Autumn 2018

Perspectives in Infant Mental Health


Professional Publication of the World Association for Infant Mental Health

Contents
From the Office of the WAIMH Executive Director,
From the Office of the WAIMH
K. Puura................................................................................1
Executive Director
From the Editors,
D. Weatherston, M. Foley & H. Fitzgerald...............3

Integrating Infant Mental Health at Primary Health Care


Level,
K. Puura, E. Malek & A. Berg......................................... 4

Dr. Robert Emde presents the history and development of


WAIMH and the field of Infant Mental Health,
................................................................................................7

Roman Reflections WAIMH 2018................................8

WAIMH Honors Exceptional Members from Around


the World,..........................................................................11

The Search for a new IMHJ Editor-in-Chief is underway,


..............................................................................................14

Public Policy and Infant Mental Health,


D. Weatherston & H. Fitzgerald ................................15

Perspectives Outreach Calling all Infant Mental Health


Professionals!,.................................................................18
similar dedication and skill. Luckily, I
By Kaija Puura, MD will not be alone, as I have Reija Latva
INTRODUCTION TO “COULD OR SHOULD A ROBOT REAR A
BABY?”, as the new Associate Executive Director
Tampere, Finland
to work with and Minna Sorsa and Sari
M. Foley.............................................................................19 Miettinen who continue to work at the
Dear WAIMH members, colleagues and WAIMH Central Office. Pälvi has also
Could or should a robot rear a baby? friends, kindly promised to act as our advisor as
long as we need – special thanks to Pälvi!
C. Andries, B. Cowley, L. Nhlanhla, J. Noble, T. This is my first column in Perspectives
Whittaker, E. Williams, B. Wirz, A. Lachman, A. Berg & L. as the Executive Director of WAIMH. The Perhaps it would be in order to write
Richter...............................................................................19 a few sentences of who I am. In my
boots I stepped into from the first of
August this year are very big and I do everyday work I am professor of Child
Book review feel quite honored and a bit intimidated. Psychiatry in the Tampere University
The Emotional Life of the Toddler, Alicia F. Lieberman, My predecessors, Hiram Fitzgerald and and head of development and research
Pälvi Kaukonen, each did a tremendous projects in the Department of Child
Simon & Schuster, 2018 (Revised and Updated Edition),
job as Executive Director. I will do my Psychiatry in the Tampere University
D. Weatherston...............................................................24 best to serve our organization with Hospital. Our research groups have

WAIMH Central Office


University of Tampere, Medical School, Arvo Ylpön katu 34, Arvo-building Room B 236, 33014 University of Tampere, Finland
Tel: + 358 50 4627379, E-mail: office@waimh.org, Web: www.waimh.org
studied the effect of maternal depression environment for our infants? At the same
Editorial Staff on child development and shared pleasure
in early parent-infant interaction. We have
time as I feel worried and guilty about
all the flights I have made and will make
also been interested in helping primary in the future, I also know that meeting
care personnel to identify infants and people through video connections or
Editor families in distress. Through our studies we having maybe your hologram appear in
have developed two measures, the Infant someone’s room cannot feel the same
Deborah Weatherston, USA
Mental Health Assessment form and the as being with friends in face-to-face real
Brief Infant Mental Health Screen (together life encounters. We need each other’s
with South African colleagues). Currently company and hugs to do the work that we
I am developing digitalized services for do on behalf of infants and families– no
Assistant Editors families with infants and young children, way we can achieve that in isolation or
Hiram E. Fitzgerald, USA hoping to help particularly anxious and solely through technology.
depressed parents easier and earlier.
Maree Foley, Switzerland As I was pondering this I also attended
The world we live in is going through a scientific conference for Nordic child
rapid changes, and, at least for me, and adolescent psychiatrists in Turku,
quite a lot of those changes bring about Finland, where one of the main presenters
Editorial Board worries and anxieties. This year we had addressed this question. He told us that
an exceptionally warm summer here in he had paid a little sum of money for
Astrid Berg, South Africa Finland, and, for the first time in my life, I protecting the environment in connection
did not feel happy about warm summer with buying his flight ticket. Should we
France Frascarolo, Switzerland weather. There was no help for it: we all start doing the same? Or might we include
Antoine Guedeney, France got to think and talk about the climate a voluntary fee for the environment and
changes and global warming. Natural the protection of infants in the registration
Anna Huber, Australia disasters like floods, draught, fires and for our world congresses? I would be
storms seem to be more frequent than happy to learn what you think and feel
Connie Lilas, USA
before, forcing people to leave their about these issues.
Catherine Maguire, Ireland homes and live in uncertainty for shorter
or longer whiles. These disasters affect Life is rich and complicated, as it always
Mary Marchel, USA infants as well. has. I do hope that we all can still remain
optimistic about the future and keep up
Mirjami Mäntymaa, Finland I found myself thinking particularly of doing our important work for infants and
flying - and congresses - since I have families all around the world. I do hope
Campbell Paul, Australia
been involved in organizing WAIMH World each and every one of us has that one
Kaija Puura, Finland Congresses since 2006. Flying has been special friend, a “go to person,” who will
identified as one of the big polluters of give us a hug when we sometimes feel
Joshua Sparrow, USA the athmosphere, and people fly more hopeless or alone.
on more every year. Should we as an
Mark Tomlinson, South Africa With my warmest regards to you all,
organization also start thinking more
Robin Treptow, USA about environmental aspects of our
activities? Is it not part of infant mental
Elizabeth Tuters, Canada health to try to ensure a healthy and safe Kaija
Hisako Watanabe, Japan

Charles Zeanah, USA

Production Editor
17th WAIMH WORLD CONGRESS
Minna Sorsa, Finland Brisbane, Australia
7-11 June 2020

Perspectives in Infant Mental Health is a quarterly ‘Holding the Infant: creating stories of
publication of the World Association for Infant
regeneration, recovery & innovation together’
Mental Health. Address correspondence to Deborah
https://www.aaimhi.org/
Weatherston (dweatherston@mi-aimh.org). ISSN
2323-4822. All opinions expressed in Perspectives
in Infant Mental Health are those of the authors, not
necessarily those of WAIMH’s. Permission to reprint
materials from Perspectives in Infant Mental Health
is granted, provided appropriate citation for source
is noted. Suggested format: Perspectives in Infant
Mental Health 2018, Vol 26, No. 2-3 WAIMH.

2 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


From the Editors

By Deborah J. Weatherston, Editor, Italian Association for Infant Mental Health, of a search for a new editor of the Infant
Michigan, USA, dweatherston@mi-aimh.org the host committee and the WAIMH Board Mental Health Journal; and, recognition of
for planning the amazing global event. Bob Emde and his historical perspective
Maree Foley, Associate Editor, Switzerland/ on WAIMH and the infant mental health
New Zealand, maree.foley@xtra.co.nz Three papers are varied and of particular community recorded on YouTube.
interest. The first is Integrating Infant
Mental Health into Primary Care, written We thank each person for their very
by colleagues Kaija Puura, Elmarie Malek, interesting and thoughtful contributions.
and Astrid Berg from Finland and South We welcome submissions from the field
This double issue continues the new Africa who have developed and integrated that challenge the way we think about
format for WAIMH Perspectives in Infant a basic infant mental health screen for us infants, families, culture, and community,
Mental Health. With the use of Social in a maternal and child health screening and offer fresh perspectives on policy,
Media, WAIMH Central Office staff posts tool. The second is Public Policy and Infant research, and practice. As always, we
each submission after it has been reviewed Mental Health, contributed by Hiram invite comments in response to what is
and accepted for circulation. Weekly or Fitzgerald and Deborah Weatherston from published in WAIMH Perspectives in Infant
bi-weekly postings on the WAIMH Face Michigan, which expands on the WAIMH Mental Health.
book page call attention to what members Policy Symposium at the WAIMH Congress
around the world are thinking, doing, presenting the thinking of participants
and writing about. Because we also value Jane Barlow (UK), Catarina Furmark
tradition, we assemble the articles and, (Sweden and Nordic countries), Catherine
with the help of the Central Office staff, Maguire (Ireland), and David Willis (US).
publish them in full issues of Perspectives. This paper invites consideration of policies
We welcome your comments and and gaps in policies specific to the well-
suggestions regarding this new format. being of babies and families in many
parts of the world. Graduate students
With his issue, we are pleased to introduce
enrolled in a new graduate Master’s
you to the new WAIMH Executive
of Philosophy in Infant Mental Health,
Director (ED), Kaija Puura, MD. Dr. Puura
developed and directed by Astrid Berg at
introduces herself to you in the first article
Stellenbosch University in South Africa,
of this issue. She brings strength, depth,
contribute a third paper, Could or Should
commitment, and a wonderful sense of
a Robot Rear a Baby? As part of the new
humor to the position. Wishing to shine a
programme, guest professor, Linda Richter
light on WAIMH members who received
(Witwatersrand University, Johannesburg,
awards at the WAIMH Congress for
South Africa), invited the students to apply
exceptional service to infants, toddlers, and
what they were learning about infant
families, we highlight Antoine Guedeney
mental health to the rapidly developing
(Rene Spitz Award), Pälvi Kaukonen (Sonya
field of artificial intelligence. This paper
Bemporad Award), Lynn Priddis (WAIMH
reflects their response to the provocative
Award), and Elisabeth Conradt (WAIMH
question.
New Investigator Award). The 2018
WAIMH Congress was memorable; we offer These articles are followed by a review of
reflections from members who travelled Alicia Lieberman’s book, The Emotional
to Rome and were eager to share their Life of the Toddler; the announcement
experiences and offer appreciation to the

3 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


Integrating Infant Mental Health at Primary Health
Care Level
By 2016). The counter-point of plasticity is Unifying various sectors of the
susceptibility. The problems our society administrations will enable a broad based
Kaija Puura, University of Tampere, Finland and many other societies are facing such inclusive message about the importance of
Elmarie Malek, Stellenbosch University, as the high rate of crime, substance abuse, the beginning of life to be delivered to all
South Africa and domestic violence can be traced population groups. Besides the endeavor
back to adverse early experiences. It thus to work together across systems, there is
Astrid Berg, University of Cape Town, South became imperative for the authorities in the challenge of delivering the message
Africa the health sector to acknowledge that the in a manner that is respectful of cultural
vision of “Quality Health for All” starts at diversity. It is in this nuance that true
the very beginning of life, not only from a transformation is manifest.
physical, but also from mental health point
The Context of view. Within the Department of Health,
awareness of the importance of the
Since the advent of democracy in South In parallel to these developments First 1000 Days has led to a better
Africa considerable advances have been there occurred a conceptual shift on understanding of the need for providing
made in health care delivery. Financial and Governmental level to move “from comprehensive services during pregnancy
human resources that were previously managing the consequences of the inclusive of maternal mental health and
concentrated in tertiary, academic sections burden of disease to improving wellness”; psychosocial support services as well as
have been channeled into primary health this shift mirrored current trends in the providing support for parental readiness
care setting and in this way have enabled mental health field as reflected in the and recognizing the important role of
an almost universal access to basic health burgeoning of interest in the promotion fathers – key domains for fostering parent-
care. of a healthy start to life. Paying attention infant attachment starting early during
The Western Cape is one of South Africa’s to infants and young children and to their the prenatal foetal/infant developmental
nine provinces with a population of over primary relationships is possibly the most stage. The First 1000 Days has thus
six million people with over half a million important ‘upstream factor’ that impacts provided a natural umbrella to also unify
being under the age of 4 years.1 Every on health and mental wellness in the previously siloed departments also within
mother and infant are recorded on a whole of society. the Health Department. Beyond this, it has
central system and receive documentation brought home the recognition amongst
on the birth of the child. These documents health workers that an empathetic
that are currently under review, provide approach is essential in working with
an opportunity to track the infant’s The Parent Infant Child Health pregnant mothers, given a better
development from a holistic perspective. understanding of the contextual factors
and Wellness Working Group surrounding the pregnant mother that in
Traditional screening tools have It was within this context that a multi- turn impact on the developing infant both
focused almost exclusively on physical disciplinary working group – The Parent pre- and postnatally.
development. Physical growth is an Infant Child Health and Wellness Working
accepted indicator of child health status In South Africa, the National Road to
Group (PICH WG) was established in 2013.
and this is inevitably linked to caloric Health Book is issued at birth to all infants.
It was mandated to drive the agenda for
intake; the weighing of infants is thus part It is a patient held record which records
the Western Cape Provincial First 1000
of the well-baby clinic visits. However, essential basic health information about
Days Initiative which is a lead project of
in addition to nutrition received or the the baby, including birth, immunization
the Provincial Strategic Plan for 2014-
lack thereof, it is known that maternal and Vitamin A, growth parameters,
2019, under the Provincial Strategic Goal
depressive symptoms are associated with a development, oral health, and hospital
3 Increase wellness and safety and tackle
40-50% higher estimated risk for faltering admissions. It also contains age-group
social ills.
weight (Surkan et al, 2016). This finding related feeding recommendations
was highlighted in a clinical survey of the The Working Group has two main aims: and play and stimulation messages. A
University of Cape Town Parent-Infant complementary tool has recently been
Mental Health Service (Berg, 2012) and 1. To unify various sectors of developed called the postnatal checklist
supported the notion that more than food administration, such as the tool to assist with implementation of a
is needed for adequate growth. Departments of Health, of Social Western Cape Postnatal Care Policy, which
Development, of Education, and provides guidance for care of mothers and
In addition to the mental health aspects others, such as the Department of infants in the first 6 weeks after birth of
as they relate to faltering weight, there Arts and Culture. The Group is raising the baby. A copy of this tool is added to
is a general and growing appreciation of awareness within these departments the Road to Health Book after birth. The
the importance of the beginnings of life. of the importance of the First 1000 Postnatal checklist has two components,
Neuroscience has demonstrated the rapid Days (that is, from conception to age 2 one for the mother and one for infant and
growth of brain structure and function in years); and both are completed at various set time
infancy, making this time the most plastic points during this 6 - week period. The 5
2. To supply scientific evidence that
period of human development (Gao et al, questions from the Basic Infant Mental
demonstrates that there are economic
benefits to investing early in the life Health Screen (BIMHS), as described
1 http://www.statssa.gov.za/ further below, have been incorporated into
publications/P0302/P03022014.pdf span.

4 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


the Post Natal Care tool (in partnership
with Edna Arends, Western Cape Provincial
Maternal and Newborn Health Program). A
training guide for staff on the background
to these questions and guidance on their
implementation is being developed.

These tools will include a checklist with


key questions and will be complemented
with more detailed parental questions and
guidance. Care has been taken to align
these processes to a broader initiative
to develop comprehensive paediatric
clinical guidelines for primary health care
clinical practitioners (Practical Approach
to Care Kit (PACK-Child), Knowledge and
Translation Unit, University of Cape Town),
which has included the infant attachment
screening questions as well as guidance on
parenting information.

The additional questions are the result


of a collaboration with colleagues in In the waiting room. Photo published with courtesy of Astrid Berg.
Finland where infant mental health has
been integrated into primary care. The
background to each requires further
elaboration. child and how the parent is feeling herself/ The third item on the BIMHS is weighing
himself. The question about parental and measuring the child for two reasons:
worry was derived from a previous study, abnormalities in weight and height can
where the question: “Overall, do you think be markers of malnutrition or somatic
The Basic Infant Mental that your child/this child has difficulties illnesses, but growth can also be slowed
in one or more of the following areas: as a result of psychological distress (e.g.
Health Screen incorporated emotions, concentration, behaviour or Patel et al. 2004, Walker et al. 2007). The
into the Maternal & Child being able to get on with other people” two further items: infant’s eye contact
Health Risk Screening Tool alone was found to be quite reliable as a with the parent and the health care
screening question for developmental or worker and the shared pleasure between
Screening infants for signs of somatic psychological problems in young children the infant and the parents are markers of
illnesses has been established as a part of in a survey done in primary health care in both parent-infant interaction and infant
primary health care in many countries and Finland (Borg et al. 2014). For the BIMHS social behavior. Eye contact between an
has been shown to be an effective way the question was rewritten to “Are you infant and the parent or examiner has
for improving health of infants and young worried about your infant/child?” and with been previously connected with good-
children (e.g. Köhler 1991). Awareness of a positive answer from a parent, further enough early interaction and healthy
the importance of mental health early questions are to be used to clarify what infant development in studies from several
in life has been steadily increasing ever sort of worry the parent has. countries (Matthey et al. 2005, Dollberg et
since 1970s, and tools for detecting al. 2006, Lopes, Ricas and Mancini 2008,
psychological distress in infants and Parental mental health problems like Puura et al. 2010; Puura et al. 2013).
young children have been developed as a anxiety and depression, have been
consequence (e.g. Guedeney, Puura and associated with poorer parent-infant Shared pleasure as defined by eye contact
Matthey 2013). Finland is one of the Nordic interaction and infant distress in several and simultaneous smile or laughter
countries with a well-baby clinic network studies (e.g. Mäntymaa et al. 2008, between a parent and an infant has in
that has long been developing strategies Luoma et al. 2013). The second question recent studies been found to be associated
and tools for screening for both physical of the BIMHS comes from a study by with good parent-infant interaction and
and mental health for infant and young Puura et al. (2010) where infants aged 4, less emotional problems in early childhood
children, and also studied the feasibility of 8 and 18-months of age were screened in samples from Finland and South-Africa
screening in primary health care (Puura et in primary health care for infant social (Mäntymaa et al. 2015, Lachman et al.
al. 2010, Kaukonen et al. 2010, Borg et al. withdrawal symptoms. In this study, a 2016, Puura et al. in press). The final item
2014). Based on findings of earlier studies, question “How has your mental health about the possible worry of the primary
The Basic Infant Mental Health Screen been during the past 12 months?” was health care worker was also found to be
(BIMHS) was developed as a joint effort of quite reliable in finding parents who had a good predictor of possible problems of
Drs. Kaija Puura, Astrid Berg, Elmarie Malek not been well psychologically, and whose young children in the study of Borg et al.
and Pälvi Kaukonen. It is a simple and short infants showed symptoms of infant social (2014) and was therefore included into the
tool to be used to screen for the basic withdrawal (Mäntymaa et al. 2008). For BIMHS.
markers of infant mental health globally, the BIMHS the question was reformulated
into “How have you been feeling?” to help For each item of the BIMHS we created
as the items most likely are not affected by some additional questions to be asked,
cultural differences, at least not during the tap any symptoms of anxiety, depression
or other mental health issues. It is also a should the parent tell about problems or
first year of life. should the primary care worker detect a
way to show the parent that the primary
The first two items are simple questions of care worker is interested in the parent’s problem in the growth or social behavior
whether the parent is worried about the well-being. of the child. These questions were meant

5 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


to help further discussion on the possible Acknowledgements Matthey S, Guedeney A, Starakis N, Barnett
problem and can be modified and added B. Assessing social behaviour of infants:
We thank Edna Arends, Assistant Director, Western Cape
to. As we wanted the BIMHS also to offer Use of the ADBB Scale and relationship
Provincial Health Maternal and Newborn Health Program and Dr
help for the primary care workers in what to mother´s mood. Infant Mental
Janet Giddy, Khayelitsha and Eastern Substructure Maternal and
do with the possible problems, Drs Berg Child Health Program for their collaboration and support in the
Health Journal 2005; 26: 442-458.
and Malek also created action guidelines. integration of these screening questions into the development Mäntymaa M, Puura K, Luoma I, Kaukonen
These guidelines naturally can and must be and implementation of new tools. Without their contribution
P, Salmelin R, Tamminen T. Infants’
adjusted according to the possibilities and the acceptability and feasibility of using these questions would
social withdrawal and parents’
services available in different sites. Prior never be known.
mental health. Infant Behavior and
to this project, the BIMHS has not been
References Development 2008; 31: 606-13.
in clinical use, but it has been mentioned
as an example in an article meant for Berg, A (2012) Infant-parent psychotherapy Mäntymaa M, Puura K, Latva R, Luoma I,
general practitioners on what to pay at primary care level: Establishment Salmelin RK, Helminen M, Tamminen T.
attention to when screening for mental of a service. South African Medical Shared pleasure in early mother-infant
health problems of young infants and their Journal, vol 102;6: 582-4 interaction: predicting later emotional
parents (Puura and Tamminen, 2016). and behavioral problems in the child
Borg A-M, Salmelin R, Joukamaa M, and buffering the influence of parental
Tamminen, T. Cutting a Long Story psychopathology. Infant Mental Health
Short? The Clinical Relevance of Asking Journal 2015; 36; 2; 223–237.
Parents, Nurses, and Young Children
Challenges Themselves to Identify Children’s Patel V, Rahman A, Jacob KS, Hughes M.
Incorporating a new element into existing Mental Health Problems by One or Two Effect of maternal mental health on
protocols is often met with resistance. Questions. The Scientific World Journal, infant growth in low income countries:
This is in large part due to a heavy patient vol. 2014, Article ID 286939, 11 pages, new evidence from South Asia. British
load in the primary health care setting, 2014. doi:10.1155/2014/286939 Medical Journal 2004; 328:820–3.
understaffing and thus not sufficient time Dollberg, D., Feldman, R., Keren, M., Puura K, Guedeney A, Mäntymaa M,
or motivation to enquire about mental & Guedeney, A. (2006). Sustained Tamminen T. Detecting infants in
health problems. In addition, nurses and withdrawal behaviour in clinic referred need: Are complicated measures
community health counsellors often feel and nonreferred infants. Infant Mental really necessary? Infant Mental Health
ill-equipped to deal with the problems that Health Journal, 27:292-309. Journal 2007; 28(4): 409-21.
might become evident. To address these
challenges, we suggest a three-pronged Gao W, Lin W, Grewen K, Gilmore JH (2016). Puura K, Mäntymaa M, Luoma I, Kaukonen
approach. Functional Connectivity of the Infant P, Guedeney A, Salmelin R, Tamminen
Human Brain: Plastic and Modifiable. T. Infants’ social withdrawal symptoms
First, by shortening and simplifying the The Neuroscientist, February. assessed with a direct infant
questions it is hoped that they will be observation method in primary health
easier to ask and by inserting them within Field, T. M. (1992). Infants of depressed care. Infant Behavior and Development
the general health checklist or screening mothers. Development and 2010; 33; 4: 579-88.
tool, they will become part of a holistic Psychopathology, 4: 49-66.
approach, so that mental health may be Puura K, Mäntymaa M, Leppänen J,
Guedeney A, Matthey S, Puura K. Social Peltola M, Salmelin R, Luoma I,
seen as part of general health. withdrawal behavior in infancy: A Latva R, Tamminen T. Associations
history of the concept and a review between maternal interaction
Second, a training guide will be developed
of published studies using the alarm behavior, maternal perception of
in order to explain the reason for asking
distress baby scale. Infant Mental infant temperament, and infant social
these questions and also to provide
prompts to follow should an answer
Health Journal 2013; 34; 6: 516-31. withdrawal. Infant Mental Health
require more in-depth exploration. It is Kaukonen P, Salmelin R, Luoma I, Puura K, Journal 2013; 34(6): 586-93.
hoped that this will empower the health Rutanen M, Pukuri T, Tamminen T. Child Puura K, Tamminen T. Pikkulapsipsykiatria
workers and increase their confidence in psychiatry in the Finnish health care - ei tarua vaan todellisuutta (Infant
asking the additional questions. reform: National criteria for treatment psychiatry – not fiction but reality).
access. Health Policy 2010; 96; 1: 20-7. Lääketieteellinen Aikakauskirja
Third, the next step would be to identify
the resources in the community that Köhler L. Infant Mortality: The Swedish Duodecim 2016; 132(10):951-9.
provide health care, such as NGOs of which Experience. Annual Review of Public Surkan P J, Patel S A, Rahaman A (2016).
there are a great number, but each working Health 1991; Vol. 12: 177-193. Preventing infant and child morbidigy
in parallel and often in isolation. There is a and mortality due to maternal
Lopes S, Ricas J, Mancini MC.Evaluation
surprising level of activity on the ground depression. Best Practice & Research
of the psychometric properties of the
that has not been noted by academic Clinical Obstetrics and Gynaecology.
Alarm Distress BaBy Scale among 122
institutions and government structures. Article in Press,
Brazilian children. Infant Mental Health
These organizations need to be identified,
Journal 2008; 29(2), 153–173. Walker S P, Wachs, T D, Meeks Gardner J,
described, and then mapped, so that the
community health worker has service Luoma I, Puura K, Mäntymaa M, Latva Lozoff B, Wasserman G A, Pollitt E. Child
providers at hand to which parents and R, Salmelin R, Tamminen T. Fathers’ development: Risk factors for adverse
infants can be referred to receive help. postnatal depressive and anxiety outcomes in developing countries. The
symptoms: an exploration of links with Lancet 2007; 369, 145‒157.
Given the above three approaches, it is paternal, maternal, infant and family
hoped that some of the challenges will be factors. Nord J Psychiatry 2013; 67; 6:
overcome. 407-13.

6 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


Dr. Robert Emde presents the history and
development of WAIMH and the field of Infant
Mental Health
Emeritius Professor of Psychiatry,
Robert Emde, presented the history and
development of the field of Infant Mental
Health in a plenary lecture at the 15th World
Congress of WAIMH in Prague in 2016. He
introduced his talk with the title: “Infant
Psychiatry and the origins of WAIMH -Early
Contributions that Energized the Field.”

In his remarks, Dr. Emde presented the


history of the field of infant mental
health, including early pioneers such as
René Spitz, Selma Fraiberg, and T. Berry
Brazelton. He talked about the science
of early relationships and its relevance to
early mental health, as well as the role the
infant plays in effective clinical practice.

The presentation is published in the


WAIMH Youtube channel and lasts for
1 hour 7 minutes. The video concludes
with a period of discussion. Dr. Emde is
introduced by WAIMH Affiliate Council
Chair, Maree Foley.
Watch the video on You Tube: Previous articles in Perspectives (Linked to
Robert Emde is the Honorary President of past text in Perspectives):
World Association for Infant Mental Health. https://www.youtube.com/
He is one of the most influential architects watch?v=AEeQYPGG9VE
of Infant Mental Health, believing in
the power of relationships to effect Bob Emde as a Plenary Speaker at 15th
change and the impact of relationship World Congress of WAIMH
on relationship, concepts of particular https://perspectives.waimh.
meaning within the infant mental health org/2015/12/15/bob-emde-plenary-
community. He is a prolific writer, having speaker-15th-world-congress-waimh/
published over 300 scholarly articles read
by infant mental health practitioners across
the world.
Robert N. Emde, Honorary President. By the
Red Cedar column. By Hiram Fitzgerald.

https://perspectives.waimh.
org/2007/06/15/robert-n-emde-honorary-
president-by-the-red-cedar-column/

A Tribute to Kathryn Barnard and Peter de


Chateau. By Hiram Fitzgerald.

https://perspectives.waimh.
org/2015/12/15/tribute-kathryn-barnard-
peter-de-chateau/

7 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


Roman Reflections WAIMH 2018

Many members from around the


world send their thanks to WAIMH and
the Local Organizing Committee for
planning and hosting an extraordinary
WAIMH Conference. From the
reflections received below, it was
personally and professionally a very
successful and meaningful experience
for research faculty, policy makers,
and practitioners from many corners
of the globe. We send our deepest
and collective appreciation for an
exceptional world conference and
Roman holiday!

Jody Todd Manly, Ph.D., WAIMH Board


of Directors
vulnerable world citizens and promoted  Karol Wilson, LMSW, IMH-E®
Clinical Director a more positive world in which they can
Infant Mental Health Mentor, Trainer,
grow and develop. Erum Mariam brought
me to tears as she shared her experiences
and Reflective Supervisor
Mt. Hope Family Center
in the refugee camps in Bangladesh. I
continue to be awed and inspired as I hear Starfish Agency, Detroit, Michigan
Rochester, NY
of the outstanding work that is being done It was an honor and a privilege to attend
I would like to express my appreciation to around the world to combat tragedy and the 16th World Congress for Infant
the Italian Association for Infant Mental promote healing. Mental Health in Rome. The opportunity
Health (AISMI) organizing committee and to listen and witness the research,
Joining together and building our own
the WAIMH staff and Program Committee clinical interventions and cross-cultural
relationships gives me hope that together
for putting together an intellectually studies that held varying perspectives of
we can make a difference and truly make
stimulating and productive 16th World caregiving practices and socio- emotional
the world a better place! As the Congress
Congress in Rome. AISMI gave a warm health was an amazing gift. 
drew to a close, the Australian Association
welcome to 1750 delegates from 72
for Infant Mental Health took the torch and To hear our Infant Mental Health Leaders
countries who delighted in hearing the
invited everyone to the 2020 Congress in and Mentors talk about the impact of
children from Schola Cantorum sing in the
Brisbane. I am looking forward to reuniting trauma and separation on families and
opening ceremony. Their final gospel song
with an amazing group of international young children, both nationally and
in English got such a rousing response,
colleagues in two years. internationally, was powerful and reignited
they repeated it for an encore!
my passion and commitment to our most
With such a large number of presentations, vulnerable citizens. The conference was
plenaries, master classes, posters, and a reminder that we cannot do this work
Margaret C. Holmberg, Ph.D. IMH-E®
meetings, it was difficult to choose what to alone and that we are not alone. There are
attend, and I often wished I could have fit 100’s of thousands of voices speaking out
President, Alliance for the
more in my schedule. I enjoyed learning on behalf of infants and young children.
so much in the sessions I attended on
Advancement of Infant Mental Health
I was proud to be one of the many voices
prenatal development, digital media, in Rome along with many of my Michigan
epigenetics, internal representations, Connecticut Association for IMH, Board
colleagues who were well represented
therapeutic interventions, public policy, Member
at the conference.   Thank you for this
and parent-child relationships. I enjoyed WAIMH was an energizing experience, incredible opportunity to learn and grow.
presenting with my colleagues, Alicia connecting with friends met at previous
Lieberman and Sheree Toth, on Child- Congresses, meeting new colleagues, and
Parent Psychotherapy. hearing messages from those committed
But the most encouraging part of the to making the world safer and more
Congress was joining together with so emotionally safe for infants and young
many people from around the world who children.  Congratulations and thank you
persevere in difficult circumstances to shed to all who made the 2018 Congress such a
light on the challenges faced by young meaningful event.
children and their families and who will
not stop until we have supported these

8 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


Astrid Berg, MD

WAIMH Board Member and Emerita


Professor University of Cape Town

Cape Town, South Africa


The 16th WAIMH World Congress was held in
Rome at the end of May 2018. True to Roman
tradition, it was a big event – possibly the biggest
WAIMH Congress with participants from many
countries having found their way to the Eternal
City.

The choice of papers was wide and large – for


some it was overwhelming, for others it felt like
a rich menu from which to choose. WAIMH faces
a challenge in that a balance needs to be found
between offering an international platform
to colleagues from all over the world, while
preserving the ‘soul’ of WAIMH. What is this ‘soul’?
It has to do with getting to know people, with a
lively exchange, with time for discussing ideas
and for sharing experiences. This is somewhat
impeded by too large a gathering and with
too many happenings. At the same time, this
largeness also attests to the enthusiasm that
is evident from all corners of the globe – the
enthusiasm for speaking up for those too young
to have the words to do so.

Of particular relevance was the Presidential


Symposium held on the last day of the
Conference. The focus on the worldwide refugee
crisis and its effect on infant mental health was
of critical importance given the catastrophes
that are facing families in the world today. Erum
Mariam spoke with urgency of the refugee camp
in which she is working in Bangladesh, leaving
us with images and stories of unimaginable
suffering. It was a call to action – action for
infants and young children – that we as WAIMH
dare not ignore.

On a lighter note, there was true Italian passion in


the air at the gala dinner when the four sopranos
transported us with their elegance and beautiful
voices to the world of the Opera. Rome is big and
very old, fascinating in its ordered chaos. It was
with sadness that we said goodbye to this City.

.
Angela Tomlin, PhD, HSPP, IMH-E ®

Professor of Clinical Pediatrics

Indiana University School of Medicine

Indiana
WAIMH is such a unique experience due to
poster session and started chatting with a is much too often about “us and them” at
the wide range of ideas that are shared from
presenter. We had a productive dialogue this point in history. It felt great to have
research, clinical, and advocacy viewpoints
about her research and then we discovered these points of alignment not just about
and from just about every cultural experience.
some similarities in our experiences with our shared work, but also about our shared
But what I would like to highlight about my
our administrators, grandmothers and experiences as human beings. 
experience are the lovely chance conversations
gardeners! What a hopeful moment for me,
that I had with people from all around the
coming from a context in the States that
world. An example that stands out: I was at the

9 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


Campbell Paul, MD the rich content of the scientific program was delivered by colleagues from all over the
world and thanks also to the Scientific Program Committee and the overall Congress
WAIMH Board Member and Associate organizers. For me the Congress provided an opportunity to learn so much about
Professor very vulnerable infants and their families and about the plethora of ways that our
colleagues in infant mental health are able to assess and so thoughtfully intervene.
Melbourne Australia
It began with the pre-Congress sessions which focused on innovative research
What an amazing Congress we have just and applications and with the importance of training supported by our Affiliate
experienced! Immeasurable thanks go to organisation colleagues. Each of the plenary sessions took us in different directions,
Giampaolo Nicolais, Massimo Ammantini and but all building a deeper understanding of the modern world of babies and their
the Italian Local Organising Committee for families. In each of the oral and poster presentations which I observed I saw a
providing such a creative fabric within which generous sharing of ideas and their clinical application. I feel very proud to be a
member of the WAIMH community.

The Presidential plenary session, however,


reinforced for me the importance of
advocating powerfully for infants in families
who are persecuted and displaced. Although
there is so much inhumanity in the world
which is difficult to comprehend, I believe
that a powerful spirit of working together to
a common goal was demonstrated moment
to moment amongst the 1700 participants
in the Congress! I really look forward to
applying what I’ve learned at this Roman
Congress and to meeting again at the next
Congress in Brisbane 2020.

Ashley McCormick, LMSW, IMH-E®

Endorsement & Communications Coordinator

Alliance for the Advancement of Infant Mental Health

Michigan
A month after the event, I find myself still in awe of the experience
of attending the WAIMH Congress in Rome.  The future of the field
of infant mental health felt limitless as I sat in the plenary room with
1,750 other individuals.  I could feel, hear, and see the energy, passion
and dedication we had in common.  Thank-you to the WAIMH staff
and Congress planning committee for providing us the space to
be inspired! 

Lindsay Biggs, LMSW

IMH Supervisor, Starfish Agency, Michigan


Coming to WAIMH and having the opportunity to hear about the work
being done around the world on behalf of infants and toddlers was so
inspiring. In a time when things often feel hopeless or overwhelming,
it was an incredible reminder that we are not alone. There is a brave
army of professionals out there with so much compassion, love and
positive energy fighting on behalf of all babies, toddlers and their
families. A strong group of people who all understand the power of
relationships, ready to change the world. The whole experience was
refueling so that I could come back and continue the most important
work there is.

10 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


Maree Foley Ph.D., WAIMH Affiliate
Council Chair
WAIMH Honors Exceptional
Practice consultant
Members from Around the World
Geneva, Switzerland Every two years, WAIMH honors members
around the world for exceptional
The 16 WAIMH World Congress in Rome
th
contributions to the field of Infant
was a wonderful Congress. I am thankful
Mental Health. Please join the WAIMH
to the Italian Association for Infant
Board in celebrating each 2018 WAI
Mental Health (AISMI), to Giampaolo
honoree for commitment to broadening
Nicolais, Massimo Ammantini and
our understanding of infancy and early
everybody on the Italian Local Organising
relationship development through
Committee; to the Scientific Program
scientific research, policy, and practice.
Committee; our WAIMH staff; and the
(https://www.waimh.org/i4a/pages/index.
Professional Conference Organisers, for
cfm?pageid=3280)
their generosity and work. Collectively
they co-created an extraordinary base
from which delegates could continue Antoine Guedeney, MD (Paris, France)
to explore and learn about our shared, received the Rene Spitz Award in
complex, and interdisciplinary field. recognition of significant lifetime
contributions to clinical practice and
Amidst the daily feast of plenaries, research studies of benefit to the infant
posters, workshops, symposiums and mental health community.
master classes, there were numerous
memorable moments of marvelousness:
from the delightful children’s choir from It is a pleasure to recognize Professor
the Schola Cantorum, in the opening Antoine Guedeney M.D. with the 2018
ceremony; to the amazing opera divas Rene Spitz Award for lifetime contributions
during the conference dinner; to listening to infant mental health. Among his
to fresh energetic new graduates; to innovative and leadership contributions His editorial leadership in infant mental
sharing time and experiences with are the following: health, serving as inaugural and continuing
WAIMH affiliate council members; and innovative editor of Devenir, and then also
His preventive interventions for infant serving as an associate editor of the Infant
being moved and heartened by the
mental health, including the large home Mental Health Journal.
narratives of colleagues who are working
visiting study in Paris for vulnerable
with families with infants in day-in and His collaborative research leadership over
families known as the CAPEDN study, that
day-out extraordinary challenging his career involving attention to multiple
continues interdisciplinary research for
conditions and yet, amidst the despair, levels of biological and psycho-social
health promotion as well as prevention of
beckoned us to keep hope on our models of development, and to integrative
psychopathology. His effective advocacy
radar. Hope rooted in deep connection theories of change for intervention
for implementation trials in other risk
with those who suffer has the capacity research.
communities of poverty, with needs
to create momentum with healing
occasioned by trauma and adversity.
and change, keeping paralysis and His educational leadership regarding
helplessness at bay. His assessments of relational social the importance of ethnic and cultural
withdrawal in infancy (also known as diversity and inclusion in communities
Experiences of face-to-face time with of need—for infants and families not
ADBB). These assessments are used in
old friends and new friends are now only in Western industrialized countries,
multiple pediatric, child psychiatric and
embedded as nourishing memories; as but those elsewhere, in Africa as well as
service settings- and cross culturally
new fuel to sustain our ongoing work underserved countries world-wide. In this
validated in multiple countries, with
together, across the globe. At the end of area we include his effective work within
longitudinal studies.
the congress, the Australian Association our organization, including as President of
for Infant Mental Health invited us all His clinical leadership, with contributions WAIMH and beyond.
to the 2020 Congress in Brisbane. I very to meaningful diagnostic classification
much look forward to meeting many of for infants and toddlers, wherein he has
you again at the next WAIMH Congress in conducted clinical trials and worked to
Brisbane 2020. revise and update useful systems, being
a leader in the revision known DC:0-3 R,
that in turn provided a basis for our current
system now known as DC: 0-5.
 

11 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


Palvi Kaukonen, MD (Tampere, Finland)
received the Sonya Bemporad Award in
recognition of her significant contributions
to the advancement of social and public
policies that benefit infants, toddlers, and
their families.

Dr. Pälvi Kaukonen has been for decades


a chief physician in the Department of
Child Psychiatry at Tampere University
Hospital, Finland. Her professional
activities as a clinical child psychiatrist have
involved: developing child mental health
assessment methods, combining research
activities with child mental health service
development, and clinical work in primary
care and mental health services. Since 2014
she has also worked as a Consulting Officer
of Health Affairs in the Finnish Ministry of
Social Affairs and Health, where her role
and impact in leading the national reform
of child and family health care and social
services has been hugely important.

Pälvi was in a crucial role in organizing


the WAIMH Tampere Congress already in Lynn Priddis, PhD (Perth, Australia) received
1996, and after the Congress she became the WAIMH Award in recognition of her
one of the founding Board Members of significant contributions to the Australian
the Finnish Association for Infant Mental WAIMH Affiliate and infant mental health
Health in 1997. When the WAIMH Central practice.
Office moved to Tampere, Finland in 2006,
Pälvi was appointed as the Associate Associate Professor Lynn Priddis is currently
Executive Director of the WAIMH, and then the Coordinator of the Clinical Psychology
as the Executive Director in 2008. Since Program, and Coordinator of the Infant
then Pälvi has worked in efficient and Mental Health Course, in the School of Arts
extremely successful manner in organizing and Humanities at Edith Cowan University,
5 WAIMH World Congresses around the Perth, Australia. She has promoted infant
world with financially favorable outcomes. mental health through her governance
In addition to this, Pälvi has lead and roles at regional and national level in
developed the work at the WAIMH Central Australia, and through research and
Office to include the WAIMH Affiliates training, especially infant mental health
and members around the world in a more capacity building programmes in Western
continuous dialogue. Australia. Lynn has been lecturing at Edith
Cowan University in Perth since 1991 and
The Sonya Bemporad Award is presented has made a substantial contribution to the
to Dr Pälvi Kaukonen for her undeniable dissemination of scientific knowledge in
merits in the development of clinical the field of infant mental health.
services for infants, and their families and
for changing the whole Finnish society In addition to her 37 peer reviewed
to a more infant friendly direction, and journal articles, she has also been an
especially for being the heart and the soul innovative practitioner researcher as
of our organization. evidenced by the development of the
Tuned-In Parent Rating Scales (TIP-RS);
a tool for intervention with targeted
cooperation of colleagues across a number
parent–child relationships. Lynn has also
of WAIMH affiliates. Lynn Priddis has been
been directly engaged with infant mental
active in Australian WAIMH affiliate and is
health competency based workforce
Member of the leadership team within The
development and training. She and her
Australian Association for Infant Mental
team designed a systems change model
Health.
designed to infuse the infant relationship
based model into all components of the The WAIMH Award is presented to Dr.
Western Australia system of care, and then Lynn Priddis for her continuing efforts to
to track cross unit referrals for evidence promote infant mental health programs
that the system of care actually functioned and practices and for her clinically oriented
as a collaborative network in support of research.
a family. This community oriented work
has been conducted via international

12 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


Elisabeth Conradt, PhD
(Utah, USA) received the
WAIMH New Investigator
Award as a very promising
new investigator.

Elisabeth Conradt received


her PhD in clinical
psychology in 2011 from
the University of Oregon,
where she studied the
psychobiological correlates
of early exposure to
maternal insensitivity
among a group of infants
raised in poverty. Her post-
doctoral training at Brown
University examined risk
and protective factors for
the development of young
children exposed prenatally
to opioids and other
substances. Elisabeth is now
an assistant professor of
developmental psychology
at the University of Utah,
funded by two grants from
the NIH to examine the epigenetic processes involved in the
development of infant stress reactivity and regulation. In her work
she tries to understand how early experiences become biologically
embedded to impact neural, physiological, genetic, and behavioral
outcomes.

Already at this early stage of her career, Dr. Conradt has a very
impressive publication record with papers in highly competitive
journals such as Child Development, Development and
Psychopathology, and Psychophysiology, among others. She
is already acknowledged as an expert in the field of behavioral
epigenetics: She published an invited review paper on this topic in
Child Development Perspectives, and was invited to submit papers
to special issues devoted to epigenetics in top-tiered journals.
Her outstanding achievements have already been acknowledged
by early career awards from the Society for Research in Child
Development, the American Psychological
Society, and the International Society
for Developmental Psychobiology.
Elisabeth sees great importance in wide
dissemination of her research findings as
evidenced by her presentations in various
applied and clinical forums such as home
visiting programs and a mindfulness-based
intervention program for pregnant women
who are addicted to opioids. She is deeply
passionate about supporting the mental
health needs of young children and their
families, particularly infants exposed to
substances in utero and those living in
poverty.

13 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


The Search for a new IMHJ Editor-in-Chief is
underway

The Michigan Association for Infant 2. Capacity to enter into and sustain The APPLICATION DEADLINE is December
Mental Health (MI-AIMH) and the World working relationships with 15, 2018
Association for Infant Mental Health professionals including academics,
(WAIMH) wish to express their deepest researchers, clinicians, interventionists THE DECISION WILL BE MADE BY April 1,
appreciation for Paul Spicer’s work as and others representing the infant 2019
Editor-in-Chief of the Infant Mental mental health community across The NEW EDITOR WILL BEGIN July 1, 2019
Health Journal (IMHJ).  Paul has been disciplines and around the world AND WORK COLLABORATIVELY WITH THE
an exceptional editor, broadening the CURRENT EDITOR UNTIL OCTOBER 1, 2019
3. Capacity to build and sustain an
reach of scientific contributions to the
interdisciplinary editorial team with
IMHJ and strengthening the depth of Please address any questions you have
representation across the world
articles as they apply in meaningful ways regarding the position or the application
to interdisciplinary practice.  Paul will 4. Understanding of editorial process to the Chair of the Search
continue as the Editor-in-Chief through tasks including ability to make Committee, Nichole Paradis at:
Volume 40, with the new editor joining him decisions about papers to be reviewed,
nparadis@allianceaimh.org
in July of 2019, and assuming responsibility knowledge with the editorial team of
for Volume 41 in October of 2019.  appropriate reviewers, organizational If you are interested in applying for the
skills to handle submissions efficiently, position of Editor-in-Chief of the Infant
Sheryl Goldberg, Executive Director of confidence to expect reviewers to Mental Health Journal, please submit
MI-AIMH, owner of the IMHJ, has asked submit reviews in a timely manner, the following information by e-mail to
Nichole Paradis, a MI-AIMH member, ability to make clear decisions about Nichole Paradis, Chair of the IMHJ Search
WAIMH member, and Executive Director of papers to accept, revise, or reject, Committee, nparadis@allianceaimh.org:
the Alliance for the Advancement of Infant ability to work with an interdisciplinary
Mental Health®, to serve as Chairperson editorial board, and creativity to plan 1. Letter expressing your interest in
of the Search Committee. The Search and solicit special issues to move the the position, relevant experiences,
Committee is composed of past editors of field of infant mental health forward in qualifications for the position, and
the IMHJ, representatives from MI-AIMH new directions vision for future for growth and
and representatives from WAIMH. development of the IMHJ
5. A 5-year commitment, beginning
The position of Editor-in-Chief of the IMHJ October 1 of 2019-September 30 of 2. Your vita/resume, with contact
requires: 2024. information including mailing address,
e-mail address(es), phone number, and
1. A broad and strong interdisciplinary
fax
knowledge base from which to
understand research, policy, clinical Note: The Editor-in-Chief will receive a 3. Contact information for 2 people familiar
work, and practice in the field of infant stipend for the editorial office. with your work
mental health

14 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


Public Policy and Infant Mental Health
By

Deborah J. Weatherston, Ph.D.

Alliance for the Advancement for


Infant Mental Health, Unites States

and

Hiram E. Fitzgerald, Ph.D.

Department of Psychology

Michigan State University, United


States

Based on comments presented during


a Symposium on Public Policy and
Infant Mental Health the biennial
meeting of the World Association
The policy brief drew attention to three young children do not live in European
for Infant Mental Health. Health (H. E.
critical principles in the Rights document: or North American, predominately
Fitzgerald & D. Weatherston, Co- Chairs),
White, countries (Fitzgerald, et al., 1999;
May 2018, Rome, Italy.
Fitzgerald, Fitzgerald, Mann, Cabrera,
1. Principle 3: The infant’s status as a
Panel participants, J. Barlow, C. Furmark, C. Sarche & Qin (2010). Remarkable changes
person is to include equal value for life
Maguire, & D. Willis in population demographics are occurring
regardless of gender or any individual
in traditionally European or Western
In 2016, the World Association for Infant characteristics such as those of
countries. For example, considering only
Mental Health (WAIMH) adopted its first disability.
birth rates, the United States is already a
formal public policy statement, drawing 2. Principle 4. The infant has the right minority-majority population. Yet, social,
attention to issues specific to the rights to be given nurturance that includes educational and health programs reflect
of infants (WAIMH, 2016). The writers love, physical and emotional safety, historical decisions made by the dominant
intended the document to serve as a adequate nutrition and sleep, in order white majority, rather than decisions based
stand-alone statement on behalf of infants, to promote normal development. on broad knowledge of diverse cultures or
and a supplement to the United Nations’ indigenous peoples. Killen, Rutland & Ruch
Convention on the Rights of the Child, 3. Principle 5. The infant has the right to
(2011) note that, “interventions to promote
which itself was a special addition to the be protected from neglect, physical,
equity, tolerance, and justice in childhood
Universal Declaration of Human Rights. In sexual, and emotional abuse, including
are not widespread and are rarely informed
the words of the WAIMH Board of Directors, infant trafficking.
by developmental theory and research,” (p.
The Rights of Infants document was 1).
…specifying the unique needs followed by a WAIMH Task Force, chaired
and rights of the child in the by Karlen Lyons-Ruth. The Task Force Equally concerning is the slow growth
report detailed the pervasiveness of in the number of researchers of diverse
first years of life was needed
emotional stress to which infants and cultures so that Western researchers are
in order to motivate infant not over-represented in the population of
very young children are exposed due
oriented actions and policies at to a wide number of adverse childhood developmental scientists studying diversity
both community and societal experiences, including poverty, exposure within early development. As Cabrera
notes, “intervention science based only on
levels…….many societies around to violence and war, poor health support,
troubled parents, racism and poor findings of adversity and maladjustment
the globe still pay insufficient can perpetuate a deficit perspective
supplemental child care (Lyons-Ruth, et
attention to infants especially and promote a harmful stereotype that
al, 2017) . Indeed, the WAIMH’s recent
in times of stress and trauma. publication “Declaration of Infants’ associates deficits of a select group with
Additionally, consideration Rights” is an intentional effort to provide an entire group of people who share
coherence for the extraordinary variation the same ethnic or cultural origin.” (p.
of infants’ needs and rights 14). On a positive note, a shift away from
among countries with respect to issues
could guide public policies and deficit-oriented research has enabled
promoting healthy social-emotional
supports for mothers, fathers, and development during the earliest years of more researchers to focus on identifying
caregivers, and in giving value development. Despite 50 years of strengths and resilience factors that build
intense research on infants and very positive life course pathways (Cabrera,
to babies in contexts of risk and
young children, relatively, we know 2013; Killen, Rutland & Ruck, 2011).
violence…
relatively little about their racial, ethnic, These issues and growing unrest with
and cultural diversity. This is of concern respect to the increasing callous treatment
because more than half of the world’s very given to infants and their caregivers

15 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


worldwide, prompted a number of infant community and societal levels.” Stated focus on babies and relationships:
mental health specialists to propose somewhat differently: We need to value
a symposium for presentation at the babies and very young children; keep them *Donald Winnicott stressed, “There is
2018 biennial meeting of the World fed, safe, nurtured, loved, protected from no such thing as a baby, only the
Association for Infant Mental Health abusive or neglectful care; and, we need baby and those caring for the baby,”
(WAIMH). The symposium opened with to value and support mothers, fathers urging attention to early developing
brief introductory comments on Dye’s and all others who provide babies with relationships. (Winnicott, 1964)
(1972) definition of social public policy as care. In discussing science to policy and *Selma Fraiberg asked, “What about
“anything a government chooses to do or practice”, distinguished, multi-disciplinary, the baby?” urging policy makers
not to do” (Dye, 1972, p.1). Because Dye’s multi-university authors offer three core and practitioners to think about
definition and approach to policy reflects principles to guide policy makers and the baby, bring the baby into focus,
a linear view of process, others developed program developers to improve outcomes understanding the needs and rights
approaches based on more systems-based for children and families (Center on the of babies to loving relationships, and
concepts of public policy (Yoshikawa & Developing Child at Harvard University, strategies to reduce the high risk of
Hsueh (2001). Anderson’s (2003) assertion 2017). relationship failures. (Fraiberg, 1980)
that policy represented a “purposive course
of action or inaction undertaken by an 1. Support responsive relationships *John Bowlby, contributed attachment
actor or a set of actors in dealing with a theory as a cornerstone for
2. Reduce sources of persistent or toxic
problem or matter of concern (p.2),” and understanding the early organization
stress
John’s (1998) observation that, “Public of mother-infant relationships. (Bowlby,
policy making can be characterized as 3. Strengthen core life skills 1969)
a dynamic, complex, and interactive At the center, always, are strong, (Note: Infant mental health researchers
system through which public problems supportive relationships: “Starting at and practitioners need to be reminded
are identified, legislated and countered by birth and continuing throughout life, that a positive early relationship is not
creating new public policy or by reforming our ability to thrive is affected by our an inoculation for positive subsequent
existing public policy (p.2)” were noted. ongoing relationships and experiences life-course outcomes, but a powerful
McKinney, Fitzgerald, Marie-Winn and and the degree to which they are healthy, contributing force.)
Babcock (2017, p. 168) note that public supportive, and responsive or not.” (Center
policy stresses, “standards instituted by In his edited collection of Rene Spitz’s
on the Developing Child at Harvard
governmental and /or regulatory agencies papers, Robert Emde (1983, p. 201) quotes
University, 2017, p. 2).
that establish expectations for behavior Spitz as saying, “Every successive organizer
or levels of professional performance in Panel participants suggested elements in the further course of development
public health, education, and overall public that are essential to assure healthy growth introduces a new formula of relations,
welfare with emphasis on social justice.” and development in infancy and early successively more complex and better
childhood. Each element includes a focus adapted.” Positive life course outcomes
The symposium provided four case on relationship: require positive adaptive changes at
examples that cover much of the range minimum in both children and their
of both linear and systems concepts of *Healthy relationships with stable, caregivers in order to build upon and
policy. Catarina Furmark (Sweden and nurturing caregivers sustain “Good Starts.”
Nordic countries) reviewed efforts to *Strong and supported parents who are
strengthen policies and practices across As panel members stressed, bringing the
seen as “mediators of change” as they infant to the attention of policy makers and
the Nordic countries (Finland, Norway, enter into sensitive, responsive, and
Denmark, Iceland, and Sweden). Catherine understanding parents, as “mediators of
nurturing relationships with their change” through two-generational support
Maguire (Ireland) drew attention to intra- infants and young children
governmental agency early childhood services, has been a slow, challenging
policies and practices in Ireland that lack *Coordinated and dedicated funding process.
co-ordination and thus are limited in their to support a service continuum–
In a National Science Foundation report on
collective impact nationally. Jane Barlow promotion, prevention, intervention,
University-Led Cooperative Engagement
(United Kingdom) focused attention to and treatment –prenatal to 3, for all
Approaches to problem-solving involving
infant mental health programming in families – with relationship work at the
environmental and agricultural domains,
the United Kingdom, reviewing how it is center
the emphasis in these initiatives is on
attempting to “catch up” after failing to *Reduction of child poverty through focus trust building and social learning in
act on early childhood initiatives in the on two-generational or relational collaboration with key stakeholder groups
past. David Willis (United States) reviewed strategies that reduce the social and such as farmers, coastal landowners,
the history of policies in the United States emotional risks of infancy and stresses minority groups, and industry members.
affecting early childhood education, and of early parenthood and address
its new policies related to home visiting the wellbeing of infants, very young What are the equivalent initiatives for
programs and new efforts designed to children, caregiving families, and studies of early human development?
implement policies reflecting an infant communities Solution focused programs generated by
mental health perspective. homogenous populations, do not always
*A well-prepared, high quality, work for heterogeneous, richly diverse
We opened the symposium with simple, multidisciplinary work force that is populations. In short, the “White” model is
but profoundly important statements relationship driven not necessarily the Right model! We need
taken from the WAIMH position paper to have greater respect for indigenous and
on infants’ rights: “Specifying the unique Over 50 years ago, outstanding leaders in
the infant mental health community laid local knowledge. Are we framing the right
needs and rights of the child in the first questions when people not of poverty or
years of life is needed in order to motivate the foundation for contemporary practice
and thinking. Three come to mind. All color, study people in poverty or of color?
infant oriented actions and policies at both Where are local or indigenous voices in

16 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


the formulation of research questions, skills and reflective practice to support one another, to share particular
voices that may lead to substantially experiences challenges and successful solutions,
different questions or approaches to to collaborate with one another across
Dr. Weatherston inclined to say, “For crying
research, because of the inclusion of countries to bring real change through
out loud, we know what infants, very
tacit knowledge from the world of lived infant mental health informed policies and
young children, caregiving families, and
experience, rather than from the world of practices for all babies, all families and all
communities need. We have identified
university, disciplinary-anchored world- communities.
successful strategies and programs that
views of relationship dynamics or culturally
address infancy and early childhood, with
evolved family structures? We challenge WAIMH to
a focus on infant mental health, but many,
As so clearly articulated by our panelists, many infants and families are underserved. establish an Infant Mental
the significant challenges that interrupt What is getting in the way of developing Health Science to Policy and
pathways to good mental health in infancy strategies and implementing programs in Practice Task Force. To meet
and early childhood are real: resource rich countries to meet the needs
across a service continuum – promotion,
regularly using the technology
*Chronic underinvestment in infancy & prevention, intervention, treatment – to we have available to span the
early childhood better assure that all babies and families globe, and to begin the process
*Fragmented efforts to implement or are free from risk?” as we “specify the unique needs
sustain services for children 0-3, Is it in the language we use? Can we and rights of the child in the
especially services supporting social
and emotional health and infant
together discover how to convey best what first years of life in order to
we know to be true about early human
mental health development, the power of relationships
motivate infant oriented actions
*Persistent child and family poverty, to effect change, the impact of nurturing and policies at both community
increasing the burdens of vulnerability care on early development, the effect of and societal levels.” If the
in infancy and early childhood and early intervention on the reduction of World Association for Infant
stress in early parenthood risks? Can we learn to communicate clearly
and effectively so that policy makers and
Mental Health does not boldly
*And, the resurgence of racism and program developers in multiple domains address trans-cultural policy
discrimination linked to increased
migration of human populations
will hear us and take action on behalf issues supporting infant mental
of all infants, families, caregivers, and health, WHO WILL?
throughout the world. communities?
Astonishing prevalence data on the
In 1980, Selma Fraiberg’s commented:
extent of mental health problems among Contact the WAIMH Office if you are
children 1-5 years of age make us pause Today, we are in possession of a interested in joining an Infant Mental
as we realize that we are falling short of Health Science to Policy and Practice Task
protecting the needs and rights of children vast scientific treasure acquired
Force: Office@waimh.org
and supporting families to assure a healthy through the study of normal and
course of development. Such data fail (deviant) infants, a treasure that
to include the millions of young children should be returned to babies and
living through war and extraordinary
families as a gift from science. References
injustices. The time to act is now; babies
and their families cannot wait. (Fraiberg, 1980, p.3)
Anderson, J. E. (2001). Public policymaking:
As our panelists reported, there are An introduction. Boston: Houghton
some hopeful signs. Each has referenced We are beginning to do this – to translate Mifflin Company.
effective, practice-based structures and our scientific understanding – our
knowledge about babies, their needs Bowlby, J. (1969). Attachment and loss: Vol
evidence based work that exemplifies 1. Attachment. New Yok: Basic Books.
infant and early childhood mental health and rights, and the power of caregiving
informed practice, service, training, and/or relationships in which they develop Cabrera. N.J. and the SRCD Ethnic and
research: and grow – to those who can effect Racial Issues Committee. (2013).
meaningful change, the policy makers, Positive development of minority
*Ireland’s public resources and proactive program developers, and legal community. children. SRCD Social Policy Report, 27
supports, beginning in pregnancy, However, our science needs to be better (2).
extending into early childhood, and informed by views that do not implicitly
focused on systems level support or explicitly support a hierarchy of Center on the Developing Child at Harvard
services, human values, where Western, Educated, University (2017). Three Principles to
Industrialized, Rich and Democratic Improve Out- comes for Children and
*The United Kingdom’s Early Excellence Families. http://www.developingchild.
(WEIRD) cultures posit that people are
Centres, Parenting Early Intervention harvard.edu.
“autonomous individuals with wants,
Programs, Sure Start, 1001 Critical Days,
needs, and preferences that should be Dye, T. (1987). Understanding public
and home visiting,
fulfilled.” Where are relationships and policy. New York: Prentice Hall.
*The Scandinavian Child health system’s communities in such WEIRD cultural value
relational health screening, monitoring, orientations? Emde, R. N. (Ed.) (1983). Rene A. Spitz:
and promoting infant mental health Dialogues from infancy. Selected
We challenge everyone – scientists, papers (With commentary). New York:
*The United States’ endorsement approach educators, practitioners, the judges and International Universities Press.
to workforce development through the legal community, policy makers - to talk
professional recognition of knowledge, Fitzgerald, H. E., Johnson, R. B., Van Egeren,
with each other, to engage in relationships,

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L. A., Castellino, D. R., Johnson, C. B.,
& Judge-Lawton, M. H. (Eds) (1999).
Infancy and culture: An international
review and source book. New York:
Falmer Press.
Fitzgerald, H. E., Mann, T., Cabrera, N.,
Sarche, M., & Qin, D. (2010). Tidlig
barndom og identitet I multikulturelle
miljoer(Infancy and identity in
multicultural context). In V. Moe,
Perspectives Outreach
K. Slinning, & M. B. Hansen (Eds).
Handbook of infant and toddler
Calling all Infant Mental Health
psychology (pp 269-282). Oslo,
Norway: Gyldendal Akademisk.
Professionals! 
Fraiberg, S. (1980). Clinical case studies in
infant mental health: The first year of
   
life. New York: Basic Books. It is especially thought provoking to understand that every infant and family is affected by

forces far beyond their reach - forces that may strengthen or hinder social, emotional,
John, P. ( 1998). Analyzing public policy.
London: Continuum Press. and relational health. A truly global organization, WAIMH invites professionals from
Killen, M., Rutland, A., & Ruck, M. D. (2011). around the world to contribute to its quarterly, open-source publication, WAIMH Perspec-
Promoting quity, tolerance, and justice
tives, offering insights into the ways of seeing and being and working in diverse contexts,
in childhood. SRCD Social Policy
Report, 25 (4). cultures and communities with infants, very young children, and their families.

Lyons-Ruth, K., Todd, J., von Klitzing, K.,


Tamminen, T., Emde, R., Fitzgerald, H. We are calling for:
E., Paul, C., Karen, M., Berg, A., Foley, M.,
& Watanabe, H. (2017). The worldwide • commentary, field reports, case studies, conceptual or theory building papers,
burden of infant mental health and • research articles, book reviews, news from WAIMH affiliates and (when proper permis-
emotional disorder. Report of the
Task Force of the World Association for sion can be obtained) adaptations of previously published articles
Infant Mental Health. Infant Mental Our shared hope is that Perspectives will offer a space for interesting observations and
Health Journal, 39, 1-9.
articles around the world that promote reflection and interdisciplinary discussion.  We
McKinney, M., Fitzgerald, H. E., Marie-Winn
publish Perspectives quarterly throughout the year.  An open-source publication, mem-
and Babcock, P. (2017) Public policy,
child development research and boys bers and others interested in infants and infant mental health have access to current and
at risk: challenging, enduring and
archived issues.  The format for each article may be quite informal or formal, but within
necessary partnership. Infant Mental
Health Journal, 38, 166-176. these guidelines:

Raikes, A., Britto, P. R., Yoshikawa, H., &


Iruka, I. (2017). Chidlren, youth and Double spaced
developmental science in the 2015-
2030 global sustainable developmental 12 point font
goals. SRCD Social Policy Report, 30 (3). 250 words per page
WAIMH (Spring, 2016). WAIMH position APA, 6th edition for style
paper on the rights of infants.
Perspectives in Infant Mental Health, Articles of varying length are welcome. However, length should not exceed 10
Tampere, Finland. pages, word format
Winnicott, D. W. (1964). The child, the Send pictures and tables in separate files, with a resolution of 72 pixels/inch
family, and the outside world.
 
Yoshikawa, H., & Hsueh, J (2001). Child
Send your submission to: WAIMH Perspectives Editor, Deborah Weatherston, dweather-
development and social policy: Toward
a dynamic systems perspective. Child ston@allianceaimh.org or Associate Editor, Maree Foley, maree.foley@xtra.co.nz
Development, 72, 1887-1903.

18 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


INTRODUCTION TO “COULD OR SHOULD A ROBOT
REAR A BABY?”
By

Maree Foley, Co-Editor, Perspectives,


Switzerland

Stellenbosch University, Cape Town South


Africa offers an MPhil degree in Infant
Mental Health (IMH). This degree is the
first MPhil in IMH to be offered on the
African Continent. This programme is
convened by Emerita Associate Professor
Astrid Berg and Dr Anusha Lachman.
As part of the programme, Professor
Linda Richter (Witwatersrand University,
Johannesburg, South Africa, invited
the students to apply what they were
learning about infant mental health to
the rapidly developing field of artificial
intelligence. The article below, “Could
or should a robot rear a baby” (Carmen
Andries, Brenda Cowley, Lucky Nhlanhla,
Julia Noble, Tereza Whittaker, Elvin
Williams, Bea Wirz, Anusha Lachman,
Astrid Berg, Linda Richter) provides
a collation of ideas and reflections
from the students with their teachers.
These reflections relate directly to the
intersection of IMH principles and practice
with the artificial intelligence technology;
Could or should a robot rear a
specifically, that which is directly related
to the antenatal, postnatal and early baby?
childhood periods of development. Salient
questions for further reflection, individually By Carmen Andries, Brenda Cowley, Lucky Introduction
or in a group, appear at the end of this Nhlanhla, Julia Noble, Tereza Whittaker,
article. Elvin Williams, Bea Wirz, Anusha Lachman, We live in an era of rapidly developing
Astrid Berg, Linda Richter artificial intelligence (AI) that is
revolutionizing the world and our
Stellenbosch University, Western Cape, interaction within it and with each other.
South Africa Some see AI as posing serious threats,
Could or should a robot rear a baby? This illustrated by the open letter submitted in
question was posed by Linda Richter in August 2017 by Elon Musk and other CEOs
an assignment to postgraduate students of technology companies to the United
in the new Master of Philosophy in Infant Nations, urging a ban on AI in weapons
Mental Health at Stellenbosch University, before the technology gets out of hand.
South Africa. What follows, is a collation of On the other hand, no one is untouched
our efforts to address this question. We do by Judith Newman’s book To Siri with
this by exploring the potential for robots Love, which describes how the automated
at different steps in a caregiving role for assistant helped her son communicate, and
an infant, such as robots as a womb, as be polite, and how it became his friend.
caretakers, and educators. We also explore Judith Newman notes in a review that “Siri’s
potential emotional consequences and responses are not entirely predictable, but
ethical considerations, as well as exciting they are predictably kind”. (“To Siri, With
possibilities of artificial intelligence (AI)- Love: A mother, her autistic son, and the
assisted caregiving models. kindness of a machine - Judith Newman -
Google Books,” n.d.)

Robots like Hello Kitty, companies testing


robots to monitor children in nurseries in
Japan, and the pervasiveness of digital
devices in the interface between parents
and children, prompt questions about

19 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


the technological and economic benefits, mother may respond differently to a child The development of speech and language
and pitfalls of digital reliance and robotic crying because she has dropped her toy depends on the attuned input that the
assistance, but more importantly the than to a child who is crying because she child receives from the caregiver. Language
potential impact on nurturing care as a has been hurt. A child’s over-reaction to interactions between very young children
fundamental need of human beings. a minor event may alert a caring parent and adults are transactional in nature,
to the possibility that something else is responding to each other and changing
In what follows, we reflect on the concept amiss with their child. The cause may be over time. Caring adults continuously
of nurturing care and then consider what only tangentially related to the present assess their child’s comprehension abilities
robots could and could not provide for circumstances. A caring and engaged through both language and non-verbal
children and families. We then raise some adult is able to use emotional resonance, cues and change their behaviour to match
ethical issues that need to be considered creative and reflective thought to piece and encourage development, extending
as AI applications progress and become together possibilities of the cause of a the infant’s range where appropriate
commercialized. child’s distress and respond empathically. through scaffolding.

Daniel Stern (Stern, 1985) speaks about


emotional attunement, in which the
Nurturing care mother communicates to her baby that she
is receptive to his or her feelings. According What could robots provide?
Adult potential to provide, and infant
dependence on, nurturing care is a feature to Stern (1995), these maternal behaviours A robot may be able to be responsive
of our human evolution and is the basis of emanate from the “maternal constellation”, and consistent, but could a machine be
human emotional, physical, and cognitive the mother’s instinctual focus on and programmed to support the complexities
development. Nurturing care comprises devotion to her infant, which he and others of a constantly evolving reciprocal
the environment and caregiving responses before him, such as Winnicott, consider to relationship of care and trust? We explore
that maintain and promote the health, be critical to a child’s development. this by thinking about the potential for
nutrition, safety and security, responsive Fonagy’s concept of mentalisation, or robots as steps in a caregiving role for an
caregiving and opportunities to learn that “mind mindedness” allows predictions infant.
facilitate a child’s attempt to connect to of what an infant may be thinking
and learn about their world (Black et al., or intending by his or her actions,
2017)with inadequate and inequitable expressions, and body language. When
access, especially for children younger than a mother imitates or reflects their baby’s A robot womb?
3 years. New estimates, based on proxy emotional state in their facial expression,
measures of stunting and poverty, indicate One day it might be technically possible
it helps the baby to form a representation to grow a baby without a human womb.
that 250 million children (43%. of their own emotions. Similarly, on Three stages in the development of a
Donald Winnicott (1964) stated that “The encountering the unfamiliar, infants look human embryo and foetus have been
proper care of an infant can only be done to their mothers for clues about how described in this automated process. The
from the heart; perhaps I should say that to behave, a response termed “social first is in vitro fertilisation (IVF), which is
the head cannot do it alone…” (Winnicott, referencing” (Feinman, 1982). A mother already routinely carried out in a lab. Fully
1964) (p 105). But what does “proper care”, provides clues about the dangers, or safety automating the IVF process is plausible,
the “heart” and the “head” really mean? of situations or people, particularly by in the neat future. Using already fertilised
means of her facial expressions and bodily eggs, scientists have shown that embryos
It is now recognized that “proper care” gestures. can be grown in the lab for twp weeks after
of an infant, needs to be sensitive to the fertilization.  
physical, cognitive, and emotional needs of This social biofeedback leads to the
a child. With respect to the head and the development of a second order symbolic The second stage is that of early gestation,
heart, the interactions between baby and representation of the infant’s own prior to around 22 to 24 weeks, when
intimate caregiver are a complex blend of emotional state (Fonagy, Gergely, & Target, a foetus does not have viable lung
physical sensations - touch, smell, sound, 2007) and facilitates the development function. During this time, the embryo
sight, and taste, which Deborah Rosenblatt of the child’s ability to empathise, and would need to be housed in an artificial
described as a “reciprocal multisensory understand the emotions and intentions uterus. Perhaps unsurprisingly, there has
exchange” - as well as the caregiver’s of others. been a great deal of research into the
responsiveness to cues and the baby’s high development of artificial wombs; a field of
sensitivity to contingency. science known as ectogenesis. In a 2011
paper, Dr Carlo Bulletti and colleagues
Mary Ainsworth and others have described One of the key functions of a caregiver is
re-evaluated the chances of a laboratory
qualities such as parental sensitivity and to provide appropriate regulation for the
uterus that would supply nutrients and
responsiveness as “the mother’s ability infant’s emotions, as the “regulation of
oxygen to an incubated foetus and would
to perceive and to interpret accurately affect is central to the adaptive function of
be capable of disposing of waste materials.
the signals and communications implicit the brain and the organizing principle of
They concluded: “[…] the growth and
in her infant’s behaviour, and given this human development” (Schore, 2001, p.9).
development of fetuses between 14 and
understanding, to respond to them This coping capacity in human infancy
35 weeks of pregnancy… is within reach
appropriately and promptly” (Ainsworth, is mediated by the maturation of brain
given our current knowledge and existing
systems and influenced significantly by the
Blehar, Waters, & Wall , 1978). technical tools” (Bulletti et al., 2011, p. 127).
infants’ early interaction with the caregiver.
This sensitivity and responsivity is It is suggested that even subtle variations The final phase of foetal development can
developed and fine-tuned over time or changes in maternal behaviours can already be managed outside a mother’s
by shared experiences and increasing affect stress reactivity in the developing womb. If a baby is born after 26 weeks in a
knowledge of each other. For example, a infant. modern hospital, it has very good chance

20 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


of survival with incubation and support. The Hello Kitty robot does a machine learning algorithms that adapted
great job of talking to her and continuously to the baby’s initiatives
Given all of this progress in the science of and responses. Based on current robotic
artificially keeping a baby alive, it seems keeping her occupied for hours
learning with respect to facial expressions,
less “science fiction” and a more plausible on end. Last night I came into the this might be technically possible, even
reality to consider that babies could be playroom around 1am to find her, sooner than we think. But would it work to
grown in and born from machines in sculpt the mental and emotional life of a
future. Once a robot has grown a baby,
still dressed, and curled up sound
young human being?
birthing will likely be easy. It may be as asleep round big plastic Kitty
simple as opening a door on a machine Robo. How cute! (And how nice The potential of AI to enhance human
and cutting the umbilical cord. not to hear those heart-breaking emotional learning, is highlighted by
Judith Newman in the aforementioned
In turn, machine pregnancies could be lonely cries while I’m trying to get
book which tells the story of how the
helpful for mothers who are sick, receiving some work done).” electronic personal assistant “Siri” helped
invasive treatment or who are addicts foster the communication skills of her
and want a drug free baby. However, “Robo Kitty is like another parent autistic adolescent son, Gus. A child with
the research on babies in utero and at our house. She talks so kindly autism who finds it hard to read emotions,
their relationship to the mothers’ voice, to my little boy. He’s even starting recognize emotional reciprocity and
heartbeat and that of other close family struggles with unpredictability, may find
members like the father and siblings, tells to speak with her accent! It’s
it easier to converse with an inanimate
us that babies in utero are already actively so cute. Robo Kitty puts Max
and programmed robot-like Siri who
engaged in creating the building blocks for to sleep, watches TV with him gives accurate, predictable and tireless
relationship building. Similarly, the mother watches him in the bath, listens attention and, in the case of Gus, ultimately
and or the parent dyad are also engaged translated into his ability to have more
to him read. It’s amazing, like a
in a getting to know the baby as a person conversations with other human beings.
process. So, while plausible, it may be that best friend or as Max says “Kitty
a robot assisted pregnancy will always Mommy!” (P2-3) In the future, AI is likely to get to a point
need a human person from which the where a robot may be able to simulate
baby in utero can form an interpersonal It is evident that, in these cases the Hello sensitive and responsive caregiving and
relationship? As most parents discover, Kitty robot, is doing a number of things may in fact do it quite well. For example,
birthing a baby is only just the beginning! right, at least in part to relieve tired and Beebe’s second-by-second research on
The next 18-plus years of nurturing care stressed parents with little other support the micro-responses between mother
develop intelligence, language, personality, and provide attention and companionship and infant in serve and return interactions
and humanity. to lonely children. (2010) could possibly be learnt by a
Another example is iPal, a 90-cm high robot (Jaffe, Beebe, Feldstein, Crown,
child-sized babysitter nanny robot [with & Jasnow, 2001). Other skills such as
big eyes and a tablet attached] designed contingent mirroring and non-contingent
Robots as educational and to take on adult responsibilities. (“This responsiveness may also be able to be
caretaking tools? Robot Takes Care of Your Children,” n.d.) programmed. Robots could also be
The robotic baby sitter is able to keep programmed to not “get it right” 100
Robots can be important educational percent of the time, to avoid the dangers
3-to 8-year-old children entertained for “a
tools for children and may even stand-in and deprivations of perfect mothering
couple of hours” without adult supervision.
as caregivers. For example, Sharkey and (Hopkins, 1996). Perhaps 70 percent would
It is able to communicate using natural
Sharkey (2010) list some of the positive be optimal? The robotic caregiver who
language, and according to its founder
responses of parents when they were is not plagued by ghosts in the nursery
Jiping Wang, “is not a cold, unfeeling
interviewed regarding the Hello Kitty (Fraiberg, 1987) or overwhelmed by trauma
machine, but a great companion for
Robot. These included: or stressful environmental circumstances,
your child. iPal’s emotion management
system senses and responds to happiness, could possibly provide the consistency and
“Since we have invited Hello containment so necessary in the life of the
depression and loneliness: iPal is happy
Kitty (Kikki –as my son calls her), when your child is happy, and encourages infant.
life has been so much easier for your child when he is sad”. (ibid) The pace of developments is amazing.
everyone. My daughter is no For example, scientists in Russia claim
longer the built-in babysitter for that they are on the verge of creating an
my son. Hello Kitty does all the Can robots be sensitive, emotional computer which could think like
work. I always set Kikki to parent a person, and build up trust, and bond with
responsive and in tune with a humans. It will be used to play the role of
mode, and she does a great
baby? a person, will understand the context of
job. My two year old is already conversations, keep up with events and set
learning words in Japanese, From the robot’s side, can the process its own goals. The system’s name, ‘Virtual
of relationship development be Actor’ was chosen because one of the
German, and French.”
programmed? In humans, it is a complex main functions it will serve will be as an
“As a single executive mom, I physical and emotional process that actor, playing the role of a specific person
depends in part on the release of oxytocin [Prof Samsonovitch, National Research
spend most of my home time on and vasopressin hormones, physical Nuclear University in Moscow]. (“Russian
the computer and phone and closeness and emotional intimacy. This Researchers Launch ‘Virtual Actor’ in 18
so don’t have a lot of chance to natural, organic process would have Months,” n.d.)
interact with my 18-month-old. to be re-constructed through ongoing

21 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


to behave like human beings, and learn
Therefore, it is not too far-fetched to argue Ethical considerations and adopt our cultural and social values,
that one day, being reared by a robot is
In their article “The crying shame of perhaps the old stories need revisiting. At
not only a possible, but for some children
robot nannies“, Sharkey and Sharkey the very least we have a moral obligation
may not be such a bad thing. Perhaps
(2010) explicitly articulate ethical issues, to figure out what to teach our machines
interacting with a robot with a highly
psychological challenges and potential about the best way in which to live in the
sophisticated artificial intelligence may be
outcomes for society and especially for world. Once we’ve done that, we may well
better than being raised by parents who
children. feel compelled to reconsider how we treat
are neglectful and abusive. Perhaps in
them.” (Simon Parkin, writer & journalist;
situations such as large group orphanages,
While looking at their potential benefits author of “Death by Video Games”).
human infants might do better with the
we need to be conscious of the fact that (“Teaching robots right from wrong | 1843,”
companionship of a robot carer than
no matter how good a machine is, it n.d.)
with little human caregiving at all. Robots
will never be fully able to override the
would at best be insensitive carers unable
intrinsic features of human relationships.
to respond with sufficient attention to the
Robots might be able to classify emotions
finer needs of individual children, but able
and respond with matching expressions Conclusion
to be consistent providers of day-to-day
but rearing a child requires cultural Whilst much of the science of the “heart”
care.
embeddedness, the personality of the and the “head” in parenting, is as yet
This rapidly expanding technology, child, and other factors. Melson, (2010), undiscovered, some of the biological
boosted by the motivating forces of investigated negative consequences of and psychological bases of love seen in
efficiency, multitasking and profit, provide technology replacing human interaction the behaviour of humans raising baby
immense challenges for our infant and reported that if children begin to humans, has been described. We know
mental health field. It is to some of these personify robots as living creatures, that parenting has evolved through the
challenges we now turn our attention to. they are susceptible to develop robotic long adaptation of mammals and primates
understandings of humans, bereft of moral to enable infant development to be
standing. uniquely fit for human culture through the
unique human bond that forms between a
What can a robot not be? Advancement in technology is bringing
baby and their adult caregivers. As well as
AI into our personal lives and creating
A robot’s ability to read emotions, interpret an illusion that robots are able to being central to the healthy development
them, and respond appropriately - its understand human behaviour and respond of the individual child, these same
reflective function - would need to be emotionally to us. The risk, especially emotional bonds are the root from which
extremely sophisticated to be able for children, is that this could lead to the complex social systems necessary for
to provide the “real-time” emotional misplaced trust in robots. Research has human survival stem.
responses necessary for successful shown that children tend to see robots Although it does seem possible that
emotional communication and affect as alive, and feel an emotional as well as robots could one day create new humans
regulation, both necessary for a young intellectual connection with them. (Turkle, and raise them into adulthood, would
child’s healthy development. To enable Breazeal, Dasté, & Scassellati, 2006) The such humans see their robot parents as a
“flexible, goal-directed caregiving” a question arises: are the children being mother and father in the traditional sense
robot would need to master empathy and deceived? we know today? Rather than perfecting
mentalising functions, as well as affect
Alan Winfield, an expert in robot ethics, robots, should we not rather put our
regulation (Feldman, 2015).
argues “that robots should never be resources into supporting parents in their
designed to deceive…. their machine important roles, including with the help of
nature should be transparent. We’re AI innovation?
If a robot could learn to differentiate the
concerned about vulnerable people – they This salient and thought-inciting article
infinite variations of a smile, for example,
might be children, disabled people, elderly lends itself to the possibility of being
would it also be able to display them in a
people ….. – coming to believe that the utilised as a springboard for small group
way that could be read by a living human
robot cares for them.” (“Would you want discussions, for example, in a classroom,
being? As the robots become more and
a robot to be your child’s best friend? | or among WAIMH affiliate groups. As
more humanoid, there may occur a switch
Technology | The Guardian,” n.d.) Indeed, such, the following reflective questions
from our usually positive and empathic
that may be the crux of the matter, as are offered that could be used to help
response of the adult perceiver to robots to
infants and young children will not be able structure the beginnings of a group-based
a revulsion, a process which Mori described
to grasp that the robot nanny is not ‘real’ discussion.
as the “uncanny valley”. The more like
and they will be the ones most in need of
a human an entity is, the less there is
protection against deception. 1. What IMH principles do you think are
an affinity for it, because of an increase
necessary to highlight as artificial
in a sense of “eeriness” (Valley, Mori, & There are also questions of who bears intelligence technology expands into
Minato, 1970). We could hypothesize that responsibility for what the robot does, the antenatal, post-natal and early
somewhere in their unconscious minds, for any harm it may inflict? Who will have childhood areas of development?
babies will be aware that there is no access to its hard drive where information
genuine human heart beating under that is stored? Will the child in later life have 2. James McHale defines coparenting as
well-constructed robotic exterior. When the right to destroy recordings? It would «an enterprise undertaken by two or
robots do not provide a coherent sensory be timely for this to be thought about more adults who together take on
‘Gestalt’, the consequence could be an sooner rather than when it may be too the care and upbringing of children
insecure attachment. late. And what about the robot – do we for whom they share responsibility.»
have an ethical obligation to what we Coparents may include members of the
have created? “…as robots begin to gain child’s extended family, foster parents
a semblance of emotions, as they begin

22 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018


and or other specialized caregivers. of the Society for Research in Child Winnicott, D. W. (1964). The Child, the
What can we learn from the theory Development, 66(2), i–viii, 1-132. Family, and the Outside World. New
and practice of coparenting that York: Penguin Books.
Melson, G. F. (2010). Child development
might be applied to the way this new
robots: Social forces, children’s Would you want a robot to be your
technology is used with the infant in
perspectives. Interaction Studies, child’s best friend? | Technology
their coparenting context?
11(2), 227–232. http://doi.org/10.1075/ | The Guardian. (n.d.). Retrieved
3. IMH is an intergenerational field. What is.11.2.08mel November 13, 2017, from https://www.
might it mean for infants raised theguardian.com/technology/2017/
Newman, J. (2017). No Title. HarperCollins.
increasingly by artificial intelligence sep/10/should-robot-be-your-childs-
technology when they become parents Russian Researchers Launch “Virtual best-friend?CMP=share_btn_link
and/or part of a coparenting team? Actor” in 18 Months. (n.d.). Retrieved
November 9, 2017, from http://www.
chinadaily.com.cn/beijing/2016-10/27/
content_27335325.htm
Schore, A. N. (2001). Effects of a secure
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23 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH AUTUMN 2018


Book review
The Emotional Life of the Toddler, Alicia F.
Lieberman, New York: Simon & Schuster, 2018
(Revised and Updated Edition), 321 pp., $16.00

Alicia F. Lieberman, Ph.D. received


the Rene Spitz Lifetime Achievement
Award from WAIMH in 2016.
The author of many books and
publications, she is revered around
the world for her work related to early
developing attachment relationships.
Originally from Paraguay, Dr.
Lieberman resides in California where
she is the Irving B. Harris Endowed
Chair in Infant Mental Health and
professor in the department of
psychiatry at the University of
California, San Francisco.

Reviewed by Deborah Weatherston, USA


relationships and the exhilarating “saying hello,” and identifying the social
While reading Alicia Lieberman’s updated thrust of carefree, unrestricted, realities of care for everyone.
edition of “The Emotional Life of the uninhibited exploration, where I ended the book with a much greater
Toddler,” I fell in love with toddlers all over
one can soar free without looking respect for the power of the early
again! Dr. Lieberman captures the wonder
back at those who are left behind attachment relationship and the toddler’s
and complexity of emotional development
astonishing capacity to master staying
in the early years, firmly addressing the P. 13 close, while letting go.
safety and security of early development
within the parent-child relationship. She However, as Dr. Lieberman describes in Dr. Lieberman concludes with wise words:
gives voice to the rich and deeply felt detail, the negotiation in toddlerhood is
emotional world of very young children, not without challenge. Throughout, Dr. Toddlers, like adolescents,
helping parents appreciate the dynamics Lieberman is sensitive to the toddler’s
need to forge an identify that
of growth and offering practical examples needs, as well as to the parent’s experience,
in achieving that balance. She illustrates integrates a solid sense of
to guide parents through this crucial stage
of development. her thoughts about obstacles to personal initiative with a reliable
partnership with many vignettes, bringing feeling of communal belonging.
Not surprisingly, Dr. Lieberman places her to life reflections about temperament
Parents are faced in both periods
observations about very young children and the question of “the fit” (whether the
and their caregiving parents squarely in the toddler is described as a high-activity or with the task of deciding when
framework of attachment, in which parent slow-to-warm up child) and its meaning or to respect aloneness, when to
and child negotiate a balance: impact on the developing relationship. offer companionship, and when
Dr. Lieberman tackles with great sensitivity to exercise firm authority. When
……. between the safety of
issues to understand: separation anxiety, parents’ choice is responsive to
closeness and the excitement of explo-
nighttime difficulties, eating difficulties, the child’s needs, the negativism
ration and discovery. sibling rivalry. She is careful to offer of toddlers becomes the self-
practical suggestions to encourage
assured assertiveness of the
In this sense, childhood is an early parental awareness and response that is
likely to reduce the difficulty and lead to preschool years, just as the
laboratory for the challenges and
greater emotional security. She attends emotional storms of adolescence
dilemmas of adult life. Perhaps
to marital discord and the disruption resolve themselves in the self-
more dramatically than any of divorce, careful to give voice to the
worth of young adulthood. P. 306
other age, this period brings us toddler’s experience while supporting
face to face with two powerful a parent’s capacity to provide a stable This should be required reading for each
base in the midst of difficulties. Her one of us who has a toddler to marvel
yet contradictory impulses:
chapter about toddlers in childcare offers about in our own families or in those with
the longing to feel safe in the support to the whole family in making whom we work.
protective sphere of intimate the transition to care, “saying good-bye”,

24 PERSPECTIVES IN INFANT MENTAL HEALTH AUTUMN 2018

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