Category Archives: Special Circumstances: Multiples, Adoption & Special Needs

For parents of children with special needs, such as disabilities, autism, and chronic illnesses. Also for adoptive and foster parents.

From Heartache to Hope: Interview with Leisa Hammett of the Autism Society of Middle Tennessee

By Rita Brhel, managing editor and attachment parenting resource leader (API)

From Heartache to HopeThe personal stories of families and individuals affected by autism in the beautifully photographed book, From Heartache to Hope: Middle Tennessee Families Living with Autism by Leisa A. Hammett, were an amazing read.

The book follows 18 families in how they have struggled with one or more family members receiving a diagnosis of autism and how they moved literally from heartache to hope — with the parenting support offered by their local Autism Society of Middle Tennessee, USA. This book illustrates the vital importance of unconditional attachment between parent and child in a circumstance where autism exists.

Leisa, a mother of a child on the autism spectrum, offers more insight into why this book came to be.

RITA: How did you first became interested in helping other parents of children with autism?

LEISA: I’ve always been a flag waver — guess I was born with one flapping in my hand. And then, after serving as a social justice reporter covering poverty, homelessness, addiction, etc., I was moved to use my life, my faith, my gifts, what I possessed, to work for change. That time in my life, my mid-20s, was catalytic. So, in many ways, it’s a bit ironic that I ended up being the type person with circumstances and challenges about whom I used to write. Also, ironically, I’d finished up a volunteer stint as my local La Leche League chapter’s librarian and had promised to do the same for Attachment Parenting International in Nashville, where I live.

But that’s when the “A bomb” dropped. Resources, time, and energy, of course, had to be redirected. Continue reading

Another Look at Breastfeeding with HIV/AIDS: An Interview with Marian Tompson, co-founder of LLLI

By Rita Brhel, managing editor and attachment parenting resource leader (API)

Marian Tompson, founder of AnotherLook and co-founder of LLLI
Marian Tompson, founder of AnotherLook and co-founder of LLLI

When we think of the Attachment Parenting International Principle of Feeding with Love and Respect, what first pops into our minds is a woman enjoying a close breastfeeding or bottle-nursing relationship with her baby or perhaps a family sitting around the dinner table engaged in a lively conversation about the day’s happenings. What many of us don’t picture are the myriad challenges many parents must encounter in order to do what seems to be such a basic part of child-rearing: feed their child.

Unless we’re experiencing a challenge at the time, we don’t think of the working mother pumping her breast milk, the parents feeding breakfast to their son via a stomach tube, or even the parents struggling with emotions toward their picky preschooler. And we certainly don’t think what it must be like for the HIV-positive mother who wants to breastfeed but is opposed by the medical community. But there remains debate about breastfeeding by HIV-positive mothers and whether the mother, particularly in developing countries where there are additional serious risks to not breastfeeding, should breastfeed or formula-feed her newborn.

Even for breastfeeding advocates, breastfeeding by HIV-positive mothers is a gray area. We want all mothers to feel welcomed to nurse their babies, but no one wants to pass HIV to their child through this naturally loving act. When going against what seems natural to us, we have to look at the research — and many of us probably do not fully understand what the studies have found.

It is because of this gap in knowledge and application of that knowledge that Marian Tompson founded AnotherLook as a 501(c)3 nonprofit organization in 2001, separate and unaffiliated with the La Leche League (LLL) International she co-founded more than 50 years ago. The opening statement on the homepage of AnotherLook’s website, AnotherLook.org, says it all: “The issue of HIV and human milk has been clouded by possibly questionable science, lack of precision concerning the definition of breastfeeding, and premature public policy statements.”

Editor’s Note: Attachment Parenting International finds the mission of AnotherLook to be incredibly important to the HIV-positive community. However, API wants to make it clear that this contents of this article do not constitute medical advice and that all HIV-positive women should consult their health practitioners regarding breastfeeding and their child’s risk of transmission. API cannot be held liable for any personal decisions made by readers based on the contents of this article.

I first heard about the monumental hurdles HIV-positive women face in breastfeeding while attending a LLL conference in Nebraska last summer. The speaker was Tompson, and her topic that morning was the nonprofit organization called AnotherLook (at Breastfeeding and HIV/AIDS), which helps to educate both parents and professionals as to the issue of breastfeeding by HIV-positive mothers.

About AnotherLook
AnotherLookBased in Evanston, Illinois, AnotherLook is dedicated to further its mission to gather information, raise critical questions, and stimulate needed research about breastfeeding in the context of HIV/AIDS. AnotherLook questions feeding strategies based solely on the possibility of virus transmission instead of on maximizing the probabilities for good mother-infant health. The organization calls for clear, published scientific evidence as to the type and manner of feeding that will minimize infant morbidity and mortality and seeks out scientific proof that infectious HIV virus is present in breast milk and is transmitted from mother to baby through breastfeeding.

AnotherLook provides presentations, position papers, and recommendations, which can be found at its website.

Tompson spoke about the variety of information related to HIV/AIDS and breastfeeding, such as that the medical community in industrialized countries like the United States advises HIV-positive women not to breastfeed their babies. The guidance is out of fear of transmitting the virus to their child. One story told was of a woman in only the last couple years whose baby was removed from her care until she promised not to breastfeed, because the authorities called the choice to breastfeed over using formula as dangerous mothering.

It is for this reason that AnotherLook exists — to give HIV-positive mothers and health professionals factual information on what we know and don’t know about breastfeeding when a mother is HIV positive, to ask critical questions, and to stimulate needed research. Knowing the importance breastfeeding has in establishing a strong mother-child attachment relationship, you can understand what this organization means to those women with HIV/AIDS for whom AnotherLook provides a voice in exclusively breastfeeding concerns.

A Call to Action
AnotherLook has issued a Call to Action to assure the best maternal-infant health outcomes in relation to infant feeding in the context of HIV/AIDS. This call is needed because current research, policy, and practice, often based on fear, are focused on the reduction of transmission while neglecting the impact on morbidity and mortality. This not only may be misleading but may inadvertently set back critical gains already achieved in public health as a result of the protection and promotion of breastfeeding.

AnotherLook acknowledges the possibility that HIV may be transmitted through breastfeeding and that there is an urgent need for feeding guidelines.

In light of the above, AnotherLook calls for immediate action to provide:

  • Clear, peer reviewed research, with careful ongoing follow-up, which will provide sound scientific evidence of optimal infant feeding practices that lead to the lowest morbidity and mortality.
  • Concise, consistent definitions of feeding methods, testing methods, HIV infection and AIDS.
  • Development of research based infant feeding policies which are feasible to implement in light of prevailing social, cultural and economic environments; which address breastfeeding (particularly exclusive breastfeeding) as a critical component of optimal infant health; and which fully consider the impact of spillover mortality/morbidity associated with infant formulas.
  • Epidemic management from a public health perspective, with the focus on primary prevention, careful, unbiased surveillance, and the achievement of overall population health with the lowest rates of morbidity and mortality.
  • Evidence-based practices which protect the rights of both mothers and infants including education, true informed consent, support of a mother’s choice, and avoidance of coercion.
  • Funding to support the above actions and those programs which improve maternal/child health in general such as prenatal and postnatal care, nutrition, basic sanitation, clean water, and education, as well as exclusive breastfeeding until clear scientific evidence supporting the abandonment of breastfeeding is available.
  • Continued commitment by local and global researchers, policy makers, health workers, and funding bodies to basic scientific, medical, public health, and fiduciary principles in responding to this critical issue.

In summary, AnotherLook calls for answers to critical questions not currently being addressed that will foster the development of policies and practices leading to the best possible outcomes for mothers and babies in relation to breastfeeding and HIV/AIDS.

With the background laid out, let’s turn to Tompson for more information on the past, present, and future of AnotherLook.

RITA: Hi Marian. I recall hearing you say at the LLL conference that, knowing the time and energy and sheer work that goes into building up a successful nonprofit organization as LLL International is, founding another organization was a task that you never thought you would do. What made you decide to pursue the organization of AnotherLook?

MARIAN: It has always been important to me (and La Leche League) that mothers get correct information.  In 1997, when WHO [World Health Organization] changed its infant feeding recommendations when a mother was HIV-positive from one where the decision would be made on a case-by-case basis as to whether or not she should breastfeed to one where all HIV-positive women were encouraged to formula-feed if at all possible, I set out to find the studies that backed up this change.

I was looking for the evidence proving that babies who are breastfed by HIV-positive mothers are more likely or less likely to get sick and die than those fed formula mixed with possibly contaminated water, which is common in developing nations with HIV/AIDS epidemics such as parts of Africa.

RITA: What did you find?

MARIAN: We question infant feeding strategies based solely on the possibility of virus transmission instead of on maximizing the probabilities for good mother-infant health. We still don’t know if HIV virus in breastmilk is actually live (infectious), and if it is infectious, if there is enough to infect the baby. We have a team ready to research this and have been looking for a grant to cover the cost.

The challenge is that most people in this field think we already have the answers to these questions.

RITA: How has AnotherLook reached out to professionals and the HIV-positive community?

MARIAN: We have had an international focus since the beginning, calling attention to the difference in recommendations depending on where the HIV-positive mother resides.

We have a private chat list that includes researchers, health professionals, speakers on this topic, health workers working with mothers in Africa, and LLL leaders and others interested in this issue.

We were invited to do roundtable sessions at an American Public Health Association annual meeting, did a poster session at the International AIDS Conference in Toronto [Canada], and our abstract was included in the syllabus of last year’s International AIDS Conference in Mexico City [Mexico]. We have given presentations at LLL conferences, both in the United States and abroad.

We’ve had letters printed in major medical journals criticizing published research.

RITA: Do you have any success stories that stand out of how AnotherLook is able to educate mothers or professionals in a way that changed the course of establishing a breastfeeding relationship when HIV/AIDS is a factor?

MARIAN: We have helped to change recommendations on infant feeding in developing countries from one in which mothers were told to formula-feed if at all possible to one where now all mothers are encouraged to breastfeed exclusively for six months.

About these Recommendations

http://www.who.int/hiv/mediacentre/Infantfeedingbriefingnote.pdf

http://whqlibdoc.who.int/publications/2007/9789241595964_eng.pdf

Our poster sessions have pointed out the lack of evidence in the citations used to back feeding recommendations. The research hasn’t been done that would give us the answers needed about breastfeeding when a mother is HIV-positive.

We have become a resource for women in the United States who have no support group, like drug users and gay people have if they are diagnosed with HIV virus.

We also educate professionals about the assumptions that have long been accepted as facts.

RITA: Where do you see AnotherLook heading in the future?

MARIAN: Continuing to provide information through presentations and our website, while responding to inquiries. Even school children have contacted us. Working to get the research still needing to be done accomplished. Raising funds to enable us to participate in discussions of this issue.

When a director from UNICEF, who initially questioned the need for AnotherLook, attended one of our presentations at an LLL International Conference, she said that AnotherLook should participate in all international discussions because we were including elements that others had overlooked.

RITA: Thank you for your time, Marian. Do you have any closing thoughts?

MARIAN: New online at www.anotherlook.org/updates is Rodney Richard’s letter questioning the wisdom of mandatory testing of newborns for HIV. Richards is a bio/organic chemist who worked many years for Amgen, the world’s largest biotechnology company, specifically in the area of HIV test development.

His letter is in light of legislation passed in Connecticut, Illinois, and New York that require mandatory testing for HIV in newborns. Many states, such as Arkansas, Michigan, New Jersey, Tennessee, and Texas, have laws requiring HIV testing of pregnant women as part of routine prenatal care and then testing of newborns if the HIV status of the mother is unknown. We will probably see this legislation being considered in other states.

Also in the works are:

  • A detailed paper on WHO’s changing recommendations on infant feeding when a mother is HIV-positive
  • A report from the session we put on at the LLL International 50th Anniversary Conference, “Breastfeeding and HIV: What Works, What Doesn’t, What Has to be Changed,” with Cathy Liles, BBA, CPA, MPH, IBCLC, a member of the LLL International Board of Directors, and Ted Greiner, PhD, coordinator for the World Alliance for Breastfeeding Action Research Task Force.

About Marian Tompson
Marian was one of seven women who co-founded La Leche League as a way for women to seek out support and education in breastfeeding as the best way to feed infants. LLL’s beginnings came at a time in history, 1956, when women were advised to forgo breastfeeding as an infant-feeding option. At this time, the U.S. breastfeeding rates dropped to only 20%.

Marian had an instrumental role in the nonprofit organization of LLL, serving as president for 25 years. In 1958, she started the newsletter that eventually became the magazine we know today, New Beginnings, and in 1973, she began the annually held Breastfeeding Seminar for Physicians.

Today, besides her work with AnotherLook, Marian is involved in the LLL Founders’ Advisory Council and the International Advisory Council for the World Alliance for Breastfeeding Action, and is vice chair of the United States Breastfeeding Committee. She and her late husband Tom raised seven children. Marian also has 16 grandchildren and five great-grandchildren.

API’s Connection >> Reedy Hickey, IBCLC
Reedy HickeyAnotherLook and API share a member of their respective Boards of Directors. Hickey not only provides leadership to both organizations but also advocates breastfeeding as a local La Leche League leader and Georgia’s LLL professional liaison. She is the mother of two grown children and 32 foster babies, and practiced AP with each.

Blessings on Our Meal: Parenting a Child with Severe Feeding Issues

By Jonna Higgins-Freese

Jonna and her children
Jonna and her children

I’m making breakfast for my two-year-old son who stands on a stool next to me. Oatmeal simmers on the stove. “Lid!” Reuben says, pointing to the rattling pan and signing that he hears something. I turn off the flame, then slice an avocado, which I slide into the Vitamix blender. I add half a cup of oatmeal, an ounce of last night’s Parmesan pan-fried pork, applesauce, carrots, and milk. “Mix!” Reuben says, smiling up at me happily as I start the machine.

“Okay, buddy, let’s have breakfast,” I say, strapping Reuben into his high chair. I open the tab of his Mic-Key button, which looks like a beach ball valve on his abdomen, screw in the extension tube, and insert the tip of a syringe filled with the food I’ve just made. I sit down next to Reuben and push ten milliliters, about the volume of an oral bite, directly into his stomach through the tube. Meanwhile, I offer him banana slices and cereal, but he leaves them on his tray.

Reuben’s unusual relationship to food wasn’t always such a comfortable part of our routine.

“Oh, I know,” Other parents say, “my Jimmy is a picky eater, too.” I don’t want to be obnoxious, so I don’t say what I’m thinking: Reuben isn’t picky — it’s that he’s not an eater.

In the Beginning

Reuben’s feeding issues stem from medical complications that arose during birth. He spent 11 weeks in the neonatal intensive care unit, undergoing increasingly invasive treatments to save his life. I could not feed him, talk to him, or touch him. (Unlike some critically ill infants who thrive when touched, Reuben’s blood oxygen levels dropped with any stimulation). But I could pump breastmilk for him. Even though he was so ill that he received only a few milliliters of it each day through a tube into his stomach, pumping became my way of connecting with him and embodying my faith that he would recover.

The doctors warned us that feeding difficulties were often a side-effect of the treatment, but my husband and I assumed that once Reuben was allowed to eat, he would.

He did not.

Common Feeding Difficulties

Oral Aversion
Oral aversion occurs when a child is reluctant or refuses to be breastfed, bottle-fed, or eat. The child may have negative associations with food or other objects near or in his mouth, or, in some cases, a child develops oral aversion when she strongly dislikes the texture of certain foods. This often happens when a child has been tube-fed for a long time due to illness or prematurity.

Dysphagia
Dysphagia is when the swallowing of food causes it to not pass easily from the mouth to the stomach, which may cause food to get stuck in the lungs and throat. Children with this disorder may also begin to refuse food. This disorder often occurs as the result of another condition, such as prematurity, cleft lip or palate, and large tongue or tonsils.

Comfort in Breastfeeding

We started by offering to nurse him several times each day. Although he never ate enough to allow us to decrease his tube feedings, breastfeeding did give him some practice at sucking and swallowing, and provided him with positive oral experiences. Each time, he would shake his head excitedly, say “ah-ah-ah,” and dive toward me. Then, he would close his eyes and raise his eyebrows in an expression of deep contentment as he settled in. Now, at nearly three, he still asks for nummies as a way to reconnect when I return from work, or when he is particularly tired or upset. He barely latches on, but finds comfort in snuggling.

Through the time that I pumped breast milk for Reuben and he recreationally nursed, I sometimes felt criticized by people on both ends of the spectrum of parenting philosophy. Some people couldn’t understand why I would make the monumental effort to pump milk for 19 months. At other times, I felt pressure from exclusively breastfeeding mothers because Reuben used a nipple shield, didn’t get his nutrition “from the breast,” and received breastmilk calorie-enriched with formula. I had to learn to trust my own instincts, knowing that I was providing the best mix of experiences and nutrition for his unique needs.

Reality Sets In

The doctors reassured us that Reuben would learn to eat when we introduced a bottle or solids. But he did not. Months went by, and the tube remained in his nose; then, the day after his first birthday, it was replaced by one in his stomach. Some family and friends couldn’t understand why Reuben did not eat by mouth, suggesting that the problem would be solved if we simply held his tube feedings and offered only the bottle. They shared stories of breastfed babies who were forced into taking the bottle at day care. We knew this wouldn’t work, even if we had been willing to try it. Babies like Reuben have been traumatized by their oral experiences. They are so out of touch with their bodies’ signals of hunger and fullness, and so lacking in the basic motor skills needed to suck and swallow, that they will starve to death without tube feedings.

But I also understood their discomfort. Eating is central to daily life, social interaction, and celebration. Reuben’s refusal to eat felt deeply strange. More than once, even though we knew all of the medical reasons for Reuben’s behavior, Eric and I asked each other in frustration, “Why won’t he just eat?”

At each meal, I prepared a bottle and a bit of food, knowing in advance that the food would ultimately go in the garbage, and the contents of the bottle would be poured into his feeding tube. “Try to relax,” my husband advised. “Sometimes you focus on the negative, and I’m sure Reuben picks up on that.” He was right, but I wasn’t sure how to remain consistently cheerful when I prepared three meals a day for a child who refused to put them in his mouth.

Easy to Love, Difficult to Discipline by Becky Bailey helped me realize that we can’t ever force another person to do anything; all we can do is set up the situation so it’s easier for them to choose what is safe, healthy, or polite. Or, in the words of one specialized feeding program we researched, “We teach our families the proper division of eating responsibility; it is the child’s responsibility to eat, and it is the family’s responsibility to provide the right environment, foods, and opportunities to eat.”

Easy to Love, Difficult to Discipline
By Becky Bailey

Easy to Love, Difficult to DisciplineEasy to Love, Difficult to Discipline provides parents with seven basic skills to turn conflict into cooperation through development of self-control and self-confidence on the part of both the parent and child. The focus of the book is to teach parents to learn to understand both their and their child’s motivations for certain behaviors and then how to help their child and themselves to improve.

Seeking Treatment

As our knowledge of feeding issues and confidence as parents increased, we became evermore frustrated with the hospital feeding specialist’s behavioral approach, which didn’t seem to work for Reuben or our family. He suggested we strive to “increase Reuben’s compliance with the spoon” and instructed us to set a timer for a three-minute “meal,” then touch the spoon to Reuben’s lips and say “bite” every 30 seconds. To our surprise, this worked well — for three meals. After that, Reuben screamed and sobbed, turning his head away from the spoon. Although we didn’t know the phrase “feeding with love and respect” at that time, we instinctively felt that seeking “compliance” was not compatible with our parenting philosophy.

When we consulted a different specialist, I immediately felt more comfortable. She approached Reuben and greeted him gently, getting to know him first as a person. She watched me feed him, then sat down to offer carrot sticks and Gerber Puffs and observe his reactions. She explained that she saw eating as a complex skill with sensory, psychological, behavioral, and biological components.

With her help, we discovered that Reuben was not comfortable with the preliminary sensory processing required for eating: He hated to have food on his face. She showed us how to work with carrot sticks and dip, as well as vibrating tools, to help him learn to tolerate sensations in and around his mouth.

She also suggested that Reuben requires strong flavors in order to locate food in his mouth. Refried beans and roasted carrot puree loaded with garlic and tahini became early favorite foods. Still, he only ate a bite or two of these foods at each meal.

Tips to Feeding with Love and Respect in Special Circumstances:

  • Let go of your sense of how things should be, and accept your child for who she is.
  • Approach your child’s doctors and other care providers as members of the team. They are experts on particular medical procedures, treatments, and diseases; you are an expert on your child. You should expect that medical professionals will listen to your experience and opinions. It is okay to ask questions like, “What other options are there for treatment?” or “What therapies are offered at other facilities?”
  • Seek out other parents and families in similar situations for support, advice, and alternative options.
  • Accept whatever is possible in your interactions with your child around food, whether it is making that food from your body or opening a can of formula with love.
  • Forgive yourself. Whatever decisions you made were based on the best available knowledge you had.
  • Trust your own intuition and your knowledge about your child. Be cautious of being influenced by those who see your decisions as either too child-focused or insufficiently pure from an ideological perspective.
  • Abandon any expectation that you will follow some perfect or pure set of principles.
  • Focus on the social, psychological, and behavioral aspects of mealtime and the possibilities for bonding they provide.

Relying on Other AP Practices, Too

Because feedings were complicated and sometimes tense, we found that other aspects of Attachment Parenting helped us maintain a secure bond with Reuben. I don’t own as many different wraps or know as many different ways to tie one as some people, but I consider myself a babywearing expert because I can get a baby into and out of a sling without dislodging a feeding tube from his nose — and have, on occasion, administered feedings while wearing the baby.

Cosleeping allowed us to ensure that Reuben didn’t become tangled in his tubes during the overnight portion of his feedings. Through soggy experiences, we learned all the ways the feeding tube could leak — once all in one night. First, I was awakened by cold wetness on my backside when the tube connected to Reuben disconnected from the bag containing his food. Two hours and a sheet change later, the medical port on the tube slipped open. This time we put a towel over the wet spot and went back to sleep, only to be awakened again when Reuben squirmed the tube extension off the button on his stomach.

People who say eating in bed is messy have no idea.

Feeding with Love and Respect in Special Circumstances

Over time, we have found ways to make Reuben’s tube feedings a nurturing and respectful experience for all of us. I choose the content of Reuben’s diet when I make his homemade blended formula (though we also use canned formula). Context is also an important part of eating, and we have learned to integrate Reuben’s tube feedings into our family meal time. We put whatever we are eating on Reuben’s plate, and he usually chews at least some of it. Eric pushes Reuben’s tube feeding while we all talk about our day. Before we start, we hold hands and say something for which we’re grateful. Then I smile at Reuben and ask, “Now what?” and he grins broadly as he says, “Blessings on our meal.”

Someday, the doctors assure us, Reuben will move to eating all of his calories by mouth and I will complain with the mothers of other teenage boys about the difficulty of keeping food in the refrigerator. Until then, we have learned that every kind of meal, whether intravenous or tube-fed, hung or pushed or pumped, eaten by mouth from the breast or the hand or the spoon – all of these are a blessing.

Family Resources

  • MealtimeConnections.com provides feeding therapy and consultation focused on developing a positive partnership between therapists and families, as well feeding in the context of a positive parent-child relationship. I especially recommend their “Mealtime Notions,” which are feeding aids based on the Mealtime Connections philosophy that “feeding is first and foremost a special relationship between the child and the feeder”; and the Homemade Blended Formula Handbook, an indispensable philosophical and practical reference for families of tube-fed children.
  • The Pediatric Encouragement Feeding Program at Kluge Children’s Rehabilitation Center is an intensive, interdisciplinary program focused on weaning children from tube feedings in a supportive environment.

America’s Family Crisis: Parental Depression Putting 15 Million U.S. Children at Risk

By Rita Brhel, managing editor and attachment parenting resource leader (API)

America's Family CrisisDepression is beyond epidemic proportions, not only in the United States but in many societies around the world. People like to blame more recent economic downturns, but these high rates of depression have been an ongoing concern for many years from before the stock markets took a dive.

If depression was the H1N1 Influenza virus (a.k.a. swine flu), no one would venture to the streets or grocery store without a face mask for fear of transmission, schools and businesses would be closed indefinitely, and medical clinics and hospital emergency rooms would be packed with people clamoring for screening and treatment.

But depression isn’t contagious like the flu – although it certainly is more debilitating and has just as much potential to kill. It doesn’t spread by sneezing and coughing, but it is still “contagious” in that people living with a depressed significant attachment figure, whether adult-adult or parent-child, are more likely to develop depression themselves and all that comes with this illness – the hopelessness, the sorrow or anger depending on the person’s response, the suicidal thoughts and possible attempts.

Depression is pervasive in the United States, and it is devastating to families – to marital relationships and to children’s development. We know through attachment research and neuroscience that the way we are parented not only affects the behavior we use in reaction to stressful events but also changes the way our brains work and our genes express brain chemistry reactions to stress. This means that if we are parented in such a way that consistently teaches us to react poorly to stress and conditions our brain to release stress chemicals at high rates, we are literally creating a child who will grow up into an adult who is prone to depression and all that comes with it.

Our families are in crisis.

New Report Brings to Light the Impact of Parental Depression

A new report, Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention, was released by the National Research Council and Institute of Medicine of the National Academies last week at a public briefing in Washington, D.C. Attachment Parenting International attended via webcast.

The National Academies consist of the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council. They are private, nonprofit institutes that provide science, technology, and health policy advice to the United States under a congressional charter.

Depression in Parents, Parenting, and Children explores the interaction of depressed parents and their parenting practices, and the impact on children. It also proposes strategies to promote more effective interventions, as well as recommendations for improving the quality of care for depressed parents and their children. The study was funded by the Annie E. Casey Foundation, The California Endowment, the Robert Wood Johnson Foundation, the U.S. Health Resources and Services Administration, and the U.S. Substance Abuse and Mental Health Services Administration.

Report committee members who attended the briefing included: Chair Mary Jane England, MD, president of Regis College in Weston, Massachusetts; William Beardslee, MD, professor of child psychiatry at Children’s Hospital in Boston, Massachusetts; Mareasa Isaacs, PhD, executive director of the National Alliance of Multi-Ethnic Behavioral Health Associations in Bethesda, Maryland; and Frank Putnam, MD, professor of pediatrics and psychiatry at the Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio.

The Prevalence of Depression

The briefing opened with an overview of depression in the United States, presented by Isaacs. The exact number of people affected with depression is difficult to pinpoint, but it’s estimated that only one-third of adults with the illness actually receive treatment. In some sample communities, as many as 70% of people with depression go without treatment. Although depression treatment is very effective, there are a number of factors preventing people from seeking help: the stigma of mental illness, lack of transportation, inability to afford services and medication, language and cultural barriers, and lack of providers or at least those with training in identifying and treating depression.

Despite not knowing the full extent of depression, there are several tendencies that Isaacs pointed out:

  • Women have double the rate of depression as men.
  • Caregivers are more likely to have depression.
  • Depression typically first shows in adolescence or young adulthood.
  • Those living in poverty are more likely to have depression.
  • Depression is more common among adults who are separated or divorced than those who are married.
  • Depression rarely appears alone – 75% of people who suffer from depression also suffer from traumatic histories such as sexual abuse or exposure to early childhood violence, substance abuse, a medical condition, or another mental health disorder especially anxiety or post-traumatic stress disorder.
  • The development of depression rests in a combination of genetic susceptibility, environmental factors, and individual vulnerability. Depression is as much the result of other issues in a person’s life, as it is the indicator that there are additional problems.
  • The majority of adults suffering from depression are parents.

The Impact of Parental Depression

It is this last point – that the majority of adults suffering from depression are parents – that is the take-home message. It is estimated that in the United States alone, one in five parents are affected by depression each year, or approximately 7.5 million. Here’s the kicker: 15.6 million children under age 18 live in these households where at least one parent is depressed, Isaacs said. Depending on the age of the child, they can be as much as 40% more likely to develop depression themselves with just one depressed parent in the home, said Putnam said – let alone both parents. “Mothers and fathers are often depressed together,” Beardslee added.

Remember what we know about attachment and how this affects the development of our children. For more than 15 million children in the United States, either their primary attachment figure or a strong secondary attachment figure is depressed and modeling all that comes with it.

“Depression is primarily a family issue,” Isaacs said. “It affects not only the individual but also children and other members of the family. It affects parenting.”

While the majority of research in parental depression has included mothers only, the few studies that have been conducted on fathers shows that the impact of children living with a depressed secondary attachment figure is just as devastating as living in a home with only the primary attachment figure suffering from depression, she said.

“Many people don’t get treatment, and those who do, don’t for years,” said Beardslee. “This makes a great impact on the family.”

Depressed parents tend to raise their children in an emotionally detached, withdrawn parenting style that affects the development of attachment, Putnam said. People with depression use fewer positive parenting approaches and more intrusive handling of children, and the end result is a child who is himself withdrawn.

“Depression causes terrible suffering,” in both parents and children, Beardslee said. Depression effectively destroys the attachment between a parent and child. The inconsistencies in parenting by depressed parents leads to a break in trust between the child and his parent. Long-standing depression causes neglect and often abuse. While depression symptoms manifest themselves differently in each person, women tend to be sad and withdrawn while men tend to be irritable and acting out.

Beardslee told of one mother who described what depression does to her parenting: When she isn’t depressed, she has very positive, emotionally close, and healthy interactions with her 12-year-old son, and when he comes home from school, they go through a routine of talking with, playing, and otherwise spending time with one another. But, when she is depressed, all that positive parenting disappears – she puts her son in front of the television and ignores the routine and his emotional and physical needs.

This break in routine, which is so important especially for older children, greatly affects the mental health of the child, Beardslee said. He feels inadequate, as though he is to be blamed for his mother’s withdrawal. Her depression affects his self esteem and models her poor responses to stress – significantly increasing the risk that he will eventually develop depression himself and unhealthy coping mechanisms expressed through social, behavioral, and other mental problems. He will feel the effects of chronic parental depression long after his mother’s depression is treated.

Not every parent with depression will inadvertently or deliberately cause harm to their children, but parental depression increases the risks for spillover consequences during critical periods of child and adolescent development.

“We’re very concerned about the impact on children,” Putnam said. While there is only a 2-4% risk of a small child developing depression when there is a depressed parent in the home, this risk jumps up to 20-40% in adolescents. “What also comes with this is the risk of substance abuse,” which is predominant among depressed individuals, Putnam added.

“To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,” England said. Beardslee added: “We need to think about people who are depressed as parents first, and individuals with depression second.”

This goes beyond postpartum maternal and infant depression – the screening and treatment of which is becoming increasingly more commonplace in the medical care community: “The first few years of life are crucial, but we need to look more into the long term,” Beardslee said.

The Report Committee’s Recommended Solution

Currently, most screening and treatment of depression happens in primary medical care settings, Beardslee said. However, because depression is more typical in families living in poverty and perhaps without the means to see a doctor, there must be more avenues for depressed parents to find help. Because depressed parents are often withdrawn and difficult to engage, more types of service providers outside the mental health system need to be trained to spot the symptoms of depression and to direct those who need help to accessible entries into the health care system.

Once parents seek treatment, the mental health care system must change the way it treats this illness. Because of the impact on children, interventions should adopt a two-generational approach – parent and child – to effectively treat depression in families, Beardslee said.

Putnam listed these critical components to an effective model of family-centered treatment for depression:

  • Integrative – meaning that all factors contributing toward the depression must be identified, whether this includes poverty, marital issues, health problems, etc.
  • Comprehensive – meaning that all co-occurring conditions must be identified and addressed, such as substance abuse and anxiety disorders.
  • Multi-generational – which encompasses screening and treatment for both parents and children by one mental health care provider rather than by separate providers who often don’t know the full extent of depression on the family members.
  • Preventive – which includes teaching parents positive parenting skills and skills to cope better with stress.
  • Developmentally appropriate – any treatment should appropriate to the particular age group of the children involved.
  • Accessible – screening should be available through programs frequently used by at-risk families such as home visitation, Headstart and other school-based programs, federal nutrition programs, etc., and those parents who are identified as depressed should then be assisted in navigating the mental health system to receive treatment. In addition, the financial barriers of at-risk families must be addressed – many may not have insurance or income, and those who are able to afford services may have difficulty paying for services for more than one person in the family. Also, the mental health system must look into ways of delivering services in nontraditional settings to be able to reach at-risk families, including schools, prisons, community programs, and even homes.
  • Culturally sensitive – which includes techniques to overcome language barriers, stigmas, etc.

“There are a number of exciting initiatives with parts of these features, but no program yet has all of these features,” Putnam said. As it is now, “parents with depression are like orphans” in the mental health system, he added.

To jump-start this model, Putnam suggested the mental health system focus first on implementing a two-generational, more comprehensive focus. More health care providers need to receive training specifically in multi-generational depression. Practices should look into ways that would reduce the financial impact on at-risk families such as charging on a sliding scale, combining children and parent charges into one office visit instead of two, and negotiating with insurance companies to provide same-day reimbursements on medical care services. Once programs are in place that effectively treat family depression, they should be included in training models for other providers.

In addition, more research dollars need to be allocated toward studies that look at the impact of parental depression on children as well as the differences between the impact of depression in fathers and mothers, Putnam said.

The report committee said this report represents a call for urgency from the U.S. Surgeon General and the various mental health organizations and agencies – a major mental health concern that needs to have a working plan in place in the next six to eight months.

What is API Doing?

API actively helps parents who are prone to depression or are depressed by teaching parenting skills and providing resources to help parents develop better ways of coping with stress and strong emotions. According to researchers at the University of Michigan, who reviewed the numerous studies on the subject, there is a link between social support and wellness. Support networks are vital not only in preventing depression but also in its treatment. Local API Support Groups provide parents with a way to develop a solid support system that can follow them through their child’s many developmental stages and the challenges that come with them.

And if parents do fall into depression, API Leaders can help direct parents to the treatment they need as well as continue providing support through the local group or personal consultations, free of charge.

Discuss this topic with other API members and parents. Get advice for your parenting challenges, and share your tips with others on the API Forum.

What Attachment Parenting Does for Your Child’s Future

By Rita Brhel, managing editor and attachment parenting resource leader (API)

Attachment as adults

Especially if you’re new to Attachment Parenting, you may be wondering what does parenting have to do with your adult relationships. Quite a lot, if you understand the impact of healthy and unhealthy parent-child attachments on the child. In fact, you could say it has to do with everything about our adult relationships.

The attachment bond you had with your primary caregiver – most likely your mother – is your model for how a relationship should work for the rest of your life. For some of us, that attachment bond was loving and nurturing and we find our adult relationships relatively easy. For many of us, we may have some difficulties in our adult relationships, mainly in trust issues, indicating that there were inconsistencies in the response by our primary caregiver when we were younger. And for some of us, our childhood homes were downright neglectful and abusive and our natural tendency in our adult relationships is not to have a relationship at all.

Because humans are social beings, having close relationships is an essence of life. Without working relationships, we are at risk for depression and anxiety, substance abuse, eating disorders, and other unhealthy and risky behaviors that we use to fill a void in our lives left by the needs left unmet in our first loving relationship – that with our parents. The success of this first attachment bond in our lives is what shapes the way our brain works, influencing the way we cope to stress, how we see ourselves, our expectations of others, and our ability to maintain healthy relationships all through our lives. Continue reading

Helping Your Adopted Teen Develop an Identity

By Rita Brhel, managing editor and attachment parenting resource leader (API)

The teenage years can be hard on your adopted childParenting during the teenage years is as trying on the young adult as it is on his parents. But if your child was adopted or if you’re fostering, the teenage years can be an especially tough time as your child tries to sort out his identity without knowing his birth parents or understanding the reasons why his birth parents are not a bigger part of his life.

Who Am I? Where Do I Belong?

As the teen years loom, many parents anticipate that their child will have some difficulties, perhaps more so than teens who are living with their birth parents, in answering these questions. Gloria Hochman and Anna Huston list a few questions parents ask themselves in this period of time, which will ultimately prove just as hard on the parents as their child, in their article “Parenting Your Adopted Teen” at Focus Adolescent Services, FocusAS.com:

  1. Will a sense of abandonment and rejection replace feelings of security and comfort?
  2. Is my child behaving in a way that reflects inner turmoil about the past?
  3. Will being adopted make adolescence harder for my child?

How Can Parents Help?

Nothing about these questions is simple, but Hochman and Huston do have a couple tips that make the teen years easier on your child:

  • Don’t ignore the fact that your child was adopted — Being adopted is an undeniable part of her history, and how she learns to deal with it will continue to impact her in the future.
  • Don’t underestimate your child’s abilities to sort out their own challenges – Trust that your child can successfully confront and resolve his identity issues, as you offer extra support in areas that take on special meaning for him.

These special areas include:

  • Identity formation – Not knowing about her birth parents can make your child question who she really is, and it’s a real challenge as they try to sort out which character traits come from which set of parents. It becomes even more difficult as your teen tries to sort out the traits that are genetic or wants answers to questions you may not have, such as: Where did I get my musical talent? Did everyone in my family have glasses or curly hair? What is my ethnic background? Do I have brothers and sisters?
  • Fear of rejection and abandonment – Your teen may suddenly become afraid of leaving home. Other teens may want to reconnect with their birth families to have their questions answered: Where did I get my writing ability or my height? Did everyone in my family have to deal with acne? Some teenagers may worry, just as their adoptive parents do, that they have a tendency toward an unhealthy behavior or mental illness and would feel more comfortable knowing more about their birth parents’ tendencies.
  • Issues of control and autonomy – This is a normal struggle for all parents and teens, but it may be more intense for your adopted teen who feels, especially, that his life’s direction has always been based on someone else’s decision: His birth mother made the decision to place him for adoption; you made the decision to adopt him.
  • Feelings of not belonging – These feelings arise when your teen cannot identify the source of her traits such as her red hair in an adoptive family of brunettes or a Hispanic ethnicity in a family of Native Americans or an artistic talent in a family of math whizzes. These feelings often first arise as her friends begin to question her differences (or similarities, mistakenly) to her adopted family. If her friends do know that she is adopted, she may struggle with answering questions such as: Who are your real parents, and why didn’t they keep you? These feelings of uncertainty then fall back to their secure feelings toward her adoptive family – she may not feel like a “real” member of the family or that you love her as much as you love (or would have loved) your biological children.
  • Heightened curiosity about the past – Your teen will think more about how his life would have been different had he grown up with their birth parents or had been adopted by another family. This is a healthy exploration of his past and necessary to helping him learn ways of coping with the realizations that some possibilities have been lost.

Parents Need to Be Aware of Their Own Emotions

Parents have their own strong emotions and need to recognize and understand them first before they can support their teen:

  • Anger or frustration at your teen’s anger – Your child may become very angry toward you. He may withdraw, run away, or act-out toward you. Understand that most teens have difficulty in handling anger, and that expressing anger is often the only way any teen knows how to deal with other strong, even more painful, emotions such as disappointment or guilt. For more information on helping your teen deal with anger, see The Attached Family article, “Dealing with an Angry Teen.”
  • Fear about your teen’s past – You may struggle with concerns centering on issues from your child’s past, such as exposure or family history of alcoholism, drug abuse, or mental illness. You may have a heightened fear toward your teen’s sexuality and view of parenthood. You may wonder what would happen if your daughter became pregnant or your son got someone else pregnant – how would their birth mother’s choices influence their choices?
  • Hurt about your teen wanting to seek out her birth family – You may second-guess how you raised her  – did you do a good enough job? Is there a problem in your attachment with her?

Listen, Support, Affirm

Adopted children, even those who have been in their adoptive families since birth and who have secure attachments, can feel a sudden emptiness when they hit the teen years, explain Hochman and Huston. Encourage your child to talk about her feelings and try to support her emotionally, even if you don’t fully understand what she’s going through.

Parents of adopted teens who are struggling with feelings of not belonging in their family, especially those of transracial adoptions, may benefit from learning about their birth family’s ethnicity and culture. Parents can help them celebrate by supporting this quest for information, talking about their feelings as they explore this part of their past, and spending time with other families of the same ethnic background as their teen.

At home, parents of transracially adopted teens – or any adopted teens who are struggling with wanting to belong – can benefit when you point out any similarities between family members, such as “Everyone in our family loves to sleep late on the weekends” or “Mom and you are both cat lovers.”

But, Kenneth Kirby, PhD, of Northwestern University’s School of Medicine’s Department of Clinical Psychiatry in Chicago, says that the most effective technique parents of adopted teens can use is their listening skills. The families where adopted teens will have problems are those where the parents insist that an adopted parent-child relationship is no different than a biological relationship. Teens do better when their parents acknowledge their fears and uncertainties and allow them to express their grief, anger, fear, and other strong emotions.

Families that encourage open communication will have an easier time than others who may have to rely on professional counseling to support their teen. Many states also offer adoptive parent support groups or post-adoption workshops to help parents better connect with teens. It’s the parent’s responsibility to encourage a supportive atmosphere for the teen to discuss his emotions, and especially if open communication is not a norm in your family, you will need to initiate these discussions.

For More Information

“Parents who recognize that their teens have two sets of parents and who don’t feel threatened by that fact are more likely to establish a more positive environment for their teens, one that will make them feel more comfortable to express their feelings,” explain say Hochman and Huston. “Secrets take a lot of energy. When there is freedom to discuss adoption issues, there is much less of a burden on the family.”

Seek Cooperation, Not Control

Because of their own fears and strong emotions, parents have a tendency to want to control their teen’s choices, but Anne McCabe, a post-adoption specialist at Tabor Children’s Services in Philadelphia, Pennsylvania, explains that teens need the freedom to develop their personalities and identities: “Kids see it as, ‘You don’t trust me.’”

McCabe advises parents of adopted teens to use positive discipline techniques in working toward solutions to disagreements between the parent and the child. The goal is to build trust between the parent and child. She suggests parents and children work together to identify options in dealing with areas of conflict such as schoolwork, chores, choice of friends, choice of leisure time activities, and curfew. Just as Adele Faber and Elaine Mazlish explain in their book, How to Talk So Kids Will Listen and Listen So Kids Will Talk, McCabe explains that the best solutions are those in which both the parent and the teen come to an agreement on what constitutes trustworthy behavior and what the consequences will be of untrustworthy behavior.

Always Consider the Possibility of Professional Help

Parents of adopted teens – especially if they were adopted at an older age – may be confronted with serious challenges such as extremely low self esteem and severe emotional and behavioral difficulties, according to Hochman and Huston. These are often the results of a past of abuse or neglect and broken attachments throughout their young lives as they were moved from foster home to foster home. It can be extremely difficult for them to learn to trust adults who, in their past, were unable to meet their emotional needs and had broken any attachments they once had.

In addition, teens adopted at an older age bring with them the memories of these broken attachments. Hudson and Hochman advise allowing your teen to talk about these memories with you as well as with a professional counselor. Working through the emotions surrounding these memories is essential to getting your child to a point where he will be able to create and maintain emotionally healthy relationships.

Seek out professional help if you observe any of the following behaviors in your son or daughter:

  • Substance or alcohol abuse
  • Troubles in school, such as a drastic drop in grade or skipping classes
  • Withdrawal from family and friends
  • Risk-taking
  • Suicidal threats or attempts.

“Giving the Love that Heals,” an interview with attachment therapist Harville Hendrix

Happy Valentine's DayDear Readers,

Click here to download your free gift from API.

As promised in the Winter 2008-09 Healing Childhood Wounds issue of The Journal of API — as a followup to the article “The 11th Commandment” — this free audio download is the full version of API Co-founder Barbara Nicholson’s interview with Imago Relationship Therapy Founder Harville Hendrix.

The author of Giving the Love that Heals, Harville’s words are inspiring and motivating — a true reminder that everyday should be Valentine’s Day. You do not want to miss this interview!

Happy Valentine’s Day from API…

~ Rita Brhel, editor of The Attached Family publications

(If you have trouble downloading the file, contact me at editor@attachmentparenting.org.)

UK Study on Orphaned Chimpanzees Could Benefit Human Orphans

From API’s Publications Team

ChimpanzeeA study published in the Development Pyschobiology journal involving the care of orphaned chimpanzees could help change the way human orphans are cared for.

According to an article in the European Union’s CORDIS News, “Chimp Study Highlights Importance of Emotional Care in Childhood,” orphaned chimps that were mothered by humans fared better emotionally than chimps raised in a more institutional setting.

The study, which was conducted at the Yerkes National Primate Research Center’s Great Ape Nursery in Atlanta, Georgia USA, was funded by the FEELIX GROWING project. In the study, the chimps that received emotionally responsive care — which included time with human caregivers doing grooming, playing, and other interactions — were happier, smarter, and more emotionally adjusted than chimps given standard care, which focused solely on meeting physical needs.

The mothered chimps were less easily stressed, less often attached to comfort items such as blankets, had healthier relationships with their caregivers, and were more cognitively advanced.

The insitutionalized chimps were more likely to display disorganzied attachment behaviors such as rocking or clutching a comfort item when distressed instead of turning to the caregiver. Because similar behaviors have been noticed in human orphanages and with neglected and abused children, the study’s authors believe  theproposed strategies of increasing emotionally sensitive caregiving to orphaned chimps can be translated to orphaned humans.

“The attachment system of infant chimpanzees appears surprisingly similar to that found in human infants,” said Professor Kim Bard of the University of Portsmouth in the United Kingdom. “Early experiences, either of warm, responsive caregiving or of extreme deprivation, have a dramatic impact on emotional and cognitive outcomes in both chimpanzees and humans. Parental sensitivity is an important factor in human infant development, and it would seem the same is true for great apes, as well.”

To read the entire article, go to http://cordis.europa.eu/fetch?CALLER=EN_NEWS&ACTION=D&SESSION=&RCN=30417.

The Role of Attachment in Healing Infant Depression

By Rita Brhel, managing editor and attachment parenting resource leader (API)

HeartDepression — a mental illness marked by unrelenting sadness and hopelessness that permeates the lives of an estimated one in 18 people — is among the most prevalent medical disorders in today’s world, affecting 12 percent of women, 7 percent of men, and 4 percent of adolescents in a given year. Eight percent of adults will develop depression sometime in their life, and women are most prone — their lifetime risk is 20 percent.

Depression is a devastating illness. In its mildest form, it drains the happiness out of a person’s life. In its most severe form, depression kills. It can lead to suicide or, in cases where depression symptoms manifest as anger and rage, as assault or worse.

Treatment of depression, overall, is usually complicated. There are many severities of depression, from mild but chronic to seasonal affective disorder to anxiety to major depressive episodes. Chemical imbalances in the brain often contribute to the development of depression, but that is rarely the only cause. Additional contributing factors may include recent events such as a death in the family or a job loss; a traumatic upbringing, such as a childhood marred by abuse; low self esteem; major life changes, such as a new baby or moving to a new city; natural disasters; physical illness; and others. Therefore, treatment often includes not only medication but also long-term counseling; very severe forms of depression can also lead to hospitalization. Continue reading

AP from a Preemie Mom’s Perspective

By Rita Brhel, managing editor and attachment parenting resource leader (API)

**Originally published in the Spring 2007 annual New Baby issue of The Journal of API

Rita doing Kangaroo Care with Rachel
Rita doing Kangaroo Care with Rachel

It was a big day for me, my husband, and my daughter. In mid-January, seven months after Rachel was born, when she had reached 18 1/2 pounds and 26 inches long, her pulmonologist told us she was ready to come off the cardio/respirations apnea monitor that had been a constant part of her life since she left the hospital five months earlier. I was nervous, but her doctor told me that it was OK – in all his many years of practice, he had never seen a healthier looking preemie than Rachel.

It was a great compliment. My daughter was born in June at 30 weeks gestation, due to a significant placental abruption, a serious pregnancy complication in which the placenta prematurely separates from the uterus. Weighing three and one-half pounds and measuring 16 inches long, Rachel was nearly three months early.

A Traumatic Start

I had been planning a drug-free childbirth, but what I got was anything but easy, natural, and beautiful. It was traumatic for me, both emotionally and physically. I had been in the hospital for four days after hemorrhaging, and I was being treated with several anti-labor drugs, one of which (magnesium sulfate) left me so weak that I required oxygen. I was given an epidural in case I needed a C-section, and I had an episiotomy that became a fourth-degree tear and later acquired an infection. This was not the childbirth of my birth plan. Continue reading