AAP Report Supports Universal Developmental Screening, Expanded Surveillance, Referrals [aappublications.org]

I agree.  Metacognition = interpenetration = connection.   Two people synching up.

When someone is frightened/frightening, a baby does not want to enter their mind.  When someone is encouraging/ mirroring/ comforting they invite the baby to enter their mind as a safe space, to meet them mind-to-mind.

There are two kids I help out with.  The baby is 20 mos.  He is not very verbal (great passive vocabulary though) but he has a *fantastic* sense of humor.  He will repeat "joke" behaviors from "jokes" we shared weeks prior.  He remembers them....  like one time he was being fussy during dinner and I made a joke by picking up one of his socks and offering him a bite of that.  He knew that was funny and got a sly smile.  Then I "tasted" the sock and spat it out and threw it on the floor and he cracked up.  Two or three weeks later, we were playing (and not eating) and he brought me his socks, and offered them to me, grinning, to repeat the joke.  

Maybe thesecure  grandmothers would be teaching mothers meta cognitive capacity..???

The capacity for metacognitive control may be particularly important when the child is exposed to unfavourable interaction patterns, in the extreme, abuse or trauma. For example, in the absence of the capacity to represent ideas as ideas, the child is forced to accept the implication of parental rejection, and adopt a negative view of himself. A child who has the capacity to conceive of the mental state of the other can also conceive of the possibility that the parent's rejection of him or her may be based on false beliefs, and therefore is able to moderate the impact of negative experience.
We examined this issue by administering a brief structured interview to parents in our sample, 18 months after they had completed the Adult Attachment Interview, concerning a number of simple indicators of family stress and deprivation which had been reported in past studies to increase dramatically the probability of adverse outcome, including, in a recent study, the likelihood of insecure infant attachment. These indicators included: single parent families residing separately, overcrowding, paternal unemployment, etc. We divided our sample into those who had reported significant experience of deprivation (more than 2 items) and those who had not. Our prediction was that mothers in the deprived group would be far more likely to have children securely attached to them if their reflective-self rating (metacognitive capacity) was high.
10 out of 10 of the mothers in the deprived group with high reflective-self ratings had children who were secure with them, whereas only 1 out of 17 of deprived mothers with low ratings did so. Reflective-self function seemed to be a far less important predictor for the non-deprived group. Our findings imply that the intergenerational replication of early negative experiences may be aborted, the cycle of disadvantage interrupted, if the caregiver acquires a capacity to fully represent and reflect on mental experience (Fonagy et al., 1994).”

“to achieve the capacity to detect and attribute their internal emotional state to themselves, they must become sensitive to and categorize together the revelant group of internal-state cues that covert with the internal Dispositional state.  It is this learning process that is made possible by the parent’s intuitive provision of state-contingent external biofeedback cue in the form of the empathic reflection of the infant’s state expressive emotion displays” 

———

In essence, for the infant to develop a coherent sense of self, he requires the empathic mirroring of the parent who serves a biofeedback function. 

From Fonagy “Affect Regulation, Mentalization, and the development of self”  Chapter 4: Social Biofeedback Theory of Affect-Mirroring... 

the one communication**

Tina, re your comment, what you DONT see is just one thing:  the "oooohhhhh, awwwww"donward-gliding prosody vocalizing comfort....the "poor you!" vocalization, along with a concerned/troubled face.  The once communication that says, "I witness your distress."

The "grandma" could simply respond to the baby in a co-regulating way (and respond to the Mom in a co-regulating way) by interacting w baby in front of the Mom... AND by mirroring the Mom.  Some instruction might help but just seeing it in action would be a help.

Co regulation is a right-brain skill.  It is learned implicitly -  by example/experience.  This is how the skill is learned, ideally, as a little child through being cared for.

A mirroring exercise (like Mimes do) would also possibly be really helpful...  watching the subtle movements of the other.   Realizing if you put your tongue out, so does baby:  "see, he's watching you!"  Basically helping that Mom get into the double dutch of it.  A mom who was treated like an object as a baby will not know how sentient a baby is without it being taught/shown,

I had an experience with a friend's foster baby that was SO instructive...  This baby, understandably, fretted a lot.  I was babysitting and the baby started to wail...  I decided to mirror her.  So I made an anguished face and wailed a bit too.  I spoke out loud, in a upset voice,  what I saw "Oh, sweetie, you are so sad!"  I focused on letting her know I was tracking her distress, by "replying" to her wails with the same fretful tone, and added some sympathetic crooning here and there once I saw she had "heard" my distress mirroring.

She calmed down inside 5 minutes.  Just by being seen/heard-- by a relative stranger.    

I would like to see these efforts focus on pregnant women. Per James Heckman, a Nobel Laureate in Economics, the perinatal period has the greatest ROI. Just imagine if pregnant women received the support need to successfully make the huge transition from being an individual to becoming a parent. These "Upstream" efforts would also help identify families that have greater needs for ongoing supports by focusing on prevention, when possible. Karen 

Laura Haynes Collector posted:

One way to scale up Nurse Family partnership-style results might be recruit para professionals, like local grandmothers who are comfortable with babies and their ways of communicating, and can support the Moms.  Like a CASA for the Mother/baby dyad.

Or maybe  get BeeBe’s book (and the fellow who wrote the NBO too). to learn, really learn infant communication or understand just how much newborns are communicating... One can learn infant communication cues.... and maybe a grandmother who has secure infants herself could help mothers to recognize infant communications and so mothers can respond with empathy to infant distress.... IDK... I just know that there is nothing more important to infant development than an attuned mother who can do a repair after a rupture... 

4 Maternal Behaviors to Infant Distress at 4 Months of age predict Disorganized Attachment at 12 Months... You can kind of see these communications when they are happening.... the communication goes really fast but if you look closely at mothers and babies for long enough... you can kind of start to see this..

Mock Surprise to Distress

Smile to Distress

Still or Blank Face to Distress

Gaze Avert  to Distress

These responses to infant distress need to be corrected if possible because having a disorganized attachment is no fun and it’s hard to reverse a personality disorder...

One way to scale up Nurse Family partnership-style results might be recruit para professionals, like local grandmothers who are comfortable with babies and their ways of communicating, and can support the Moms.  Like a CASA for the Mother/baby dyad.

If we could get really good services into Early Intervention 0-3 that is in every state... You could help the mothers who are having difficulty attuning to their babies. Now the infant mental health specialist would need to be able to see like you can see in the micro taping like Beatrice BeeBe does - where the miscommunication comes from and the specialist would have to be very sensitive and empathic to the mother....and would have to be skilled at attuning with the baby and showing the mother how... (frankly, I think many of the babies with colic that I have seen - probably are these babies so the infant mental health specialist is who the mom needs) so as not to invoke intense feelings of shame and humiliation because these traumas, are attachment traumas (especially disorganized /preoccupied) and they are really terrifying experiences to have.  They are about an inability to regulate intense emotional states which is  incredibly confusing and disorienting so working with the mothers takes real understanding and care. No invalidation of these mothers allowed. 

A crying baby causes strong emotions in a mother who has never had her own emotions regulated... It’s extremely shame provoking  to believe one is flawed, marred, incompetent, empty, unseen and unknown and emotionally out of control and  it’s terrifying not to know who you are or what you feel.... But doctors can  find these children on Ages and Stages Social Emotional at 4 months. I worked in a 80 percent poverty clinic, 75 percent involved with child welfare... and I was finding social emotionally delayed kids left and right. Now the kids I found may have more severe delays and are easier to pick up and possibly a far worse prognosis for adult mental health - ie personality disorders like borderline... but one would want to pick up these babies early plus attachment trauma IS Trauma. (I can think of no greater trauma for a child than to not have a bodily based felt sense of the love of a mother).   If you can identify the kids at 4 months (and you can) you can still change their developmental trajectory.  The personality framework for Borderline is developed in infancy between 3-6 months of age.  And developmental screening is a part of pediatrics. I used Ages and Stages 3 also and it was no where as good at picking up really early delays. The SE delays come first and they come fast.