Parental depression and developmental outcomes of their babies

Dear families,

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Depression hurts everyone. Parental depression can disrupt not only parents' own well being but also caregiving and nurturing which leads to negative developmental consequences in babies. The following article explains how parental depression impacts developmental and socioemotional outcomes in developing babies. 

- Minnie

          Babies are born with tremendous abilities to develop relationships with their primary caregivers, mainly their parents (Bowlby, 1958, 1969; Campa, 2013; Kaplan, Bachorowski, Smoski, & Hudenko, 2002).  Their tiny body constantly sends and receives non-verbal signals with their parents which allows parents to meet babies’ physiogical and psychological needs (Browne & Talmi, 2015).  Parental observation, interpretation, accommodation, and adaptation in order to meet babies’ current needs are the foundation for developing infants.  However, many studies (e.g., Aktar et al., 2016; Guyon-harris, Huth-bocks, Lauterbach, & Janisse, 2016 ; (Kaplan et al., 2002) have shown that parental mental health can interfere with their ability to respond their babies.  Consequently, babies’ paths for optimal development can be in jeopardy.  In this paper, a literature review will be drawn upon to explain how parental psychopathology, especially depression impacts developmental and socioemotional outcomes in developing babies.

          Developmental psychologists have tried to introduce human development into several progressive orders.  Many of them agreed that basic physiological and psychological needs should be met first within the relationship with parents in order to achieve a more sophisticated and complex development.  For example, Maslow (1943) believed that there are five different layers of needs.  One level should be fulfilled to pursue the next level.   He explained that the first two fundamental needs are physiological needs, such as food and water, and security needs, such as security and shelter.  These are the foundation for the next step, love and belonging.  Greenspan (1997; 2006) introduced six basic developmental capacities for early childhood.  He (1997; 2006) explained that the first step is developing the ability to regulate their own body as well as attention and focus on the world followed by the second step, mutual engagement and forming relationships and the third step, interactive intentionality and reciprocity.  Winnicott (1960; 1986) also argued that satisfaction when babies’ physical and psychological needs are met through parental care, babies start learning about themselves and the world around them.  Therefore, parental ability to provide a safe environment, read their babies’ signals, and adjust their behaviours to meet their babies’ physical and psychological needs are cornerstones for optimal development in babies.

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          We often only think about parental influence on their babies, not their fetus.  However, the interactions between expecting mothers and their fetus start earlier than the birth of newborn babies.  For example, Feldman (2007) argued that expecting mothers support their unborn babies’ biological rhythms.  In the third trimester, expecting mothers and their fetus synchronize their states, which supports the fetus to consolidate their sleep-wake cycle and the cardiac rhythm, which controls heart rhythms.  However, when expecting mothers are depressed, the development of the fetus can be compromised.

          Field (2011) argued that the evidence of prenatal depression could be found to be 6-38% in the published literature.  There is no clear explanation of the mechanisms underlying the influence of depressed expecting mothers on the development of their unborn child, however, dysregulated hormones among expecting mothers are considered one of the key influencers of developmental consequences (Lewis et al. 2015).  In a literature review, Field (2011) showed that prenatal depression is associated with excessive activity and growth delays in the fetus.

          Other researchers attempted to unveil prenatal maternal depression and the developmental outcomes after birth.  Field (2011) explained prenatal depression could lead to prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate.  In addition, Junge et al. (2017) argued that prenatal depression caused high cortisol exposure prenatally which may cause children to be reactive to stress after birth.

          Developmental oddness can be found in older children.  Eichler et al. (2017) investigated that the relationship between prenatal maternal depression and social outcomes among children at four years of age.  One thing that makes this study unique is that children’s social outcomes were measured by trained phycologists, not a parental report to avoid parental bias.  They found that children whose mothers were depressed prenatally displayed more antisocial behaviour symptoms at this particular age.

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          Postpartum depression can be found in 13-20% of new mothers (World Health Organization, n.d.).  Maternal depression interferes with interaction with their babies (Kaplan et al., 2002).  Infant direct speech (ID) is crucial to stimulate babies (Fernald, 1985).  Kaplan et al. (2002) observed the conditioned attention paradigm, ID as a signalling stimulus and smiling as reinforcer among infants whose mothers were depressed and not depressed at four months of age.  Babies of depressed mothers could not attain learning opportunities due to inappropriate maternal support (e.g., withdrawn, negative affect, lower quantity of stimulation, less salient stimulation).  However, the important thing is these children demonstrated attention when other non-depressed females prompted them.  This aligns with the view of capable infants and emphasizes the importance of not only early detection but also support for mothers who are depressed. 

          Synchrony is another key element in the early relationship between mothers and their babies.  Schore and Shore (2008) argued that sensitive parents attune infants’ arousal in order for them to synchronize together to regulate affective states and then, move towards the next emotional state together.  Therefore, in these relationships between mothers and their babies, mothers can support babies’ development of both central (CNS) and autonomic (ANS) nerve systems after birth.  Granat, Gadassi, Gilboa-Schechtman and Feldman (2017) studied the differences of synchrony between three groups of mothers; depressed, anxious and typical, and their babies.  Depressed mothers demonstrated frequent but short gazing to their infants which did not help synchrony between them and their babies.  These babies display social withdrawal (less gaze, aversion) which can lead to an increase in behavioural issues in the near future.  Also, in stressful circumstances, for babies of depressed mothers, the presence of mothers was not effective to reduce negative emotions as an external regulatory agent.  Anxious mothers achieved the highest level of frequency of synchrony.  However, their babies moved to a negative emotional state (anxious) together with their mothers.  Moreover, the intrusiveness of anxious mothers hindered their babies’ opportunity to develop autonomy.  Therefore, a different type of mental illness of mothers requires different strategies to support early relationships with their babies.

          Maternal depression can increase undesirable emotional/behavioural outcomes in older children (Woolhouse, Gartland, Mensah, Giallo, & Brown, 2016).  Woolhouse et al. (2016) measured maternal depression in early pregnancy and at 3, 6 and 12 months postpartum and again at four years postpartum and emotional/behavioural difficulties of children at four years.  Even though any point of maternal depression increased the chance of emotional/behavioural difficulties, children with mothers who were depressed at four years postpartum displayed three times more emotional/behavioural difficulties than children with non-depressed mothers.  This study provides insight into the needs of support for depressed mothers during an extended period.

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          There are many studies about the impacts of maternal depression on child developmental outcomes, but there is a lack of studies related to father influences.  In consideration of the social-ecological systems theory (Bronfenbrenner, 1979) and the transactional theory (Sameroff, 2009), it is important to understand the complex bi-directional, non-linear impact on maternal depression and father contribution.  Fathers can impact a child’s development as well as maternal mental health.  Paulson & Bazemore (2010) found that 10% of fathers suffer from prenatal and postpartum depression and it had a moderate positive correlation with maternal depression. Kim and Kim (2017) compared high-income and low-income families to see the relationship between fathers' indirect influence on children's social/emotional outcomes.  In both groups, fathers' involvement mediated maternal depression and parenting stress, and consequently, children demonstrated better social and emotional outcomes.

          Within the dyad, characteristics or conditions of babies can contribute and influence maternal depression.  For example, the negative temperament of babies is more related to maternal depression (Aktar et al., 2016).  Premature birth also contributes not only to maternal depression (Bakalar, 2008), but also paternal depression (States News Service, 2016).  In fact, maternal postpartum depression is found among as high as 40% of mothers who give premature birth (Vigod, Villegas, Dennis, & Ross, 2010).  Moreover, having a child with developmentally delay is another major risk factor for parental mental health (Alvarez, Meltzer-Brody, Mandel, & Beeber, 2015).  Alvarez et al. (2015) illustrated that depression and anxiety symptoms could be found in as high as 68% and 52 % respectively among these parents.  Therefore, more dedicated support is necessary for these parents whose babies are medically fragile in promoting their mental health as well as the early relationship with their babies.

          Babies are capable communicators (Bowlby, 1958, 1969; Campa, 2013; Kaplan et al., 2002) and their non-verbal communication allows parents to help meet babies’ physiological and psychological needs (Browne & Talmi, 2015).  Parental ability to observe, interpret, accommodate, and adapt are cornerstones for developing infants.  Prenatal depression disrupts developmental outcomes not only in the fetus but also in babies after birth.  Moreover, maternal postpartum depression interferes with the maternal ability to communicate and synchronize with their babies, consequently resulting in undesirable developmental and social/emotional outcomes.  Fathers should also be the centre of our attention due to their own suffering from depression and their influences on child development.  Lastly, the characteristics and conditions of babies can be risk factors to parental depression.  Therefore, those parents whose babies are medically fragile requires more dedicated support to promote their mental health as well as the early relationship with their babies.

References

Aktar, E., Mandell, D. J., de Vente, W., Majdandzic, M., Raijmakers, M. E., J, & Bögels, S. M. (2016). Infants’ temperament and mothers’, and fathers’ depression predict infants’ attention to objects paired with emotional faces. Journal of Abnormal Child Psychology, 44(5), 975–990. http://dx.doi.org.fgul.idm.oclc.org/10.1007/s10802-015-0085-9

Alvarez, S. L., Meltzer-Brody, S., Mandel, M., & Beeber, L. (2015). Maternal Depression and Early Intervention: A Call for an Integration of Services. Infants and Young Children, 28(1), 72–87. https://doi.org/10.1097/IYC.0000000000000024

Bakalar, N. (2008). Depression linked to premature deliveries. The New York Times, p. 6.

Bowlby, J. (1969). Attachment: Attachment and loss. London, England: The Hogarth Press and the Institute of Psycho-Analysis.

Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal of Psychoanalysis, 39 (5), 350-373.

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.

Browne, J. V. & Talmi, A. (2015). BABIES and PreSTEPS Manual.

Campa, M. I. (2013). Built to bond: Coevolution, coregulation, and plasticity. In C. Hazen & M. I. Campa (Eds),  Human Bonding: The Science of Affectional Ties (PP. 41-74). New York, NY: Guilford Press.

Eichler, A., Walz, L., Grunitz, J., Grimm, J., Doren, J. V., Raabe, E., … Moll, G. H. (2017). Children of prenatally depressed mothers: Externalizing and internalizing symptoms are accompanied by reductions in specific social-emotional competencies. Journal of Child and Family Studies, 26(11), 3135–3144. https://doi.org/10.1007/s10826-017-0819-0

Feldman, R. (2007). Parent–infant synchrony: Biological foundations and developmental outcomes. Current Directions in Psychological Science, 16(6), 340–345. https://doi.org/10.1111/j.1467-8721.2007.00532.x

Fernald, A. (1985). Four-month-old infants prefer to listen to motherese. Infant Behavior and Development, 8(2), 181-195.

Field, T. (2011). Prenatal depression effects on early development: A review. Infant Behavior and Development, 34(1), 1–14. https://doi.org/10.1016/j.infbeh.2010.09.008

Granat, A., Gadassi, R., Gilboa-Schechtman, E., & Feldman, R. (2017). Maternal depression and anxiety, social synchrony, and infant regulation of negative and positive emotions. Emotion, 17(1), 11–27. http://dx.doi.org.fgul.idm.oclc.org/10.1037/emo0000204

Greenspan, S. I. & Wieder, S. (1997). Developmental patterns and outcomes on infants and children with disorders of relating and communicating: A chart review of 200 cases of children with Autistic Spectrum diagnoses. Journal of Developmental and Learning Disorders, 1(1), 87-141.

Greenspan, S. I. & Wieder, S. (2006) Engaging autism. Boston, MA: Da Capo Press.

Guyon-harris, K., Huth-bocks, A., Lauterbach, D., & Janisse, H. (2016). Trajectories of maternal depressive symptoms across the birth of a child: associations with toddler emotional development. Archives of Women’s Mental Health, 19(1), 153–165. http://dx.doi.org.fgul.idm.oclc.org/10.1007/s00737-015-0546-8

Junge, C., Garthus-Niegel, S., Slinning, K., Polte, C., Simonsen, T. B., & Eberhard-Gran, M. (2017). The impact of perinatal depression on children’s social-emotional development: A longitudinal study. Maternal and Child Health Journal, 21(3), 607–615. https://doi.org/10.1007/s10995-016-2146-2

Kaplan, P. S., Bachorowski, J.-A., Smoski, M. J., & Hudenko, W. J. (2002). Infants of depressed mothers, although competent learners, fail to learn in response to their own mothers’ infant-directed speech. Psychological Science, 13(3), 268–271. https://doi.org/10.1111/1467-9280.00449

Kim, J., & Kim, J. M. (2017). Fathers’ indirect contribution to children’s social-emotional development via mothers’ psychological parenting environments. Social Behavior and Personality, 45(5), 833–844. http://dx.doi.org.fgul.idm.oclc.org/10.2224/sbp.6187

Lewis, A. J., Austin, E., Knapp, R., Vaiano, T., & Galbally, M. (2015). Perinatal maternal mental health, fetal programming and child development. Healthcare, 3(4), 1212–1227. http://doi:10.3390/healthca re3041212.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396

Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36(1), 9–20. http://dx.doi.org.fgul.idm.oclc.org/10.1007/s10615-007-0111-7.

Sameroff, A. (2009). The transactional model of development: How children and contexts shape each other (2nd ed.). Washington, DC: American Psychological Association.

States News Services. (2016). Paternal Depression Linked to Premature Birth.

Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA, 303(19), 1961–1969. https://doi.org/10.1001/jama.2010.605

Vigod, S. N., Villegas, L., Dennis, C.-L., & Ross, L. E. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 117(5), 540–550. https://doi.org/10.1111/j.1471-0528.2009.02493.x

World Health Organization (n.d.). Maternal mental health. Retrieved July 14, 2018, from http://www.who.int/mental_health/maternal-child/maternal_mental_health/en/

Woolhouse, H., Gartland, D., Mensah, F., Giallo, R., & Brown, S. (2016). Maternal depression from pregnancy to 4 years postpartum and emotional/behavioural difficulties in children: results from a prospective pregnancy cohort study. Archives of Women’s Mental Health, 19(1), 141–151. http://dx.doi.org.fgul.idm.oclc.org/10.1007/s00737-015-0562-8

Sleep like a Baby

Dear Families,

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 If you are expecting and want to have a healthy start for your baby or if you have a newborn and want to help your baby sleep, this is for you!  

               - Minnie                    


Understanding Baby's Sleep


          After departing from your nice, warm uterus, your baby suddenly needs to do many things by himself. He needs to breath, eat, eliminate, control body temperature and etc. Regulating and maintaining homeostasis is a huge job for him to accomplish during the first few months after birth. Sleep/arousal is one of these big tasks.         

          You would like to see your little one to sleep and be awake in more predictable patterns, sleep for longer stretches, have a smoother transition between sleep and being awake, being awake for feeding, enjoying time with you, learning the world, and eventually more consolidated night time sleep. His sleep and arousal can be divided into six states characterized by observable evidence such as breathing, eye movement, and body movement. The big changes in states is that full-term babies spend 50% of their sleep for active sleep at birth and it reduces to 25% by 6 months. Studies have suggested that this change correlates to rapid brain development. Moreover, they have shorter sleep cycles (60 minutes) when compared to adults (90 minutes) which equates to more vulnerable moments for arousal.

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          Sleep/arousal is organized based on the circadian rhythm and homeostatic processes. Circadian rhythm incorporates cues from the external environment to regulate timing. So, sunlight in the morning, and darkness at night are cues to activate circadian rhythm. Sleep pressure in the homeostatic process is relieved by sleep. Let's imagine a spring toy – When you wake up, you are constantly tightening the spring and once you fall asleep, the spring is released. Your baby's sleep gradually is organized by these two bodily processes.

          If your baby is premature or medically fragile, they need more support from you to organize their sleep and arousal due to the immaturity of central nervous system and lack of typical habituation* due to hospitalization.

*Habituation: The world of sensory stimuli can be overwhelming for your baby. If your baby is exposed to a familiar environment, he will learn how to react less to those repeated sensory inputs, consequently lessening their arousals. This is called habituation.
 

Why is your baby's sleep important?

There are several reasons of which, studies have confirmed

  • Physical health (growth & development, obesity, immune system)
  • Brain development and function (brain metabolism, memory consolidation, learning)
  • Awake time performance and safety
  • Emotional well-being
  • Your baby's sleep = whole family's well-being
  • Sleep issues can become chronic

Supporting your baby's sleep


          First and foremost, is creating a safe environment to prevent sudden infant death (SID). Here are general guidelines of safe to sleep (campaign) created by the U.S. Department of Health and Human Services. 

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          The needs for each baby is as unique as those for the family. The ways of supporting your baby's needs largely depending on who your child is and what situation he is in. The following suggestions are not made as solutions but should help guide you in finding ways to meet your little one's unique needs by observing and understanding his sleep and arousal.

OBSERVATION & RECORD

          Sleep/arousal states should not be looked at as isolated but interdependent. Therefore, your observation should be done in 24-hour time-frames.   

 

Your child

  • How's his sleep/arousal patterns? You can look into this while relating it to the six states.

  • What about his sleep cycles? 

You

  • What changes have been made that have made your baby more or less sleep/calm/alert/irritable (e.g., your voice, mood, pace, how to play with, feed, change him, hold, move, bundle him, efforts to calm him down, etc.)?

Environment

  • What sensory inputs made him more or less sleep/calm/alert/irritable (e.g., lights, sound, new blanket, visitors, weather, etc.)?

FOLLOW YOUR CHILD'S LEAD & SUPPORT HIM TO DEVELOP MORE HABITUATION.

          Now, you are aware of your child's sleep patterns and what help his sleep and attention while he is awake. It's time to create the best daily routine for him. It cannot be a rigid schedule, since his needs can change from time to time. However, it is good to have some predictable patterns/flows which can help him react less to sensory stimuli when he is tired (habituation).  

YOUR SLEEP IS IMPORTANT, TOO!

          Studies have confirmed that parental sleep deprivation due to their babies' sleep issues can cause depression, poor sleep quality, fatigue, physical health issues and can also, increase potential accidents (e.g., micro sleep while driving). This tremendously impacts the relationship between you and your baby since you are prone to having less patience and making less than ideal parenting decisions in order to meet his needs, including his sleep needs. This two can become an endless chain effect. Therefore, your attempt to addressing your own sleep should coincide with one another. The best way to approach this is lifestyle changes. Food intakes (e.g., caffeine), usage of electronics, exercise, relaxation techniques, etc. should be looked at as compounding factors. 

OTHER CONSIDERATIONS

          As your child become bigger and stronger, his needs will change. Therefore, your observation and readjusting your support should be a constant focus. It is also important to keep in mind that it is common to have sleep disturbances during the first few years of life. However, it is also important to seek medical help if your baby's sleep issues become out of control or chronic. 

                      Sleep is important for your baby's growth and development as well as                 the well-being of your whole family!

             

Bibliography

Bayer, J. K., Hiscock, H., Hampton, A., & Wake, M. (2007).  Sleep problems in young infants and maternal mental and physical health. Journal of Pediatrics and Child Health, 43, 66–73. 

Browne, J. V. & Talmi, A. (2015). BABIES and PreSTEPS Manual and materials.

Ficca, G., Fagioli, I., Giganti, G., & Salzarulo, P. (1999). Spontaneous awakenings from sleep in the first year of life. Early Human Development, 55, 219–22

Galland, B. C., Taylor, B. J., Elder, D. E., & Herbison, P. (2012). Normal sleep patterns in infants and children: A systematic review of observational studies. Sleep Medicine Reviews, 16, 213-22.

Gomez, R. L., Newman-Smith, K. C., Breslin, J. H., Bootzin, R. R. (2011). Learning, Memory, and Sleep in Children. Sleep Medicine Clinics, 6, 45–57. doi: 10.1016/j.jsmc.2010.12.00

Goodlin-Jones, B.L., Burnham, M.M., Gaylor, E.E., & Anders, T. (2001). Night waking, sleep-wake organization, and self-soothing in the first year of life. Journal of Developmental and Behavioral Pediatrics, 22(4), 226-233.

Halbower, A. C., & Marcus, C. L. (2003). Sleep disorders in children. Current Opinion in Pulmonary Medicine,9, 471-476.

Hall, W. A. (2015). Taking Young Children's Sleep Seriously: From Research to Practice. IDSC Summer Institute, UBC.

Hall, W.A., Saunders, R. A., Clauson, M., Carty, E. M., Janssen, P. A. (2006). Effects of an intervention aimed at night waking and signaling in 6- to 12-month-old infants. Behavioral Sleep Medicine, 4(4), 242-261.

Hall, W.A., Scher, A., Zaidman-Zait, A., Espezel, H., & Warnock, F. (2012).  A community-based study of sleep and behavior problems in 12- to 36-month-old children. Child: Health, Care, and Development, 38(3), 379-389. doi:10.1111/j/1365-2214.2011.01252.

upbach, A., Gomez, R. L., Bootzin, R. R., & Nadel, L. (2009). Nap dependent learning in infants. Developmental Science 12(6),1007–1012. doi: 10.1111/j.1467-7687.2009.00837.x

Jenni, O., & O’Connor, B. B. (2005). Children’s Sleep: An interplay between culture and biology. Pediatrics, 115 (1), 204216.  

Martin, J., Hiscock, H., Hardy, P., Davey, B., & Wake, M. (2007). Adverse associations of infant and child sleep problems and parent health: An Australian population study. Pediatrics, 119 (5), 947-955. 

Mastin, L. (2013). How sleep works. Sleep-awake homeostasis. http://www.howsleepworks.com/how_homeostasis.html 

Mindell, J. A., Meltzer, L. J., Carskadon, M. A., & Chervin, R. D. (2009). Developmental aspects of sleep hygiene: Findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Medicine, 10, 771-779. 

Nall, R. (2015). What are the benefits of sunlight?. Healthline. http://www.healthline.com/health/depression/benefits-sunlight 

Pattinson, C.L., Staton, S. L., Smith, S. S., Sinclair, D. M., & Thorpe, K. J. (2014). Emotional Climate and Behavioral Management during Sleep Time in Early Childhood Education Settings. Early Childhood Research Quarterly, 29, 660-668. 

Shriver, E.K. (2014). What Does a Safe Sleep Environment Look Like?. National Institute of Child Health &  Human Development: Safe to Sleep Campaign https://www.nichd.nih.gov/sts/about/environment/Pages/look.aspx 

Touchette, E. Petit, D. Pacquet, J., Boivin, M. Japel, C., Tremblay, R.E., & Montplaisir, J.Y. (2005). Factors associated with fragmented sleep at night across early childhood. Archives of Pediatric and Adolescent Medicine, 159, 242-249. 

University Washington. (2016). What is sleep and why do we do it?. http://faculty.washington.edu/ 

Weiss, S. K. (2006). Better sleep for your baby and child: A parent’s step-by-step guide to healthy sleep habits. Hospital for Sick Children: Toronto, Ontario. 

Weissbluth, M. (1995). Naps in children 6 months – 7 years. Sleep, 18(2), 82-87.

Whittingham, K., & Douglas, P. (2014). Optimizing parent-infant sleep from birth to 6 months: a new paradigm: A new paradigm in infant sleep. Infant Mental Health Journal, 35(6), 614-623. doi:10.1002/imhj.21455

Promoting early language development by enhancing joint attention from parents

Dear families,

This posting will review the literature on joint attention as a critical tool for early language development.  The different types of joint attention will be explored and discussion on how children develop joint attention will be conducted.  Moreover, typical early language development will also be introduced.  Finally, based on the findings from the literature review, suggestions and recommendations will be made for parents providing them with how they can better promote early language development for their child by facilitating joint attention.  In this posting, the hope is that parents understand the importance of joint attention and facilitating joint attention in order to improve early language development in their child. 

- Minnie

            Testing ancient Deoxyribonucleic acid (DNA) explained that language even existed 50 ka (Klien, 2017).  Language expresses observation, thoughts, feelings, and needs (McKay, Davis, & Fanning, 1995).  Language is socially constructed (Benveniste & McKeon, 1965).  The ironic thing is that human cognition created language but language is a tool of the cognition process.  In other words, we use language for thoughts, a medium of all human symbolization, and acquisition of many other concepts (Carruthers, 2002).

            When we talk about language, we often refer to the verbal language.  In fact, language can be categorized into two colossal categories: non-verbal and verbal (Gonzalez-Mena & Eyer, 2014).  Both forms of language can be used for communication, however, the more sophisticated form is a verbal form (Berk, 2012).  For example, even a newborn lets us know if it's tired, hungry, in discomfort with crying from day one, but the first word of a typically developing child usually occurs at the age of one.  Non-verbal communication starts in infancy and persists throughout human life (Machado, 2007) while verbal language supports conveying messages consciously (University of Minnesota, 2016). 

            Another way to categorize language is expressive language and receptive language (Allen et al., 2014).  Expressive language refers express thoughts and ideas in a language form such as speaking and writing whereas receptive language means understanding other’s message which delivered in a language form (Smith, 2011).  Receptive language develops earlier than expressive language (Gonzalez-Mena & Eyer, 2014).

            DeGraffenreidt, Gransmick, Grafwallner, and O'Malley (2010) conceived child development into five closely linked areas: physical, social, emotional, cognitive, and language.  They argued that children are born with tremendous potential and capacity for learning across all developmental domains.  For example, the progress a child makes in one area affects the progress he or she makes in another area.  Not one area of child development is more important than another which emphasizes the importance of a well-balanced nurturing environment.  For example, social development and language development support each other and vice versa (Prizant & Wetherby, 1990).  According to Prizant and Wetherby (1990), developing attachment is crucial for early language development while language development support young children’s building friendships and autonomy in children.  Moreover, mastering new motor skills changes children’s experiences and this allow them to practice skills relevant to language acquisition before they are needed for that purpose (Iverson, 2010).  Therefore, promoting language development is important not only for this single domain but also for other domains of development.

            Many researchers have tried to unveil the secrets of early language acquisition and found joint attention[1] to be a precursor to early language acquisition (Colonnesi, Stams, Koster, & Noom, 2010; Farrant & Zubrick, 2011; Morales, Mundy, & Rojas, 1998; Okumura, Kanakogi, Kobayashi, & Itakura, 2017; Scofield & Behrend, 2011; Rocha, Schreibman, & Stahmer, 2007; Tomasello & Farrar, 1986; Vuksanovic & Bjekic, 2013).  By measuring the frequency and/or quality of joint attention and the outcomes of language, they found a strong correlation.  Due to this, enhancing joint attention can be a way to promote early language development.

            In consideration for the importance of language development and correlation with joint attention, the following questions guide this posting:

            i) What is typical early language development?

            ii) What is joint attention and how does it develop?

            iii) What are some suggestions for parents who want to promote early language development in their child by enhancing joint attention?

Early Language Development

Infancy (Birth to 12 months of age)

            Infants start cooing at the age of two months followed by babbling at six months (Machado, 2007).  These types of language development usually accelerate at four months of age (Whitebread, 2012).  The preverbal communication is the foundation for the emergence of language skills (Prizant & Wetherby, 1990).  According to Prizant and Wetherby (1990), parental interpretation and labeling are important.  The first words usually occur around one-years-old (Gonzalez-Mena & Eyer, 2014).

Toddlerhood (12 months to 24 months)

            At the beginning of toddlerhood, new word acquisition is very slow; toddlers may learn a new word but at the same time, they may forget a word they already knew (Prizant & Wetherby, 1990).  At about 18 months, a sudden surge occurs in vocabulary growth (Gonzalez-Mena & Eyer, 2014) such as more words, combinations of words (Prizant & Wetherby, 1990).  According to Prizant and Wetherby (1990), toddlers can initiate and maintain communication.

Early Childhood (24 months to 48 months)

            At 24 months of age, he will begin to acquire fundamental skills related to organizing words and sentences (Prizant & Wetherby, 1990).  According to Prizant and Wetherby (1990), a child’s language becomes more exquisite and purposeful.  Due to this, a child’s social development blossoms through play and friendships.   

Joint Attention

            Joint attention is a part of non-verbal language (Vuksanovic & Bjekic, 2013).  Joint attention refers to parents’(caregivers’) and infants’ shared experiences on the same object or activity (Tomasello & Farrar, 1986).  Joint attention can be presented in various forms, such as mutual eye gazing, pointing, and gestures (Tomasello & Farrar, 1986) and there are two distinct aspects of joint attention; Initiating joint attention and responding to joint attention (Vuksanovic & Bjekic, 2013).  According to Mundy, Sigman, Ungerer, and Sherman (1986), initiating joint attention means capacity to gather others’ attention and share experiences through the use of the direction of eye gazes and gestures.  On the other hand, responding to joint attention involves following others’ direction of eye gaze, and/or gestures.

            Many researchers (Colonnesi, Stams, Koster, & Noom, 2010; Farrant & Zubrick, 2011; Morales, Mundy, & Rojas, 1998; Okumura, Kanakogi, Kanda, Ishiguro, & Itakura, 2013; Okumura, Kanakogi, Kobayashi, & Itakura, 2017; Scofield & Behrend, 2011; Tomasello & Farrar, 1986; Vuksanovic & Bjekic, 2013) revealed the vital role of joint attention in early language acquisition.  For example, Tomasello and Farrar (1986) revealed the vital role of joint attention in the acquisition of language.  In the study, 24 Caucasian, middle-class children and their mothers were recruited to local daycare facilities in the United States.  The children and mothers were given a set of toys to play with while they were being videotaped for a 15-minute time period.  Observations were performed using the same procedure when these children reached the ages of 15 months old and 21 months old.  In case of engaging joint attention with their mothers, toddlers produced more utterances per minute and maintained longer conversations.  From these findings, Tomasello and Farrar (1986) concluded that joint attention can scaffold early mother-child linguistic interaction.  

            Okumura et al. (2017) conducted a nine-month longitudinal study with thirty-seven 9 months old infants in Japan.  They were observing their responses to joint attention measured by a Tobii T60 Eye Tracker when they were 9 months old.  Also, their language was assessed through the Japanese version of the MacArthur-Bates Communicative Development Inventories (CDI) completed by their parents at 18 months.  Okumura et al. (2017) discovered that the more times infants at 9 months spent responding to joint attention, the larger the size of their vocabularies at 18 months.  

Joint Attention Development

            In a meta-analysis study which involved 734 children from twenty-five studies, Colonnesi et al. (2010) discovered that the correlation between pointing and language development became stronger as children got older.  For example, the ability to respond to joint attention occurs earlier than the ability to initiate joint attention (Bocha et al., 2007).  As young as 6 month old infants can follow the direction of an adult’s eye gazing (Morales, Mundy, & Rojas, 1998).  With the consolidation of attachment, their ability of joint attention continually develops (Prizant & Wetherby, 1990), between 15 to 18 months, toddlers are able to demonstrate highly coordinate joint attention (Lewy & Dawson, 1992).

            Pointing gestures also evolve along with children’s maturity.  Lisxkowski and Tomasello (2011) compared whole hand pointers and index finger pointers.  They concluded that whole hand pointing and index finger pointing are different in terms of quality of joint attention.  In fact, index finger pointing is a more sophisticated form of joint attention, therefore, and it is the first step of intentional communication (Lisxkowski & Tomasello, 2011).

            Cochet et al. (2011) conducted another study about the changes of joint attention due to children’s maturity.  They explained the interconnection between brain development, the changes of joint attention, and language development.  Over a five month-observation, Cochet, et al. (2011) found that children who experienced lexical spurt demonstrated higher rates of asymmetry preference of pointing based on the maturation of the left cerebral hemisphere.  They argued that present and persistence of hand preference corresponded to lexical spurt.  In other words, changes in the form of joint attention can predict changes in language development. 

Suggestions for Parents

Figure 1. Eye gazing – human vs. robot (Okumura et al., 2013, p.128).

Figure 1. Eye gazing – human vs. robot (Okumura et al., 2013, p.128).

            The socio-ecological systems theory (Bronfenbrenner, 1979) provides insight into children’s development from a sociocultural perspective.  This theory acknowledges the ways that children are positioned within their families, child care settings, neighbourhoods, and the broader society, and how this impacts their development.  According to this theory, parents belong to the microsystem that directly impacts a child’s development.  In other words, parents are the most important and influential people in their child’s learning which includes language development.  In this session, some suggestions are made for parents who have a desire to promote their child’s language development through enhancing joint attention.

Be with the Child

Okumura et al. (2013) conducted an interesting experiment with Thirty-two 12 months old infants who were typically developing.  During the first experiment, they observed how infants responded to eye gazing from both humans and robots.  In this study, infants demonstrated a longer duration of object fixation.  In this study, Okumura et al. (2013) clearly revealed that the importance of humanness to facilitate the joint attention.  In addition, Farroni, Johnson, Menon, Zulian, Faraguna, and Csibra (2005) found that infants naturally had more attraction to the shape of the human face.  In this study, infants spent more time looking at face like shapes instead of
other.

Figure 2. Newborns’ preference of face shape stimuli (Farroni, Johnson, et al., 2005, p.17246).

Figure 2. Newborns’ preference of face shape stimuli (Farroni, Johnson, et al., 2005, p.17246).

Have More Eye Contacts

Figure 3. Eye gazing of robots with and without eyes (Farroni et al., 2005, p.131).

Figure 3. Eye gazing of robots with and without eyes (Farroni et al., 2005, p.131).

            Okumura et al. (2013) did another experiment with robots and infants.  Sixteen 12 months old infants participated in this study and were observed to see how they followed the introduced directions of the robots with eyes and without eyes.  Even though the movements (head turning) of both robots were identical, infants only followed the robot with eyes.  Okumura et al. (2013) revealed that infants did not consider the robot without eyes as being an agent who initiated joint attention.  In addition, in the study that I mentioned earlier about an infants’ natural attraction to the human face, researchers found that the focal point was the eyes (Farroni et al., 2005). Therefore, eyes play a vital role to recognize parents as agents that exchange joint attention and focus.                                   

Demonstrate Warm and Sensitive Parenting Style and Ensure One on One Time        

            Farrant and Zubrick (2011) found that parenting style and the number of siblings had an effect on joint attention facilitating early language development.  In their longitudinal study, 2188 children and their parents were observed twice.  For the first and second observations, the median age of children was 9 months and 34 months respectively.  The more warm and sensitive parenting the parents displayed, the more joint attentions occurred during the first observation and the more use of words were counted at the second observation.  On the other hand, the number of siblings in the family appeared to have a negative impact on joint attention experiences and word counts.  In their study, the more siblings the children had, the less joint attention and less words were observed.  Farrant and Zubrick (2011) assumed it was due to lack of one to one time.

Read More Books

            Farrant and Zubrick (2011) argued that book reading is a more structured joint attention activity.  It requires simultaneous pointing, sharing of experiences and verbal labeling (Farrant & Zubrick, 2011).  In fact, Farrant and Zubrick (2011) found the correlation between book reading and more word counts among 2188 children whose median age was 34 months.  They concluded book reading is an outstanding structured joint attention opportunity which fosters vocabulary expansion.

Share Positive Experience With the Child

            Joint attention occurs more when parents display positive emotions.  Leaven at el. (2014) examined 73 dyads of parents and their infants (6 to 18 months old) in a laboratory setting.  Parents were asked to hold their infants on their laps.  They were observed on how they reacted when dolls were animated on the opposite side of the table.  Leaven at el. (2014) found affective and referential synchrony, in other words, they smiled more when they pointed at the dolls.

            On the other hand, Adamson and Bakeman (1985) observed 27 infants of ages 6 to 18 months playing with their mothers, peers and alone at their homes.  They found infants displayed more effective rates with mothers and peers.  Also, they discovered that high rates of positive emotions were displayed when infants shared joint attention experiences.  These two studies clearly explained that sharing positive experiences between parents and their children will not only help parents demonstrate more preferential behaviour but also, their young children will initiate more joint attention behaviour. 

Promote Non-Verbal and Verbal Language Simultaneously      

            Vuksanovic and Bjekic (2013) compared 25 late talkers aged 18-22 months old and 25 children who are five months younger than the first group but typically developing in a 10 month-longitudinal study.  Even though there was no significant difference between late talkers and typically developing children in terms of frequency of joint attention bids, late talkers demonstrated a negative relationship between joint attention bids and language function.  From this findings, Vuksanovic and Bjekic (2013) concluded that typically developing children use non-verbal and verbal language together for their communication whereas late talkers use one or the other.

            Based on this study, parents should be role models in communicating with their young children in both means.  In other words, parents should use facial expressions which match the verbal messages.  Also, using sign language and gestures while talking to young children can be beneficial.  Moreover, inviting children as active participants in communication can provide them with more opportunities to experience and to practice their non-verbal and verbal communication.

Conclusion

            The aim of this project was to promote early language development through enhancing joint attention by parents.  To achieve this goal, typical courses of early language development from infancy to early childhood were introduced.  Joint attention refers to sharing experiences on the same object or activity between parents and infants (Tomasello & Farrar, 1986) as a part of non-verbal language (Vuksanovic & Bjekic, 2013).  Joint attention has two distinct aspects; Initiating joint attention and responding to joint attention (Vuksanovic & Bjekic, 2013).  Both initiating joint attention (Colonnesi et al., 2010; Tomasello & Farrar, 1986; Vuksanovic & Bjekic, 2013) and responding to joint attention (Farrant & Zubrick, 2011; Morales et al., 1998; Okumura et al., 2013; Okumura, et al., 2017) have vital roles in early language development.  Like any other development, the development of joint attention evolves along with child’s maturity.  For example, the ability to respond to joint attention occurs earlier than the ability to initiate joint attention (Bocha et al., 2007).  Index finger pointing is a more sophisticated form of joint attention, and it appears later than whole hand pointing (Lisxkowski & Tomasello, 2011).  In addition, emerging more persistence of asymmetry hand preference (e.g., using right hand dominantly) of pointing based on the maturation of the left cerebral hemisphere corresponds to the period of vocabulary spurt in children (Cochet et al., 2011).

            Based on the socio-ecological systems theory (Bronfenbrenner, 1979), parents are the most important and influential people in their child’s learning including in language development.  Therefore, some suggestions were also made for parents who want to promote their child’s language development through enhanced joint attention; being with the child, more eye contact, demonstrating a warm and sensitive parenting style, ensuring one on one time with the child, reading more books, sharing positive experiences with the child, and promoting non-vernal/verbal language simultaneously for communication with their child.  Through this project, the hope is that parents will thoughtfully reflect on the understanding of typical early language development, the importance of joint attention, understanding, and enhancing joint attention in order to promote language development in their child.

[1] Joint attention refers shared experiences on the same object or activity by to parents and infants (Tomasello & Farrar, 1986).

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