The impact of poverty on infant mental health.
(Very little if you are securely attached!)
The extent of the problem in the U. K. • According to ‘Save the Children’ the number of children living in conditions of “severe poverty” rose by 260,000 to 1.7m in the period 2004 to 2008. This represents 13% of UK children. • They define severe poverty as households with income of less than 50% of the UK median income (disregarding housing costs) who were also missing such basic possessions as a winter coat or a bed. • Figures vary across the UK: Northern Ireland 8%; Scotland 9%; England 13% (London 19%); and Wales 15%.
These signs of poverty and neglect overlap. o frequently going hungry; o frequently having to go to school in dirty clothes; o not being taken to the doctor when they’re ill; o regularly having to look after themselves at home alone under the age of 16; o being abandoned or deserted; o living in dangerous conditions i.e. around drugs, alcohol or violence; o finding it difficult to adapt to school; o children who are often angry, aggressive or self harm; o children who find it difficult to socialize. (See: www.actionforchildren.org.uk )
Human relationships, and the effect of relationships on relationships, are the building blocks of healthy development. From the moment of our conception to the finality of death, intimate and caring relationships are the fundamental mediators of successful human adaptation. (p. 27) National Research Council and Institute of Medicine (2000) From Neurons to Neighbourhoods: The Science of Early Childhood Development. Committee on Integrating the Science of Early Childhood Development. Jack P. Shonkoff and Deborah A. Phillips, eds. Board on Children, Youth and Families, Commission on Behavioral and Social Sciences and Education. Washington D. C. :National Academy Press.
The first relationships may be the most important.
Positive predictable interactions with nurturing caregivers profoundly stimulate and organize young brains. The quality of early caregiving has a long lasting impact on how people develop, their ability to learn, and their capacity to both regulate their own emotions and form satisfying relationships.
Inequality, not poverty, is the main stressor. • Greater inequality seems to heighten people’s social evaluation anxieties by increasing the importance of both social status and social competition. • Inequality decreases trust and increases the social distance between different groups of people. • A much higher percentage of the population suffer from mental illness in the more unequal countries. • Inequality is associated with lower life expectancy, higher rates of infant mortality, homicide & use of illegal drugs, shorter height, poor self-reported health, low birthweight, AIDS and depression. See: Wilkinson, R. & Pickett, K (2010) The Spirit Level. Penguin Books.
Low income creates a particularly stressful context in which positive interactions with children are threatened, and punitive or otherwise negative relationships may result. The high prevalence of depression, attachment difficulties, and posttraumatic stress among mothers living in poverty serves to undermine their development of empathy, sensitivity, and responsiveness to their children, which can lead to diminished parenting behaviours and thus decreased learning opportunities and poorer developmental outcomes. (Shonkoff & Phillips, 2000:353)
Poverty has the potential to titrate stress into the parent-infant relationship. • Living in poverty can (not invariably) adversely affect the caregiving relationship. • Infancy is the time of greatest developmental change and brain plasticity, and thus vulnerability. • Poverty has less to do with income than being about a lack of choice and life opportunities, exposure to social and psychological misfortune, and how other people see you. • All these stresses may make the parent emotionally distant (in many different ways) for the baby. This will immediately impact attachment.
First-year attachment cycle. Felt distress, or sense of need.
Soothed, relief, relaxation, affect regulation. Secure base
Development of trust and secure attachment. Baby internalises a model of a Some form of affective parent who can contain communication: e.g. arousal, displeasure, painful states. Sensitive response, excitement, fear. which depends on state of mind. Attuned caregiver Parent receives communication and interprets it correctly, reflects & responds promptly: e.g. a cuddle, play, feeding, talking.
But when this goes wrong. Felt distress, or sense of need.
Baby feels abandoned. Distress intensifies. A state becomes a trait.
Distress reduces. Baby internalises parent s defences.
Some form of affective communication: e.g. arousal, displeasure, excitement, fear.
Unresolved emotions in parent activated. Anxiety triggers stress & defences. Parent’s own state of mind interferes with recognising that of the baby. No reflective function or affect attunement.
Parent does not recognise, or ignores, communication, preoccupied by own concerns or feels stressed.
The early attachment relationship influences later development in a combination of ways. 1) Experiences with parents affect the neurobiology of the infant s developing brain. 2) It is the foundation for learning affect-regulation and impulse-control. The baby is soothed by the parent s responses, which then become internalised. 3) Here the infant learns relationship skills, especially empathy, behavioural regulation and synchrony. 4) Internal working models are derived from this time, as the infant begins to anticipate the responses to his actions and signals. These are the unconscious expectations of relationships that may last a lifetime.
Disordered attachments are created within the family. The child has been alarmed by the caregiver, for whatever reason, rather than the external situation. Caregiver may be experienced as: Frightening – physically alarming, hostile state of mind and dangerous behaviour. Or, Frightened – psychologically alarming, helpless state of mind and a lack of protective behaviour. Thus there is a simultaneous activation of 2 incompatible responses within the infant. FEAR and ATTACHMENT avoidance (alarm) approach (comfort)
These experiences of threatened protection and unresolved trauma and loss lead to disorganised attachment. In the long-term this has been shown to put the individual at a later risk of losing behavioural and mental organisation and control whenever the attachment system is aroused. Since the carer is both the source of fear and its proper protector the child experiences – fear without escape; fright without solution In such a situation of adversity the child remains fearfully aroused, and struggling with unintegrated states of mind that the parent does not contain.
Disorganised attachment stems from disruption in the emotional communication between parent and baby. A withdrawing response.
Strongest predictor
Borderline symptoms in late adolescence.
Negative-intrusive responses. Hostile / frightening response. A role-confused response.
Lack of effective regulation of fearful arousal in infant. (Disorganised attachment.)
Disoriented/confused responses. Emotional communication errors, e.g. giving conflicting cues to baby, failure to respond to infant s signals.
Dissociative symptoms in late adolescence.
Parental sensitivity is a predictor of later behavioural problems; and this is easily influenced by both internal and external factors.
Sensitivity
Internal Working Model
Self-confidence. Empathy. Moral development. Social attributions. Affect regulation. Pro-sociability. Self-esteem. Mentalizing ability.
Behavioural problems
Sensitivity
responsiveness.
The baby adjusts his or her emotions by monitoring the reactions of the mirroring parent and assigning meaning to the felt sensations and bodily experiences through the experience of the caregiver s affective responsiveness. Such congruent feeling states, where what the baby observes in the mother match his internal world, are based upon the action of mirror neurons and build up a sense of self. A mismatch could lead to a false self developing. (Winnicott)
Birth of the sense of self. Representation of infant s mental state. Reflected back to infant. Inference. Core of psychological self. Internalisation.
Inaccurate mirroring (or non-contingent responses) leaves the baby with unlabelled feelings, which will be harder to regulate.
Low maternal sensitivity and responsiveness at 10-12 months predicts: at 1.5 years: aggression, non-compliance, temper tantrums; at 2 years: lower compliance, attention getting, hitting; at 3 years: problems with other children; at 3.5 years: higher coercive behaviour; at 6 years: fighting, stealing;
The infant has no comparisons, and family relationships are their world.
So what influences the parents?
Poverty Adverse life conditions Adult health Child health Unemployment
Housing Exposure to violence
Infant mental health
Social network Friends Family Community institutions
Psychological distress Marital conflict Maltreatment Parental mental illness
Grandparent behaviour
Parent internalised working models
Partner relationship
Parenting behaviour Infant Attributes Health temperament
Sibling behaviour
The outside world enters the family. • There is a great difference between parents in their ability to buffer children from the effects of environmental stress. • Living in (and feeling trapped in) relative poverty will uncover and magnify the effects of any pre-existing vulnerabilities in the parents; these may stem from current pressures, adversity in their own childhood or mental illness within the family, etc..
Family reliant on State benefits. Self-esteem. Confidence. Personal resources.
Chronic strain of never having enough money. Limits choice of where one can live. Limits available support; e.g. extended family, health, education, leisure.
Family placed in a context where all around may also be concerned with their own survival.
Signs of stressed caregiving. • • • • • •
Failure to thrive. Sleep difficulties. Eating problems. Depression. Separation anxiety. Multiple and inexplicable fears. • Inconsolable crying. • Night fears.
• Severe and prolonged tantrums. • Impulsiveness. • Distractibility or hyperalertness. • Lack of age- appropriate impulse control. • Uncontrolled anger. • Dissociation.
There are many different risk factors that can titrate stress into a vulnerable family and so compromise the attachment relationship.
Biological vulnerability in the baby: Low birth weight / prematurity Failure to thrive / feeding difficulties / malnutrition Exposure to harmful substances in utero Developmental delay Delivery complications Head injuries Congenital abnormalities/illness Low or high muscle tone Very lethargic/non-responsive Very difficult temperament/extreme crying Chronic maternal stress during pregnancy Regulatory / sensory integration disorder
• Under conditions of poverty an infant is significantly more likely to be born constitutionally vulnerable and to be a difficult to care for baby. • A fussy, hard to settle, frequently crying lowbirthweight infant is likely to overtax the possibly limited physical and emotional resources of an already over-stressed mother. • In turn, she may respond to that baby in ways that do not aid his recovery from distress – affect modulation ; e.g. by leaving him alone inappropriately or allowing too long a period of crying.
2) Observable interactional or parenting variables: Lack of sensitivity to infant s cries or signals Negative affect towards child Physically punitive towards child Lack of vocalisation to infant (next) Lack of eye-to-eye contact Lacks knowledge of parenting Lack of preparation during pregnancy Negative attributions made towards child Infant has poor physical care (e.g. dirty and unkempt) Does not anticipate or encourage child s development Quality of partner relationship Infant a victim of maltreatment.
Based on a 3 year period of data collection in America, this is what, on average a child under 3 would hear every hour. Words. Professional families. Working class families.
2, 150
Affirmative statements. 36
Prohibitions.
1,250
12
7
Families on benefit.
620
5
11
5
At age 4 these groups showed large differences in speech and language skills. Hart, B. & Risley, T. (1995) Meaningful Differences in the Everyday Experience of Young American Children. Baltimore: Brooks.
Read to every day at age – UK sample..
Differences in child outcome. • By age 3 children who had heard 33 million words with 500,000 affirmations had I.Q. scores on average 25 points higher than children who had heard only 10 million words and fewer than 60,000 affirmations. • At age 9 children s scores on standard vocabulary, language and academic tests strongly correlated with language use at age 3; and they correlated even more strongly with language input from parents in the early years.
Inequality in early cognitive development of children in the 1970 British Cohort Study. Socioeconomic status.
Low cognitive score at 22 months.
Parental history and current functioning: Severe mental illness, including depression (next slide) Serious medical condition Parent(s) seem incoherent or confused Developmental delay / learning disability Criminal or young offender s record Own mother mentally ill / substance abused Previous child in foster care or adopted Mother has experienced loss of a child Previous child has behaviour problems Alcohol and/or drug abuse Caregiver in household not biologically related to infant Background of abuse, neglect or loss in childhood Presence of acute family crisis
The context of parental depression, effect on infant security. Economic hardship.
Lack of pleasure in parenting.
Less sensitive interactions
Infant attachment security.
Relationship stress.
Increase in frequency of spanking.
Some research. • Maternal depression co-occurs with poverty. This is one of the greatest risks for both internalising and externalising problems among pre-school and school age children. • In high-risk, low socio-economic status families, the rate of disorganised attachment in young children with depressed mothers has been estimated to be as high as 60%. (Lyons-Ruth,
K., et al. (1990) Infants at social risk: Maternal depression and family support services as mediators of infant development and security of attachment. Infant Mental Health Journal. 17, 257-275.)
Mothers who suffer post-natal depression.
Post-natal depression is linked to an increase in insecure attachment in toddlers, behavioural disturbance at home, less creative play and greater levels of disturbed or disruptive behaviour at primary school, poor peer relationships, and a decrease in self-control with an increase in aggression. It impacts cognitive, emotional, behavioural & attachment domains of development. (Cummings & Davies, 1994; Murray, 1997; Sinclair & Murray, 1998; Murray et al., 1999; Zeanah et al., 1997)
Depression in pregnancy is associated with: Diagnosis of depressive disorder in both boys and girls. Every 16 year old in this group had a mother who had been depressed in pregnancy. Overall lower scores on a global developmental assessment measure. Outcome of post-natal depression when child is 16 years old. Lower I.Q. in boys (10 points on average) Fewer core GCSEs at A to C passes in boys. Increase in diagnosis of conduct disorder. Greatly increased hyperactive behaviour in boys. (South London Child Development Study)
Children of parents with mental health difficulties have: 70% chance of developing at least minor adjustment problems by adolescence 10% - 15% chance of becoming seriously mentally ill if one parent has a mental health problem 30% chance if both parents have mental health problems.
4) Social Factors: Poverty – i.e. Chronic unemployment. Inadequate income/housing. Frequent moves/no telephone. Low educational achievement. Plus: Any violence reported in the family Severe family dysfunction. Lack of support/isolation. Single teenage mother without family support. Recent life stress, especially during pregnancy (e.g. domestic violence, bereavement, job loss, ethnic intolerance, etc. ).
Poverty, sleep disruption and self-control. • This is common because of overcrowded households, chronic stress, noise from neighbours, hunger, and poor temperature control in the sleeping environment. Low SES has been linked to increased rates of sleep problems in children. Buckhalt, et al. (2007) Children’s sleep and cognitive functioning: race and socioeconomic status as moderators of effects. Child Development, 78, 213-231.
• Attention-control tasks involving the prefrontal cortex are sensitive to sleep. A lack of sleep impairs performance on attention-control tasks and increases parent reported behaviour problems. Sadeh, et al. (2002) Sleep, neurobiological functioning and behavior problems in school-age children. Child Development, 73, 74-81.
Regular bed times at age 3.
Poor women are significantly more likely than their economically advantaged peers to: • have poor health histories, including smoking & obesity, before becoming pregnant; • to take less advantage of pre-natal care; • to experience higher levels of stress during pregnancy;
• to engage in behaviours harmful to health during pregnancy.
Stress in pregnancy leads to children s psychological problems. Analysis of stress hormone levels in 10-year-old children whose mothers suffered stress during pregnancy has provided the strongest evidence yet that prenatal anxiety may affect the baby in the womb in a way that carries long-term implications for well-being. The study suggests that foetal exposure to prenatal maternal stress or anxiety affects a key part of their babies' developing nervous system; leaving them more vulnerable to psychological and perhaps medical illness in later life. (O'Connor, T. G., Ben-Shlomo, Y., Heron,J., Golding, J., Adams, D., & Glover, V. (2005) Prenatal Anxiety Predicts Individual Differences in Cortisol in Pre-Adolescent Children. Biological Psychiatry; 58:211-217)
Passing on stress during pregnancy. Hypothalamus Hypothalamus
Paraventricular nucleus
Negative feedback
Corticotropin Releasing Hormone CRH
Cortisol Pituitary gland gland Pituitary
Placenta
corticotrophs
Adrenocorticotropin ACTH
Mother s adrenal glands. Cortisol
CRH pituitary
ACTH
adrenal glands
Antenatal maternal stress, effects on child. Foetal programming describes the physiological adaptations made to the characteristics of the intrauterine environment. If a mother is stressed while pregnant her child is substantially more likely to have: • Emotional and / or cognitive problems; • Increased risk of attention deficit/hyperactivity; • Anxiety; • Language delay. (Independent of effects of postnatal depression & anxiety)
Talge, N. M. et al. (2007) Antenatal maternal stress and long-term effects on child neurodevelopment: how and why?J.Child Psychology & Psychiatry, 48:3/4, 245-261.
Influence of poverty on development. Substance misuse. Criminality. Domestic violence.
P O V E R T Y
Parental life events, anxiety & stress.
Ethnic minority status.
Parental sensitivity, rejection, inconsistency.
Social- emotional outcomes: e.g. attachment.
Stress in pregnancy. Exposure to environmental toxins, smoking, trauma, alcohol, malnutrition. Workless household.
Tend to speak less to infants.
Identity, self-esteem, confidence.
Brain development
Less stimulation, routine and boundaries within home. Too much and/or poor quality of daycare.
Learning experiences Compromised vocabulary & lower I.Q. scores
School readiness, academic achievement
• • • • •
Taken together, the correlates of poverty preoccupy parents in ways that may undermine their preoccupation with their babies. They: sap parents physical energy, leading to exhaustion; try their patience and instill a sense of frustration; undermine their feelings of competence; reduce their sense of control over their own lives; contribute to general irritability and anger. Thus the attentiveness that affect attunement needs is compromised, as is the sensitive responsiveness that follows. This is the basis of secure attachment.
Children brought up in conditions of poverty may learn early on to survive with lessened protection, support, encouragement and validation from their parents and the broader environment. But the cost is in their trust in and beliefs about the wider world – in their own ability to form healthy reciprocal relationships and in their capacity to use these relationships as a foundation for their own development. As adults this emotional poverty may be exacerbated by a perpetuation of economic disadvantage.
The long-term economics of early childhood poverty. “Compared with children whose families had incomes of at least twice the poverty line during their early childhood, poor children completed 2 fewer years of schooling, work 451 fewer hours per year, earn less than half as much‌and are more than twice as likely to report poor overall health or high levels of psychological distress. Further, poor children have BMIs that are 4 points higher than those well above the poverty line, are are almost 50% more likely to be overweight as adults.â€? (p. 312) Duncan, G. J., Ziol-Guest, K. M. & Kalil, A. (2010) Early-childhood poverty and adult attainment, behavior and health. Child Development, 81 (1) 306-325.
Where you live makes a difference. • Studies support a link between exposure to community and domestic violence and aggression, anxiety or depressive symptoms in children aged 6 to 15 living in violent urban neighbourhoods. • Children exposed to family violence in the preschool years showed a greater frequency of externalising (aggressive) and internalising (withdrawn & anxious) behaviour problems in comparison to children from non-violent families. This result controlled for IQ, SES, stress, child abuse and neglect. ( Sroufe, L. A., Egeland, B., Carlson, E. A. & Collins, W. A. (2005) The Development of the Person : the Minnesota Study. The Guilford Press.
Domestic violence as a correlate of child abuse. • Domestic abuse is a strong indicator of child abuse, including child sexual abuse. • Separate studies have found that between 30% and 60% of children on Child Protection Registers also were exposed to domestic violence. • Children who have been exposed to domestic violence are 158% more likely to be abused themselves than those from non-violent households. The risk is 115% higher for boys & 229% higher for girls. (Mitchell, K. J. & Finkelhor, D. (2001) Risk of crime victimisation among youth exposed to domestic violence. Journal of Interpersonal Violence, 16, 944-964)
Poverty and child maltreatment. • The National Incidence Study in America compared the maltreatment rates for families with incomes below $15,000 to those above $30,000. • This study demonstrated that abuse is 14 times more common and neglect 44 times more common in poor families than in middle income families. Sedlak, A. & Broadhurst, D. (1996) Third incident study of child abuse and neglect: Final report. Washington DC: Child Welfare League of America.
• The Minnesota Study (2005) has found: • All types of abuse in the first years related to significant emotional problems in adolescence, and predicted the need for treatment. • 90% of the sample qualified for at least 1 psychiatric diagnosis by age 17. • Every form of abuse was related to delinquency, with a history of psychological unavailability being the strongest predictor. Neglect also predicted delinquency, although these children tended not to be angry or defiant. • Witnessing parental violence correlated with externalising problems for boys at age 16 and internalising problems for girls. This was independent of other predictors such as abuse or neglect.
Frightened children become frightening adults. •  Exposure to violence in the home and community is a major risk factor for youth violence. (Thornton, T. N., Craft, C., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2002) Best practices of youth violence prevention: A sourcebook for community action. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.)
•  Abused and neglected children have higher rates of arrest for both adult and juvenile criminal behaviour than non-abused children. (Windom, C. S. & Maxfield, M. G. (1996) A prospective examination of risk for violence among abused and neglected children. Annals of the New York Academy of Science, 794, 224-237)
Adverse Childhood Experiences (A.C.E.) study. The more Adverse Childhood Experiences an individual has endured, the greater the later incidence of: 1. Smoking, fractures, severe obesity, alcohol and drug use; 2. Ischaemic heart disease, stroke, chest diseases, cancer; 3. Diabetes, hepatitis, sexually transmitted diseases; 4. Depression, attempted suicide. Felitti, et al. (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 14, (4)
The Adverse Childhood Experiences were: • • • • • • • • •
Emotional abuse – recurrent humiliation. Physical abuse – beating. Physical neglect. Emotional neglect. Contact sexual abuse. Mother treated violently. Household member was alcoholic or drug user. Presence of mental illness. Parental separation or divorce – not raised by both biological parents. • Incarcerated household member.
A.C.E. scores and self -acknowledged chronic depression.
A. C. E. scores.
Risk of Victimization (%)
A.C.E. score and the risk of being a victim of domestic violence. 15
Women. Men.
10
5
0 0
1
2
3
4
>5
0
1
2
3
4 >5
A.C.E. score and the risk of perpetrating domestic violence. Risk of Perpetration (%)
15
Women
Men
10
5
0
0
1
2
3
4
>5
0
1
2
3
4
>5
Ever hallucinated. * %
Abused alcohol or drugs.
*Adjusted for age, sex, race and education.
A.C. E. score.
Prescription rate. (Per 100 person-years.)
A.  C. E. scores and rates of anti-psychotic prescriptions.
A.C.E. score.
Percentage have injected drugs.
A. C. E. scores vs Intravenous Drug Use.
A.C.E. score.
A.C.E. scores and later attempted suicide. 25
% Attempting Suicide
20
15
10
5
0
1
2
3
ACE Score
4
5
Disadvantaged children die young. Adverse Childhood Experiences. Social, emotional & cognitive impairment. Adoption of health-risk behaviors.
Disease, disability & social problems. Early death!
From: Felitti, et al. (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 14, (4)
On the other hand we have -
The Great Smoky Mountains Study.
In the middle of an 8 year community study on mental health problems in children, the sudden opening of a new casino raised income levels among an entire, but localised, community of American Indians. The researchers were able to compare the changes in diagnosed mental health disorders in the enriched community with a similar population who remained poor.
They found: • Before the casino opened poor children across the region had more psychiatric symptoms than neverpoor children. • Moving out of poverty was associated with a decrease in the frequency of psychiatric symptoms over the next 4 years – by the 4th year the symptom level was the same in children who moved out of poverty as in children who were never poor. • Adding to the income of never-poor families had no effect on the frequency of psychiatric symptoms. Costello, E. J., Compton, S. N., Keeler, G. & Angold, A. (2003) Relationships between poverty and psychopathology: A natural experiment. J. American Medical Assoc. 290, 15, 2023-2029.
In summary: poverty acts to concentrate and amplify all the other risk factors.
And the end result will sculpt the developing brain.
If a significant proportion of the early emotional experiences one has had are due to activation of the fear system rather than positive systems, then the characteristic personality that begins to build up from the parallel learning processes coordinated by the emotional state is one characterised by negativity and hopelessness rather than affection and optimism. (p.322) Joseph LeDoux, (2002) Synaptic Self: How Our Brains Become Who We Are. Penguin Books.
• The organising brain requires patterns of sensory and emotional experience to create the patterns of neural activity that will guide the neurobiological processes involved in development. • In the face of interpersonal trauma, all the systems of the social brain become shaped for offensive and defensive purposes. • A child growing up surrounded by trauma and unpredictability will only be able to develop neural systems and functional capabilities that reflect this disorganisation.
Psychosocial causes of psychosis. “Poverty is even more strongly related to schizophrenia and psychosis than to other disorders. British children raised in economic deprivation are four times more likely to develop nonschizophrenic disorders, but are eight times more likely to grow up to be schizophrenic. Even among those with no family history of psychosis, the deprived children are seven times more likely to develop schizophrenia, demonstrating that you do not need a genetic predisposition to develop schizophrenia.� (p. 219) Read, J., Fink, P. J., Rudegeair, T., Felitti, V. & Whitfield, C. L. (2008) Child maltreatment and psychosis: A return to a genuinely integrated bio-social model. Clinical Schizophrenia & Related Psychosis, 2 (3) 217-225.
Trauma in infancy: attachment system compromised. Disorganised attachment.
Sensitised nervous system as brain adapts to emotional environment. Stress in adult: reminders & experiences of trauma, life events, etc. Attention has to be diverted from unbearably painful emotional states.
Retreat: isolation dissociation depression
Self-destructive actions: substance abuse eating disorders deliberate self-harm suicidal actions
Destructive actions: aggression violence rage
The first Policy Objective from the recent Marmot Review.
• ‘Reduce inequalities in the early development of physical and emotional health, and cognitive, linguistic and social skills.’ And it recommends – • ‘Increase the proportion of overall expenditure allocated to the early years and ensure expenditure on early years development is focused progressively across the social gradient.’ • The support to families should include – ‘Giving priority to pre- and post-natal interventions that reduce adverse outcomes of pregnancy and infancy. p. 16. Fair Society, Healthy Lives. The Marmot Review: Executive Summary. (2010)
All prevention needs an early start.
Association of Infant Mental Health (UK). This is an organisation for those interested in all branches of infant development as well as early intervention with babies and their families. It has a newsletter twice a year, and offers reduced rate at conferences. Application forms from: Administrator AIMH(UK). email: info@aimh.org.uk website: www.aimh.org.uk Our advisory panel.