Journal of Counseling Psychology 2014, Vol. 61, No. 4,513-520
© 2014 American Psychological Association 0022-0167/14/$ 12.00 http://dx.doi.org/10.1037/cou0000035
Neurosciences of Infant Mental Health Development: Recent Findings and Implications for Counseling Psychology Adriana Sampaio
Karin Lifter
University of Minho, Braga
Northeastern University
This article is about the neural correlates of infant mental health and their correspondences to social emotional development. These correspondences are organized in terms of the definition of infant mental provided by Zero to Three (2001), centered on infants’ capacities regarding the experience and expression of emotions, interpersonal relationships, and learning. We conclude with implications of these correspondences for counseling psychology— namely, working with children’s caregivers to maximize children’s healthy social and emotional development. Keywords: infants, infant mental health, parent-child relationships, social development, emotional development Supplemental materials: http://dx.doi.org/10.1037/cou0000035.supp
Brain development, which is a continuous process with increas ing specialization and differentiation, is correlated with what in fants and young children say and do, and what they and their caregivers bring to their reciprocal interactions. Recent research in cognitive neuroscience has been providing new insights about how the genetic, environmental, and experience factors shape brain development, in utero and throughout the life span. Early experi ences, especially caregiver-child interactions, matter (Zeanah & Zeanah, 2009). As described by the Center on the Developing Child at Harvard University (2012), “experiences ‘authorize’ ge netic instructions to be carried out and shape the formation of the (brain) circuits as they are being constructed” (p. 1). This article is about the neural correlates of infant mental health and their correspondences to social emotional development. We begin with a definition of infant mental health, taken from Zero to Three (Zero to Three, 2001), which centers on infants’ capacities regarding the experience and expression of emotions, interpersonal relationships, and learning. We then present several studies on the neural correlates of infant mental health.1 We conclude with im plications for practice and research in counseling psychology.
secure interpersonal relationships; and explore the environment and learn—all in the context of family, community, and cultural expectations for young children. Infant mental health is synony mous with healthy social and emotional development” (Zero to Three, 2001, p. 1). These three capacities provide a useful way to organize the emerging literature in cognitive neuroscience. Studies of infants have demonstrated that the neural substrates of these developing capacities can be uncovered by the use of noninvasive neuroimaging techniques as electroencephalogram (EEG)/eventrelated potentials (ERPs), psychophysiology, magnetic resonance imaging (structural and functional), positron emission tomography (PET), magnetoencephalography, and functional near-infrared spectroscopy (NIRS).
Neural Correlates of the Ability to Experience, Regulate, and Express Emotions Infants’ abilities to perceive, experience, and recognize emo tions, which allows them to engage with caregivers, have been studied mainly through behavioral and EEG/ERP studies.
Definition of Infant Mental Health
Perception, Experience, and Recognition of Emotions
Infant mental health, which is an interdisciplinary field, is centered on “the developing capacity of the child from birth to age three to experience, regulate, and express emotions; form close and
At birth, the neonate is rapidly able to perceive emotions by selecting significant and important information from human faces and voices. Infants are able to learn about the other’s emotion by integrating social-perceptual stimuli such as face and human voice in their internal states (e.g., imitation; O’Reilly & deHann, 2009) and by recognizing emotional states. Face specialization. The first signs of face specialization are present early after birth, including attention to eye gaze, face and face-like patterns. Attention to eye gaze emerges early after birth,
Adriana Sampaio, Neuropsychophysiology Lab, CIPsi, School of Psy chology, University of Minho, Braga; Karin Lifter, Department of Coun seling and Applied Educational Psychology, Northeastern University. We thank Sara Cruz for her help in the reviewing process. Correspondence concerning this article should be addressed to Adri ana Sampaio, Neuropsychophysiology Lab, CIPsi, School of Psychol ogy, University of Minho, Braga, Portugal. E-mail: adriana.sampaio@ psi.uminho.pt
1 For a summary of the neural correlates of infant mental health, please see the supplemental materials. 513
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with infants preferring to look at faces with directed rather than averted eye gaze (Farroni, Csibra, Simion, & Johnson, 2002). Underlying neural correlates include enhanced amplitude of N170 component, which is evident in 4-month-old infants when attend ing to direct gaze. Consistent with this is a distributed brain cortical activation that overlaps the adult face-processing area (Tzourio-Mazoyer et al., 2002). Auditory specialization. The infant’s ability to perceive emo tions by selecting significant and important information from the human voice is also present at birth. Research has demonstrated that neonates prefer human speech to other auditory stimuli, spe cifically, the maternal voice (DeCasper & Fifer, 1980). ERP cor relates of the auditory processing of the infant’s mother’s voice are associated with a smaller P350 and increased N450 amplitudes, when compared to an unfamiliar voice (Purhonen, KilpelainenLees, Valkonen-Korhonen, Karhu, & Lehtonen, 2004). Recognition of different emotional states. There is evidence of an early ability of the neonate to recognize, discriminate, and imitate facial expressions (Field, Woodson, Greenberg, & Cohen, 1982). Infants are relatively consistent in discriminating happy expressions from other emotions (Kotsoni, de Haan, & Johnson, 2001). Studies have demonstrated that in 4-month-old infants, the Nc amplitude is increased to happy expressions (Farroni, Menon, Rigato, & Johnson, 2007). However, this pattern of preferential attention allocation to happy faces changes to fearful expressions at 7 months of age. Consistent behavioral and EEG/ERP evidence shows that infants around this age allocate more attention re sources to fearful emotional expressions, in addition to an increase in the Nc component to fearful faces (Kotsoni et al., 2001). Despite this converging behavioral and neural evidence showing an increasing maturation of auditory and facial emotional expres sion recognition, sensorial modalities are integrated in most social interactions. Integration of facial and vocal emotional information was assessed within 7-month-old infants while processing emo tionally congruent and incongruent face-voice pairs, using EEG. The authors showed emotionally incongruent pairs were associated with larger negative ERP component, and emotionally congruent pairs were associated with an increased positive ERP component, which suggested infants are able to recognize emotional content and affect across modalities (Grossmann, Striano, & Friederici, 2006).
Regulation of Emotions Early regulation of emotions is imposed by caregivers in a responsive caregiving environment. Studies have shown that in fants prefer an infant-directed (ID) speech (DeCasper & Fifer, 1980). High arousal positive vocal emotion contributes signifi cantly to the infant’s preference for ID speech (Corbeil, Trehub, & Peretz, 2013). Maternal speech is therefore central to infant atten tion, arousal, and regulation. Studies have shown differential psychophysiological data according to the affective emotional state of the ID speech, namely a deceleration of the infant heart rate to ID speech independent of affective content (Santesso, Schmidt, & Trainor, 2007). Studies have shown that emotional prosody is associated with different psychophysiological and EEG signatures. More intense startle responses were documented in 5-month-old infants when exposed to angry facial emotional expressions (Balaban, 1995).
EEG/ERP studies have revealed that angry prosody elicits a more negative ERP component than does happy or neutral prosody in 7-month-old infants (Grossmann, Striano, & Friederici, 2005). Increased EEG power in the frontal regions of 9-month-old infants was documented in response to fear, as opposed to surprise and love/comfort (Santesso et al., 2007). Infants’ neural processing to emotional tone of voice, portrayed by non-physical interparental conflict, has been assessed with functional magnetic resonance imaging (fMRI) in 6- to 12-monthold infants (Graham, Fisher, & Pfeifer, 2013). Results have shown that higher inter-parental conflict (very angry tone of voice) was associated with increased activation of the rostral anterior cingu late cortex, as well as subcortical regions— brain regions associ ated with emotional regulation and stress. These data suggest a greater allocation of brain and attention resources to negative emotions such as anger and fear.
Expression of Emotions Electrophysiological studies have suggested a lateralized brain response underlying the expression of positive and negative emo tional facial expressions. This cerebral asymmetry was demon strated in newborns when exposed to stimulus-eliciting affective responses. Fox and Davidson (1988) found that EEG frontal acti vation asymmetry could discriminate a range of positive and negative facial expressions in 10-month-old infants: specifically, greater left frontal relative activation in response to mother and happy stimuli, when compared with strangers and sad stimuli, respectively (Davidson & Fox, 1982; Fox & Davidson, 1988). By 18-21 months, toddlers begin to demonstrate awareness of themselves, which includes the expression of the social emotions (e.g., shame, guilt, pride). They also display increases in symbolic representation, as a function of developments in cognition (Rosenblum, Dayton, & Muzik, 2009). However, more studies on the perception and expression of these discrete expressions in infancy are clearly warranted in order to understand early emotional de velopment. In sum, these experience-dependent capacities that infants dem onstrate allow them to engage with the caregivers in their envi ronments, setting the stage for reciprocal interactions.
Neural Correlates of the Ability to Form Close and Secure Interpersonal Relationships Close and secure positive interpersonal relationships are central to infant mental health, forming the basis for attachment. They contribute to the development of prosocial behaviors.
Neural Correlates in the Development of Attachment As we have discussed, the infant is bom with the capacity to engage the environment, and in particular, to engage caregivers. The infant is able to focus and follow stimuli, being preferentially oriented toward human forms and sounds, when compared with non-social-oriented stimuli (Legerstee, Anderson, & Schaffer, 1998). These capacities are nurtured and encouraged by a respon sive caregiving environment; it is the moment that both parent and infant are attracted to each other, seeking contact and proximity that lead the dyad to establish affect-regulative interactions, where the mother-infant interaction is privileged.
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Social and emotional developments contribute to the transac tions between infants and caregivers, setting the stage for caregiver responsiveness to the infant’s developing capacities. A secure attachment style provides a platform for exploring the environ ment. Around 9 months of age, the foundations for higher socioemotional and cognitive functions are being built as the infant develops the sense of understanding subjective states of others as well as acting jointly. These processes are threatened when the caregiver is depressed or unable to respond sensitively (Murray, Fiori-Crowley, Hooper, & Cooper, 1996). A synchronous caregiver-infant relationship is associated with optimal parenting, and it is predicted by cardiac vagal tone (Feld man & Eidelman, 2007). Higher affect synchrony and infant social engagement are also associated with increased peripheral oxytocin measures (Feldman, Gordon, & Zagoory-Sharon, 2010). Studies have supported a dynamic interplay between the maturation of the “social brain,” involving the orbitofrontal cortex, amygdala, and temporal regions and the establishment of an attachment relation ship (Moriceau & Sullivan, 2005). However, the role of these brain regions in mother-infant attachment has been studied mainly from the mother’s perspective; limited information is available on the infant’s brain areas underlying the development of attachment relationships. In fact, most studies in the neurobiology of infant attachment have been conducted in animal models (see Moriceau & Sullivan, 2005). Indirect evidence of infant brain development documents sub sequent increases in glucose uptake in these attachment-related brain regions, including frontal and various association regions, around 8 months (Chugani, 1998). A cortical surface expansion of the superior and medial temporal, superior parietal, medial orbito frontal, lateral anterior prefrontal, occipital cortices, and postcen tral gyrus areas has been observed (Li et al., 2013). These func tional and structural changes correspond to the precursors of theory of mind, thinking, self-referential activity, and internal regulation. They correspond to the emerging understanding of persons and objects as permanent entities and to the ability to use symbols in the representation of experience.
Neural Correlates in the Disruption of Responsive Caregiving Studies have demonstrated neurological impacts as a result of less than optimal caregiving (e.g., Hanson et al., 2013; Stratheam, 2011). Neglect has been identified as “the most prevalent form of child maltreatment” (National Scientific Council on the Develop ing Child, 2012, p. 6). Events such as “abandonment . . . by the parent; early separation or loss of the primary care-giving figure; early exposure to trauma; abuse (and neglect); maternal depression and parental psychopathology; conflicted family relationships; se vere lack of resources; premature birth; difficult infant tempera ment; and poor supplemental care settings” (Fitzgerald, Weatherston, & Mann, 2011, p. 181) are all threats. Studies have demonstrated that children who are neglected show atypical EEG power distribution, including lower absolute alpha power (Tarullo, Garvin, & Gunnar, 2011), as well as abnormal activity in the amygdala and hippocampus as a consequence of neglect (Totten ham et al., 2011). Infants of depressed mothers experience more negative expressions than do infants of non-depressed mothers, showing altered EEG signature, namely greater relative right fron
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tal activation (Diego, Field, Jones, & Hernandez-Reif, 2006). The emotional environment provided by the mother’s affective dispo sition is associated with the infant’s processing of facial expres sions of emotion (de Haan, Belsky, Reid, Volein, & Johnson, 2004). Studies conducted in infants who were maltreated, neglected, and abused show a deleterious impact in both mental and physical health development. Indeed, atypical rearing condi tions are believed to hinder the development of stable relation ships (Bakermans-Kranenburg et al., 2011) and to inhibit the normative shift in socio-emotional development during the first years of life. Moreover, difficulties with responsive caregiving often co-occur with other threats to family and community life (Murray et al., 1999).
Neural Correlates of the Ability to Explore the Environment and Learn In order to explore the environment and learn, the infant needs to develop the social and emotional skills (i.e., attachment) to create a secure base for exploration. The infant also needs to integrate multisensory stimuli into internal and self-regulatory states and to develop motor skills in order to move about— both moving in relation to the environment and moving objects in relation to the stationery self and others. Finally, the infant needs to develop cognitive and social communicative skills—to acquire knowledge about objects, people, and events and the relationships among them and to express that knowledge in his or her language and play.
Neural Correlates of Multisensorial Integration The neonate is already able to apprehend and explore the envi ronment, through multiple sensory cues (e.g., olfactory, somato sensory, visual, and auditory). Salient cues include the perception of the mother’s odor, as olfactory learning occurs during the first hours of postnatal life. Functional data (NIRS) have shown that in the 6 hr to 192 hr after birth, the neonate demonstrates a differ ential pattern of changes in blood flow over the left orbitofrontal region when exposed to vanilla and colostrum smell (Bartocci et al., 2000). Greater activation of the orbitofrontal cortex to the odor of maternal breast milk compared to formula milk was demon strated (Aoyama et al., 2010). Human tactile stimulation was reported to be associated with improvement in certain biological and behavioral conditions, by promoting body and mental development. Several studies exam ining electric potentials and magnetic fields (supplementary eye fields) showed consistent neural responses (N1-P1-P2 and M60) distributed from posterior to anterior regions, generated in the primary cortex (e.g., Nevalainen et al., 2008). fMRI evidence has revealed an activation of the contralateral primary somatosensory cortex to tactile stimulation (Arichi et al., 2010). These markers, found in healthy, full-term newborns, corresponded to changes in developmental processes (Gois-Eanes, Gonsalves, Caldeira-daSilva, & Sampaio, 2012). Although the neonate's ability to differentiate visual details is limited, the visual system is characterized by substantial changes in the first year: a fast increase in synaptic density in the visual cortex in parallel with intense myelination of the visual tracts in
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the first four postnatal months (Dubois et al., 2008). At 1 month of age, early visual evoked potential components, such as N l, PI and N2, play an important role in healthy brain development, as the presence of these components is associated with healthy visual stimuli processing (Benavente, Tamargo, Tajada, Yuste, & Olivan, 2005). By 6 months of age, healthy full-term born infants show a positive P2 component associated with good neural maturation of the neonatal visual cortex (Benavente et al., 2005). One of the earliest functions to emerge is the auditory function. In fact, the P I50, N250, P350, and N450 peak components were identifiable both at birth and at 12 months (Kushnerenko et al., 2002). However, the maturation of these components is considered to be a continual process throughout infancy, as the amplitude of the peaks increase and the latency of the peaks decrease through out time (Wunderlich & Cone-Wesson, 2006). All these brain maturational processes are corroborated by an increase in the glucose uptake in the parietal, temporal, and primary visual cortex, among other brain regions, at 2-3 months (Chugani, 1998). Multisensorial integration allows the infant to pick up and explore toys (around 6 months), to create relationships between and among toys (around 12 months), and to represent his or her experiences in play activities (around 18 months; Lifter & Bloom, 1989). These developments depend upon the maturation of specific neuromotor networks in parallel with specialized brain circuits involved in motor planning, anticipation, motor imagery, and spatial cognition. They are strongly associated with cognitive, emotional, and language skills (Koziol & Lutz, 2013).
Neural Correlates of Motor Development At birth, the motor behavior repertoire consists of an array of neurological reflexes (e.g., grasping, sucking) and specific combi nations of limb and muscle movements (flexors activity, extensor activity). From birth to about 3 -4 months of age, in parallel with advancements of the visual system, postural trunk control, eyehand coordination, and arm velocity and muscle forces regulation, infants develop a phase of pre-reaching movements (AnguloBarroso & Tiernan, 2008). Increased glucose metabolism in the primary sensorimotor cortex, cingulate cortex, thalamus, brain stem, cerebellum, and hippocampal region has been described in the newborn (Chugani, 1998). These results are consistent with activity of the resting state networks (e.g., sensorimotor) detected in the infant brain (Fransson et al., 2007). Maturation of these brain networks is associated with adjustments in motor behavior but also in motivation, attention, anticipation, learning about current and prospective control of movement, motor planning, motor memory, and recognition of motor actions. This maturation is modulated by the experience; the infant’s experiences will have a structural and functional impact in the development of these neuromotor systems (Angulo-Barroso & Tiernan, 2008).
Neural Correlates of Language and Cognitive Development Joint attention emerges at around 9-10 months of age and is considered an important milestone for language and socialemotional development (Carpenter, Nagell, & Tomasello, 1998). Neural signatures underlying infant attention allocation (increased Nc amplitude) were evident when 9-month-old infants viewed
objects after an interactive joint attention task compared to a non-joint attention interaction (Striano, Reid, & Hoehl, 2006). The neural precursors (e.g., left dorsal prefrontal cortex) are evident at the age of 5 months (Grossmann & Johnson, 2010). Consistent with this neurobiological readiness for sharing attention, it was observed that the white matter integrity of the right fronto-limbic connection (uncinate fasciculus) at 6 months predicted infants’ responding to joint attention at 9 months (Elison et al., 2013). Joint attention is an important predictor of socio-communicative skills, with these fronto-temporal networks involved in the later development of language skills. Maturation of the auditory cortex is associated with early language learning skills (e.g., speech sound discrimination). Infants at 3 months are able to discriminate speech presented in normal and reversed order, exhibiting greater func tional activation of left temporal areas (similar to adults) to speech stimuli and a right frontal activation when processing normal speech (Dehaene-Lambertz, Dehaene, & Hertz-Pannier, 2002). These results are consistent with other fMRI and magneto encephalography studies showing an activation of speech produc tion brain areas when infants are processing speech-related stimuli (Dehaene-Lambertz et al., 2006; Imada et al., 2006). There is evidence of an increasing synchronized perceptualmotor brain activity when listening to speech, as activation of both auditory and motor brain regions is only detected in 6- and 12-month-old infants and not in newborns (Imada et al., 2006). Infants at 12-18 months recruited adult-like left fronto temporal areas necessary for processing lexico-semantic infor mation (understanding new and old words; Travis et al., 2011). This knowledge about word meanings and underlying ERP signature (N400m) is possibly related to an infant’s ability to produce words, with a marked spurt in vocabulary evident around 18 months (Lifter & Bloom, 1989). Moreover, increased neural efficiency is associated with language proficiency, with ERP components to comprehended and unknown words being more widely distributed over bilateral anterior and posterior brain regions in 13- to 17-month-old infants compared with more focal and limited activation of left temporal and parietal regions at 20 months (Mills, Coffey-Corina, & Neville, 1997). Toddlers are also likely to be sensitive to syntactic violations in spoken sentences, showing an early left-lateralized brain re sponse when an expected verb is wrongly replaced by a noun (Bernal, Dehaene-Lambertz, Millotte, & Christophe, 2010).
Implications for Practice and Research in Counseling Psychology Implications for practice and research include working with families to support responsive care, and examining the impact of interventions on behavior and underlying neural correlates.
Implications for Practice: Working With Families to Support Responsive Care This work would begin with practitioners being alert to threats to responsive care, which would include neglect and abuse by caregivers, depression and psychopathology of care givers, a severe lack of resources for the family, and vulnera bilities imposed by the infants (e.g., prematurity, difficult tem peraments; Fitzgerald et al., 2011).
NEUROSCIENCES OF INFANT MENTAL HEALTH DEVELOPMENT
Once families who are risk are identified, interventions can be put into place. In their meta-analysis of sensitivity and attachment interventions in early childhood, Bakermans-Kranenburg, van IJzendoom, and Juffer (2003) concluded enhancing parental sen sitivity plays a causal role in enhancing attachment security. They reviewed various interventions that increase maternal sensitivity, concluding that effective interventions require a moderate number of sessions with clear behavioral focus (Bakermans-Kranenburg et al„ 2003). Fortunately, developmental outcomes for children who have been neglected may be changed through counseling interventions. Improvements in quality of care have been found to promote security (van den Boom, 1994; van den Dries, Juffer, Van IJzen doom, & Bakermans-Kranenburg, 2009). Strategies exist for working with caregivers to improve their relationships with their children, and as noted in the Bakermans-Kranenburg et al. (2003) review, relatively short behavioral interventions focused on ma ternal sensitivity were highly effective. Strategies include working with caregivers to build skills, provide support, and provide pos itive interactions (Tomlin & Viehweg, 2003) and focusing on working with the family as opposed to using interventions that focus on the child alone. Heffron (2000) recommended services along a continuum of support. Included were more globally based services that promote community health, which could involve working with pediatricians to identify families in which the infant-caregiver relationship is compromised (Heffron, 2000). More individual levels could in clude relationship-based support strategies that include the provi sion of general support and education to new parents. Still more intensive support would involve psychotherapeutic interventions for caregivers who suffer from depression, for example, and are unable to provide responsive caregiving. Interventions have been identified for children who have suffered from neglect, and a number have focused on the resilience of infants. Social, emotional, and environmental de privation has been associated with atypical brain development, emotional problems, and increased risk for psychopathology (McLaughlin, Fox, Zeanah, & Nelson, 2011). These deleterious effects exert their maximal influence during sensitive periods of development where there is maximal effect on the developing brain. Windows of vulnerability to experience-dependent changes may be mitigated by specific preventive interventions in order to potentiate flexible human adaptational systems that allow infants to be resilient (Masten, 2001). There is also evidence that some children are more affected by their envi ronmental experiences than others (Belsky, BakermansKranenburg, & van IJzendoorn, 2007).
Implications for Research The need for developing, implementing, and testing effective interventions continues to be important. A major line of re search is in child-parent psychotherapy (CCP; Lieberman & Van Horn, 2009). CPP centers on the premise that “nurturance, protection, and culturally and age appropriate socialization from the attachment figure(s) comprise the cornerstone of men tal health in infancy and early childhood and create interactive patterns that are internalized by the child in the forms of stable
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and lifelong psychological “structures” (Lieberman & Van Horn, 2009; p. 439). Another empirically validated clinical model is the Circle of Security (Powell, Cooper, Hoffman, & Marvin, 2009), which is an attachment-based method to help caregivers provide a secure base for their infants. Still other interventions focus on the education of the caregivers, especially if they are compromised in some way (Suchman, DeCoste, & Mayes, 2009). Given the use and validation of such interventions, it will be important to see change in the neural correlates—for both care givers and children—that result from them, in addition to behav ioral outcomes. Currently, outcomes are measured in behavioral terms (Lieberman & Van Horn. 2009) and in improvements in attachment scores (Powell et al., 2009). Although there are substantial data on the infant’s ability to experience and express emotions and explore the environment and learn, research on the neurobiology of infant attachment consists mainly of studies from the mother’s perspective or based on the use of animal models. Therefore, an important line of research would be to investigate in infants the neural corre lates of forming close and secure attachment relationships. More studies using neuroimaging methods for unraveling the neural correlates of infant mental health should be encouraged. In fact, few studies are available partially due to the fact that neuroimaging methods (e.g., positron emission tomography, fMRI) are challenging to use in healthy infants. New fMRI protocols as well as the advent of multichannel NIRS, however, may overcome these limitations. Another line of research is to include other neurobiological markers (e.g., oxytocin) and per form genetic and epigenetic studies in order to assess how genetic expression can be regulated by the environment and “translated” into different neural and behavioral phenotypes through a Gene X Environment (GXE) perspective. Finally, several studies of infants show the brain’s ability for experience-dependent plasticity (Cramer et al., 2011), with specific associative brain areas (e.g., the prefrontal cortex) being highly modifiable by cognitive and affective experiences. Interventions have demonstrated increased nurturing in the caregivers as well as improved self-regulation and more orga nized attachment in the children (Dozier, Dozier, & Manni, 2002). The National Scientific Council on the Developing Child (2012) provides an overview of promising intervention models that have demonstrated psychosocial (e.g., more secure attach ments) and neurological (e.g., more typical patterns of cortisol production) impacts. Obviously, more studies are needed.
Conclusions Although this article is not an exhaustive review of the literature on neural correlates, the correspondences we pre sented suggest important implications for practice and research. It is critical for counseling psychologists to recognize the nature of these neural correlates and their impact on development when caregiving is less than optimal. Counseling psychologists are in a pivotal role in their work with individuals, families, and the community to identify caregivers who are unable to deliver responsive care. They also play central roles in working with personnel in community agencies (e.g., Early Intervention Cen ters, Head Start) to develop and sustain policy and system
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efforts to aid families in the care of their children. Future research should continue to investigate the neural correlates of what children say and do, and what their caregivers say and do, in addition to the impact of these interventions on the devel oping brain.
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Received January 1, 2014 Revision received April 23, 2014 Accepted April 27, 2014 ■
Correction to Brewster et al. (2014) In the article “Moving Beyond the Binary With Disordered Eating Research: A Test and Extension of Objectification Theory With Bisexual Women ” by Melanie E. Brewster, Brandon L. Velez, Jessica Esposito, Stephanie Wong, Elizabeth Geiger, and Brian TaeHyuk Keum (Journal o f Counseling Psychology, 2014, Vol. 61, No. 1, pp. 50-62. doi:10.1037/a0034748), the name of author Brian TaeHyuk Keum was misspelled as TaeHyuk Brian Keum. The online version of this article has been corrected. http://dx.doi.org/10.1037/a0038172
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Neurosciences of Infant Mental Health Development: Recent Findings and Implications for Counseling Psychology Adriana Sampaio
Karin Lifter
University of Minho, Braga
Northeastern University
This article is about the neural correlates of infant mental health and their correspondences to social emotional development. These correspondences are organized in terms of the definition of infant mental provided by Zero to Three (2001), centered on infants’ capacities regarding the experience and expression of emotions, interpersonal relationships, and learning. We conclude with implications of these correspondences for counseling psychology— namely, working with children’s caregivers to maximize children’s healthy social and emotional development. Keywords: infants, infant mental health, parent-child relationships, social development, emotional development Supplemental materials: http://dx.doi.org/10.1037/cou0000035.supp
Brain development, which is a continuous process with increas ing specialization and differentiation, is correlated with what in fants and young children say and do, and what they and their caregivers bring to their reciprocal interactions. Recent research in cognitive neuroscience has been providing new insights about how the genetic, environmental, and experience factors shape brain development, in utero and throughout the life span. Early experi ences, especially caregiver-child interactions, matter (Zeanah & Zeanah, 2009). As described by the Center on the Developing Child at Harvard University (2012), “experiences ‘authorize’ ge netic instructions to be carried out and shape the formation of the (brain) circuits as they are being constructed” (p. 1). This article is about the neural correlates of infant mental health and their correspondences to social emotional development. We begin with a definition of infant mental health, taken from Zero to Three (Zero to Three, 2001), which centers on infants’ capacities regarding the experience and expression of emotions, interpersonal relationships, and learning. We then present several studies on the neural correlates of infant mental health.1 We conclude with im plications for practice and research in counseling psychology.
secure interpersonal relationships; and explore the environment and learn—all in the context of family, community, and cultural expectations for young children. Infant mental health is synony mous with healthy social and emotional development” (Zero to Three, 2001, p. 1). These three capacities provide a useful way to organize the emerging literature in cognitive neuroscience. Studies of infants have demonstrated that the neural substrates of these developing capacities can be uncovered by the use of noninvasive neuroimaging techniques as electroencephalogram (EEG)/eventrelated potentials (ERPs), psychophysiology, magnetic resonance imaging (structural and functional), positron emission tomography (PET), magnetoencephalography, and functional near-infrared spectroscopy (NIRS).
Neural Correlates of the Ability to Experience, Regulate, and Express Emotions Infants’ abilities to perceive, experience, and recognize emo tions, which allows them to engage with caregivers, have been studied mainly through behavioral and EEG/ERP studies.
Definition of Infant Mental Health
Perception, Experience, and Recognition of Emotions
Infant mental health, which is an interdisciplinary field, is centered on “the developing capacity of the child from birth to age three to experience, regulate, and express emotions; form close and
At birth, the neonate is rapidly able to perceive emotions by selecting significant and important information from human faces and voices. Infants are able to learn about the other’s emotion by integrating social-perceptual stimuli such as face and human voice in their internal states (e.g., imitation; O’Reilly & deHann, 2009) and by recognizing emotional states. Face specialization. The first signs of face specialization are present early after birth, including attention to eye gaze, face and face-like patterns. Attention to eye gaze emerges early after birth,
Adriana Sampaio, Neuropsychophysiology Lab, CIPsi, School of Psy chology, University of Minho, Braga; Karin Lifter, Department of Coun seling and Applied Educational Psychology, Northeastern University. We thank Sara Cruz for her help in the reviewing process. Correspondence concerning this article should be addressed to Adri ana Sampaio, Neuropsychophysiology Lab, CIPsi, School of Psychol ogy, University of Minho, Braga, Portugal. E-mail: adriana.sampaio@ psi.uminho.pt
1 For a summary of the neural correlates of infant mental health, please see the supplemental materials. 513
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with infants preferring to look at faces with directed rather than averted eye gaze (Farroni, Csibra, Simion, & Johnson, 2002). Underlying neural correlates include enhanced amplitude of N170 component, which is evident in 4-month-old infants when attend ing to direct gaze. Consistent with this is a distributed brain cortical activation that overlaps the adult face-processing area (Tzourio-Mazoyer et al., 2002). Auditory specialization. The infant’s ability to perceive emo tions by selecting significant and important information from the human voice is also present at birth. Research has demonstrated that neonates prefer human speech to other auditory stimuli, spe cifically, the maternal voice (DeCasper & Fifer, 1980). ERP cor relates of the auditory processing of the infant’s mother’s voice are associated with a smaller P350 and increased N450 amplitudes, when compared to an unfamiliar voice (Purhonen, KilpelainenLees, Valkonen-Korhonen, Karhu, & Lehtonen, 2004). Recognition of different emotional states. There is evidence of an early ability of the neonate to recognize, discriminate, and imitate facial expressions (Field, Woodson, Greenberg, & Cohen, 1982). Infants are relatively consistent in discriminating happy expressions from other emotions (Kotsoni, de Haan, & Johnson, 2001). Studies have demonstrated that in 4-month-old infants, the Nc amplitude is increased to happy expressions (Farroni, Menon, Rigato, & Johnson, 2007). However, this pattern of preferential attention allocation to happy faces changes to fearful expressions at 7 months of age. Consistent behavioral and EEG/ERP evidence shows that infants around this age allocate more attention re sources to fearful emotional expressions, in addition to an increase in the Nc component to fearful faces (Kotsoni et al., 2001). Despite this converging behavioral and neural evidence showing an increasing maturation of auditory and facial emotional expres sion recognition, sensorial modalities are integrated in most social interactions. Integration of facial and vocal emotional information was assessed within 7-month-old infants while processing emo tionally congruent and incongruent face-voice pairs, using EEG. The authors showed emotionally incongruent pairs were associated with larger negative ERP component, and emotionally congruent pairs were associated with an increased positive ERP component, which suggested infants are able to recognize emotional content and affect across modalities (Grossmann, Striano, & Friederici, 2006).
Regulation of Emotions Early regulation of emotions is imposed by caregivers in a responsive caregiving environment. Studies have shown that in fants prefer an infant-directed (ID) speech (DeCasper & Fifer, 1980). High arousal positive vocal emotion contributes signifi cantly to the infant’s preference for ID speech (Corbeil, Trehub, & Peretz, 2013). Maternal speech is therefore central to infant atten tion, arousal, and regulation. Studies have shown differential psychophysiological data according to the affective emotional state of the ID speech, namely a deceleration of the infant heart rate to ID speech independent of affective content (Santesso, Schmidt, & Trainor, 2007). Studies have shown that emotional prosody is associated with different psychophysiological and EEG signatures. More intense startle responses were documented in 5-month-old infants when exposed to angry facial emotional expressions (Balaban, 1995).
EEG/ERP studies have revealed that angry prosody elicits a more negative ERP component than does happy or neutral prosody in 7-month-old infants (Grossmann, Striano, & Friederici, 2005). Increased EEG power in the frontal regions of 9-month-old infants was documented in response to fear, as opposed to surprise and love/comfort (Santesso et al., 2007). Infants’ neural processing to emotional tone of voice, portrayed by non-physical interparental conflict, has been assessed with functional magnetic resonance imaging (fMRI) in 6- to 12-monthold infants (Graham, Fisher, & Pfeifer, 2013). Results have shown that higher inter-parental conflict (very angry tone of voice) was associated with increased activation of the rostral anterior cingu late cortex, as well as subcortical regions— brain regions associ ated with emotional regulation and stress. These data suggest a greater allocation of brain and attention resources to negative emotions such as anger and fear.
Expression of Emotions Electrophysiological studies have suggested a lateralized brain response underlying the expression of positive and negative emo tional facial expressions. This cerebral asymmetry was demon strated in newborns when exposed to stimulus-eliciting affective responses. Fox and Davidson (1988) found that EEG frontal acti vation asymmetry could discriminate a range of positive and negative facial expressions in 10-month-old infants: specifically, greater left frontal relative activation in response to mother and happy stimuli, when compared with strangers and sad stimuli, respectively (Davidson & Fox, 1982; Fox & Davidson, 1988). By 18-21 months, toddlers begin to demonstrate awareness of themselves, which includes the expression of the social emotions (e.g., shame, guilt, pride). They also display increases in symbolic representation, as a function of developments in cognition (Rosenblum, Dayton, & Muzik, 2009). However, more studies on the perception and expression of these discrete expressions in infancy are clearly warranted in order to understand early emotional de velopment. In sum, these experience-dependent capacities that infants dem onstrate allow them to engage with the caregivers in their envi ronments, setting the stage for reciprocal interactions.
Neural Correlates of the Ability to Form Close and Secure Interpersonal Relationships Close and secure positive interpersonal relationships are central to infant mental health, forming the basis for attachment. They contribute to the development of prosocial behaviors.
Neural Correlates in the Development of Attachment As we have discussed, the infant is bom with the capacity to engage the environment, and in particular, to engage caregivers. The infant is able to focus and follow stimuli, being preferentially oriented toward human forms and sounds, when compared with non-social-oriented stimuli (Legerstee, Anderson, & Schaffer, 1998). These capacities are nurtured and encouraged by a respon sive caregiving environment; it is the moment that both parent and infant are attracted to each other, seeking contact and proximity that lead the dyad to establish affect-regulative interactions, where the mother-infant interaction is privileged.
NEUROSCIENCES OF INFANT MENTAL HEALTH DEVELOPMENT
Social and emotional developments contribute to the transac tions between infants and caregivers, setting the stage for caregiver responsiveness to the infant’s developing capacities. A secure attachment style provides a platform for exploring the environ ment. Around 9 months of age, the foundations for higher socioemotional and cognitive functions are being built as the infant develops the sense of understanding subjective states of others as well as acting jointly. These processes are threatened when the caregiver is depressed or unable to respond sensitively (Murray, Fiori-Crowley, Hooper, & Cooper, 1996). A synchronous caregiver-infant relationship is associated with optimal parenting, and it is predicted by cardiac vagal tone (Feld man & Eidelman, 2007). Higher affect synchrony and infant social engagement are also associated with increased peripheral oxytocin measures (Feldman, Gordon, & Zagoory-Sharon, 2010). Studies have supported a dynamic interplay between the maturation of the “social brain,” involving the orbitofrontal cortex, amygdala, and temporal regions and the establishment of an attachment relation ship (Moriceau & Sullivan, 2005). However, the role of these brain regions in mother-infant attachment has been studied mainly from the mother’s perspective; limited information is available on the infant’s brain areas underlying the development of attachment relationships. In fact, most studies in the neurobiology of infant attachment have been conducted in animal models (see Moriceau & Sullivan, 2005). Indirect evidence of infant brain development documents sub sequent increases in glucose uptake in these attachment-related brain regions, including frontal and various association regions, around 8 months (Chugani, 1998). A cortical surface expansion of the superior and medial temporal, superior parietal, medial orbito frontal, lateral anterior prefrontal, occipital cortices, and postcen tral gyrus areas has been observed (Li et al., 2013). These func tional and structural changes correspond to the precursors of theory of mind, thinking, self-referential activity, and internal regulation. They correspond to the emerging understanding of persons and objects as permanent entities and to the ability to use symbols in the representation of experience.
Neural Correlates in the Disruption of Responsive Caregiving Studies have demonstrated neurological impacts as a result of less than optimal caregiving (e.g., Hanson et al., 2013; Stratheam, 2011). Neglect has been identified as “the most prevalent form of child maltreatment” (National Scientific Council on the Develop ing Child, 2012, p. 6). Events such as “abandonment . . . by the parent; early separation or loss of the primary care-giving figure; early exposure to trauma; abuse (and neglect); maternal depression and parental psychopathology; conflicted family relationships; se vere lack of resources; premature birth; difficult infant tempera ment; and poor supplemental care settings” (Fitzgerald, Weatherston, & Mann, 2011, p. 181) are all threats. Studies have demonstrated that children who are neglected show atypical EEG power distribution, including lower absolute alpha power (Tarullo, Garvin, & Gunnar, 2011), as well as abnormal activity in the amygdala and hippocampus as a consequence of neglect (Totten ham et al., 2011). Infants of depressed mothers experience more negative expressions than do infants of non-depressed mothers, showing altered EEG signature, namely greater relative right fron
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tal activation (Diego, Field, Jones, & Hernandez-Reif, 2006). The emotional environment provided by the mother’s affective dispo sition is associated with the infant’s processing of facial expres sions of emotion (de Haan, Belsky, Reid, Volein, & Johnson, 2004). Studies conducted in infants who were maltreated, neglected, and abused show a deleterious impact in both mental and physical health development. Indeed, atypical rearing condi tions are believed to hinder the development of stable relation ships (Bakermans-Kranenburg et al., 2011) and to inhibit the normative shift in socio-emotional development during the first years of life. Moreover, difficulties with responsive caregiving often co-occur with other threats to family and community life (Murray et al., 1999).
Neural Correlates of the Ability to Explore the Environment and Learn In order to explore the environment and learn, the infant needs to develop the social and emotional skills (i.e., attachment) to create a secure base for exploration. The infant also needs to integrate multisensory stimuli into internal and self-regulatory states and to develop motor skills in order to move about— both moving in relation to the environment and moving objects in relation to the stationery self and others. Finally, the infant needs to develop cognitive and social communicative skills—to acquire knowledge about objects, people, and events and the relationships among them and to express that knowledge in his or her language and play.
Neural Correlates of Multisensorial Integration The neonate is already able to apprehend and explore the envi ronment, through multiple sensory cues (e.g., olfactory, somato sensory, visual, and auditory). Salient cues include the perception of the mother’s odor, as olfactory learning occurs during the first hours of postnatal life. Functional data (NIRS) have shown that in the 6 hr to 192 hr after birth, the neonate demonstrates a differ ential pattern of changes in blood flow over the left orbitofrontal region when exposed to vanilla and colostrum smell (Bartocci et al., 2000). Greater activation of the orbitofrontal cortex to the odor of maternal breast milk compared to formula milk was demon strated (Aoyama et al., 2010). Human tactile stimulation was reported to be associated with improvement in certain biological and behavioral conditions, by promoting body and mental development. Several studies exam ining electric potentials and magnetic fields (supplementary eye fields) showed consistent neural responses (N1-P1-P2 and M60) distributed from posterior to anterior regions, generated in the primary cortex (e.g., Nevalainen et al., 2008). fMRI evidence has revealed an activation of the contralateral primary somatosensory cortex to tactile stimulation (Arichi et al., 2010). These markers, found in healthy, full-term newborns, corresponded to changes in developmental processes (Gois-Eanes, Gonsalves, Caldeira-daSilva, & Sampaio, 2012). Although the neonate's ability to differentiate visual details is limited, the visual system is characterized by substantial changes in the first year: a fast increase in synaptic density in the visual cortex in parallel with intense myelination of the visual tracts in
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the first four postnatal months (Dubois et al., 2008). At 1 month of age, early visual evoked potential components, such as N l, PI and N2, play an important role in healthy brain development, as the presence of these components is associated with healthy visual stimuli processing (Benavente, Tamargo, Tajada, Yuste, & Olivan, 2005). By 6 months of age, healthy full-term born infants show a positive P2 component associated with good neural maturation of the neonatal visual cortex (Benavente et al., 2005). One of the earliest functions to emerge is the auditory function. In fact, the P I50, N250, P350, and N450 peak components were identifiable both at birth and at 12 months (Kushnerenko et al., 2002). However, the maturation of these components is considered to be a continual process throughout infancy, as the amplitude of the peaks increase and the latency of the peaks decrease through out time (Wunderlich & Cone-Wesson, 2006). All these brain maturational processes are corroborated by an increase in the glucose uptake in the parietal, temporal, and primary visual cortex, among other brain regions, at 2-3 months (Chugani, 1998). Multisensorial integration allows the infant to pick up and explore toys (around 6 months), to create relationships between and among toys (around 12 months), and to represent his or her experiences in play activities (around 18 months; Lifter & Bloom, 1989). These developments depend upon the maturation of specific neuromotor networks in parallel with specialized brain circuits involved in motor planning, anticipation, motor imagery, and spatial cognition. They are strongly associated with cognitive, emotional, and language skills (Koziol & Lutz, 2013).
Neural Correlates of Motor Development At birth, the motor behavior repertoire consists of an array of neurological reflexes (e.g., grasping, sucking) and specific combi nations of limb and muscle movements (flexors activity, extensor activity). From birth to about 3 -4 months of age, in parallel with advancements of the visual system, postural trunk control, eyehand coordination, and arm velocity and muscle forces regulation, infants develop a phase of pre-reaching movements (AnguloBarroso & Tiernan, 2008). Increased glucose metabolism in the primary sensorimotor cortex, cingulate cortex, thalamus, brain stem, cerebellum, and hippocampal region has been described in the newborn (Chugani, 1998). These results are consistent with activity of the resting state networks (e.g., sensorimotor) detected in the infant brain (Fransson et al., 2007). Maturation of these brain networks is associated with adjustments in motor behavior but also in motivation, attention, anticipation, learning about current and prospective control of movement, motor planning, motor memory, and recognition of motor actions. This maturation is modulated by the experience; the infant’s experiences will have a structural and functional impact in the development of these neuromotor systems (Angulo-Barroso & Tiernan, 2008).
Neural Correlates of Language and Cognitive Development Joint attention emerges at around 9-10 months of age and is considered an important milestone for language and socialemotional development (Carpenter, Nagell, & Tomasello, 1998). Neural signatures underlying infant attention allocation (increased Nc amplitude) were evident when 9-month-old infants viewed
objects after an interactive joint attention task compared to a non-joint attention interaction (Striano, Reid, & Hoehl, 2006). The neural precursors (e.g., left dorsal prefrontal cortex) are evident at the age of 5 months (Grossmann & Johnson, 2010). Consistent with this neurobiological readiness for sharing attention, it was observed that the white matter integrity of the right fronto-limbic connection (uncinate fasciculus) at 6 months predicted infants’ responding to joint attention at 9 months (Elison et al., 2013). Joint attention is an important predictor of socio-communicative skills, with these fronto-temporal networks involved in the later development of language skills. Maturation of the auditory cortex is associated with early language learning skills (e.g., speech sound discrimination). Infants at 3 months are able to discriminate speech presented in normal and reversed order, exhibiting greater func tional activation of left temporal areas (similar to adults) to speech stimuli and a right frontal activation when processing normal speech (Dehaene-Lambertz, Dehaene, & Hertz-Pannier, 2002). These results are consistent with other fMRI and magneto encephalography studies showing an activation of speech produc tion brain areas when infants are processing speech-related stimuli (Dehaene-Lambertz et al., 2006; Imada et al., 2006). There is evidence of an increasing synchronized perceptualmotor brain activity when listening to speech, as activation of both auditory and motor brain regions is only detected in 6- and 12-month-old infants and not in newborns (Imada et al., 2006). Infants at 12-18 months recruited adult-like left fronto temporal areas necessary for processing lexico-semantic infor mation (understanding new and old words; Travis et al., 2011). This knowledge about word meanings and underlying ERP signature (N400m) is possibly related to an infant’s ability to produce words, with a marked spurt in vocabulary evident around 18 months (Lifter & Bloom, 1989). Moreover, increased neural efficiency is associated with language proficiency, with ERP components to comprehended and unknown words being more widely distributed over bilateral anterior and posterior brain regions in 13- to 17-month-old infants compared with more focal and limited activation of left temporal and parietal regions at 20 months (Mills, Coffey-Corina, & Neville, 1997). Toddlers are also likely to be sensitive to syntactic violations in spoken sentences, showing an early left-lateralized brain re sponse when an expected verb is wrongly replaced by a noun (Bernal, Dehaene-Lambertz, Millotte, & Christophe, 2010).
Implications for Practice and Research in Counseling Psychology Implications for practice and research include working with families to support responsive care, and examining the impact of interventions on behavior and underlying neural correlates.
Implications for Practice: Working With Families to Support Responsive Care This work would begin with practitioners being alert to threats to responsive care, which would include neglect and abuse by caregivers, depression and psychopathology of care givers, a severe lack of resources for the family, and vulnera bilities imposed by the infants (e.g., prematurity, difficult tem peraments; Fitzgerald et al., 2011).
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Once families who are risk are identified, interventions can be put into place. In their meta-analysis of sensitivity and attachment interventions in early childhood, Bakermans-Kranenburg, van IJzendoom, and Juffer (2003) concluded enhancing parental sen sitivity plays a causal role in enhancing attachment security. They reviewed various interventions that increase maternal sensitivity, concluding that effective interventions require a moderate number of sessions with clear behavioral focus (Bakermans-Kranenburg et al„ 2003). Fortunately, developmental outcomes for children who have been neglected may be changed through counseling interventions. Improvements in quality of care have been found to promote security (van den Boom, 1994; van den Dries, Juffer, Van IJzen doom, & Bakermans-Kranenburg, 2009). Strategies exist for working with caregivers to improve their relationships with their children, and as noted in the Bakermans-Kranenburg et al. (2003) review, relatively short behavioral interventions focused on ma ternal sensitivity were highly effective. Strategies include working with caregivers to build skills, provide support, and provide pos itive interactions (Tomlin & Viehweg, 2003) and focusing on working with the family as opposed to using interventions that focus on the child alone. Heffron (2000) recommended services along a continuum of support. Included were more globally based services that promote community health, which could involve working with pediatricians to identify families in which the infant-caregiver relationship is compromised (Heffron, 2000). More individual levels could in clude relationship-based support strategies that include the provi sion of general support and education to new parents. Still more intensive support would involve psychotherapeutic interventions for caregivers who suffer from depression, for example, and are unable to provide responsive caregiving. Interventions have been identified for children who have suffered from neglect, and a number have focused on the resilience of infants. Social, emotional, and environmental de privation has been associated with atypical brain development, emotional problems, and increased risk for psychopathology (McLaughlin, Fox, Zeanah, & Nelson, 2011). These deleterious effects exert their maximal influence during sensitive periods of development where there is maximal effect on the developing brain. Windows of vulnerability to experience-dependent changes may be mitigated by specific preventive interventions in order to potentiate flexible human adaptational systems that allow infants to be resilient (Masten, 2001). There is also evidence that some children are more affected by their envi ronmental experiences than others (Belsky, BakermansKranenburg, & van IJzendoorn, 2007).
Implications for Research The need for developing, implementing, and testing effective interventions continues to be important. A major line of re search is in child-parent psychotherapy (CCP; Lieberman & Van Horn, 2009). CPP centers on the premise that “nurturance, protection, and culturally and age appropriate socialization from the attachment figure(s) comprise the cornerstone of men tal health in infancy and early childhood and create interactive patterns that are internalized by the child in the forms of stable
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and lifelong psychological “structures” (Lieberman & Van Horn, 2009; p. 439). Another empirically validated clinical model is the Circle of Security (Powell, Cooper, Hoffman, & Marvin, 2009), which is an attachment-based method to help caregivers provide a secure base for their infants. Still other interventions focus on the education of the caregivers, especially if they are compromised in some way (Suchman, DeCoste, & Mayes, 2009). Given the use and validation of such interventions, it will be important to see change in the neural correlates—for both care givers and children—that result from them, in addition to behav ioral outcomes. Currently, outcomes are measured in behavioral terms (Lieberman & Van Horn. 2009) and in improvements in attachment scores (Powell et al., 2009). Although there are substantial data on the infant’s ability to experience and express emotions and explore the environment and learn, research on the neurobiology of infant attachment consists mainly of studies from the mother’s perspective or based on the use of animal models. Therefore, an important line of research would be to investigate in infants the neural corre lates of forming close and secure attachment relationships. More studies using neuroimaging methods for unraveling the neural correlates of infant mental health should be encouraged. In fact, few studies are available partially due to the fact that neuroimaging methods (e.g., positron emission tomography, fMRI) are challenging to use in healthy infants. New fMRI protocols as well as the advent of multichannel NIRS, however, may overcome these limitations. Another line of research is to include other neurobiological markers (e.g., oxytocin) and per form genetic and epigenetic studies in order to assess how genetic expression can be regulated by the environment and “translated” into different neural and behavioral phenotypes through a Gene X Environment (GXE) perspective. Finally, several studies of infants show the brain’s ability for experience-dependent plasticity (Cramer et al., 2011), with specific associative brain areas (e.g., the prefrontal cortex) being highly modifiable by cognitive and affective experiences. Interventions have demonstrated increased nurturing in the caregivers as well as improved self-regulation and more orga nized attachment in the children (Dozier, Dozier, & Manni, 2002). The National Scientific Council on the Developing Child (2012) provides an overview of promising intervention models that have demonstrated psychosocial (e.g., more secure attach ments) and neurological (e.g., more typical patterns of cortisol production) impacts. Obviously, more studies are needed.
Conclusions Although this article is not an exhaustive review of the literature on neural correlates, the correspondences we pre sented suggest important implications for practice and research. It is critical for counseling psychologists to recognize the nature of these neural correlates and their impact on development when caregiving is less than optimal. Counseling psychologists are in a pivotal role in their work with individuals, families, and the community to identify caregivers who are unable to deliver responsive care. They also play central roles in working with personnel in community agencies (e.g., Early Intervention Cen ters, Head Start) to develop and sustain policy and system
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efforts to aid families in the care of their children. Future research should continue to investigate the neural correlates of what children say and do, and what their caregivers say and do, in addition to the impact of these interventions on the devel oping brain.
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Received January 1, 2014 Revision received April 23, 2014 Accepted April 27, 2014 ■
Correction to Brewster et al. (2014) In the article “Moving Beyond the Binary With Disordered Eating Research: A Test and Extension of Objectification Theory With Bisexual Women ” by Melanie E. Brewster, Brandon L. Velez, Jessica Esposito, Stephanie Wong, Elizabeth Geiger, and Brian TaeHyuk Keum (Journal o f Counseling Psychology, 2014, Vol. 61, No. 1, pp. 50-62. doi:10.1037/a0034748), the name of author Brian TaeHyuk Keum was misspelled as TaeHyuk Brian Keum. The online version of this article has been corrected. http://dx.doi.org/10.1037/a0038172
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