Therapist's Guide to Pediatric Affect and Behavior Regulation

344 Pages·2013·23.701 MB·English

by  Johnson, Sharon (Auth.)

1
CHAPTER
The Regulatory Disordered
Infant and Child
“There is no such thing as a baby” – only a baby and someone.
Donald Winnicott (Finichel & Eggbeer, 1990)
To comprehend fully the implications of pediatric disorders of regulation in affect and
behavior requires a fundamental background in child development, family systems theory
and psychopathology. Such a clinical perspective provides the framework to utilize the
following information as a basic review on normal or typical child development versus the
development of psychopathology which is the foundation necessary for assessment, accurate
diagnosis and effective treatment.
The regulation of affect and behavior are developmental processes extended through
infancy and childhood, thus establishing the foundation of lifelong abilities and individual
differences associated with self-control. The individual differences in emotional regulation
1
underlie important differences in psychological well-being, social competency and, in
some cases, evolving psychopathology. Therefore, this section will focus on the processes
of development associated with emotion regulation, temperament, attachment, the role of
emotion regulation being influenced by the child’s conceptual growth and understanding,
and social/environmental influences, thereby demonstrating a complex factorial interplay in
normal and abnormal development.
It is nothing short of amazing that a human conception survives the journey to birth.
Congenital abnormalities and the loss of embryos and fetuses prior to birth are caused both
intrinsically and extrinsically. For those who survive, both parents and professionals are
challenged by the presentation of early regulatory problems commonly exhibited by babies.
Regulation is basically the sensory processing method used to recognize, organize, and make
sense of incoming sensory information (hearing/auditory, vision/ocular, smell/olfactory,
touch/tactile, taste/gustatory) and internal sensations (vestibular system which detects
movement/tells us when we are surrounded by something that is moving or on something
moving/tells us up from down/influences concept of outside space and proprioceptive
system which is body awareness/tells us where the body parts are). An adaptive response is
created by the external information being reviewed along with input from the body. When
irregularities in regulation are present they are demonstrated by problems associated with
sleep cycles, feeding, digestion, attention, arousal, mood regulation, and self-soothing.
According to DeGangi (2000), these infants are often hyper- or hypo-sensitive to sensory
stimulation. Most of these issues have been resolved by the time the infant is 6 months of
age. However, some infants continue to demonstrate problems of regulation in these areas
including mood regulation. For these infants, their development into toddlerhood is marked
Therapist’s Guide to Pediatric Affect and Behavior Regulation. DOI: http://dx.doi.org/10.1016/B978-0-12-386884-8.00001-X
© 2013 Elsevier Inc. All rights reserved.
Therapist’s Guide to Pediatric Affect and Behavior Regulation
by problems in regulation (Kostuik & Fouts, 2002; Fox & Calkins, 2003; Schore, 2005; Bell &
Deater-Deckard, 2007):
l Difficulties with attention
l Sensory processing
l Intolerance for change
l Socially inappropriate behavior
l A hyper-alert state of arousal
l Severe separation anxiety.
As a result of the observation of infant to child difficulties with regulation in affect and
behavior as well as increased emotional distress of the parents, these infants and children
find their way into pediatric medical and psychological practices. The clinical presentations
offer a unique opportunity to understand and to intervene early and proactively with
young children and their families. Therefore, the understanding of emotion possesses
important implications for revealing “normal” as well as “abnormal” development. This
significant focal point is directed to the role and development of links between emotion,
behavior and psychopathology. The clinical perspective seeks to clarify which category or
parameters the infant/child demonstrates difficulty with, how much it interferes with
their or others’ lives and what the impact is to their level of functioning. There may be
identified symptoms in one category and none in another or some symptoms in more
than one category. The different types of regulatory disorders described by Diagnostic
Classification: 0-3 (DC:0-3R) are utilized for the presentation of symptomology, disorders
and subtypes.
NORMAL DEVELOPMENT OF REGULATORY PROCESSES
2
IN INFANCY
Emotion regulation is a component of emotional activation in a network of multilevel
processes consisting of internal and external processes responsible for monitoring, evaluating
and modifying emotional reactions – specifically their timing and intensity in meeting
one’s goals. These processes are exemplified by the interaction and feedback between higher
and lower systems, such as the mutual influence of multiple emotional related systems
which sometimes contribute to maladaptive outcomes, especially in circumstances of
environmental hardship (Thompson et al, 2008). This complex construct is an integration of
behavior (including motor skills), genetic mechanisms, attention, cognition, environmental
influences and emotional control (especially negative emotions). All of these factors
contribute to the unique differences in self-regulation. Self-regulation is the ability to
control inner states (responses) with regard to emotions, thoughts, attention, and function
(performance) (Bell & Deater-Deckard, 2007). It is the development of competence in
responding to life demands. The brain is continually sensing and responding to the needs of
the body and the environment. An infant/toddler is able to maintain internal equilibrium
by modulating sensory stimulation from their environment by altering or adjusting the
intensity of arousal experienced while remaining engaged in an interaction or being able to
disengage easily from an activity. Much of this regulation takes place automatically outside
of conscious awareness. Therefore, an adaptive response is an appropriate action resulting
from the synthesis of incoming sensory information received through the central nervous
system. It can be conscious or unconscious (predominantly) and is the consequence of
adequate sensory integration which, in turn, reinforces the improvement or continuing
refinement of sensory integration. Therefore, normal regulation or modulation is not a
straight trajectory, but rather a developmental process which takes place within a range of
limits. Normal, healthy self-regulation is related to the capacity to tolerate the sensations of
distress that accompany an unmet need through the repetition of the experience of a chain
CHAPTER 1
The Regulatory Disordered Infant and Child
of associated stimulus response cues (Schore, 2001, 2005; Bell & Deater-Deckard, 2007;
Thompson et al, 2008; Benson & Haith, 2009). For example:
hunger > discomfort > distress > tearfulresponse
> satisfaction = leaarning
(this is a simple example of early learning that the feeling of distress will pass as a result of
the intervention of an attuned adult. This leads to learning skills of self-management which
includes increased tolerance and eliciting appropriate resources).
As the child learns to tolerate distress they become much less reactive and impulsive. This
is a demonstration of the evolution of self-regulation. The responsiveness of the attuned
adult facilitates the learning that allows the child to build the capacity to place a moment
between the impulse and an action. Such a delay results in reinforcing success and increasing
self-regulation. When the child is able to insert a moment between a feeling and an action
they then have achieved the ability to take the time to think, plan, and develop a response
to the challenge and demonstrate goal directedness. This scenario is a simplistic example
of the multifaceted process of developing self-regulation. However, it does provide a useful
display of the power of interplay between an infant/child and a positive effective caregiver.
Additionally, it serves to demonstrate the emergent knowledge and skill development
associated with self-regulation. The infant’s success at regulation significantly depends on
the caregiver’s awareness, flexibility, and responsivity to the child’s emotional expression
and need for caregiver intervention. The toddler advances this theme with the ability to
initiate a greater repertoire of self-regulating behaviors critical to developmental progression
of independence, control and an identity separate from the caregiver. As the toddler makes
the transition to preschool and subsequently to school there is a marked acquisition of an
integrated set of domain-specific mechanisms or “self-regulation”.
3
Over the course of development, initiated prenatally and evolving into sophisticated and self-
initiated processes from toddler > preschool > school years, regulatory processes progress in
association with the child’s increasing capacity to regulate their motoric and effective behavior.
This takes place first in the dyadic relationship (infant), progresses to guiding caregiver in
toddlerhood, and later as a function of voluntary and effortful control. The transition from
toddler to preschooler (age 2 to 3 years) is particularly interesting in normal or typical
regulatory development. The child begins to gain control over impulses and actions that are
primarily activated situationally, whereby they demonstrate increased capability regarding
behavior compliance and delay of gratification. During their preschool experience they begin
to engage in more executive or cognitive control of thoughts and actions. It is the emergence of
these skills that supports the successful transition to the school and peer environment which
demands independent and adaptive behavioral functioning (Rothbart et al, 2000, 2003; Fox &
Calkins, 2003; Calkins 2004; Rothbart & Rueda, 2005). Increases in language development,
cognitive abilities, and specific self-regulation skills acquired during toddlerhood allow for
most children to learn to control early (normal) non-compliant, aggressive, and impulsive
tendencies resulting in a decrease in problem behavior (Campbell, 2002).
In conclusion, a child’s emotional health is molded by a complex interaction between
genetic, constitutional and environmental factors. The environmental factors are double
edged offering a compelling influence of risk and protection. These factors are dependent
on quality and availability in their command by either protective aspects via buffering
and encouraging resilience and typical development or by exacerbating the likelihood of
emotional, social and cognitive problems.
CAREGIVER CHARACTERISTICS
l Mental health (emotional/psychological functioning)
l Educational level
Therapist’s Guide to Pediatric Affect and Behavior Regulation
l Self-efficacy/self-sufficiency
l Resourcefulness and coping
l Health and general well-being
FAMILY FACTORS
l Caregiver–child relationship
l Emotional atmosphere
l Marital quality/task collaboration
l Degree of stress
l Stability
l Sibling issues
COMMUNITY CONNECTEDNESS FACTORS
l Caregiver social support
l Quality of child care
l Child’s peer relationships
l Extended family influence
l Cultural/ethnic norms and expectations
ENVIRONMENTAL/NEIGHBORHOOD FACTORS
l Availability and diversity of resources
l Adequacy of housing
l Violence/safety
Attachment
At birth, the brain is the most undifferentiated organ. It has a plasticity that enables the
4
creation of neural circuitry throughout life. This means the brain is capable of renewing
its structure and function as a result of experiences, in particular, social experiences.
Attachment, the emotional bond that is formed between an infant and their primary
caregiver, profoundly influences both the structure and the function of the developing infant
brain. When that attachment bond is not adequately formed, whether as a result of abuse,
neglect, or emotional unavailability on behalf of the caregiver, brain structure and function
can be negatively impacted, causing relational or developmental trauma (Diener et al., 2002;
Schore, 2001, 2005; van der Kolk, 2005).
The role of attachment in association with emotion regulation during early childhood
emphasizes the importance of the context of the parent–child relationship. As the infant
develops and directs interest outwards, it is the caregiver who is responsible for helping
the infant to regulate the level of arousal. The caregiver accomplishes this by responding to
infant cues of distress and providing comfort as well as intense positive arousal experiences.
The infant learns from these interactions to trust the caregiver and their help to resolve
distressing arousal. This relationship development lays the foundation for establishing an
effective attachment relationship, or the dyadic regulation of infant emotion and arousal. As
a result, the quality of care provided during this developmental period (dyadic regulation)
significantly contributes to the infant’s regulatory ability. This relationship has a bidirectional
quality for the infant. Not only do they receive from the attuned caregiver, but they directly
elicit through their willingness to utilize the caregiver as a secure base, thus allowing
them to expand the exploration of their world. As the infant progresses to toddler and
then preschooler the role of dyadic regulation and then caregiver-guided self-regulation is
replaced with a desire for increased autonomy. The transitional states from dyadic regulation
to caregiver-guided regulation to self-regulation are significantly influenced by the quality
and consistency of the attachment relationship. Attachment security is associated with
effective self-regulation and fewer behavioral problems in preschool. In other words, secure
CHAPTER 1
The Regulatory Disordered Infant and Child
FIGURE 1.1
Family members toast
with water glasses.
infant–caregiver attachment is related to lower risk for later peer and behavioral problems.
Of course, other features unique to the infant (genetic, temperament, as well as other
characteristics) are also a part of this evolving matrix of skill development, or deficiencies in
development. Bottom line, competence is associated to healthy developmental trajectories as
a protective factor which also increases opportunities for positive interactions and feedback
(Mahler et al, 1975; Weinfield et al, 1999; Zeanah, 2000; Schore, 2001) (Figure 1.1).
Schore (2001, 2005; Benson & Haith, 2009) clearly speaks of the relationship between
5
emotion and biology. Multiple regions of the brain and neurohormonal processes are
intertwined with emotion and its management. In the nature–nurture scheme, the
capacities of emotion regulation unfold along with developmental advances of maturity
and the neurobiological influence of attachment. At birth, these systems are active but lack
maturity. The HPA (hypothalamic–pituitary–adrenocortical) axis and the subcortical
structures such as the amygdala and hypothalamus work together in the activation of the
sympathetic nervous system thus arousing the newborn infant. In a manner similar to
the activation of sympathetic arousal, the other branch of the autonomic nervous system,
the parasympathetic branch, has an inhibitory affect. These immature nervous system
responses are the underlying reason for the all or nothing quality of infant response (such as
crying). Thus demonstrating that the infant cannot yet regulate manifestations of arousal. An
additional feature on the nature side of the equation is the constitution that the infant brings
with them, particularly temperament.
Neurological functioning stems from both genetics and environmental influence. Genetics
provides innate capacities shaped by experience toward optimal functioning or by limiting
capacity. Neurobiology is an integrated network of crucial developmental elements and is the
cornerstone of attachment relationships as well as executive functions development. In turn,
secure attachments provide the foundation of optimal brain development which facilitates
and reinforces skill of executive function such as judgment, planning and management
ability of emotional trauma, loss and neglect. Likewise, in the fashion of a negative
feedback loop trauma, loss and neglect have the ability to impact negatively neurobiological
developmental capacities for attachment, self-regulation and executive function. The
demonstration of the neurobiological factors works much like a bidirectional arrow: external
(information taken in) ←→ internal (integrated) ←→ external (reflected in skill development
and risk). A central characteristic of neurobiology is plasticity. Plasticity is a lifelong ability
of the brain to reorganize neural pathways based on new experiences (or the ability of the
Therapist’s Guide to Pediatric Affect and Behavior Regulation
brain to change with learning). Children imitate and internalize influences of their caregiving
experiences. Therefore, sensitive responsive care, as well as the opposite, shape brain
development (Shore 2001, 2005; Teicher, 2002; Charney, 2004; Lieberman, 2004).
The model of the caregiver–infant attachment relationship (Schore, 2001,2005) facilitates
increasing the dimensions of the child’s coping capacities. Thus suggesting, “adaptive infant
mental health can be fundamentally defined as the earliest expression of flexible strategies
for coping with the novelty and stress that is inherent in human interaction”. The caregiver
role of providing sensory stimulation through physical contact such as bathing, dressing
and soothing, and play activity facilitates sensorimotor modulation. The quality of the
attachment relationship between an infant and a caregiver is determined by the quality of the
caregiver’s response to the infant at times when the infant’s attachment system is activated
(i.e., emotionally distressed, physically hurt, ill, etc.). The integration of the caregiver–infant
experiences of touch, movement, auditory stimulation and visual stimulation, which takes
place during the first 18 months of life, makes possible the development of self-soothing
behaviors (Schore, 2001). Self-soothing behaviors use internal and external resources: visual
in the form of looking at sights of interest in their environment; auditory via listening
to pleasant or calming sounds; self-touch such as holding on to their own hands or feet,
sucking, and holding on to a familiar object such as a blanket or soft toy. Mahler et al (1975)
describe face-to-face affective synchrony, symbiotic phase, as beginning at 2–3 months,
generating high levels of positive arousal and shared or mutual regulation (attuned) called
instances of “optimal mutual cueing”. In this pleasurable state of symbiosis (a state in which
the infant behaves and functions as if it were one with the caregiver), the infant (Mahler
et al, 1975; Polan & Hofer, 1999)
l is in a state of undifferentiation
l is in a state of fusion with the caregiver
6 l experiences interaction regulation synchronicity
l experiences dual unity within one common boundary
l is within a self-organizing system composed of caregiver and infant as one unit.
This concept of attachment, as a deep and enduring connection established between a
child and caregiver, as an interactive regulation of biological synchronicity is possibly best
demonstrated by the sharing of facial expressions between caregiver and infant becoming
one, or shared-mutual reflection. Attachment refers to the child’s thoughts, feelings
and behaviors in reflection to significant others, most often the primary caregiver. Early
experiences with caregivers shape a child’s core beliefs about self, others, and life in general.
Experiences of the infant and young child are encoded in the brain. Emotional experiences
of nurturance and protection are encoded in the limbic system. Over time, repeated encoded
experiences become internal working models or the “lens” through which the child views
themselves, others and, overall, their world (Schore, 2001). Healthy social-emotional
development for infants and toddlers unfolds in an interpersonal context, namely that of the
positive ongoing relationships with familiar, nurturing adults. These expanding capacities
help young children to become competent in negotiating increasingly complex interactions.
Between the ages of 8 and 18 months, the infant develops the ability to modify responses
in relation to events and object characteristics in accordance with intentionality, reciprocal
interactions and organized affects. Thus, there is meaning in verbal and contextual cues. This
stage is marked by the blossoming of skill development (DeGangi, 2000):
l initiate, maintain, and inhibit physical actions
l the emergence of problem solving
l intentionality
l awareness that actions lead to a goal
l increasing awareness of self as a separate identity (allowing for the differentiation of their
own responses from the actions of others).
CHAPTER 1
The Regulatory Disordered Infant and Child
At about 18 months of age, self-control emerges with the creation of mental images. Mental
images have immense utility for homeostasis of the self. They allow the internalization of
routines and responding to requests or commands, pretend play and functional language,
delaying actions to comply with social expectations (without external cues), and being
able to differentiate self from others. Representational thought and recall memory are
hallmark features of development at this stage. The role of the caregiver is one of reflective
interpretation in pairing affective meaning to situations as well as providing social
expectations and values related to particular and specific emotional responses. This caregiver
attachment of affective meaning facilitates the infant to label and understand emotion and
its context. The instrumental features in achieving emotional regulation are identified as
(DeGangi, 2000; Schore, 2002; Thompson et al, 2008):
l Action schemes
m Vocalizations, self-distraction, motoric responses
l Cognitive organization
m Representational thinking and self-monitoring
l Motivation
l Caregiver support.
Another accepted construct of attachment was set forth by Bowlby (1969). His theory of
attachment views the infant’s emotional tie to the caregiver as an evolved response that
promotes survival. Bowlby’s stages of attachment begin as a set of innate signals used
by the baby to summon the parent and gradually develops through four stages into an
affectionate bond:
1. Pre-attachment (birth to 6 weeks): inborn signaling bringing newborn into close contact
with other humans who comfort them
2. Attachment-in-the-making (6 weeks to 6 to 8 months): the baby responds differently to a 7
familiar caregiver than to a stranger and begins to develop a sense of trust
3. Clear-cut attachment (6 to 8 months to 18 to 24 months): the baby displays separation
anxiety, becoming upset when the trusted caretaker leaves
4. Formation of reciprocal relationship (18 to 24 months and on): separation protest
declines.
Therefore, emotional security is attachment’s role in the regulation of emotion. It is a central
concept as a regulatory process in normal or typical development and the development
of psychopathology. Moreover, failure to acquire mental-age appropriate social-emotional
skills may be associated with greater risk for concurrent and later emotional/behavioral
problems. For example, secure infant attachment is related to lower risk for later peer and
behavior problems. Emotional security serves as a model emphasizing the interplay between
social-emotional and biological processes whereby the regulation of emotional well-being
and security develop. The experience of this concept is defined from an organizational
perspective of the entire person and their unique responses (reactions to events) illustrating
a central focus on the impact of marital and parent–child relations on the child’s emotional
security. There are additional implications for social-emotional development associated with
the interaction between attachment and temperament (Cummings & Davies, 1996).
Effortful Control
The study of temperament and the associations to neural circuitry and attentional tasks
furthers the examination of development of executive attention and self-regulation. The
construct of effortful control tends to increase with age and is associated with several
characteristics of children and parents. This construct includes the ability to inhibit
dominant responses to act upon subdominant responses, to detect errors, and to engage
in planning. Effortful control includes focused attention, perceptual sensitivity, inhibitory
Therapist’s Guide to Pediatric Affect and Behavior Regulation
8
FIGURE 1.2
Young boy creates
bubbles.
control, and low intensity pleasure (Figure 1.2). Given the range of abilities in which
effortful control plays an important role, it is not unexpected that it is associated to the
development of conscience and aggression. It is also a protective factor which promotes
following instructions and obedience to caregiver rules.
An infant’s ability for focused attention combined with maternal responsiveness and
caregiver personality characteristics (such as dependability, effective management and
self-control) are also associated with the demonstrated range of effortful control. For
example, the influence of affective synchrony in caregiver–infant interaction in the
development of effortful control is significant for children demonstrating high negative
emotionality in childhood versus the effect of affective synchrony for infants not
demonstrating negative emotionality being much smaller. Features defining effortful control
include (Rothbart et al, 2000; Carlson & Moses, 2001; Casey et al, 2001; Blair, 2002; Calkins
et al, 2002; Fan et al, 2003; Jones et al, 2003; Rueda et al, 2004; Rothbart & Rueda, 2005):
l Temperament, or individuality, in constitutional reactivity and self-regulation.
Temperament refers to the relatively enduring framework influenced over time by
heredity, maturation, and experience. Temperament evolves from genetic provision,
however, it influences and is influenced by the individual’s experience.
l Reactivity refers to the excitability, responsivity, or arousability of the behavioral or
physiological systems.
l Self-regulation refers to neural and behavioral processes functioning to modulate the
underlying reactivity, or the ability to control inner states.
CHAPTER 1
The Regulatory Disordered Infant and Child
*Competence functions as a protective factor or buffer which supports the understanding
of varying developmental trajectories. Competencies also increase opportunities for positive
interactions and feedback which serves to diminish problem behavior.
Temperament
Temperament is defined as a constitutionally or biologically based characteristic associated
with differences in emotional, motor and attentional reactivity and self-regulation. It is the
relatively enduring biological framework influenced over time by heredity, maturation and
experience. Infants respond to their environment with reactivity, emotion, and attention with
their own unique responsivity from infant to infant. These reactions to the environment,
along with the mechanisms that regulate them, make up the child’s temperament
(Rothbart & Rueda, 2005). Temperament is seen to be relatively consistent across situation
and stable over time. It is seen as a key factor in early child characteristics being predictors of
later personality development, behavioral patterns, emotional response patterns, adjustment,
and the presence as well as severity of clinical symptoms. It is with temperament that the
concept of goodness of fit plays a significant role. Goodness of fit refers to the degree of
correspondence between child characteristics and parental expectations and demands. Thus,
a “good fit” results in a positive adjustment and outcome, whereas, a “poor fit” results in a
negative outcome or less than satisfactory adjustment (Wolraich et al, 2008; Benson & Haith,
2009).
With regards to temperament, infants who are easily frustrated use more physical regulation,
scanning and caregiver orienting and less distraction. Additionally, they have higher activity
levels and demonstrate decreased attention during task exercises. Aside from anger and
frustration, other characteristics of temperament include vocal expression/excessive crying,
impact of caregiver availability, caregiver attachment quality, and physical stimulation.
Constructs of ineffective self-regulation and difficult temperament overlap. Therefore, a child 9
may have a regulatory disorder but not present with a difficult temperament or the opposite
can be evident as well (DeGangi, 2000). *Terrikangas et al (1998), in the conclusion of a
15-year longitudinal study, identified infants with difficult temperaments demonstrating an
increased risk of developing psychiatric symptoms in adolescence. This risk was diminished
for these children when families received mental health interventions.
There exists a direct contribution to social-emotional and personality development by
means of temperament and its interactions with caregivers, family, and other environmental
factors. For instance, gender differences in temperament of infants/toddlers reveal males to
demonstrate higher levels of activity and tendency to approach, while females demonstrate
greater hesitation/withdrawal behavior. Furthermore, females show greater fearfulness as
well as higher levels of regulation-related skills in early childhood. Individual differences in
temperament play a role in children’s selection of environment and associated adaptation.
Johnson & Johnson (2011) state that, over the course of the toddler–preschool years, the
development of successful regulation of reactive responses is associated with four cognitive
skills as the ability to:
l inhibit a preponent motor response
l switch attention
l focus attention
l plan and execute strategies.
The developmental progression of change associated with the growth of these skills is related
to parental influence, contextual environmental factors, and underlying neural changes
(predominantly maturation of prefrontal cortex areas). Parents offer important input by
providing physical comfort, secure attachment, and moderating negative affect or distress.
Since the neural structures necessary for successful regulation have not yet developed,
Therapist’s Guide to Pediatric Affect and Behavior Regulation
parenting behavior allows and supports the child to learn to contain response to arousal,
such as distraction and inhibition and is beneficial for regulating negative affect.
Differences in Self-Regulation
Distinguishing, or demonstrating the differences between reactivity and self-regulation
is useful for the general conceptualization of development in that early behavior can be
seen as reactive to immediate stimulus events and endogenous changes, whereas complex
self-regulatory systems develop to modulate reactivity (executive attention system). The
development and refining of self-regulatory mechanisms, which transpire over the first
two years of life, are associated with physiological maturation, caregiver responsivity, and
the infant’s adaptation to environmental demands. The self-regulatory systems encompass
(Lyons-Ruth & Zeanah, 1993; Rothbart et al, 2000; Rueda et al; 2004):
l affective relationships
l purposeful communication
l use of self and others to control internal states
l an understanding of causal relationships
l development of self-initiated organized behaviors.
The function of emotion regulation is to manage arousal, and assert control over behaviors
and reactions, thus defining and adjusting interactions to fulfill appropriately and
effectively the needs of the individual as well as social demands. Both intrinsic and extrinsic
factors contribute to the development of self-control. Intrinsic factors include the infant’s
temperament and cognitive processes (attention and inhibitory control). Extrinsic factors
involve the caregiving environment, sibling/peer relationships, and cultural expectation of
emotional display. The development of emotion regulation evolves from the growth and
integration of numerous behavioral and biological processes. Without expounding, the
10
complexity of these systems is a challenge to researchers. Strategies of self-emotion regulation
by infants can be observed by their (Rothbart et al, 2000; Thompson et al, 2008):
l passive engagement
l physical regulation/effects of touch
l scanning
l distraction
l self-soothing.
Self-regulation is the infant’s first task in learning to modulate themselves and demonstrate
an interest in their environment. This ability to control inner states is a critical milestone
of development and essential to personality and behavioral adjustment. Associated
correlates include competence for engagement and attachment with a demonstrated
ability to modulate and process sensory experiences. The caregiver’s consistent, sensitive
and supportive responding helps to manage emotional arousal within normal limits and
these early interactions are important factors in the development of a secure parent–child
relationship. An additional aspect of self-regulation is the capacity to coordinate simple
motor actions (Figure 1.3). In conjunction, these factors are referred to as “sensorimotor
modulation”. Touch, vision, hearing, movement, body-awareness, and thought are the
building blocks for future learning. Furthermore, the development of this system plays a
crucial role in the internalization of moral principles and socialization (Schore, 2001, 2005;
Bell & Deater-Deckard, 2007; Benson & Haith, 2009).
As the basic knowledge of brain structure and function are expanded and incorporated into
developmental sciences it promotes progress in the complex view of human infancy and
increased understanding of the psychoneurobiological mechanisms that are the foundation
of infant mental health. Integrated intermodal sensory-motor coordination of the newborn
infant’s orientation to environmental stimuli and preferential learning of human signals