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I suspect that a baby lacking enough hours of focused attention from their attachment figure looks very similar in any socioeconomic tier.   And I am struck (but not surprised) you can see it that early.  Think of those Romanian orphans and how totally tuned out they became by two.

Whats different in suburbia now is that many *affluent* women also leave babies in daycare, which did not happen in 1970.   So neglect is more widespread. 

There are interventions that have worked in other vulnerable populations-- carrying is one; in one study w/ vulnerable new moms, giving the mom a soft carrier and telling her to use it every day DOUBLED the rate of secure attachment.  Obviously Nurse Family Partnership is a very good intervention.  



Allan Shore basically agrees with what you are saying about early daycare.  Infants cannot tolerate these early separations from attunement with the mother.  I am not familiar with the woeful state of mental health in the suburbs as I come from rural MI and have always worked with the poor, but if what is happening and getting worse for the poor is happening in suburbia now as well, we are really in trouble.  Child well-being in the US is Number 26 of OECD countries.... That's on the bottom. 

I have seen up close what happens to kids who aren't attuned to there in Michigan.  I'm a general pediatrician.   (And unfortunately, I've lived  what happens and I'm all too familiar with how incredibly difficult and how incredibly long this is to overcome)

I'm just not sure what is happening with pediatrics.  I am really worried about screening older kids for an ACE score without developing a well trained workforce that can care for these complex kids and their parents.  Most of the parents I have worked with have a lot of trauma too (both attachment and ACE) and this is multi-generational.   I don't believe that it is enough to go to an ACE-Interface presentation or some 1/2 day "trauma" education and believe an entire agency is now knowledgable enough to treat these complexly traumatized kids. 

You cannot send kids to the rural CMH for attachment and ACE related trauma treatment and expect a good outcome. with "treatment as usual."   These kids are too complex.  There needs to be some work into learning what works best to deal with emotional dysregulation resulting from attachment trauma.    I worry all this screening w/o really good treatment for the child and the parent will just result in more kids being given psychotropic drugs.  What do we really know about the long term effects of psychotropic drugs on a child's developing brain, especially a child with attachment +/- ACE trauma?   We don't have any information that this is safe, and I have seen compelling science indicating that it may be very harmful., possibly irreversibly harmful plus  there is zero evidence for poly psychopharmacology in these kids but that's what happens all the time.    It should be a huge concern to every pediatrician.   Where is the concern?    

I also have no idea why we aren't taking attachment trauma seriously.   Emotional regulation is essential to any kind of happy life.  We also have a really easy way to detect attachment concerns early... a way that is acceptable to parents at least as a screener (maybe it isn't sensitive enough to reach the babies in suburbia, I don't know but this is why asking the questions is so important).. We have the Ages and Stages Social Emotional.... I have seen social emotional delays at 1-2 months of age.  What does this mean?  How does a 1 month old baby already show social emotional delays? Because  of lack of "good enough" attunment and repair.  That baby is already showing signs of abnormal Right Brain development.     At least that is what I suspect.  But when I found delays in babies --- I had no effective treatment... I sent the kids to Early On but was told not delayed enough.   Very few of the kids I found, and I found a ton of kids with delays, got services from Early On or from anywhere no matter how hard I tried.   If I cannot get help for a baby with social emotional delays, how am I going to help a kids with 6 ACEs?  

My thought is we have to find ways to respond to what we find on these screenings no matter what screening we do if we are going to screen otherwise screening isn't very useful and might be harmful.  

Last edited by Tina Cain

Tina, you and I seem to think alike.  I think many of the most life-impacting ACES happen in babyhood.   I think the woeful state of child mental health in the affluent suburbs is probably an indictment of mother baby separation, and the lack of a dyad in our baby/ daycare culture.

Allan Schore is brilliant.  His work has been critical to my understanding of ACEs.

This is why we need a list of "Baby ACES" that may not have the drama of a "trauma" event... like  a mom who does not make EYE CONTACT, which is an ACE for a baby.   Reasonably brief separations with kind people helping in the meantime CAN be trauma for a baby or toddler.  If you have not seen the old film by Bowlby "A 3 year old goes to the hospital, "pull it up online.  It is powerful.

The traumas of neglect, indifference, not connecting, not getting it, etc are extremely powerful at this very early time.  A mom who was herself abused can dissociate caring for her own baby.  This is a trauma to the baby.

From 0-3 the rapid growth of the right brain absorbs so many messages about "reality" that inform the rest of the person's life.

"Early Development Certainly is the Foundation of Health and we know that there is an enduring impact of early maternal care and the role of epigenetic modifications of the genome during critical periods of early development and it is directly related to health and disease. It may well be that this enduring impact of early maternal care, um it may be one of the most important discoveries in all of science and has significant impact on our field.  Brain development is not just genetically encoded, it needs the epigenetic social experiences that build brain capacity." 

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