A Study into Infant Mental Health

This book is a study of infant mental health which blends knowledge and
understanding from three perspectives: international research, theory, and inter­
vention. The volume increases awareness of the significance of infant mental
health, adding to the growing body of literature on influences upon lifestyles,
communities, society, and attainment.
The significance of mental health to development has come to the fore in
recent years and research in neuroscience is used to explore, and to understand
the complexities of the human brain. Each infant is exposed to unique influences
before and after birth. Neuroscience, genetics, adverse childhood experiences,
and personalities feature in the chapters as mitigating factors to attainment.
Exemplars create a bridge between research and implementation of recommen­
dations, and illustrate the myriad of influences and permutations that can
enhance or hinder development. This book discusses internal influences from an
infant’s biological make-up, alongside the circumstances and relationships within
a family unit, as understanding these key aspects is integral to promotion of each
infant’s life chances. The volume concludes by considering future approaches to
nurturing infant mental health.
Carefully designed to stimulate discussion and professional inquiry, this
volume is an invaluable resource for researchers, academics, and scholars with
an interest in infant mental health.

Hazel G. Whitters is a practitioner-researcher who works in an early years

service in Glasgow, Scotland. Interests include the professional–parent rela­
tionship, therapeutic play, and infant mental health.
Advances in Mental Health Research

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The Prevention of Suicide in Prison

Cognitive Behavioural Approaches
Edited by Daniel Pratt

Schizotypy
New Dimensions
Edited by Oliver Mason and Gordon Claridge

Supervision and Treatment Experiences of Probationers with Mental Illness

Analyses of Contemporary Issues in Community Corrections
Babatunde Oluwaseun Adekson

Mental Wellbeing and Psychology

The Role of Art and History in Self Discovery and Creation
Sue Barker with Louise Jensen and Hamed Al Battashi

Neurolinguistic Programming in Clinical Settings

Theory and Evidence-Based Practice
Edited by Lisa de Rijk, Richard Gray, and Frank Bourke

A Study into Infant Mental Health

Drawing together Perspectives of International Research, Theory, and Practical
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Hazel G. Whitters

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Research and Practice
Joshua L. Cohen
A Study into Infant
Mental Health
Drawing together Perspectives of
International Research, Theory, and
Practical Intervention

Hazel G. Whitters
Designed cover image: © Getty Images
First published 2023
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 Hazel G. Whitters
The right of Hazel G. Whitters to be identified as author of this work has
been asserted in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library

ISBN: 978-1-032-41441-6 (hbk)

ISBN: 978-1-032-41445-4 (pbk)
ISBN: 978-1-003-35810-7 (ebk)
DOI: 10.4324/9781003358107

Typeset in Times New Roman

by Taylor & Francis Books
I dedicate this book to children, parents, and carers throughout
the world. Nurturing the next generation is key to attainment for
all within happy, fulfilling lives. I include a dedication to my hus­
band John whose continuous support and encouragement has
enabled me to achieve. Thank you.
Contents

Preface viii

1 Infant mental health 1

2 Relationships, involvement, and well-being 28
3 The developing child 58
4 Learning and adversities 88
5 Ability, capacity, and creativity 122
6 Research, theory, and intervention 150

Index 181
Preface

This book is a monograph that presents knowledge and understanding of

infant mental health from the three perspectives of research, theory, and
intervention. I hope that this monograph will stimulate discussion and pro­
fessional inquiry from scholars and researchers. I have worked for 40 years in
childcare and education, and in the past 12 years I have undertaken research
and training in infant mental health. The key to an infant’s independent
learning is transformation of his inner working model.
This monograph aims to engage readers by contributing to the knowledge
base that informs issues pertaining to this field of study. Current and past
research from international sources is used to increase a reader’s under­
standing of mental-health issues in young children with an emphasis on
neural development and the impact of adversities. Participants in these studies
have experienced negative influences upon development and include minority
groups. A deeper understanding of neuroscience and environmental impact is
gained by contextualising research findings within daily lifestyles.
Knowledge is weak as a single entity but rich if accompanied by under­
standing which can influence strategy and, ultimately, implementation of
intervention. I feel passionately that learning and professional development
should be shared with others to generate discussion, investigation, and to
increase expertise in the field of infant mental health.
This book discusses the attainment gap by accessing research on high abil­
ity, additional learning needs, and developmental norms. The current focus
upon attainment is contextualised by reference to the COVID-19 pandemic.
COVID-19 has presented a new multilayered adversity and prompted profes­
sionals to seek out knowledge and to reflect upon pertinent issues. The lock-
down periods narrowed the daily world of the workforce but increased
opportunities and time for research and professional development. Infant
mental-health teams are being established throughout the world to target this
area of need.
The pandemic has resulted in unpredicted influences upon mental health in
adults, children, and infants. The book describes how children are presenting in
services with unusual demonstration of trauma which is emerging within
research as associated with social and emotional isolation, and parents’ anxieties.
 Preface ix
Knowledge and understanding of these aspects feature in studies throughout the
world, and findings will continue to be published over the coming months and
years.
I feel that this is an opportune time to write a monograph in response to
these issues. The book is designed to increase awareness of the significance of
infant mental health through presentation of research, theory, and intervention,
and to add to the growing body of literature on influences upon lifestyles, com­
munities, society, and attainment. This book is primarily aimed at scholars in the
disciplines of health, education, social work, and family therapy.
1 Infant mental health

Chapter 1 commences by considering the meaning of infant mental health

and by using the definition of Zeanah and Zeanah (2019) to refer to the
period of pre-birth to five years throughout the manuscript. This chapter
provides an explanation of infant mental health and detailed description of
the neurobiological changes that occur pre-birth and post-birth. Research in
the field of neuroscience (Dismukes et al., 2019) has greatly increased under­
standing of brain development. The physiological impact of adversities upon
neural connections is discussed, for example, disorganised attachment at the
age of one year is regarded as a predictor of psychopathology in adolescence
(Cassidy & Mohr, 2001). Practice examples provide narratives to illustrate
research findings. Genetics and environmental circumstances are identified as
influential in contexts of experience-dependent and experience-expectant stages
of development. Stress is described from a neural and behavioural perspective
which includes the short- or long-term effects from normal, tolerable, and toxic
stress upon an infant and parent (Shonkoff et al., 2021). Formal and informal
interventions are highlighted as valuable responses to infant mental-health issues
which are founded upon secure attachment relationships.

Understanding infant mental health

The terms “infant mental health” and “child” in this book refer to the period
from pre-birth to five years as used by Zeanah and Zeanah (2019). Other
organisations refer to infant mental health as encompassing slightly different
timescales within early childhood. The Scottish Perinatal Mental Health
Curricular Framework describes the perinatal period as pregnancy, childbirth,
and the first 12 months of childhood (NHS Education for Scotland, 2019).
The emotional aspect of infant mental health, in accordance with the frame­
work, links to the attachment relationship from birth which has long-term
implications throughout the lifespan. This publication also presents stages of
infant mental health which include 3–5 years. The Infant Mental Health
Competency Framework is targeted towards professionals who work with
parents and infants from pregnancy to the second year of life (Association of
Infant Mental Health, UK, 2021). In 2000, a researcher published an article
DOI: 10.4324/9781003358107-1
2 Infant mental health
that focused upon the role, responsibilities, and characteristics of the infant
mental-health specialist. The specialism related to working with parents and
children from birth to three years of age (Weatherston, 2000).
Despite slight variation in age groups which are associated with the term
“infant”, or “child”, these authors universally define infant mental health as a
young child’s capacity for social and emotional development. Social and
emotional development are intertwined, and one is dependent upon the other.
In 2019, the concept of infant mental health was broadened to include posi­
tive cognitive development by NHS Education for Scotland (2019). Certain
conditions are necessary to support these aspects of human development to
mature. Trevarthan and Aitken (2001) inserted context and rationale to the
study of mental health in young children by stating that it created a founda­
tion for interpersonal needs throughout the lifespan. This chapter explores
these issues in the perinatal and antenatal periods.
Perinatal mental health has recently come to the forefront of practice in health
disciplines as a significant aspect of care and education from birth to five years. A
baby’s mental health is also influenced before birth. The perinatal stage is regarded
from the pre-birth period up to one year post-birth. Pregnancy, childbirth, and the
first year of life are periods when intervention can make positive changes to the
mental health of a mother and her infant. Extended family members can also
be affected by maternal and infant mental-health issues. Research has indicated
that postnatal depression which is not treated can have a negative impact upon the
operational daily functioning of a family unit (Balbernie, 2013).
In the earliest stage of life, a young child’s emotions are led by physical
needs relating to survival. At birth, a baby is exposed to a multitude of sen­
sory stimuli. His instinct is not to explore but to seek comfort. His instinct is
not to learn but to gain protection in this new world in which he cannot dif­
ferentiate between danger and safety. His needs are based upon physical sur­
vival, and emotions lead his body to a state of alert by prioritising these
goals. The newborn has only one familiar contact within the initial moments
of entry to the world. Nurture by his mother is welcomed by the tiny baby as
her voice is recognisable from his pre-birth experiences, and over time her
warmth and smell represent a circle of security. This circle embraces the
infant physically and emotionally.
These potent statements elevate and prioritise infant mental health within
the context of childcare and education services. During the past twenty years
the concept of mental health has received attention from researchers, and
governments, due to an increase in comprehension of the long-term impact
upon the individual and society. In the United Kingdom, one in five children
are diagnosed with an emotional behavioural disorder which is experienced as
internal trauma and exhibited externally through behaviour. Disorganised
attachment at the age of one year is regarded as a predictor of psycho­
pathology in adolescence (Cassidy & Mohr, 2001).
Many countries have focused upon exploring and supporting mental health
in infants. For example, in Scotland a multidisciplinary group of professionals
 Infant mental health 3
compiled the Perinatal Mental Health Curricular Framework which reflects
learning levels for the professional, as depicted within the NES Transforming
Psychological Trauma Network (NHS Education for Scotland, 2019). These
levels of continuous professional development are constructed in an incre­
mental way and describe four stages of knowledge, understanding, and prac­
tical skill in the field of infant mental health: informed, skilled, enhanced, and
specialist. It is interesting that the four levels transcend many different roles
and responsibilities in disciplines throughout care and education fields. The
rationale for this broad spectrum gives significance to multidisciplinary roles
in a context of mental-health knowledge and practical skill.

Pre-birth and post-birth

Antenatal is termed from birth onwards so there is an overlap of time in
which the two descriptors of perinatal and antenatal can be applied to the
first 12 months of childhood. A mother is a baby’s host before birth so it is
inevitable that her mental health will impact upon the baby’s well-being
during the gestation months. Figures were published by NHS England in
May 2021 that recorded the number of women who accessed perinatal mental
health services in 2019–2020. This coincided with lockdown periods of the
COVID-19 pandemic, and the figure of 4.6 per cent of total births was
slightly above the predicted level of 4.5 per cent. The figure 4.6 per cent
equates to 30,625 women.
Zeanah and Zeanah (2019) describe mental health in a context of capacity;
therefore, targeting support to a mother during pregnancy is an essential
context for intervention by services. The ultimate aim is to increase the
infant’s capacity for good mental health throughout his life. The National
Centre for Infant and Early Childhood Health Policy, in America, identified
three levels of intervention: universal and preventative services, focused ser­
vices, and tertiary intervention service (Zeanah et al., 2005). This report
referred to mitigating factors as relating to the environment, infant, parent or
carer, and the adult–child relationship. Relationships are promoted as the
most important aspect of any parenting programme or informal intervention.
Pregnancy is a time of change, physically and emotionally. It is a period in
which a woman and her partner acquire different roles and responsibilities in
the creation of a new life, and adaptation of a family home, and lifestyle. The
research of Slade and Sadler (2019) emphasised influences from the concep­
tion route to the parents’ emotional adaptation. Factors related to a preg­
nancy being assisted or non-assisted, and planned or unexpected. The
pathway towards, and during pregnancy, affects both parents’ conscious and
unconscious experiences and their reactions to the early stages of parenthood.
It has been shown that a mother’s brain has an increase in growth and devel­
opment of social and emotional connections preceding and following birth. The
state of pregnancy prepares the mother’s neural networks for mentalisation and
a nurturing capacity that supports an infant’s socio-emotional development. The
4 Infant mental health
neural networks which are activated throughout pregnancy include the oxytocin
system relating to attachment and bonding, the hypothalamic–pituitary–adrenal
axis to regulate stress and respond to danger, and the dopaminergic centre as the
area of the brain that activates pleasure experiences (Slade & Sadler, 2019).
Examples of pre-natal stress include socio-economic adversity, domestic or
community violence, isolation within an environment or culture of a community,
and mental-health issues. The emotional and physical status of a mother will
impact directly or indirectly upon her baby, pre-birth and post-birth.

Neural development
Research in the field of neuroscience (Dismukes et al., 2019) has greatly
increased understanding of brain development and portrays the composition
of a neuron that has a cell body, axon, and dendrites. Brain growth is com­
plex, and dependent upon influences between physiological, emotional, and
genetic characteristics of an infant. An outcome is the creation of links
between neurons. The space between neurons is termed synaptic cleft, and the
process of connection is synaptogenesis.
It is fascinating to read that the branching between dendrites occurs when
the neuron nucleus is full, which means that it has accumulated its maximum
complement of electrical inputs. At this stage electrical inputs will continue to
be received but travel down the axon, cross the synaptic cleft through neuro­
transmitters, and branch out to different dendrites. These dendrites lead to
more neurons, and neural connections are established.
Questions emerge from reading about brain processes, for example, does
the neuron nucleus release all the electrical outputs together at the point of
maximum capacity? Perhaps the release occurs in minuscule levels for output
to the axon, in tandem with further input of electrical impulses. Reaching
capacity may be the catalyst for this process to be initiated. I reflect upon my
thoughts on potential patterns or timed sequences in the release, and uptake
of electrical charges, and consider if I can relate this neural process to practice
knowledge. It is important that new learning which contains challenging
issues is retained and can be applied in linking research to daily practice.
The axons are well protected by insulation in the form of myelin. The
myelin allows the electrical inputs to travel very quickly along the axons to
cross the space of the synaptic cleft. Neural circuits which are created
throughout this process are termed synaptic transmission. Over time, pruning
takes place of synapses which are not being used, or less actively used than
others. It seems that the myelination process protects the circuits from being
pruned.
These processes are often represented in training for practice by the use of
cartoon symbols and sequences that demonstrate interdependency of compo­
nents. An animation medium can promote understanding of these events in a
straightforward, predictable, and simplistic way. It is also essential that prac­
titioners appreciate the intricacies of brain development, and the myriad of
 Infant mental health 5
mitigating factors. It is a fascinating topic to study which imposes respect and
worthiness to the role of an early years practitioner. I feel that knowledge of
neural processes instils a sense of wonder, and awe as understanding of the
complexities are gained.
From a practical perspective, a lack of nurturing conditions, or direct
influences from adversities can prevent the neuron nucleus from reaching its
capacity. These barriers are described in practice as hindering or halting
achievement of potential. Subsequent branching and links between dendrites
and further neurons will not take place. This information gives stark realisa­
tion of the significance of early intervention work to construction of the
brain’s architecture that affects the baby throughout his lifespan.
Classification of the nervous system by functionality presents a visual pic­
ture of the internal layout and workings of the neural space. Mechanisms for
basic life functions are tucked safely in the middle of the brain, surrounded by
the cortex which supports the higher-level functioning of human beings. The
frontal, parietal, occipital, and temporal cortex lobes have essential roles to
play in the infant’s interpretation of the world which is based on sensory
experience and communication with others.
The 27th day after conception is obviously a significant milestone in preg­
nancy due to formation of the neural tube which is the foundation for the
brain and spinal cord. It is interesting that one reason for significant brain
growth after birth is to ensure a safe birth passage. The small brain is pro­
tected from damage during the birthing process and subsequently grows
rapidly in the early stages of childhood. A baby’s brain increases in weight by
2.5 times from birth to 12 months of age. Neural development in such a short
period is influenced by environmental conditions, internal well-being, and the
infant–primary carer relationship. The first year of life is a sensitive period of
learning for the mother and child thus presenting an optimum opportunity
for early intervention.

Adversities and stress responses

Research has indicated that life experiences can have a positive effect on
creating and consolidating the connections between neurons (Gerhardt, 2004).
Bowlby (1979) describes reconfiguration of the inner working model as the pro­
cesses occur and the neural connections extend and create branches to adjoining
cells. An image is gained of foetal neurons busily connecting and ensuring via­
bility through the establishment of a framework for bodily functions, between 5
and 9 months of pregnancy. This stage of development encompasses information
that health professionals can easily share with expectant parents, and initiate
responsibility for the well-being of their unborn child.
Toxic stress is defined by the enduring time and impact upon the individual’s
biological responses and interlinked emotional consequences. The toxicity results
from interactions between environmental influences, personal experiences,
genetic predisposition, and developmental timing (Shonkoff et al., 2021). Stress
6 Infant mental health
can have a toxic impact during the same period of development in which an
infant is known to be affected by specific bacterial species. The bacteria are
described as colonising the newborn baby’s intestines, following influences from
maternal transmission and environmental exposure, and can result in a lifelong
impact upon immune functions. Adversities which are experienced in the peri­
natal period can increase the infant’s vulnerability to physiological and psycho­
social stressors thereafter.
Shonkoff et al. (2021) presented evidence that indicated that the prevalent
biological response to early adversity is a predisposition to a chronic pro-
inflammatory phenotype. There are associations with conditions such as car­
diovascular disease, chronic obstructive pulmonary disease, autoimmune dis­
ease, and depression. The authors suggest targeted intervention to specific
minority groups within the earliest years to promote equality in health and
well-being, and to increase opportunities for lifelong achievement. The opti­
mum intervention is preventative and proactive: reduction of the impact from
toxic stress, in addition to measures that aim to increase the child’s resilience
and promote educational attainment.
The two systems for responding to stress are the sympathomedullary
(SAM) system, and the hypothalmic–pituitary–adrenal (HPA) axis. It was
useful for my own practice to learn that the hormone adrenalin, as a reg­
ulator of cell/organ activity, can take up to 20 minutes to course around the
body through the bloodstream (Berens & Nelson, 2019). However, an emer­
gency “universal energy store” of adenosine triphosphate (ATP) is situated
within muscles to enable an immediate response to threat by releasing che­
mical energy that triggers a physical reaction. In reality, an infant can respond
by moving away from a negative influence, and his body undergoes physiolo­
gical changes to support this reaction to adversity. The external stress results
in internal changes as epinephrine (adrenalin) increases circulation and
breathing rates and releases glycogen throughout the body. The body makes
this response based upon rapid assessment of the immediacy of a threat.

Early stages of development

Cortical inhibitory control commences between 2 and 4 months of age.
Mothers and carers notice subtle changes in the baby’s behaviour and his
emotions during this time. For example, the neonatal reflexes subside, and
sleep–wake cycles can be recognised. These patterns of behaviour within rou­
tines are influenced by cultural parenting practices. Parents gain a growing
awareness of their baby’s needs and personalities, and the baby begins to
demonstrate consistency in his reactions and actions in response to common
daily events. His lifestyle becomes immersed within a family culture. At this
stage, parents are encouraged by health workers and practitioners to establish
routines that suit the baby’s emerging needs. Changes can occur rapidly as the
infant gains an awareness of his proximal environment in addition to the
influences from his primary carers.
 Infant mental health 7
At 9 or 10 months, the baby uses memory and goal-directed behaviour in
his responses to stimulation, as opposed to response tendencies which was the
term applied by Thompson (1991). An attentive carer adapts the proximal
environment to reflect the baby’s emerging personality and needs, and his
learning processes are stimulated and activated by these increasing opportu­
nities. Over time, the infant perceives the circle of security which is provided
by his secure attachment relationship with a primary carer. This circle is
represented physically and emotionally, and it enables the infant to demon­
strate his preferences, interests, and emotional or physical reaction to his
lifestyle. An infant actively seeks out experiences that match his personality
and developmental needs from birth. The initial 12 months of life are a sig­
nificant period for learning, and the baby should be supported by carers to
maintain good health for genetic potential in the neural connections to be
fulfilled. A stimulating and safe environment in which to learn about the
world is essential at home and within services.
Shonkoff et al. (2021) presents an interactive gene–environment–time fra­
mework. The framework encompasses several aspects which are influential to
development. This approach to understanding infant brain development
reflects the influences from an infant’s adaptation to different contexts, his
immune system, metabolic regulation, and the plasticity of his neural con­
nections. Examples of change can be detected in systemic inflammation and
insulin responsivity. Variation in sensitivity to these influences is a significant
factor, particularly among siblings, and it is influenced by personality in
addition to genetic composition of the body. The conclusion of this research
study explains that gaining understanding of the interplay between pre­
ventative, and responsive intervention, is key to determining effective primary
health care in early childhood. A responsive adult, who interacts with an
infant in a context of a secure attachment relationship, has an invaluable role
in overcoming or preventing negative impact upon development in the earliest
years.
Shonkoff et al. (2021) also apply the term “relationship-focused coaching”
as a means of supporting primary carers to create effective relationships with
an infant. Care which is given in a context of a positive relationship compli­
ments the implementation of preventative, and resilience measures in
adversity. These authors highlight the promotion of secure attachment as a
response to perinatal depression. Findings from this particular research
study identified targeted interventions as the promotion of male caregiver
interactions and home-visiting programmes. Additional measures included
limiting the use of media screen time for parent, and child, and increasing
literacy in a context of adult–child book interactions. Reduction of eco­
nomic stress can also increase the capacity of an adult to participate in
caregiving activities with an infant. Examples of useful daily activities are
consistent and predictable routines that focus upon feeding, resting, and
play. Brain development responds positively to this model of a caring
environment.
8 Infant mental health

Box 1.1 Example from practice

Jake was referred to our service by his health visitor. Infant mental health
due to trauma of home circumstances. This broad referral criteria presented
little information excepting a young child who was suffering emotionally,
cognitively, and physically, as affected by indeterminate influences.
At induction day, Dad stood at the back door waiting patiently as I rushed
down the long corridor to welcome the family. It was raining, a wet cold
January shower. Dad’s face mask made his voice sound muffled and devoid
of emotion. I could not see Jake. I quickly introduced myself to Dad and
ushered him into the service. The bright fluorescent lights and blast of heat
emanating from the service was stark contrast to the inclement weather.
Behind Dad I spotted Jake. A small slim child of three years who was
wearing a yellow jacket with a hood tightly pulled under his chin. My greet­
ing was directed towards this little child’s eyes as he peeked out from under
the raindrops.
We entered a meeting room which released a scent of antibacterial
cleaning products. I noticed that Jake wrinkled his nose as he was encom­
passed by the new environment. Dad perched on the edge of a settee and
faced me silently as he pulled the little boy onto his knee. Dad loosened his
son’s outer clothing and began to talk. Mother had a difficult birth, memories
of losing a previous baby, diabetes during pregnancy, postnatal depression,
work stopped due to COVID-19 lockdowns, lack of money, cold house,
always using food bank – Mum can’t leave the house. This final comment
encapsulated the difficulties faced by the family within a myriad of influences
that could be fitted easily into a bio-ecological framework of human
development.
I thanked this family for attending our service. I showed photographs of
our playrooms and garden areas – unfortunately out of bounds to parents
during this pandemic. Jake pointed to the pictures, and Dad described the
scene to his son. At this point I had observed a healthy dad and son who
appeared to have an attachment relationship that involved comfortable
physical contact and responsive interaction, albeit within this stark environ­
ment of a cleaned-down meeting room. Suddenly Jake made a loud growl­
ing noise, threw his two arms back against his dad, and slid to the floor. His
wet jacket made this slide quick and easy, and the little boy gave me direct
eye contact as he leaned forward to spit. I quietly said to Dad, “Jake is
showing us that he is tired of talking and he just wants to play, and to learn.”
The care plan for this family had commenced through attendance at nur­
sery. Each adversity, as cited by Dad, had an influence upon the adults and
children and required sensitive exploration and actions to minimise the
effect. Each influence conjoined with others to create an accumulative
negative impact upon the family’s well-being. Jake’s behaviour, delayed
development, and aggressive outbursts represented this little three-year­
 Infant mental health 9

old’s vivid reactions to his family circumstances, daily challenges from the
pandemic, his expressions of need, and desire to have his interests met.
Behaviour is language, the original communication media of human beings,
and Jake’s expression of his emotions in the context of adverse childhood
experiences.

Theory and infant mental health

The World Association of Infant Mental Health (WAIMH, 2000), and the
Zero to Three taskforce (2001) present clear descriptors of infant mental
health. The former emphasises an active response by adults in promotion of
an infant’s mental health which is equated with optimal development for the
whole family. The latter presents an infant’s developing social and emotional
capacity which enables his learning and development to progress. Refer­
ence is made to the bio-ecological systems theory (Bronfenbrenner, 1979;
Bronfenbrenner & Morris, 2006) on which practice models and curricular
guidance are based. This framework represents the multilayered and mul­
tidirectional influences upon development of a human being.
Practitioners learn about developmental milestones in relation to a child’s
age during undergraduate study. Frameworks of normative development pro­
vide a means to identify delay. The early childhood ecosystem, as termed by
Shonkoff et al. (2021), presents understanding of external influences upon
development. Post-qualification, it is important that this knowledge is main­
tained to provide a framework for identification and response to temporary or
long-term additional support for learning needs. Temporary needs may result
from a change of home circumstances, for example, different carers, accom­
modation, or lifestyle of parents. The mantra that I have learned over a 40­
year career in services is that there is a solution to every problem, and life can
be good, life can be fulfilling, and happiness is achievable by every individual
and family.
Sloan and Donnelly (2021) recently conducted research on perinatal mental
health in the Glasgow area of central Scotland. The focus was an investiga­
tory study on factors that inhibited or protected the mental health of expec­
tant mothers. The projected outcome was to map service provision and
contribute to an improvement plan for the entire city. This research was con­
ducted as the COVID-19 pandemic was emerging across the United King­
dom, and throughout the world. Findings identified a range of personal and
socio-economic factors that the 200 participants identified as impacting
upon mental health. Poverty, housing, childcare, and stigma associated with
perception of failure in the parenting role were recurrent issues in the data.
The youth of parents, ethnic origin, and traumatic experiences were addi­
tional factors that participants expressed as affecting mental health during
10 Infant mental health
pregnancy. Interestingly, the study revealed provision for severe perinatal
health in this city but lack of services that offered early intervention or pre­
vention in a context of “mild to moderate” mental-health problems, as
defined within this research. Accessible community services were recom­
mended by the research team in addition to peer support from family,
friends, and services.
Bronfenbrenner (2005) presented influences in pictorial form as the bio­
ecological systems of human development. Concentric circles indicate poten­
tial bidirectional links between four main systems with the infant at the
centre:

1 The microsystem refers to influences from structure, processes, and rela­

tionships closest to the child, for example, family unit and services. The
microsystem also represents family culture, which may be influenced by
religion, nationality, community, or parental choices.
2 The mesosystem refers to influences from processes that bridge the set­
tings in which the infant is involved, for example, the nursery–home links.
This source of impact is significant for the early years workforce.
3 The exosystem refers to indirect influences between settings, for example,
changes to a parent’s workplace may affect attendance patterns at
nursery.
4 The macrosystem refers to influences that affect all systems through
policy, procedures, and legislation. The macrosystem encompasses com­
munity and societal expectations.

Bronfenbrenner also refers to time as an important consideration within a con­

text of development. Influences and their impact upon a family change over
time, and certainly the infant’s responses will alter as he matures. The knowledge
and understanding within his inner working model increases, and it is refined by
retaining salient points that relate to personal characteristics and genetic dis­
position. The developing infant gains more options as his experiences and
capacity to make positive personal and social choices increase.

Epigenetics
Epigenetics is a familiar concept for researchers, and it indicates links
between environmental influences and activation of genes by changes in the
body before and after birth. Effective planning and implementation of learn­
ing opportunities relies on knowledge of each child’s interests and needs in a
context of child-led pedagogy. The findings of Dismukes et al. (2019) indi­
cated five important points regarding epigenetics.

1 Epigenetics entails a set of interactive processes.

2 Development occurs within a reciprocal relationship between the envir­
onment and biology – before and after birth.
 Infant mental health 11
3 Environmental changes can affect interaction of these epigenetic processes.
4 Disruptions to development in infancy can result in long-term negative
impact across the lifespan.
5 Brain plasticity can provide opportunities, or threats to development, as
the neural connections reflect experiences which are positive and negative
to the infant’s well-being.

Characteristics of an individual are sourced to two sets of influences (Dismukes

et al., 2019):

1 Genes – 50–80 per cent influence.

2 Environment – 20–50 per cent influence.

These figures portray a broad range and, most importantly, the knowledge
that characteristics are informed by activation of genes and interaction with
environmental influences. The genotype or genetic make-up that affects a
baby’s physical characteristics is innate but greatly influenced pre-birth and
post-birth. Additionally, temperament or phenotype can be affected nega­
tively by a parent’s lifestyle and reflected within the infant’s interpretation
and reaction to the world. Common examples of family adversities are par­
ental drug or alcohol use, domestic violence, poverty, and isolation in a
community.
In my experience, the physical presentation of an infant who is living in
adversity can change markedly after he has been taken into kinship or foster
care, even for short-term respite. Hair colouring can transform from low-nutri­
tional grey to natural healthy pigment, weight and height are gained rapidly, sad
eyes begin to shine with hope and motivation, and demonstration of the positive
aspects of temperament are observable features that indicate good care. It is
important that positive change is recorded in addition to negative as it clearly
highlights the influential aspects of a previous home environment and pinpoints
areas for intervention. Physical and mental well-being can activate an infant’s
motivation to seek out learning as opposed to maintaining his basic bodily
functions within survival mode. This knowledge is gained through observation
and assessment by a practitioner. Many countries use intervention to close the
attainment gap in recognition of the impact of adversities. For example, my work
is based in Glasgow city which is currently responding to the attainment gap in
relation to poverty, and family learning is promoted as an effective strategy to
change (Scottish Government, 2019).

Emotions and resilience

Resilience of an infant is apparent during his interactions and involvement
with a learning environment. These features associated with development can
be recorded within a matrix that indicates links between protective factors,
adversities, vulnerability of the infant, and his resilience. National guidance,
12 Infant mental health
or recording scales, may highlight these issues and promote understanding of
the impact from multiple adversities (Scottish Government, 2008; Laevers,
1994).
Fogel (1982) describes affective tolerance as the young child’s ability and
capacity to cope positively with stimulation which can lead to heightened
excitement. This research study focused upon a period within the first 6
months of childhood prior to language development. New parents can learn
to read their baby’s emotional and attentional cues within this time of rapid
change, for example, motivation, disinterest, fatigue, or overstimulation, and
to respond with affective attunement (Stern, 1985). Affective attunement can
be a catalyst to emotional regulation by an infant. Alternatively, lack of par­
ental responsiveness can negatively affect the advent of the infant’s emotional
capacity, particularly in a context of adversities.
Thompson (1991) emphasised a link between emotional regulation in early
childhood and the capacity of adults to self-regulate. Emotion is represented
by behaviour and actions, and it is influenced by the ability and capacity to
self-regulate. It is an important aspect of planning for practice that an infant
is offered choices throughout daily routines to gain an awareness of his sense
of self from an early age. Emotional processing is inherently linked to one’s
own needs, interests, and personality.
The phenomenon of “take-up” time is regularly observed in childhood and
throughout formal learning circumstances of adulthood. Parents and practi­
tioners may misinterpret the associated actions as disengagement. Young babies
may turn away from excessive stimulation during reciprocal interaction, and
research has shown an intake in sugar to the brain at this stage. It is recognised
that primary-aged children require absorption time for the brain to retain
knowledge, sometimes termed, “the 10 second rule” in education, and adult
learners will swiftly look away from a lecturer as the brain assimilates infor­
mation to gain understanding.
Creation of a foundation for these self-regulating strategies commences in
the earliest years of life, and social referencing from adult to infant con­
tributes to socialisation within a family, a community, and supports children
to integrate within the wider world over time. The development of language
increases capacity to self-regulate emotions. Language provides a universal
forum for parents to discuss emotions, and prior experiences with children
which enriches their comprehension of situations. Language also enables the
child to gain symbolic recognition of his internal emotional state and to
create links to influences in the external world.
The management of emotions is a contributory factor to effective learning.
Processes include the child’s ability and capacity to minimise negative emo­
tions by transferring his attention to another area of learning. The foundation
of emotional self-regulation commences at birth, and primary carers are
influential in supporting this aspect of an infant’s development. The adult’s
emotional responses to the infant are based upon family culture and beliefs
which contribute to a role model. Another effect comes from the adult
 Infant mental health 13
guiding the child towards a specific emotional response which may be led by
implicit or explicit social rules.
The research findings by Thompson (1991) referred to the use of self-talk
by a child and singing to oneself as a further strategy for self-regulation.
Singing and self-talk can serve the purpose of blocking or reducing sensory
intake, and these strategies can support a child to regain control of his emo­
tional status, albeit for a few moments or longer. Self-regulation links to the
child’s personality, his perceived social status, and his desire to identify with a
social group reaction, or to focus inwards to his own needs and preferences.
As this knowledge base increases then the child acquires emotional literacy
and the ability to self-regulate his emotions, actions, and reactions. Over time, an
understanding of pride and morality is influenced by cultural values and beliefs
of the family, and potentially the local community or service setting. Attendance
in services greatly enhances these processes by providing multiple opportunities
for the child to experience and to understand emotional literacy. The child’s
comprehension of consequences, for example, the repercussions of displaying
negative behaviour in a setting, demonstrates his integration and discrimination
of social contexts and emotional parameters. As a child matures then he begins
to associate emotional regulation and personal gain with a growing awareness of
the negative impact from anger, fear, or frustration upon his desire to learn, and
to achieve goals.
Young babies experience different internal states in relation to rage, fear,
pain, loss, play, and care. Activation of a baby’s emotions results in physio­
logical change. Cortisol is released and influences behaviour and actions.
These internal reactions contribute to the infant/child’s developing sense of
self over time. Emotions are deeply entwined with socialisation and expecta­
tions of feelings in relation to a family and community culture. An infant’s
interpretation of the world can be led by the primary carer’s reaction or the
role model of a practitioner. Babies may reflect the emotions of a parent
which can be prohibitive of positive emotional development if the parent is
suffering from short- or long-term mental-health issues. Young children’s
emotional literacy can be supported and the early stages of self-regulation
initiated through sensitive care that supports up-regulation and promotes a
pathway to down-regulation. Practice should respond to the child’s person­
ality and needs.
Thompson (1991) described a developmental stage that emerges around 36
months, termed meta-emotive understanding or knowledge of emotional
processes. The young child has increasing capacity to recognise and to use
strategies that are associated with self-regulation of emotions. He gains com­
prehension of conditions that lead to heightened emotions and the resultant
sensory experiences, the reactions of other people in this context, and psy­
chological processes. This study found that adults managed emotions by
changing their surroundings and minimising or increasing direct influences
upon their emotional responses. Alternatively, children’s emotional self-reg­
ulation involved restriction of the stimuli which was usually at a sensory level.
14 Infant mental health
A child may reduce sensory intake by covering eyes and ears to block the
stimulatory input. The outcome is relative to the emotional stimulus being
reduced rather than the emotion being regulated by the child. Additionally, a
child may ignore circumstances of emotional arousal by turning away from
the situation or turning towards a primary carer. A carer can support a child
to interpret and to react positively to stimuli. For example, the sound of sirens
of emergency vehicles or reverse horns on utility vehicles form a common back­
drop to play within inner cities. Carers can support a child to gain understanding
through linking to small-world play, showing a child the source of the sound
from a window, and role-modelling interest and curiosity as opposed to fear and
anxiety. Common occurrences within services or home environment present
invaluable opportunities for development of self-regulation.

Experience-expectant and experience-dependent stages

I considered these findings in the context of my practice within a playroom
for infants aged 0–2 years. Referrals for placement in a service give details of
perceived stresses upon babies and children, for example, domestic violence,
substance misuse, parents’ additional support needs, and mental-health issues.
Negative circumstances and assumption of positive influences may be pre­
sented within neatly compartmentalised sections of a referral form: adversity,
protective factors, vulnerability, and resilience. However, the child’s person­
ality and his evolving sense of self are key aspects in his interpretation and
reaction to influences. Siblings who attend the same service often demonstrate
different reactions to adversities within the family home.
Experience-expectant and experience-dependent stages of development give
clear representations of the responsibilities of carers. Experience-expectant is
associated with support, which is given in a context of the normative path­
ways of development, for example, feeding and walking independently. These
areas of development relate to neural connections that form after the infant
has undergone a regular experience: a cry of hunger being rewarded by his
mother’s milk or a desire to walk being supported by a nurturing relationship
and stimulating environment. This type of development is time-limited as it
occurs within a critical period (Berens & Nelson, 2019).
In contrast, experience-dependent development is relative to personal
experience and may occur in infancy and throughout the lifespan. Experience-
dependent is the cultural influence upon synaptogenesis. Stimulation and
development of the five senses requires exposure to light, sound, touch, smell,
and a variety of tastes. Many children attend services in their early years of
childhood on placements which are funded by governments. This funded
strategic approach to education broadens the young child’s exposure to
learning opportunities. Research shows that experience-dependent learning is
most effective during sensitive learning stages with a focus upon birth to 3
years (Centre for Excellence and Outcomes in Children and Young People’s
Services, 2010).
 Infant mental health 15
Berens and Nelson (2019) present an illustrative example of behaviour that
may be influenced by development based upon experience-expectancy and
experience-dependency. These authors describe the capacity of an infant to
form attachment as being experience-expectant which occurs within the ear­
liest stages of childhood. However, the quality of attachment reflects the per­
sonal experience-dependent learning opportunities which are offered to the
infant by his primary carer.
At entry to a service, some children are vigilant, which is demonstrated by
quick reactions and physical withdrawal from assumed sources of threat. The
infant’s perceived sources of threat include adults or peers breaching the per­
sonal space around his body, unexpected movements in his visual peripheries,
and unidentifiable loud noises from outside the immediate setting. Nurturing
and reassurance are offered to the infant by practitioners but may be rejected
in the early stages of a relationship and interpreted as a potential threat.
Physical and emotional contact which is given to the infant by a key worker
may result in an increase in signs of his stress, for example, rapid heartbeat
and perspiration. These physiological responses can appear as an overreaction
by an infant within the caring and supportive context of a service.
Knowledge of physiological reactions will support comprehension of a
practitioner in these circumstances and increase expertise in delivering
responsive care to the infant’s emotions. I have often encountered practi­
tioners who do not fully understand trauma in childhood feeling rejected by
an infant who creates a barrier to relationships. Practitioners in an early years
service may not have access to the details of a family’s circumstances. How­
ever, daily observations can provide invaluable information to support inter­
vention in response to the infant’s interpretation of his experiences.
The complex internal working of an infant in this context can result in
exhaustion during and after these episodes. The practitioner presents a buf­
fering relationship to minimise the effects but equally importantly by offering
positive experiences within a child’s world to reconfigure his inner working
model and to use the secure attachment relationship for the optimum out­
comes. Babies require time and repetition to assimilate the positive relation­
ship overtures and to adjust internally. The transition can be observed as the
behaviour changes. The art of observation and responsive care in services are
key attributes to a practitioner’s understanding and promotion of mental
health in infants.

Stress
The hormone cortisol can have positive effects in the short term and negative
for long-term periods if stress is prolonged. The circadian rhythm, as the 24­
hour cycle of light and dark, regulates cortisol levels, but lifestyles can cause
changes to these patterns. Many families do not adhere to the traditional
pattern of sleep during darkness and activity during daylight hours. Parents
express that they can spend prolonged sessions on internet activity during the
16 Infant mental health
night and struggle to cope with a waking baby in the early hours of sunrise.
Long-term stress results in lengthy periods in which the body experiences high
levels of cortisol which impacts adversely upon blood sugar, blood pressure,
ability to sleep, and cognitive skill. Knowledge of the destructive properties of
cortisol provides rationale to strategic planning and funding for intervention
(National Scientific Council on the Developing Child, 2006). In addition, I
feel that daily practice is greatly informed through understanding that exces­
sive cortisol can stop neural connections occurring and create stress reactions
which are barriers to learning and achievement of potential.
A high level of stress can also result in a stress response system being
underactive. For example, a baby’s lifestyle is profoundly disrupted if parent­
ing skills are affected by toxic stress which the parent is unable to reduce. A
baby experiences the negative impact of this stress albeit indirectly from the
source that affects his parents. During these episodes, the baby’s hippo-
campus, which is the area of the limbic system supporting memory and links
to emotion and sensory learning, produces fewer cortisol receptors thus stress
remains at a high level.
I have not heard the concept of learned helplessness applied to practice for
many years, but the associated presentation is well known in a context of
child protection and displayed within observations of infants and primary
carers who have experienced abuse. The young child may appear to be placid
and content to an inexperienced practitioner, or to a parent. The child may
appear preoccupied with his proximal environment, particularly his own
clothing or body. I observe children actively hiding from a perceived threat by
covering their faces with hands or play items, moving under equipment, or
shutting their eyes and dipping their heads downwards towards their chests.
I have frequently observed the presentation of some infants as being non-
responsive and challenging for a practitioner to stimulate with learning
opportunities. Primitive dissociative adaptations, and physical and cognitive
freeze, are accompanied by physiological responses to prepare the body and
mind for dealing with a forthcoming threat. The heart rate slows down, blood
flows away from extremities, endogenous opioids reduce physical pain and
may flood the mind with a sensation of calmness and psychological distancing
from an attack. An infant who operates within a lifestyle of adversities learns
to minimise the potential for stress by limiting human interaction despite the
context of a nurturing nursery.
In the early stages of my career, the children who presented with these
characteristics were termed still children which depicted their body language.
During the 1980s, and 1990s, we observed and recorded this behaviour and
sought to devise practical strategies that supported engagement. As practi­
tioners, we did not have access to scientific knowledge or an opportunity to
increase our understanding from research. Throughout a career, it is useful for
practitioners to reflect upon previous practice, and historical memories, in
order to enhance understanding. An increase in comprehension of the cir­
cumstances is valuable. Reflection is a key factor in gaining optimum value
 Infant mental health 17
from work experiences and raising a practitioner’s ability to link research, and
practice, thus closing the implementation gap.

Box 1.2 Example from practice

A key worker called me into the baby room to observe our new nursery
infant, Joy. I slipped quietly through the doorway which was festooned with
brightly coloured ribbons and welcoming photographs, and I tucked myself
into a corner of the warm playroom. I am well aware of the intrusive impact
of an adult entering a playroom mid-session and disturbing the ambience
between familiar practitioners and children. The key worker nodded towards
Joy. I saw an infant of seven months with fine blond hair sitting steadily
upon a patterned rug. The key worker called her name, and she gently rolled
a soft red ball towards the little girl. A quiet bell emanated from the ball at
each tumble. The ball had been constructed for play by babies or young
infants, and the soft velvet material prevented this toy from reaching its
destination upon the black-and-white checked rug.
Joy’s body stiffened, her fists clenched, and she turned her head sharply
to one side, averting gaze or potential interaction with this red intruder. Joy’s
body language depicted her uncertainty and indicated to staff that the little
girl did not know how or where to seek help. She had not recognised the
secure haven which the key worker offered. The practitioner touched the ball
with two fingers to make it spin. The intention was not to invade the perso­
nal space of this fearful infant but to stimulate curiosity and potential learn­
ing from the proximal environment of a nursery playroom. The infant
perceived an increase in threat level. Joy’s head dipped forward, and she
removed eye contact from her immediate surroundings.
Learned helplessness implies that the child has consciously acquired this
behaviour; however, it is a demonstration of an instinctive protective reac­
tion to external negative influences. The disconnection results in the child
gaining some control over the threat by focusing inwards and minimising
interpretation of the negative aspects. This strategy reduced the potential for
emotional and physiological impact upon Joy’s mind and body.

Social development
Social development of an infant is cultural and contextual. The first rela­
tionship and dyad in life before birth is the infant and his mother. By 26
weeks gestation, a foetus can react to the sound of his mother’s voice, and
hearing is known to be one of the first systems to develop.
At birth, babies demonstrate an intense interest in human faces and
attempt to copy gestures. This important finding signifies learning through
socialisation. Normative development indicates that socialisation progresses
18 Infant mental health
from a context of care routines at birth to a baby of 4 months seeking out
stimulation of the wider environment beyond his care needs. Thereafter, an
infant will make use of social referencing by adopting reactions and emotions
of the primary carer as his world is extended.
The framework of reference that the baby uses to engage, to interact, and
to understand the world evolves rapidly throughout the first year. The initial
12 months of life are regarded as one of the most sensitive periods for learn­
ing, and the baby should be supported to maintain physical and emotional
health for genetic potential to be fulfilled. Babies learn at different rates, and
the astute practitioner appreciates the importance of repetition and con­
solidation of knowledge to support understanding.
Care routines take place many times per day. These nurturing adult–child
interactions provide perfect opportunities for a key worker to observe a baby’s
needs and interests and to support expansion of his inner working model.
This internal framework is based upon experiential learning, and positive or
negative emotions rapidly become associated with care patterns. Secure
attachment is a key concept in services, and early years settings commonly
operate with a key-worker system. This adult–child relationship is not an
exclusive partnership, and an infant can create nurturing relationships with
other staff and students in the age group in which he is based. Some early
years services describe these room-worker relationships as positively extend­
ing the rationale of key worker, in a context of secure attachment and learn­
ing. During the pandemic, children in nurseries were cared for by a group of
practitioners within a “care bubble” as opposed to designated key workers
due to isolation periods impacting upon the service delivery.
Human beings continue to need secure attachment relationships through­
out life to achieve and to support mental and emotional good health.
Attachment is an adaptation to a set of circumstances. Insecure attachment is
exhibited by an inability to self-regulate; therefore, the circumstances must
change to promote agency and a sense of self. Balbernie (2013) explained that
a value of poor should not be linked to attachment as the infant is simply
demonstrating effective survival responses to adversities albeit he is not
securely attached.
It is often the case that concerns about relationships are expressed as a
child “not having secure attachment to an adult.” Each infant has an inherent
predisposition to seek out positive relationships with a primary carer from
birth, but attachment requires a dyad in which an adult responds to a baby’s
emotional and physical needs and provides the optimum conditions for
development. Strengthening of attachment occurs within every moment of
interaction. The conditions nurture and respond to the baby’s overtures for a
supportive relationship.
The relationship with a primary carer is a template that informs future
relational capacity, and it provides the infant with a medium in which he can
learn to regulate emotions, behaviour, and actions. Lack of self-control, and a
limited capacity to regulate, can create conditions of high vulnerability in
 Infant mental health 19
childhood and potentially relational and mental-health issues in adulthood.
Four aspects are identified by Balbernie (2013) as stress factors that can
impact upon the infant–mother relationship.

1 Biological vulnerability of each infant.

2 Parental history of adversities and current parenting skills.
3 Interactional or parenting variables in each family.
4 Socio-demographic factors which may be influenced by a community.

Promotion, prevention, and intervention

In practice, I find that sources of stress are commonly described by parents as
external factors in the form of environmental issues, for example, inadequate
housing, poverty, and neighbourhood discrimination. Shonkoff and Fisher
(2013) commented that daily financial stresses lead to families operating
within crisis mode over long-term periods, which is associated with low self-
regulatory skills. These authors stated that ability and capacity to plan and to
receive delayed gratification is greatly reduced in a context of poverty.
Intervention should support development of parents and increase their
capacity to manage the daily stresses. Two examples are the Head Start and
High Scope programmes in the USA (Schweinhart, 2005). These innovative
approaches to education and care were created in the 1960s in response to the
needs of children living in poverty by targeting the potential for academic
failure in the early school years. Findings indicated long-term benefits from
preschool interventions for the children of families who existed in a context of
daily poverty. Conclusions highlighted consistent patterns of cause and effect
from preschool programmes of one or two years to achievement in adulthood.
Achievement in this study of 123 participants included a reduction in episodes
of criminality in relation to the norm, graduation from high-school education,
and earnings in adulthood.
The initial programmes contributed to shaping parental interventions
today, and consideration is given to location, staff skill, needs, and cultural
characteristics of families, in addition to timing and duration of intervention.
Some programmes commence in the prenatal period and focus upon a
strengths-based model, for example, the Nurse–Family Partnership in the
USA. In the UK, this programme is termed the Family Nurse Partnership
(Family Nurse Partnership, 2011).
Toxic stress can affect the architecture of the brain, and this finding is sig­
nificant to early intervention work and the necessity of supports by multi-
agencies. Alleviation of these factors does not necessarily result in a reduction
of toxic stress. Implicit memories which are based upon emotions can repro­
duce the stress reactions although the original source is minimised. Parents
and grandparents will often recount historical instances of sexual abuse and
exhibit emotions from a childlike perspective to service providers. It is chal­
lenging as a practitioner to respond with the optimum support as disclosures
20 Infant mental health
usually occur in unexpected circumstances. For example, within my work­
place, the cloakroom area is a regular discussion venue for parents to exhibit
help-seeking behaviours to professionals (Braun et al., 2006; Broadhurst,
2003; Whitters, 2015). Early years services are busy, active environments, and
staff have to adhere to adult–child ratios at all times. Parents expect an
immediate response to help-seeking cues. During this COVID-19 pandemic,
parents cannot access service buildings, and other means of help-seeking
communication have emerged, for example, by phone, text, and email.
Patterns of responses may evolve in relation to circumstances of toxic
stress. These patterns result in physiological changes and associated repeated
behaviours. Patterns which are created in the earliest years of childhood can
persist throughout the lifespan and be activated by minor and major threats.
Intervention by services, or positive role-modelling by an influential adult,
can have a positive impact at any age. Changing the operational skills of an
infant is best achieved through intervention with the extended family unit.
Families require guidance in rethinking interpretation of their world, and
subsequently the chemical reactions in the body will change and toxic stress
reactions will reduce for an infant and his family.
Each registered workplace adheres to national care standards which give
detailed expectation of the learning environments and skills required by
practitioners to keep every child safe, healthy, achieving, nurtured, active,
respected, responsible, and included. An example is the Scottish National
Practice Model, termed Getting It Right for Every Child, and this document
guides planning, practice, assessment, and child protection (Scottish Govern­
ment, 2008, 2021). The model provides a context in which to implement the
curricula: current Scottish curricula are Curriculum for Excellence (Scottish
Government, 2004) and Pre-Birth to Three (Scottish Government, 2010). The
four UK countries have similar curricula, and guidance is based upon the
United Nations Rights of the Child (United Nations Convention on the
Rights of the Child, 1989).
Curricular guidance is informed by research findings which additionally
influence legislation. Early years practitioners have a responsibility to seek
understanding from guidance and to apply knowledge within the context of
their roles. Time to reflect is a necessary condition of professional develop­
ment. Many care and education settings use “clean-down” time for collegiate
discussion. Sorting and sterilising equipment and preparing a learning envir­
onment provide repetitive but therapeutic activities for an early years team.
This type of group professional reflection has great value due to the local
context and relevance to timely discussion of a concern or celebration of a
family’s progress.
The study by Thompson et al. (2019) identified an increase in cortisol of a
participant group of children throughout the period of a day spent in early
years care. Findings indicated an increase in activation and overtaxing of the
stress response systems. The control group of children who remained at home
did not demonstrate an increase in this stress hormone. The research team
 Infant mental health 21
described three common sources of adversity in families: low socio-economic
status, mental-health issues relating to the mother, and child abuse. The study
did not portray the day-care environment as directly contributing to stress but
implied that the environment did not alleviate the stress experienced by the
children. This finding is informative for early years services. Practitioners
cannot change the lifestyles of families, but a key responsibility is supporting
the child’s resilience and changing the local environment to reduce any nega­
tive impacts upon learning and development.
Three brain systems which are susceptible to toxic stress are emotional reg­
ulation, memory, and executive functioning. Constant states of agitation can
also impact negatively upon the immune system. In 2018, the American Heart
Association advised that emphasis should be given to interventions that reduce
exposure to adversity in childhood as a preventative measure to chronic inflam­
mation throughout adulthood. Short-term adaptations to stress have been linked
to long-term consequences of adversity, for example, maladaptive behaviour, an
acceleration of the ageing process, chronic illness in adulthood, and a shortened
lifespan (National Scientific Council on the Developing Child, 2020).
It is known that relationships and environment affect the emotional devel­
opment of young children. A high level of cortisol during waking hours has
been linked to negative emotions of infants, alongside maternal depression.
Infants who exhibit higher than average cortisol levels demonstrate char­
acteristics which can also be observed in depressed adults. Examples cited by
Luby and Whalen (2019) included a distinct lack of mood change from
negative to positive in a context of environmental stimulation, inconsistent
sleep patterns, and alteration to daily appetite.
Luby and Whalen (2019) conducted research on depression in early child­
hood, and these authors described infants as young as 2 months old display­
ing negative emotions, which included sadness. At 6 months of age, infants
were demonstrating sad and joyful expressions. These reactions corresponded
to events in the study which were designed to create negative or positive
emotion. Behaviour associated with depression in infants includes withdrawal
from proximal stimulation in the environment, apathy, and failure to thrive.
Improving the infant’s relationship with a primary carer is regarded as a key
aspect of intervention.
In the earliest years of life, the infant’s emotional arousal is regulated by a
responsive parent or practitioner. Tronick and Beeghly (2011) described how
infants create a bio-psychosocial state of consciousness by use of non-verbal
meaning. Making meaning is an iterative, lifelong process that is individual to
each infant and influenced by multiple internal and external drivers. The
infant’s interpretation of his world is demonstrated by movement, actions,
and emotions. The adult–child dyad supports the infant to increase his com­
prehension of the proximal world by reference to other beings and to himself.
Emotional regulation, effective communication skills, expression of emotions,
social competence, and the capacity to explore an environment are indicators
of good mental health.
22 Infant mental health
However, if a carer’s capacity to support an infant is compromised, then
the infant may struggle to develop and to maintain emotional homeostasis as
termed by Thompson (1991). Jennings et al. (2008) studied 134 infants to
explore potential links between development of self-regulation, comprehen­
sion of the autobiographical self, and maternal sensitivity to an infant’s needs
and emotions. Findings had revealed that an infant’s ability to use his vision,
and his eye contact to gain attention can be contributory factors to predicting
development of self-regulation skills. A mother’s warmth towards her child
prompted motivation to learn, and children in this study appeared to adopt
and to strive towards their mothers’ goals. The conclusion indicated that
maternal depression could affect the infant’s capacity to gain self-regulation.
Experiences that focused upon internal and external influences upon the child
were recommended.
Experiences are influenced greatly by the culture and beliefs of each family,
and particularly the interpretation of the world which is given to the infant by a
primary carer, usually his mother (Rosenblum et al. 2019). Thompson (1991)
described regulation as intrinsic and extrinsic processes that influence emotional
reactions. Examples of intrinsic processes are language, cognitive skills, and the
development of a sense of self. Extrinsic processes include parental and key-
worker strategies and experiences that provide opportunities for the management
of emotions and, ultimately, development of self-regulation.
Emotional experiences are affected by socialisation, and meanings are acquired
that are pertinent to the individual and family. Over time, the young child’s ability
to regulate his emotions provides a foundation for his comprehension of others.
For example, the child’s expectations of emotional reactions are associated with
social functioning in different contexts, and the personalities of his primary carer,
extended family carers, and other significant adults. Thompson (1991) comments
that social competence, cognitive functioning, and academic achievement are
influenced by these stages of emotional development.
This increase in knowledge and understanding is embedded within the
infant’s behavioural processes, and emotions can quickly be associated with
the infant’s reaction to extrinsic influences from the environment. The man­
agement of emotion evolves from the nervous system (Thompson, 1991),
which is immature at birth, therefore dependent on extrinsic influences to
support development and capacity. There are two significant stages in inhibi­
tory control at approximately 4 months and 10 months of age. Activation of
emotional reactions can be positive and negative for an infant. For example,
heightened emotions can stimulate and invigorate the young child by focusing
his attention and facilitating learning. Emotions can support an infant to
respond rapidly to changes in self or environment and to maintain a high
level of engagement and interaction. Additionally, positive emotions prompt
the use of memory and creation of relationships which can complement and
capitalise upon learning opportunities. Alternatively, negative emotional
reaction can create a barrier to knowledge acquisition if an infant is focused
upon coping with an adversity and maintaining his perceived or actual safety.
 Infant mental health 23
Rosenblum et al. (2019) applied two theoretical perspectives to the under­
standing of human emotions: the structuralist and fundamentalist approa­
ches. Structuralists associate behaviour and timescales with emotions.
Fundamentalists emphasise the relational aspects of emotions by linking to
specific stimuli and preparing the infant for action. Risk and protective fac­
tors can hinder or enhance development, and infants encounter multiple
potentially adverse factors throughout their earliest years. Biological factors
are often regarded as the most obvious source of negative influence, for
example, prematurity, accompanying low birth weight, and additional learn­
ing needs.
Research by Schechter et al. (2019) indicated that an infant’s capacity to
recall events is increasingly evident throughout the first year of life, although
the ability to comprehend experiences emerges over time alongside language
and communication skills. Adversity which is chronic or a single event which
has an extreme impact upon the infant may result in dissociation, and affect
recall and neurobiology of the brain.
The Centre on the Social and Emotional Foundations for Early Learning
(2007) identified areas of adversity and strengths in families which may be
adapted for use within assessment processes. These are family make-up, par­
enting skills, extended family influences, stress and responses by a family,
infant’s personality and particular strengths, family and community culture,
and, finally, communication and emotional expression.
Larrieu et al. (2019) described dimensions of the caregiving environment
and the infant’s characteristics as providing a framework for determining
intervention which is based upon the strengths of each family. The caregiving
environment encompasses the primary carer’s ability to conduct problem-sol­
ving, conflict resolution, understand role and responsibilities, communicate
instrumentally, and respond to emotions. Additionally, to demonstrate emo­
tional investment, support behavioural regulation and coordination, and
maintain sibling harmony. Infant characteristics that affect implementation of
an intervention include temperament, sensory awareness, physical and mental
health, learning style, and developmental status (Zero to Three, 2016). Inten­
tional communication by an infant is also an important factor in intervention.
In the early stages of childhood, communication is characterised by three
functions: behaviour regulation, joint attention, and social interaction (Saletta
& Windsor, 2019). These areas are described in later chapters of this book.
The research of Beebe et al. (2012) focused upon the use of a dyadic system
to support positive development of a secure attachment relationship and
internal working model in an infant. This system incorporates joint coordi­
nation as expressed by these authors. Each person in the dyad coordinates his
behaviour with the other. Another term which is used in practice is the dance
of reciprocity. Daily care routines, in addition to exploration of an environ­
ment, provide contexts for intrapersonal and interpersonal rhythms to evolve.
Routines present multiple opportunities for emotional patterns to be created,
or changed, as the infant’s comprehension of his sense of self matures.
24 Infant mental health
Findings from the aforementioned research indicated that the infant learns by
his own experience and the experience of the other person in this dyadic
system; thus, the participants are interdependent on one another.
Beebe et al. (2012) promote three principles to interactions within the
dyadic system of adult and infant: ongoing regulations, disruption and repair,
and heightened affective moments. As the interaction progresses, each parti­
cipant recreates a psychophysiological state in the sense of self which is simi­
lar to that of his partner in the dyad. If a mother is unable to achieve this
level of comprehension of the infant’s state, then her empathy towards her
child is affected adversely (Beebe et al. 2012).
Responses to infant mental health encompass promotion, prevention, and
intervention to minimise the impact of negative influences in the earliest
stages of life (Centre on the Social and Emotional Foundations for Early
Learning, 2007). A strategic and operational approach is to extend the
infant’s experiences, environmental and relational, and to actively support his
mental health. Zeanah et al. (2005) identify three principles of infant mental
health.

1 Consistent relationships as building blocks of social and emotional

development.
2 Use of a continuum of services which can be matched to family needs
and preferences.
3 Finally, training and supervision of the practitioner workforce.

Intervention aims to activate or to increase the infant’s capacity and to

achieve positive outcomes by using a strengths-based approach. The common
target areas for intervention are described below.

� The parent–child, practitioner–child, and practitioner–parent relationships.

� A positive environmental context for learning that supports social and
emotional well-being and associated behaviours.
� Continuous professional development of the workforce, which promotes
an increase in knowledge, understanding, reflection, and practical exper­
tise in infant mental health.

Assessment of the primary carer to infant relationship is essential to deter­

mine responsive intervention for each dyad. Consideration must also be given to
nurturing potential in a context of supportive practitioner–infant and practi­
tioner–parent relationships. The practitioner–parent relationship is a key feature
in family services which can effectively link the micro-systems of home and
playroom. Partnership skills with child and parent develop over time through
experiential learning. Professional characteristics in the context of infant mental
health are the ability to listen and to consider, to reflect on positive and negative
influences upon each infant and self, to increase knowledge, and significantly to
gain deeper understanding.
 Infant mental health 25
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2 Relationships, involvement, and
well-being

Chapter 2 focuses upon the infant’s relationships and the impact upon well­
being and involvement with a learning environment. The chapter describes
the infant’s demonstration of attachment behaviours from birth (Howe, 2005).
Separation protest and proximity-seeking are key behavioural systems that are
expressed in the early years. Discussion is presented of the bio-social homeo­
static regulatory system and includes reciprocal adult attachment behaviour
(Fonagy, 1999). Babies are unable to regulate their emotional reactions at
birth; however, the dyadic system develops over time, and it creates an essen­
tial baseline of knowledge and understanding for the developing infant
(Fukkink, 2021).
Transgenerational transmission of deprivation is described alongside inter­
vention that can support families to change and to develop in a context of
daily living. Three significant aspects of change to the inner working models
of primary carers that support infant mental health are highlighted: beha­
vioural, cognitive, and social. Attunement, reciprocity, marked mirroring,
containment, and reflective functioning are described as contributing to the
ability and capacity of an infant to adapt to different environments and rela­
tionships. The Circle of Security (Cooper et al., 2016) and the Solihull
Approach (Douglas & Rheeston, 2009) are presented as interventions that
support development of a secure interdependent family unit.

Relationships
Creation of a relationship with another fellow being is an inherent need of
every infant, and a secure attachment relationship is the foundation for a
healthy and fulfilling life. Infants demonstrate attachment behaviours from
birth, for example, seeking close physical contact, holding tightly onto an
adult, and showing preference for familiar human faces and voices with par­
ticular emphasis on eye contact with a mother. Separation protest and proxi­
mity-seeking are key behavioural systems that are expressed in the early years.
Fonagy (1999) found that reciprocal adult attachment behaviour responds to
and encourages the relationship overtures of an infant. Interactions lead to
the infant experiencing security on a physical and emotional level. Babies are
DOI: 10.4324/9781003358107-2
 Relationships, involvement, and well-being 29
unable to regulate their emotional reactions at birth; however, the dyadic
system develops over time, and it creates an essential baseline of knowledge
and understanding for the developing infant. In the early stages, regulation is
based upon the infant’s expectations and role-modelling from the primary
carer’s behaviour. Fonagy (1999) applied the term “bio-social homeostatic
regulatory system” to these processes.
Bonding is presented as the emotional relationship from adult to child, and
attachment is the child’s emotional bond with the parent or a primary care­
giver (Association of Infant Mental Health, UK, 2021).
These terms are often used interchangeably by carers. A caregiver can be
closely associated with a proximal environment, for example, a parent within
the home or a key worker in a nursery. During teaching sessions on relation­
ship processes to parents, and practitioners, I feel that it is important to
communicate that the infant does not have responsibility for creating a secure
attachment relationship with an adult. Attachment requires a dyad, and the
adult must present appropriate conditions and a responsive relationship in
order for the child’s attachment cues to be recognised and to support his
status of emotional well-being and safety.
The Royal College of Midwives (2020) present common terms relating to
infant mental health: “attunement”, “reciprocity”, “marked mirroring”,
“containment”, “reflective functioning”. These terms can be applied to
describe actions that promote a positive attachment relationship and bonding
between adult and infant.

� Attunement: the sharing of emotions between parent and infant as a

response to an external influence, the baby’s internal influences, or a
positive emotional reaction to the parent–child relationship itself. A
baby’s internal influence is often detected by demonstration of physiolo­
gical changes. After feeding, a baby may burp excess wind, and the parent
celebrates this achievement with a positive emotion which the baby will
thereafter associate with his internal sensation.
� Reciprocity: a parent described reciprocity to me as the “back and for­
ward game”. This descriptor accurately implies the turn-taking and
creative aspect of reciprocity. The parent observes the baby’s cues and
quickly gives a response that meets the needs and interests as expressed
by a cue. The baby initially copies the carer’s body language and develops
the interaction by use of his personality and changing needs at a point of
time. Reciprocity incurs attunement, a feeling of great satisfaction by
parent and infant, and entails a rich source of learning.
� Marked mirroring: a parent represents the infant’s emotion by copying his
expression which is often prompted by internal positive or negative
influences and by supporting emotional containment. The baby may feel
contented after a feed and change or express anxiety as a response to
hunger and discomfort. A parent interprets his emotion by reference to
knowledge of the baby’s usual reactions to common circumstances.
30 Relationships, involvement, and well-being
Repetitive care processes each day provide a parent or practitioner with
numerous opportunities to determine the baby’s personality, specific
characteristics, and reactions to his world.
� Containment: practitioners often receive training on the use of contain­
ment and strategies to support emotional expressions by parent and
child. Adults can learn to contain a baby’s emotions and to support his
regulation without adopting the emotions.
� Reflective functioning: this is an essential aspect of childcare and education,
and a parenting role. An adult caregiver considers the infant’s individual
needs, wants, and interests and presents a sensitive response in order to
assuage these needs.

In 1954, Abraham Maslow described the hierarchy of needs in ascending

order as physiological needs, safety and security, love and belonging, self-
esteem, and self-actualisation (Maslow, 2000). Maslow determined that needs
which were met created a foundation for further needs to be realised, and to
be responded to by primary carers and community.

Bonding
Research indicates a link between maternal oxytocin levels and bonding
between mother and foetus, and mother and infant (Royal College of Mid­
wives, 2020). Low levels are associated with higher incidence of postnatal
depression. During a Caesarean section there is no oxytocin released during
the process. There is a delay of 48 hours before oxytocin is detected after this
assisted birth (Levine et al., 2007). However, skin-to-skin contact between a
newborn infant and mother has been found conducive to prompt oxytocin
release at birth (UNICEF, 2021). In many countries, a newborn will be placed
upon his mother’s chest at birth to encourage the attachment processes and a
bond which will last a lifetime.
The parent–child dyad supports the newborn to regulate his emotional
reaction to external influences in the context of responses to objects, people,
environmental conditions, and his changing internal physiological state.
Acquiring and maintaining a status of emotional and physical security forms
the rationale of the human attachment system, and seeking to achieve this
goal is a motivational force upon the infant’s behaviour. Adequate resources
for development are required in the form of a variety of experiences, con­
sistent relationships, and time for reflection that supports the infant to absorb
and assimilate knowledge within his inner working model. His reactions,
actions, and behaviour increase in complexity and intent over time. As the
bio-social homeostatic regulatory system evolves, then the infant’s ability and
capacity to demonstrate resilience to adversity increases, and negative influ­
ences have less impact upon development.
Attachment is described in theory (Bowlby, 1979) as a bio-behavioural
mechanism which is demonstrated as a response to anxiety and founded upon
 Relationships, involvement, and well-being 31
an outcome of survival. Observation of practice indicates that confirmation
and consolidation of the attachment relationship occurs during an infant’s
exploration of his environment. The attachment system is not activated but
maintained and strengthened during this time within adult–child reciprocal
interactions. The dyadic regulation of affect encompasses the primary carer
and infant working in partnership to achieve stability of the child’s emotional
states. Attachment is based upon needs and strategies associated with survi­
val, in addition to supporting up-regulation and down-regulation of emotions
encountered during learning.
Howe (2005) presents the child’s organisation of attachment behaviours.
Over time, the child’s inner working model acquires representations of himself
within a proximal environment, his interpretation of other people, and
expectations of a relationship based upon his personal perspective and actions
of others. This base of knowledge leads to the child’s use of attachment
behaviours to increase the responses from primary carers to his need for
availability, and responsivity. His behaviour is communication about his needs
and often indicates how an attachment figure can respond to these needs at a
point of time. For example, an infant who desires physical reassurance will
cry, give eye contact to a primary carer, and raise both arms to indicate that
he wants to be lifted. If the adult lifts the child, then he will move his head
towards her body and hold onto her clothing with both hands. This reinforces
the message to the child that his communication methods are effective, and it
provides the carer with the knowledge and practical skill that responds effec­
tively to the particular attachment behaviour of this infant. The carer and
child adapt their behaviour and create a goal-corrected partnership as termed
by Howe (2005).
Fonagy (1999) expressed that activation of the attachment system is
dependent on the child’s interpretation of his world and resultant status of
security, or insecurity. However, a child’s understanding of environmental
influences can also be led by the reaction of his parent or carer. The primary
carer’s reaction is based upon an adult inner working model which in itself
was influenced by childhood experiences, positive and negative. Research
indicates that children who are insecurely attached often have parents with a
similar attachment status, which Fonagy termed the transgenerational trans­
mission of deprivation.
Attachment behaviour includes over-regulation, in which the child is pre­
occupied with seeking care responses, or under-regulation, in which the child
may avoid potential stress. A disorganised care environment does not support
the child to identify or to use patterns of seeking and gaining secure attach­
ment responses. Children who have experienced chaotic and inconsistent car­
egiving may perceive adults as a source of fear and reassurance. Anxiety is
experienced by an infant as internal physiological changes in response to the
behaviour of one specific adult, family members within a household, or
strangers in a community (Fonagy, 1999). Behavioural patterns can exist in
the context of chaotic households, but the complexity of identifying, and
32 Relationships, involvement, and well-being
using, these patterns to support mental stability is beyond the developmental
capability of most infants.

Circle of Security
Acquiring the skill of reflective functioning is significant to the development
of secure attachment capacity in parents whose relationships are influenced by
their own childhood adversities. Fonagy (1999) presents potential for change
in a parent’s behaviour if opportunities and interventions can specifically
support the development of this skill. In turn, a parent’s increase in reflective
functioning instigates reflection in the child, and this intersubjective process
contributes to the development of their secure attachment relationship. The
Circle of Security (Cooper et al., 2016) and the Solihull Approach (Douglas
& Rheeston, 2009) are used within my workplace to train practitioners and
parents in the rationale and behaviour associated with reflective functioning
between adult and child. The primary carer, as an attachment figure, provides
two main functions:

1 A safe haven from potential threat. Threat may relate to new and unpre­
dictable environments or a young child’s inability to differentiate between
safety and danger. This haven is communicated to the child by the adult’s
body language, availability, and reassurance through role-modelling from
the perspective of an adult’s interpretation of the potential danger. In
addition, attuning to the child’s changing emotions and behaviour as his
knowledge and understanding increases confirms the status of an envir­
onment being safe for exploration. A safe haven refers to the attachment
figure and not the environmental setting, although a primary carer can
present a positive interpretation of an environment to the child by her
behaviour and attitude.
2 A secure base results in the attachment system being deactivated as the
child recognises conditions which are conducive to exploration, discovery,
and learning about his proximal and distal world. In practice, the child
does continue to refer to his attachment figure during these forays and to
share his delight in discovery through eye contact and body language.
Infants will often return to the attachment figure every few moments to
gain reassurance. I ask parents to imagine a string of elastic thread con­
joining adult and infant. It can be stretched over time, but the connection
remains constant. If an adult responds consistently to a child’s relational
overtures, usually by the use of gesture or verbal interaction, then the
attachment relationship will be consolidated.

Secure and insecure are usually the attachment classifications given to par­
ents as a baseline for understanding their role and infant’s behaviours. These
two descriptors represent the child’s emotional well-being in a context of the
parent–child relationship. Secure, ambivalent, avoidant, and chaotic are
 Relationships, involvement, and well-being 33
further descriptors that support practitioners to recognise and interpret
these behaviours. A child can have different categories of relationships with
adults and siblings since attachment is a reciprocal phenomenon that
depends on a carer’s responses to the child’s initiations.

Relationship dyad
Difficulties in forming positive relationships do not just affect the individual
but impact upon the relationship dyad, and the behaviour of one partner may
be detrimental to the other. The establishment of secure attachment with a
key worker in a service can provide a change in understanding and expecta­
tions of a relationship with a parent for an insecurely attached infant. How­
ever, if the parent is unable to change his or her attachment responses and to
provide a safe haven and secure base, then the infant will remain insecurely
attached to his mother or father. Sroufe et al. (2000) linked physical abuse,
lack of emotional care, and empathy to conduct and anxiety issues in a child.
This research suggested that formation of a positive relationship with an adult
who is not a primary carer, for example, a grandparent or a professional, can
mitigate the negative effects of a parent–child relationship.
Doyle (2001) conducted a small significant study twenty years ago that high­
lighted the influence of comfort objects in a context of attachment and security.
The participant group was composed of 14 adult survivors of childhood emo­
tional abuse. Findings indicated that the parents of some of the participants had
experienced difficulties in demonstrating love but had allowed children to create
positive relationships with others. These children had gained nurture from com­
fort toys, pet animals, or personal artefacts. Participants in this study had iden­
tified contact with pets as a key source of impactful relationships in childhood.
The aforementioned study cites play-therapy sessions as contributing to an
accumulation of positive experiences for a child, although these sessions do
not directly impact on changing parental behaviour (Doyle, 2001). It is
known that interventions based upon play-therapy principles can have a
major impact upon a child’s resilience to adversity, and his ability and capa­
city to minimise the negative effects upon his sense of self can increase. Pre­
vious studies have shown that parents may attempt to block opportunities for
a child to form relationships with other significant people, and the research by
Farmer and Owen (1995) indicated that parents may actively sabotage these
relationships. The authors present an example of a child’s relationship with a
play therapist.
Doyle (2001) concluded that social support does not have to be intense or
even long-lasting in order to gain a long-term effect on a child’s security and
positive sense of self. One or more positive relationships can be supplemented
by the use of comfort objects or pets. Due to restrictions imposed by the
current COVID-19 pandemic, to minimise potential for virus transfer, chil­
dren cannot bring personal objects into a service from home. However, the
key-worker relationship is formed in the early moments of induction, and this
34 Relationships, involvement, and well-being
strategy has supported creation of a secure attachment between practitioner
and child. Forming patterns of behaviour during transitions are significant
representations of a safe haven that are retained by each child integrating into
a service. Implicit memories are formed that can reconfigure the inner work­
ing model and promote a positive blueprint of relationships to the young
child. Transition from home to nursery can be supported by the use of a
nursery toy in place of a home toy as representative of a safe haven. The final
finding from this research indicated that the cumulative effect of multiple
positive experiences is a key aspect to healthy social and emotional develop­
ment within the context of adversities.

Separation anxiety
Sroufe et al. (2000) linked challenging relationships to a disorder in the cate­
gory of psychopathology. Separation anxiety is one illustration of a relation­
ship problem. This condition is one of the effects of the COVID-19 pandemic
which is currently being exhibited in services. Infants are referred for place­
ment who have not experienced life outside the home environment due to
lockdown conditions throughout the country. Many infants have adopted the
high level of anxiety and stress that is being experienced and exhibited by
their parents on a daily basis. The continuation of COVID-19 procedures and
regulations has meant that parents are unable to enter a service.
This set of circumstances may appear detrimental to the formation of a
key-worker–infant relationship in a context of separation anxiety. In reality,
many anecdotal reports from services indicate that families can cope with the
home-to-nursery transition more effectively than pre-COVID. Infants and
parents appear to be compartmentalising their relationships to specific con­
texts and minimising transition anxiety. Due to COVID conditions, the tran­
sition is focused upon two people: the parent and key worker representing a
relational person-to-person transition bridge. Each attachment figure is loca­
ted within a specific environment: the parent is outside a service that repre­
sents the home environment; and the key worker is inside a service. Previously
a parent would create a person–environmental transition bridge between
home and nursery by entering a service with the child. I feel that key workers
have benefited from these necessary health and safety conditions by focusing
with greater intent, purpose, and understanding on the creation of a secure
attachment relationship with an infant. The practitioner has gained an
increase in self-worth and value of his relationship with key children.

Self-regulation
The ability and capacity to adapt one’s behaviour and actions to different
environments, and relationships with others, are unique to human beings
(Tomasello, 1999). These skills encompass comprehension of other people as
being intentional mental agents which is gained within a specific species and a
 Relationships, involvement, and well-being 35
social group culture. In the early stages of infancy, and throughout childhood,
a baby relies on sensitive responding from a primary carer to co-regulate his
emotions. As the months progress over the first year of life, the infant devel­
ops purpose in his actions and begins to direct his caregiver. The infant is
influenced at the behavioural and physiological level, and he gains an ele­
mentary ability and capacity to make decisions in relation to his felt needs.
The self-regulation processes evolve throughout a lifespan from a foundation
that is created during infancy.
By the end of the first year, an infant has the capacity to use learning skills
in the form of gaze, absorption of information, followed by social referencing,
and imitation. Tomasello (1999) refers to triadic interactions at this stage of
development in which the infant’s focus is extended from self to a primary
carer, and their shared interest in the proximal environment. This research
study found that 12-month-old infants copied intentional actions of a primary
carer which were used for a specific purpose, and the infants ignored acci­
dental actions by the adult. Furthermore, findings indicated that infants could
apply the intentional actions to multiple circumstances, which increased their
skill sets and extended cultural learning.
The infant begins to understand his ability to direct an adult’s attention to
his chosen object or area of exploration by the use of direct gesture or subtle
body language. In services, the practitioners will use observations and infor­
mation-sharing with parents to acquire intimate knowledge of an infant’s
personality, interests at a point in time, and communication strategies. The
child’s perception of his own mental state depends on ability and capacity to
notice his caregiver’s representation of their shared world and to create a
foundation of knowledge and understanding for personal use. Imaginative or
pretend play between an adult and child provides multiple opportunities for
the developing infant to be guided towards an understanding of reality in his
external world through his internal representation of these experiences. The
parent’s involvement with the child’s internal world, in a context of imagina­
tive play, supports development of an understanding of self as an intentional
mental agent. Over time, the child can appreciate that his imaginative world
does not need to replicate his external experiences. Imagination and creativity
lead to the child gaining mastery, control, and increase in self-esteem by
exploring and consolidating his ideas and understanding.
During the teleological period, in the development of self, the child inter­
prets behaviour of others within a context of visible outcomes, as opposed to
non-concrete beliefs. The infant may experience anxiety, or satisfaction, with
reference to his internal physiological changes and interpretation of the
external environment. The infant’s body and mind are in a state of arousal.
His experience includes representation of the world by his primary carer,
usually the mother, foster carer, or key worker in the earliest days and
months. The infant’s behaviour is initially a representation of his internal
experiences and reactions. Patterns can rapidly evolve, and persist, particu­
larly if the infant is exposed to situations that induce chronic anxiety.
36 Relationships, involvement, and well-being
Mirroring
Mirroring is a key learning medium at this early stage of development, and
infants will copy, and assimilate, a parent’s interpretation and emotional
reaction to circumstances or events. A mother’s interpretative signals will
incorporate her personal comprehension allied with historical life influences
and encompass her parenting goals and attempts to guide her infant. Bowlby
(1979) applied the term of “inner working model”, which is a framework of
reference for the operational skills and executive functioning of human
beings, based upon prior experiences and interpretations of the world. The
inner working model is influenced by a cultural context that reflects family or
community attitudes, in addition to parental values and beliefs that support
decision-making.
Marked mirroring, as described previously, is a term that is applied to this
context. A primary carer may briefly reflect her infant’s emotion then present
a representation that supports containment of his negative emotions. The
adult is momentarily experiencing the infant’s negative emotion and activat­
ing his or her own regulation skills to react resiliently. This experiential
learning scenario can occur many times within a daily lifestyle at home or
within services. Fonagy (1999) describes this period as supportive of symbol
formation. The infant is given information to extend his understanding of
internal self and external representation in this intersubjective process with a
primary carer. Comprehension matures over time, and meaning gains com­
plexity as multiple experiences are presented to the infant. The caregiver’s
response to the child is assimilated with a representation of his physical,
emotional, and mental state. This knowledge is stored within the infant’s
inner working model and will be refined, consolidated, or reconfigured over
time.

Sensitive responding
Training for practitioners in the early years, and parenting programmes, have
developed rapidly over the past two decades to incorporate knowledge and
understanding of therapeutic support. This approach specifically targets the
infant/child’s emotional state and coping mechanisms (Bratton et al., 2006;
Solihull Approach Parenting Group Research, 2009). The majority of parents
will soothe their child effectively and support his emotional regulation. Fur­
ther positive influences will be gained from a key worker within an early years
setting. During these processes, the adult uses containment and supports an
infant to acknowledge his emotions, to reflect, and to gain strategies that
lessen negative impacts. The infant acquires responses that are embedded
within his family culture of values, attitude, and beliefs. The young child will
identify feelings and actions with experiences and eventually associate with
his regulatory responses. The brain accumulates patterns through the creation
of neural networks. These patterns can be regarded as providing a shortcut to
 Relationships, involvement, and well-being 37
infants in their use of protective strategies and resilience that minimises the
influence of adversities.
The proximal world of an infant is usually quite narrow, particularly in the
earliest days and months of life. The infant’s response time to access coping
strategies increases as he matures and circumstances and events are experi­
enced on multiple occasions. A sensitive caregiver will instinctively contribute
to the child’s intentional mental agency by providing a rationale for his emo­
tions and actions, particularly within daily care tasks. An example is gained
from the process of nappy changing. An adult responds to the child’s emo­
tional and physical discomfort by presenting a practical solution, thus sup­
porting comprehension of intentional mental agency. The child’s teleological
understanding of a wet sensation followed by parent interaction, and ulti­
mately a dry sensation, is enriched through the merging of his associative
emotions and communication strategies. As he matures, the infant begins to
use his help-seeking skills proactively in response to his needs. Help-seeking
through targeted communication is a key milestone for babies, and there are
many opportunities within each day and night for an infant to source
responses to his basic physical needs. Parents rapidly gain expertise in inter­
preting these signals from their baby.
If parents do not demonstrate sensitive responding to the infant, then his
sense of self can be adversely affected. Exposure to harm generally activates
the attachment system, and infants may seek out physical comfort from
caregivers who are abusers. Chaotic disorganised attachment is created. A rise
in cortisol levels, as a result of this negative parent-to-child interaction, can
result in neuro-developmental abnormalities. The brain’s architecture is affec­
ted by negative caregiving patterns over time.
A child who is vigilant due to circumstances of perceived danger may
demonstrate an increased ability to mentalise his parent’s behaviour. This
process occurs within, and contributes to, an insecure attachment relationship
between child and parent. The infant inherently strives to gain comprehension
of his world and to gain a sense of predictability, despite chaotic living con­
ditions. An infant may adopt his parent’s negative reactions and assimilate
this image internally as his own sense of self. The process results in the child
experiencing vulnerability and high anxiety even if he is removed from the
source of adversity. His negative representation of himself is stored internally,
and led by implicit memories; therefore, the actual source of adversity does
not need to be present.
Fonagy (1999) also suggested that children who experienced adversities in
early childhood may reject mentalisation of their caregiver’s actions. This strat­
egy can provide the child with emotional protection in a context of perceived
harm. Alternatively, a mother may not have the capacity to reflect upon her
infant’s mental state, and instead she dissociates herself from his cries and dis­
comfort. This reaction creates a barrier to the child’s understanding of himself
through his mother’s representation. Inability to use reflective capacity can result
in an unstable sense of self in parents and children.
38 Relationships, involvement, and well-being
It is thought that negative memories, in a context of childhood abuse, can
preside over positive experiences and thereafter increase likelihood of mental-
health issues. McCrory et al. (2017) reported that any alteration to threat,
reward, and memory-processing could impact upon socialising ability and
emotional reactions. These effects could be apparent throughout a lifespan as
reaction to new stress is exacerbated.

Transitions
Transitions are particularly significant points of contact. For example, the trau­
matised child is entering a service with current experiences of adversity from the
home environment affecting his body and mind. A practitioner can set the scene
for a child to experience a safe and stimulating session by presenting a positive
empathic and nurturing approach. The adult–child relationship supports the
child to interpret the physical, emotional, and social learning environment as
non-threatening. Short-term negative interactions between peers occur within an
early years environment on a daily basis as incremental steps towards social
development. For example, sharing and negotiating the use of toys provides
numerous opportunities for the practitioner to use the secure attachment rela­
tionship to promote positive behaviour and to nurture the child’s physiological
and emotional regulation.
Children are able to compartmentalise relationships within different envir­
onments, and I have often observed insecurely attached children walking
quickly away from their parents on entering a service building. The child will
focus straight ahead and greet a key worker with positivity. His expectation
during this transition is secure attachment to a practitioner in the service. I
have noticed some children refusing to turn around or to wave goodbye to a
parent despite urgent prompting by the mother or father. Occasionally, a child
puts a hand behind his back to wave but remains focused firmly upon the key
worker and entrance area of the service. It is fascinating to observe these
interactions, and practitioners can gain expertise by seeking out theory and
research that extends their comprehension of transitions.
Upon leaving the service, a child will revert to behaviour that he has learned to
use in the company of his parent. Environmental factors prompt memories and
associated behaviour and actions which the young child has learnt to apply over
time. As the proximal context and carers change then the infant demonstrates
patterns of behaviour that are based upon emotions. An increase in under­
standing the complexities of human relationships by a primary carer contributes
to application of supportive strategies in response to each child’s needs.
The infant with ambivalent attachment will try a variety of strategies to
gain the attention he desires from his parent, for example, holding tightly,
hiding his face against a parent, crying for long periods of time, which esca­
lates into fear as the parent leaves, and an inability to self-regulate his emo­
tions and, consequently, his actions. The timescale of this emotional reaction
may be a few minutes or lengthy periods. The high level of anxiety and the
 Relationships, involvement, and well-being 39
direct expression of emotion and needs will subside, and the exhausted child may
revert to “still sitting” and non-interaction with the learning environment. The
infant or young child’s sense of self has been affected negatively. His actions have
failed to achieve his desired outcome. Alternatively, this infant may demonstrate
aggression towards his parent by rejecting her overtures, removing eye contact,
hitting, kicking, and crying angrily. He is expressing negative emotions that are
not being met. The infant has an inherent need for consistency and predictability
of surroundings and relationships.
Over time, the infant’s attachment cues will reduce dramatically if he is not
responded to, and avoidant attachment will be demonstrated. The infant will
stop attempting to develop an attachment relationship, may appear placid,
may remove eye contact from others, may limit his physical explorations, and
may begin to demonstrate introverted behaviour. This infant may appear
more interested in his own body and clothing as opposed to stimulation
within the environment or relationships with others.
Children who have chaotic attachment may experience inconsistent care
and neglect that usually includes direct and indirect abuse. Procedural
memory, as unconscious memory, is the way in which the child develops
expectations of relationships with caregivers which are associated with his
patterns of behaviour. These representations can be changed through formal
intervention and informal responsive support from an adult, sibling, or peer
who nurtures a positive relationship with a child.
The assessment of attachment between parent and child is a challenging area as
demonstration of a relationship by a parent and child is influenced by personalities
and the culture of a family. Ainsworth established a method of measuring attach­
ment which continues to be used for children aged 12 months. The “Strange
Situation” has a focus upon behaviours associated with the stage in which a
mother returns to her child after a short absence (Ainsworth et al., 1978). Inter­
actions prior to this age can be measured with the Parent–Infant Observation
Scale, the Keys to Interactive Parenting, and the CARE-Index. The Keys to
Interactive Parenting review 12 behaviours including limits and consequences
(Comfort et al., 2011). The CARE-Index places emphasis upon three aspects of
the mother’s behaviour towards her child: sensitivity, control, and unresponsive­
ness, in addition to four aspects of the infant: cooperativeness, compulsivity, diffi­
culties, and passivity (Crittenden, 1985, Crittenden et al., 1991).

Intervention
Howe (2005) identified four different rationale that encompass intervention
approaches:

1 Behavioural change in which the parent’s sensitivity and responsiveness

towards the infant develops.
2 Cognitive change in which the parent’s mentalisation of her relationship
and behaviour with the child develops.
40 Relationships, involvement, and well-being
3 Social change in which the parent is supported to function more effectively
through support in a community, home, and alternative environments.
4 Well-being change in which the parent is supported to improve her
mental health and physical well-being.

Behavioural change supports a parent to observe her baby or young infant

during play and daily routines and to gain knowledge of sleep patterns. The
parent learns to view the baby’s world, interpreting the environment, stimuli,
and relationships from his perspective. The parent learns to notice and to
understand his attachment cues and ultimately to develop her capacity to
empathise with the baby and to increase her skill of personalised responding.
Cognitive change supports a parent to consider, and to alter, her mentali­
sation of the parent–child relationship. The parent is encouraged to recall her
own childhood experiences. She learns to reflect and to understand the impact
of positive and negative influences from childhood upon her emotional well­
being and desire for learning. Over time, the parent can use this knowledge to
alter her understanding of herself and her baby. The parent’s attachment
model will be reconfigured based upon comparison to past experiences and
her hopes and dreams for the baby’s future.
Social change supports the parent to gain positive relationships within the
home, extended family, and local community. The parent learns to identify
appropriate sources of support, to initiate and to develop progressive rela­
tionships, and to recognise the positive impact upon her mental health. The
parent creates links between her emotional well-being and her parenting
abilities.
Well-being change focuses upon support for a parent that increases her
physical and mental well-being. Generic intervention by health staff – for
example, a midwife and health visitor – provides information and guidance
on promoting the well-being of babies and infants. However, it is recognised
that the physical well-being of each mother is equally important, pre-birth
and post-birth. Physical well-being provides a necessary foundation for
mental health to improve and to impact positively upon parenting ability and
capacity. An increase in the psychosocial development of a mother has a
direct impact upon an attachment relationship and a parent’s understanding
of intersubjectivity within the parent–child dyad.
Emotions occur as a response to stimuli from the infant’s inner working
model based upon prior experiences, his instinctive reaction to potential
danger, and physiological changes. Emotions also evolve from the infant’s
reaction to external stimuli in his proximal world. Howe (2005) linked pri­
mary carers with psychobiological regulation of an infant’s arousal. It is for
this reason that interventions should provide opportunities for parents to
understand the impact of influences, positive or negative, upon every aspect of
the body. Intervention approaches often support a parent’s interpretation and
understanding from a personal viewpoint but can be enriched by promoting
the infant’s perspective.
 Relationships, involvement, and well-being 41
Howe (2005) associated children who have suffered maltreatment with
sensory impairment. This researcher uses the terms “clumsy” and “accident­
prone” to describe children who have sensory deprivation. Howe indicates
that experiences within daily living may cause reactions to trauma which are
triggered by an infant recalling a similar incident from his past and by
experiencing the associated emotions. This information is based upon sensory
input, and it is processed in the limbic system of the brain. The limbic system
develops prior to the cognitive areas within the cortex. The infant’s instinctive
reaction and initial interpretation of stimuli may pose potential threat to his
safety and well-being. Practitioners and parents can support reconfiguration
of the child’s inner working model by nurturing the creation of neural links in
cognitive areas of the brain. Plasticity can lead to adaptive patterns of neural
networks that respond positively to adversities on a short-term basis; however,
research also indicates an increase in vulnerability in later childhood and
adulthood.
Every early years practitioner will be able to identify children who react in
this way to everyday occurrences, and it is important that practitioners
understand and respond sensitively to a traumatised child. Behaviours should
be regarded as a complex language, and the practitioner should develop the
art of interpreting children’s cues and emotional reactions to accurately com­
prehend their needs. It is not sufficient to provide a nurturing and safe envir­
onment to a young, traumatised child in a nursery setting. This child’s default
position is interpretation of danger until the therapeutic relationship is used
to change his understanding. Every single interaction with a child in a setting
provides a valuable opportunity to influence his emotions and physiological
reactions. Change processes should not only be promoted within the time
frame of formal intervention but encompass all aspects of a nursery.
Many nursery activities can be linked to a rationale that promotes the
child’s resilience, his ability to predict and prepare for outcomes, or to reg­
ulate and to contain his emotions in unpredictable circumstances. Examples
of hide-and-seek, tig, and peek-a-boo give children an understanding of the
permanence of an attachment figure. The infant and young child experience
short-term fear in a context of fun, unpredictable actions from the adult and
others and the relief and joy of recognising a secure relationship. These games
offer fun interactions for both parties in addition to valuable learning opportu­
nities with regard to trust, relationships, and self-regulation of emotions within a
short time frame.
Observation and interpretation of the child’s body language are the key
approach to sensitive responding and to identification of a formal intervention
for a family. Body language reveals the child’s inner being, which encompasses
his physiological and emotional reactions to stimuli. Key aspects to note are
frequency of eye contact, verbal or noise communications, movement or non-
movement, and the child’s stance – standing, sitting, open arms, or body curled
up tightly and defensively. A child’s use of his hands provides major insight into
emotional well-being: fists clenched, hands hidden in pockets or under a blanket,
42 Relationships, involvement, and well-being
hands used to hide face or specific areas of the body, hands used to protect face
or body, hands and arms to comfort self and accompany rocking of the body,
hands used for sucking and comfort, hands used to hurt oneself accompanied by
direct eye contact and expectation of adult intervention, or non-eye contact and
internal focus as the child hurts himself, hands used to actively hit another
person or toy or to reject offer of toys, hands used to urgently wave bye in order
to reject adult overtures, and open hands and movement of fingers in response to
his explorations or interaction from an adult.
I practise child–parent relationship therapy (Bratton et al., 2006), and sessions
are used to observe and to gain comprehension of a child’s attachment status, his
ability, and his capacity to seek out learning from the proximal environment, and
to note the impact of prior experiences upon his play. The intervention play and
exploration sessions are used to promote and to nurture secure attachment
between facilitator and child or parent and child. A popular medium for learn­
ing by families, in this context, is the use of videos. The child’s emotional well­
being and involvement, within this specific learning environment, are assessed
and charted by using the Leuven Involvement Scale (Laevers, 1994). These tools
provide a means to discuss issues with parents and to clarify comprehension of
action, reaction, emotions, and intersubjectivity.
The outcome of therapeutic support is the child’s experience of safety
within a range of environments, an increased capacity to learn, and an ability
to self-regulate his body and mind. Sensory integration experiences can be
implemented within interventions and throughout daily routines and play
opportunities. Children learn to control their physical bodies and to create links
with the accompanying emotions. When physical integration is established then
the child begins to understand emotional integration. Sensory-emotional mod­
ulation leads to sensory-emotional discrimination, which is promoted through
cognitive and language-based therapy, and nurturing approaches to delivery of
the curriculum in services. Over time, the child gains insight into his own emo­
tions of despair, anger, guilt, happiness, shame, rage, and fear, which contributes
to his increasing understanding of other people’s emotions.
Howe (2005) described the processing of emotions at a sensorimotor level and
a cognitive level. These processes encompass mental representations and con­
tribute to development of self-regulation. Areas of the brain which are dis­
sociated due to trauma can be integrated by activation of the left cortex and left
hemisphere, which deal with language, and the limbic system and right hemi­
sphere, which deal with emotions. Tracking, emotional literacy, and play therapy
are informal and formal approaches which are used in early years settings.
During my work with intergenerational families, I observe common pat­
terns in the interactions between parents and children who are insecurely
attached. I have noticed that parents in adverse circumstances may pay great
heed to the child’s physical well-being but ignore emotions. Physical and
emotional well-being are partners. Practitioners should use every opportunity
to share strategies with parents regarding this significant aspect of develop­
ment. Parents learn within the context of interventions. Additionally, drop-off
 Relationships, involvement, and well-being 43
and pick-up times in early years settings provide practitioners with opportune
circumstances to upskill parents in situ. Emotionally responsive parting and
reunions between parents and children create significant developmental blocks
that contribute to nurturing a secure attachment relationship. During daily
transitions, a key worker can role-model good practice to a parent by describing
the child’s actions, behaviour, and associative emotions. The practitioner can
capitalise upon these opportunities and promote responses that extend a parent’s
comprehension of the child’s physical and emotional well-being.
It is essential to revisit these strategies within a short time period and to
reinforce the rationale and skills to the parents. Parents benefit greatly from
descriptive praise and recognition from practitioners of their developing skills
on this daily informal basis. Learning encompasses every aspect of life, and
informal interactions on a nursery doorstep provide ideal circumstances
which are conducive to development of parent and child together. These
encounters emphasise the importance of working alongside whole families.
The ultimate outcome is a secure interdependent family unit whose members
support one another to gain resilience to adversities by using their attachment
relationships.

Adversities and therapy

Boyce et al. (2021) present factors that influence variation in sibling reaction
to adversities. Adversities can be regarded as a lack of supportive conditions
for normal development or imposition of threatening conditions that disrupt
development. Examples include genetic influences, family circumstances,
community environments, and developmental timing. This research by Boyce
and his colleagues links psychopathology in adulthood to childhood trauma
and physiological responses to stress. Unsupportive parenting was identified
as influential upon subsequent generations, in addition to undue reactions
from participants to their life events. Asmussen et al. (2020) recently pub­
lished research findings that also indicated negative effects upon the human
immune system from lengthy exposure to trauma.
Findings from the research of Boyce et al. (2021) indicated that positive
maternal responses can mitigate the negative effects of chronic immune-
system activation. This study presented optimum intervention as approaches
that are personalised to each child’s circumstances and the family context.
Inter-agency working is key to implementation as family resources are often
depleted in vulnerable families. Intervention must respond to all aspects of life
and lifestyle in order to support change and development of children and
parents.
A few years ago, I was fortunate to attend a lecture by a visiting relation­
ship counsellor, Charles O’Leary. This educator presented rich information on
the practitioner’s role in family counselling, and he introduced me to the
concept of an “invisible extra beat of time” (O’Leary 2012). The rationale of
counselling, regardless of referral criteria, is creating a safe space to think and
44 Relationships, involvement, and well-being
to talk. It is often the case in early years practice that emphasis is placed
upon physical safety due to contexts of child protection and domestic vio­
lence. O’Leary emphasised the significance of establishing emotional space to
allow freedom of thinking, freedom to remember, to hope, to plan, and to
download issues and accompanying emotions.
The extra beat of time reminds the practitioner that his role is to facilitate
emotional repair and growth through nurturing resilience to adversity. The
early years practitioner cannot remove adversities, but she can support an
individual to annul or at least to reduce the impact upon daily living. The
practitioner is seeking to understand the other person’s perspective and to
communicate interest by allocating time. Time is invaluable, but value is not
equated to the number of minutes for interactions so much as the quality of
space to talk which is created. O’Leary (2012) presented a simplistic but
effective gauge to the practitioner: the use of one question demonstrates
politeness; the use of two questions demonstrates interest; and the use of three
questions demonstrates investment in the other person.
The beat of time within counselling, in a formal or informal context,
represents the respect and care that one person has for another. The beat of
time can give permission for silence. Silence is required for an individual to
absorb the impact of exposing her latent emotions, to embrace physiological
changes, and, potentially, to accept her developing relationship overtures that
evolve through a counselling session. The beat of time can nurture worthiness,
pride, and personal regard in a vulnerable participant.
O’Leary (2012) recommended that the counsellor acknowledges the
wisdom of the developing person, and this approach is relevant to early years
practice with infants, children, and their parents. Client motivation, quality of
relationship, and a client’s hope for a positive outcome are cited as con­
tributory factors to change and development. I believe that the quality of
relationship can incite motivation for change in parents, and a practitioner’s
belief in a parent’s capacity can ignite hope. Upon reflection on practitioner–
parent interactions, I have observed that this belief prompts an actualising ten­
dency. This means that the parent is empowered to change her inner working
model and to capitalise upon her skills, strength, and resilience as she progresses
along the developmental journey.
The early years practitioner is not usually trained in counselling skills, but
he or she has extensive knowledge, understanding, and practical experience in
forging, nurturing, and consolidating positive relationships. These relation­
ships, whether practitioner–child or practitioner–parent, provide a necessary
foundation for learning and development. Tracking a child’s actions, emo­
tions, and intentions is commonplace in a playroom, and the same strategy
can provide a useful framework to support parenting skills, formally or
informally, at drop-off and pick-up times as described in previous section.
Six conditions for family therapy were promoted widely by O’Leary (2012)
and remain applicable to every setting today. These conditions require the
practitioner to create an ambient atmosphere, to promote a positive attitude,
 Relationships, involvement, and well-being 45
and, most importantly, to maintain an effective relationship which is enriched
by interaction with the developing person. The following section describes
these principles in a context of early years practice that relates to formal and
informal meetings with families. The practitioner has a role which includes:

1 Seeking to understand and to demonstrate acceptance of each member of

the family.
2 Providing a structure for each session.
3 Supporting each family member to identify his or her purpose in the
session.

These first three principles present definitive tasks to the early years practi­
tioner from a strategic perspective and practical skill in building relationships
for a purpose. It is important to be prepared for a meeting with family
members. There have been occasions when I have forgotten to set up the
meeting space, and I recall in Box 2.1 a recent example.

Box 2.1 Example from practice

I led a family towards a room which was locked. An old printed black-and­
white sign on the closed door declared an identity: Multipurpose Room. For
a few seconds, I felt disappointment. I had read this sign many times without
due consideration for the message it portrayed to service-users. I wanted
the declaration to be vibrant, colourful, attractive, and to set the scene for a
welcoming Family Room.
The pencilled time and date in the service booking diary was the only sign
of my preparation. I found myself experiencing stress as I realised my failure.
I felt anxiety, a dip in confidence, and disappointment in self as I searched
frantically for a key, babbling irrelevant excuses as the family waited silently
in the darkened corridor. A dusty building smell emanated towards us as I
pushed the stiff door with my shoulder to reveal a classic picture of a service
meeting room. The old-fashioned metallic blinds were closed, the heating
was switched off, and chairs were stacked high in a corner of the room. A
stale jug of water sat silently in the middle of the table, a forgotten repre­
sentation of a previous meeting. The ubiquitous box of tissues lay in waiting
at the far side of the table. These circumstances present an immediate bar­
rier to effective information-sharing and interaction.
I tugged the strands of thin nylon cord to open the blinds, and the family
helped me to bring forward the cold, plastic chairs. My idea of a semicircle
for chatting could not be achieved as I did not want to reject the family’s
input by rearranging their setting of chairs. My teaching space was smaller
than I had planned. The heater sprang into action and created an intrusive
hum as the convection setting struggled to impact upon this damp, unwel­
coming venue for change.
46 Relationships, involvement, and well-being

Preparing a space for a specific purpose demonstrates respect and care

for others, and it validates a role for the family and the practitioner. I usually
find that families are apprehensive in the initial time period of any meeting,
and this emotional reaction may be presented as silence, defensive anger, or
disaffection. The first few moments of a conversation sets the atmosphere
for family meetings which should be positive and welcoming and present
learning in a context of hope for change. As practitioners, we all make mis­
takes. Distractions divert from preparation, and prioritising needs can impact
upon our planned use of time. However, negative environmental issues can
be used to the advantage of a positive relationship. Honesty and humility are
key levellers in relationships.
I apologised to the family for the lack of preparation. I commented on the
cold atmosphere, and we shared laughter as the heater ticked loudly into
action. I dramatically threw the stale water away, replacing it with juice and a
generous plate of biscuits and encouraging the family to partake. I thanked
the family for helping to set our scene for discussion. I confidently moved
my chair to create an appropriate and effective learning space between
myself and family, explaining my actions. We shared our COVID-19 aware­
ness strategies together, empathising with the challenges and constraints of
ever-evolving guidelines. We had established a shared context. The meeting
began with positive anticipation.

The final three of O’Leary’s principles (O’Leary, 2012) reflect aims for the
practitioner to achieve through body language, attitude, and a mindful pre­
sence towards interpretation and responses of others.

1 Communicate your belief in each person’s ability to actualise her thoughts

and wishes.
2 Share knowledge and support change and development.
3 Demonstrate empathy and mindfulness towards the other person.

A positive attitude does not need preparation or to be induced by external

props within a meeting space. Belief in another person is conveyed within an
attitude that encompasses empathy and personalised care. Listening and con­
sidering the other’s viewpoints. Observing and reflecting body language, tracking
actions, and verbalising emotions from past and present events. Acknowledging
and accepting priority of needs as identified by each family member. Contribut­
ing the professional perspective, which is led by child protection, knowledge of
development, and pedagogy of each service. These relationship skills can be
generated from a motivated and confident practitioner in any workspace.
One or multiple interactions with parents can support development of the sense
of self in a primary carer. This foundation of knowledge and understanding makes
a positive contribution to an infant’s mental health by supporting a parent to
 Relationships, involvement, and well-being 47
identify and to make alternative lifestyle choices. The study by Boyce et al. (2021)
highlighted the importance of time and neural plasticity to the processes of change
and development. This research team also studied emotional regulation and
identified that the timing of an intervention was a significant factor in relation to
positivity of the child’s responses. The degree with which cells and organs are
influenced can be used to define their sensitivity to external influences. There are
critical and sensitive developmental periods in which plasticity in neural networks
facilitates change in response to positive influences.

Genetic and environmental influences

Recent research has shown that genetic and environmental factors can acti­
vate, support, or hinder developmental plasticity (Boyce et al., 2021). Mental
illness has also been identified as a potential disruptive factor to these pro­
cesses. These authors found that pathological processes which are associated
with some disorders demonstrate the greatest effect before birth and immedi­
ately post-birth. Timing is important in nurturing positive effects or minimis­
ing negative impact in the interactions of genes, environmental influences, and
relationships. The timing of adaptation can affect the outcome. This finding is
an important contribution to health promotion and influential to planning
and delivery of intervention in the context of disease prevention and the rea­
lisation of developmental potential.
Some areas of the brain, for example, circuits which are linked to executive
functioning, may continue to be affected by negative influences on a longer-
term basis (Boyce et al., 2021; Cross et al., 2017). The work by Asmussen
et al. (2020) indicates that toxic stress in the early childhood years can result
in a reduction of the white matter in the brain that supports executive func­
tioning. This study centred upon Romanian orphanages and, surprisingly,
concluded little significant difference in executive functioning of children who
experienced foster care and those who remained in institutional care. It may
be that the children in orphanages did not experience toxic stress in the form
of direct and regular abuse, but a lack of stimulation contributed to weakness
in their social, emotional, and cognitive skills. Findings from this research
indicated a greater incidence of psychiatric disorders at 12 years of age, and
beyond, compared to the norm.
The Bucharest Early Intervention Project researched the emotional develop­
ment of young children who were placed in foster care following a residential
stay in an orphanage (Kondo & Hannan, 2019). Findings indicated that the
youngest children, who were less than 2 years old, showed the most positive
outcomes for cognitive skill and emotional regulation. It was concluded that
cognitive and socio-emotional functions show a high level of adaptation to cir­
cumstances during the earliest developmental periods of childhood.
Parents can gain awareness of their contingent responsiveness if they are
attuned to their babies’ needs. Role-modelling and descriptive praise are
useful strategies to support each parent’s increase in practical responses which
48 Relationships, involvement, and well-being
are associated with the baby’s emotions. During the first three months of life,
babies expect interactions with adults that reflect their emotional states;
however, as the baby’s interpretation of the world develops, then the interac­
tions can provide appropriate challenges that contribute to development.
The use of video feedback has provided a significant tool in the development of
families. It is a familiar medium which society uses to communicate on a daily
basis, and it clearly depicts the actions, behaviour, and attitude of a parent in rela­
tion to infant’s attachment, capacity, and ability to learn and develop. Following an
intervention session, I share video feedback with a family, and together we discuss
the scenarios that are presented through the recording of interactions between
practitioner, parent, and child. Trust, cooperation, and partnership-working can be
nurtured through recording and critique of the practitioner’s actions and behaviour,
which incorporates role-modelling. Subtle but significant gestures, nuances of
speech, and overtures of bonding (McClure, 1985) from parent to child can be
celebrated and enhanced by sensitive responding.
Behavioural patterns that occur in the earliest weeks and months of life are
termed proto-conversational turn-taking. Serve-and-return interactions are
important to confirmation of attachment and introduce the wider social and
cultural world to the infant. Synchrony may be followed by short instances of
rupture and responsive repair. Mid-range tracking and contingency were identi­
fied by Beebe and Steele (2013) as repeated patterns of synchrony, rupture, and
repair in which the parent effectively regulates herself in addition to her baby.
Parental reflective functioning occurs in this context as the primary carer has an
awareness of his or her own mental state, the baby’s state, and accompanying
behaviours. This base of knowledge and understanding requires the parent to
acknowledge the infant’s capacity to be an intentional mental agent.
Sequencing may not occur if a parent is preoccupied in regulating herself,
which may relate to postnatal depression. A parent who is suffering from
depression may exhibit low levels of attunement to her baby and lack of syn­
chrony. Alternatively, a mother may demonstrate intensive tracking of the infant
in which she imposes control upon his interactions and does not respond to his
expressed emotional needs. This parental behaviour is associated with insecure
attachment and the parent’s representation of the baby as a physical being. These
circumstances are often exhibited within my workplace by teenage mothers who
are suffering from high levels of anxiety. The parents are seeking to find a sense
of an adolescent self, alongside the mothering role.

Box 2.2 Example from practice

I observe a young teenage mother and her new baby attending the service.
The baby, mother, and accompanying paraphernalia are clean, and the
equipment is in new condition, but the mother is not attuned to her baby’s
needs. The pram covers are carefully ironed, tucked smoothly and neatly
around the little baby, and decorative additions are solely aesthetic for adult
viewing as opposed to the baby’s comfort. The mother focuses upon
 Relationships, involvement, and well-being 49

showing the pram, bags, bottles, and baby’s clothing to practitioners and
arranges these artefacts deftly and with pre-planned precision. This young
adolescent gives little attention to her baby’s emotional state as he copes
with the influx of new faces in the vicinity of his world and comfort base, the
pram.
His needs at this point in time, and characteristics as a unique and
responsive human being, are unheeded by his primary carer. I notice the
mother lifting the baby out of the pram and placing him across her shoulder.
She automatically faces him away from her view and towards the busy sti­
mulation of urban life. This teenage parent straightens her son’s clothing and
realigns the presentation of her own outfit as a reaction to the baby wrig­
gling his body in her arms. Eye contact from her baby is not sought by this
mother, verbal interaction, and reassurance, supplemented by face-to-face
nurturing, and mingling her smell to this little infant’s sleep scent is not an
observable action during the encounter. Opportunities for secure attachment
are available, multifold, but remain disconnected.

I found the research by Lyons-Ruth (2003) interesting as the five beha­

viours, and apt descriptors which are associated with parental trauma, are
observed regularly in the context of parent–infant interaction within a service.
The previous practice example depicted these circumstances:

� Threatening: the parent views the baby from above his body and face,
which blocks the light and creates an intensive looming presence.
� Dissociative: the parent uses an unusually weak voice which is different to
regular communication.
� Deferential or timid: the parent uses a manner of communication that
does not instil confidence in a baby, usually through physical interactions.
� Disrupted: the parent does not repair the relationship following periods
of rupture.
� Affective communication errors: inappropriate and unpredictable reac­
tions from the parent to the infant’s emotions.

A parent’s presentation depicts her mental state and capacity at a point in

time. Observations at drop-off and pick-up from a service provide invaluable
information to use in supporting families to succeed. Early years practitioners
interact with parents in the context of childcare sessions within a service. At a
surface level, parents may appear to be coping well by arriving on time and
attending assiduously to the infant’s physical needs. However, multi­
disciplinary professionals may gain differing views of a parent’s well-being
and ability to care for a baby which are based upon assessment from the
perspective of a particular discipline. For example, health visitors, social
workers, and family nurses interact with parents in their home environments.
50 Relationships, involvement, and well-being
Living conditions can portray a mother’s capacity to embrace, or to be chal­
lenged by, motherhood within a daily lifestyle and indicate the level of sup­
port from a father and an extended family unit.
During the past year, several pre-birth referrals have been received for our
service which describe mothers being hospitalised during the perinatal period
due to poor mental health. The research evidence on this significant period,
and knowledge of the impact from a mother’s well-being to development of
her baby, are influencing practice. Reflective functioning can be a complex
skill for a mother to acquire if she is coping with mental-health issues. Mental
health can reduce the capacity of a mother to observe her child’s reactions, to
interpret his emotional status, and to use marked mirroring. Depression,
anxiety, borderline personality disorders, schizophrenia, domestic violence,
substance abuse, parental trauma, and eating disorders can impact negatively
upon a parent’s health in this context.
Early intervention has to ensure that the parent is healing internally phy­
sically, mentally, and emotionally in order that she can focus outwards to
her baby’s needs from a stable and established sense of self and agency
(Miell, 1995). It is important to ascertain physical well-being as the initial
step to recovery as mental well-being requires a healthy body as a founda­
tion for emotional healing. Effective practice includes partnership-working
by blending the parental and professional expert knowledge of the infant. A
practitioner can share information with a primary carer that places great
value and worth upon the general parental role but also gives recognition to
the characteristics, skills, and preferences of each parent within a specific
family culture.
An example of information exchange between professional and parent can
include the three wake states for infants termed quiet alert, unsettled, and
crying. Additionally, the three sleep states are described as drowsy, light, or
deep sleep. In the early days of a baby’s life, his parents will focus assidu­
ously on sleep and wake patterns. Every conversation enlightens a listener
upon the number of hours of sleep which a parent has achieved, and is often
linked to a judgement of a “good” baby. I find that parents have acute
insight into their babies’ patterns of behaviour throughout each day and
night, but it is often the case that parents do not appreciate the significance
and value of this knowledge. A reflective practitioner will prompt a parent
to share this knowledge through direct questions, professional curiosity, and
demonstration of a desire to create an integrated partnership with an
infant’s primary carers.
All babies will experience these six states throughout each day, but, over
time, wake/sleep patterns are established that can be associated with routines
and expectations within each family. For example, parents can encourage
progress from drowsy to deep sleep through a bedtime routine, and in the
early hours of daylight the baby can be supported sensitively to transition
from a light sleep state to quiet alert in preparation for his first feed.
 Relationships, involvement, and well-being 51
Nurturing environment
Services may focus upon delivering universal, targeted, or indicated approa­
ches in relation to service rationale, funding opportunities, and needs in the
local area. Engaging parents in an intervention is a key issue (Edelman,
2004), and non-engagement is a barrier to development of mother and child.
Consideration should be given to parent’s learning styles, motivation, and
social ability to interact in group or individual support sessions. Informal
universal approaches incorporate aspects of targeted and indicated interven­
tions. For example, empowerment of parents to support realisation of inher­
ent parenting skills and promoting the sense of self and the agency of the
mother/father and child (Heath, 2004).
A recently published study by Fukkink (2021) reviewed the well-being of
children aged 0–4 years within day care. Findings indicated that well-being
varied significantly throughout the day for each child in the participant sample
of 30; however, the average recording of well-being in this study was defined as
neutral. The researcher described this finding as well-being without dominant
signs of joy or discomfort. Links were made between well-being and free-play or
teacher-led activities as opposed to lower well-being during transitions, meal­
times, and peer conflicts. The data did not indicate an association between a
child’s well-being and a carer’s sensitivity. Recommendations highlighted the
need for carers to respond quickly to the socio-emotional needs of infants due to
rapid fluctuation of well-being within a day-care setting.
Creating a COVID-safe environment in services has presented challenges;
however, many measures have positive, and unexpected, outcomes. At entry to a
service, the infant is introduced to a key worker and led gently away from the
parent or carried into a playroom to commence the transition period while par­
ents complete necessary paperwork. Surprisingly, young children have been
adapting to the service more quickly and positively without their parents being
present in the playroom. The key worker is the secure attachment figure in the
early stages, and the increase in stimulation and a nurturing environment in
addition to therapeutic pedagogy are key factors in facilitating this transition.
The use of contingent responsiveness, role-modelling, prompting, scaffold­
ing, and interpretation of each child’s mental health by marked mirroring are
supportive strategies to inclusion and attainment. A baseline is created to
support progress throughout childhood and beyond (Bomber, 2007; Depart­
ment for Children, Schools and Families, 2010; Geddes, 2006). Parents have
accepted the COVID-safe conditions, and photographs, videos, and regular
feedback by phone or social media reassure families that their children are
well and thriving in the nursery environment.
Trevarthen (2001) used the term “relation emotions” to identify emotions
that are associated with companionship and separate from self-regulatory
emotions. Examples of the self-regulatory emotions refer to experiences of
pain, pleasure, or hunger. This research study indicated that relation emotions
are associated with mental illness through a lack of intersubjectivity. Sroufe et al.
52 Relationships, involvement, and well-being
(2000) described negative impacts upon interpersonal relationships as potential
criteria for a diagnosis of psychopathology and a route to understanding the
origin of this disorder in adulthood. Experience of negative parenting techniques
in the form of rejection, or lack of supervision, are deemed to be risk factors for
the child developing psychopathology in later life. Emotional unavailability is
associated with conduct problems in childhood and may be contextualised by
parental disharmony and violence. The research indicated the significance of
relationships to human functioning. Positive, secure, and consistent relationships
can reduce the negative impacts. However, this research also raised the issue of
“boundary violation”. This term was used by the authors in reference to a parent
interacting with the infant in a similar relationship to the peer or spouse part­
nership (Sroufe et al., 2000).
The research by Condon and Corkindale (2011) on antenatal attachment had
a participant group of 238 women in their third trimester of pregnancy. Findings
indicated that depression and a lack of social support are detrimental to the
mother’s attachment to her baby prior to birth. Additionally, antenatal attach­
ment was suggested as an indicator for maternal infant attachment. This
research described relationships as encompassed by interconnections and emo­
tional regulation that can be linked to psychopathological disorders. Condon
and Corkindale (2011) concluded in their study that services should respond to
an expectant mother’s low mood and limitations in social support from extended
family or friends during the antenatal period. The significance of intervention
before birth is related to the development of secure attachment after birth.
Sroufe et al. (2000) found that alternative relationships to primary carer and
child were also effective in minimising the negative impact of adversity, for
example links to grandparents or a therapist.
During the first year of life, an infant learns to adapt his responses in
accordance with the reactions or lack of responsive action by his primary
carer. For example, a distressed infant may lift his arms above his head and
cry for support; however, if the support is not forthcoming, then he will learn
to take further action and to crawl towards an adult. Sroufe et al. (2000)
describe this stage as the infant progressing from the use of reflexive signalling
to active intentional communication. These infantile foundations are essential
to support comprehension of the autobiographical self, and secure attachment
within a dyadic relationship facilitates the processes. Furthermore, relation­
ships in middle childhood and adolescence will evolve positively if the capa­
city and ability for self-regulation has been realised in infanthood.
It is known that the interplay of genes, environment, and time promote a
unique response in each child, and subsequent actions and outcomes are also
influenced by personality. Boyce et al. (2021) emphasised the impact of
genetic variation upon the individual’s sensitivity to adversity, and to trauma,
and this study cited a lack of supportive parenting as increasing these risks.
The research indicated a causal element to risk as sympathetic activation of
inflammatory cytokine production. Family support that promotes strengths
and supports weaknesses is promoted as an effective intervention.
 Relationships, involvement, and well-being 53
Interestingly, the research by Boyce et al. (2021) included a study of the ado­
lescent period, and findings suggested that maternal responsivity can protect
against or reduce the impact from chronic immune system activation. The period
of growth in the teenage years is regarded as a time when cells and organs are
sensitive and reactive to external influences. The researchers referred to differ­
ential plasticity through comparison of sensory processing which can respond to
influences within months, and executive functioning which can be responsive to
external influences throughout the lifespan. As critical period timing varies in
individuals, it not only exposes challenges for the implementation of intervention
but also increases opportunities for change and development.
Humans are predisposed to seek relationships and interactions with others from
birth and to share their emotional reactions to the external environment, in addi­
tion to expressing their internal states through behaviour. The infant is immersed
in family and community culture, which affects his understanding and interactions
with the world from birth. Svanberg and Barlow (2009) identify significant aspects
of an infant’s emotional development between one and six months:

� His capacity to use reciprocal interactions with caregivers.

� His experience of a range of emotional states.
� His need for containment.
� His development of an early representation of his sense of self, and
others.
� His cognitive and intellectual growth.
� The level of his parents’ sensitivity and responsiveness.

The research by Davis and Montag (2019) described the use of emotions in
mammals as fulfilling the need for survival, to nurture young, and to encou­
rage participation and interaction with a stimulating learning environment.
Early experiences create patterns for the creation of future relationships and a
foundation for self-regulation of emotions and behaviour. Sroufe et al. (2000)
linked effective self-regulation in adulthood with experience gained within an
adult–child dyad during the earliest years.
Barlow and Svenberg (2009) highlighted that a negative impact upon an
infant can be expressed through neglect or intrusion by a mother who is experi­
encing depression and low mental health. The infant experiences disruption
periods of inconsistent attention and lack of attention, and there may also be
periods of positive interaction with a primary carer. These babies may develop
insecure attachment in the early stages of life and learn to up-regulate in a bid to
gain attention and down-regulate as a self-protection strategy over time. The
babies acquire behaviours in response to their mothers’ changing moods, abil­
ities, and capacity to provide care.
Research has indicated that a parent’s mind-mindedness, as used by Barlow
and Svenberg (2009) in depicting a parent’s sensitive responding to her child’s
needs and emotions, is a more effective predictor of developmental rate than
educational background or socio-economic status. Beebe and Steele (2013)
54 Relationships, involvement, and well-being
identified that the infant’s experiences guide his perception of himself, in
addition to development of strategies to deal with negative emotions, and this
is influenced by interactions with his primary carer. In a context of danger,
the young child may be hypervigilant and more acutely aware of his mother’s
cues in relation to his internal mental state. Fonagy (1999) describes a mother
presenting her child with a particular mental state through actions and beha­
viour in response to his needs. This author regarded reflective capacity as a
transgenerational acquisition.
It is also indicated that the infant in adverse circumstances has greater
capacity to interpret the mental state of his primary carer than his own
mental state. A mother may reflect, and consequently exacerbate, the negative
emotions of the infant or ignore his state of stress. The study by Cassidy and
Mohr (2006) indicated a status which was termed as unsolvable fear. The
authors expressed that it appeared impossible for an infant to develop orga­
nised attachment responses within a context of a chronic source of fear.
Cassidy (1994) explored the close links between attachment relationships and
the ability and capacity to regulate emotions in infanthood. Infants who have
avoidant attachment, through rejection by a primary carer, will minimise emo­
tional impact by actively reducing their relationship cues as a protective strategy.
These actions are described by Cassidy as contributory to maintaining the par­
ent’s own state of mind in which the need for attachment is minimised. Alter­
natively, infants who have developed ambivalent attachment through
intermittent availability of a primary carer will use a variety of means to capture
attention. These actions represent the infant’s need for an attachment relation­
ship and directly influence the parent’s responses to attachment cues.
Underdown (2009) identified touch as a powerful and effective tool in creating
and sustaining a secure attachment relationship between mother and child. This
author indicated that lack of tactile connection adversely affected emotional
development and physical health and growth. The use of infant massage, as a
learned intervention, has increased greatly since McClure founded the Interna­
tional Association of Infant Massage in the United States (McClure, 1985). Infant
massage reduces and stabilises cortisol, epinephrine, and norepinephrine, which
relate to the level of stress experienced by a baby or child (Underdown, 2006).
A child with disorganised attachment may experience historical ideas and
emotions with the same intensity as current external events. Parents often express
that their children “are reliving past experiences” in a context of trauma and
child abuse. Practitioners observe children in nurseries immersed in thought and
outwardly exhibiting signs of internal stress, for example, sucking clothing,
twisting hands together, biting lips, or clenching fists. Insecure relationships
during infancy may lead to personality distortions in later stages of development
as described by Fonagy (1999).
An interesting study by Witherington and Crichton (2007) focuses upon the
functionalist approach to emotions. These authors describe the emotion system as
a complex nonlinear system that functions in accordance with interaction of the
components. Development in one area can alter the system, for example, motor
 Relationships, involvement, and well-being 55
skill and the accompanying emotions. The authors indicate that behaviour by an
infant is influenced by emotional reaction and used to establish, to maintain, or to
change the relationship with a proximal environment. An example of a new skill is
crawling and venturing beyond the Circle of Security in relation to a primary
carer. This gross motor skill may incur fear or excitement and achievement; thus,
the emotion system is reconfigured based upon an increase in knowledge, under­
standing, and potentially new interpretation of the world. The reconfiguration
reflects an impact of emotions as the infant explores, learns, and develops.
A recent publication from the UK Government (2021) describes an
impactful intervention as the Healthy Child Programme in England. It is a
national public-health framework for children and young people. Health
promotion is available from birth to 19 years, or 25 if the young person has
particular health needs. Antenatal, newborn, and infant screening for health
issues are also encompassed within the delivery of this programme. NHS
England provide a postnatal check for new mothers and their babies at 6 to 8
weeks, which includes mental health and well-being of the mother.

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3 The developing child

Chapter 3 reviews developmental processes and includes discussion on the

developing sense of self in the earliest years. Mitigating factors are described
as the psychological resources of each adult, personality, and particular
characteristics of an infant. Sroufe et al. (2000) indicated that infants have the
ability to adjust their behaviour if an adult misinterprets the initial cues.
Asmussen et al. (2020) advised that adversities may incur deprivation of
intellectual stimulation. Overcoming this detrimental effect requires particular
adaptation by a child, and this chapter explores high ability (Silverman,
2016), internal and external asynchrony, and additional needs.
Knowledge and understanding from flow theory are used to describe influ­
ences upon development which include situational features and personal
characteristics (Csikszentmihalyi, 1990). The six conditions of a therapeutic
relationship by Rogers (1990) are also presented to the reader for considera­
tion. Rogers had stated that specialist knowledge is not required in the crea­
tion of a therapeutic relationship. Differentiation is made between the
concepts of caring for someone that encompasses physical, and environmental
care or caring about someone that refers to a carer’s responses to needs, and
emotional reactions (Hogg & Warne, 2010).

Attainment gap
I consider an infant’s chronological age and his stages of development, which are
led by interaction of gene potential and environmental factors. This knowledge
identifies contributory factors to the expansion of an attainment gap between the
average child and disadvantaged children. Babies and toddlers who attend my
workplace struggle to cope with daily survival, and withdrawal symptoms are
common from birth to 18 months due to parental drug or alcohol use. These
adversities can be experienced directly from mother to foetus or indirectly from
both parents using drugs within the home environment. Asmussen et al. (2020)
recently expressed that further research is required to gain understanding of the
social processes that prolong the impact of adversities, in addition to the emo­
tional aspects that increase a child’s resilience. All topics are complimentary to
one another within the context of infant mental health.
DOI: 10.4324/9781003358107-3
 The developing child 59
Research indicates that babies can experience internal states in relation to
seeking support, rage, fear, pain, loss, play, and care. These emotions con­
tribute to the infant’s or child’s developing sense of self over time. Activation
of a baby’s emotions results in physiological change, for example cortisol
release, and subsequently impacts upon behaviour. An infant’s interpretation
of the world can be led by the primary carer’s reaction, or the key worker’s, in
the circumstances of a child attending services. Young children’s emotional
literacy can easily be supported within daily living. The early stages of self-
regulation can be initiated through sensitive care that supports up-regulation
and promotes a pathway to down-regulation if responses are paced appro­
priately to personality and needs. Therapeutic intervention can be used to
identify and to respond to developmental gaps by increasing knowledge and
skills of the child, parent, and practitioner. I have always taught the concepts
of self and agency in partnership, which increases understanding of these
issues to practitioners.
The term “marking”, in relation to mirroring, refers to a parent, or practi­
tioner in a service, responding to a child by copying his emotions initially and
subsequently presenting an interpretation of a situation for the child to
assimilate. By using this approach, an adult can nurture a child’s skill of
independent emotional containment. Infants reflect the emotions of a parent
which can be prohibitive of positive emotional development if the parent is
suffering from short- or long-term mental-health issues.

Box 3.1 Example from practice

Nine-month-old Murad and his mother, Ebi, have recently commenced nur­
sery. It is clear that Murad is aware of the sudden increase in noise and sti­
mulation in his personal space. During lockdown periods, he had a quiet,
predictable lifestyle at home with his mother and older brother. Murad is
seated comfortably on a thick, woollen, red-checked rug in which each
square is adorned with a farm animal – cows, sheep, chickens, and horses
dance across the rug ready to stimulate little learners. However, Murad does
not feel comfortable. He glances from side to side without moving his body.
His fists are clenched and held tightly against his body. I have often
observed children hiding their hands during periods of anxiety. A fire engine
suddenly creates a raucous intrusion as this external influence impinges
upon the ambience of the nursery playroom.
The key worker and Ebi are seated on a navy corner settee, under a dark-
green canopy which is strewn with artificial greenery and flowers: the book
corner and nurture area. The practitioner is completing induction forms,
seeking permission from Murad’s primary carer for the nursery team to take
the little boy outside the building, to change his nappy, to brush his teeth, to
participate in individual play, to take photographs, and many more examples
that encompass a typical nursery day.
60 The developing child

Murad makes a plaintive whimper of fear, his cry is directed randomly out­
wards as he is unable to see his mother seated within the nurture corner. The key
worker smiles and quickly gestures to Ebi to approach her son. The induction
forms are deprioritised in preference to the infant’s needs. Ebi kneels beside
Murad. Her large mother-and-baby bag slides forward from her shoulder, and
impatiently she pushes it aside. This mother has one focus only at this moment:
responding to Murad’s emotion. I notice that momentarily Ebi mimicked the
infant’s distressed face, and she acknowledged her son’s angst by expressing
his negative emotion to him verbally. However, a reassuring hand upon his back,
a mother’s broad smile, nodding with positivity, and using motherese to create a
non-threatening atmosphere supported Murad to regain his composure.
In a few moments, this little child leant against his mother, his mouth
uplifted in a smile, and he nodded up and down as his relaxing body
demonstrated liberation from potential threat and fear. I commented to this
mother on the effect of her skills, I described her actions, and I linked to
Murad’s self-esteem and regaining of his composure: marked mirroring. Ebi
shrugged as she looked down shyly, seemingly embarrassed to receive my
recognition. I said her name clearly, and, as this young mother looked up, I
reiterated my message, “Ebi, you are the expert on your child’s needs. I
want to learn from you on how to support Murad to achieve.” This time Ebi
nodded, and I could see that she felt pleased and perhaps empowered.

Similar momentary incidents occur frequently within every early years ser­
vice and in a home environment. I often observe marked mirroring from
mother to child upon public transport on my journey home from work. I feel
strongly that practitioners and parents should be given awareness of the value
of their input to a distressed infant. The interaction may appear to be insig­
nificant, and a natural response, but it contributes to an essential foundation
for development of a sense of self and regulation of emotions. Senior staff and
key workers should gain confidence in noticing and tracking each other’s
practice and by reaffirming through verbal recognition. Early years practi­
tioners should capitalise upon opportunities to give parents positive feedback
on parenting skills, within and out-with interventions.
Trauma impacts upon the comprehension of one’s own mind and subse­
quently upon the capacity to appreciate the mind of a baby. Mirroring without
marking can also occur between parent and child. A mother who has unresolved
trauma replicates and emphasises the infant’s own reaction without emotional
containment. The infant is not presented with an understanding of his emotions
in relation to context or supported to develop resilience, or to adopt social
behaviours. Alternatively, the parent’s own emotion which is based upon implicit
memories of historical trauma may be communicated and adopted by the infant.
The former response can prolong the trauma reaction, and the latter contributes
to the baby’s creation of a false sense of self.
 The developing child 61
An infant can develop a false sense of self by referring to interpretation of
the world from another person’s perspective and by adopting their emotional
reactions. His representation of the world is a direct copy from his role model,
as opposed to his emotions and behaviour being influenced by experiential
learning. At times, parents may contribute inadvertently to this dependency
by directing the child’s actions and dismissing his cues. Montessori (1964)
promoted the key-worker system in services and elevated the significance of
the role of primary carer to secure attachment figure in the earliest years of
childhood. Siraj-Blatchford et al. (2003) researched the effects from multiple
carers on children’s development in a long-term study called The Effective
Provision of Pre-school Education Project (Department for Education and
Skills, 2004). Findings reported positive effects from the consistent care of a
key worker and professional–parent relationships. This approach to nurturing
children in services continues throughout the world. A responsibility of the
key worker is promotion of each infant’s sense of self and agency.
The use of containment encompasses the delivery of intervention in a ser­
vice (Bratton et al., 2006) and supports the skill of reflective functioning. It is
essential that practitioners communicate comprehension of these processes to
each parent in response to individual modes of learning, for example, by
using video feedback to prompt discussion and reflection upon the parent’s
actions and baby’s responses. The aforementioned child–parent relationship
therapy is filmed at each session and used to increase understanding of parent
and practitioner.
Many countries have placed an increase in emphasis on supporting practi­
tioners, in a breadth of disciplines, to gain knowledge and practical expertise in
the field of infant mental health. My workplace is informed by the recent Scot­
tish framework for practice that promotes understanding from the impact of
trauma upon neurological, biological, psychological, and social development
(Scottish Government & NHS Scotland, 2021). There are five key principles:

1 Physical and emotional safety.

2 Transparency and trustworthiness.
3 Choices and voice.
4 Collaboration and development.
5 Empowerment of individual and organisations.

The projected result is an increase in positive responses to service-users who

are affected by adversity, in addition to nurturing self-compassion in the
workforce and leading to an improvement in mental health for all.

A sense of self
By five years of age, most children have developed an elementary sense of the
autobiographical self by experiencing five consecutive stages of learning
(Whitters, 2018).
62 The developing child
1 Physical agency.
2 Social agency.
3 Teleological agency.
4 Intentional agency.
5 Representational agency.

These stages are traversed incrementally, and development is iterative in

relation to experiences and opportunities for learning based upon an infant’s
personal interests. This responsive context maintains a high level of involve­
ment with the environment and nurtures emotional well-being. As I pre­
viously commented, the average age of a sense of self emerging (Stern 1998)
differs markedly from my experience of an infant’s comprehension of his
emergent, core, subjective, and verbal self, in contexts of adversity. The
negative effects of adverse childhood influences upon the timing of the stages
of normative development are clear. These milestones represent the infant’s
growing sense of agency in which he understands and uses his ability, and
capacity to influence the environment and people. Trauma can delay or pre­
vent the child’s comprehension of agency progressing. Psychopathological
disorders are linked to gaps in functioning within these states of agency.
During the first year of life, an infant will begin to demonstrate intentional
actions. He has elementary understanding of cause and effect: for example, lift­
ing both arms towards his parent is a direct cue for a nurturing response. If this
action is rewarded by close physical contact that supports his emotional need,
then the infant will quickly learn patterns of cause and effect as responses to his
physiological and emotional experiences.
The work of Sroufe et al. (2000) showed that infants have the ability to
adjust their behaviour if an adult misinterprets the initial cues. For example,
the action of raising both arms might be extended to include fists opening
and closing, indicating that the child is seeking to latch onto his parent. Over
time, these early experiences will be used by the infant to generalise beyond
the care of his mother or father, and his expectations of action and reaction
will be extended to other adults and, potentially, siblings. Sroufe et al. (2000)
describe attachment as the dyadic regulation of emotions in infants which is
operationalised by the caregiver guiding the young child’s self-regulation.
Caregivers have an essential role in providing a child with opportunities to
regulate his emotions through the use of predictable, consistent responses to
his needs and actions. Over time, the infant’s inner working model retains this
increase in knowledge and understanding.
Memory, and actions associated with secure attachment in early childhood,
directly influence the capacity and ability to create positive and fulfilling relation­
ships in middle childhood, adolescent years, and adulthood. Sroufe et al. (2000)
link insecure attachment to anxiety disorders, dissociative symptoms, which can be
associated with chaotic circumstances, and inconsistent relationships during
childhood, but not causally. Psychopathology results from combinations of multi­
ple adverse influences and lack of protective factors throughout the lifespan.
 The developing child 63
Gaining insight into normal learning and developmental processes provides
a route for intervention to facilitate and to support systems for infants who
have been adversely affected by internal and external influences. In the earliest
stages, following birth, the infant demonstrates a propensity for his mother’s
voice which has been a consistent circumstantial aspect throughout his
growth period in utero. Newly born babies also indicate a desire to seek out
their mother’s eye contact, recognise her appearance within a few days, and
react positively to maternal smell as opposed to the smell of other adults.
Trevarthen and Aitken (2001) describe evidence of 6-month-old infants who
were motivated to share cognition with caregivers that related to their prox­
imal environment. During the first year of life, an infant demonstrates a range
of emotions that encapsulate his desire to engage with learning.

Box 3.2 Example from practice

Xiang is six months and started nursery today. Six months is a useful age to
commence a service as most children are ready to accept a second
attachment figure in their quest for knowledge and understanding of a
widening world. The new baby’s parents had been relieved when their
daughter had finally arrived. Nine months of hopes and dreams had culmi­
nated in a beautiful raven-haired girl whose tiny nails were bright pink, and
her cheeks flushed red as she entered the world. On arrival at nursery, Xiang
did not cling to her key worker for reassurance, but the infant moved her
head around and about as she noticed the new environment. Xiang acti­
vated her senses quickly to absorb this increase in stimulation.
Xiang had managed to sit independently from 4 months of age, and cur­
rently, at 6 months, she could balance with a straight back, reach for toys,
resume a sitting stance, and competently transfer items from one hand to
another. This skill contributes to the creation of a baseline for exploration
and supports acquisition of immense knowledge in the first year of life.
Xiang’s fingers worked in tandem to turn over a fir cone, her tongue and lips
confirmed the hard properties of this natural object, and her nose detected a
similar smell to home as the cone had been cleaned industriously with dis­
infectant by a member of staff. Her eyes observed the item from every angle,
and her ears messaged no sound from shaking the fir cone.
Xiang sought eye contact with her key worker, seeking a reference point
for her investigations. The explorer paused for a few seconds as the key
worker responded to her cues for interaction and conversed with the 6­
month-old infant. Xiang sat very still for a few seconds as she listened and
absorbed information from this new voice which would quickly become a
familiar backdrop to nursery. Moments later, Xiang discarded the item in a
definitive backward throw, but, interestingly, the young learner swivelled
around, and she attempted to retrieve her chosen toy. Only infants can turn
successfully in a complete circle by using their legs as rudders and bodies
as ballast. Learning opportunities emerge in vast quantities when this 360­
64 The developing child

degree motor skill is achievable. Xiang’s memory was certainly active, and
her neural connections were rapidly creating a vivid picture to inform her
inner working model. A smile enveloped Xiang, and her head bobbed up and
down as she demonstrated great motivation to engage with the learning
environment of her nursery playroom and to commence a relationship with
her key worker.

Emotions and communication

Babies exhibit communication cues continuously, and time to observe is essential
within a nursery environment and the home. When any adult approaches a baby
then it is important to take a few seconds to assess the infant’s circumstances,
emotions, and involvement with the proximal environment. An adult should aim
to seamlessly create a dyad with an infant that compliments and takes account of
his current status, including his physiological well-being, his emotional reaction
to the adult’s presence, and his immediate interests. A necessary first stage to
development is comprehending and accommodating the young child’s reaction
and interaction to his world prior to a dyad being formed.
Plutchik (1980) investigated emotions in infants, and the study indicated
that emotions were organised in a similar way within adults and young chil­
dren. A few years later, Panksepp (1998) identified opposing pairs of emo­
tions that related to basic functions for survival and regulation of behaviour:
seeking/curiosity, fear/escape, rage/attack, and distress/affection.
An obvious desire to learn which is accompanied by emotion can act as a
source of motivation for a parent to engage in an intersubjective dyad with
the infant in a context of imitative and complementary reciprocal responses.
This aspect of development contributes to daily living within a family and
community culture. However, dis-regulation of such emotions can indicate
psychological disorders, including difficulties in relating to objects and people
(Trevarthen & Aitken, 2001).
An awareness of the permanence of meaning, as termed by Trevarthen and
Aitken (2001), is also acquired within the first 12 months of childhood, and
the infant apportions intrinsic value to particular gestures and resultant
actions. These communications are often immersed within the family culture
or relevant to a particular caregiver. Maternal or paternal depression affects
operational skills in daily living and impacts upon relationships with others.
The creation of positive relationships can create a foundation for intervention
and a means to repair the adverse effects.

Parenting role
Belsky (1984) identified three domains which affect the parenting role.
 The developing child 65
1 The psychological resources of each adult.
2 Personality and particular characteristics of each child.
3 The environmental context of stress and the minimising or maximising
factor of support.

This author expressed that the capacity and ability of the parent is the most
significant factor. It is often the case that concerns about attachment are
expressed as a child not having secure attachment to an adult. Each infant
has an inherent predisposition to seek out positive relationships with a pri­
mary carer from birth, but attachment requires a dyad in which an adult
responds to a baby’s emotional and physical needs and provides the optimum
conditions for development. These conditions provide nurture and encourage
the baby’s overtures for a supportive relationship. Insecure attachment is
exhibited by an inability to self-regulate; therefore, the accompanying condi­
tions must change in order to promote agency and a sense of self.
Social learning through copying the role model of primary carers can be
described as a key source of children’s behaviour. Parenting programmes
focus upon the promotion of positive behaviour by giving parents under­
standing of their negative responses and the impact upon the child’s learning
and development. Positive strategies can be implemented with optimum value
if the parent’s psychological resources are used to increase his or her capacity
and ability to fulfil the parenting role. A parent’s experience is founded upon
his or her own childhood, in addition to parenting skills that accumulate
through caring for several children in a family. A child’s additional support
needs can present a new experience and challenges to the parent’s executive
functioning as she learns to interpret and to respond the child’s understanding
of the world. Practitioners should support parents to use prior knowledge
with confidence in addition to embracing learning opportunities and new
parenting skills.
Environmental enrichment is a term that describes intervention in the form of
stimulation and opportunities for development which are directly targeted to
individual children or families. The ecological systems theory (Bronfenbrenner,
1979) portrays the potential of influences to impact upon the developing child by
presentation in the form of concentric circles. The micro-system, meso-system,
exo-system, and macro-system are composed of influences from different sources
that can impact directly and indirectly upon the child’s ability and capacity to
progress. Although plasticity is regarded as being most relevant to the critical
periods of learning in the earliest years, factors can continue to shape neural
connections throughout a lifespan.
Toxic stress can affect the architecture of the brain, and this finding is sig­
nificant to early intervention work and the necessity of supports by multi-
agencies. I find that sources of stress are often described by parents as envir­
onmental and circumstantial, for example poor housing, poverty, and neigh­
bourhood discrimination. Alleviation of these factors does not necessarily
result in a reduction of toxic stress. Implicit memories which are based upon
66 The developing child
emotions can reproduce the stress reactions although the original source is
minimised. Parents and grandparents will frequently, and emotively, recount
historical instances of sexual abuse to service-providers and exhibit emotions
from a childlike perspective.
It is challenging as a practitioner to respond with the optimum support as
disclosures usually occur in unexpected circumstances. For example, within my
workplace the cloakroom area is a regular discussion venue for parents to exhibit
help-seeking behaviours to professionals (Broadhurst, 2003; Braun et al., 2006).
Since the COVID-19 restrictions to building access have been in place, parents
will frequently discuss issues in the carpark, which is the designated area for
drop-off and pick-up between parent and service-provider (Scottish Govern­
ment, 2020). Awareness of potential data confidentiality breaches can impose
pressure on practitioners during such encounters in public spaces; however, par­
ents’ overtures should not be rejected. Ingenuity in communication media with
families has been necessary during this uncertain period of the pandemic.

Therapeutic relationship
Hogg and Warne (2010) conducted a study on the responses to mental health
by lay people. This term, as applied by the authors, referred to members of
the public who did not have a professional designated role in the field of
mental health. Participants in the research included a hairdresser, a parish priest,
and a bar-worker. Responses from people in these roles to service-users, in a
general public domain, had previously been described by Hochschild (1983) as
emotional labour. This concept included management of people’s emotions
alongside tasks associated with a daily role or specific responsibilities. Differ­
entiation can be made between the concepts of caring for someone, which
encompasses physical, and environmental care, or caring about someone, which
refers to a carer’s responses to a service-user’s needs and emotional reactions
(Hogg & Warne, 2010).
The study by Hogg and Warne (2010) published interesting findings by
highlighting the significant impact from lay people upon the mental health of
a population. Skills of empathy, sensitive responding, and a non-judgemental
attitude can accompany daily encounters between familiar and unfamiliar
people and contribute effectively to good mental health in a community.
Rogers (1990) had categorically stated that specialist knowledge, which is
based upon professional training, is not required in the creation of a ther­
apeutic relationship. The research by Rogers identified that relationships with
friends can have therapeutic qualities which may be exhibited momentarily or
arise periodically throughout relational interactions.
The research by Rogers (1990) also highlighted the longevity and con­
sistency which could be achieved in a therapeutic relationship between a
professional and client in a context of mental health. Rogers’ six conditions
are used as a framework for the creation and maintenance of therapeutic
relationships and continue to influence guidance and practice today.
 The developing child 67
1 Two people in a psychological contact.
2 One person, a client in a state of incongruence.
3 The second person, a therapist in a state of congruence.
4 The therapist experiences unconditional positive regard for the client.
5 The therapist experiences empathic understanding of the client’s frame of
reference and communicates this to the client.
6 This communication is achieved to a minimal degree.

Rogers (1990) expressed that these six conditions require to exist over a period
of time in order to inform constructive personality change in the client. One of
Rogers’ colleagues, Lyon (2014a, 2014b) summarised conditions on the char­
acteristics of an effective teacher. Lyon identified one outcome as the trust that
emerged within practice led by the six conditions. Tausch (2014) was another
colleague of Rogers and Lyon, and his research findings indicated that non-gen­
uineness created a relationship of mistrust. Demonstration of these conditions in
practice do not simply affect each dyadic relationship but contribute to a positive
atmosphere that permeates through a service. A practitioner who has knowledge,
understanding, and capacity to use these interpersonal skills is extremely valu­
able to a service, particularly if his or her responsibilities encompass a leadership
or supervisory role.
Lyon (2014a) and Rogers (1990) agreed that a challenge for the therapist
was supporting the client to set and to achieve a goal of functioning posi­
tively. Lyon (2014a, 2014b) described the process of giving power to a devel­
oping person by nurturing his or her ability to operate independently from the
therapist. It seems that power is knowledge and understanding in this context
which leads to availability and extension of choices. This requires each person
to recognise and to make choices that reflect his inner working model of
beliefs, ideas, interests, and standards of living. A professional in early years
care and education may have gained knowledge of mental-health issues
through training, but comprehension and application of a skill set requires
time and experience. However, every newly qualified or experienced early
years practitioner can empower a parent, child, or colleague by generously
sharing expertise, cooperating, collaborating, and nurturing the other person’s
capacity and ability.
Over the past thirty years, there have been several studies conducted that eluci­
date the characteristics of a professional and service-user relationship and reflect
the six conditions of Rogers (1990). Smith (1992) conducted a study on the caring
relationship within general nursing, and she clearly identifies the importance of
role-modelling of the therapeutic alliance by a senior staff. The research indicated
that the nursing team followed cues from their ward sister or charge nurse by using
a therapeutic relationship to deliver care to patients. The team also commented on
the benefit to each professional from the positive nurturing atmosphere which was
created throughout the wards.
Stickley and Freshwater (2002) described love with healing potential as
representation of the therapeutic relationship between nurse and patient.
68 The developing child
These authors noted the challenge for nurses in creating a relationship of care
and caring. This two-pronged relationship included delivering intervention
within the parameters of disciplinary role and responsibilities in addition to
responding to a patient’s emotional well-being. Reference is made to Rogers
(1990) and one of his core conditions for a therapeutic relationship: the coun­
sellor experiences unconditional positive regard for the client. Nurses encounter
patients who have a broad range of home circumstances, and it is essential that a
non-judgemental professional approach is maintained at all times.
Early years practitioners and parents equate the delivery of care, education,
and nurture with professional love (Whitters, 2019). This is not a replacement for
parental love, which is unconditional between primary carer and child. Profes­
sional love is created for a purpose within the specific context of a service. This
purpose broadly relates to holistic development of the child or parent which
includes good mental health. The love projected from the practitioner to the
family is unconditional on an emotional level, but it is formed within conditions
that inherently create boundaries and recognisable parameters to the creation
and maintenance of the relationship. Time, context, environment, and char­
acteristics of each person are a few of the factors that define this type of love
between service-provider and service-user. The human emotion of professional
love encompasses a therapeutic connection between two human beings that
portrays respect, and it promotes responsive care in a context of learning and
development (Whitters, 2019). A highly valued and necessary skill is commu­
nicating belief in each person that he or she can achieve.
Emotional intelligence was investigated by McQueen (2004) in a literature
review within a context of nursing studies. The use of emotional intelligence was
identified as adoption of strategies to protect the mental health and well-being of
professionals. Strategies included adequate supervision of general, and indivi­
dual practice, in addition to periods of reflection and learning time. This author
also promoted the use of emotional intelligence in negotiations within multi­
disciplinary teams, in the nursing context. Findings indicated the importance of
emotional labour, but McQueen also warned about the potential for emotional
burnout in a professional if the outlay was prolonged or intensive.
The pedagogical culture of any workplace has an important impact upon
the delivery of a service, which inherently links to the well-being of employees
and their capacity to use emotional labour with emotional intelligence. The
service-provider and service-user relationship is a medium for communica­
tion, interaction, promotion of key issues, and transforming knowledge into
understanding regardless of the context being health or care and education in
the early years. Healing of a whole person takes place physically, emotionally,
and socially within a therapeutic alliance. Professional love is demonstrated
within a sensitive and responsive attitude towards an individual’s emotional
needs at a point of time, and it is accompanied by actions that promote
development and minimisation of adversities. An early years worker practises
in a role that encompasses interpersonal and intrapersonal aspects of care
provision. Parents and children may gravitate towards practitioners, ancillary
 The developing child 69
staff, or peers who demonstrate skills that match their areas of need. Parents
may also choose to seek support from lay people due to freedom from con­
ditions and expectations of these relationships.
Bowles and Jones (2005) discuss the concept of protection time in a context
of mental-health nursing. These authors describe an inbuilt allocation of time
within each shift which could be used to form a therapeutic relationship with
a patient. Early years services are bound by adult–child ratios, but protected
time can be gained through effective deployment of staffing at a local level.
For example, the head of a service or senior practitioner may not be allocated
within these ratios, or absences of children may result in fewer practitioners
required to work directly with a group of children. In my experience, this
protected time between parent and practitioner can also arise unexpectedly
and can be capitalised upon. An example relates to the induction session in
which a new child to the nursery is accompanied by his parent; therefore, he
is not counted in the service adult–child ratios. Parents frequently use this first
contact with a service to seek out emotional support. Information from a
referring agent often provides the focal point of the meeting, and it acts as a
catalyst for a parent to divulge his or her fears, anxieties, adversities, and to
express emotional reactions. An induction session is conducive to a help-
seeking context for a parent. The therapeutic alliance is a significant aspect of
service-delivery, and protected time to support mental health needs should be
given due consideration within health, education, and care services.
Parents may actively reject interaction with professionals or may not be
aware of the route to accessing this support (Rogers & Pilgrim, 1997). In any
service, child protection is paramount, and it is essential that the entire team,
regardless of role, is trained in this area of work and takes responsibility to
share information by following policies and procedures. Parents should
always be aware that information is being shared, to whom, and the reason.
The only caveat to withholding this communication from parents is the
potential for a child to be harmed as a response to data-sharing between
professionals in a child-protection context.
There are many mitigating factors to progress which are unpredictable, for
example, chronic illness of parent or child or a diagnosis of a self-limiting
illness. These barriers to change and development can create undue pressure
on development of parenting skills. Holmes (2014) had promoted acceptance,
courage, and adjustment to daily living as desirable outcomes for parents in
these adverse contexts.

Parenting responses
Holmes (2014) reviewed parenting programmes from around the world and
identified five common approaches within a context of early intervention.

1 Parent and child are supported alongside each other within a programme.
2 Child receives support within a programme.
70 The developing child
3 Parent is the primary participant in a child-focused programme.
4 Parent is primary participant in a generic programme.
5 Parent and child are primary participants in an intervention programme.

Many services are adopting a therapeutic approach to behaviour manage­

ment which has been re-termed as promotion of positive behaviour. The adult
acknowledges the child’s feelings and associated actions as a basis for pro­
moting his sense of self and to guide him into replacing negative behaviours
with positive. The young child is supported to recognise and to make positive
choices that are proportionate to the social circumstances and cultural
boundaries. The response by an adult is commonly termed “mind mind­
edness”, which contributes to the child’s maturation of the autobiographical
self and the theory of mind.
The use of behaviour-management strategies by parents and professionals
may affect the relationship on a temporary basis, but this cycle of rupture and
repair is common. Children learn that relationships can be sustained despite
these negative communications. Boundary-setting is a responsibility of a pri­
mary carer which supports socialisation, the child’s comprehension of cause
and effect, ownership of actions, and acceptance of consequences.
Adversities and poor mental health are not exclusively relevant to families
who live in deprivation with outcomes of low attainment. Vaivre-Douret
(2003) reported that development in children of extraordinary ability could be
related to many high-level potentialities linked to functioning within the
neuron networks. A property of cerebral functioning is plasticity, which pro­
vides opportunities for adaptation and regulation in response to influences.
Findings from the study indicated that particular maturational developmental
processing occurs in children who demonstrate higher ability than the chron­
ological average. Plasticity in cerebral functioning is key to a child achieving
his potential and actualising his desire for knowledge, but higher-than-average
ability can also create vulnerability in a young child through a sense of frus­
tration, isolation, and injustice. Vaivre-Douret concluded that high ability
may coincide with neuropsychological or psychopathological disorders which
are genetically based.

Genetic and environmental influences

Vaivre-Douret (2003) conducted research in the pre-birth and post-birth
period. He identified that physiological development of the nervous and neu­
romuscular systems is affected by genetic and environmental factors, directly
and indirectly. For example, an expectant mother may improve her diet
during pregnancy and create a direct influence upon the foetus’s development.
This positive effect originates from an external source but creates an internal
change. The mother’s mental-health condition may deteriorate throughout the
pregnancy and affect her well-being, which in turn has an indirect influence
upon the foetus in-utero development.
 The developing child 71
Another factor to consider, in the context of an infant’s development, is the
creation of neural links at greater speed than the norm. Interactive processes
which take place between genetic and environmental factors can modify the
speed in development of nervous and neuromuscular systems within a child
(Vaivre-Douret, 2011). A salient point is made by findings within the previous
research of Vaivre-Douret (2003). This researcher noted that a child of high
ability may rapidly acquire the solution to a problem but be reticent in
exposing his skills to peers or adults. Findings indicated that this behaviour
can be interpreted as emotional immaturity but actually represents hyper-
maturity. This is due to the increased level and speed of information-proces­
sing capacity and analytical abilities. Normative responses of children with
high ability may be demonstrated at an earlier age than peers and indicate
greater intent and purpose within learning contexts. In accordance with this
research, processes include attitudes and values placed upon educational
attainment by primary carers that influence the child’s engagement and
involvement with learning.
Silverman (2016) described signs of ability as good memory, an early
retention and use of a wide vocabulary, excessive physical activity, shorter
sleep periods than the average child, sensitivity to the emotions of others, and
a preference for playing with older peers. It is significant that these traits
encompass intellectual, physical, and emotional development.
Unusual alertness is observed in some babies at birth and during forthcoming
weeks and months. This characteristic is recognised as an indicator of high abil­
ity (Silverman, 2016). The baby will seek out eye contact with familiar caring
adults and maintain this communication strategy for longer than expected of an
infant. The baby will also seek out eye contact with unfamiliar adults in his
proximal environment as an inherent response to a learning opportunity. He
may conduct lengthy observations, and consideration of these circumstances,
before engaging positively or seeking reassurance from a primary carer.
It is important to note that alertness in babies and children can also be
observed in contexts of adversity. A baby who lives in a daily environment of
potential danger, for example, parents with addictions, domestic violence, or
abuse, may demonstrate vigilance. This human emotional reaction to fear is
initially instinctive but develops into learned behaviour in accordance with
home circumstances. It relates to personal safe-guarding strategies that can
incur the baby demonstrating unusually focused and lengthy observations of
his proximal environment. This knowledge equips the baby to determine a
level of threat and to inform his subsequent actions.
Tronick and Beeghly (2011) highlight the negative effect upon the making
of meaning if adversities are prolonged. These authors describe meaning-
making as a transactional process in the lifespan which is supported through
learning within a dyad, for example, mother–infant and practitioner–infant.
The baby who is regarded as a developing system loses emotional stability,
and he becomes vulnerable to effects of further threat if he experiences long­
term toxic stress (Whitters, 2020).
72 The developing child
Asmussen et al. (2020) advised that adversities may incur deprivation of
intellectual stimulation. Overcoming this detrimental effect requires particular
adaptation by a child. A further consequence of significant negative influences
within childhood is highlighted as alteration of processing associated with
threat, reward and memory which can be impactful upon social-emotional
functioning. The result can be accumulative stress responses throughout the
lifespan which originated from an initial childhood adversity. This research
team suggested that resilience may be achieved through positive relationships
with adults and peers. The study concludes by raising a question on whether
resilience is an outcome of these secure attachments, or perhaps particular
resilience characteristics of the child facilitate the creation of supportive rela­
tionships. It is always interesting when research presents a reader with a
question to consider and to ponder – and potentially to investigate.
Motor development and physical prowess can be observed in some children at
an earlier stage than the norm. The infant will rapidly recognise and respond to
opportunities and actively seek out circumstances in which to practise his skills.
In accordance with Vaivre-Douret (2011), sequencing of motor skill commences
from fertilisation. Following birth, the order of sensorial and motor systems’
development is cutaneous sensitivity, vestibular, gustatory, olfactory, auditory,
and visual aspects. In a prior research study by Vaivre-Douret (2003), findings
had indicated that children of high ability were observed to use their eyes and
head in a noticeably active manner immediately after birth. The average newly
born baby will be able to hold his head in axis for about two seconds, and after
one month this motor skill will greatly increase. A baby with high ability can
develop this skill more rapidly.
A focus on communication is common in the early years, and many young
children seek out interaction between adults and books. This interest can stem
from the close physical and emotional contact that arises when an adult and child
share a book. Children of high ability often exhibit a keen interest in verbal and
written communication and demonstrate an ability to link these two. Engaging
with literature, without an adult’s presence, can commence independently from an
early stage of development. Recognition of letters can be retained more easily than
peers, and the child may have an insatiable appetite for identifying familiar letters
or words throughout his play environment within the home and community.
Expressive and receptive language, including the use of grammar and tenses, are
above average levels in accordance with age-group (Vaivre-Douret, 2003). First-
time parents may not have an awareness that their child has high ability until the
regular developmental checks are conducted by a health professional.
Alternatively, a child of high ability may be silent and demonstrate a ten­
dency to learn by conducting lengthy observations, copying actions in situ, or
applying extensive memory. The child’s expressive language is displayed later
than his peers. A child may exhibit the use of formed sentences with appro­
priate grammar and inflection, albeit the child is older than his peers and he
has not demonstrated the babbling stage of communication or incremental
effect of acquiring language over time.
 The developing child 73
Imaginative skills and motivation to use learning are shown by a strong desire
to access further knowledge and understanding within tasks, supported activ­
ities, or free play. “A thirst for knowledge” is often expressed by parents or
grandparents in describing a young child’s avid responses to the world. These
anecdotal comments by primary carers are upheld by research (Vaivre-Douret,
2003) in this field which identifies the constant searching for knowledge and
understanding as a characteristic of some children. Learning through the senses,
sight, hearing, smell, touch, and taste, is experienced with greater intensity than
the average child, and the rich feedback of information can result in a vivid
imagination which is accompanied by powerful emotional reaction. Heightened
emotional reactions can be observed in children which depict their personal
experience or portray a reaction and adoption of the emotions of others. This
characteristic is founded on the child’s capacity to experience empathy, and to
understand the world from another person’s perspective at a young age.
Personality and demeanour contribute to a child’s reaction and interactions
with learning processes. An infant may be extrovert and restless due to his
quest for stimulation to fulfil his intellectual or physical needs. He may access
adults as a source of knowledge and stimulation in his learning journey, but
he can be attributed labels that actually describe the adult’s inability to sup­
port the young child’s needs: demanding, challenging, and non-compliant. If
adults do not differentiate for the child’s needs, then he may demonstrate
unruly behaviour based upon rejection and his dissatisfaction. Research has
linked behavioural disorders and disaffection with non-fulfilment of an
infant’s learning needs (Vaivre-Douret, 2003).
Alternatively, an infant may have a quiet, shy, or even introverted personality.
He may use personal strategies to fulfil his needs by himself. For example, I have
often observed a young child presenting increasingly difficult challenges to him­
self in play: problem-solving, remembering vast amounts of information, and
calculating numerical goals with or without the use of external prompts. Exter­
nal prompts are accessed in accordance with the child’s preferences in using one
or more of his five senses: visual prompts through recording the information in
writing or electronically, auditory prompts through reciting information or sub­
stituting tapping for counting internally. A quiet child will often accelerate his
own learning, or use enrichment by exploring topics in depth, and ultimately a
multitude of sources of information become his teachers. Reciprocal interaction
emerges between the child and his preferred media of knowledge, as opposed to
interaction within a carer or peer relationship. Intellectual stimulus abounds but
emotional and social stimuli are depleted.

Box 3.3 Example from practice

The context was an orange and green double-decker bus in Glasgow city
centre, the 34 bus to the Southside. It was seven o’clock in the morning,
and I was travelling to work alongside a motley assortment of fellow
employees: office workers who were neat and tidy, keen to embrace the
74 The developing child

daily tasks, students in jeans and college sweatshirts with large, ubiquitous
bags of knowledge slung across their shoulders, and night-shift staff who
were tired and jaded, ready to go home and sleep during daylight hours. As
a childcare worker, I notice children and parents in every context, and my
interest was alerted as a young mother climbed aboard with a buggy.
The time was autumn of 2020 as the COVID-19 pandemic continued to
encompass our world. My fellow travellers wore face-coverings, and we
were separated carefully by definitive signs on each seat that welcomed or
rejected a potential user. We sat quietly, socially distanced, behind, and
diagonally, COVID-safe. This vantage point was useful as I could see the
buggy and occupant clearly. A little girl with masses of dark curls peeked
around her rain cover. I considered her age to be 12 months.
I smiled broadly as a generic introduction to any young child; however,
masks only reveal smiling eyes, and the little girl was too young to interpret
my overture. She frowned and dipped her head back inside the security of
her buggy hood. Disappointed, I glanced out of the dark window and could
only see reflections of streetlights shining against the still water of the river
Clyde. The bus moved smoothly across the bridge, and I returned my gaze
to the bright interior. The scenario had developed. The young mother had
given her child an identity badge. I recognised the health-service colours on
this badge, and I wondered about the mother’s role.
The child was fascinated by this new toy, and it was obvious that her
involvement and well-being were high. I noticed that the little girl had mas­
tered the skill of observation and planning. She used two hands, liberating
ten fine motor tools as her fingers felt the webbing on the lanyard. Strangely,
I found myself touching the lanyard of my own identification badge, which
was hidden from view and tucked inside my winter jacket. For a few
moments, I thought about the processes of learning, applicable to all human
beings, young and old. I had followed a basic learning principle of copying
by emulating this little girl’s movements.
The fastening on a lanyard requires opposing forces to release it, although
professionals in public-health fields are usually issued with sophisticated
versions with a quick safety release in case of assault by a client, but the
hard sharp pull required in this context was beyond the capability of a 12­
month-old learner.
The girl leant forward, and I had a front-seat row to view the drama. She
rapidly found the plastic clip and momentarily put it into her mouth. I wat­
ched the scene unfolding, and I was fascinated by the child’s competent use
of her five senses within this exploratory task. Two hands worked together,
first attempt then one failure, two attempts then success, and the two ends
of the lanyard sprang apart. The child rubbed her curls back and forward
against the buggy in celebration and smiled to herself. Goal achieved!
 The developing child 75
Common daily scenes depict the ability and capacity of a child at a point in
time. The motor and coordination skills that this child applied were developed
in situ, and the achievement of the planned outcome demonstrated motiva­
tion to learn within the task.

Internal and external asynchrony

Silverman (2016) described higher-than-average ability as atypical develop­
ment, and she highlights aspects of internal and external asynchrony.

� Internal asynchrony relates to different rates of growth in the child’s phy­

sical, intellectual, and emotional development compared to the norm for
his or her age group.
� External asynchrony can occur during the child’s interactions with a
learning environment as compared to the norm. The child’s interpretation
and reactions to objects and circumstances usually differ from the peer
group and expectations of adults.

Differentiation and integration

Learning is a sensory, emotional, and intellectual experience in which the
sense of self can be affirmed or changed. Csikszentmihalyi (1990) describes
flow theory as a process in which the understanding of a sense of self increa­
ses, and extends, by the use of two psychological processes. He identifies these
processes as differentiation and integration.
Differentiation occurs as the person gains an increase in skill and capacity,
and application of knowledge is greater. Integration is achieved as thoughts
and emotions are focused upon the same goal and result in a deeper level of
understanding. Findings by Csikszentmihalyi (1990) indicated that differ­
entiation emphasises individuality whereas integration can support identifica­
tion and connection with others who demonstrate a similar interpretation and
comprehension of a learning environment.
Four steps are identified by Csikszentmihalyi (1990) in the achievement of flow
during processes of learning, and the term autotelic self indicates an overarching
sense of purpose as experienced by the individual. As I consider these steps, I am
reminded of my 12-month-old fellow passenger on the number 34 bus in Glasgow.

1 Setting goals.
2 Involvement in an activity.
3 Focused attention.
4 High level of intellectual involvement and emotional well-being in current
experience.

Task commitment is closely associated with motivation to seek out learning

opportunities. McCoach and Flake (2018) describe motivation as domain­
76 The developing child
and task-specific. The alignment or non-alignment between the factors of
domain and task represents flow theory and directly affects motivation.

Flow theory
Flow theory refers to the influences from two variables upon a child’s experiences.

1 Situational features are the challenges or facilitators that an activity pre­

sents to the child from the proximal environment. The parent or practi­
tioner has a direct impact upon this influence.
2 Personal characteristics are the child’s own skill set which encompasses
personality, emotions, and reaction to the world.

Flow theory is a subjective experience in which a young learner feels alert,

competent, fulfilled, and also motivated to remain on his continuum of learning
and achievement. Csikszentmihalyi (1990) spent many years researching con­
cepts associated with optimal experience, and he identified six characteristics of
flow theory described from an infant’s internal perspective:

1 He merges actions and awareness. Awareness is relative to an infant’s

stage of a sense of self.
2 He is fully concentrating on the present situation.
3 He explores without being self-consciousness.
4 His body language expresses an expectation of success.
5 He senses that time is speeding up or slowing down during the interaction.
6 He has a desire to engage in the activity for the experience of joy, termed
autotelic motivation.

It is widely accepted that there are three ways in which knowledge is acquired
in the early years. The first approach is an infant observing and copying in
situ. For example, if an adult sticks out his tongue in close proximity to a 6­
week-old baby, then he will copy the action as long as the prompt remains
visible. The second approach entails an infant observing and reproducing an
action from memory in the short term. For example, if an adult demonstrates
a practical instruction of putting one brick on top of another before taking
the bricks apart and creating a learning space, then the infant will attempt to
reproduce these actions. The young infant may require reminders of the
actions required to build the tower of bricks if the visual prompt is no longer
available. The final approach is an infant internalising instructions and
applying knowledge, or collaborative learning with peers and adults in a
variety of contexts, and time frames. For example, if an infant attempts to
touch a specific hot surface, the carer will firmly say “No” and actively stop
the child’s hand from completing this action. On subsequent occasions, the
adult will simply say “No” without the practical prompt, and an infant will
internalise representation of this word as cause and effect in the context of the
 The developing child 77
aforementioned hot surface. Over time, an infant will acquire the ability to
extrapolate actions and meaning associated with the word “No” to other
similar contexts.
Vygotsky (1978) studied the social nature of learning throughout his career,
and he believed that co-constructivism provided the optimum context in
which potential could be achieved; however, one child may have greater con­
trol over environmental change and internal representation than another. An
increase in intrinsic motivation can serve to minimise distractions from
external events or adversities which can be observed in the performance of
some infants. These infants have greater independence and less reliance on the
environment as a prompt for learning. The children require fewer stimuli from
the environment than their peers in order to achieve internal representation of
consciousness in a context of knowledge and understanding. Parents and
practitioners have often commented to me in reference to an independent
young child, “He can find learning opportunities in any situation!”
Alternatively, Csikszentmihalyi (1990) found that greater dependency on
the external environment is required by some individuals to create a repre­
sentation of reality. This knowledge of approaches to learning directly
informs practice, and it underlines the importance of planning and of setting
a playroom for infants and young children at different stages of development.
Every practitioner develops skill in presenting choices to children at their
developmental levels. It is always effective practice to have supplementary
items prepared and ready to offer learners who rapidly achieve their goals in
addition to learners who benefit from repetitive interactions with artefacts
relating to lower levels of thinking.
Anxiety and boredom were identified by Csikszentmihalyi (1990) as two main
impediments to enjoyment in life. Anxiety can occur if challenges are perceived as
unachievable, and, conversely, boredom can arise if a child perceives his abilities
as greater than the opportunities that are presented in a particular environment.
Young children may not have an awareness of the reason for feeling boredom but
exhibit unruly behaviour as a response to lack of stimulation from minimal
learning experiences, or restrictive boundaries. The adult should seek to under­
stand this medium of communication and to interpret the infant or child’s beha­
viour. At times, I have heard carers comment, “There’s no reason for this
disruptive behaviour”, in reference to unruly actions and aggressive tendencies.
Anxiety or boredom often underlie these behavioural communications by a child.
Challenging cognitive tasks or introducing new physical activities are useful
responses. It is not always possible for workers to leave a playroom in order to
bring new artefacts into the play arena, but ingenuity and enthusiasm from a
team can support reconfiguration of resources to stimulate a child. Involving
children in creating a new venture can channel emotions associated with anxiety
or boredom towards emotions linked to achievement of a new task. Actions can
support self-regulation as a child reinterprets his learning environment.
Zhou and Brown (2015) explored three approaches to changing behaviour
which are applicable to all children within the earliest years of childhood: cueing,
78 The developing child
shaping, and modelling. Cueing is the use of verbal or non-verbal prompts that
link specific behaviour to circumstances. Cueing is most effective if used to pre­
empt negative behaviours by promotion of a positive change model rather than a
response to a child’s unsociable actions.
A child’s responses can also be shaped by practical scaffolding or verbal
interaction. Shaping entails an educator using strategies to incrementally
support a child to change his behaviour. All the steps may be explained to the
child at the outset of a task and linked to expectations and outcomes. The
child gains awareness of changing his behaviour. Alternatively, the change
process can be determined by an adult introducing each small step in context.
The child may not have an awareness that his behaviour is changing through
these subliminal accumulative steps. This lack of awareness can result in a
child positively embracing a situation of change. If a child perceives that he is
losing control of his environment, then he may rebel against the change
through fear and anxiety associated with an unfamiliar situation.
Modelling is often described as role-modelling within a service in which an
adult or peer actively demonstrates expectations of behaviour to a child
throughout the generic context. Zhou and Brown (2015) make the important
point that modelling can lead to diversion from the original source of learn­
ing. For example, a child can produce unique patterns of behaviour as he
attempts to replicate the adult’s actions. The use of child-led pedagogy has
minimised the educator’s focus upon predetermined goals and subsequently
liberated children to demonstrate imaginative and creative skills.

Motivation
The research by Gottfried et al. (1994) referred to intrinsic motivation which
was linked to the content of a task, a child’s personal interests, and the
experience of pleasure in intellectual attainment. The achievement of intel­
lectual goals is experienced internally but may be rewarded externally by
teachers or parents which can lead to dependency on external recognition.
This study by Gottfried and his research team had focused upon a child’s
internal reward system and his motivation to seek out higher levels of under­
standing. Links were made between intrinsic motivation, giftedness, and
pleasure which were associated with cognitive processing. Findings indicated
that family circumstances, resources, and social status in a community had
positive impact upon cognitive development; however, the study concluded
that familial influences can also hinder or prevent the realisation of genetic
potential.
Twenty-five years later, the same researcher, Gottfried (2019), collected
data on adolescents’ perceptions of their parents’ support during young for­
mative years. The adolescent participants expressed that task-intrinsic
approaches by their parents were more effective than task-extrinsic. Findings
indicated that a parent’s affirmation of the child’s internal emotional experi­
ence, and the child’s recognition of his goal, supported learning processes.
 The developing child 79
The study by Kreppner (2001) had also noted particular responses in rela­
tion to mothers of children who had high ability. These mothers adapted their
interactions and information-sharing with their children in accordance with
developing cognitive skills. Additionally, Kreppner found that mothers of
children who had lower abilities tended to interrupt the child’s play and did
not use instructions which reflected his maturation and changing abilities.
This approach restricted the child’s opportunities to access learning experi­
ences and to broaden his understanding of the world.
If children gain pleasure and fulfilment during cognitive processing, then
they will develop tendencies to engage with activities and pursuits which fur­
ther these outcomes.

� Intrinsic value represents the child’s apportioning of worth upon a task

relative to his interests and personality.
� Attainment value has relevance to the child’s own goals and his sense of
self.
� Utility value impacts upon present or future goals and applications
(McCoach & Flake, 2018).

Extrinsic motivation is instrumental due to dependency on an external

reward. This reward may be tangible as a sticker or toy which is given to the
child, or perhaps emotionally based in the form of praise, or socially based in
the form of acceptance by a peer group, or, finally, culturally based integra­
tion within a family group. These outcomes are apportioned value by the
child, and he may actively seek out specific rewards through his behaviour.
Rewards incite the creation of behavioural patterns within daily interactions
and incorporate expectations of the child and caregiver.

Intervention
Stern (2018) reviewed the purpose and effect of interventions which are
delivered in a context of therapeutic support. He described therapeutic inter­
vention as building upon a relationship of trust between parent and therapist.
This foundation creates a medium for effective communication and the par­
ent’s belief and acceptance in the therapist’s input, which increases the value
of the intervention. Stern also commented that many interventions encompass
a rationale of a strengths-based approach that focuses upon a parent’s current
skill set instead of areas for development. This approach was described by
Stern as superficial interventions of support as opposed to therapies.
Stern (2018) advocated therapies that promote understanding and ultimately
acceptance of past events. One strategy is giving a parent knowledge and a
rationale for using sensitive responding between adult and child. For example,
child–parent psychotherapy assists a family in exposing emotions and reactions
to trauma and gaining resilience to negative impact. Contextualising the nega­
tive experiences, in addition to comprehending and accepting the accompanying
80 The developing child
emotions, can support a parent’s ability to change and develop. Over time, par­
ents can be supported to reflect upon experiences that change their perceptions
of the parenting role and responsibilities. A therapeutic alliance between thera­
pist and parent can contribute to the parent’s capacity to show empathy towards
a child. The therapist’s unconditional positive regard is a key factor in this pro­
cess in which the parent’s inner working model is reconfigured, leading to a
change in perceptions, actions, and reactions.
The therapist in child–parent psychotherapy guides these complex processes
by nurturing links between internal beliefs and external behaviours. The term
“port of entry” applied by Lieberman et al. (2019) refers to the use of spon­
taneous behaviour, interactions, and free play within the intervention session
to capitalise upon potential for change in parent and child. Personalities,
temperament, and identified clinical issues are often determining factors in
the therapist prioritising a port of entry. Blechman (2016) particularly high­
lighted the transition period in which a parent commences the process of
change. During this time, the parent learns to express problems in an abstract
manner and gradually identifies solutions and applies concrete actions within
the circumstances of daily living. Blechman believed that solutions encom­
passed overt words and actions, in addition to covert thoughts and feelings of
the individual.
Lieberman et al. (2019) also reviewed family intervention therapy, which
specifically targets areas of change for parents, and children from birth to five
years, by focusing upon negative aspects of family life. Findings indicate that
trauma-informed treatment promotes knowledge and understanding that
supports reconfiguration of the parent’s and child’s inner working models.
Examples of areas for change were given by the researchers as unsafe envir­
onmental conditions, mental-health issues that have an adverse impact upon
the parent–child relationship, and maladaptive internal and external parent or
child behaviours. Internal behaviour can include difficulty in recognising and
expressing emotions, which can lead to social withdrawal. Reaction to adver­
sities may be demonstrated externally through aggression and a desire for
excessive control of situations.
The rationale of child–parent psychotherapy is presented by the therapist
during play sessions with parent and child. A link between parent’s and
child’s actions and reactions is explored, and the caregiver is supported to
identify negative and ameliorative factors. These factors may be current or
based upon historical experiences. The child and parent learn to put their
trauma experiences into context and to differentiate between remembering
and reliving the events and emotions. The therapist promotes parent and child
engagement with developmental goals and guides the parent to shape a future
positive family life.
Research indicates that the therapeutic alliance is strengthened by the skill
of each therapist in facilitating discussion of traumatic events. This positive
context encompasses change, development, and an increase in mental well­
being of child, parent, and extended family (Lieberman et al., 2019). The
 The developing child 81
context of an intervention therapy is essential to give the parent and child a
means of controlling the emotional impact of trauma within a safe environ­
ment. Families learn to rationalise and to compartmentalise the adversities
within their own time frames. The family members also learn how to create a
new framework for daily living in which negativity is replaced with positivity
and hope for a better future.
I work in a care setting that implements therapeutic pedagogy throughout
all activities and places significance on nurturing practitioner–parent, practi­
tioner–child, and parent–child relationships. Families attend the service to
access a nursery placement in addition to parenting support. Referring agents,
for example, social work, addictions, and health professionals, identify the
adversities and the impact upon each member of a family. Formal interven­
tions are promoted that support this process of change and development.
However, parents also choose to share trauma experiences informally at times
which are opportune to their emotions, well-being, and understanding of
specific practitioner–parent relationships. These interactions often occur out-
with an allocated intervention session, and it is important that the practi­
tioner is equipped to respond sensitively within this moment of personal dis­
closure by a parent. In recent years, training in adverse childhood experiences,
neural processes, and trauma-informed practice have become key core com­
ponents of continuous professional development for registered practitioners.

Play as therapy
Play that is based upon experiences of trauma provides rich and valid
opportunities to create narratives that respond to emotional issues in a safe
and protected environment. The review by Lieberman et al. (2019) also pro­
moted an ongoing narrative by the therapist as an effective strategy to alter
perceptions and interpretation of actions. The play is tracked by the therapist
throughout a session. This specific use of words to express actions and
accompanying emotions has great value in increasing understanding of parent
and child. The therapist encourages the parent to demonstrate nurture and
love through physical contact with a child. I have found that this context can
be challenging for some parents. Role-modelling by a practitioner is a useful
approach to experiential learning for a parent. In every interaction between
adults and children, there are multiple opportunities to demonstrate respect,
care, and love.
In the mid-1960s, a husband-and-wife team of researchers created the filial
therapy model in which recognition is given to parents’ use of play-therapy
principles and skills within adult–child interactive play sessions (Guerney,
1964). This model responded to the mental-health needs of young children
and continues to be implemented today. Adaptation includes the use of a
trained practitioner in the role of facilitator, for example, a key worker within
an early years service (Morrison & Helker, 2010). The therapeutic skills can
be extrapolated beyond the intervention and applied by the facilitator within
82 The developing child
any other environment in which interaction occurs between adult and child
(Post, 2010). This transitional feature of child–teacher relationship training is
supportive for the child’s transference of self-belief, emotional literacy, and
self-regulation within common daily contexts.
Child-centred play therapy is another effective intervention that targets the
mental health of a child and parent (Baggerly, 2010). The child participates in
sessions of interactive play, supported by his parent or trained facilitator. The
conceptual toys stimulate the child’s exploration and increased understanding
of his emotions in relation to trauma. The adult reflects the child’s non-verbal
behaviour, emotions, ability, and capacity to overcome challenges. The ratio­
nale of this intervention stems from the belief in the child’s increasing capa­
city to gain an understanding of self and to regulate his emotions and actions.
Ray and Edwards (2010) promoted the role of adult as facilitating an envir­
onment of permissiveness and freedom to understand and to make choices.
The optimum outcome is the child’s transference of this learning to environ­
ments out-with the therapeutic context.
Fall (2010) describes self-efficacy as belief in oneself. It is this belief that
can create reparation links between adversities and a positive fulfilling life.
The reparation element is founded upon an increase in knowledge, under­
standing, and resilience, in addition to appointing value and respect to one­
self. This belief is necessary for an individual to create internal change and the
confidence to express these changes externally.
Nurturing this belief is a key aspect of trauma-informed practice. Self-belief
can increase dramatically within multiple contexts: formal and informal
intervention and daily living experiences. Short interactions between an
attachment figure and a child can engender self-belief, and the output from an
interaction does not rely upon a specific timescale. Play therapy reinforces
strengths but acknowledges weaknesses. Tracking phrases contribute to the
child’s creation of a trauma and a resilience narrative. Facilitator responses
are built upon principles of acceptance and change.

� Acknowledge the child’s actions and accompanying emotion.

� Communicate the social boundary.
� Target an alternative action within the session context which responds to
the child’s need and emotion at this point of time.

Bandura (1997) had identified the formation of self-efficacy judgements

based upon the blending of four influences: mastery experiences, social
experiences, social influences, and physiological responses. Tyndall-Lind
(2010) conducted research on shared play-therapy sessions with siblings who
had experienced domestic violence in their home environment. The study
explored these influences in relation to each child. Findings indicated that the
play flow was fluid throughout the sessions, and there was evidence of secure
attachment between the children. The sibling relationships, and play-therapy
context, provided appropriate conditions for the children to experience, and
 The developing child 83
to practise, different behaviours with one another. Participants were also able
to access conceptual toys in this safe, predictable setting. The study applied
the term “therapeutic partners” to the brothers’ and sisters’ relationships.
Animals are also known to represent secure attachment to children in this
context of therapeutic partners. Research indicates that physical contact with
a pet animal triggers a release of neuropeptides that results in the child
experiencing a feeling of security and comfort. Findings from a research study
highlighted positive effects from animal relationships upon children who had
been emotionally and socially abused (Doyle & Timms, 2014).
Stern (2018) regarded the child’s development as impacting greatly on
repeat or extended intervention. This researcher explained that each session
supports a parent to make changes to his parenting responses, but week four
of a therapy will be delivering intervention to a child who has developed since
week one. An initial intervention, repeat interventions, and extended sessions
should recognise that the child and parent have a continuously evolving
foundation of knowledge and understanding.
During video feedback sessions, I have observed that parents can easily
identify their negative parenting interactions or lack of reaction to the child’s
overtures. However, with encouragement, the parents can also identify posi­
tive skills and reconfigure their understanding of each scenario by making
suggestions for change. The child adapts alongside the parent, and positive
effect can occur quickly. The reconfigured approach is presented to the child
in the context of developmental changes which are occurring continuously;
therefore, the parent needs be motivated and alert to embracing and adapting
to change as it occurs. Empowerment of primary carers is a key factor in
promoting interventions with longevity of outcomes.
In my experience, many parents request extra sessions of parenting support.
Stern (2018) suggested that parents gain value from the therapeutic relation­
ship in addition to the practical strategies. Memory of the positive relation­
ship, and the accompanying belief that the therapist demonstrates to a parent,
can maintain the momentum of an intervention after completion. A ther­
apeutic relationship between therapist, or early years practitioner and parent,
will eventually come to an end as the child moves between age-appropriate
services.

Fatigue
Professional fatigue is a mental-health issue that has come to the fore in
recent years, and this condition has been highlighted repeatedly by the media
during the current COVID-19 pandemic. However, stress can also be stimu­
lating and lead to professionals achieving optimum performance within their
disciplines, as described by Ulrich-Lai and Herman (2009). These authors
identified that stress may represent positive stimuli and the physiological effect
is similar to that of stress that induces negative effects. The research revealed
that delight/elation and fear/terror produced similar biological reactions.
84 The developing child
Additionally, findings indicated that reward behaviours reduced stress
responses by creating physiological and psychological change.
It is well known that healthy eating and regular exercise impact positively
upon long-term stress. During the lockdown periods of 2020 and 2021,
populations throughout many countries were allocated short daily exercise
times outside as a means to improve mental health. There was also a notice­
able increase in the public’s engagement with physical activity via indoor
media across all age groups. Throughout our lifespans, the hippocampus
generates neurons. Exercise is linked to this process of neurogenesis (Erikkson
et al., 1998) by generating neurotrophic proteins that are responsible for
growth, maintenance, and survival of neurons. It may be the case that the
increase in society’s focus upon exercise and well-being will continue after the
effects of the pandemic have reduced.

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4 Learning and adversities

Chapter 4 presents the infant and adult mind as a complex system that
encompasses many layers and potential connections (Siegel, 2003). Mental
health is described as a self-organising process that supports an individual to
achieve maximum complexity by use of differentiation and integration.
Uneven adaptation can occur as the mentalising resources are split between
the external world and influences of others and the internal world of the
individual and comprehension of his sense of self (Fonagy, 1999).
Multi-modal approaches are indicated which target different learning styles
of families and can respond sensitively to increasing capacity and ability as
time progresses. Examples of experiences throughout play environments are
linked to activation of the child’s genes. The result is protein production,
which changes the architecture of the brain as new synapses form. Recent
findings of Boyce et al. (2021) referred to individual susceptibility to adversity
and links between unsupportive parenting and increased inflammatory reac­
tions throughout the lifespan. Knowledge of the destructive properties of
cortisol is used to inform the rationale for strategic planning and intervention
(National Scientific Council on the Developing Child, 2006).

Adverse childhood experiences

Infants learn through interaction with the world, which creates an inner frame­
work of reference to support understanding and inform actions. These actions
are established as patterns over time, and they become recognisable as beha­
viours and reactions which are associated with circumstances and personalities.
The embryo is termed a foetus by the ninth week of gestation, and develop­
ment adheres to a unique genetic pathway. Intervention in the pre-birth context
is common if a previous sibling has been supported by social work or the parent
has been referred to family services by health. The Family Nurse Partnership
refer many teenage parents to our service, and it is often the case that the
mothers and fathers are care-leavers (The Family Nurse Partnership, 2011).
Anxiety and depression are regarded as the most common mental-health
problems pre-birth and post-birth, and mental-health status is often con­
firmed on a referral form with a diagnosis by a general practitioner. I observe
DOI: 10.4324/9781003358107-4
 Learning and adversities 89
that young teenage parents describe these conditions frequently during child-
protection conferences and present mental health as an explanation for
inadequate parenting skills, aggression towards service-providers, and limited
engagement with an action plan. Older parents tend to describe short-term
negative feelings which are related to childhood abuse. I feel that society has
become conversant with mental-health issues, particularly during this
COVID-19 pandemic, and, in my experience, the younger generation of par­
ents appear to seek medical support more readily than older peers. These
reflections are simply based upon anecdotal evidence from my workplace, and
I appreciate that interpretation of mental-health issues may vary in different
racial and environmental cultures, even throughout the city of Glasgow. I
work in a multicultural setting, and parents’ attitudes and beliefs on these
issues are formed through many different influences.
Exposure of an adversity by the media is useful, and in recent years
domestic violence and support mechanisms have been publicised to and by
governments, funding bodies, and victims. Domestic violence is a recurrent
aspect of referrals to our service and often includes violence from teenage
boys to their mothers. As a long-serving practitioner in a community service,
I can usually recall the teenage boys as infants in the nursery playrooms.
These circumstances present me with a realistic illustration and rationale for
ante-natal care, pre-birth assessment in child protection, and early interven­
tion for mother, father, and baby.
Foetal alcohol syndrome disorders are the greatest single cause of learning
disability, and during COVID-19 lockdown periods the consumption of alco­
hol by local service-users increased, in comparison to drug use. Poverty and
availability of substance supply contributes to the source of negative influ­
ences upon the unborn child. I clearly recall working in the 1980s in Glasgow
as glue-sniffing and inhalation of shoe polish had a major destructive impact
upon the mental health and physical well-being of young people. This sub­
stance misuse occurred in a context of high unemployment, perceived
inequalities, and youth disaffection. Bronfenbrenner’s bio-ecological systems
of human development (Bronfenbrenner, 1979) gives great depth and clarity
to understanding positive and negative direct, and indirect influences, from
the strategic level of governments to the micro-systems of families and indi­
vidual relationships.
I have worked with many babies who spend the first 18 months of life
coping with withdrawal symptoms from parental drug use. Their little bodies
arch with distress, and high-pitched crying depicts emotional and physical
pain as the babies desperately attempt to seek solace from the effects. It is
challenging for parents, and foster-carers, to understand and to respond to the
cues of babies who are withdrawing from drug or alcohol abuse. The new
little human body is confused and fighting to live within the context of trau­
matic influences. The baby is solely focused upon the physical effects, and
emotional comfort is often rejected as his energy and motivation are given to
coping with internal negative impact upon his well-being, and survival.
90 Learning and adversities
Reflective functioning and responsive care are often difficult attributes to
acquire and to demonstrate by parents who are affected with drug usage. The
health and well-being of parents need to be established before a baby can be
given adequate parental support. Mother and baby residential rehabilitation
facilities can provide useful environmental contexts to encourage change, but
returning to a home community, and maintaining progress, are challenging
for families.
Fonagy (1999) discussed the long-term effect of trauma upon relationships
in childhood and adulthood. A child who experiences adversity does not have
the benefit of a positive relationship role model to use throughout his lifespan.
The context encompasses negative effects upon his reflective capacity and
development of a sense of self. Illustration is based upon the child inhibiting
his capacity to mentalise traumatic circumstances. The lack of understanding
can lead to the child actively seeking support from an abuser, which Fonagy
(1999) indicates as a need for physical contact.
The attachment system is activated within a context of trauma and abuse,
and a consequence is chaotic attachment. Behaviours relating to an inherent
desire for secure attachment prompt negative and inconsistent abusive actions
of a perpetrator. A child’s instinct is protection of himself emotionally and
physically in the context of adversity. Findings from the study by Fonagy
(1999) give four reasons for abuse impacting negatively upon the reflective
functioning of a child in the earliest years and throughout his adulthood. This
research was based upon data collection from adult participants who had low
levels of reflective capacity.

1 If a child acknowledges the negative intentions of an abusive parent, then

he views himself as worthless. The research indicates that a child who has
low mentalisation capacity will interpret the behaviour of others by
focusing upon the consequences: abuse which is directed to himself.
2 The child may gain a distorted view of reality which is based upon the
abusive parent’s interpretations.
3 The child may have minimal exposure to positive external influences from
the world outside his immediate family.
4 The family atmosphere may negatively impact upon his reflective capa­
city which affects interpretation and comprehension of his sense of self.
The child may link his emotional arousal with negative interaction or
even abandonment. Consequently, the child limits his emotional reactions
or adopts the parent’s internal state within his own sense of self. Raised
levels of cortisol may also contribute to neurodevelopmental abnormal­
ities and a reduction in mentalisation.

Fonagy (1999) linked personality disorder in adulthood to individuals who

had rejected a caregiver’s abusive tendencies in childhood. This coping mechan­
ism can lead to a child directly inhibiting mentalisation; thus, abuse in the early
years can delay or impair development of a sense of the autobiographical self. In
 Learning and adversities 91
a context of normal development, integration of skills supports the child to
mentalise his behaviour. However, in a context of personality disorder, the ability
to use reflective functioning is diminished due to fractionation of these skills.
Maltreatment activates the attachment system, but the context of abuse by a
potential attachment figure results in disorganised or chaotic attachment.
Fonagy (1999) emphasised the domination of non-reflective internal work­
ing models within the relationships of individuals who have personality dis­
orders. Uneven adaptation occurs as the mentalising resources are split
between the external world and influences of others and the internal world of
the individual’s own mental state and comprehension of his sense of self. The
research states that chaotic attachment emerges from a disorganised sense of
self in which the child feels vulnerable and unsafe due to the negative internal
representation of himself. He has limited reflective capacity.
Parents may respond to an infant’s distress by a demonstration of fear or
presentation of behaviour that induces fear within an infant. Explanation of
these circumstances relates to the parent’s inability to view the infant as an
intentional mental being. The result is the infant’s association with fear and
lack of care in response to his emotional arousal. Over time, the child may
adopt and demonstrate a similar dissociative response to his parent, and
others. The participants in this research by Fonagy (1999) were adults who
had personality disorders, and the researcher indicated palliative care as sup­
porting development of the intentional mental self. The projected outcome is
lessening of the gap between internal and external reality.
The rationale for this approach is also applied to intervention in the early
years as a response to infant mental health. Emotional literacy has become a
significant aspect of many curricula (Scottish Government, 2004), and nurture
groups, or therapeutic play that promotes development of the intentional self
in young children (Bratton et al. 2006).

Targeted interventions
Targeted interventions are available to families who are deemed to be “at
risk” during pregnancy and post-birth. An identified outcome is to support
reconfiguration of the child’s internal working model. Parent–child support
programmes can be effective in enabling the parent to view her child as an
intentional mental agent and promoting the sense of self to the child. Imma­
turity in these areas can be exhibited as an unstable sense of self and impul­
sivity, which Fonagy (1999) associated with lack of emotional awareness, and
the predominance of physical reactions in response to stress.
These programmes are often implemented through home visiting by health
workers. Indicated interventions can be accessed for women who experience
issues that are detrimental to the mother and unborn baby. Many interven­
tions are twofold and support mentalisation and resolving past trauma, in
addition to development of positive parenting, secure attachment, and healthy
lifestyles. A bridge is created between internal and external reality for the
92 Learning and adversities
child, and opportunities for imaginative play, supported by a secure attach­
ment figure, can enrich this stage of development.
Researchers from Harvard University recently published an action guide
for policy-makers, in 2020, which indicates three key messages regarding
influences upon child development: adult–child relationships, early experi­
ences, and environmental exposure (National Scientific Council on the
Developing Child, 2020). Prior research (Siegel, 2003) highlighted the inter­
action between these influences and social-emotional development throughout
the lifespan, specifically from the prenatal period to three years of age. These
influences have a profound impact upon long-term health and well-being as
foundations for healthy functioning systems are established.
A pregnant mother’s stress, lack of nutrition, and environmental exposure can
result in the child having an increased risk of heart disease, obesity, diabetes, and
mental-health conditions. Anxiety, hypervigilance, and depression affect devel­
opment and impact upon the emergence of systemic properties, for example,
mobility and communication skills. Chronic negative influences can contribute
to a cycle in which the child’s resilience is reduced and he becomes more sus­
ceptible to future adverse influence. Pathological outcomes may result if a child’s
understanding of himself is detrimentally affected (Siegel, 2003).
Siegel (2003) described the mind as a complex system that encompassed
many layers and potential connections which were influenced by genetics, envir­
onment, and time. Mental health is regarded as a self-organising process that
supports an individual to achieve maximum complexity. If the system does not
progress towards complexity, then it is regarded as experiencing stress. The
complexity of this system emerges from two fundamental processes, termed
“differentiation” and “integration”. Differentiation relates to specialisation of
components and integration to the forming of a whole system. A functional link
is created by neural integration which occurs as differentiated circuits in the
brain form a coherent information-processing system.

Complexity
Therapeutic relationships, whether in a formal context of psychotherapy or
informal interactions, can enable self-organisation of the mind to progress
towards complexity. Siegel (2003) stated that human minds are created through
neural functioning, and this researcher identified 12 aspects that feature in ther­
apeutic relationships and support organisation of the mind: connection, com­
passion, contingency, cohesion, continuity, coherence, clarity, co-construction,
complexity, consciousness, creativity, and community. The mind is a sub­
jective entity that evolves over the lifespan in accordance with influences from
genetics, environment, relationships, and personality. There are patterns of
flow in the mind that involve energy and information. These patterns can
occur intra-personally and inter-personally. Ultimately, the mind can alter the
brain and the brain alter the mind as a result of information-processing
(Siegel, 2003).
 Learning and adversities 93
Neural integration refers to the different elements of the brain, or proces­
sing modalities, functioning as a whole entity (Siegel, 2003). As neurons are
activated then patterns of brain activity emerge which are consolidated and
extended during common or repeated experiences. Practitioners will observe
similar actions and emotions in infants during daily drop-off and pick-up
times that become established as routines. Personality and well-being affect
infants to a greater degree than children and adults. As humans mature then
their ability and capacity to overcome personal inclination and to adhere to
social expectations increases.
The young child relies on a consistent secure attachment relationship to direct
his learning. Over a period of time, the child is able to function independently by
referring to memories created by this essential relationship. Informal interactions
occur between parent and child on multiple occasions throughout every day and
night. Practitioners can support parents by highlighting the importance of con­
structing communication pathways with a young child to nurture development
and to form secure attachment. Therapeutic progress is often expressed as an
increase in creativity. In nurseries, children may not participate in arts and crafts
activities or imaginative play for several weeks after the induction period. A
child needs time to feel liberated from his perceived emotional and social bar­
riers in order to express his inner thoughts and ideas through creative play.
The parent’s own experiences of attachment relationships in early childhood
impact upon the care of subsequent generations. In 2003, a team of researchers
concluded a 23-year longitudinal study, and the findings focused upon a concept
termed “earned secure attachment” (Roisman et al., 2003). This research
explored the potential changes in understanding and demonstration of attach­
ment in adults who had described childhood relationships with their parents as
insecure. The descriptor “earned secure” referred to the increase in the adults’
ability and capacity to experience and to express secure attachment with their
own children. This ability was realised for many of the participants, and secure
attachment was established with the second generation.
Brain development includes a process of pruning. This emotive and
descriptive term refers to negative impact upon synaptic growth in which
neural connections may be not form due to minimal or no activation, and
some neurons die. The pruning process is particularly activated during ado­
lescent years. Activation is dependent on genetic timing of growth in these
circuits in addition to experience or activity-dependent development.
The infant/child’s interaction with the environment, and relationships, is
influenced by genetic coding and determines developmental pathways.
Memory is a major catalyst to development. For example, a visual/pictorial or
text prompt to the retina activates the optic nerve, and the information tra­
verses to the left side of the brain towards the communication-processing
area. Memory is one of the neural processes that benefits from repetition to
increase the likelihood of neurons linking together on more than one occa­
sion. Memory can cause prior experiences and accompanying emotions which
are associated with a specific prompt to be recalled and to assimilate with a
94 Learning and adversities
new experience. Siegel (2003) described integration of experiences within one
person’s brain being influenced by the flow from another person’s brain.
Knowledge and understanding of influences upon integration provides a
rationale for implementation of learning being supported by an adult or peer.
Care plans, and regular observation and assessment of each child by a key
worker, facilitate effective curriculum delivery within a service. In addition,
recall is used to support children’s skill in reflecting upon past events, gaining
awareness of memory storage by focusing upon internal thoughts, experien­
cing these processes, and expressing personal interpretation. The recall and
discussion of positive experiences creates a useful initial stepping stone to
children accessing memories and understanding their actions and emotions.
One example relates to a child’s memory of nursery activities from the pre­
vious day.
Reference to previous experiences provides an opportunity for a carer to
recall the child’s actions in detail and to create a vivid picture by using rele­
vant and realistic prompts to support the child’s reflective capacity. Reflection
upon prior experiences which have not been observed by a key worker, for
example a birthday party in the home environment, provide opportunities for
the practitioner to use questions as prompts and to explore the memory
alongside a child. These scenarios appoint control of the situation to a child
and increase his mastery. Conversing with an infant or young child is an art
form and requires skills in empathising with others, accurate observation and
assessment of needs and emotions, and responses based upon reflection and
interpretation.

Neural development
The mind and brain are regulated by the following:

1 Internal constraints and facilitators in the form of synaptic connections

between neurons. These barriers and enhancers to development can
change quickly over time.
2 External constraints and facilitators, which include experiences from the
proximal and distal environments, relationships, and communication
skills.

The infant or young child’s mental health has a direct impact on his capacity to
self-regulate emotions and actions. Siegel (2003) used the term “two-person
governed self-regulation” to described support strategies from an adult or peer to
a child. Initially, these strategies can alter external influences and thereafter
contribute to reconfiguration of the child’s inner working model. Relationships
can change the physiological aspect of neural connections within the brain of
each person. Neuroplasticity is significant to development (Doidge, 2008). Con­
nections support self-regulation and contribute to achievement of complexity
and, ultimately, good mental health. This optimum outcome from a secure
 Learning and adversities 95
attachment relationship in early childhood can continue to be achieved whether
the attachment figure is present in person or within the child’s implicit memories.
During the first three years of life, development of the right hemisphere of
the brain dominates neural growth. This right side is responsible for proces­
sing non-verbal communications, for example, tone or gestures, facial expres­
sions, emotion, and social cognition, which relates to theory of mind. The
theory of mind entails a child understanding that other people have opinions,
thoughts, and emotions that differ from his own. I have often heard lay terms
used colloquially that demonstrate comprehension of this concept from the
perspective of parents or grandparents, “He is putting his thoughts together.
He is using joined-up thinking. He can sense what other people are thinking.
Both sides of the brain are talking to each other.” These are phrases I reg­
ularly hear from families during parenting work, and it is easy to capitalise
upon these thoughts to promote the significance of a parent’s input to a
child’s neural development.
The left side of the brain develops at a later stage than the right side, and it
uses syllogistic reasoning. This type of reasoning encompasses cause and
effect, and it contributes toward the development of self as a teleological
agent (Whitters, 2019). The left side of the brain relies on information from
the right side to create coherent narratives in order to understand sequences
of events and, ultimately, lead to neural integration between the left and right
hemispheres of the brain. The brain follows an innate tendency to seek out
complexity of processes by integration, differentiation, and regulation.
Barriers to these processes may include short-term stress responses or long­
term post-traumatic stress disorder. Additionally, research indicates potential for
damage to the corpus callosum which connects the two hemispheres (Teicher
et al., 2002). The corpus callosum consists of bands of neural tissue that support
information transfer. Damaged connections have also been related to shrinking
of the hippocampus which can affect a child’s ability to develop and to use
explicit memory.
Findings from research have linked damage of this neural area to child abuse
and neglect (Teicher et al., 2002) and association with excessive toxic hormone
secretion as a result of stressful experiences. Too much cortisol can cause
death of neuron cells. The hippocampus has cortisol receptors that increase
vulnerability to the impact of stress. This area of the brain does not fully form
until 16–18 months of age, which is a period when the child starts to use
explicit memory (Siegel, 2003). These milestones of development signify the
importance of early intervention by practitioners, parents, society, and
governments.
Therapeutic support delivered within a secure relationship can instigate
connections between the two hemispheres. Emotion influences all neural cir­
cuits and, subsequently, mental functioning. The amygdala processes emo­
tions, which results in the child’s internal experience of an emotion, his
expression of this sensation to the outside world, and his perception of emo­
tions in others. It is known that the face-recognition cells within the amygdala
96 Learning and adversities
are activated by facial representation of emotions in others. Daily encounters
between a parent/carer and infant provide multiple opportunities to support
links between the two hemispheres.
It is important for parents and practitioners to appreciate the power of any
interaction to reduce the impact of stress upon learning and development.
Many services will implement formal therapeutic interventions to families,
but daily play and home/nursery routines also present rich and stimulating
environments. Multi-modal approaches can target different learning styles of
families and can respond sensitively to increasing capacity and ability as time
progresses. Broad experiences throughout play activate the child’s genes which
results in protein production and changes to the architecture of the brain as
new synapses form. Experiences gained from play also change brain function.

Promoting attachment
We continue to wear COVID-19 protection face masks at drop-off and pick­
up time, and, contrary to expectations, secure attachment is established
between infants and carers. It is never too late to promote attachment rela­
tionships with children. Research by Siegel (2003) outlined five approaches
that contribute to secure attachment if actioned by parents: contingent com­
munication, reflective dialogue, repair following rupture of the relationship,
emotional communication, and coherent narratives.
These approaches can change the neural connections as described by the
following examples.

1 Contingent communication: The parent notices the infant signalling,

interprets the message, and responds in a timely and sensitive manner.
The infant is waiting for a response, and he embraces the message
because it is attuned to his needs and interests at a point of time. The infant
uses the parent’s response to develop his own perception of the situation
then sends another signal to his parent; thus, the cycle continues. I often
observe parents and children during daily encounters as they interact with
stimuli which includes the parent’s face or pram artefacts. Contingent com­
munication prevails. Contingent communication has a predominant cultural
element, and it immerses the infant in a lifestyle relating to his family.
Family-based culture includes beliefs, needs, interests, and the characteristics
that give every family a unique identity.
2 Reflective dialogue: Contingent communication as used for babies in their
earliest years develops with the addition of verbal dialogue. The parent
is no longer reflecting the infant’s needs in isolation but extending
knowledge and understanding in relation to self and others. The parent
introduces the infant to a communication medium through this
dialogue.
3 Repair: Ruptures in relationships can occur often in relation to issues of
tiredness, prioritising attention, and tasks, limit setting, poor health, and
 Learning and adversities 97
stress of a parent. Repair entails acknowledgement of the infant’s needs,
information on mitigating circumstances that have caused the rupture,
and a route to repair. It is always useful for children to learn that a
parent, and others, may not always be able to attune affectively, but a
strong consistent attachment relationship can create a repair bridge.
4 Emotional communication: Supporting a child to experience and to cope
with negative emotions is equally as important as rejoicing and celebrat­
ing the positives. The child begins to gain self-control, regulation, and
resilience for the occasions when he is dealing with adversities without
direct support from an attachment figure.
5 Coherent narratives: Storytelling between parent and child can greatly
support the creation of coherent narratives of family events, and circum­
stances, in addition to issues external to the household. These narratives
broaden the child’s knowledge, prompt imagination, contribute to explicit
memory coding opportunities, and create multiple interpersonal bonding
experiences for parent and child. My work with families who are affected
by internal trauma, and adverse lifestyles, responds to immaturity in
areas of social and emotional development, particularly from birth to
three years of age. Monthly observations of each infant, and records
which many parents keep of significant milestones, demonstrate areas in
which development is steady, plateaued, or delayed. It is important to
target areas of strength in order to provide a framework for holistic
development.

The orbitofrontal cortex is behind the orbit of the eyes. This is a key loca­
tion in the brain that facilitates the cortex’s role in neural integration. Coor­
dination occurs between the cortex, limbic structures, and the brain stem, and
impacts upon mental health and repairing the effects of trauma. Schore
(1994) identified a function of the orbitofrontal cortex as regulation of the
autonomic nervous system that controls heart rate, respiration, and intestines.
The two branches are termed:

1 The sympathetic branch, which speeds up processes.

2 The parasympathetic branch, which slows down processes.

Short- or long-term effects upon the effective functioning of the orbitofrontal

region can lead to a sensation of disconnection from the proximal environ­
ment and difficulty in reflecting upon self. Practical consequences can result in
an infant or child being unable to give direct eye contact to another person,
despite an available nurturing attachment figure. This results from emotional
influences upon the infant rather than a physical restriction. The behaviour
may be interpreted incorrectly as an infant or child choosing to be inattentive
and to reject relationships. It may well be that the child is creating a barrier to
a relationship due to the effects of prior trauma and implicit memories of
similar overtures from adults in his adverse lifestyle.
98 Learning and adversities
Stress
Coates (2010) investigated the neuroendocrine system in a context of adverse
childhood experiences and the impact of stress in adulthood. This system
comprises interaction between the brain, nervous system, and hormones, and
it regulates emotions and stress responses. Findings indicated a long-term
impact of adversity linked to disruption in the neuroendocrine system which
altered the hypothalamic-pituitary-adrenocortical. The state of hyper-arousal
may persist during the lifespan as the body remains primed for a flight or
fight reaction. Fear is experienced and regarded as relative to current influ­
ences, although it originates from past events. Additionally, trauma response
tendencies can be acquired from one generation to another through copying
and learned behaviours.
The study by Coates (2010) clearly describes the brain’s reaction to stress.

� The limbic system is composed of a network of neural cells that encom­

passes the amygdala and hippocampus.
� This area of the brain controls emotions in relation to survival and acti­
vates a response to threat.
� Threat causes the amygdala to release hormones in preparation for fight,
flight, or freeze responses.
� Emotions are processed by the amygdala prior to information being
registered by the cortex.
� The hippocampus supports information to be processed and passed to the
cortex.
� The hippocampus can be affected adversely by hormones, and function­
ing ability may decrease.
� The volume of the hippocampus can be reduced in a context of environ­
mental stress and associated with negative emotional states of dissocia­
tion, panic, anxiety, and poor memory.
� The cortex is the outer layer of the brain which relates to cognition, and
messages are passed from limbic system to cortex.
� Problem-solving occurs in the front area of the cortex and learning which
relates to experience takes place in the prefrontal cortex.

Potential threat is registered within the fast tracts of the limbic system. The
information which is passed to the prefrontal cortex may not be sufficient for
an infant to differentiate between an actual or a perceived threat, and he may
misinterpret stimuli and appear to overreact (Coates, 2010). Carers are
familiar with children overreacting to minor issues, and this explanation by
Coates provides comprehension of these processes which supports interven­
tion and responsive practice within daily routines.
The left side of the brain is responsible for perception and expression of
language, and interpretation of circumstances. The right side of the brain has
responsibility for perception and expression of emotions. Research has
 Learning and adversities 99
indicated a negative impact upon development of the left side of the brain in
a context of adverse childhood experiences. A research study found that
verbal abuse from parents can be associated with lack of development in areas
of the left hemisphere of the brain that process language (Choi et al., 2008) in
addition to negative impact upon the tracts linked with emotional regulation.
This study accessed data from 1,271 healthy young adults who were initially
screened for exposure to childhood adversity. Fractional anisotropy was
investigated, and three white matter tract regions on the left side of the brain
indicated a significant reduction compared to the norm. Findings associated
the differences in fractional anisotropy with the level of maternal verbal abuse
and potential effect upon language development in addition to evidence of
psychopathology. These findings are informative by publicising the negative
impact of ridicule, humiliation, and disdain upon brain connectivity.
Teicher et al. (2004) conducted a neural study in which child abuse was
shown to affect development of the corpus callosum by limiting growth. The
right and left hemisphere of the brain are connected through this corpus cal­
losum and interact with one another in a context of neural processing. Find­
ings indicated that neglect had a high association with this reduction in
growth, and sexual abuse was specifically linked with smaller corpus callosum
in girls. Participant group was composed of 25 girls and 26 boys. A smaller
corpus callosum resulted in reduced integration between left and right hemi­
sphere and noticeable changes in mood or personality. Intervention was
recommended by Rothschild (2000) as a means to lower stress hormones and
to maintain healthy functioning of the hippocampus.
Memory was investigated in a study by McClelland (1998). Findings indi­
cated that explicit memory, based upon stimuli from the environment, had a
series of stages that supported the retention of information. The first stage of
the brain registering an experience lasts for under half a second, and it
involves input to sensory memory. During the second stage, which lasts for
about 30 seconds, the information is deposited within working memory. The
third stage may incur days, months, or years, as the information is retained in
long-term memory. The final stage is the consolidation of long-term mem­
ories into permanent memory which may take days or months to be com­
pleted. Permanent memory is independent of the hippocampus.
It is informative that the study by McClelland (1998) raised sleep as an
important contributing factor to these memory processes. Health visitors,
midwives, social workers, and early years practitioners have an essential role
to play in educating parents about the reason for establishing healthy sleep
patterns appropriate to an infant’s age, physiological needs, and personality. I
find that parents are keen to understand sleep patterns in their children, and it
is intriguing to learn about our brains working hard during sleep periods to
process and to retain information.
Research has identified evidence of stress responses in the foetus before
birth (Gunnar & Barr, 1998). Cortisol is known to impact physiologically and
psychologically upon the development of the foetus and subsequently upon
100 Learning and adversities
behaviour during childhood. Outcomes associated with antenatal anxiety
include premature delivery, low birthweight (Association of Infant Mental
Health United Kingdom, 2021), and difficulty in creating an attachment
bond. These challenges may stem from a mother’s negative representation of
her baby before the birth which is created within a context of stress and high
anxiety.
The COVID-19 pandemic is a current stress upon infant mental health
through the mother’s experience of direct and indirect adversities. A survey
conducted in 2020 identified two main causes of stress which occurred during
the first wave of the pandemic: participants felt unprepared for the birth and
fearful of infection from COVID-19. Poverty was also cited as an influential
factor to a high level of stress which was experienced by mothers during this
time (Association of Infant Mental Health United Kingdom, 2021). Digital
media were described by parents as useful means of communication which
could be accessed at opportune times. Participants identified positive out­
comes from the digital media as choices in response to needs at a point of
time and privacy to share information in this learning context.
Environmental stress factors lead to a fight, flight, or freeze reaction that
can impact upon the following bodily systems.

� The brain and nervous system, which manage and respond to stress
factors.
� The heart and cardiovascular system, which distribute oxygen throughout
the body within the blood.
� The gut and metabolic system, which transform food into energy for the
body.
� The immune system, which defends against disease, and also supports
healing of injuries.
� The neuroendocrine system, which maintains the balance of hormones.

The Harvard study (National Scientific Council on the Developing Child,

2020) concluded that policy-makers should implement programmes of inter­
vention that reduce daily stresses and toxic exposure within the environment
and provide support in the earliest prenatal stages. Daily stresses are cited as
poverty, community racism, a lack of suitable housing, and ongoing food
insecurity. Community programmes can react to issues within a local area,
and implementation strategies can be responsive to needs and culture of the
residents, for example, food banks and second-hand clothing stores.

Learning and development

Vygotsky (1978) studied the processes of learning and development in a con­
text of socio-cultural theory. This theorist termed learning as a higher process
which is integrated with development from birth. Inherent human psycholo­
gical functions mature and develop in accordance with genetic timetabling
 Learning and adversities 101
relating to growth. Consistent growth requires a regular source of food, rest,
and stimulating learning opportunities.
These functions are influenced by family and community culture and
expectations of society and may support or hinder realisation of develop­
mental potential. Vygotsky (1978) concluded that learning was not regarded
as development per se, but it was a process that accompanied development
and enabled it to occur. He proposed two developmental levels with the
descriptors of “actual” and “potential”, which indicated that one level was
achieved and the second level could be achieved if nurtured by influences
responsive to the circumstances.

� Actual developmental level: achieved through independent problem-sol­

ving. Quantitative scales may be used to determine a child’s actual
developmental level in comparison to the norm of a particular chron­
ological age.
� Potential developmental level: achieved through an increase in problem-
solving skill which is guided by adults or more capable peers. The
potential level of attainment is higher than the actual developmental
level. Qualitative methods are generally used to record this level of
attainment. Professional observations and direct involvement with a
child’s interactions provide insight into evidence of a higher level of skill
through application.

The zone of proximal development, as termed by Vygotsky (1978), is

regarded as the distance between actual development (retrospective) and
potential development (prospective). Actual development relates to an out­
come which is already achieved, and potential development encompasses a
successive stage of learning in which an outcome is not necessarily pre­
determined. It is not always easy for an adult to establish if a child has
achieved his initial goal or been diverted to a different goal through internal
or external factors. This process incurs divergent thinking.
The popular educational approach of child-led play provides opportunities
for children to use creativity and imaginative thinking, although play occurs
within an environment implemented by adults. Consideration of a zone of
proximal development by an educator can enhance the learning experience by
removing the constriction and potential limitation of predetermined goals,
particularly within a service in which the pedagogy is bound by curricular
outcomes. Comprehension of child development and learning processes liber­
ates the educator to reflect upon each child’s potential and to maintain
delivery of a curriculum in a context of responsive and inclusive teaching.
Language functions as an interpersonal and intrapersonal aid to the
acquisition of knowledge and understanding. Language facilitates commu­
nication between peers and adults, and it can be used to incite a child’s curi­
osity by indicating further learning through scaffolding of ideas. Language
also provides a tool for internal thoughts and ideas to be processed and
102 Learning and adversities
compared to prior knowledge. Finally, language supports consolidation or
reconfiguration of the inner working model.
Copying is a common source of learning which is often described within a
context of the mirror neuron system, particularly in the earliest years. The theory
of mind is dependent on this skill and usually develops by the age of four or five
years. This significant stage also contributes to socialising effectively within a
society, and Cicchetti and Toth (2006) described the process as a shift from
situation-based to representation-based understanding of behaviour. The fol­
lowing outcomes emerge from the theory of mind.

� Ability (intellectual) and capacity (emotional well-being) to self-regulate

actions.
� Knowledge and understanding of the link between actions and behaviour.
� The ability to differentiate and to understand emotions and context and
to communicate emotions through language or other media – emotional
literacy.
� The capacity to demonstrate empathic responding to the needs of others.

Humans are products of culture and contributors to propagation of family,

community, and national culture throughout each generation. Language or
alternative communication skills are integral to development, and verbal
intercourse provides a medium for transferring family, community, or societal
culture to a learner. The concept of culture includes knowledge, under­
standing, attitudes, values, and beliefs. These aspects can guide the child’s
actions and reactions to the world in a manner that reflects his local context
and contributes to formation of his sense of self in the earliest years.
Tronick and Beeghly (2011) linked infant mental health to a young child’s
level of understanding. In childhood, comprehension is gained through play.
Vygotsky (1978) explored the concept of play from a theoretical perspective.
He proposed that babies and infants seek and expect the fulfilling of needs
within a short time frame; therefore, the time gap between desire and fulfil­
ment is brief. Vygotsky assimilates play and imagination by presenting the
two issues together as he describes the actions and experiences of children
over three years of age. Imagination is termed a new psychological process at
this early stage of development.
Therapeutic and generic play provide a safe context for children to identify
their interests, to express their personalities, to change their ideas quickly or
over time, and to use imagination to fulfil unrealistic objectives. Play also
supports children to emulate daily observations of life in practice and to
experiment and develop skills safely within an arena that has limited reper­
cussions. Repercussions relate to the imposition of social rules, and consequences
that contribute to the creation of a safe play space and necessary boundaries to
exploration for a young learner. During a child’s early years of development, the
breaking of friendships or negative communications with carers can affect his
self-confidence, albeit on a temporary and fluctuating basis.
 Learning and adversities 103
A young child’s behaviour can indicate over-responsiveness in which he seeks
high-intensity movement. Examples are climbing, hanging upside down, and
risk-taking that may be misinterpreted as aggressive defiance to social and phy­
sical boundaries. The child may appear agitated as he attempts to conform to
expectations of behaviour, for example, biting his sleeve, moving his legs during
periods of sitting, and drumming his fingers. Alternatively, a young child may
demonstrate under-responsiveness and appear defensive to touch, express
apathy, and fail to notice changes or stimulation in the environment. The child
may have a poor sense of direction and immature sequencing memory.

The early years environment

Every childcare and education student will learn why and how to set up a variety
of learning environments. However, over time I have observed that practitioners
develop favourite personalised approaches to setting up a playroom. The ratio­
nale is not clear, the curricular links are not easy to detect or to action, and
aesthetic presentation can take prominence for the practitioner. The following
section highlights playroom areas or stations, the rationale, outcomes, and key
points for implementation. It is noted that the provision of an adult space within
each area is a significant contributory factor to creation and maintenance of a
secure attachment relationship between key worker and child.

� Physical: indoors and outdoors.

� Arts and crafts: creative, water, sand.
� Imaginative: small world, home corner.
� Table-top.
� Literacy and book corner.
� Floor play.

Physical
Rationale: To understand physical and emotional self.
Outcome: Gross motor skills, balance, proprioception, spatial awareness,
social rules, sequencing, action, and reaction.

� Proprioception may be termed body awareness and relates to the child’s

knowledge and understanding of the interaction between his skeleton and
muscles and control of his physical movements.
� Spatial awareness is the child’s knowledge and understanding of environ­
mental structures, spaces, and how to negotiate his body around the play
area.

Key points of implementation: Health and safety for individual and group, risk
assessment in response to children’s maturity, attraction, stimulation, con­
solidation and extension, adult space.
104 Learning and adversities
Arts and crafts
Rationale: To understand physical, emotional, and social self.
Outcome: Fine motor skills, hand-to-eye coordination, sensory awareness,
science concepts, numerical concepts, action, and reaction.
Key points of implementation: Variety of choices, variety of media, personal
and group space, adult space.

Imaginative
Rationale: Play that represents own world or imaginary world, social and
emotional self.
Outcome: Conceptual understanding of the world, understanding of personal
impact upon the world.
Key points of implementation: Accessible individually or group, comfortable,
appropriate choices, adult space.

Table-top
Rationale: Cognitive skills, sequencing, solitary/parallel/cooperative play
Outcome: Memory, hand-to-eye coordination, scaffolding learning, seeking
support – peers or adult.
Key points of implementation: Attractive, accessible, stimulating, adult space.

Literacy and book corner

Rationale: Literacy and emotional literacy, opportunity for down-regulation.
Outcome: Fine motor skills, sequencing, link word and text, imaginative
skills, memory, rest.
Key points of implementation: Attractive, accessible, stimulating, adult space

Floor play
Rationale: Sense of physical, social, emotional, and teleological self, cognitive
skills.
Outcome: Fine and gross motor skills, action, and reaction, increase resi­
lience, problem-solving.
Key points of implementation: Attractive, accessible, safe, combining several
choices of media, adult space.
Lack of opportunity for physical development can induce passivity, and it
can result in the brain existing in a neurologically neutral state. The passive
child may appear to have a high level of well-being, but his cognitive and
emotional development are limited by the proximal environment. A readiness
to learn leads to behaviour in which the infant actively seeks out knowledge
and identifies opportunities to explore, despite limited stimulation. Good
 Learning and adversities 105
mental and physical health are important and include the meeting of basic
needs, for example, food, water, and personal hygiene. The availability of an
attachment figure and opportunities that provide predictability, consistency,
and repeatability contribute to a child’s readiness to learn. Explicit memories
are formed from the environmental experience, and implicit memories are
created by the emotions that accompany the child’s explorations and interac­
tions with others.
Self-control is usually high during free play as the young child is using
developing skills associated with his imagination, and he begins to develop
abstract thought. Objects can be transformed for different purposes, initially
within the child’s imagination then followed by actions that specifically relate
to the child’s interests, needs, and knowledge of the world. Vygotsky (1978)
expressed that a preschool child’s actions are led by his ideas as opposed to
his reaction and interactions with concrete objects. A child may previously
have demonstrated subordination to social rules; however, during free-play
episodes, a child can experience pleasure and fulfilment. The child can change
rules and take control of his own actions. The child’s perceptions of his
proximal and distal world change. The child achieves mastery and power,
which can increase his resilience to life’s adversities; however, distraction
within the external environment can rapidly reduce a child’s involvement and
well-being.

Box 4.1 Example from practice

The early morning mist had cleared, and a pale autumn sunshine was
peeping over the horizon. The horizon in this scene was the distant back­
drop of Glasgow city centre, which made an impact statement through a
vision of slim church spires stretching high into the watery blue sky. I
transferred my gaze from the vista to my immediate environment of a city
community nursery. I was perched on the edge of a log fence which was
designed to be eco-friendly and to promote an aesthetic space within the
concrete play setting, but it was not so comfortable for conducting my pro­
fessional task.
I considered my role for today. I had come to this early years service to
observe 4-year-old Zeeshan as a prelude to implementing therapeutic inter­
vention. The little preschool boy had been referred by his family and nursery
staff as emotionally immature and displaying challenging behaviour. A per­
ceptive line within the referral form by the boy’s key worker had tentatively
suggested that a higher ability than peers was emerging; however, the final
referral comment had conclusively stated, “Zeeshan will not cope well in
school at this stage of his development.”
The council referral form boxed the child’s behaviour into tight compart­
ments, and the word “concerns” was highlighted in bold black print and
featured within each section heading of the referral. An easy copy and paste
for the creator of this communication and a concept that leads the writer
106 Learning and adversities

and reader to focus upon negative interpretation of Zeeshan’s involvement

with his learning arenas.
Considering the presentation of information upon a referral form is
insightful to the professional as each word is heavily laden with nuance,
implications, and emotion that tell a child’s story from a carer’s perspective.
A record of information can be useful in communicating a professional’s or
carer’s interpretation and understanding of a child’s needs. The conclusive
statement indicated to me that referrers had placed the responsibility of
integrating within the school environment upon the 4-year-old boy.
As I study the written record of Zeeshan, I am gradually creating visual
images of the way in which his interactions are portrayed, and responded to,
by his parents and early years educators. A picture emerges of Zeeshan’s
behaviour, and it is clear that mention is not made of his needs. Behaviour is
a child’s communication with the world that has a rationale based upon
need. Behaviour reveals emotions, strengths, weaknesses, and fears. Beha­
viour can represent a child’s plea for help to interpret and to respond to the
trials of childhood. Challenging behaviour emerges from a gap in a child’s
development which may relate to a limitation of input from an adult, or ability
and capacity to learn. Identification of the referrer is significant too, and it
relays the source of concern from a parent or professional perspective.
The rationale of my observation was Zeeshan’s perspective of the world
in addition to his preferred mode of learning and communication strategies.
The play space was adorned with the ubiquitous outdoor equipment used
by early years teams throughout the world: bikes, tyres, wooden ramps,
weather shelters, and balls. An indication of a nurture corner was displayed
by a large green and yellow tartan rug which was scattered with a few books
and large purple beanbags. I could see that Zeeshan was restless and dis­
satisfied with the play choices. As I watched quietly from my wooden perch,
the tall 4-year-old started to jump up and down on the spot. His arms were
held flat against his sides and head held high.
Zeeshan increased the height of his pogo jumps, and I noticed that he
shook each hand sharply downwards, and he maintained the beat of this
play by flicking his wrists. He appeared to relish the sense of achievement.
Suddenly Zeeshan stopped. A few plastic drainpipes had been laid invitingly
at angles to one another and set alongside a box of little hard balls. Zeeshan
approached with caution then quickly he made his plan of action. Pipes
were constructed at various descending heights, and a little crowd of peers
gathered to watch respectfully. A young girl explored alongside Zeeshan,
near to his play space but not integrated into a peer dyad. Rebecca
favoured the smallest yellow balls and quickly gathered them together as
Zeeshan drew nearer to her domain.
Zeeshan placed an orange ball into the top pipe with purposeful intent,
and the group held their breath and watched. Zeeshan cocked his head to
one side as he listened to the ball tumbling from one pipe to another. The
 Learning and adversities 107

youngsters clapped and laughed; however, this response seemed to distract

the 4-year-old constructor, and Zeeshan abruptly left the scene. A snapshot
observation which was packed with information on Zeeshan’s skills and
needs. I scribbled furiously to record my notes as I considered the child’s
motivation, task focus, and creativity.
The clapping of peers had caused Zeeshan to leave the scene of the
activity. This external influence affected the young boy’s focus upon
achieving his goal. Adaptability is a key skill in demonstration of creativity
and imaginative play, especially within a social context of a busy nursery in
which the pedagogy is child-led and often unpredictable.

Making meaning
The term “distance”, as used by Vygotsky (1978), relates to the transitional
phase of the child’s intellectual capacity. A transition occurs as the child is
supported by an adult or peer, and his knowledge and understanding increa­
ses to a higher degree than would have been achieved through independent
play. Zeeshan and his peers transformed plastic pipes into a learning experi­
ence that portrayed understanding of height, weight, length, speed, and skill
in eye–hand coordination. Once potential development is achieved then the
new knowledge and understanding is assimilated by the child within his inner
working model. Processes are internalised and thereafter encompassed within
the capacity for independent achievement. This level of functioning is subse­
quently maintained without further adult or peer input. Vygotsky’s law of
double formation refers to these two levels of higher psychological function­
ing (Whitters, 2019).
The work by Tronick and Beeghly (2011) highlighted the enormity of bio­
psychosocial processes which contribute to making meaning for an infant,
and the core bio-psychosocial state of consciousness. Personality affects the
infant’s interactions with his world, and positive feedback can elicit emotions
of joy and well-being. The cycle of learning commences at conception and
continues throughout the entire lifespan.
Tronick and Beeghly (2011) also describe the making of meaning by infants
as limiting engagement to specific areas, in addition to extending the infant’s
awareness of his role and ability within a family context. The infant’s increase
in understanding of his world impacts positively upon development, for
example, physical skills and communication; however, influences may also
affect development adversely. The study by these authors indicated that
meanings that limit growth on a long-term basis increase the potential for
pathological outcomes. An example of adverse childhood experience in
infancy is a mother who is suffering from postnatal depression. The young
baby may develop representation of himself as negative which results in
108 Learning and adversities
withdrawal from active investigation and exploration of the environment or
hypervigilance to perceived dangers. If the infant is exposed to a variety of
stimulating opportunities for learning, then he will acquire resilience to
negative impacts which promotes normative development.
Shonkoff et al. (2021) published research that focused upon the foundations
of health, learning, and behaviour. Findings emphasised the significance of
the perinatal period and infancy to brain development, the immune system,
and metabolic regulation. The discussion includes the use of an interactive
gene–environment–time framework to promote comprehension of the effects
from adversities. Adversity deprives a child of physical, social, emotional, and
intellectual stimulation and may additionally pose a direct threat to develop­
ment (Asmussen et al. 2020).
The study by Shonkoff et al. (2021) indicates that health and development are
influenced by interactive adaptations that commence prior to conception and
continue throughout the lifespan. Impact factors that should be considered
within a context of intervention by services include genetic predispositions.
Genetic factors may be activated by physical and social environments, age, and,
inextricably, the time period with regards to an infant or child’s ability to uptake
learning. An additional consideration is the sensitivity of the individual to a
learning context, which often relates to personality, as described in the example
from practice.
Another issue was raised by Schechter et al. (2019) as the stage of devel­
opment in which the adversity was experienced. It is known that memory
recall of events is apparent in infants during their first year of life, and by 24
months long-term memories can influence an infant’s reactions and emotions.
If an adversity is experienced prior to language development, then it can be
difficult for a child to gain comprehension of these circumstances. There may
be specific sensory triggers that remind the child of an adversity by influen­
cing his body’s reaction in a similar way to the initial source. A child may use
dissociative processes to gain protection from his emotions, and this can affect
memory recall and subsequent understanding of the issues.
One recent research study found that infants who demonstrated the greatest
sensitivity to adversities were also the most responsive to intervention
(Shonkoff et al., 2021). Impact factors can be used positively to reduce
adversity, or the effects minimised in order to promote resilience. Stress is an
example of an impact factor which is commonly categorised into three levels.

1 Positive stress is associated with a short-term physiological reaction which

can be managed by the individual with the support of a responsive adult.
2 Tolerable stress also activates physiological reaction, for example, immune
or metabolic responses. This category of stress is often associated with a
particular event or trauma. The physiological impact can be reduced by an
adult promoting the child’s coping skills which increases his resilience.
3 Toxic stress can have a severe and long-lasting impact upon health and
development. Frequent and prolonged activation of the stress response
 Learning and adversities 109
system can result in permanent changes to neural connections, and bio­
logical systems. For example, increased inflammation and inability to
regulate insulin levels. This category of stress is linked to circumstances in
which a protective relationship is not available, or the adversities, and
effects, are beyond control of the adults who are present. Poverty is often
cited as a source of toxic stress. Furthermore, the available relationship
itself may be the source of adversity. Shonkoff et al. (2021) advised that
the source of stress is not the defining factor of toxicity, but it is the
duration and timing of biological affects which can lead to an increase in
chronic illness.

Responsive practice
Asmussen et al. (2020) suggested that an alteration in threat, reward, and
memory-processing, as a result of adversity, could cause changes to children’s
social-emotional functioning. Consequently, these authors indicated that the
changes may affect relationships with others, and cause carers and peers to
reduce or to remove their supportive strategies.
Recommendations by Shonkoff et al. (2021) include supportive and
responsive relationships for infants and children that reflect individual needs,
reactions, and interactions within an environment. Additionally, family­
centred learning promotes secure attachment between child and caregiver
within a consistently nurturing context. Interventions can have a direct posi­
tive impact upon the cycle of negative parenting in response to endemic
adversities and support a parent to improve self-regulation of herself and the
child. Further recommendations advocated reduction of stress through eco­
nomic and psychosocial interventions.
The study by Milot et al. (2016) of 33 neglected children and 72 non-
neglected children, focused upon potential links between neglect, complex
trauma, and short-term consequences. Key messages for practice include
application of knowledge by the practitioner. This information is gained
through in-depth assessment of trauma history within a case file and an
understanding of the personal characteristics of child and parent. Trauma-
informed practice encompasses provision of an environment in which each
child feels safe, therapeutic intervention increases responsiveness of parents,
and there is greater comprehension of links between emotions and behaviours
of parent and child.
Interestingly, the previous authors (Shonkoff et al. 2021) also placed
importance on a practitioner’s use of normative values for infants and chil­
dren in accordance with age and expected stage of development. Knowledge
and understanding of developmental norms and projected outcomes support
planning and implementation of intervention by services and may increase
understanding of primary caregivers in the context of a home environment.
A public-health report was published in Scotland, in May 2020, just a few
months after the first wave of COVID-19 pandemic, and the writer indicated
110 Learning and adversities
that the long-term impact of coronavirus upon society is unknown at this
stage (Hetherington, 2020). The pandemic is clearly recognised as an
impactful adversity of the 21st century, and Hetherington described that a
response should occur at community, family, and individual level, in addition
to broader society. This author advocates a public-health approach that pre­
vents or minimises children’s adverse experiences during formative years.
Public health focuses upon the needs of a population or specific groups, as
opposed to a clinician’s response to an individual. The study identifies social
determinants of health as childhood experiences, housing, education, social
support, family income, employment, community, and access to health
services.
Hetherington (2020) describes three approaches to public health.

1 Primary prevention: Early intervention to prevent negative impact.

2 Secondary prevention: Early intervention to minimise negative impact.
3 Tertiary prevention: Intervention that directly responds to known negative
impacts.

Ghosts in a nursery
The concept of ghosts in a nursery was presented in research which was con­
ducted half a century ago (Fraiberg et al., 1975), and the understanding of
these issues continues to have current relevance (Scottish Government & NHS
Scotland, 2021). It is well known that parenting patterns are often learned
and repeated between generations. Fraiberg and the research team described
these ghosts as being expressed unconsciously within the parent–infant
relationship.
The descriptor of unresolved parents (Fraiberg et al., 1975) is associated
with the concept of ghosts in a nursery; however, current practice states that
negative issues should not be used to define an individual’s identity. Each
organisation has a duty to review terminology for potential stereotypical bias
in this field. Trauma is regarded as an emotional reaction based upon an
inner working framework which was created in a context of adverse child­
hood experiences. The foundation of a pedagogy and the message which is
given to service-users is hope and potential for change. For example, the
Scottish Family Support Strategy, 2020–2023, uses the voice, validation and
hope model (Glasgow City Council, 2020). This model promotes that practi­
tioners and families discuss issues as unresolved trauma, which implies
potential for positive change, as opposed to unresolved parents, which impo­
ses a negative status upon the parent’s identity.
Unresolved trauma can only be resolved if the parent is supported to
develop his or her sense of self and agency and to take ownership of the
child’s destiny. I practise in a multigenerational context, and I have found that
longevity of change and minimisation of intergenerational transmission of
trauma can be achieved. Children, parents, and grandparents learn to work
 Learning and adversities 111
alongside the professional and together as a family unit. Families who use
drugs or alcohol can improve their lifestyles over time, but there are always
peaks and troughs in the change processes. A wide network of available sup­
portive adults, out-with the immediate family, can also provide multiple pro­
tective factors.
The second and third trimester of pregnancy are often opportune times to
implement intervention. These stages naturally incur the mother developing
maternal representation of her unborn baby. This maternal comprehension of
the forthcoming baby informs the mother’s inner working model. The work­
ing model of the child interview (Theran et al., 2005) can be used to cate­
gorise the mother’s representation of the forthcoming baby as balanced,
disengaged, or distorted. Negative childhood experiences may result in
inadequate parenting if a pregnant woman develops a disengaged or a dis­
torted mental representation of her unborn baby. I have recently learned that
fathers experience physical changes during pregnancy, which includes an
increase in cortisol levels in the early stages and a reduction in the production
of testosterone pre-birth. Physical changes for both parents occur in tandem
with emotional and mental representations of their unborn baby emerging.
Belsky (1984) described three determinants of parenting as the personal
psychological resources of parents, the characteristics of the child, and the
contextual sources of stress and support. Contextual sources which Belsky
regarded as inducing stress, or giving support were marital relationship, social
networks, and employment. The research by this author identified that per­
sonal resources of the parent were more effective in enhancing the parent–
child relationship than contextual sources of support. Additionally, contextual
sources had a greater impact upon the parent–child relationship than the
characteristics of the child.
The literature review by O’Hara et al. (2019) accessed 22 publications on
parent–child and family–child interventions to examine the impact of video
feedback upon parental sensitivity. The studies were conducted in Canada,
the Netherlands, the United Kingdom, and the United States of America.
Single studies were also conducted in Italy, Germany, Lithuania, Norway, and
Portugal. Findings indicated that the sensitivity of parents did increase with
the use of feedback from videos of parent–child interactions. Visual media are
excellent tools to use in parenting work and encompass photographs, videos,
narratives, or role-play. It is important that parents are supported to interpret
a photograph or video and to link their increase in comprehension to devel­
opment of skills.

Box 4.2 Example from practice

Jenny and her mother, Nikki, were referred to our service by social worker
and health workers. The referral identified generic parenting work as a useful
approach to increase attachment between mother and child. This interven­
tion took the format of four stay-and-play sessions which I facilitated
112 Learning and adversities

through presentation of specific toys and by guiding the parent in reacting

and interacting with her young daughter during the session. Jenny was 30
months old.
At an initial parenting session, I always set out a selection of toys which
can provide opportunities for exploration and development in each area of
growth, and the process of play exhibits the way in which mother and
daughter relate to one another. Additionally, the interactions express the
interests and needs of Jenny and her stage of development. All of this
information gives me guidance on setting up an appropriate environment for
week two, and beyond.
Jenny and her mother entered the small therapeutic room. The blue roller
blinds had been lowered to minimise distraction from the wet and windy
weather and to direct Jenny’s attention to the activities. A tall corner light
shone down upon the scene, highlighting a rich learning environment. I had
put pastel-coloured yoga mats upon the floor and a small selection of toys,
some tucked safely inside long-life bags and other items displayed attrac­
tively in situ to invite investigation and creativity. The little girl immediately
sat down to study a jigsaw.
As Jenny was discovering how to remove each animal piece by shaking
the board, I took the opportunity to offer Nikki the choice of a folder from
several options. Nikki quickly declared that purple was her favourite colour. I
handed the young mum a marker pen to write her name and to take own­
ership of this aspect of the intervention. I explained that the play sessions
would involve interactions with Jenny and Nikki. I would sit aside from the
yoga mats unless Jenny invited me into the domain of her mother and self. I
would use questions, prompts, and make suggestions during play to extend
Jenny’s learning and enrich the interactions. Together, we would decide
which parts of the play to photograph, and these memories would rapidly fill
the purple folder, accompanied by Nikki’s responses and action points. As I
struggled to use the digital camera, Nikki leant forward spontaneously, and
she guided me competently and confidently in mastering the digital media.
These little spontaneous actions are consequential and contribute to an
effective practitioner–parent dyad.
Week by week, I met with Nikki and noticed her gaining self-esteem.
Many brightly coloured photographs quickly filled the pages of Nikki’s folder
and included her interpretation and understanding on the importance of
play, attachment, and good physical and mental health. I sat next to this
young mother as she opened the folder depicting interactions from the pre­
vious week. Nikki always smiled shyly as she viewed the mother and child
play scenes, and she looked at me expectantly.
Taking time to give parents an awareness of their skills is invaluable to
parenting work and creates a strong, positive foundation of hope for change.
I pointed to the details within each photograph and commented upon Nikki’s
open body language, her broad smile, eye contact with her little girl, the use
 Learning and adversities 113

of gestures to indicate questions, the offering of two choices for boundary

setting, one toy in each hand, just out of reach to encourage thinking time
for Jenny. I drew an imaginary triangle on one photograph: Nikki, Jenny, and
the toys. I indicated an elastic thread from Nikki to Jenny and stretching
beyond towards the activities as the child had gained confidence in explor­
ing out of physical touch of her mother’s circle of security. I turned a page
quickly to access a special photograph and to remind Nikki of the enormous
bear hug which she had given to Jenny at the end of session one.
We talked about aspects of good physical health and mental health, and
jointly we created our definition of attachment. We considered sleep and
food as contributory aspects of a learning journey, and we agreed that family
life has good moments and many challenging times. We explored and
interpreted the communication methods of Jenny into questions, insecu­
rities, needs, wants and interests: her high-pitched screams and throwing
toys, hitting her mother, and spitting on the furniture. We identified and
captured Jenny’s fleeting eye contact, her gentle touches, the golden smile
that slowly spread across her face, and her excited happy body language as
she jumped, and jumped, and jumped again. We understood the world of
Jenny, and we gained insight into this little girl’s quest for her mother’s
attention, positive or negative. Together, we considered approaches to pro­
moting positive behaviour in a context of learning and not reprimanding.
Nikki gained confidence as I expressed, “there’s a solution for everything …
what do you think?”

Home and services

Media, in the form of photographs or videos, has transformed parenting work
over the past 40 years of my career. In general, parents are enlightened by
reviewing their parenting strategies, recognising inherent skills, and creating
different approaches with the support and guidance of a practitioner. It is an
exciting and fulfilling pathway for an early years practitioner to take along­
side a parent. Change takes time, it is challenging, there are peaks and
troughs and plateau periods in which development of parent and child
appears to be stationary. As practitioners, we contribute to a lifelong learning
journey for parent and child; we provide memories full of knowledge and
understanding that may remain latent for many years but can be activated for
use in the right conditions. Small impacts have great potential for develop­
ment of human beings.
The COVID-19 pandemic is a current adversity which to date appears to
impose long-term impact upon mental health, and one significant area is
loneliness through isolation periods of lockdown within many countries. The
importance of self has been highlighted to the public and governments across
114 Learning and adversities
the world throughout 2020–2022, and the topic is a current area of research
(Moore & Churchill, 2020). Twenty years ago, Trevarthen (2001) published
findings upon companionship and infant mental health. This researcher
identified collaborative intersubjectivity as significant for good mental health
and brain development in the early years, and impactful upon interpersonal
needs through the entire lifespan. Babies have been shown to participate in
reciprocal interactions at 6 weeks of age that are accompanied by emotional
expressions.
A play environment is a useful context in which to commence this process.
The infant’s resilience to positive stresses from low-level negative influences is
nurtured and promoted during interactions with peers. This experience forms
an excellent foundation for gaining resilience to toxic stress. Resilience is
incremental and created over a period of time. Personality, family circum­
stances and outlook on life, and the extended social support system are fac­
tors that affect the child’s resilience.
Current thinking indicates that demonstration of cognitive ability can
change over time, and the processes are affected by external and internal
factors relating to proximal and distal supports, or childhood adversities.
Neural circuits may respond rapidly to maturation in the period from birth to
three years. Alternatively, circuits relating to executive functioning continue to
be sensitive to influences throughout childhood and adulthood (Boyce et al.
2021). Childhood adversities may impose effects from latent influences many
years after the adverse event has occurred (Whitters, 2020); however, maternal
responsivity in the adolescent years can reduce negative impacts (Boyce et al.
2021). Changing the operational skills of an individual is best achieved
through intervention with the extended family unit. Families require sensitive,
responsive support, and guidance in rethinking interpretation of their world,
and subsequently the chemical reactions in the body will change and toxic
stress reactions will reduce for individuals and future generations.
The recent findings of Boyce et al. (2021) referred to individual suscept­
ibility to adversity and links between unsupportive parenting and increased
inflammatory reactions throughout the lifespan, particularly in a context of
significant life events. Resilience is adaptation to adversity that reduces the
negative impact upon learning and well-being. Research has indicated the
significance of a mother–infant communication to secure attachment which
contributes to appropriate conditions for adaptation (Beebe & Steele, 2013;
Zeanah et al., 1994). Alongside targeted and specific intervention for families
is daily universal support from early years settings which is implemented by
practitioners who are trained in trauma-informed practice. Timing an inter­
vention to a pre-crisis context is dependent on services working collabora­
tively by sharing information on concerns and by ensuring that families are
supported to express their needs and anxieties.
McCrory et al. (2017) conducted a study that underlined the significance of
preventative intervention. Findings indicated that maltreatment could cause
alteration in neural networks and cognition, which resulted in latent
 Learning and adversities 115
vulnerability to developing a psychiatric disorder in later life. The six core
strengths to minimise violent tendencies can be nurtured from birth (Perry et al.,
1995). This research team applied the terms of attachment, self-regulation,
affiliation, attunement, tolerance, and respect as representative of these strengths.
A child who expresses an act of violence may give justification in relation to his
current cognitive interpretation of the world, but the violent tendency is actually
based upon emotions which are stored in the limbic system, created during his
earliest experiences of life (Perry et al., 1995).
The two systems for responding to stress are the sympathomedullary
(SAM) system, and the hypothalmic-pituitary-adrenal axis. It was useful for
my own practice to learn that the hormone adrenalin, as a regulator of cell or
organ activity, can take up to 20 minutes to course around the body through
the bloodstream. An emergency universal energy store of adenosine tripho­
sphate (ATP) is situated within muscles to enable an immediate response.
Chemical energy is released which triggers a physical reaction to threat based
upon survival strategies. The external stress results in internal changes as
epinephrine (adrenalin) increases circulation and breathing rates and releases
glycogen throughout the body. The body makes this response based upon
rapid assessment of an immediate threat.
I consider these findings in the context of my practice within the birth to
2-year-old playroom. Referrals for placements in the service give details of
perceived stresses upon babies and children, for example, domestic violence,
drug use, parents’ additional support needs, and mental-health issues. Addi­
tional underlying factors to vulnerability include poverty, seeking asylum,
community violence, and isolation. At entry to the service, I observe that
many children are vigilant, which is demonstrated by quick reactions and
physical withdrawal from assumed sources of threat: adults or peers breaching
the infant’s safety space around the body, unexpected movements in the visual
peripheries, and loud indeterminate noises from outside the vicinity. Physical
and emotional contact is immediately given to the infant who demonstrates
rapid heartbeat and perspiration. Nurturing and reassurance are offered to
the infant but may be rejected in the early stages of a relationship and inter­
preted as potential threat. Responses can appear as an overreaction by an
infant to local issues, and it is essential that practitioners appreciate the
ongoing impact of current or historical adversities from out-with the setting.
An understanding can be gained of the complex internal working of an
infant in this context and the potential exhaustion which the body and mind
experience during and after these episodes. The practitioner presents a buf­
fering relationship to minimise the effects but equally importantly by offering
positive experiences within the child’s world to reconfigure his inner working
model and to use the secure attachment relationship for the optimum out­
comes. Babies require time to assimilate the positive relationship overtures
and to adjust internally which can be observed in external behaviour. The
skill of observation in services is key to understanding mental health in
infants, and adults, and providing responsive care for the individual.
116 Learning and adversities
The hormone cortisol has positive effects in the short-term timescale and
negative effects in long-term periods as stress is prolonged. The circadian
rhythm as the 24-hour cycle of light and dark regulates cortisol levels; how­
ever, lifestyles can cause changes to these patterns. Many families that our
service supports do not adhere to the traditional pattern of sleep during
darkness and activity during daylight hours. Parents can spend hours on
internet activity during the night and struggle to cope with a waking baby in
the early hours of sunrise. Long-term stress results in lengthy periods in which
the body experiences high levels of cortisol which impacts adversely upon
cognitive skill, blood sugar, blood pressure, and ability to sleep.
The knowledge of the destructive properties of cortisol provides rationale
to strategic planning and funding for intervention (National Scientific Coun­
cil on the Developing Child, 2006). In addition, I feel that practice is greatly
informed through understanding that excessive cortisol can stop neural con­
nections occurring and create stress reactions which are barriers to learning
and achievement of potential. A baby’s lifestyle is profoundly disrupted if the
primary carer’s parenting skills are affected by toxic stress. In turn, the baby
experiences this toxic stress albeit indirectly from the source that affects his
parents. During these episodes, the baby’s hippocampus, which is the area of
the limbic system that supports memory and links to emotion and sensory
learning, produces less cortisol receptors. Stress remains at a high level.
High levels of stress can also result in the stress response system being
underactive. I have frequently observed the practical presentation of babies
and young children, who operate within a lifestyle of stress factors, as being
non-responsive and challenging to stimulate with learning opportunities. The
baby has learned to minimise the potential for stress to occur by limiting any
interactions with adults, despite the context of a nurturing nursery. These
effects represent primitive dissociative adaptations and physical or cognitive
freeze. Dissociation is accompanied by a physiological response to prepare the
body and mind for reducing the effect of threat: the heart rate slows down,
blood may flow away from extremities, endogenous opioids reduce physical
pain and flood the mind with a sensation of calmness and psychological dis­
tancing from attack.
In the early stages of my career, the children who presented with these
characteristics were termed still children which depicted their body language.
During the 1980s and 1990s, we recorded this behaviour and devised practical
strategies to support re-engagement. As early years practitioners, we did not
have access to scientific knowledge or comprehension from research. As a
professional, I have always sought understanding of my work; however, I can
recall supporting these still children without the benefit of theory and under­
standing. In Scotland, it is only since professional registration was introduced
that practitioners can access research databases through NHS sites (Scottish
Social Services Council, 2003). Research has enriched the role of the early
years workforce. Completing postgraduate study over the past 20 years, and
professional registration that incurs continuous development, have given me
 Learning and adversities 117
opportunities to fulfil my desire for knowledge by reference to current
research and theory.
The drive to achieve perfection can have positive or negative effects upon
the child’s well-being and his involvement with learning. Many high-level
intellectual or creative outcomes can be achieved which are based upon the
child’s rationale of a perfect goal; however, a child may never be satisfied with
his own work. Consistent use of positive praise by primary carers may actu­
ally hinder his intrinsic motivation. Interpretation of the world at heightened
sensitivity, physically or emotionally, can lead to a child experiencing a sense
of failure and an unusually negative reaction if outcomes are not achieved.
Almost 40 years ago, Roedell (1984) conducted research that explored the
emotional status of children with high ability and focused upon their vulner­
abilities. Findings indicated correlation between an increasing level of advance­
ment and a risk of the child exhibiting social maladjustment. Roedell highlighted
a lack of confidence as the prevailing sign of maladjustment in this research
study. Contexts were identified as a tendency to seek perfectionism, high adult
expectations of the child’s output, an increase in emotional and physical sensi­
tivity, and, interestingly, role conflicts. The latter refers to the child’s immature
sense of self and dependency on extrinsic motivation from primary carers.
Role conflict can occur in a context of family, community, or societal expec­
tations of a child which are often based upon socio-economic circumstances,
culture, or gender. Chichekian and Shore (2014) placed importance upon the
influence of social interaction on learning, but children may lack confidence
or skill in seeking assistance from others. Some children may demonstrate
preference for solitary or parallel play and actively reject opportunities for
cooperative constructive play.
Children quickly adopt the social code of a service or family and under­
stand an implicit child-imposed ranking system that can denote acceptance or
rejection in the group and subsequently promote an increase or decrease in
self-confidence. Zhou and Brown (2015) suggested that self-appointed ranking
can also adversely affect a child’s sense of efficacy.
Environment provides a rich learning arena that immerses a child in his
family influences, in addition to the local community and national culture.
Vygotsky (1994) highlights the influences from a changing environment,
which may incur circumstantial adaptation of the context, and, consequently,
the child’s increase or decrease in involvement within this arena. It seems that
an environment instigates change in the child which is prompted by his evol­
ving interactions with learning opportunities. The learner’s interpretation of
and reaction to an environment alters as he assimilates knowledge, gains
understanding, and reconfigures his inner working model (Bowlby, 1979).
This adapted inner working model inevitably affects his actions and emotions.
Tronick and Beeghly (2011) described the outcome as a new bio-psychosocial
state of consciousness within the child.
Tronick and Beeghly (2011) conducted research on the ways in which
infants acquire meaning and explored the issue within a context of mental
118 Learning and adversities
health in young children. The adult–child dyad is regarded as integral to a
child’s capacity to learn. The positive reciprocal relationships with adults
create a foundation for a child to potentially achieve the zone of proximal
development. This system enables scaffolding of knowledge from adult to
child which is responsive to individual needs, interests, and well-being at any
moment in time. The adult–child system also promotes the child’s self-reg­
ulation of emotions by presenting opportunities to copy reactions and to
adopt coping mechanisms within the daily learning context.
Involvement underpins the mesosystem which links home and services by
practitioner, parent, and child sharing a positive attitude towards learning
opportunities. El Nokali et al. (2010) describe one measure of parental
involvement in an education system as quality and frequency of communica­
tion with teaching staff. These authors indicated that this involvement may be
considered as a static predictor of positive outcomes within the context of
schooling. It was concluded that this is an aspect that contributes to an
increase in motivation for learning in children and young people. Some years
later, a study by Weiss (2019) also found that behaviours associated with
learning, for example motivation and persistence, were variables that could be
used to predict future academic success in formal schooling: high scores in
reading and writing were associated in the research with parental involvement
in learning within a home environment.

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5 Ability, capacity, and creativity

This chapter presents teaching and learning as interdependent partners that

blend within a symbiotic relationship. Teaching should capitalise upon the
child’s initial level of understanding, and incrementally support and influence
realisation of potential for children of all abilities. The research by Roedell
(1984) on significant uneven development in young children who had higher
than average ability is presented. The recommendations by Fidler (2006) on
promoting a child’s developmental strengths are discussed in relation to
additional learning needs.
Four levels of intervention are described within the play cycle (King &
Sturrock, 2020), and organisation of neural networks is contextualised as
time-dependent or experience-dependent. Perry (1997) related disruptions to a
lack of sensory experiences during critical periods of development or the
direct impact of adversities upon the infant. Attention restoration theory
(Ohly et al., 2016) is accessed to explain an increase in and restoration of
executive functioning through exposure to natural environments. Exemplars
are given to represent hard and soft fascination activities. Csikszentmihalyi
et al. (2018) emphasised the complexity of the psychological aspects of flow
theory and the systems model of creativity is used to increase knowledge and
understanding of links between capacity, creativity, and emotional well-being.

Teaching and learning

Some years ago, I was collecting data by observing participants who were chil­
dren aged 4–5 years and teachers within a context of early years in primary
schools. I noted that several teachers were so busy teaching a planned lesson to a
class that they did not notice, or respond spontaneously, to the children learning.
Delivery of the lessons was constricted by curricular expectations, professional
accountability, and restrictive timetables based upon predicted attainment. These
circumstances bypass the use of scaffolding and sensitive responding and
decrease the opportunities for creative and imaginative ideas to be fulfilled.
Potential to reach a higher level of learning is reduced.
Teaching should always encompass periods in which an educator is
informed by observing and by understanding each child’s learning processes
DOI: 10.4324/9781003358107-5
 Ability, capacity, and creativity 123
as he interacts with an environment and peers. Observations of children
should facilitate identification of the aptitudes of individual pupils and record
the changing of abilities over time. Observations should also recognise pupil
motivation and application to overcome obstacles in completing tasks. Snap­
shot or planned observations, even for a few minutes, can be rich sources of
understanding of a child’s ability, capacity, and motivation to learn.
Teaching and learning are interdependent partners, and each process
directly impacts upon the other. The creation of a lesson plan, or a nursery
activity, is a preparatory stage of the learning process within an educator-to­
child relationship. The plan may only have momentary value as a child’s
reaction and response to this knowledge exchange commences an iterative
reciprocal process between adult and child. Consequently, the plan should be
adaptable and responsive to the child’s capacity and ability to learn. Teaching
and learning are merged within a symbiotic relationship. Delivery of knowl­
edge should be shaped and led by activation of a child’s learning processes.
Teaching should capitalise upon the child’s initial level of understanding and
incrementally support and influence realisation of potential for children of all
abilities.
Blumenfeld et al. (2006) noted that an effective learning environment
depended upon knowledge of a teacher, knowledge and experience of a lear­
ner, design of tasks, and community influences. These authors reported that
outcomes of a learning environment should relate to learning in academic,
social, metacognitive, and developmental categories. In early years practice,
learning encompasses all these outcomes, and broad holistic opportunities are
key aspects in implementation of a curriculum in the child’s earliest years.
Multimodal environments provide children with a range of learning materials
and a range of media in which to demonstrate achievement. A rich environ­
ment responds to children’s interests, needs, and wishes, in addition to
reflecting a curriculum.
Siegel (2003) discusses complexity of neural processes as the result of dif­
ferentiation and integration. Opportunities to achieve this optimum state
occur within stimulating environments, and good mental health is the self­
organisational process that supports this system. Exposure to experiences
leads to neural firing patterns. Siegel estimated that there are millions of firing
patterns within a human brain.

Memory
Memory is formed through integration that inputs to a holistic information
system. It is known that during rapid eye movement sleep experiences are
associated with consolidation and integration of emotions and knowledge
(Siegel, 2003).
Explicit memory has two forms: semantic or factual memory and episodic
or autobiographical memory. Autobiographical memory includes a sense of
self in the memory recall and an awareness of time. There are two known
124 Ability, capacity, and creativity
components to implicit memory: procedural memory, which is associated with
behaviour, and the emotions accompanying an experience. For example, the
actions required to ride a bike are retained in procedural memory, and the
associated emotion which may be positive or negative remain within implicit
memory. Siegel (2003) makes an interesting point as he described the poten­
tial for an implicit memory in the earliest years being retained as a sense of
familiarity as opposed to actual remembering of details. Young children may
recall and express emotions and reactions to experiences that occurred before
effective communication skills had been established. This recall is based upon
the sense of familiarity.
It is fascinating that the brain has the ability to process past experiences at
a higher level over time as development and maturity occur. This creates
rationale for the use of counselling in adulthood which targets unresolved
trauma from childhood. Hart and Rubia (2012) highlighted the impact of
childhood maltreatment upon brain architecture and functions. Adversity in
childhood impacts upon infant mental health. The infant experiences internal
issues, for example, anxiety, and demonstrates external behaviours, for example,
poor impulse control. Long-term changes to the infant’s brain architecture and
functioning can occur. These authors indicated links between child abuse and
deficits in intellect, memory, working memory, attention, response inhibition,
and the ability to discriminate between emotions.
The therapeutic process provides verbal media to support resolution of
trauma by enabling an individual to create a coherent narrative of the issues.
Additionally, this process provides non-verbal media in the form of a secure
attachment relationship that supports self-regulation and integration of
experiences. Lack of resolution of trauma is regarded as the mind’s incapacity
to balance differentiation and integration of energy and information flow
(Siegel, 2003).
Stress interferes with integration and differentiation, but a therapeutic
relationship can fulfil the purpose of liberating the mind from these barriers
and by supporting a desire to achieve maximum complexity. Siegel (2003)
studied the mind and brain, and this researcher concluded that the mind
emerges as the brain matures. The development of the mind is influenced by
self, and others, and affected by personality. Interaction occurs between neu­
rophysiological and interpersonal relationships. Over time, neural connections
can be made independently and separate from the influences of the ther­
apeutic dyad. Sensory input, for example, auditory, visual, or tactile, can
affect perceptions and direct actions. These processes are often associated with
creativity.
Differentiation is influenced by genetics and experiences, particularly
during the earliest years. It is the young child’s involvement with learning
experiences that is key to development, and not solely the environment per se.
It is essential that practitioners and parents appreciate and embrace the value
of their role in supporting a child’s engagement, interaction, and response to
learning.
 Ability, capacity, and creativity 125
Siegel (2003) clarified internal and external constraints, and this author
identified self-regulation as essential to good mental health. Internal con­
straints refer to the composition of synaptic connections among neurons.
External constraints refer to environmental experiences and include inter­
personal communication with others, particularly if a relationship has an
emotional significance. A relationship is an external factor that can influence
the neural system by leading to changes in internal constraints. Positive
changes increase the potential for complexity to be achieved.
Secure attachment is a descriptor of the relationship which a child has cre­
ated with another person, for example, a parent, carer, peer, or practitioner.
The child may have different types of relationships with his range of carers.
Fosha (2003) identified skills which are required by a caregiver to nurture a
secure attachment status with a child, and to achieve optimal development.
These skills or characteristics apply to parents and practitioners in early years
settings.

� Adult’s affective competence.

� Adult’s reflective self-function.
� Adult’s capacity to support periods of repair following short-term rupture
of the relationship.

Therapeutic intervention can support neural integration between the right

and left hemisphere of the brain and impact positively upon the effects of
unresolved trauma. The term “earned–secure” was used by Roisman et al.
(2002) in relation to an adult who has achieved secure attachment within her
relationships despite a history of negative relational experiences. A 23-year­
longitudinal study was conducted with adult participants who had insecure
attachments in childhood. Findings indicated that a change in relationship
potential impacted favourably upon secure attachments between the partici­
pants and their children.

High ability
It has been recognised for many years that identification of children who are
developmentally delayed is an important consideration in implementing early
intervention (Pfeiffer & Petscher, 2008). However, children of high ability
should also be identified and supported in response to individual learning
needs.
A study by Freeman (1998) was conducted over twenty years ago, and the
knowledge and understanding from findings continues to be applied by current
educators. Recommendations were compiled into guidance for teachers regarding
recognition of pupils who had high ability. Freeman focused mainly on assessment
of teacher–pupil interaction in a school setting. Findings included checklists that
contained ability criteria, for example, the use of complicated rules and extensive
imaginative play, alacrity in the use of symbolic communication – talking, reading,
126 Ability, capacity, and creativity
and writing – and extended concentration on tasks from an early age. The
conclusion of this research highlighted circumstances that accompanied problem-
solving and a child’s ability to respond to unexpected circumstances within a
learning context as significant factors.
There are points found on many checklists that provide a useful foundation
for learning about universal traits associated with ability. Examples are
memory and retention of factual knowledge, regulation of oneself, and iden­
tification of preference for learning style and medium. Freeman’s research
indicates that the use of checklists can provide knowledge to an educator and
promote professional awareness of the concept of ability, but the author
warns that checklists can be self-limiting (Freeman, 1998). Mental health is
currently regarded as influential to the learning context. This aspect does not
specifically feature on Freeman’s guide to educators.
Intelligence is understood by Freeman (1998) as a way of organising and
using knowledge in relation to a physical and social environment. Findings
did refer to the influence from culture and family upon development, and
the study concluded that every child’s potential can be realised with
encouragement, learning materials, and educational support. Freeman’s
study outlined the use of two intelligence quotient (IQ) tests to determine
ability in a context of chronological age. Findings indicated that testing was
applicable to measuring a child’s academic ability within the early years of a
school environment.

� Stanford-Binet test is based upon verbal interaction.

� Wechsler Intelligence Scales are based upon mathematics.

Wechsler was an American psychologist who used statistical standardisa­

tion to determine the ranking of an individual in relation to the norms of the
general population within a particular age-range. Wechsler created a standard
IQ of mean = 100, and standard deviation = 15, and he applied this approach
to different tests. The Wechsler scale for young children was established in
2004, in France, and termed WPPSI-111 (Vaivre-Douret, 2011). This scale
can be used to measure IQ of children aged from 2 years and 6 months until 7
years and 4 months.
The indicators by Freeman (1998) are still applicable today and provide
support to educators in understanding the capacity and ability of all children
to learn. A few years ago, Renzulli grouped ability under three clusters as a
means of identification in order to provide education which nurtured aca­
demic, and creative achievement (Renzulli, 2019). This educator applied the
term three-ring conception of giftedness to represent three aspects.

1 Ability which is greater than the norm for a child’s age group.
2 Task commitment.
3 Creativity.
 Ability, capacity, and creativity 127
Forty years ago, Renzulli (1978) conducted research that indicated that the
aforementioned three clusters of ability, task commitment, and creativity were
equal partners in contributing to a child’s overall ability. Recent research by
Renzulli and Reis (2018) concluded that gifted behaviour is reflected by
interaction of these three clusters which could be applied to any area of
human development. The researchers emphasised that the three clusters did
not need to be present for a child to exhibit high ability. The constant factor
was demonstration of interaction by two or more clusters at a higher level
than the norm. Findings indicated that task commitment and creativity tend
to be applied together.
It is enlightening to consider research that investigates issues beyond the
immediate scope of a research topic. As a researcher and practitioner in early
years, my focus for this monograph is infant mental health; however, the dis­
cussion by Renzulli and Reis (2018), albeit in relation to high ability, certainly
contributes to understanding of generic learning processes. In addition, I refer
to research in children who have additional support for learning needs.
Understanding of the norm can be strengthened by information on outliers.

Ability
Ability is multilayered, and initial subdivisions relate to the use of cognitive
and physical skill that demonstrate the child’s level of prowess. Physical skill
can be further refined by consideration of fine and gross motor skills, spatial
awareness, and proprioception. Ability can be extended through copying
which encompasses a child’s interpretation and reproduction of what he has
observed, including elements of creativity. The skill to copy, and to represent,
requires memory, which is a child’s recall of prior knowledge and application
of his understanding over time. The time period for application may be short
or long term.
Bergen et al. (2018) identified memory potential within every neuron of the
brain, and these researchers indicated that emotional development formed a
necessary foundation for cognitive skills to accumulate and to refine. Implicit
memories are greatly influenced by emotions that accompany an experience,
and from birth these memories are stored in the middle and lower part of the
brain. Also, during this period of growth is the development of cognition.
Enactive cognition entails an infant gaining understanding of the actions of
real objects. Iconic cognition entails comprehension of pictures and symbols
that represent real objects (Bergen et al., 2018).
Explicit memories are based upon experiential learning and emerge
throughout childhood due to dependence on the development of the cerebral
cortex (Bergen et al., 2018). Explicit memories may be expressed in the age
group of 12 months onwards. By 3 years of age, children have the ability to
use their memories voluntarily. Many strategies promote emotional literacy
which often entails prompting a young child’s memory through discussion,
photographs, and actions. Thelen and Smith (2006) conducted research on
128 Ability, capacity, and creativity
tasks that used memory. Findings from their study indicated that the ability of
a young child to reach and achieve a goal through experiential learning cre­
ates a significant long-lasting memory. Experiential play which is supported
by an attachment figure is a key response to education in the child’s earliest
years, and it nurtures conditions for attainment.

Additional learning needs

In a context of children with Down’s Syndrome, Fidler (2006) recommended
that practitioners promote a child’s developmental strengths in order to sup­
port weaker areas. Down’s Syndrome is a common genetically based syn­
drome that occurs in approximately one per 700–1,000 births (Bergen et al.,
2018). The syndrome is characterised by the existence of an extra chromo­
some, termed trisomy 21, and it is exhibited by additional support for learn­
ing needs. Areas of strength commonly relate to social functioning and the
creation of positive relationships, and weaknesses relate to visual processing
and visual motor coordination.
Fidler (2006) explains that children with Down’s Syndrome have reduced
motivation in tasks that are cognitively challenging and demonstrate reliance
on social interactions. Fidler described the reduction in motivation to complete
tasks as a secondary phenotype that resulted from enhanced primary strengths
in social functioning and deficits in instrumental thinking. Instrumental in this
context referred to tasks with identified goals. During the first twelve months of
childhood, the infants in this study demonstrated a decline in contingency
learning compared to the norm.
The use of imaginative skills, often based upon prior knowledge and crea­
tivity, can provide potential solutions to challenges during play. Fidler (2006)
indicates that infants and preschool children with Down’s Syndrome may have
difficulty with problem-solving due to a reduced creative ability in comparison to
the norm. The research describes how a child with Down’s Syndrome accesses
his strengths in social interaction by diverting attention from a challenging
situation or by recruiting a peer to complete a task.
Evidence from a study by Ruskin et al. (1994) indicates that a young child
with Down’s Syndrome has difficulties in linking sequences of goal-directed
behaviours. Many daily tasks in early years settings involve regular repeated
steps which may be implemented on several occasions each session. An
example is hand-washing, which has increased in frequency in services as a
response to the COVID-19 pandemic. Timelines and photographic prompts
are effective, common strategies in supporting every child to recognise, apply,
and recall behaviour sequences in order to complete a task.
In busy early years settings, it is not feasible to display personalised
prompts for every child, but it is effective practice to use photographs of the
child who requires the greatest level of support. Parents can also be encour­
aged and supported to print out photographic prompts for home use. It is
easy to share strategies with families, but it is equally important to determine
 Ability, capacity, and creativity 129
if families have the means to action these approaches. Additionally, a wall of
mirrors situated in front of a child during play or routine tasks can have a
major impact upon each child’s comprehension of his sense of self. Use of a
mirror reinforces the link between cognitive thinking, actions, and behaviour.
Viewing one’s own image as tasks are completed is an effective approach to
support the retention of learning and development of a sense of self.
Ruskin et al. (1994) showed that infants with Down’s Syndrome displayed
lower levels of causality pleasure than the norm. For example, fewer positive
facial displays were observed during tasks that involved the infants using
instrumental thinking to problem-solve. Lowered persistence for completing
tasks is associated with temperaments that include stubbornness and strong
will. The use of targeted and time-sensitive interventions in response to
decreased motivation should consider each child’s capacity and interest in
engaging with specific instrumental tasks. Interests can be used to capture a
child’s curiosity to explore and to learn, and early years practitioners are
skilled in scaffolding and extending development within any context. Fidler
(2006) recommended that intervention should be implemented in the earliest
days of childhood in order to promote an infant’s adaptation to circumstances
and to contribute to attainment and independence throughout the lifespan.
Roedell (1984, 1989) commented on significant uneven development in
young children who had higher than average ability and emphasised blending
of opportunities for social, physical, and emotional development. This
researcher also promoted the use of experimentation with manipulative
materials as a means to increase visual-motor skills. These media are popular
in the early years field for all children. Playdough, gloop, paint, food mixes,
and mud kitchens are common features. The rationale for the use of these
experiential play activities is broad-ranging, and implementation supports
cooperation, social interactions, sensory exploration, imaginative play, hand–
eye coordination, gross and fine motor control, and includes the therapeutic
value of play in an outdoor green environment.
Tourette’s Syndrome is a neuro-developmental disorder which is associated
with stereotypical movements and vocalisations. This syndrome tends to
become apparent in the middle childhood years, and behavioural symptoms
are difficult for the child to control. Bergen et al. (2018) highlight a particular
trait linked to children with Tourette’s Syndrome as an increased ability to
process time. These authors reiterated the message of Fidler (2006) and
emphasised the importance of practitioners and parents focusing upon a
child’s strengths.
Physiological changes have been detected in children who suffer adverse
childhood experiences. Patterns of electrical activity in the frontal and tem­
poral lobes are different to the norm. These differences may be exhibited as
impulsivity hyperactivity and poor affect regulation as described in the
research by Bergen et al. (2018). A previous study, by Bremner et al. (1997),
indicated atrophy in the hippocampus of abused children which included
long-term memory deficits. These children may react to minor incidents of
130 Ability, capacity, and creativity
stress with extreme behaviour, and this can be observed in a nursery setting
during play. It is often situations in which the child feels that he has lost
control, for example, a social activity requiring cooperative play.
Bergen et al. (2018) studied neural development in children who suffered
from the brain condition known as attention-deficit/hyperactivity disorder
(ADHD). These authors identified that white and grey matter areas are
affected in children who have been diagnosed with this condition, and evi­
dence indicates executive dysfunction and immaturity in frontal-lobe devel­
opment. The frontal lobe is responsible for regulating and inhibiting actions
and planning complex tasks. Panksepp (1998) had closely observed groups of
children who had an ADHD diagnosis and noted that their behaviour during
play regularly encompassed physical, unplanned movements. Panksepp sug­
gested that extended opportunities for rough-and-tumble play could support
frontal-lobe development in children with ADHD. This researcher speculated
that drug treatment which induced passivity in children with ADHD could
potentially inhibit frontal-lobe development.

Child-led pedagogy
It is so interesting that Panksepp (1998) assumed that children’s natural
inclination for a particular type of play was a response to their developmental
needs. Early years practitioners are trained to observe children during free
play, to assess developmental levels and each child’s preponderance to parti­
cular activities in comparison to the norm. Results are recorded on care plans
in the categories of personality, interests, and schemas. Daily observations of
children can reveal deficits in development and indicate the body’s inherent
response to these needs. Interpretation of this information provides a valid
baseline for personalised intervention.
Current implementation of curricula is presented within a child-led peda­
gogy, and children’s interests lead the planning and implementation of a
learning environment. Greater understanding of these issues can be gained
through the research by Panksepp (1998) and the growing awareness in prac­
tice of the human body’s inherent responses to need by young children’s
choices of play activities and behaviour. Behaviour may not adhere to social
boundaries and expectations of a setting. It is important to provide the child
with alternative behavioural choices which continue to respond to needs,
including the impact of trauma and social circumstances.
Many years after Panksepp (1998) published his findings, early years set­
tings in many countries provide daily periods of outdoor active play and
learning for all children. The therapeutic benefit upon mental health from
play within green spaces is recognised by educators and parents. Early years
settings provide multiple opportunities for children to develop and to practise
skills in a range of environments. Stress can be reduced over time with a
therapeutic and nurturing approach which is based upon a secure attachment
relationship.
 Ability, capacity, and creativity 131
Emotional development and support
Emotions are regarded as responses to external stimuli or internal mental
representations based upon the inner working model of an individual. Ochsner
and Gross (2005) described emotions as incurring changes within experiential,
behavioural, peripheral, and physiological systems. These authors distinguished
emotions from moods by relating a trigger to the onset of an emotion. Emotions
can be based upon an instinctive response to direct stimuli, or a learned response
which may be influenced by prior experiences.
Research studies have shown that infants and young children who have
experienced long-term adversity in the form of toxic stress have difficulty in
identifying emotions through facial expressions. It is also suggested that
emotional discrimination ability is affected by the type of abuse which the
child has suffered. Pollak et al. (2000) indicated that neglected children had
the greatest difficulty in discriminating between facial expressions compared
to children who had experienced physical abuse. The latter group of children
demonstrated a noticeable response to angry expressions compared to other
negative emotions.
Research indicates three significant aspects which have emerged through
studies of emotion regulation and cognitive control. Ochsner and Gross
(2005) describe these aspects as:

1 Defence mechanisms.
2 Management of situations that exceed the resources of an individual.
3 Self-regulation in a context of socio-emotional development.

This study investigated the impact of behavioural or cognitive regulation (Ochsner

& Gross, 2005). A significant finding indicated that regulation of behaviour asso­
ciated with negative emotions would limit the individual’s actions. However, the
regulation did not reduce the negative emotional experiences which were retained
as memories after an event. For example, children can learn to adhere to social
boundaries while continuing to experience an emotional impact which is triggered
by memory of negative influences.
Alternatively, cognitive regulation can reduce the negative emotional
impact and, potentially, the physiological effects. Cognitive regulation is sec­
tioned into two strands: attentional control and cognitive change. The study
by Ochsner and Gross (2005) revealed marked variability in the type and
impact of emotional responses from participants. Links were indicated
between gender, personality, negative affectivity, and regulatory ability.
Structural and functional changes in control and appraisal systems in chil­
dren may influence emotional responses. Additionally, abilities are dependent
upon interactions between prefrontal systems that support control processes
and posterior cortical and subcortical systems that represent different types of
modality, for example, visual, spatial, and auditory information (Ochsner &
Gross, 2005). Modulation of appraisal systems can be influenced by first
132 Ability, capacity, and creativity
supporting an infant or child to reinterpret stimuli and promote meaning that
engenders different emotions; and, second, to associate a different emotional
response to the same stimuli. Attachment figures in services and the home
environment can provide effective role models in supporting a child to reconfi­
gure previous understanding of stimuli and emotions.
Many opportunities occur within daily living to promote emotional literacy
and to contribute to positive infant mental health. Therapeutic approaches are
regularly used within early years settings to support emotional needs and include
activation of the child’s higher cognitive abilities, for example, promoting the use
of working memory, long-term memory, and mental recall. These abilities sup­
port reappraisal of one’s own emotional reactions, and behaviour.
Specific interventions of play therapy have been commonly implemented
within services in response to mental-health issues, particularly in the past
two decades. It is inciteful to gain understanding from the study by Ritzi and
Ray (2017) on play therapy. These authors associated reflection on emotional
events with an enhanced ability to increase or to decrease amygdala respon­
ses. The intervention of play therapy enabled the children to reappraise their
emotional responses and to alter their behaviour accordingly.

Neural changes and abuse

Childhood abuse has a long-term impact upon mental health and overall
development. During this period, the brain’s development encompasses
synaptic remodelling, myelination, and cell death which affects the organisa­
tion of the grey and the white matter. Hart and Rubia (2012) indicated that
adverse childhood experiences could result in physiological, neurochemical,
and hormonal changes that altered brain structure and, ultimately, neural
functioning. These authors described modulation changes by the serotonin
system, sympathetic nervous system, and the hypothalamic-pituitary adrenal
axis. Findings indicated internal behavioural problems as reduced tolerance
for stress, anxiety, affective instability, depression, suicidality, and post-trau­
matic stress disorder. External behavioural symptoms include limited impulse
control, episodic aggression, substance abuse, ADHD, and conduct disorder.
Ochsner and Gross (2005) linked disruption in the development of the
fronto-limbic neural circuits to effects from childhood that can endure
throughout adulthood. For example, motor control, memory, emotion reg­
ulation, and ability to learn social behaviours. However, the findings of Hart
and Rubia (2012) showed that emotion discrimination can improve through
time. A child’s understanding of his own emotions, and others, is a key ele­
ment of the curriculum in an early years service and promotion of broad
experiences contribute to maturation in childhood, and beyond.
Studies have found that the volume of the brain is affected by a child’s age at
the onset of trauma and duration of abuse (Hart & Rubia, 2012). Neuroimaging
of the brains of children who had been known to suffer abuse demonstrated
brain structural differences compared to the norm. The imaging was associated
 Ability, capacity, and creativity 133
with limitations in memory, working memory, attention, response inhibition,
and emotion discrimination. The neuroimages showed reduction in the brain
volume and the grey and white matter distribution in the dorsolateral and ven­
tromedial prefrontal cortex, hippocampus, amygdala, and corpus callosum. In
addition, diffusion tensor imaging revealed deficiencies in the neural networks.
Research can give great insight into children’s mental health, an acute awareness
of the impact of various levels of stress upon each child, and increase under­
standing of actions, reactions, and intervention routes.
McCrory et al. (2011) also identified differences in the corpus callosum of
children who had experienced abuse and variations in the hippocampus of
adults who had experienced adversities in childhood. The study described
amygdala hyperactivity and atypical activation of frontal regions in the
adults. The findings indicated a direct link between abuse, brain structure, and
the impact from gene–environment interaction. It was reported that specific
genotypes may moderate the association between childhood maltreatment
and psychopathology.
Research by Bergen et al. (2018) revealed different patterns of electrical
activity in the temporal and frontal lobes of abused children in comparison to
the norm. It is known that abused children can exhibit extraordinary physio­
logical responses to minor issues. Research indicates that trauma affects the
brainstem areas that regulate these physiological responses relating to survival
(Perry, 1997). Alongside this overdevelopment of the brainstem areas, Perry
identified restriction in development of the corticol and the limbic areas that
control higher-order thinking and emotions. Bremner et al. (2008) also inves­
tigated these topics, and findings showed that the hippocampus may be atro­
phied in children who have experienced abuse. This defect can impact upon
long-term memory; however, an enriched environment can promote hippo­
campal neurogenesis.
Perry (1997) describes the human brain as an organ that processes infor­
mation from inside and outside the body in order to act and to ensure survi­
val. The lower areas of the brain encapsulate the brainstem and midbrain
which maintain simple regulatory functions, for example, heart rate, body
temperature, and blood pressure. It is within higher areas of the brain that
complex functions are maintained, for example, the use of language and
abstract cognition. This hierarchy of activity begins pre-birth, and the main
structural organisation is formed throughout childhood.
It is enlightening to read Perry’s explanation of the neurobiology of vio­
lence. Perry (1997) explored neurodevelopment, violence, and potential influ­
ences, and this author determined that experience has the greatest impact
upon human behaviour. Perry clearly states that genetics do not result in the
neurobiological factors which are commonly associated with violence. Find­
ings from this study indicated that violence, aggression, and impulsivity are
closely linked to an increase in reactivity of the brainstem as a result of toxic
stress and a decrease in the moderation capacity of the limbic or cortical
areas. This decrease can be influenced by adversities associated with neglect.
134 Ability, capacity, and creativity
The study described the brain’s impulse-mediating capacity as relating to
activity in the lower primitive parts of the brain and activity in the higher
cortical areas.
It is well documented that there are critical and sensitive periods for devel­
opment in which the brain gains optimum value from learning experiences
with a focus upon sensory input (Perry, 1997). Any atypical patterns of neural
activity during these periods can impact negatively upon functions through­
out the lifespan such as empathy, affect regulation, and attachment. Perry
linked emotional neglect in childhood to violence in adulthood by identifying
a decrease in strength of the subcortical and cortical impulse-modulation
capacities. The research also highlighted a limited ability to empathise or
sympathise with others. Perry associates the use of alcohol or drugs with
negative attitude and physical violence in late childhood and adulthood. This
author explained that intoxicating agents can further reduce the ability to
control oneself physically and emotionally and for individuals who already
have reduced capacity then the outcome may incur aggression and violence.
The aforementioned explanation of neural workings is complex and chal­
lenging to relate to practice knowledge in order to enhance the day-to-day
delivery of a service. However, Perry (1997) highlights moderating capacity as
a key neurodevelopmental factor that provides a target area for intervention.
Each child’s capacity to moderate his actions and reactions can be increased
by an adult supporting consolidation and change in the child’s inner working
model. Exposure to curricular and home experiences and a secure attachment
relationship are key contributions to the change process in this context.

Time-dependent and experience-dependent

Organisation of the neural networks is time-dependent or experience-depen­
dent. Any disruptions can result in abnormalities or deficits in neurodevelop­
ment. Perry (1997) relates disruptions to a lack of sensory experiences during
critical periods of development, or the direct impact of adversities upon the
infant. The research emphasises the sequential development of the brain as a
critical factor in the impact of disruptions. Findings indicated that adversities
in early childhood, including the perinatal period, can alter development of
the brainstem or midbrain and subsequently impact upon the limbic and
cortical development.
It is useful to visualise this hierarchy of developmental stages as building upon
a solid foundational base of knowledge and understanding which is provided by
learning opportunities in the early years. Practitioners are taught to assess and to
respond to a child’s stage of development as opposed to using age-appropriate
activities. This approach to early learning and development is an essential factor
in supporting the incremental stages of neural development, and practice should
focus upon relationships, opportunities, and environment.
Quality and breadth of experiences have direct relevance to growth of the
human cortex; therefore, a lack of sensory-motor and cognitive opportunities
 Ability, capacity, and creativity 135
reduces potential for development. The research of Perry (1997) highlighted
smaller cortical and subcortical areas linked to neglect of children. The term
“cortical atrophy”, as used by Perry, referred to underuse of the cortical areas
and subsequently underdevelopment. Infants who exist in adversity present as
hypervigilant and unusually sensitive to external stimuli. Perry indicated that
this group of infants and children tend to focus upon non-verbal commu­
nication cues, in a context of survival. Limitations on cognitive thinking can
reduce cortical growth. Findings revealed an increase in muscle tone, a greater
startle response, unusual sleep patterns, affect regulation issues, anxiety, and
abnormal cardiovascular regulation in the participant group.
Aggressive behaviour gives the child perceived or actual control over his
environment, which is an inherent reaction to threat. The child is seeking a pre­
dictable response from another person in order to prevent or to control poten­
tially harmful interactions. Early years services promote nurturing caring
learning contexts, but the neglected infant may interpret tentative overtures from
peers or practitioners as a prelude to abuse. Repeated observation and inter­
pretation of the child’s emotional, behavioural, cognitive, social, and physiolo­
gical functioning, in the broad influential context of home, service, and the
community, are necessary responses. Practitioners should apply this information
to support sensitive responding through an attachment relationship and appro­
priate environmental stimulus. Engaging with a stressed child and supporting
containment of his aggression is the first step of a therapeutic approach. Over
time, the child gains patterns of skills that allow him to refocus his reaction to
non-verbal indicators, to verbal reflection, cognitive solutions, and ultimately
reconfiguration of the inner working model.

Green spaces
Early years services use sensory activities as a medium for promoting the
development of children from birth to three years of age (Scottish Govern­
ment, 2010). An increase in comprehension of the rationale of this approach
can transform the impetus, motivation, and creativity of practitioners in
teaching and caring for our youngest learners. Once again, research findings
highlight the importance of curriculum planning and implementation of a
rich learning environment that nurtures optimum capacity of the neural areas
of each child.
Robinson and Brown (2016) referred to the use of outdoor spaces to induce
a calm, ambient atmosphere. Green exercise was the term applied by Barton
and Pretty (2010) within research using data from adult participants. The
study compared short- and long-term health benefits that could be gained
from an outdoor environment. Findings indicated that the greatest positive
changes were demonstrated by the youngest participants who had existing
mental-health conditions.
Louv (2005) applied the descriptor “nature-deficit disorder” to indicate the
negative effects that relate to lack of outdoor stimulation in the context of
136 Ability, capacity, and creativity
urban dwellings. Jawer (2005) reviewed the topic from the young child’s per­
spective, and he suggested that environmental sensitivity can be nurtured
through the provision of outdoor play opportunities. Outcomes for the child
represent outcomes for nature. The child’s understanding of himself as relevant,
respected, and looked after by society, is gained through his comprehension and
response to the natural world (Whitters, 2019).
Ohly et al. (2016) explain this phenomenon in the context of attention
restoration theory. A literature review of 31 studies had been used to investigate
attention fatigue, which is a condition associated with low self-regulation, poor
decision-making, and physical ill-health. Findings indicated that ability and
capacity to concentrate and to increase executive functioning can be restored
through exposure to natural environments.
Attention restoration theory explains the ability and capacity to refocus
and increase attention to learning in four categories (Kaplan, 1995):

1 Short-term respite from daily adversities.

2 Exposure to broader contexts of living through interactions within
enhanced spaces.
3 Opportunities to follow personal interests and respond to needs.
4 Experiencing stimuli that do not impose demands upon the individual.

The principles of fascination, compatibility, and extension traverse the four

categories as described by Kaplan (1995). Kaplan made an important dis­
tinction between hard fascination and soft fascination. Hard fascination
activities tend to have identifiable goals and one outcome for the participant
is an increase in stimulation of the human senses that may incur a physiolo­
gical reaction such as rapid heartbeat and a feeling of dejection or euphoria.
Soft fascination activities may not have a specific goal. The outcome for the
participant occurs within a period of reflection which includes a restorative
effect upon the human body, an increase in awareness of self and potentially
appreciation of the wonder of nature.

Box 5.1 Example from practice

Attention restoration theory in practice: two young friends are supported to
don green rubber boots and striped blue and red waterproof jackets for
garden play in their local nursery garden. Glory and Lewis are 2½ years old,
a significant age of development in which the infant has progressed through
the toddler stage and is entering a period in which competence and a sense
of self increase markedly. The garden is also experiencing an important
transformation in this penultimate season of the year. Autumn is a time of
endings and beginnings. Orange, brown, and green leaves tumble down in
unpredictable spirals to land softly upon the sodden withered grass. Rubber
matting surrounds the apple tree swing to maintain a semblance of dry
ground for intrepid adventurers. Miniature green shoots can already be
 Ability, capacity, and creativity 137

spotted peeping around the edges of the rubber mats, responding to a few
days of mild weather. Papers and sundry refuse items have escaped from
the large industrial metal bins, and the wind encourages these items to fly
across and over the garden, high into the dark sky, and beyond the
rooftops.
Glory and Lewis are best friends. They share a passion for energetic play,
for digging in a mud kitchen, for exploring familiar corners of the garden, and
hiding excitedly in the long bamboo grasses. Lewis always has a goal, and
he uses this green space to further his interests. Currently his play focuses
upon building upwards, and along. The garden offers ample materials for
this constructor of ideas, and he works industriously and individually by
gathering wooden bricks and freeze blocks. The child stands back to survey
his preparations, and he puts a plan into action. It looks like this little boy is
constructing a tower. Lewis could be described as experiencing hard fasci­
nation within the outdoor environment. He builds upwards and along the
winding path which is strewn with bark pieces. His plan changes and adapts
to the materials and to his ability in creating a stable structure. As the thin
tower cascades to the ground, Lewis giggles, his plan has changed instan­
taneously, and his new goal has been achieved.
Glory is sitting under a bush. The rhododendron creates a tent-like
canopy of dark green foliage above the little girl’s head, and isolated drips of
rain disrupt her play flow, just momentarily. Glory has a worm in the palm of
her hand. The long slender worm is unsure of this new warm environment.
He lifts his head and waves it around to detect familiar territory. Glory tou­
ches the worm with a fingertip, and he retracts quickly, curling tightly upon
her palm. The movements feel like gentle tickling to this young explorer. The
child waits and watches – a silent learner. Glory is experiencing soft fasci­
nation within her nurturing bush corner in the nursery garden.

A later study by Kaplan and Berman (2010) identified two types of atten­
tion: voluntary and involuntary. Voluntary attention is currently termed
“directed attention”, and it relates to a child’s conscious focus upon an
activity. Involuntary attention requires less concerted effort due to a specific
interest of the child being met or attraction to the content through curiosity
or prior knowledge. An outdoor environment is commonly regarded as a
context in which children and adults demonstrate involuntary attention;
however, the restoration effect from interaction within green spaces can also
support directed attention associated with specific plans and goals.
Good health and attainment were linked by Kuo and Taylor (2004) within
a study upon play within green spaces. Findings indicated that symptoms
associated with attention fatigue, which is a periodic condition, were similar
to characteristics of ADHD, which is a long-term condition. Conclusions
reported that direct interaction within green spaces, or indirect pictorial
138 Ability, capacity, and creativity
representations linked to attainment in activities which immediately followed
these experiences. Findings concluded that exercise in green spaces reduced
the characteristics of attention fatigue and increased the capacity for learning
that occurred after the physical activity. Many settings incorporate physical
play outdoors during the initial period of a session. Anecdotal comments by
parents declare that “Children learn better if they run off their energy first!”
Outdoor play stimulates the physical body, and mind, in addition to envel­
oping a child in the therapeutic atmosphere of a natural space.
The data of 175 participants, which was collated in a study by Corraliza et
al. (2012), had indicated that children who were exposed to nature on a reg­
ular basis had increased coping strategies in response to adversities. Interest­
ingly, in this study, the children who were most vulnerable experienced the
greatest positive effects from contact with the natural environment.
Since I have been studying research, I have realised that findings can often
be given clarity by linking to practical experiences in the field. Research
informs practice by presenting rationale, knowledge based upon theory, and
findings gained within a formal context of information retrieval. Practical
experience educates the practitioner by presenting understanding and appli­
cation of knowledge in situ. Research and practice should be regarded as
interdependent and equally valuable for professional development.
It is important for early years practitioners to liaise with parents in order to
analyse characteristics that aid attention restoration and to reflect the cultural
context of the area, for example, urban or rural, and needs of service-users.
Strategies can be actioned through effective professional–parent partnerships
and consistent communication links between service and home environment.
Facebook pages are currently popular media for sharing ideas between ser­
vice-providers and service-users. An increase in the use of social media has led
to many services using instructional videos to encourage and to support
parent–child interaction within a family home. Videos present a role model
for parents and children to copy. It may be that the parent provides a learning
medium by copying the interactions from the video, and the child copies his
parent. Alternatively, child and parent may jointly use the video as their
source of role-modelling.

Capacity
Capacity relates to emotional well-being, which is founded on a child’s
secure attachment with one or more adults, and it increases alongside a
child’s resilience to adversities. The current term which is being used in
childcare is “homeostasis” (National Scientific Council on the Developing
Child, 2020). This descriptor is representative of a child having optimal
emotional well-being and resilience that leads to demonstration of motiva­
tion and curiosity to seek out learning opportunities. Stern (1998) describes
daily social interactions and care routines as major contributions to this
status of a young child.
 Ability, capacity, and creativity 139
Increasing capacity includes an infant learning by gaining knowledge and
understanding of the world through the medium of his senses: sight, hearing,
smell, taste, and touch. Emotional well-being is a necessary condition for a child
to liberate his five senses for learning that leads to development. If a child is suf­
fering from internal stresses, then he may appear vigilant and alert for danger to
himself, even within the safe environment of a nursery. The receptivity of his five
senses becomes heightened. Being alert is a basic survival instinct, and, although a
child’s senses are attuned and primed to gain understanding of the proximal
environment, it is for the purpose of detecting danger as opposed to development.
Bowlby (1997) recorded different forms of behaviour that linked to attach­
ment status:

� Interactive behaviour with mother, which includes physical contact.

� Responses to mother’s interactions.
� Behaviour that attempts to avoid separation from mother.
� Behaviour on reunion with mother which includes greeting responses,
avoidance, rejection, or ambivalence.
� Withdrawal behaviour based upon fear.
� Exploratory behaviour which is orientated towards the mother.

Bowlby (1997) described exploratory behaviour by focusing upon three

actions. The infant moves his head and body into a position that prepares
muscles and cardiovascular system for action, the senses are primed to seek
out and to process information, and, finally, manipulation of an object com­
mences which is led by curiosity. This behavioural system is led or stopped by
stimuli with particular characteristics relating to novelty and familiarity.
Exploration and learning transform a novel object into a familiar one.

Play cycle
King and Sturrock (2020) identified four levels of intervention which could be
implemented to support a play cycle:

� Play maintenance in which the adult observes the activity. I would add
that the adult presents a positive attitude and demonstrates an interested
focus upon the child’s play.
� Simple intervention in which the adult can suggest uses for the resources.
The key term indicates the adult should not lead the play cycle.
� Medial intervention in which the adult is invited to participate by the child. I
add that the adult suggests ideas for the play but takes direction from the
child and responds promptly to his play cues, and to his emotional reactions.
� Complex intervention in which the adult becomes intertwined in the
child’s play cycle. Reciprocal interactions can occur in this context, but
the adult should continue to overtly recognise the child as the director of
his play.
140 Ability, capacity, and creativity
Freeman (1998) indicated that negative emotions can inhibit curiosity in
accordance with findings from an extensive German study on children.
Divergent thinking will not occur if a child’s capacity is lowered. Adversities
may have a short-term effect upon capacity to learn, or detrimentally affect a
child’s lifestyle on a long-term basis. Interruption of a play cycle was descri­
bed by King and Temple (2020) as resulting in dysplay and this hiatus in
learning was linked directly to negative emotional reactions. During observa­
tions in a playroom practitioners should consider whether the play cycle is
interrupted by an internal emotional influence from within the infant which is
based upon memory, or an external factor that leads to this emotional barrier.
An infant who is reacting to an external source will usually turn towards that
source, for example, a loud noise in the vicinity, or deliberately turn away
from a local source, for example, another child screaming.
In early years settings and the home environment, children may demon­
strate emotional reactions when their play cycle is curtailed, for example,
crying, shouting, aggressive behaviour, or quiet emotional withdrawal. The
child’s homeostasis becomes uneven. There are many valid reasons for short­
ening a play cycle, particularly within a service that is encompassed by the
necessity of routines. However, the key to responsive support by an adult is pre­
paring the child for ending a play cycle and by introducing transitional strategies
that lead towards the next event. Preparation is a valuable approach that facil­
itates a child’s emotional and physical adaptation to situations. I observe young
children in nurseries completing their play cycle rapidly after being informed that
“tidy-up time” will commence in a few minutes. Practitioners can support the
ending of a play cycle through verbal tracking of the child’s actions and
encouragement to look forward to the next activity or event.
One important component of learning is delivery of knowledge in a manner
and medium that promotes understanding by each recipient. Instruction
needs to be on par with the developmental level of the individual child and to
be accompanied by motivational prompts that match his personality, needs,
and interests at a point in time. The research of McCoach and Flake (2018)
indicated that frequent praise in relation to achievement may impact nega­
tively upon a child’s resilience. Zhou and Brown (2015) had referred to a self-
ranking system in which a child may gain a sense of the autobiographical self
as good or bad; thus, the child’s sense of self is inadvertently linked to adult
or peer feedback. Motivation is reliant on an external source. Harter (2006)
commented that abuse in childhood can result in the child viewing himself as
bad, and this writer linked adverse circumstances to depression in the early
years.
Ability may not be demonstrated consistently by a child due to internal
and external influences upon the learner. Hypervigilance can direct a baby or
young child’s attention away from his learning needs, and interests. Mental
health, personality, and environment, which is conducive to the child’s inter­
ests, are factors that can strongly impact upon application and, consequently,
demonstration of ability.
 Ability, capacity, and creativity 141
Task commitment is represented by motivation to focus upon a specific
problem or area in which understanding is being sought (Renzulli & Reis,
2018). Descriptors which are used in association with this cluster are “ded­
ication”, “endurance”, and “self-confidence”. Task commitment is under­
pinned by the child’s sense of self, albeit at a rudimentary stage in earliest
childhood, which includes being a physical, social, and teleological agent
(Whitters, 2019).
Harter (2006) presents a parental responsibility as supporting a child to
develop a narrative of self, for example, a positive representation of childhood
as recorded in photographs, memory stories of significant events, and cultural
routines pertaining to each family. This narrative includes perceptions and
interpretation of the world from a young child’s viewpoint in addition to
parental interpretation or other dominant adults. Harter used the term
“impoverished self” to represent the outcome of a parent’s failure to support
the child’s creation of a positive narrative of self. Application that demon­
strates commitment by a parent will support a child to understand his fourth
level of self as an intentional mental agent. An elementary level of the auto­
biographical self is generally achieved within the first five years; however,
environmental and social adversities may hinder this stage of development.
During parenting work, I find that many parents and children who live in
adversity require sensitive prompting and probing questions in order to recall
positive memories of the early days of their lives. Creating a narrative of self
is a significant stage of childhood that affects early and middle childhood,
adolescence, adulthood, and parental identity. Interventions must support this
foundational aspect of development. Harter (2006) emphasised the impor­
tance of creating an autobiographical memory which influences hopes and
dreams for the future. Creativity is linked to the sense of self, and this trait is
only fully liberated when an autobiographical self is understood and
embraced by the individual.

Creativity
Creativity involves devising and following a plan that leads to a unique out­
come. There are numerous skill sets associated with planning and imple­
mentation of self-appointed goals by children. Plucker and Barab (2005)
describe creativity as interaction between environment, process, and a child’s
aptitude, and, finally the acknowledgement of an end goal. These authors did
comment that creativity may be directed by cultural influences and led by
expectations of adults, in addition to the child’s own goals.
Creativity requires imagination and an ability and desire to extrapolate
beyond the status quo. A point of clarification is made by Renzulli (2019) as
he does not exclusively link creativity to process and production of an end
goal. This author includes descriptors of creativity as originality of thought,
receptivity to new experiences, curiosity within a learning environment, sen­
sitivity to detail, and awareness of the emotions of self and others. In the
142 Ability, capacity, and creativity
early years services, these descriptors are commonly used to understand and
to assess children’s progress in a context of curriculum delivery and to guide
practitioners in planning a rich learning environment.
It is interesting that Kayal (2020) mentions links between creativity and the
child’s relationships with teachers and parents. The impact from relationships
upon learning indicates that development can be supported within formal and
informal environments which may have different cultures. Culture can exist
within a local setting, such as a family home or nursery, or it can be asso­
ciated with a particular talent or embedded within the expectations of a
nation. Creativity should be embraced and used to forge links between areas
of learning. Diversity among siblings and peers should be celebrated in order
to recognise unique attributes as positive.
Csikszentmihalyi et al. (2018) emphasised the complexity of the psycholo­
gical aspects of flow theory and applied the systems model of creativity to
promote understanding. A cyclical process occurs as a child experiences flow
theory. He uses intrinsic motivation to achieve goals which are based upon
creative ideas. This theory indicates that genes may predispose an individual
to a high level of learning, but creativity is regarded as a social construction
that embraces all stages of cognitive development. Creativity is recognised as
a child learning and demonstrating application of existing domain knowledge
which is enriched by his original ideas. Prior knowledge in a particular
domain provides a framework for the scaffolding of creativity. Csikszentmi­
halyi et al. (2018) commented that creativity may be identified within a spe­
cific context through demonstration of cultural relevance and improvement to
a child’s previous creations.
Opportunities for creativity are regularly incorporated within parenting pro-
grammes and also support primary carers to explore their own identity which is
based upon interests, needs, and spontaneous ideas. The National Scientific
Council on the Developing Child (2020) recently published research that portrays
the importance of brain development in the pre-natal period and postnatal years of
life to long-term success and health in adulthood. The conclusion of this investi­
gation declares that it is never too late to reduce risk to development. This research
upholds the implementation of parenting work by services with members of the
extended family, for example, a third generation in the context of grandparents.
Individuality and developmental progress can be observed by the adapta­
tions of children and adults to situations and evidence of their maturity and
experience during ongoing interactions with the environment. An opposing
influence upon developmental progress is resistance to change (Rathunde &
Csikszentmihalyi, 2006). Rathunde and Csikszentmihalyi described equilibrium
in human systems as being affected by boredom and anxiety. An individual can
overcome boredom by seeking out challenges, and he can overcome anxiety by
increasing skills and resilience which give him greater choices and a sense of
control. The former entails creativity within a process of seeking novelty. The
latter entails problem-solving and reliance upon current skills or scaffolding
which culminates in an increase in understanding.
 Ability, capacity, and creativity 143
The following two studies illustrate the importance of the adult–child rela­
tionship to a young child’s interpretation, understanding, and involvement
within a learning environment (Bernier et al., 2012; Nermeen et al., 2010). In
2012, Bernier and a research team identified three distinct dimensions of
parental involvement with their children’s learning in the formative years:

1 Sensitive responding.
2 Mindfulness.
3 Promotion of the child’s autonomy.

The study focused upon children from birth to 2 years. The brain grows
rapidly during the first two years of life, and it attains 90 per cent of the size
of an adult brain during this period. The findings indicated that stimulation
during the first two years directly impacted the infant’s frontal brain devel­
opment. Additionally, mindfulness of a parent enhanced the response to an
infant and supported his self-regulation within contexts of emotionally chal­
lenging situations. The research concluded that infants, who are securely
attached to a primary carer, are more competent in transferring their skill sets
to circumstances out-with the dyadic relationship.
Nermeen et al. (2010) conducted research on potential links between par­
ental involvement and academic and social development in the early stage of
school attendance. Findings indicated that if parents adopted the values and
expectations of a school then there was a direct and positive impact upon
their child’s behaviour. Consistency and continuity of expectations and
boundaries were also key influences that supported children’s autonomy. The
authors suggested that an indirect impact may result from an increase in the
child’s motivation to engage with learning and a subsequent increase in aca­
demic achievement.

Acceleration and enrichment

Two approaches were used to promote development of children 30 years ago
in the form of acceleration or enrichment. The rationale of using acceleration
or enrichment is to promote three levels of thinking: divergent, convergent,
and evaluative. In early years services, play spaces are bound by adult to child
ratios and formal registration of each area in accordance with a specific age
group. Acceleration of learning, by moving a child from chronological age
group to a playroom with older peers, may not be achievable within registra­
tion policies. Additionally, greater comprehension has been gained over the
past 30 years of the significance of emotional development in a context of
learning and attainment. The passing of time, a secure attachment to an
adult, and exposure to a range of experiences, are factors that directly affect
maturation of a child’s emotional literacy. A child with a higher than average
level of ability may embrace the cognitive stimulation and challenges which
are presented within an older age group; however, his level of emotional
144 Ability, capacity, and creativity
development may not be sufficient to cope with the complexity of social
interactions. Currently, enrichment tends to be the more common approach to
promoting children’s development.

Divergent thinking
Divergent thinking leads to a new base of knowledge and understanding from
an original foundation termed the child’s inner working model, as described
by Bowlby (1997). As a child explores an environment, or a concept, he uses
information from his current inner working model to interpret, and to
respond. The child’s memory, and imagination, are activated during these
processes, and neural links are made to prior knowledge on similar topics.
Cognitive skill supports the brain to merge these links, and to formulate new
ideas that lead to the child interpreting the concept from a different perspec­
tive. This new perspective reconfigures the child’s inner working model, and
his original foundation of knowledge and understanding alters. Rathunde &
Csikszentmihalyi (2006) used the term “creative thinking” to describe the
various steps and “closure” to indicate completion of this cognitive process.
In an early years setting, it is important that children are offered multiple
choices of materials to support divergent thinking, and creativity. Choices
should always include familiar and unfamiliar items.

Box 5.2 Example from practice

Natalia and Mehwish started nursery on the same day. These two 4-year-old
girls have been placed together in the Yellow Group and share a key worker.
It is fascinating to observe friendships emerging in young children. This is an
area of development which is the child’s own domain. Key workers may
offer opportunities of partnership activities or set out furniture and toys to
encourage cooperative play and turn-taking of resources; however, the
creation of a peer relationship is incited by a child’s personality and nurtured
by her emotional well-being.
Mehwish enters the playroom and scans the corners for her friend. The
room is quiet at this point. Families follow timetables based upon lifestyles,
and every practitioner is well aware of the early birds in nursery and the
latecomers who have to be gently integrated into breakfast routines which
are already ongoing in the nursery. Natalia and Mehwish are always early,
and ready to learn. Both children chose to bypass the breakfast choices and
marched determinedly towards an unfamiliar box. The tall cardboard box is
sitting squarely in the middle of the jungle corner. Yesterday, this box was
the receptacle for nursery supplies. Today, it promises to expose a myriad of
exciting artefacts in the playroom. Recycling not only helps the environment
but also provides stimulating challenges for developing youngsters.
The jungle is an area which has been transformed by a creative early
years student: multiple green and yellow paper strands curl downwards and
 Ability, capacity, and creativity 145

across the corner to create a hideout. Large soft rubber animals nestle in
amongst a mat of artificial wiry grass: elephants, tigers, giraffes, hippopota­
mus, crocodiles, and a solitary sheep which has escaped from the farm box.
The surface has been dotted with round ladybird leaves that act as little
seats for the children.
The two friends peep into the box and open their eyes wide as they
exchange excited glances. Mehwish jumps up and down, and the intrepid
Natalia stretches her hand to retrieve some kitchen-roll holders. In seconds,
she has placed a holder onto the head of each animal, obscuring their faces,
and Natalia declares to her peer, “Putting on their hats.” There is no need for
the girls in this learning partnership to use long sentences as the core
information is shared. Additionally, communication between friends always
contains understanding which is sourced from knowledge of one another
and the focus upon shared interests. Mehwish nods vigorously in agree­
ment, and the little girl covers her eyes as she laughs, “They can’t see any
more.” Divergent thinking in an instance.

Convergent thinking
Convergent thinking occurs when the brain identifies similarities in knowl­
edge and understanding of an environment or concept in relation to previous
experience. This array of information from the child’s inner working model is
sorted and merged during problem-solving to result in a consensus. A young
child can be observed in a nursery, or home setting using this base of infor­
mation to influence his response to a practical problem. Key workers or par­
ents can often recall past experiences which have informed a child’s inner
working model and subsequently lead to a demonstration of convergent
thinking. In an early years setting, this understanding of a child’s learning
processes is important to inform curricular planning and implementation
within a playroom or outdoor setting.
During the past two decades, the presentation of educational choices that
respond to children’s interests has been identified as a significant influence
upon engagement and involvement with learning. Reflection on evidence-
gathering and identification of links to progress are essential aspects of pro­
fessional development. Planning an environment to support delivery of a
curriculum, and ultimately attainment, is a key skill within the early years
services. Regular records by key workers on each child’s progress should be
one aspect of evidence-gathering that can be linked directly to a curriculum
room planner and evaluation of provision for each child in addition to
assessment of the overall service.
Lloyd and Howe (2003) conducted a study on potential links between dif­
ferent types of solitary play and convergent or divergent thinking. There are
146 Ability, capacity, and creativity
many factors that can lead a child to choose solitary play: age and stage of
development, environmental prompts, personality, adversity, or lower and
higher ability than peers. Solitary play was categorised by these authors into
three aspects: active, passive, or reticent, in which the child demonstrated
little emotion. Participants in this study were 72 children aged 4½ years of
age. Findings indicated that active solitary play was positively associated with
divergent thinking. Solitary play that was accompanied by reticent behaviour was
negatively associated with convergent and divergent thinking. This study indicates
that children demonstrate divergent thinking through use of intrinsic motivation,
as portrayed by this research context of active solitary play, and creativity.

Evaluative thinking
Evaluative thinking relates to a child taking time away from practical inter­
action, albeit momentarily, to reflect upon newly acquired knowledge and
understanding. The evaluative process supports creation of memories and
retention of information as patterns of exploration and problem-solving.
Neural networks need time and appropriate conditions to make connections,
and busy, noisy playrooms are not always conducive to evaluative thinking.
Breakout areas, for example, tents and quiet corners, and reducing the intru­
sion of external noises, can positively influence evaluative thinking in young
children. Specific periods for evaluation are incorporated into education and
care settings and termed thinking and recall times.
Runco (1991) conducted an interesting study in the 1990s, in which he
researched evaluative thinking with over 100 young schoolchildren. This
researcher wanted to determine if the use of creativity was intentional or
unintentional. It seems that creativity is intentional if shown to link with
evaluative thinking by a child. Findings indicated correlation between diver­
gent thinking which inherently involved creativity and evaluative ability.
Additionally, it was noted that evaluation by a child was influenced positively
by a teacher’s questions. This finding suggests that open questioning can be
used as a positive strategy to promote evaluation as an aspect of learning.
Reflection spaces, circle time, news time, and nurture groups are current
descriptors of practical responses which are commonly used in early years
settings and primary schools. These strategies encourage divergent thinking,
creativity, and evaluative ability.

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6 Research, theory, and intervention

The final chapter describes a human being as an evolving bio-psychological

organism. Proximal processes, dispositions, and structuring proclivities con­
tribute to an infant’s understanding of his interactions. Traits and behaviours
are contextualised through reference to the social address model (Magnusson &
Stattin, 2006). This model presents the principles of novelty, pleasure, and rea­
lity in a context of learning opportunities. The model promotes comprehension
of each person’s unique interpretation of and reaction to an environment
which is influenced by his or her perception of variants. The play cycle is
reviewed in this chapter and play flow considered. Inclusive pedagogy must
include opportunities for children of low and high abilities and many different
stages in between.
This chapter concludes with implications for the future. Current messages
from research, policy, and practice identify a two-pronged approach as the
way forward by supporting individual attainment and by improving access to
education, health care, and income. Findings by Tal (2021) highlighted four
main influences upon development as agency, relationships, education, and
professional expertise. A core competency which is required by a professional
is knowledge and understanding of infant mental health (Association of
Infant Mental Health UK, 2021).

Attachment over time

In 2020, the National Scientific Council on the Developing Child (2020)
published information to inform the creation of a foundation for health and
development. Research indicated significant stages of development that per­
tained to the pre-birth months and the earliest years of childhood. These findings
are reminiscent of sensitive periods for learning as previously highlighted by
John Bowlby (1997).
Brain architecture is affected by internal and external influences such as
interaction of genes and experiences over time. The report by the National
Scientific Council on the Developing Child (2020) describes interdependency
between human systems. For example, a context of feedback loops are used to
send signals from the brain to influence responses by the heart and lungs,
DOI: 10.4324/9781003358107-6
 Research, theory, and intervention 151
digestive system, energy production, infection control, and physical growth.
The learning environment affects brain development, which directs actions
and reactions in the physiological systems. Default patterns of response are
acquired in the earliest years and activated throughout our lifespans.
Homeostasis refers to a balance of the systems within this operation. Adap­
tation to threat is termed “allostasis”. If the body’s reaction to a stressful situa­
tion is prolonged, for example raised blood pressure and rapid heartbeat, then
long-term damage may occur. The developing pattern of responses can include a
propensity to negative reaction. Consequently, the period between an individual
encountering stressful circumstances and a physiological reaction by the body’s
systems may shorten over time and be disproportionate to the context.
Comprehending, and responding to, relationality of physical and mental health
is key to supporting attainment. Current messages from policy and practice are
equally applicable to all children regardless of ability or short- and long-term
additional support for learning needs. A two-pronged approach is the way forward
by supporting individual attainment and by improving access to education, health
care, and income. Responsive actions include the creation of relationships with
primary carers and peers, reducing family sources of stress in addition to a child’s
personal stress, and, finally, strengthening skills, which provide a necessary base­
line for self-regulation and executive functioning (National Scientific Council on
the Developing Child, 2020).
Sensitive responding is based upon the features of attachment theory
(Simpson & Belsky, 2008), and interventions are developed from this rich
source of knowledge and understanding. Three particular aspects of this
theory are the synchronisation of parent–infant behaviour in the post-birth
stages, the young child’s need, and his tendency to seek proximity to the pri­
mary carer, and the pathway to learning which is created as the attachment
relationship matures and changes.
At the moment of birth, a mother experiences hormonal influences that
support her to bond with the new baby. Exaggerated facial expressions, slow
and intentional speech, and seeking out close eye and facial contact are nat­
ural behaviours from a new mother towards her infant. The infant responds
by engaging in three types of behaviour that support his need to have contact
(Simpson & Belsky, 2008).

1 The baby will use signalling to indicate his desire for positive interaction,
rooting for milk, seeking his mother’s eye contact or being still as he lis­
tens and senses his mother in the early stages post-birth.
2 He will use aversive behaviours, for example, crying and screaming, to
prompt his carer to respond to his needs.
3 Over time, the infant will use active intentional behaviours and move
towards his attachment figure.

Bowlby (1997) commented that lack of response by a carer can cause a

fourth behaviour which encompasses withdrawal, silence, and despondency.
152 Research, theory, and intervention
These survival strategies result from a lack of safety provided by a primary
carer as the baby attempts to hide from perceived threat and danger.
The interpretation of the first relationships in life for a baby are retained
within an inner working model. This experience represents a blueprint model
of self and others within attachment dyads. The function of the model is
integral to the child’s understanding of future relationships with peers and
potential lifelong partners (Bretherton & Munholland, 2008). The attachment
working model is relationship-specific, and it is influenced within numerous
daily interactions between the young child and primary figures.
Mikulincer and Shaver (2008) applied the term “broaden and build the
cycle of attachment security” in a specific context of emotional development
and well-being of insecurely attached adults. These authors promoted the use
of actual or symbolic representations of attachment figures to instil self-worth
associated with positive relational experiences. Photographs of family mem­
bers or partners are common screensavers on phones or computers. Activat­
ing secure attachment status through mental representations of personal value
to a child or adult induces the effects experienced within these responsive
relationships. Over time, coping skills will be activated autonomously and
lead to the operation of other behavioural systems, for example, exploration
and caregiving. Psychological benefits pertain to reduction of distress and
restoration of emotional stability.
Aspects of attachment were studied by Mikulincer and Shaver (2008) in a
context of adult participants. Results highlighted outcomes that inform inter­
ventions for children in their early years and provide a rationale for practice.
The first aspect refers to life appraisal which encompasses an ability to assess
negative situations and to maintain optimism, hope, and a sense of control.
The second aspect relates to mental representations of others, which includes
the belief that other people have positive intentions. The research included
participants who were partners, and findings showed that activating positive
mental representations of a partner, even momentarily, promoted positive
expectations about his or her behaviour.
Mikulincer and Shaver (2008) applied the term “authentic self-esteem” to
describe the third aspect as confidence in one’s worthiness, competence, and
mastery of a situation. These authors indicated that this aspect has the
potential to engender autonomous emotion regulation which can reduce
stress, even if the attachment figure is unavailable. The experience of being
loved and valued by an attachment person can lead to a personal mental
representation of self in this context. The final aspect is termed “constructive
coping strategies”, which encompasses the ability to minimise stress through
the use of problem-solving, planning, applying cognition skills, and accessing
support from others.
Gross (1999) described these types of strategies as “antecedent-focused
emotion regulation”. This concept referred to minimisation of emotions prior
to the full negative effects being experienced. Thirty years ago, Lazarus (1991)
described the same process as a “short circuit of threat”. This term referred to
 Research, theory, and intervention 153
the ability of an individual to use the functional and adaptive qualities of
emotions instead of being affected adversely by dysfunctional aspects. Secure
attachment supports a person to express distress, to verbalise experiences, to
seek help from an appropriate source, and, finally, to implement effective
coping strategies that minimise the impact of negative emotions.
Inner working models evolve through adaptation to changing circum­
stances and relationships. A primary carer will inevitably have lapses in sen­
sitivity which can relate to issues such as a carer’s illness, prioritisation of
tasks, short-term distractions, or protecting the young child from immediate
danger. Stability in the attachment relationship is maintained by the child
accepting these short-term lapses and the carer being aware of the need to
repair the relationship over time. It is felt that children are more likely to
develop adaptive working models if parents encourage a child to explore his
inner world and to communicate emotions (Bretherton & Munholland, 2008).
The need for self-protection can also influence a child’s rejection of a rela­
tionship in response to interpretation and adaptation of circumstances and
actions by the adult.
The secure relationship supports a baby to mature into a competent emo­
tionally aware child who has a set of skills to use in self-regulation of emo­
tions and behaviour. Research links secure attachment to an increase in the
child’s emotional understanding of self and others, to social cognition and
formation of peer relationships, memory, and, finally, to the development of
conscience in the early years (Thompson, 2008). Memory is influenced by
representation of emotions associated with attachment-related events, and
conscience is linked to compliance and cooperation within the dyadic rela­
tionship of a primary carer.
Mikulincer and Shaver (2008) also referred to memory, and their research
findings indicated that preconscious activation of the attachment system
increased access to mental representation of an attachment figure. The study
described how these mental processes could influence intentions and beha­
viour prior to conscious formulation. The dispositional attachment style is
informed by experiences, for example, positive expectations, and a route to
gaining support. Even young babies can use help-seeking behaviours which
are directed towards their secure attachment figure, and in adulthood sources
of support are easily identified and accessed confidently. The negative experi­
ences that lead to insecure attachment can cause children and adults to use
secondary survival strategies, for example, hyperactivation or deactivation of
the attachment system (Mikulincer & Shaver, 2008).

Person–environment interaction
Bronfenbrenner (2005) explored the theory of human development, and he
proposed that family was the most significant influence in the earliest years
and impactful throughout adult life. According to Bronfenbrenner, family is
defined as a group of people who have unconditional commitment to one
154 Research, theory, and intervention
another’s well-being. It is useful to read this theorist’s views from a practi­
tioner’s perspective. Bronfenbrenner focused upon the operational aspects of the
parent–child dyad and influence from a third party. He describes the third party
as composed of friends, community, or organisations that facilitate optimum
effect from the two-person system of parent and child. In working with families
over many years, I have found that each parent–child dyad has a distinct identity
which is steeped in a family culture influenced by historical and current experi­
ences. The dyad evolves over time, and the relationship has immense potential to
support development of the two members: parent and child.
In a recent publication, Nagy and Nagy (2022) refer to the skilful adapta­
tion of working conditions within a context of the COVID-19 pandemic in
Hungary. During lockdown periods, role-modelling of physical and emotional
nurturing by early years practitioners was replaced by the use of information
technology. This medium provided an aid to maintain communication
between services and home. Key workers used the format of Facebook to
upload videos of activities that promoted parent–child interaction within the
home environment, and it supported the family’s processing of trauma asso­
ciated with the pandemic. This study highlighted the ingenuity of practi­
tioners in responding to the unprecedented crisis of COVID-19 in addition to
the importance of person-to-person interactions.
Research by Duffy et al. (2021) investigated the use of a screening tool for
the long-term mental-health condition of post-traumatic stress disorder
(PTSD). The participant group was 141 young people who had experienced
maltreatment in childhood. Findings indicated three items which were asso­
ciated with PTSD as a history of being on the child-protection register, prior
mental-health issues, and interpersonal trauma. These authors reported an
unexpected finding as data from the young people that identified the death or
loss of a close relationship as a traumatic experience. This research indicates
the importance of interpersonal relationships to reduce the impact of loss.
Tal (2021) recently highlighted four main influential concepts upon
development.

1 The child’s agency.

2 Interactions and relationships.
3 Educational practice.
4 Professional development.

Agency refers to the child’s ability and capacity to influence operations

within daily living. Ryecraft (2019) reviewed research on the agency of chil­
dren who were living within a disadvantaged context but deemed to have
higher than average ability. The findings identified 16 common traits. It is
interesting that the single trait that negatively affected attainment related to
limited communication skills, and it is described within the research as a low
level of knowledge and vocabulary. The development of verbal communication
commences in the home environment, from birth, and the aforementioned
 Research, theory, and intervention 155
research highlights the need for children and families to be supported in their
earliest years.
The traits from the research by Ryecraft (2019) are regarded as positive
influences upon a child’s agency, his ability to embrace learning opportunities,
and his achievement of potential. Findings indicated the 15 positive traits as
the child being alert and curious, independent, using non-verbal fluency, being
an experiential learner, and creative, able to take risks, and to demonstrate a
sense of humour, the use of imagery in language, showing leadership skills,
interested in music and art, responsible, adaptable, externally motivated, using
memory and observational skills, and being responsive to learning.
A research study by Zero to Three (2017) publicised behaviours that could
indicate concerns regarding an infant or young child’s mental health in the
earliest years. The research findings included: chronic eating or sleeping diffi­
culties, irritability, difficult to console with excessive crying, clear distress if
primary carer leaves, difficulty in adapting to new situations, easily startled by
familiar routines, inability to establish relationships with other children or
adults, excessive hitting, biting, and pushing of other children or very with­
drawn behaviour, little to no emotion, engaging compulsive activities, exces­
sive and repeated tantrums/aggressive behaviours, little interest in social
interaction, immature communication, and indicative loss of earlier develop­
mental achievements. The works by Ryecraft (2019) and Zero to Three (2017)
present broad lists of behaviours associated with attainment or mental health.
Each child’s interpretation of and reaction to influences is unique, and
responses should reflect personal characteristics, and emotional effect.

Social address model

These traits and behaviours can be understood in greater depth by reference
to the social address model by Magnusson and Stattin (2006). This theoretical
model presents the principles of novelty, pleasure, and reality in a context of
an infant, child, or adult embracing learning opportunities. The social address
model promotes comprehension of each person’s unique interpretation and
reaction to an environment which is based upon his or her perceptions of
variants. The research is informative to educators as all children should be
supported to develop these positive traits in the early years to promote
development. Therapeutic approaches have been introduced to early years
work in the past decade within contexts of targeted intervention and generic
pedagogy. Organisations that specialise in working with families focus upon
nurturing secure attachment between parent and child primarily and sub­
sequent relationships thereafter.

Intervention strategies
In a context of infant mental health, the attachment relationship from child to
adult, and the bonding relationship from adult to child, are key aspects of
156 Research, theory, and intervention
healthy development and resilience to adversities. Barlow (2016) described
several factors of significance to the strengthening of an attachment bond
based upon the principles by Simpson and Belsky (2008): a parent’s sensitivity
to an infant’s needs and emotional reactions, the quality of attunement from
parent to infant, and parental ability to reflect and adapt behaviour to an
infant’s presentation, and interactions within a midrange context. In curri­
cular guidance, the term “sensitive responding” is often used to promote the
behaviour, emotion, and intent of an adult’s reflective interaction to an
infant’s needs and preferences.
Berlin et al. (2008) identified three approaches that could accumulatively
respond to attachment needs of infants. The three approaches are inter­
dependent and incorporated into many formal and informal intervention
contexts:

1 First, implementation of intervention that targets a process of change in

the parent’s internal working model by prompting reflection, and re-eva­
luation of parenting skills.
2 Second, the creation of a base of knowledge which can be used to change
a parent’s behaviour towards an infant by supporting interpretation of the
infant’s needs and interests.
3 Third, the development of a therapeutic alliance between professional
and parent as an effective medium to promote learning and development
of parent and child.

A recent report from Child Protection Committees in Scotland (Scottish

Government, 2021) identifies key approaches to minimising the impact of
neglect: clarify the issues, engage the family, create a safe environment,
increase parenting sensitivity, assess family circumstances, support parenting
capacity to change, and reflect upon historical family circumstances. This
report is designed to provide guidance to services and advocates imple­
mentation of a comprehensive, multilayered response. Time and timeliness for
change and development are highlighted alongside an approach that addres­
ses social supports and inclusion. This approach ensures that vulnerable
families receive help that is equitable, proportionate, and effective.
Family programmes from birth, and even the pre-birth period, can provide
valuable planned and spontaneous opportunities for learning. A literature search
by Hogg (2019) identified 27 specialised parent–infant teams throughout the
United Kingdom that provide intensive support to vulnerable mothers and babies
during the perinatal period, pre-birth to one year. These multidisciplinary teams
promote secure attachment between parent and infant by using a therapeutic
approach. Ultimately, each child requires a consistently secure relationship with a
carer to support activation of curiosity and exploration and to kindle a desire for
knowledge. Nurture groups and nurturing practices are recognised as impactful
upon social and emotional competencies in the early years and primary-school
settings, and as contributing to closing the attainment gap.
 Research, theory, and intervention 157
Doyle and Cicchetti (2017) conducted a broad literature review on attach­
ment, and the discussion highlighted findings from the Bucharest Early
Intervention Project. The study encompassed development of children who
had been placed in Romanian orphanages at birth. Findings indicated that
the children had ongoing developmental deficiencies across all domains. The
study acknowledged that neural plasticity and intervention can support the
negative effects to be reduced in some children. However, a significant finding
indicated that mental representations from early experiences have the poten­
tial to influence parent–child relationships in subsequent generations. Mala­
daptive parenting requires intervention beyond parenting programmes, and
these authors refer to the use of child–parent psychotherapy. Child–parent
psychotherapy is founded upon the parent and child dyad being regarded as
the client rather than separate individuals. Responsive intervention focuses
upon safety, affect regulation and the creation of a shared trauma narrative.

Theory of development
Bronfenbrenner (2005) investigated the concept of developmental outcomes
and explored the establishment of mental processes. Developmental outcomes
occur from the joint functioning of a person and his proximal or distal
environment. There are many similarities among the neural workings of
human beings; however, the importance of personal characteristics upon
subjective interpretation, and actions, was consistently promoted by Bronfen­
brenner. This theorist described changes that occur in the development of a
person between systems as ecological transitions (Bronfenbrenner, 1979).
Influences that prompt these changes are known as “variable factors”.
Patterns of motivation and actions create developmental trajectories which can
be observed within different settings, for example, home or nursery, indoor or
outdoor play. The trans-contextual dyad of adult and child supports transference
of knowledge and application within different circumstances. Bronfenbrenner
(2005) applied the term “mesosystem phenomenon” as the changes gained
developmental validity by occurring in more than one setting. A secure attach­
ment relationship is a key influence upon this event of ecological transitioning.
Bronfenbrenner indicated that momentum gave meaning and perpetuity to short-
term molecular behaviours which were categorised as stimulus-responses or
transitory actions. These behaviours subsequently transformed into longer-term
molar activities if the conditions were conducive.
Bronfenbrenner (2005) researched the concept of variance. He believed that
variance between human beings related to a heritability system. This means
that genetic influences are actualised into observable phenomena. In the con­
text of an early years nursery, a practitioner conducts daily observations on
key children, and she rapidly accumulates examples of influences upon the
child’s functioning although evidence of a genetic link is unconfirmed. Varia­
tion is demonstrated by joint functioning of proximal processes and char­
acteristics. The child’s actions are influenced by his personality and specific
158 Research, theory, and intervention
strengths or weaknesses. Practitioners are well aware of variance through
observing different actions, behaviour, and emotional reactions from siblings
to the same family circumstances, and to their involvement with the learning
environment of a playroom.
Influences may be formative life events or the predispositions which are
based upon personal characteristics of the individual. Examples are genetic
defects, congenital damage, severe and long-term illness, in addition to a high
level of ability, and capacity which is built upon good health at birth, genetic
potential, and learning opportunities. A change in mental health can be the
result of these issues, and this is regarded as a triggering event to alteration of
the child or parent’s interpretation, perceptions, and reaction to a proximal
environment. Bronfenbrenner (2005) termed the outcome of these develop­
mental processes as having a social stimulus value, and his work continues to
increase comprehension of negative and positive influences which are relevant
to today’s society.
Bronfenbrenner and Morris (2006) explored indirect impact from a defi­
ciency, for example, a low birthweight that could reduce a child’s capacity to
engage with learning. Low birthweight can be associated with many adverse
childhood experiences, including poverty and poor health of the mother.
Research has also indicated that stress exhibited by a baby in adverse circum­
stances will result in a stress response by a parent whereas a baby who demon­
strates increasing competence and social skills will prompt a parent to provide
stimulation and lead to reciprocal interaction. Parenting work with primary
carers and their children is a relevant and valuable response to these issues.
Clemens et al. (2020) recently conducted research on an extensive sample
group of over 2,000 parents in Germany. The results showed that parents who
had experienced adverse childhood experiences exhibited a higher acceptance
of negative behaviours in their own parenting roles. This study focused speci­
fically upon behaviours which had resulted in a head trauma upon the child.
Findings indicated that a mother’s resilience to a crying baby might be
reduced if her personal memory of childhood stress was associated with
negative responses from her own parents. Memories retained from early
childhood experiences shape interactions between adults and children within
each generation.

Therapeutic alliance
Cain (2010) noted that the skill of a third party could facilitate development
of others, and he promoted the therapeutic relationship as an effective
medium for communication. Twenty years previously, Carl Rogers indicated
one such skill as the ability to enter the perceptual world of a child, and he
applied the term “therapeutic alliance” (Rogers, 1990). The Scottish Govern­
ment (2009) describe this alliance as contributing to a healing process within
the body and mind of parents and children. Hope and potential for change
are key messages gained from research on these topics.
 Research, theory, and intervention 159
Several authors have studied the therapeutic relationship in a context of
parenting support. An extensive literature review was conducted by Moran
and a research team in 2004, and it projected an important message in
response to issues that affected the capacity and motivation of a carer to
engage with parenting support (Moran et al., 2004). The use of relational
skills to engage parents was a common factor that featured in the findings of
this review. A previous study by Benjamin and Karpiak (2001) had indicated
that this type of relationship also had a positive effect upon personality sta­
bilisation. Braun et al. (2006) commented that the therapeutic alliance could
be used by a parent to activate support from a professional in response to
current and potential needs which were forecast.
Carl Rogers (1990) studied in the field of psychotherapy, but parallels can
be drawn with his findings to the professional–parent relationship in the early
years sector. Rogers identified six necessary conditions to the creation of an
alliance between professional and a client (Whitters, 2015).

1 Two human beings, a therapist and a client, who are in psychological

contact. For example, a practitioner and parent communicating about
needs and support.
2 The client existing in a state of incongruence. For example, a parent
experiencing mental health issues within a chaotic lifestyle.
3 The therapist existing in a state of congruence and integrated in the
relationship. For example, a practitioner demonstrating empathy and
supporting containment in this context.
4 The therapist experiences unconditional positive regard for the client. For
example, the practitioner demonstrates a caring and non-judgemental
approach.
5 The therapist experiences an empathic understanding of the client’s frame
of reference and attempts to communicate this understanding. For
example, the practitioner uses tracking and description to emphasise care
and understanding.
6 The therapist achieves a positive communication of empathic under­
standing and unconditional positive regard to a minimal level. For
example, an effective communication medium is achieved within a ther­
apeutic alliance.

Professionals can achieve congruence through self-disclosure, articulation of

thoughts and emotions, and responses which are not necessarily bound by spe­
cific requirements of a professional discipline (Klein et al., 2002). The effect of
congruence can be transferred within the medium of a relationship, and Rogers
promoted this stage as significant to creation of a therapeutic alliance. Rogers
(1990) applied the term “transcendent phenomenon” to describe the effect of
congruence upon a client that encompasses transfer of emotional, physical, and
social well-being from service-provider to service-user. The term “value system”
was linked to this alliance, and Rogers indicated that the inner choices of a
160 Research, theory, and intervention
parent had greater value than choices of compliance within the relationship. It is
important that the developing person, the parent, is aware of undergoing this
process of change and placing value and worth upon her progress. The parent’s
comprehension of self will alter over time, and past perceptions of the world are
actively rejected as new interpretation emerges.
Cain (2010) had expressed that secure attachment and corrective relational
experiences had a positive impact upon the congruence of parent and profes­
sional. The therapeutic alliance is a fluctuating and ongoing medium for
communication which has great potential impact upon learning and devel­
opment. The relationship may be fragile in the earliest stages, but it can be
consolidated and strengthened over time. Consistency and predictability of
reaction and actions from the attachment figure are key outcomes from a
secure relationship.
Theories provide understanding, and direction, to the implementation of
interventions that target change and development of parenting skills. Lave
and Wenger (1991) described the process by which a parent integrates within
an established socio-cultural practice. For example, participating in formal
and informal parenting intervention within the context of a service-pedagogy.
Parental choice, empowerment, decision-making, and personality stabilisation
are aspects of many parenting programmes and interventions. Over time, the
parent adopts the socio-cultural approaches and becomes an agent of practice
within this context. Convergence and agreement in the perceptions of profes­
sionals and parents have been linked to positive outcomes in contexts of child
protection cases (Cleaver & Freeman, 1995; Trotter, 2002).

Resources, disposition, and demand characteristics

The development of human beings follows a pattern that commences with a
young baby’s predisposition to focus upon his physical and social environ­
ment, and, ultimately, his representation within these contexts. Babies respond
to vestibular stimulation by reacting to the physical responses of different
people, and newborn babies will start to demonstrate preferences in the ear­
liest days of life. Every new parent quickly learns to interpret her baby’s cues
of likes or dislikes in relation to physical interaction. Some babies prefer to be
held in a prone position, feeling the warmth of an adult’s arms, or facing the
primary carer and absorbing voice and smell, or in the vertical position to
look outwards and view the wider world.
A human being is an evolving bio-psychological organism. Proximal pro­
cesses are regular, and reciprocal interactions occur between a person and
others, objects, or communication systems. These processes are regarded as
developmental, and improvement in the quality leads to a higher level of
heritability and elevated developmental functioning (Bronfenbrenner, 2005;
Whitters, 2015). Dispositions relate to personal interests which can activate
proximal processes. Bronfenbrenner and Morris (2006) used the term “struc­
turing proclivities” to describe a baby’s inclination to seek out particular
 Research, theory, and intervention 161
proximal processes and to develop and sustain reciprocal interactions. Over
time, the young child begins to gain an understanding of his interactions
which pertain to deeper conceptual levels as maturity increases.
Demand characteristics refer to the motivation and needs of an individual
which can support or can prevent proximal processing. Bronfenbrenner and
Morris (2006) made a distinction between developmentally generative char­
acteristics and developmentally disruptive characteristics (Whitters, 2015).
1. Developmentally generative characteristics: Proximal processes have
greater power to support actualisation of genetic potential within a consistent
and positive living environment and lifestyle.
2. Developmentally disruptive characteristics: Proximal processes in a
disadvantaged context will hinder development potential. Disadvantage is
categorised as instability in the domains of space and time. This negative influ­
ence is represented by chaotic and unpredictable lifestyles within non-stimulating
and disorganised households.
The findings by Moran et al. (2004) on early years provision described the
organisation of an environment as a determinant factor in the functioning of
processes as an asset or deterrent to development. An environment functions
and changes through ongoing processes of interaction and interdependence in
respect of social, cultural, and physical factors (Magnusson & Stattin, 2006).
In early years services, the presentation of a learning environment is deter­
mined by health and safety parameters, curricular guidance, and the unique
pedagogy of each organisation in addition to practitioner skill and creativity.
Thelen and Smith (2006) applied the terms “coupling” and “continuity” in
order to promote further comprehension of developmental influences. Cou­
pling refers to links and interactions between all components within each
person’s developing system. Continuity indicates that processes are iterative
and always based upon the merging of previous and current experiences. The
parent and professional are key to supporting activation of these processes in
the context of a child’s development. Proximal processing may extend over
time if there are influences or characteristics from more than one source.
Educators and parents are distinctive influential sources of learning for chil­
dren, and the home environment may also be enriched by input from siblings,
grandparents, and the local community. A context of multiple rich influences
increases retention of learning. A positive learning environment can be gained
through attendance at an early years service and primary school, which
includes home–school links.
Each person is an active intentional component within a complex,
dynamic, person-environment system (Bronfenbrenner, 2005). As an inexper­
ienced practitioner, I felt challenged by this statement, and I sought under­
standing by focusing upon my practical base of knowledge, which was gained
from implementation in the field. I realised that this research finding matched
my daily experiences in the playrooms, and it granted worthiness to the daily
interactions of the early years workforce. Every infant, parent, and practi­
tioner actively contributes to changing an environment and creating learning
162 Research, theory, and intervention
opportunities that instil knowledge and understanding within each person.
The person and the environment are interdependent and contribute to devel­
opment of the system, the individual, and the local setting.
In 2006, Spencer contributed to this debate through her research within an
African American context. This researcher indicated that differences in per­
ceptions could account for human variation in the context of development
(Spencer, 2006). This approach is known as the phenomenological variant of
the ecological systems model. Differentiation, and interaction of resources,
disposition, and demand characteristics, can account for variation of actions
by human beings to the same circumstances. It is often the case that several
siblings display different reactions to their shared home micro-system. It is
important to note that differentiation and interaction also affect the primary
carer who is a separate, but influential entity to the child.

Focus of attention and practice

Bronfenbrenner and Morris (2006) commented that the power of the bio­
ecological model to affect a child’s development increases in accordance with
the focus of attention by the developing child and the parent. The focus of
attention within a parent–child dyad can be supported and promoted through
intervention by a third party. The third party relates to practitioners, thera­
pists, or any influential beings. Demand characteristics from a help-seeking
parent can also intensify the focus of attention.
These theories are relevant to strategic and operational practice in services
today. The current approach to family support is tailoring intervention in
accordance with family perceptions of need, characteristics, strengths, and
specific areas identified for development within a context of child protection.
Establishing patterns of positive parent and child interaction can be linked to
a third party. In current services, an early years worker, health visitor, speech
therapist, social worker, or educational psychologist promote the agency of a
parent–child dyad. This third party supports agency by giving recognition to
the parent’s role which strengthens, consolidates, and highlights the sig­
nificance of influences. The professional directly supports the development of
the parent’s skills in order to actualise potential of the child. Bronfenbrenner
(2005) also placed importance on informal and indirect third-person influ­
ences from family and community throughout daily living.
Ten years ago, research by Walsh et al. (2010) identified four principles for
implementing a curriculum in a specific context of children who demonstrated
higher than average ability. These principles are still applicable and current to edu­
cation in early years settings, regardless of the child’s ability in relation to a norm:

1 Identification of child’s ability through practitioner observation and

information from parents. This information informs the creation of an
individual learning plan that reflects developmental needs, interests, and
personality of the child.
 Research, theory, and intervention 163
2 Presentation of a child-led learning environment which is based upon
children’s interests and a pedagogy that incorporates opportunities for
accelerated content through scaffolding by practitioners.
3 Lateral enrichment opportunities that feature in the layout of an envir­
onment and support children to make choices and to link concepts
throughout a playroom and outdoor play spaces.
4 Peer interaction between children of similar ability by mixing different
age groups and encouraging parents to present stimulating social oppor­
tunities for sibling play at home and peers in the community.

Enrichment, extension, and differentiation

Knowledge and understanding of developmental goals which are based upon the
norms for an age range inform the creation and delivery of a curriculum within a
year group. This pedagogy can reflect the needs of many children, and knowledge
of norms is a foundation of early years practice. However, the ability to recognise
and to respond to a child’s potential which is above or below these developmental
levels are also essential skills in a context of inclusion and equality. Enrichment
tends to be the approach that has prevailed in education as a strategy to support
developmental potential.
Enrichment of learning opportunities reflects a child’s interests and sche­
mas at any point in time and leads to a deeper detailed level of understanding
of a topic beyond mandatory curricular content. Extension of an activity can
incorporate opportunities for divergent thinking and creativity. Extension
invariably leads to enrichment due to activation of the child’s curiosity and
motivation to satisfy his desire for knowledge and understanding.
Differentiation of pedagogy in the delivery of curricular content can take
many forms. Taylor (2019) analysed the responses of 5,000 teachers and
identified five common aspects of practice. This study had been conducted in
a context of primary schooling; however, these five classroom strategies can
also be applied within an early years setting and home environment:

1 Oral questions: The use of open questions, prompts, and probes to further
the child’s knowledge and to support comprehension by tailoring inter­
actions to suit current capacity and ability.
2 Feedback: The provision of feedback that responds to each child’s output
can provide scaffolding of knowledge in verbal format, and it builds upon
the current base of information which is held by a child.
3 Linking with prior attainment: This strategy supports a child to recognise, and
to use his current base of knowledge and understanding to advance to the next
level. Learning follows an iterative pathway in response to the child’s ability.
4 Scaffolding: An effective and common practice throughout many different
learning environments that requires an adult or peer to use encourage­
ment, specific ideas, role-modelling, prompts, and probes, and to demon­
strate an interest in the child’s interests to further development.
164 Research, theory, and intervention
5 Outcome: It may be necessary to have a range of outcomes for children
who present at different stages of development. This approach requires an
educator to consider each task as composed of many aspects and to
determine appropriate goals/outcomes which can reflect every child’s
capacity, ability, and recognise attainment.

A catalyst for learning is the secure relationship between child and a suppor­
tive adult. Good mental health empowers the young child to seek out oppor­
tunities, to make effective social choices, and to gain satisfaction and
fulfilment from furthering knowledge and understanding. The home environ­
ment presents a rich cultural experience for learning within a family unit. It is
a venue in which children can observe and adopt values, attitudes, and beliefs
of parents and gain opportunities for accelerated and enriched learning with
older siblings. Supporting children in the home environment does not need to
entail formal educational experiences, but parents, brothers, and sisters can
utilise everyday resources to activate intrinsic motivation in a child.

Box 6.1 Example from practice

Cold rain slides down the windows in straight lines, and it splashes loudly
onto the white painted windowsills. Three-year-old Gracey and her older
sister, Brooke, are standing side by side as they observe the watery scene
outside. Gracey sighs as she brushes her fine red hair away from her eyes
and looks toward her sister, expectantly. The world is experiencing lengthy
periods of society lockdown to temper the virulence of COVID-19. Home­
schooling, home-friendships, and home-play are familiar concepts to every
child and parent. Brooke turns her mind to entertainment and places a pink
spiral notebook on the low glass coffee table alongside several little
coloured pencils. For the next ten minutes, the 7-year-old proceeds to teach
her little sister ante-preschool and preschool skills. She is inadvertently
scaffolding Gracey’s development during play. Their secure sibling relation­
ship ensures that Gracey invests in the tuition which is freely given by her
sister. The skill set acquired by the 3-year-old is multifold:

� Using fine motor skills and hand–eye coordination to pick up a pencil

from the slippery table surface.
� Observing and copying the role model of Brooke’s adept finger move­
ments to position a pencil for creativity.
� Understanding and reproducing hard and soft strokes, noticing light and
shade as she strives to copy the numbers and kisses that Brooke
instigates upon the page.
� Coordinating her little hand and wrist to reproduce the circles of sun­
shine one way and the other, her wrist action gaining skill and speed
over time.
 Research, theory, and intervention 165

� Moving each pencil up and down, little ticks and big ticks, filling each
white page.
� Selecting a sheet of paper, listening, and counting as she follows the
noise of the spiral notebook releasing a page, hole by hole.
� Folding the paper along its faint printed lines, using both hands as tools,
a firm press and creativity is activated in the 3-year-old explorer.

The early stages of literacy are fun to learn in a play environment and
gained easily within the context of a positive sibling relationship on a rainy,
lockdown Saturday afternoon at home.
Learning environments should promote intrinsic rather than extrinsic
reward and activate the child’s curiosity and motivation to learn within a
cultural context. Creativity should be embraced and used to forge links
between areas of learning. Diversity should be celebrated in order to recog­
nise unique attributes as positive.

Knowledge and understanding

One key aspect of learning involves delivery of knowledge in a manner and
medium that promotes understanding by each recipient. Instruction needs to
be on par with the developmental level of the individual child and to be
accompanied by motivational prompts that match his personality, needs, and
interests at a point in time. Traditional programmes such as heuristic play are
useful for the newly ambulant child (Whitters, 2017). This specially prepared
play environment can support young children to follow their interests and to
learn incrementally as the experience is offered twice weekly. A range of toys
is presented to the child that support problem-solving, sensory exploration,
and imaginative play. A multitude of containers support schemas and activate
the child’s interest in developing the play environment. The key worker
responds to the child’s emotional and social needs within this context, which
increases the child’s capacity to seek out learning opportunities independently.
The quiet atmosphere is conducive to good mental health and exploration.
The term “observational learning” refers to a child observing a scene,
interpreting the actions of peers or adults, and subsequently reproducing his
acquired knowledge in the same context or another. An early years setting, or
home environment, can provide multiple opportunities to support observa­
tional learning. Researchers identified four coexisting processes that occur
within this context (Zhou & Brown, 2015):

1 Attention: The child will demonstrate a capacity to focus upon one

activity and minimise the effect from other influences.
2 Retention: The child will create memories from his exploration which
increase his comprehension.
166 Research, theory, and intervention
3 Production: The child will apply his knowledge to current and future
activities.
4 Motivation: The child will demonstrate intrinsic motivation, which links
to his curiosity and interests.

A child requires a broad understanding of the world – not just facts and
information, but many opportunities to experience and to apply what he has
learned in practice. The young learner will use objects in different ways and
gain understanding of concepts such as size, weight, height, and length. Most
nurseries set up defined areas of play which are designed to promote con­
textual experiences within a playroom, for example, a home corner, book
corner, an arts and crafts area, a cognitive area, and physical play. A child
can independently extend his learning by linking adjacent toys and materials
in response to interests and needs and to create something new and personal.
Inclusive pedagogy must include opportunities for children of low and high
abilities and many different stages in-between. Responsive staff can nurture
positive relationships and provide rich opportunities to support formation of
a child’s neural connections.
During the first wave of the COVID-19 pandemic, children in UK nurseries
were restricted to several small groups called bubbles (Early Learning and
Childcare Directorate, 2020). The rationale for these circumstances was based
upon necessity for an increase in hygiene, reduction of human interaction,
and minimal use of artefacts in order to decrease the risk of virus transfer.
Settings scaled down the range of choices for children and compartmentalised
items for access by each bubble group. The resources and learning environ­
ment were sterilised after contact with every group of children. Two years
later, these routines continue to be implemented in relation to the enduring
nature of this pandemic and COVID guidance.
An unexpected outcome of this presentation of learning materials was an
increase in the imaginative and creative play of children. The children used
the limited resources to achieve a deeper level of learning by repeatedly
exploring concepts over time and problem-solving by using materials for dif­
ferent functions. It was also observed that children were initiating interactive
play more frequently with their peers, and they developed greater compre­
hension of sharing and turn-taking. It appeared that fewer external choices
prompted the children to access implicit memories, leading to an increase in
motivation, creativity, and group interactions. These anecdotal findings are
important to consider, and current research is ongoing to explore the effect of
COVID-19 upon education and care in the early years of childhood (Moore
& Churchill, 2020).

Loose parts and divergent thinking

Outdoors is a rich natural environment that can be presented safely to chil­
dren in services by eliminating the use of potentially dangerous areas and by
 Research, theory, and intervention 167
creating a designated space for active play. The outdoor environment provides
an extended opportunity for children to apply the skills achieved within
heuristic play sessions. Play in a context of the natural world has a therapeutic
effect due to the space, colours, sensory stimulation, freedom from human-
made boundaries, and reduced social rules (Whitters, 2020). Divergent think­
ing is an aspect of development that is supported easily outdoors and evolves
through scaffolding of play, role-modelling, prompting, creativity, and use of
imagination.
Outdoor spaces have become invaluable resources which have gained sig­
nificance within the context of COVID-19. Gardens and local woodland areas
have rapidly been granted registration as safe play spaces in order to reduce
numbers of children who play together inside and to present an environment
which is deemed to minimise spread of this virus. It is 50 years since Nichol­
son (1971) published his theory on loose parts, and this pedagogical approach
to educating children has become popular in recent years, with renewed
interest during the pandemic of 2019 due to the outdoor context.
Nicholson (1971) placed emphasis on the role of practitioner in providing
children with adequate choices and environments in which to learn, including
indoors, outdoors, natural, and human-made resources. The rationale is to
support development through opportunities for divergent thinking that nur­
ture ability, capacity, and creativity. The adult observer is present as an
attachment figure, but he does not interfere with the child’s play flow and
refrains from making suggestions, introducing ideas, or correcting actions.
The atmosphere is quiet and conducive to the use of problem-solving and
creativity through divergent thinking. This approach continues to be applied
within services, and it is commonly encompassed within child-led pedagogy.

Play cycle
The play cycle refers to the processes that occur during play and include the
play flow (King & Sturrock, 2020). The child expresses play cues externally
which are based upon internal influences in relation to his interests, needs,
and emotions. These play cues may also be given direction or prompts from
another person or the proximal environment. The research findings by King
and Sturrock (2020) indicated that play cues would reduce over time unless
strengthened by interactions with another child or adult or an aspect of the
environment. The distal environment can also affect the direction of play cues
through sensory stimulation which links to familiar concepts. For example,
the distant sound of an emergency vehicle’s siren can induce specific cues, and
it can inform imaginative actions.
The child’s knowledge and understanding that is gained from interaction
between his play cue and another person or environmental stimulus is termed
the “play return”. During observations by key workers, and analysis of each
child’s play, it can be useful to consider the source of the play return from a
behavioural, environmental, or social cue. The play return is processed by the
168 Research, theory, and intervention
child who chooses to extend the play or to introduce another play cue; thus, a
play cycle is completed (King & Sturrock, 2020).
There are six elements to a play cycle as termed by King and Sturrock
(2020): metalude, play cue, play return, play frame, loop and flow, and anni­
hilation. The metalude refers to the child’s drive to participate in play. Inter­
nal influences result in his external expression through a play cue of actions
and potentially words. If a response is not readily available to activate his play
cue to a subsequent stage of the play cycle, then the child may issue a second
cue, withdraw from play, or react with negative emotion (annihilation). If a
response is available (play return), then a play frame is created. This frame
may encompass physical and psychological elements. The play frame con­
tributes to the child’s learning and induces an increase in knowledge, under­
standing, and experiential learning. Developmental outcomes are gained
through reciprocal interaction of the child’s play cues and person or environ­
mental feedback. These aspects inform the inner working model of the child
and encompass the loop and flow stage of the play cycle. Play cues and
returns will continue unless the child withdraws or this particular cycle is
ended by another person or factor in the environment or social boundary.
The adult’s role and responsibilities within a play cycle should be adapted
to enrich the capacity and abilities of every child, and the ultimate outcome is
a high level of well-being and involvement with a learning environment. For
example, a practitioner may introduce a play cue to a child through role­
modelling and support interpretation of an environment, particularly in con­
texts which are unfamiliar. During delivery of a therapeutic intervention
(Bratton et al., 2006), I have found that children who have experienced
trauma often require play cues to be introduced by the facilitator before par­
ticipation in this context can commence. The important factor is the outcome
of encouraging play and learning.
King and Sturrock (2020) commented upon this phenomenon within an
investigation on cues for playful behaviour in an adult organisational meet­
ing. Potential cues were provided on a material level by the use of objects and
sweets which were displayed openly to employees within the environmental
context. Findings indicated that these artefacts were associated with light­
hearted behaviour from the adults in the meeting and regarded as cues or
stimulation that led to frivolous behaviour in this particular context.
The play frame in services occurs within contexts that reflect social
boundaries, health, and safety requirements, and respond to additional sup­
port for learning needs. It is necessary that the practitioner has a responsi­
bility to have a “holding” role in the play frame. King and Sturrock (2020)
applied this term within a discussion of data from a study in the UK. The
research focused upon children’s behaviour and practitioners’ interpretation
of play cues (Nottingham City Council & Russell, 2006). Findings had indi­
cated that playworkers often misinterpreted play cues as challenging beha­
viour. The study concluded that adults have a role to play in maintaining the
play frame in accordance with social and safety boundaries relevant to each
 Research, theory, and intervention 169
setting and to the needs of each child. A description of containment was
given by the authors to represent the adult role in supporting a child to adapt
his play frame as necessary but to maintain the integrity of the child’s original
plan.
Containment involves the use of a broad skill set by a practitioner or parent
which includes observation, interpretation, emotional literacy, assessment of
risk, awareness of the child’s interests and needs, and, ultimately, responsive
intervention. The adult creates a dyad with a child, and he may be allocated an
active or passive role within the play cycle. It is often the case that an adult’s role
fluctuates throughout an interaction and encompasses tentative steps by the
adult and responsive, prompt reaction to the child’s communications.
In 2020, research was conducted that reviewed the understanding of prac­
titioners regarding the play cycle (King & Newstead, 2020). Findings indi­
cated that comprehension was dependent on the source of practitioner’s
knowledge of this cycle and experience in the field. The use of pre-cue as
explanatory for the term “metalude” has been inserted into the discussion by
these authors, and it supports comprehension of the complex processes for
practitioners in the early years and primary sector.

Play flow
Csikszentmihalyi (1975) defined flow as a holistic sensation and associated
this experience with focused involvement in learning. This researcher com­
mented that the term “flow” refers to the consistent nature of a person’s
actions as interactions take place with an environment or other people. This
autotelic experience is led by the person’s motivation in a particular context
which can be related to interests, emotions, curiosity, creativity, and a desire
to gain knowledge and understanding.
There is a significant characteristic of flow which was originally identified
by Csikszentmihalyi (1975) and currently features in practitioner guidance in
the early years and play work. Continuation of the play flow does not need a
reward which is external to the child. The motivation to continue this
experiential learning is driven by the child’s inner working model. Csikszent­
mihalyi (1990) believed that the function of consciousness is for the inner
working model to support each person to make sense of the internal and
external world through use of prior knowledge, understanding, and emotional
reactions. Emotions lead interpretation and contribute to the formation of
perceptions which may differ for each person. A lack of consciousness relates
to an immature sense of self and a child leading his life through the use of
instinct and reflexes.
The flow can be interrupted if the child reflects upon the context, reviews
his capacity, and alters his plan. For example, a child may confidently com­
mence climbing upwards upon a wall frame driven by his internal motivation
which maintains his physical competence. However, if the child stops and
considers the height, danger, and isolation, then these negative interpretations
170 Research, theory, and intervention
can affect or halt the play flow on a temporary or longer-term basis. A child’s
focus upon negative influences can lead to disorder in his inner working
model which affects interpretation of the environment and reaction to stimuli.
An external prompt in the form of encouragement and empowerment from
another person can support the immersion back into the play flow. Csiks­
zentmihalyi (1990) commented that individuals who achieve a flow experi­
ence, despite adversities, demonstrate intrinsic motivation and are not easily
distracted by external influences.
A process that follows flow is differentiation, and integration takes place
throughout the learning experience. The infant or young child has an increase
in capability and skill, and his thoughts and actions are integrated by a spe­
cific focus. The ability to capitalise upon personal skills, in order to maximise
outcomes, depends on a child’s capacity, which relates to his mental health
and emotional status. Comprehension of flow experience highlights the sig­
nificance of infant mental health and the role of adults in supporting well­
being.
Csikszentmihalyi (1990) described happiness in terms of a flow experience
in which each person’s skill set matched available learning opportunities. This
researcher described inner happiness as pertaining to harmony with oneself as
opposed to an individual gaining control over the environment or other
people. An activity is autotelic and becomes intrinsically rewarding and
independent of the social environment. This outcome may occur during a
child’s involvement with the environment and alongside his interactions
towards a planned goal.
Several theorists felt that the sensation and outcome of enjoyment was
characterised by the principle of novelty (Csikszentmihalyi, 1990; Magnusson
& Stattin, 2006). Attention is captured by curiosity, and it is a determining
factor in improving quality of experiences along the continuum of enjoyment.
Csikszentmihalyi (1990) identified major components of enjoyment, and these
aspects are used to evaluate and inform assessment of a child’s well-being and
involvement during intervention. The Leuven Involvement and Well-being
Scales (Laevers, 1994) are commonly used to interpret, to understand, and to
record these issues by practitioners. From the child’s perspective these com­
ponents include:

� Tasks which are achievable by a child using his skill set.

� Identifying clear goals.
� Gaining timely feedback from an attachment figure.
� Experiencing meaningful involvement with an environment that provides
respite from everyday pressures.
� Recognising a sense of control within this environment.
� No requirement for an immediate assessment or concern for safety of self.
� An unusual interpretation of the concept of time. For example, the pas­
sing of minutes may feel like hours, or hours may feel like they have
passed within the usual temporal experience of passing minutes.
 Research, theory, and intervention 171
Additionally, Csikszentmihalyi (1990) identified three sources of support
which a human being can access to deal with stressful situations: social net­
works, prior experience and understanding, and personality. Daily lifestyles
provide opportunities for infants to explore independently, to make autono­
mous decisions, and to experience freedom in investigation and achievement
of self-appointed goals. It is important for all children to feel nurtured within
safe environments which leads to activation of intrinsic motivation. The pre­
sence of an attachment figure is the key to providing a foundation and con­
text for internal stimulation to flourish and to increase resilience to life’s
adversities over time. The rationale is for children to make choices based
upon personal evaluation of an experience as opposed to choices based upon
external influences, for example, peer pressure or attempting to satisfy the
needs of an adult. Csikszentmihalyi concluded by emphasising the impor­
tance of integration, cooperation, and universal flow which allow for indivi­
duality to be expressed.
The flow theory by Csikszentmihalyi et al. (2018) can be used to under­
stand the processes of learning within everyday life and to provide guidance
for working with children. This theory includes the importance of teaching
children to focus upon external stimulation and to minimise their danger
responses to a proximal environment. Learned responses may reflect adverse
childhood experiences and impact upon the child’s attention, retention, pro­
duction, and motivation.

Transitions
The movement from one learning environment to another is recognised as a
significant stage in a young child’s developmental pathway. Transitions are
not solely based upon familiarisation with the new environments but should
primarily consider relationships, the child’s sense of self, and potential change
within a new environment. The relationship is a transitional medium which is
essential to promote good mental health during the integration period. The
rationale for positive transitions is based upon the understanding that a child
should be supported within a secure attachment relationship to leave one area
and to enter a new area. His ability to engage with learning has to be main­
tained and to be enhanced by the new circumstances in order that the transi­
tion has a positive impact upon development. A positive or negative
transition can affect a child’s learning over a long period of time.
The key internal transition between age groups in a service marks an
important stage of development, and it is managed in accordance with the
personal needs and circumstances of each child. There are several aspects to
consider during the transition period. The child’s current, and receiving, key
worker should commence the process by planning the transition period with
parents, and colleagues, in response to the child’s needs. The child’s referral
details are discussed, stage of development, and child’s ability and capacity to
engage with a learning environment. The care plan is reviewed and updated.
172 Research, theory, and intervention
Each child’s personal interests, preferred medium of learning, and preferences
are shared between the appropriate staff members.
The transition is discussed with a parent in a context of information
exchange and collaboration. It is important to remember that the parent is
also experiencing a transition between relationships and environments. The
child is supported to prepare for leaving his current playroom by the use of
photographs, discussion, and joint interactions with the new key worker. The
child is supported to integrate into the new playroom alongside the new key
worker by using a personal photograph, welcome time, opportunities for
small and large group activities, inside and outside, and experiencing snack
time. Similar processes should be experienced by the transitioning parent. A
key strategy is supporting a child and his parent together and to project a
sense of belonging within the new environment through role identity and clear
expectations. Parents are given regular updates during this time and encour­
aged to talk to their child about the transition.
Transitions incur a child coping with the loss of a familiar relationship and
the creation of a new secure attachment relationship. Five areas of develop­
ment need to be considered in a context of transitions between, and within
services. Changes for the child are multiple during this period, and expecta­
tions within each area of development should be established alongside the
relational support. The following information highlights five areas of devel­
opment, expectations of skill sets, and support which is founded on the
attachment relationship.

1 Physical: A new environment invariably requires a child to extend or

adapt his gross and fine motor skills. For example, the transition from
home to a birth-to-2-year playroom or to a 2–3-year playroom presents
many physical challenges to the young child. Tables, chairs, bikes, slide,
trampoline, and small toys for manipulation are a few examples of arte­
facts that require the child to develop a new skill set during engagement
and interaction. A secure relationship can minimise emotional barriers to
the child’s engagement with unfamiliar physical activities and underpin
role-modelling and scaffolding to encourage exploration.
2 Social: A new environment encompasses relationships with different
adults and peers, in addition to new social rules and expectations asso­
ciated with routines and play experiences. Understanding a child’s inter­
pretation and reaction to a social environment informs the practitioner’s
reflective responding skills which facilitates the child’s adaptation and
involvement.
3 Communication: The visual and auditory stimuli within a 2–3-year play­
room are vastly different to the birth-to-2-year playroom and may appear
overwhelming to a young child. Friezes on the walls, and displays on
floors and descending from the ceilings are used to communicate knowl­
edge. The uptake is dependent on a child’s ability to interpret information
in this format. Verbal communication can be challenging to process for
 Research, theory, and intervention 173
the young transitioning 2-year-old. He is presented with language from
adults and peers in many different styles and levels of comprehension.
The secure relationship is used to encourage communication in the child’s
own learning mode.
4 Intellectual and cognitive: Many choices of play items are presented to a
child within a 2-to-3-year playroom. Accessing these artefacts requires the
child to interpret the social rules of play within child-led pedagogy. A
secure relationship can be used to guide the child’s involvement in the
initial stages of transition and to create links to his previous learning
environment. Transition toys may be used to create consistency between
one environment and another and to create a familiar play experience for
a child.
5 Emotional: Behaviour exhibits a child’s knowledge of his world, inter­
pretation at a particular point in time, and his associated emotions.
Desire and motivation to learn are instinctive and activated in a context
of emotional well-being but hindered by anxiety and stress. The child’s
stress should be managed responsively during a transition period. Social
behaviour may be demonstrated at a lower level of development during
the process of transferring from one learning environment to another, as
a child seeks to comprehend the new circumstances and expectations. A
child under duress may regress to display immature behaviours that
reflect influences from previous childhood adversities.

Adversities may have a greater impact during transitions as the child’s

resilience to change can be lowered if he feels vulnerable and he has an
increased level of anxiety. Interactions may indicate immaturity in develop­
ment within the initial transition period. The relationship with a familiar
adult is invaluable to promote emotional stability and mental health at this
time; therefore, creation of secure attachment with a new key worker is sig­
nificant to a positive transition.

Infant mental health: research, theory, and intervention

This book has explored infant mental health and used theory to gain com­
prehension of learning processes. As I complete the final chapter, the COVID­
19 pandemic has entered another period of invasion across our world and
represents a significant adverse childhood experience (Moore & Churchill,
2020). In the findings of the UK Trauma Council (2020), mitigation of these
effects requires training in trauma responses by the professionals who educate
and care for children. All children have potentially been affected by the pan­
demic, and the challenges for early years and primary teachers have
increased. However, the human instinct to learn and to achieve is strong, and
it can transcend adversities if the young learner is encompassed within sup­
portive and responsive relationships.
174 Research, theory, and intervention
The Association of Infant Mental Health, UK (2021) identifies seven
domains as areas in which knowledge, comprehension, and practice should be
developed:

1 Relationship-based practice.
2 Normal and atypical development.
3 Factors that influence caregiving capacity.
4 Assessment of caregiving.
5 Supporting caregiving.
6 Reflective practice and supervision.
7 Working within relevant legal and professional frameworks.

In a professional role, it is essential that reflection on competency considers any

local or specific disciplinary parameters of knowledge and skills for use within
practice. Experience cannot always be tagged neatly or easily to competency
outcomes from a framework. It is often the case that formal support and super­
vision, and informal comments from colleagues or service-users, are the key to
realisation of your own ability and capacity to achieve such outcomes.
It is widely acknowledged that practice strategies for generic teaching, or
within a context of high ability, or responses to children with mental-health
issues, are transferrable to all learners. Walsh et al. (2010) advised that a curri­
culum should be matched to the child’s abilities and applied the term “devel­
opmentally appropriate curriculum”. In order to implement curricula effectively
within an early years services, the educator needs to understand the individuality
of every child in his care. Educational contexts of inclusion and equality require
teachers and early years practitioners to observe, to understand, and to respond
to a child’s engagement and well-being within a learning environment. Compre­
hension goes beyond the child’s daily interactions, and it pays heed to direct and
indirect influences in the form of adverse childhood experiences and protective
factors in the home and community.
Educators, researchers, practitioners, and parents would agree that achieve­
ment of potential should be supported and promoted as appropriate to a child’s
capacity and interests. Observing and understanding a child’s emotions, nurtur­
ing a secure attachment relationship, and facilitating involvement are key aspects
which every educator should strive to achieve. Future practice is dependent on
supporting professionals and carers to notice and to value each child’s interac­
tions, and, importantly, to nurture personal attainment and fulfilment.
A professional-to-parent helping relationship is formed in a context of
unmet needs and a practitioner’s desire and responsibility to respond by
minimising the impact of adversities. These negative influences may be his­
torical or current. Rogers (1990) described activation of the latent inner
resources of a person who is seeking help through a supportive relationship.
This researcher also highlighted a focus upon the sense of self and others
during interactions. Rogers felt that awareness of the inner self created a
healing presence within a dyad, which he identified as a transcendent
 Research, theory, and intervention 175
phenomenon. As the developing person is changing then he is accompanied
by the helper along an emotional journey which is constructed around a
person-centred approach.
Rogers (1990) clarified his understanding of research and practice. The
former provides a forum for reviewing a subjective topic with objectivity, and
the latter provides the subjective experience. The practitioner may use
research findings to extend his knowledge in an area in which he does not
practice or to seek out further information on a particular topic of interest.
Further education often leads educators towards research as a means to for­
ging a career in an unfamiliar specialism.
Sigel (2006) reviewed the practitioner’s need for research, and he identified
an ability to absorb knowledge and to apply understanding to daily work as
necessary steps in the transfer of research findings to practice in the field. The
dissemination of research findings to the workforce may be sourced directly
from the original research, the practitioner may be a participant in an inves­
tigation, or findings may inform local or national training and guidance.
Experiential learning provides practitioners with an essential first layer of
applied knowledge. Our understanding is preliminary in the early stages. Over
time, this interpretation becomes familiar, and we gain a sense of ownership and
a right to be led by our emotions towards comprehension which is based upon
professional skill. This emotional level is superficial, but familiarity with a con­
cept over time, and opportunities to explore which are supported by research as
a framework for learning, lead us towards a deeper understanding. Under­
standing has a subjective element which is based upon our lived experiences and
interpretation influenced by prior learning. However, understanding also
embraces an objective viewpoint which is informed by others and based upon
their experiential learning and research. The outcome is a broad, rich construc­
tion that consolidates and transforms our inner working models.
I believe that each employer and employee has a responsibility to support
the use of research in practice. O’Brien and Mitchell (2021) reported upon the
valuable contribution of early years practitioners to a perinatal mental-health
service in Sussex, England. Findings included knowledge of mental health
from the early years participants and the experiences of services from the
mothers’ perspectives. The report concluded that practitioners were integrated
positively into the mental-health team. Routes for each employee may vary
and should accommodate the needs, abilities, and interests of practitioners.
Practitioners who access generic guidance which is based upon research,
practitioners as participants, or practitioner-researchers, provide rich sources
of knowledge and understanding which are invaluable to developing practice
in any workplace.

Final thoughts
I take time to reflect upon learning from my personal perspective as an early
years practitioner and researcher in the twilight of my career. Reflection upon
176 Research, theory, and intervention
individual and collaborative practice is a common strategy which is applied
on a daily basis to review and to develop implementation of a service and to
justify funding for specific projects (Moon, 2004). Reflection on professional
expertise and comprehension of a field are also mandatory aspects of regis­
tration by an appointed body, for example, Scottish Social Services Council
(Scottish Social Services Council, 2003).
Reflective assessment is one aspect of a learning process that has to be
judged against a standard in order to gain value and to contribute to a fra­
mework for development. Gibbs (1988) promotes a model of reflection which
is used regularly by practitioners in care and education, at times inadvertently.
The model encompasses review of current and past actions, and associated
emotions. This approach is significant to my work context of child protection.
Emotional impact can incentivise educators and support adherence to policy
and procedure, or result in subjective judgement and create a dichotomy
between professional and personal actions. It is essential to gain self-aware­
ness during these processes.
Gaining sense and rationale for our actions is often achieved by consideration
of emotions which can be influenced by our own childhood experiences, culture
of a workplace, or mental health at a point in time. I have always used reflection
for myself as a positive tool in recognising professional skill and areas for devel­
opment. Each person learns from reflection of self and others. Actions are based
upon teamwork, whether directly or indirectly. I feel that it is essential to widen
the reflective scope beyond the individual and to consider the curtailing influences
from strategic boundaries in addition to the freedom within operational skills of
practice. I have learned over the years that strategy binds, and leads, or inhibits
pedagogy and practice. However, practice without strategy and rationale may
appear to liberate the practitioner but diminishes quality due to lack of bound­
aries and direction which can reduce consistency of a desired output.
The parent and infant form an interdependent dyad in the earliest stages of
life which is influential throughout the lifespan. Effective professional–parent
relationships are essential for the development of both generations and to
enable sensitive interpretation and responses to needs, emotions, and mental
health. The COVID-19 pandemic has resulted in many emotive conversations
being conducted outside service buildings in cold, wet, and challenging
environments. I feel humbled by the trust and respect which parents bestow
upon teams. We have all quickly adapted to COVID-19 regulations, and
strategies can be effective if responsive to need. It is important to notice, and
to capitalise upon, help-seeking overtures from parents.
The pandemic has certainly increased professional understanding of
empathic relationships and infant mental health. It is clear that the human
need for relationships continues to be at the forefront of our daily existence. A
therapeutic alliance can be created in any environment and can facilitate the
learning and development of parent and child.
A study published in 2021 reviewed 40 family intervention programmes
from the USA, Australia, UK, Sweden, Netherlands, Canada, Denmark,
 Research, theory, and intervention 177
Finland, and France (Lagdon et al., 2021). Findings indicated that 25–50 per
cent of the children whose parents had a mental-health issue experienced a
psychological disorder during childhood or adolescence. Subsequently, 10–14
per cent of these children received a diagnosis of psychotic disorder during
childhood or adulthood. This study also links parental mental-health issues
and child abuse, as published by previous authors (Cleaver et al., 2011;
Finkelhor et al., 2015). The investigation concluded that a universal definition
of family-focused practice would encapsulate key strategies and rationale. Addi­
tionally, despite a consistency of components across the 40 studies, and within
each country, greater emphasis on engagement with local community supports
was recommended by the authors.
Change which is embedded within a family and local community encom­
passes factors of sustainability, and positive long-term outcomes. A valid
response to infant mental-health issues is joint working between adult
mental-health services and children’s services. Strengthening the links
between research, theory, and practice, in a context of change and develop­
ment of family units would upskill the workforce in this field. Researchers,
practitioners, and parents are key contributors to supporting infant mental
health.

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Index

ability 127–128 Balbernie, R. 18–19

abuse 16, 21, 33, 37–39, 47, 83, 89–90, Bandura, A. 82
99, 124, 129–133, 135, 176; sexual 19, Barab, S. A. 141
66, 99 Barlow, J. 53, 156
acceleration 143–144 Barton, J. 135
achievement of potential 5, 16, 116, Beebe, B. 23–24, 47, 53–54
155, 174 Beeghly, M. 21, 71, 102, 107, 117–118
additional learning needs 128–130 behaviour management 70
ADHD see attention-deficit/hyperactivity Belsky, J. 64–65, 111, 156
disorder Benjamin, L. S. 159
adolescence 2, 52–53, 62, 88–89, 114, 176 Berens, A. E. 15
adrenalin 6, 115 Bergen, D. 127, 129–130, 133
adversities 5–6, 11, 19, 21, 23, 43–47, 52, Berlin, L. J. 156
58, 62, 69–72, 88–118, 124, 133, Berman, M. 137
135–136, 138, 158, see also individual Bernier, A. 143
adversities bio-ecological systems theory 9
aggression 8, 39, 52, 89, 133–135 birthweight 100, 158
Ainsworth, M. D. S. 39 Blechman, E. A. 80
Aitken, K. J. 2, 63–64 Blumenfeld, P. C. 123
alcohol use 11, 58, 89, 111, 134, see also body language 16–17, 29, 32, 35, 41–42,
substance misuse 46, 76, 112–113, 116
American Heart Association 21 bonding 29–32, 47
animals 83 books 7, 72
anxiety 30–31, 33, 35, 37–38, 47, 50, 59, borderline personality disorders 50, 91
62, 69, 77, 88, 92, 98, 100, 124, 135, boredom 77
173; separation anxiety 28, 34 Bowlby, J. 5, 36, 139, 144, 150–152
apathy 21, 103 Bowles, N. 69
Asmussen, K. 43, 47, 58, 72, 109 Boyce, W. T. 43, 47, 52–53, 88, 114
Association of Infant Mental Health 174 Braun, D. 159
asynchrony 75 Bremner, J. D. 129, 133
attainment gap 11, 58–61, 156 Bronfenbrenner, U. 10, 89, 153–154,
attention restoration theory 136–137 157–158, 160–162
attention-deficit/hyperactivity disorder Brown, A. M. 135, 140
130, 132, 137–138 Brown, D. 77–78, 117
attunement 29 Bucharest Early Intervention Project
autobiographical memory 123, 141 47, 157
autobiographical self 22, 52, 61, 70, 90,
140–141 Cain, D. J. 158, 160
autoimmune disease 6 capacity 138–139
182 Index
cardiovascular disease 6 differentiation 58, 75–76, 92, 124,
care routines 18, 23–24, 30, 37 162–165
CARE-Index 39 Dismukes, A. R. 10–11
Cassidy, J. 54 disorganised attachment 2, 37, 39, 54, 65
Centre on the Social and Emotional divergent thinking 143–146, 166–167
Foundations for Early Learning 23 domestic violence 11, 14, 50, 71, 89, 115
chaotic attachment 31–33, 37, 39, 62, Donnelly, R. 9
91, 159 Down’s Syndrome 128–129
Chichekian, T. 117 Doyle, C. 33, 157
child protection 16, 20, 44, 46, 69, 89, drug use see substance misuse
154, 156, 160, 162, 176 Duffy, M. 154
childbirth 1–2, 8; Caesarean section 30
child-led pedagogy 130 early years environment 103–107
chronic obstructive pulmonary disease 6 eating disorders 50
Cicchetti, D. 102, 157 Edwards, N. A. 82
Circle of Security 28, 32–33, 55 Effective Provision of Pre-school
Clemens, V. 158 Education Project 61
Coates, D. 98 El Nokali, N. E. 118
complexity 92–94 emotional intelligence 68
Condon, J. T. 52 emotional literacy 12–13, 42, 59, 82, 91
containment 29–30 emotions 2, 11–14, 18–23, 39–42, 46, 49,
continuous professional development 3, 138 52, 59, 64, 66, 68–69, 81–82, 95–98,
convergent thinking 143, 145–146 102, 108–109, 111, 115, 118, 124,
coping mechanisms 36–37, 138, 152, 172 131–134, 141, 154
Corkindale, C. 52 empathy 24, 33, 38, 40, 46, 66–67, 73, 80,
Corraliza, J. A. 138 94, 102, 134, 159, 176
cortical atrophy 135 enrichment 143–144, 163–165
cortisol 13, 15–16, 20–21, 37, 59, 95, environmental influences 47–50, 70–75,
99–100, 116 150, 153–155
counselling see therapy epigenetics 10–11
COVID-19 pandemic 3, 8–9, 18, 20, episodic memory see autobiographical
33–34, 46, 51, 59, 66, 74, 83–84, 89, memory
96, 100, 109–110, 113–114, 128, 154, ethnic origin 8
164, 166–167, 173, 176 evaluative thinking 143, 146
creativity 35, 92–93, 101, 107, 112, experience-dependent stage 1, 14–15,
122–127, 141–146, 161, 163–167, 169 122, 134–135
Crichton, J. A. 54 experience-expectant stage 14–15
criminality 19 eye contact 8, 17, 22, 28, 31–32, 39,
Csikszentmihalyi, M. 75–77, 122, 142, 41–42, 49, 63, 71, 97, 112–113, 151
144, 169–171
cultural parenting practices 6, 12–13, 19, Facebook 138, 154
22–23, 50, 53, 64, 142, 154 factual memory 123
Fall, M. 82
dance of reciprocity 23 Family Nurse Partnership 19, 88
Davis, K. L. 53 Farmer, E. 33
defence mechanisms 131 fatigue 83–84
delayed development 8–9 Fidler, D. 122, 128–129
demand characteristics 160–162 filial therapy model 81
depression 6, 21, 50, 52–53, 64, 88, 92; Fisher, P. A. 19
perinatal 7; postnatal 2, 8, 30, 47, 53, Flake, J. K. 75–76, 140
107–108 flow theory 58, 75–78, 122, 142, 171
developmental processes 58–84, 157–158, focus of attention and practice 162–163
see also individual processes foetal alcohol syndrome 89
diabetes 8 Fogel, A. 12
 Index 183
Fonagy, P. 28–29, 31–32, 36–37, 54, 10–11; intervention 19–24, 39–43, 51,
90–91 79–81, 155–157; neural development
food banks 8, 100 4–5, 14, 93–94, 125, 132; perinatal
Fosha, D. 125 2–4, 7, 9–10, 17, 50, 70, 108;
foster care 11, 47 promotion and prevention and
Fraiberg, S. 110 intervention; relationships see
Freeman, J. 125–126, 140 relationships; social development
Freshwater, D. 67–68 17–19, 22, 65; theory 9–10, 150–176;
Fukkink, R. G. 51 three principles of 24; understanding
1–3
genetics 1, 11, 43, 47–50, 52, 70–75, 96, Infant Mental Health Competency
157–158, see also epigenetics Framework 1
Getting It Right for Every Child 20 International Association of Infant
ghosts in a nursery 110–113 Massage 54
Gibbs, G. 176 intervention 19–24, 39–43, 51, 79–81,
Gottfried, A. E. 78 155–157; targeted interventions 6–7,
grandparents 19, 33, 52, 66, 73, 95, 110, 91–92, 155
142, 161 IQ tests 126
green spaces 135–138, 166–167 isolation 11, 19, 65, 115
Gross, J. J. 131–132, 152
Jawer, M. 136
Hart, H. 124, 132 Jennings, K. D. 22
Harter, S. 140–141 Jones, A. 69
Head Start programme 19
Healthy Child Programme 55 Kaplan, S. 136–137
help-seeking behaviour: of infants 37, Karpiak, C. P. 159
153; of parents/carers 19–20, 66, Kayal, N. G. 142
69, 162 Keys to Interactive Parenting 39
Herman, J. P. 83 King, P. 139–140, 167–168
Hetherington, K. 110 kinship care 11
heuristic play 165 Kreppner, K. 79
hierarchy of needs 30 Kuo, F. E. 137
high ability children 125–127, 129,
143–144, 150, 158 language development 12, 22–23, 72,
High Scope programme 19 101–102
Hochschild, A. 66 Larrieu, J. A. 23
Hogg, C. 66 Lave, J. 160
Hogg, S. 156 Lazarus, R. S. 152–153
Holmes, J. 69–70 learned helplessness 16–17
housing 9, 19, 65, 100, 110 Leuven Involvement Scale 42, 170
Howe, D. 31, 39–42 Lieberman, A. F. 80–81
Howe, N. 145–146 living conditions 50, 67
hypervigilance 54, 92, 108, 135, 140 Lloyd, B. 145–146
hypothalamic–pituitary–adrenal (HPA) Louv, R. 135–136
axis 6, 115 low birthweight 100, 158
Luby, J. L. 21
impoverished self 141 Lyon, H. 67
infant massage 54 Lyons-Ruth, K. 49
infant mental health: ability, capacity
and creativity 122–146; adversities and Magnusson, D. 155
stress see adversities, stress; definition marked mirroring 28–30, 36, 50–51,
of 2; developmental processes 58–84, 59–60
see also individual processes; early Maslow, A. 30
stages of development 6–9; epigenetics McClelland, J. L. 99
184 Index
McClure, V. 54 parents/carers: cultural parenting
McCoach, D. B. 75–76, 140 practices 6, 12–13, 19, 22–23, 50,
McCrory, E. J. 38, 114, 133 53, 64, 142, 154; father’s role 8;
McQueen, A. 68 help-seeking behaviour of 19–20, 66,
meaning making 107–109 69, 162; mental health issues of 14, 40,
memory 93–94, 97, 123–125, 133, 146, 176, see also mother’s mental health;
153, 158 parenting responses 69–70; parenting
Mikulincer, M. 152–153 role 64–66; parenting skills 18–19, 23,
Milot, T. 109 40, 43, 51, 60, 65, 89, 113, 116, 141,
mindfulness 46, 143 156; youth of 9, 48–49, 89, see also
mirroring 28–30, 36, 50–51, 59–60 relationships
Mitchell, C. 175 perinatal mental health 2–4, 7, 9–10, 17,
Mohr, J. 54 50, 70, 108
Montag, C. 53 Perry, B. 122, 133–135
Montessori, M. 61 personality 7, 14, 23, 30, 65, 73, 80,
Moran, P. 159, 161 93, 157
Morris, P. A. 158, 160–162 photographs 8, 17, 51, 59, 111–113,
mother’s mental health 3–4, 21; postnatal 127–128, 141, 152, 172
depression 2, 8, 30, 47, 53, 107–108 plasticity, neural 7, 11, 41, 47, 53, 65, 70,
motivation 64, 73, 75–79, 89, 140–141, 94, 157
143, 155, 157, 166, 171 play cycle 139–141, 150, 167–169
motor skills 103–104, 127, 129, 164, 172 play flow 167, 169–171
play therapy 33, 42, 81–84, 91, 132
Nagy, A. V. 154 Plucker, J. 141
Nagy, V. 154 Plutchik, R. 64
National Centre for Infant and Early Pollak, S. D. 131
Childhood Health Policy 3 postnatal depression 2, 8, 30, 47, 53,
National Scientific Council on the 107–108
Developing Child 142, 150–151 post-traumatic stress disorder 95, 154
nature-deficit disorder 135–136 poverty 9, 11, 19, 65, 89, 100, 115, 158,
neglect 39, 53, 95, 99, 109, 131, see also stress (economic)
133–135, 156 practice, examples from 8–9, 17, 45–46,
Nelson, C. A. 15 48–49, 59–60, 63–64, 73–74, 105–107,
Nermeen, E. 143 111–113, 136–137, 144–145, 164–165
neural development 4–5, 94–96 pregnancy 1–5, 7–10, 52, 70, 92, 111,
NHS Education for Scotland 2 see also perinatal mental health
NHS England 3, 55 prematurity 23, 100
Nicholson, S. 167 Pretty, J. 135
Nurse–Family Partnership 19 problem-solving 23, 73, 98, 101, 104,
nursery 8, 17–18, 34, 41, 51, 59, 63–64, 128, 142, 145–146, 152, 165–167
69, 94, 130, 142, 144–145, 161, 166 promoting attachment 96–97
nurturing environment 51–55 psychopathy 2, 43, 52, 62, 70, 99

O’Brien, R. 175 racism 100

observational learning 165–166 Rathunde, K. 142, 144
Ochsner, K. N. 131–132 Ray, D. C. 82, 132
O’Hara, L. 111 reciprocity 28–29, 31
Ohly, H. 136 reflective assessment 176
O’Leary, C. 43–44, 46 reflective functioning 29–30, 32, 50
Owen, M. 33 Reis, S. M. 127
oxytocin 4, 30 relationships 1–3, 7–8, 28–30, 94–97, 150,
153–154, 157, 174; bonding 29–32, 47;
Panksepp, J. 64, 130 Circle of Security 28, 32–33, 55; and
Parent–Infant Observation Scale 39 creativity 142–143; disorganised
 Index 185
attachment 2, 37, 39, 54, 65; mirroring Siegel, D. J. 92, 94, 96, 123–125
28–30, 36, 50–51, 59–60; nurturing Sigel, I. E. 175
environment 51–55; relationship dyad Silverman, L. 71, 75
33–34; role-modelling 12, 14, 20, 29, 32, Simpson, J. A. 156
43, 47, 51, 65, 81, 90, 132, 138, 167; singing 13
sensitive responding 36–38; separation Siraj-Blatchford, I. 61
anxiety 28, 34; transitions 38–39, see Slade, A. 3
also parents/carers sleep 6, 15–16, 21, 40, 49–50, 71, 74, 99,
Renzulli, J. S. 126–127, 141 113, 116, 123, 135, 155
resilience 11–14, 21, 114 Sloan, H. 9
responsive practice 109–110 Smith, L. B. 127–128, 161
Ritzi, R. M. 132 Smith, P. 67
Robinson, C. 135 social address model 150, 155
Roedell, W. C. 117, 122, 129 social development 17–19, 22, 65
Rogers, C. 58, 66–68, 158–160, 174–175 Solihull Approach 28, 32
Roisman, G. I. 125 solitary play 145–146
role-modelling 12, 14, 20, 29, 32, 43, 47, Spencer, M. B. 161
51, 65, 81, 90, 132, 138, 167 Sroufe, A. 33–34, 51–53, 58, 62
Rosenblum, K. L. 23 Stanford-Binet test 126
Rothschild, B. 99 Stattin, H. 155
Royal College of Midwives 29 Steele, M. 47, 53–54
Rubia, K. 124, 132 Stern, D. N. 79, 83, 138
Runco, M. A. 146 Stickley, T. 67–68
Ruskin, E. M. 128–129 still children 16
Ryecraft, J. R. 154–155 Strange Situation 39
strengths-based approach 24, 79
Sadler, L. S. 3 stress 5–6, 15–17, 19–21, 23, 31, 34, 38,
scaffolding 51, 78, 101, 104, 118, 122, 43, 54, 65, 83–84, 92, 95, 98–100,
129, 142, 163–164, 167, 172 108–109, 116, 124, 130, 135, 151, 158,
Schechter, D. S. 23, 108 173; brain’s reaction to 98–99; cortisol
schizophrenia 50 13, 15–16, 20–21, 37, 59, 95, 99–100,
Schore, A. N. 97 116; economic 7–8, 19, 21; pre-natal 4;
Scottish Perinatal Mental Health PTSD 95, 154; signs of 15–17, 54;
Curricular Framework 1, 3 toxic 5–6, 16, 19–21, 47, 65, 71,
screen time 7, 15–16 108–109, 114, 116, 131
security 7, 18, 23, 28, 30–33, 37–38, 43, Sturrock, G. 139, 167–168
51, 65, 72, 83, 90, 93, 95, 125, 130, substance misuse 11, 14, 50, 58, 71,
153, 156–157, 174 89–90, 111, 134
self-regulation 12–14, 22, 34–35, 42, Svanberg, P. O. 53
51, 53, 62, 65, 82, 94, 97, 109, 115, sympathomedullary (SAM) system 6, 115
118, 131 synaptic cleft 4
self-talk 13 synaptogenesis 4–5, 14, 93–94, 125, 132
sense of self 12–14, 18, 22–24, 33, 37, 39,
46, 50–51, 53, 58–65, 70, 75–76, 79, Tal, C. 150, 154
88, 90–91, 102, 110, 117, 123, 129, targeted interventions 6–7, 91–92, 155
136, 140–141, 169, 171, 174 Tausch, R. 67
sensitive responding 36–38, 156 Taylor, A. F. 137
separation anxiety 28, 34 Taylor, I. 163
sexual abuse 19, 66, 99 Teicher, M. H. 99
Shaver, P. R. 152–153 Temple, S. 140
Shonkoff, J. P 6–7, 9, 19, 108–109 Thelen, E. 127–128, 161
Shore, B. M. 117 theory of development 157–158
siblings 7, 14, 33, 39, 43, 82–83, 142, therapy 33, 42–47, 70, 79, 92–93, 96, 105,
158, 161 124, 130, 132, 135, 157–160; play
186 Index
therapy 33, 42, 81–84, 91, 132; Vaivre-Douret, L. 70–72
therapeutic relationship 66–69 videos 42, 47, 51, 83, 111, 113, 138
Thompson, S. F. 7, 12–13, 20, 22 voice, validation and hope model 110
time-dependent 122, 134–135 Vygotsky, L. S. 77, 100–102, 105,
Tomasello, M. 35 107, 117
Toth, S. L. 102
Tourette’s Syndrome 129 Walsh, R. L. 162–163, 174
toxic stress 5–6, 16, 19–21, 47, 65, 71, Warne, T. 66
108–109, 114, 116, 131 Wechsler Intelligence Scale 126
transitions 38–39, 51, 171–173 Weiss, L. 118
trauma 8, 15, 38, 41–43, 49–50, 52, 60, Wenger, E. 160
62, 80–82, 91, 97–98, 109–110, 124, Whalen, D. 21
133, 154, 157–158, 173; PTSD 95, 154 Witherington, D. C. 54
Trevarthen, C. 2, 51, 63–64, 114 World Association of Infant Mental
Tronick, E. 21, 71, 102, 107, 117–118 Health 9
Tyndall-Lind, A. 82
Zeanah, C. H. 1, 3
UK Trauma Council 173 Zeanah, P. D. 1, 3, 24
Ulrich-Lai, Y. M. 83 Zero to Three taskforce 9, 155
Underdown, A. 54 Zhou, M. 77–78, 117, 140
United Nations Rights of the Child 20 zone of proximal development 101, 118