ACQ_Vol_11_no_3_2009

Mental health

Clinical insights A good start to attachment: The Story Telling and Rhyme Time (START) group Lisa Dyer

The START group aims to develop the protective life skills of good communication. Through story, song, and rhyme “at risk” families cement the parent-child relationship and promote healthy social emotional development. By increasing caregivers’ awareness of infant development the START group, supporting the development of caregiver-infant interaction, fosters attachment, communication skills, and global development. T he Story Telling and Rhyme Time (START) group evolved in the corridors of the Cranbourne Integrated Care Centre in the City of Casey, 45 kms south east of Melbourne’s CBD. With 146 new residents moving into the area each week, Casey is one of the country’s fastest growing municipalities (as of 2006 census, www.casey.vic. gov.au/demographics). Understandably, the workload of maternal and child health nurses has grown exponentially in recent times and through their partnerships with Child and Adolescent Mental Health Service (CAMHS) and Community Health (CH), a growing number of “at risk” mother–infant dyads – that is, dyads presenting with attachment disorder, post natal or general depression, lower socioeconomic status, babies of low birth weight or perinatal complication, and/or infants/toddlers who have been abused (Baker & Cantwell, 1987) – have been referred to post natal depression self-help groups or Parent and Infant Relationship Support(PAIRS) groups. It was observed by CH that a proportion of these infants presented for speech pathology services at 2 or 3 years of age. The question was raised “Had we missed the boat?” The World Health Organization’s Report on the Social Determinants of Health emphasises the role of early intervention to reduce the risk of disadvantage (Wilkinson & Marmot, 2003). With this in mind, the idea of a group that would support the mother–infant relationship while enhancing the carers’ language enrichment skills at a very early age was born! The START group, a multi-faceted program, draws on a range of existing programs including The Parent–Child Mother Goose Programme ® (2003; http://www.nald.ca/ mothergooseprogram/), Keys to Caregiving ® (NCAST-AVENUW; http://www.ncast.org/), and Parent Child Interaction Teaching Scales (NCAST, 1995; http://www.ncast.org/), and taps into the literature supporting the crucial link between early attachment and development. Speech pathology has

long been aware of the critical period for language development – birth to four years of age. It is well established that the first two to three years of life are considered vital for developing emotional control and set the foundations for competence and coping skills, elemental to learning and health throughout life (McCain & Mustard, 1999). Attachment describes the affective bond between an infant and a primary caregiver (Bowlby, 1988). Through healthy attachments the infant learns to respond in socially acceptable and flexible ways, demonstrating a range of appropriate spontaneous reactions and emotions. By 6 to 12 months of age infants have usually learnt to elicit a desired response from their caregiver (Cooper, Hoffman, Marvin, & Powell, 2001). The relationship between early attachment, emotional regulation, language development, and cognitive development has become increasingly clear (Van IJzendoorn, 1995). Van IJzendoorn’s meta-analysis revealed that (i) the quality of parent infant attachment is strongly associated with language development and (ii) insecure attachment is more often associated with lower cognitive functioning and language competence. Insecure emotional attachment and poor stimulation are thought to lead to: restricted school readiness, low educational attainment, problem behaviour, and increased risk of social marginalisation in adulthood (Wilkinson & Marmot, 2003). Early attachment is dependent on many factors including the primary caregiver’s mental health. Field (1995) found that 3-month-old infants who detected depression in their mothers demonstrated developmental delays at the age of 1. Interestingly, “treating mothers’ depression, even successfully, is not in itself sufficient to change the mother– child relationship, or the mother’s negative view of the child” (Forman, O’Hara, Stuart, Gorman, Larsen, & Coy, 2007, p. 507). In contrast, interventions designed specifically to improve a mother’s sensitivity to her infant’s communication have been successful, particularly with low-risk samples (e.g., van den Boom, 1995). Focusing on just one aspect of parenting behaviour is likely to have less effect upon the overall parent–child relationship (Egeland, Weinfield, Bosquet, & Cheng, 1999), suggesting that partnerships between services such as CAMHS and CHS with a holistic approach are more likely to effect change. The START group, a weekly program over two months, is facilitated by two speech pathologists, one each from CAMHS and CH. Up to eight caregivers and their infants attend. Pre and post interviews provide outcome measures based upon the results of the Communication and Symbolic Behavior Scales™ (CSBS) Infant Toddler Checklist (Wetherby & Prizant, 2001), which screens early language and symbolic

Lisa Dyer

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ACQ Volume 11, Number 3 2009

www.speechpathologyaustralia.org.au