3 Infancy, Toddlerhood, and Preschool 75Why are some parents better able to provide empathic care that meets
the developmental needs of the infant/child? Factors such as social isolation,
poverty, and stress can combine with factors such as lack of knowledge of
child development and parental mental health challenges such as maternal
depression to inhibit the caregiver’s ability to accurately perceive and respond
to the emotional, social, and physical needs of the developing child thereby
creating a context of risk and vulnerability for the child. These factors limit
the caregiver’s ability for “reflective function,” or the capacity of the parent
to “understand that her own or another’s behaviors are linked in meaning-
ful, predictable ways to underlying mental states, to feelings, wishes, thought
and desires (Slade, 2002, p. 11). Sensitive, attuned, reflective parenting helps
the child to “make meaning of feelings and internal experience and states of
psychophysiological arousal associated with feelings without becoming over-
whelmed and shutting down” (Slade, 2002, p. 11).
Affective disturbances, such as maternal depression, have been shown
to increase vulnerability in the developing child (Tronick & Reck, 2009).
Children of depressed mothers have higher rates of developmental vulnerabil-
ity as indexed by impairment with the regulation of behavior and attention,
increased rates of childhood depression and higher rates of other externaliz-
ing and internalizing disorders (Center on the Developing Child at Harvard
University, 2009). Longitudinal studies have also shown that children of
depressed mothers have lower rates of secure attachment, less well-developed
social skills and more difficulties with school readiness and peer relationships
(Ashman, Dawson, & Panagiotides, 2008).
Vignette One: Maternal Depression and Infant Withdrawal
Jennie is a 5-month-old infant, born somewhat small for her gestational age
into an economically stressed family. Jennie appears small for her age but more
importantly, somewhat withdrawn from human interaction, lethargic, and not
socially responsive to cues from her family members. Jennie’s mother also has
low energy levels, seems disinterested in interpersonal interaction, and speaks
very little. Jennie’s mother says that she is the “best baby” because she can stay
“by herself” for “hours at a time” in her crib and while there, makes “no noise.”
Vignette Two: Maternal Depression and Infant Anxiety
Eddie is a physically healthy, 12-month-old infant of a depressed mother. Born
full term and neurologically intact, Eddie showed no signs of developmental
delay or impairment in the first 6 months of life. Recently, Eddie has shown a
marked decrease in human interaction and playing with toys. When observed,
Eddie is quiet, making few movements and not exploring toys; he is preoc-
cupied with searching his mother’s face. Eddie’s mother has been clinically
depressed for the past 6 months following episodes of intense marital conflict
now culminating in an impending divorce. Eddie’s mom has become preoc-
cupied and less available for interaction with Eddie, labile in her moods and
affective expression. Eddie, in turn, is more withdrawn and shows little expec-
tation for shared positive affect with his mother. Eddie has begun to show
signs of anticipatory anxiety as he stares at his mother’s often flat or blank