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Webwords 35: November 2009
Wednesday's Child
Caroline Bowen |
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Monday's
child is fair of face,
Tuesday's child is full of grace,
Wednesday's child is full of woe,
Thursday's child has far to go.
Friday's child is loving and giving,
Saturday's child works hard for a living,
But the child born on the Sabbath Day,
Is fair and wise and good and gay. Mother Goose |
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Beautiful Val was uncontainable when
she brought four year old Timothy to his Wednesday speech
appointment several weeks ago. Interrupting constantly with peals of appreciative laughter
- in response
to her own witticisms and asides - she disrupted the session
to the point that persisting was futile.
"Oh God, I'm terrible,
terrible, terribly terrible" she
chortled unrepentantly, flicking her perfectly coiffed hair
with impeccable, fluttering French Tips. "I promise to be good next time.
Best behaviour." Even in this loud, agitated, witty
state there was something brittle about her. A needy,
vulnerable fragility.
She switched topic unexpectedly,
exploding into song to the tune of I'm getting married in
the morning, "I'll make a motza minta money, when I buy those fresh food people shares;
pull out the stopper, let's have a whopper! But get me to
the Broker on time!" The melody changed to a familiar
supermarket refrain. "Oh! Woolworths the fresh food people,
get me to the Broker on time." She stopped. "Would Woolies be one ell or two? Two would be a jumper,
wouldn't it? Warm woollies from Woolies. My English Dad always talked about his woollies. Winter
woollies. Tepidus vestio;
valde tepidus ornatus -
he was a Classics scholar,
you know! Latin, Greek, Hebrew, not Yiddish. Anyway, with
those shares I'll be a rich wo-MAN." New tune. It took
me back to 1976, Fiddler on the Roof , and my
unforgettable first encounter, as a speech-language
pathologist, with a family in which the mother had a
mental illness. I remembered her name, and the child's, and the
father's. Alison and Lindsay, and Ben aged three. And there
was a baby.
"If I were a rich man,
Ya ha deedle deedle, bubba bubba deedle deedle dum.
All day long I'd biddy biddy bum.
If I were a wealthy man.
I wouldn't have to work hard.
Ya ha deedle deedle, bubba bubba deedle deedle dum.
If I were a biddy biddy rich,
Yidle-diddle-didle-didle man."
Timothy looked at me imploringly with
a face that said, "Make her stop!"
"Do you know what the midwife said
to my Dad when I was born? She told him I was strong and
healthy, and he said, 'then she shall be called Valerie'."
"Is that what Valerie means?"
"Well, yes, in Latin, but
obviously, OBVIOUSLY, it's a joke, a nonsense..."
shrieked Val. "A paradox, a contradiction, an absurd and
illogical inconsistency, a cruel and ironic joke...a mad
misnomer...oh God, you know...with my mental health
issues...you know, iss - youse...are youse
having iss - youse?"
She continued talking and singing
incessantly, ideas and neologisms flying, as worried, over responsible
little Timothy propelled her out
the door. I wondered about his mental health,
now and
in the future. |
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A
STATE OF WELL-BEING
Mental health is defined in the section of the
WHO web site devoted to such matters as a state of
well-being in which every individual realizes his or her own
potential, can cope with the normal stresses of life, can
work productively and fruitfully, and is able to make a
contribution to her or his community. Elsewhere on the web,
in dictionaries and encyclopaedias it is described as a
state of emotional and psychological well-being in which an
individual is able to use his or her cognitive and emotional
capabilities, function in society, and meet the ordinary
demands of everyday life.
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FULL
OF WOE
The following week saw a different Val, medicated to
the hilt. Still beautiful, with that indefinable frailty,
the French Tips had been gnawed to nothing, the hairdo
was awry and she drooped into the room - a picture of
defeat. Timothy, hair lank and knotted, clothes grubby and
breath sour, followed her closely: casting sad, apprehensive
eyes around the room, slumping into a chair,
bearing his unpredictable world on his shoulders.
Wednesday's mother; Wednesday's child. "Mine Nan
bring me d-nuther day. Mine Nanny Sylvia. Mummy go hos-pul get better again.
Mummy come back." He hugged himself for reassurance. "Yes,"
she said expressionlessly to herself, self-absorbed, without
looking at him or at me. "I'll be back."
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TOGGLING BETWEEN WINDOWS
Timothy and his grandmother arrived bright and early the following week, both
bandbox fresh, enjoying each other's company. Sylvia and I were
probably both thinking that this was the fifth time we had
met and that each time was because Val was having treatment. The first time had been when
Timothy presented initially as a non-verbal two year old.
Sylvia explained that Val would be bringing him to therapy
in due course, but not for a while because she had
postpartum depression and wasn't up to it. Surprisingly, in rapid succession over just eighteen months,
Val's psychiatric diagnosis had been changed to
chronic depression and then, soon after her
husband left and filed for divorce,
bipolar disorder. She was in and out of
hospital repeatedly, and, as she put it, "Toggling between
windows". When I asked what she meant she responded that
life, frankly, for her was either at a distance, through a window
on the world clouded by mood stabilizing medications and
deep malaise, or up close and extreme. The view from this
second, exciting window was intensified by manic mood swings
and (usually) a refusal to medicate.
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MATERNAL DEPRESSION
The incidence of depression in all women is reported to be
between 10 and 12%. This figure skyrockets to at least 25%
for low income women. Exposure to maternal depressive
symptoms, whether during the prenatal period, postpartum
period, or chronically, has been found to increase
children's risk for later cognitive and language
difficulties (Sohr-Preston & Scaramella, 2006). Indeed,
depression is a significant problem among both mothers and
fathers of young children. Intriguingly it has a more
marked impact on the father's reading to his child (as
opposed to mothers' reading) and, subsequently, the child's
language development (Paulson, Keefe & Leiferman, 2009).
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Classically, depressed mothers are seen as "under
stimulating", being less involved than well mothers, or
inconsistently nurturing with their children (Field, 1992).
They have been found to:
- initiate parent-child
interactions less frequently than non-depressed mothers
and not get as much pleasure from them;
- talk less to their infants;
- have reduced awareness
of and responsiveness to their infants' cues;
- rarely, if ever, use child
directed speech ("parentese");
- be slow to respond to their
children's overtures for verbal or physical interaction;
- make overly critical comments
and criticise more frequently;
- show
difficulty in fostering their children's speech and
language development;
- experience trouble asserting
authority and setting limits that would help the child
learn to regulate his or her behaviour; and
- find it hard to provide
appropriate stimulation.
By contrast,
some depressed mothers interact excessively, over
stimulating their infants and causing them to turn away.
Whether under or over stimulating, these mothers are not
responding optimally to their infants' cues or providing a
suitable level of feedback to help their children learn
to adjust their behaviour. Additionally, there is evidence
to show that the children of depressed mothers mirror their
mothers' negative moods and are overly sensitive to them
(Goodman & Gotlib, 2002). Some mothers envelop their
children in an inappropriate closeness and
over-identification with their own moods. Children who are
preoccupied with and invested in the reactions of their
mothers, fathers or other caregivers may not learn to seek
out comfort or accept consolation or reassurance when
they need it. As a result, their own activity and ability to
express emotion may not develop adequately. |
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ANOTHER
STORY
Of course it is impossible to
predict how the story of Val and Timothy will unfold, but
hopefully it will not be as tragic as the 1976 story of
Alison, Lindsay, Ben and the baby. When Alison brought Ben
for a speech assessment the three weeks old baby, there in a
corner in a carry cot, had not been named. I was concerned
when Alison told me dully that she had not had the energy to
talk to Lindsay properly about a name for "it", and the
perfunctory, disinterested way she dealt with the tiny
infant's survival needs. She told me she would be all right
when the
baby blues had passed, as they had done months after
Ben's birth. But this was more than the blues, it was more
like postpartum depression. She was off her food, wasn't
sleeping, was irritable with intense angry outbursts, and
overwhelmingly tired. As the weeks passed she told me that
she was not bonding with "it" (Jessica) and that she was
having troubling fantasies about harming herself and the
baby. At the time I shared rooms with a psychiatrist, and a
meeting with him for Alison and Lindsay was quickly
organised. Once on medication she seemed better, but still
something was
not quite right. Towards the end of Ben's therapy block
Lindsay rang to cancel his last three appointments,
explaining that they had had "a family calamity". I left the
door open, not daring to guess what the calamity was. When
Ben resumed his intervention there was no Alison and no
baby. She had smothered the infant and taken an overdose. |
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JUST SIMPLY ASK
Debriefing was hard. The
psychiatrist said I had done the best one could do by
facilitating the referral, and I told him I knew he had done
all he humanly could. It was unsatisfactory and sad. His
advice to me at the time has been integrated into practice
over several decades. "Ask," he said, "When you take
a history, ask each Mum, or Dad, or other primary caregiver
who accompanies new clients, as a matter of routine, about
his or her state of mind. Don't try to look for tell-tale
signs or red flags in a history. Just simply ask."
This good advice is to be had
everywhere in the Internet era on a wide range of web sites.
It can be found in the U.S. Preventive Services Task Force
(2009) recommendations for the routine screening of adults
for depression, where health professionals are advised to
ask two basic questions that may lead to appropriate
referrals:
1. "Over the past two weeks, have you felt
down, depressed or hopeless?" and
2. "Over the past two weeks, have you felt little interest
or pleasure in doing things?"
If an adult client
answers "yes" to either or both questions they should be
referred, according to the Task Force, to an appropriately
qualified professional in the mental health field to be
guided through an in-depth questionnaire to rule depression
in or out.
The panel did not
make a comparable recommendation for (or against) routine
screening of children (7 to 11 years) and adolescents (12 to
18 years) for depression, citing a
lack of evidence about the reliability and efficacy of
such tests in youngsters.
Speech-Language Pathologists
working with young children should know that a loss of
interest in play is a red flag that a child of three to six
years of age is depressed, and that two other major warning
signs are sadness and irritability (Luby, et al.,
2003). |
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REFERENCES
Field, T.
(1992). Infants of depressed mothers. Infant behavior
and development, 18(1), 1-13.
Goodman, S. H. & Gotlib, I. H. (2002)
(Eds.), Children of Depressed Parents: Alternative
Pathways to Risk for Psychopathology, Washington, DC:
American Psychological Association Press.
Luby, J. L., Mrakotsky, C.,
Heffelfinger, A., Brown, K., Hessler, M., & Spitznagel, E.
(2003, June). Modification of DSM-IV Criteria
for Depressed Preschool Children, American Journal of
Psychiatry, 160,1169-1172.
BRIEF REPORT
Paulson, J. F., Keefe, H. A., &
Leiferman, J. A. (2009). Early Parental Depression and
Child Language Development, Journal of Child
Psychology and Psychiatry, 50(3), 254-262.
ABSTRACT
Sohr-Preston, S. L. &
Scaramella, L. V. (2006). Implications of Timing of
Maternal Depressive Symptoms for Early Cognitive and
Language Development, Clinical Child and Family
Psychology Review, 9(1), 65-83.
ABSTRACT
U.S.
Preventive Services Task Force (2009). Screening and
Treatment for Major Depressive Disorder in Children and
Adolescents: U.S. Preventive Services Task Force
Recommendation Statement. Pediatrics,
123,1223–28. |
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LINKS
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ACQ
ACQ (ACQuiring Knowledge in Speech, Language and
Hearing) is Speech Pathology Australia's clinical and professional
journal. It provides a forum for the 4,000 members of the association, and is
published three times a year in February/March, June/July and October/November. Each issue of ACQ
has a main theme or topic as well as articles that are not tied to a
particular subject area. Its Internet
column, Webwords, usually addresses the central theme of the issue of ACQ
in which it appears. You can find
Webwords in print in the magazine itself, and also here
on this site, with live links to featured resources. |
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Page updated
Tuesday, 23 March 2010
http://speech-language-therapy.com/webwords35.htm
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COPYRIGHT
©
Caroline Bowen ALL RIGHTS RESERVED
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