[1].

In this part, we’re going to look at the last piece of pertinent information—viewing the difficult infant as a ‘plastic’ infant—and then finishing with a look at what we can do going forward.

The Difficult Child as the ‘Changeable’ Child

There’s a wonderful article by Drs. Jay Belsky and Michael Pluess on the misconception we tend to have about individuals we label as “at-risk” as being only sensitive to the negative that there is in the world or their environment[2]. That is, for years, we’ve viewed certain temperaments (like the difficult temperament) as being simply more prone to experience certain events more negatively. Heck, I even alluded to such research in the bit on Attachment Parenting – after all, infants who are difficult are more likely to be insecurely attached for whatever reason is behind it. But what we have failed to consider when adopting this view is that it may not be that these individuals, or in this case babies, are simply more influenced by the negative, but that they are more “changeable”. These are the individuals who will experience an adverse environment and fall lower than most, but who also may fly higher than most when given an enriching environment. As written in the paper as the tenet of this differential-susceptibility hypothesis:

[T]hose putatively “vulnerable” individuals most adversely affected by many kinds of stressors may be the very same ones who reap the most benefit from environmental support and enrichment, including the absence of adversity. (p. 886)

In this paper, Belsky and Pluess review the literature on the topic with respect to the “difficult” child, and it’s not scarce. The findings show that children with sensitive, responsive parents not only fail to show this vulnerability to negativity, but can do better. For example, one study found that these difficult children who had sensitive, responsive mothers were more moral than those with mothers who used power-assertion techniques[3]. In fact, the difficult children who had low power-assertion parents at 22 months scored the highest on the moral self at 56 months. The interaction looks like this:

This is the type of interaction that causes Belsky and Pluess to argue that we should not view these difficult children as being only “at-risk” but rather more malleable than their easier counterparts.

While not discussed in the Belsky paper, the aforementioned work by Megan Gunnar and colleagues also demonstrated a similar interaction with respect to cortisol activation during a physical exam and inoculations. I previously mentioned that the highest cortisol reaction was in children who were difficult/high fear and who had insecure attachments, but even more interesting is that the difficult/high fear children who had secure attachments showed the lowest cortisol increase, suggesting they were the least stressed out of the entire group. Again, the interaction looked as follows:

The point here is that these children are not just at-risk for negative outcomes, but if nurtured and cared for in a loving, gentle way, they are the kids who will thrive. They are the ones whose environment plays a large role in the person they will grow up to be.

What Do We Do?

What does this mean? Beyond the obvious fact that certain people are more likely to have a “difficult” baby based on their own behaviours and attitudes, it should highlight the fact that it may be possible to change this. And even when it isn’t possible (because we all know there are difficult babies who are just, well, difficult, regardless of parenting assumptions and beliefs), we need to make sure we still provide these children with an environment that leads to a secure attachment because that will help them immeasurably.

In line with the previous article on abuse and parenting (see here), mothers who were known to abuse their children responded more aversely to the cries of a child than those who did not abuse their children[4]. Given that this aversive reaction can be found prenatally, it may be used to identify those who are at a higher-risk for abuse and allow for greater education prior to the birth of their child. Many women today feel anxiety about child rearing because they have so little experience with what it entails. Their only experience is from their own parents, which is probably why we see the transmission of attachment across generations[5]. One way to fix this and to help women (and men) feel more confident in their parenting abilities is to increase people’s exposure to children prior to having their own because without that exposure many parents have insufficient experience to overcome any deleterious effects of their own upbringing and also can end up with unrealistic expectations of their children which only make matters worse. I’m not sure how practical this is though, so at the very least we need to change people’s expectations about what it is to have a child. Too many people go into parenting expecting their life to remain close to it is, but with a little person who will sleep when you want them to and only eat when you want them to. Yes, you might get a little sleepy, but by and large, they should be able to resume many aspects of their life and that’s just not the case. If these are your expectations, anything other than that will seem “difficult”, and many people will then respond with even harsher parenting techniques to try and get that child to fall into line with these insane ideas of parenthood.

I imagine this may explain the difference between the securely and insecurely attached infants. The securely attached, difficult infants are probably the babies that are truly “difficult” by nature (or because of some as-yet discovered reason), but their parents went into this whole parenting thing with appropriate expectations. By having appropriate expectations, they’re able to parent these children with love and compassion, knowing that holding their children more and not leaving them to cry-it-out are exactly what these kids need to feel secure. And we see in research that these “difficult” kids can absolutely thrive when paired with parents who provide this environment.

It also may be possible to help families simply by having them employ certain attachment parenting practices. I draw this conclusion based on the success of cognitive-behavioural therapy (CBT) in dealing with anxiety and depression (two of the biggest predictors of poorer parenting behaviours). In CBT, there is no Freudian examination of why we behave the way we do, the focus is on tackling the symptoms with the knowledge that sometimes you have to “fake it to make it”. Someone’s depressed? You tell them to go out. Anxious? Face the fear head-on (via exposure). Now this is obviously a simplified view of therapy, but the essence remains and works quite well for these types of disorders. How? Well it’s not entirely clear, we know hormones play a role and in the case of attachment and the difficult child, the closeness between mother and child should promote the release of oxytocin and other positive mood-inducing hormones while suppressing the more negative mood-inducing hormones. This can help the attachment and potentially work to reduce the anxiety and depression that certain mothers face. In short, we have to try and get more parents on board with developing secure relationships with their children however it’s done. This will not only benefit the child (as we’ve seen), but can hopefully help the mother in handling the problems that may lead to these psychological states to begin with; after all, oxytocin is a very powerful hormone.

Finally, I truly believe we need to be very careful about the blaze attitude our society has about many parenting practices, notably things like cry-it-out and the reduction of touch. We are constantly told that there is no harm to infants to employ these harsher parenting techniques (yes, they are harsh, and for my own response you can see What You Need to Know About Crying-It-Out), and while I will admit that the damage may not be strong universally (kids are resilient; though I believe there is harm each and every time because of the messages being sent), if done with the wrong child, it can be devastating. Are you willing to risk your child’s moral development or cause your child to endure greater stress responsivity in certain situations? I don’t believe many parents are. But only when we get beyond the notion of every difficult child being unchangeable and of the importance of being loving and caring when change doesn’t happen will we be able to convince parents that these methods are not worth the risk they pose.

[1] Gunnar MR, Brodersen L, Nachmias M, Buss K, Rigatuso J. Stress reactivity and attachment security. Developmental Psychobiology 1996; 29: 191-204.

[2] Belsky J, Pluess M. Beyond diathesis stress: differential susceptibility to environmental influences. Psychological Bulletin 2009; 135: 885-908.

[3] Kochanska G, Aksan N, Joy ME. Children’s fearfulness as a moderator of parenting in early socialization: two longitudinal studies. Developmental Psychology 2007; 43: 222-237.

[4] Frodi A. When empathy fails: aversive infant crying and child abuse. In B Lester & Z Boukydis (Eds.), Infant crying: Theoretical and research perspectives (pp. 263-277). New York: Plenum (1985).

[5] Benoit D, Parker KCH. Stability and transmission of attachment across three generations. Child Development 1994; 65: 1444-1456.