What’s Going on in a Child’s Mind?

Imagine that your 3-year-old child is observing a scenario where his/her friends Sarah and Mary are hiding a rock underneath a blue or red cup. While Mary is looking, Sarah places the rock underneath a blue cup; however, as Mary looks away, Sarah switches the rock to underneath the red cup. If Mary is prompted to choose which cup the rock is underneath, which colored cup will she select?

Will your child understand that because Mary was not looking while Sarah changed the rock’s location, Mary will incorrectly believe that the rock is underneath the blue cup? If so, then congratulations– your child has developed theory of mind! If not, do not worry; most children do not develop theory of mind until they reach the ages of 4 and 5 [9]. At this point, you are probably wondering this: what exactly is theory of mind, and how does this theory relate to my child’s growth and development?

The first experiment to support the existence of theory of mind was conducted by Wimmer and Perner in 1983, and the framework of the experiment they used– now called the false-belief test– was similar to the hypothetical scenario that I described above. Theory of mind is the ability for individuals to understand that others may possess mental states (such as beliefs, intents, and perspectives) that vastly differ from their own. This lends to an individual’s ability to decipher another person’s thoughts, feelings, and intents, which will then contribute to his/her ability to successfully navigate social situations [9]. Thus, in reference to the hypothetical scenario described above, a child who has yet to develop theory of mind will mistakenly believe that Mary will know the rock’s correct location because he/she knows rock’s correct location. In other words, he/she will believe that Mary shares the same beliefs as him/her.

What are signs that your child is well on his/her way to developing theory of mind? Here is a list of behaviors your child should be exhibiting during infancy and childhood:

• Nonverbal communication such as imitation and reciprocity (looking, smiling, and smiling back are indicators of a baby’s natural sense of empathy with his/her mother) [2]
• Attention to the emotional expressions of others [8]
• Ability to verbally identify emotions as “sad” or “happy” and understand both the causes and consequences of emotions [8]
• The ability to differentiate between direct and averted gaze [6], though an infant is unable to make explicit judgments regarding direct versus averted gaze until around 3 years [5]
• The ability to use nonverbal hand gestures such as pointing [3]

By the ages of 4 and 5, most children will be able to understand that different people have qualitatively different thoughts and feelings pertaining to the same thing. Additionally, they are able to comprehend that people can hold false beliefs, and others may not overtly display their emotions and instead choose to hide them [7]. The absence of these insights is called mind-blindness and is often associated with developmental delays or neurodevelopmental disabilities such as autism spectrum disorder [1].

Like many other developmental milestones, theory of mind is the result of a complex interaction between neurodevelopment and (social) environment [8]. Thus, parents can engage in activities to encourage the development of theory of mind. An example milestone that ensures that your child is on track for developing theory of mind is mentioned within our BabyNoggin app: grown-up pretend play, which should be reached between the ages of 29 and 31 months. Pretend play encourages children to take part in scenarios that exercise their ability to take on a mindset that is separate from their own. Check out our BabyNoggin app (link to download BabyNoggin app here) to gain access to fun developmental activities you can do with your child!

If you suspect that your child is not developing theory of mind at an appropriate age, please visit your local pediatrician in order to gain further insight into your child’s developmental trajectory.

Remember, early detection and intervention are key to mitigating the effects of developmental delay and reducing the need for costly interventions over time [4]. At BabyNoggin, we  have specially developed the BabyNoggin app in order to aid you in tracking your infant’s major milestones and detecting any developmental abnormalities, thus giving you the power of early detection in the palm of your hands!

REFERENCES

[1] Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind. Cambridge, MA: The MIT Press/Bradford.

[2] Baron-Cohen, S., & Cross, P. (1992). Reading the eyes: Evidence for the role of perception in the development of a theory of mind. Mind Lang, 7, 172–186.

[3] Camaioni, L., Perucchini, P., Bellagamba, F., & Colonnesi, C. (2004). The role of declarative pointing in developing a theory of mind. Infancy, 5, 291–308.

[4] Centers for Disease Control and Prevention. (2015). Facts about developmental delays. Atlanta, GA.

[5] Doherty, M. J., & Anderson, J. R. (1999). A new look at gaze: preschool children’s understanding of eye-direction. Cog Dev, 14, 549–571.

[6] Farroni, T., Csibra, G., Simion, F., & Johnson, M.H. (2002). Eye contact detection in humans from birth. Proc Natl Acad Sci USA, 99, 9602.

[7] Korkmaz, B. (2011). Theory of mind and neurodevelopmental disorders of childhood. Pediatric Research, 69, 101–108.

[8] Westby, C., & Robinson, L. (2014). A developmental perspective for promoting theory of mind. Topics in Language Disorders, 34(4), 362-383.

[9] Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: Representation and constraining function of wrong beliefs in young children’s understanding of deception. Cognition, 13, 103-128.

Why Parent Empowerment is Key: A Story for Pediatricians and Providers

The following is a guest post from www.preemieworld.com written be CEO, Deb Discenza

As a NICU team worked to keep my 30-weeker preemie daughter Becky alive in her 38-day stay in the Neonatal Intensive Care Unit (NICU), I find myself struggling with so many emotions.  Intermixed with guilt was extreme pride in my daughter fighting the good fight but also a huge amount of fear.  Would she make it home?  If she did, would she walk?  Would she talk?  Would she have a normal life?

That was 2003 but I remember this like it was yesterday. 13.5 years later I have watched my daughter work through numerous diagnoses, get tons of therapy and more.  This did not unfold as I would have expected it to, with the pediatrician running developmental checks and making suggestions.  The reality is, my kid tended to run under the radar on so many levels. She compensated beautifully but to this Mom’s eye – something was not right.  I ended up focusing on the pediatrician as a link to resources but I made sure that I was the one vocalizing any concerns and making it incredibly clear I wanted help.  Even then, I found that unless the doctor was familiar with a particular condition, it was not something that he was really eager to focus upon.

So while you think that the Pediatrician is going to be your go-to for developmental checks, let me warn you otherwise.  This is just not the case.  Pediatricians are generalists which means that they are there to make sure your baby is doing well in “general” terms.  They have so many checklists to check for various issues health-wise/development-wise that everything happens in a very hurried fashion.

So who is key to your child’s development?  YOU.  You are key.  You are around your child more often than anyone else and you pick up on things that seem off, am I right?  Yes.  Listen to your gut instinct, listen to your inner voice. It will not fail you.  And by all means act on any concerns . . . now.

So what happened with my daughter?  Here is a quick timeline:

• In the NICU for 38 days and came home on medical equipment.  Did not qualify for Early Intervention based on our state’s guidelines for severity of delay.  On the discharge paperwork were two options:  1) Local Health Department Infant Monitoring Program and 2) NICU Follow-Up Program.  I signed my daughter up for both.
• At 18 months the health department team suggested we get our daughter evaluated by Early Intervention. She was not walking, barely talking, and had a major feeding issue.  She got into Early Intervention at 19 months old and had speech, occupational therapy and physical therapy throughout 7 months and was then discharged.
• At 32 months, and prior to preschool I had Early Intervention out again for an evaluation to see if there were any other issues to be aware of before her 3rd birthday.  She got the all-clear.
• At age 3, Becky entered preschool and at my repeated request to her teacher I asked that she be “proactive and not reactive” if there were any concerns because Becky was a premature baby. She told me not to worry and that all preemies catch up by age 2.  I repeated my request again and she heard me out.
• At Becky’s first preschool parent/teacher conference 6 weeks later, the teacher walked into the room and started our conference with “You obviously know more about this than I do.” She proceeded to tell us our daughter was not speaking in class and suggested we reach out to ChildFind Preschool for an evaluation.  I was so grateful she had heard me.
• Months later Becky was given a label of Developmental Delay and had a Preschool Resource Teacher assigned to her case through the rest of preschool.  She had an Individualized Education Plan (IEP) from here forward.
• As my daughter transitioned into Kindergarten I met with the elementary school’s IEP team.  With 10 people around the table, I told them that I felt my daughter was doing well in Kindergarten but that something wasn’t right. I went on to explain numerous challenges and the team heard me out.  It was the school psychologist who responded with, “Does she look you in the eye?”  I was stunned.  Yes, she did look me in the eye.  However, apparently she did not look anyone else in the eye.  After testing by the school and a neuropsychologist, Becky was diagnosed with Autism Spectrum Disorder (ASD) and her new IEP reflected that.
• In 2nd Grade at a well-check appointment with the pediatrician, I pushed for an ADHD discussion.  The pediatrician had experience in this area and heard me out.  He felt that we needed a couple of appointments to settle a diagnosis.  With one appointment, he quickly diagnosed her and I walked out with a prescription to trial on our daughter.
• In 3rd Grade, I felt that something still wasn’t right and decided it was time to take my daughter to a Developmental Pediatrician to make sure we had not missed anything.  Becky’s gross motor skills had always been a little off.  We walked out of that appointment with a diagnosis of Developmental Motor Coordination Disorder (DCD).  Becky entered a year of therapy for that plus sensory issues.
• In 5th Grade and in having my daughter work out with a personal trainer for ongoing physical fitness and overall coordination, I noticed during one session that her ankles were reacting kind oddy on the elliptical machine.  The trainer suggested orthotics and ultimately we ended up at an Orthopedic Surgeon for a prescription.  These helped and we moved on from there.  While at the appointment I specifically asked the doctor about the potential for my daughter to actually have Cerebral Palsy (CP).  The doctor looked at her walk and run and heard me out.  She said that it is possible but that if it was CP it was very mild.  No diagnosis, no treatment.  We moved on from there.
• This year, in 7th grade, I had to take Becky back to the Orthopedic Surgeon for a re-scrip of the orthotics.  I didn’t think twice about asking again because I assume there were no more concerns.  The doctor had Becky do the usual routine of walking up and down the hallway barefoot and then running down the hallway.  Her run had actually gotten worse.  As the doctor had Becky sit on the examination table and check my daughter’s range of motion, she asked me all sorts of questions about Becky’s premature birth and the NICU stay as well as development.  She then flexed one of Becky’s feet and said, “See her foot lock up?  That is spasticity.”  I nearly choked as I said “So are we now diagnosing …?”  She said yes.  We walked out of the office with a diagnosis of mild spastic diplegia.  My daughter is currently undergoing Physical Therapy, about to start night braces and if that doesn’t work there could be serial casting, Botox injections, and heel cord surgery in her future.

Supporting families as I do on the Inspire Preemie Community (https://preemie.inspire.com) tens of thousands of parents worldwide, my story is not uncommon.  BabyNoggin will give you the tools you need to assess your baby’s development in private ongoing and help you walk into the doctor’s office with confidence as you request assistance with referrals and more.

How is Becky doing today?  With all of that therapy, my daughter is doing extremely well in school, has friends and is thriving on many levels.  This did not come easy.  But it started with my starting to trust my instinct and to start asking questions and doing my research.

STRENGTHENING YOUR CHILD’S EARLY MATH ABILITIES

What is Dyscalculia?

Mathematics is part of the core programing of the world. Children across the world have some understanding of the underlying connections of math. Some of the early concepts children learn through the exploration of their world include patterns, sequences, sorting, comparing, and classifying [2]. Sometimes connections are not made correctly. Dyscalculia (aka math learning disability) is a type of learning disability that affects how an individual processes, comprehends, and learns math facts. About 1 in 20 people have some degree of math learning difficulties [6]. When recognized early, you can help your child develop good math skills and prevent/reduce math anxiety. Researchers at the University of Missouri have identified some key early math skills children should understand before the first grade: the number line and how to place numbers on the line; understand numbers and quantity; and breaking complex problems into smaller parts [5].

Below are some activities you can do with your baby to encourage math exposure.

1. Shape toys and puzzles

Did you know that poor visual- spatial reasoning is linked to dyscalculia [4]? Matching shapes is a common assessment of visual perception as it utilizes visual- spatial reasoning to recognize form consistency [4]. At around 2 years, children should be able to match shapes: same size and orientation, different size and orientation [4].  Since babies learn best from hands-on experiences, shape toys and puzzles are a great way for your baby to gain experience with pairing like shapes together.  Matching games can also help develop reasoning skills.

2. Manipulatives (Blocks, cars, etc )

As your baby learns to count, they will start explore the meaning behind numbers; by 4-5 years, your child should understand the logical concept of numbers under 10 [2]. Manipulatives such as blocks or toy cars offer a hands on experience of the concept of numbers. One study found that students who start elementary school with a difficulty with one-to-one correspondence went on to being diagnosed with math learning disability by fifth grade [1]. An example of this is “printed number 3 represents 3 dots on a page” [1]. Blocks allow your baby to stack and count the sequence. When playing with your baby, ask them how many blocks there are in their tower. Point to each one and count with them.

3. Flashcards and picture books

Those with dyscalculia have difficulty with being able to immediately name something that is presented to them, known as rapid automatized naming [7]. This task utilizes our working memory by retaining the visual information in order to either name or learn the name of the object [7]. To strengthen your baby’s working memory, use flashcards of colors, shapes, or animals and help them pair the names with each. Also, when reading to your baby, point to the pictures and say the name of the object.

What you can do and what to look out for

Although many of the learning disabilities aren’t noticeable until your child starts school or learning math, it is never too early to help foster good math skills. Try the example activities above to help your child gain exposure to basic math concepts. As they grow older, find ways to make math fun; this will help keep math anxiety at bay. Play math related games with them or take them to a tech museum for kids to show them the amazing things that can be done with math.

When your child reaches preschool and elementary school, some common signs and symptoms that you can look out for include difficulty in understanding concepts of place value, fractions, and number lines [3]. Also look out for avoidance of math and noticeable difficulties [3]. Math literacy is important in all aspects of life and skills carry over to different stages of life. Although it cannot be completely assessed until elementary school, you can still aid your child in developing a good number sense. Remember to make math fun!

REFERENCES

[1] Bock, R. (2011, October 25). Math disability linked to problem relating quantities to numerals. Retrieved December 8, 2015, from http://medicalxpress.com/news/2011-10-math-disability-linked-problem-quantities.html
[2] Davis, G., & Keller, J. (2014, May 1). Mathematics Development. Retrieved December 19, 2015, from http://www.education.com/reference/article/mathematics-development/
[3] Dyscalculia. (n.d.). Retrieved December 6, 2015, from http://ldaamerica.org/types-of-learning-disabilities/dyscalculia/
[4] Mazzocco, M. M., & Thompson, R. E. (2005). Kindergarten predictors of math learning disability. Learning Disabilities Research & Practice, 20(3), 142-155.
[5] Psychology study finds key early skills for later math learning. (2011, July 11). Retrieved December 8, 2015, from http://medicalxpress.com/news/2011-07-psychology-key-early-skills-math.html#nRlv
[6] Wilson, A. (n.d). What is dyscalculia? Retrieved December 8, 2015, from http://www.aboutdyscalculia.org/dyscalculiamain.html
[7] Willburger, E., Fussenegger, B., Moll, K., Wood, G., & Landerl, K. (2008). Naming speed in dyslexia and dyscalculia. Learning and Individual Differences, 18(2), 224-236.

Why I Started BabyNoggin: A Personal message from Founder & CEO: Dr. Jin Lee

As the first product of Qidza, BabyNoggin was born out of a personal need.

Soon after I said “I do” to my best friend and partner, we started planning for kids.

My husband asked, “Hon, when will the baby start seeing me?”

“Well, at birth they can only see in black and white. It’s not until about 3 months that they see in color and not until 6 months that they see as vividly as we do.” I replied with a smile, proud to find use for that Oxford PhD in my personal life.

“What about being able to crawl to me?”

“Ehhh, I think it’s about 8 months?” Pause. “I’m actually not sure.”

“What if our baby doesn’t crawl until much later? How soon should we worry?”

Silence.

I was amazed that I, who once supervised Oxford medical students in developmental neuropsychology, could forget such a simple fact. And if I, with all my education, can’t keep track of these milestones, then how do parents do it?

So I chatted with friends who have young babies and asked them for tips and tricks on monitoring early baby development. Their answers were consistent:

“I just record the big events on my calendar, like when he starts crawling or walking.”

“And what if he doesn’t start walking until much later?” I was curious.

“Well, I wait ‘til my mommy-feeling tells me that something is wrong and then call my baby’s doctor.”

While I fared well under my own parents’ intuition and guidance, there has to be a better way to help today’s parents anticipate a baby’s next milestone, check for development, and follow-up with “actionable insights” – additional training activities and health care advice, if necessary.

At Qidza, we understand that every baby develops differently. The BabyNoggin team stays current on the relevant and peer-reviewed science. We translate the science into easy and clear instructions on your smartphone and prompt you with fun activities tailored to your baby’s age and ability. We know you are doing your best and a great job taking care of your little one. BabyNoggin is with you, every step of year one.

Our mission is to give you peace of mind when it comes to your baby’s development. Join us in this mindful parenting movement and track your baby’s development.

Thank you for joining,

Dr. Jin Lee
Founder & CEO, Qidza, Inc.

WHAT SHOULD YOU DO WITH YOUR BABY’S SLEEP HABITS?

What are parents to do when their infant has repeatedly woken them up every night for months on end? Do they attend swiftly to every cry or should they simply let them “cry it out?” This dilemma has sparked many impassioned debates amongst concerned parents. Some argue that babies thrive on attention and affection and by neglecting your child you are doing them harm. Others counter that by weaning babies off constant attention you are allowing the child to develop some form of independence while, at the same time, affording yourself some semblance of sleep which is critical to proper parenting. There are valid points to be said on both sides of the arguments with a variety of studies pointing to conflicting evidence. Here we will try to explore all aspects of each side of the debate in order to offer some guidance to any torn parent who is just trying to do the best thing for their child.

The building of independence of the crying child is at the root of this debate. What fosters it best? Letting them come to it in your baby’s own time while you attend to his or her needs with love and affection or letting him or her learn to deal with a situation on their own? Those on the “pick up” side claim that parents who quickly attend to the needs of their bellowing baby build a sense of self-confidence for their child.[1] Their child sees themselves as worthy of love because of their parents’ fast responses to their cries. This builds the confidence required to be independent. Another study found that the “crying it out method” may lead to a baby crying less often throughout the night or for shorter intervals and that their levels of cortisol, a stress hormone, were higher than normal.[2] High levels of cortisol can be inhibitory to healthy brain development.3

The “crying it out” method was pioneered and recommended famously by Dr. Richard Ferber. It is a sleep training technique meant to help babies fall asleep without parental aid. It involves breaking sleep associations through gradually not engaging in the activities that your baby usually needs to fall asleep such as continuous nursing or rocking. Proponents of this method claim that it builds independence for children through learning how to self-soothe. However, the method also raises questions about whether it is producing enough distress to cause long-term damage to the infant. Numerous studies, though, have provided contradictory results to this notion showing that children who were recipients of sleep training techniques were not at an increased risk of psychological, behavioral, or emotional disorders at age six in comparison to their non-sleep trained counterparts.[4],[5] Another study found that babies who had to wait longer for their parents to intervene at 3 months of age turned out to be better self-soothers at 12 months of age.[6] It is possible that the lack of intervention allows babies to figure out the best way to fall asleep which could translate into important skills later on in life such as dealing with anxiety and stress.

Both sides of the debate offer compelling claims with evidence from numerous sources. The “pick up” method may not be doing any harm to a baby’s path to independence, but it appears that the “cry it out” method won’t either. “Picking up” your baby may help you to have more bonding time with them, but at the same time minimizing your intervention throughout the night may allow you to get more sleep. Getting adequate sleep as the parent of an infant may seem like an impossibility, but it is something to strive for. This is because it allows you to make better decisions which is critical as a parent.[7]

We recommend you to look analytically at both sides and try to choose what is best for the temperament of your child and of course take into consideration your lifestyle. Please comment below the style that has worked for you! We would love to hear your story.

REFERENCES

[1] Stein, Judith A., and Michael D. Newcomb. “Children’s Internalizing and Externalizing Behaviors and Maternal Health Problems.” J Pediatr Psychol Journal of Pediatric Psychology 19.5 (1994): 571-94.

[2] Wendy Middlemiss. “Infant Sleep: A Review of Normative and Problematic Sleep and Interventions.” Early Child Development and Care 174.1 (2004): 99-122.

[3] Gerhardt, Sue. “Why Love Matters: How Affection Shapes a Baby’s Brain.” Infant Observation 9.3 (2006): 305-09.

[4] Price, A. M. H., M. Wake, O. C. Ukoumunne, and H. Hiscock. “Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial.” Pediatrics 130.4 (2012): 643-51.

[5] Hiscock, H. “Randomised Controlled Trial of Behavioural Infant Sleep Intervention to Improve Infant Sleep and Maternal Mood.” Bmj 324.7345 (2002): 1062.

[6] Burnham, Melissa M., Beth L. Goodlin-Jones, Erika E. Gaylor, and Thomas F. Anders. “Nighttime Sleep-wake Patterns and Self-soothing from Birth to One Year of Age: A Longitudinal Intervention Study.” J Child Psychol & Psychiat Journal of Child Psychology and Psychiatry 43.6 (2002): 713-25.

[7] Harrison, Yvonne, and James A. Horne. “The Impact of Sleep Deprivation on Decision Making: A Review.” Journal of Experimental Psychology: Applied 6.3 (2000): 236-49.