Importance of attention and emotion regulation for optimal brain development 

Active experience shapes the infant brain

Infants acquire new abilities and skills through active experience; they learn by doing. 

Importantly, brain development is promoted when infants and toddlers engage in intentional, goal directed actions: they know what they want and use all their available resources to achieve their goal. 

The quality and quantity of infant learning from experience is shaped by: 

• The opportunities for learning that present themselves during the infant’s day
• The way in which the infant engages with each new opportunity, including sustained attention and persistence in pursuit of their goals. 

Temperament and infant learning 

Active infants with an easy going temperament are alert, curious, and eager to explore their environment and find new ways of doing things and achieving their goals. They are persistent and will keep trying despite repeated failure and take great pleasure when they succeed.

Infants who are good at exploring their environment and finding ways to achieve their goals, are also good at controlling their state of alertness and emotional response to challenges and novelty.  They o make good use of their capacity for focusing and shifting their attention in a way that supports their goals.

Infants and toddlers who are cautious or fearful (known as an inhibited temperament) are less willing to try out new things, get easily distracted or distressed, request help as soon as a task is challenging and are generally less active than their temperamentally more easy going peers.

Inhibited infants who display fearful and very cautious behavior usually have poor attention skills and are less able to moderate their negative emotional responses. Their behavior is highly reactive, they are readily upset and often take time to calm down and recover from their distress. They often have poor emotion regulation abilities. 

Autism and infant learning

Infants at risk for autism often have difficulties with attention and self-regulation. In particular they have difficulties with anticipating and predicting what happens next. They may also have difficulties integrating information from different sources,so that what they see and hear and feel can become disjointed and incoherent. To cope  and achieve some sense of stability infants start may engage in repetitive behaviors which are predictable and feel safe. 

Emotion regulation in infancy 

Emotion regulation includes "the strategies, behaviors, skills and strategies, whether conscious or unconscious, automatic or effortful, that serve to modulate, inhibit, and enhance emotional experiences and expressions." (Calkins 2012) The regulation of emotion is considered to be strongly associated with attentional control. 

Infants and toddlers encounter many situations that require emotion regulation: when they encounter unfamiliar and unpredictable circumstances, when they are restrained and cannot move freely, when they are over-stimulated, frustrated because they cannot get what they want, when a favorite toy is removed, when mommy leaves them alone with an unfamiliar person. 

Infants with poor motor skills object to lying on their tummies because their movement are restricted.

Very young infants depend on their caregivers to help them manage their emotional responses: we use pacifiers, holding, rocking, singing to moderate the infant's negative arousal and distress. We recognize when they have become over-stimulated and remove then from the situation.  At other times we help infants to moderate their distress by using distraction in an effort to get the infant to shift attention to something that is interesting and non-threatening. 

Over time infants develop their own self-calming abilities: they seek out pacifiers and comforters to self-comfort, they learn to select where they focus their visual attention (looking) and, importantly, they learn to shift their attention away from events or situations that they find threatening or over-stimulating.  

They learn to manage frustration and to employ different strategies to get what they want. 

Infants around 10 months show a big shift in their ability to regulate their emotions: this happens at about the same time that the new connections are forming between brain regions (known as the executive attention network) that control the ability to select between different and competing internal and external information, including thoughts, feelings, and behavioral responses, as well as inhibit inherent tendencies to approach or avoid a situation. 

How infants learn to use attention to moderate their emotional responses 

Attention is typically defined as achieving and maintaining an alert state, orienting to sensory events, and controlling thoughts and feelings (Posner & Fan, 2008). Attention is guided by three attention networks in the brain which support different aspects of attention.

Alerting is the most basic aspect of attention and describes the state of wakefulness and arousal. It is present from birth.

Orienting refers to the ability to respond to interesting and novel events in the environment, to select which information to pay attention to, as well as the ability to disengage attention from one set of stimuli and shift it to another source of information.  

The very young infant's attention is captured by interesting and changing events in the environment. This early orienting is still quite reactive and the infant has a limited ability to select what sensory events get their attention or to shift their attention once it has been captured. 

At  18 weeks Toesies has well developed attention skills: playing with a suspended toy allows him to explore the toy with his hands in a sustained manner which build the connections between the brain areas that link what he sees, does and feels.

Sustained attention refers to the ability to maintain attention on a task in a flexible manner.

As the orienting network matures and becomes more effective, the infant's ability to select, disengage and shift their focus of attention improves.  These improvements, along with improved ability to maintain an alert positive and adaptive state of arousal, allows the infant to engage in activities for longer periods of time. 

Executive attention involves mechanisms for evaluating and choosing between internal and external information, including conflict among thoughts, feelings, and behavioral responses (Rueda, Posner, et al., 2005).

This ability to choose between competing drives, such as those originating in the emotional brain (approach and avoidance tendencies) and the desire to achieve a goal and respond to the environment, allows the infant use attention to regulate emotional tendencies. 

Joint attention refers to the infant's ability to coordinate their looking (focus of visual attention) and actions with that of a social partner.  

Executive function refers to a set of cognitive (thinking) abilities that support all forms of learning: they include working memory, inhibitory control, cognitive flexibility. 

How infants use attention to guide behavior

From birth infants have a well developed ability to shift their attention to interesting and changing events in their environment, an ability that is supported by the orienting response. 

Infants turn their heads towards new sounds and turn to look at bright, moving objects.  Their attention also get caught by talking, smiling faces.  

In the early weeks an infant's attention may be hooked by busy and attention demanding visual scenes and they are not able to turn away, and respond with distress.  

The ability to control how and where to focus attention improves over the first months so that by 3-6 months infants have a well developed orienting system that allows them to select where to look, as well as to disengage and shift their attention to another aspect of the environment. 

When an infant pays attention to an interesting event,  the alert infant will moderate his/her arousal level,  the heart rate slows down and movement is reduced. In other words paying attention has a direct effect on the infant's arousal level and is one way in which infants gain control over their emotional reactivity. (Swingler 2014). 

Over the first few months infants also learn to focus their attention in a more sustained manner. The will watch events unfold in their environment and start to learn about the cause-effect nature of the physical world, and how events can be predicted by paying attention to how one event follows another. They hear mommy's voice and expect her to appear. They associate barking with the dog.  

Many studies have shown the link between an infant's ability for sustained attention and better emotional regulation and executive function as the child gets older. Over the next few years the toddler and preschool child's attention abilities start to support executive functions needed for planed, goal directed actions.  

Attention and emotion regulation abilities improve with practice 

There have been numerous studies that have shown that infants or toddlers' ability to pay attention in a flexible manner and to regulate their emotional reactivity are improved with practice. In particular, parenting that is sensitive to the infant's signals of interest and distress, that engage in many episodes of collaborative play and help infants to engage with challenging situations and persist in achieving their goals improves attention and emotional regulation not only in children who are developing typically but also those that face developmental challenges associated with premature birth, a fearful temperament, joint hypermobility, congenital heart defects, developmental delay and brain damage.   

How parents can promote attention and learning from experience 

Parents and caregivers play a major role in promoting infant learning from experience: they do this in two important ways:

• By providing a safe and interesting social and physical environment that provides just-right challenges for the infant
• By supporting and enhancing the infant’s capacity for staying on task, shifting attention to important aspects of a task or activity, providing feedback and encouragement and dealing with disappointment and failure. 

Infants who need extra help 

Pre-mature infants
Preterm birth has an impact on brain development, and even in infants whose development appears to be progressing well in the first year, preterm infants are at risk for development of fine motor and attention skills as they reach school age (Bos 2013). 

In addition, the premature infant’s early experience in the NICU is stressful and affects the infant’s fear systems in the brain, which impacts on behavior.

Research has shown that early intervention that targets the development of social and attention abilities in the first year reduces the risk of attention and fine motor difficulties when the child reaches school age. (Spittle 2015) 

Infants with congenital heart defects
Infants with congenital heart defects are at risk for developmental delays which affect social-emotional, language and motor development. (Goldsworth 2015)

The risk of a developmental delay in is increased by more cardiac surgeries, longer hospital stay, poorer linear growth, and tube feeding. (Mussatto 2015)

Infants at risk for CP
Very premature, very low birth weight infants and those with a difficult birth  are at risk for developing cerebral palsy.

Overt signs of movement difficulties associated with CP are often only noticed at 6-12 months.  If an infant is at risk for developing CP, early intervention that promotes attention and social-emotional skills provides the infant with a greater capacity for overcoming the challenges that he/she will face when learning motor skills.

Infant’s with a highly reactive/fearful temperament (behavioralal inhibition) 
About 15-20 of the population have a cautious / fearful temperament. This temperament style often first manifests itself as highly reactive behavior in young infants. Older infants with a cautious temperament are slow to warm, hesitant in the face of new (novel)  situations and will often avoid situations, tasks and activities that they perceive as difficult or threatening. This tendency limits the infant's experience, delays motor milestones as well as communication and language skills. 

Given the right encouragement, cautious infants learn to be brave, take on challenges and learn to overcome their tendency to treat anything new or unfamiliar as a threat.

However, some infants remain fearful and react with strong negative emotions to even non-threatening situations. These infants grow into fearful toddlers. 

Infants at risk for autism
The siblings of children diagnosed with autism have an increased risk of developing autism. Although autism can reliably diagnosed at 18 – 24 months, there are differences in the infant’s social and attention skills which are apparent before the age of 12 months. 

Early intervention, starting in the second year, has been shown to change the course of development of autism related behaviors. (Green 2015)

Providing an enriched and supportive environment right from birth influences brain development is a way to helps to counteract the impact of autism on brain development, and prevent the emergence of autism related behaviors. 

Infants with joint hypermobility, congenital torticollis, breech delivery, hip dysplasia  
Infants with conditions that affect their joints and muscles need to work harder to achieve their motor milestones. They need to be more active and more persistent to reach their motor milestones. Sitting, crawling and walking  may be delayed which means that their opportunities for actively exploring their environment are also delayed. 

Infants with joint hypermobility very often have a cautious nature which means that they need extra help to overcome their avoidance of difficult task and gain the strength and coordination needed for reaching the gross motor milestones. 

Different ways parents can promote attention and emotion self-regulation

There are different ways that parents can promote their infant and toddler's attention and emotion regulation abilities, including:

Making optimal use of everyday routines to engage and promote very young infant's ability to attend to interesting events in the environment in a flexible way, including caregiver-infant conversations, mirroring, hand watching and anticipation games. 

Social interaction activities and games draw on the infant’s interest in interacting with people and use words, gestures, and facial expressions to grab and sustain the infant and toddler's attention. 

How to maximize learning opportunities during shared activities: book sharing, singing action songs together, mirroring activities, anticipation games and having conversations and playing pretend games.

Collaborative activities and games that involve taking turns and interacting with toys and interesting objects in interesting ways.

Collaborative games and activities uses the power of social interaction to engage the child, hold the child’s interest and maintain attention on the game or task.

Social support and assistance for independent action when a child is exploring a task that requires sustained attention, persistence and problem solving.

The assistance should be just enough to help the child complete aspects of a task that are too difficult to accomplish on his/her own. At other times the social partner/facilitator acts to bring the child’s attention back to task.