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Wendelboe KI, Stuart AC, Smith-Nielsen J, Linkhorst TB, Væver MS. Offline and online parental mentalizing in mothers with symptoms of postpartum depression: Examining the association between self-reported parental reflective functioning and interactional mind-mindedness. Infant Ment Health J 2024; 45:301-317. [PMID: 38446014 DOI: 10.1002/imhj.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/10/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
Mentalizing is, to a certain extent, considered context specific. However, research on the association between parents' abilities to reflect upon their infant's mental states outside social interaction (offline) versus during ongoing parent-infant interaction (online) is currently limited. This study investigated the association between self-reported offline and online mentalizing in a sample of primarily ethnically Danish mothers (N = 142), with symptoms of postpartum depression, and their 1-11-month-old infants. Offline mentalizing was assessed with the Parental Reflective Functioning Questionnaire-Infant Version (PRFQ-I) and online mentalizing was assessed with interactional mind-mindedness. Ordinal logistic regressions showed that a higher score on the PRFQ-I prementalizing subscale was negatively related to number of overall mind-related comments and appropriate mind-related comments produced by mothers during interaction with their infant. Our results indicate partial overlaps between self-reported parental reflective functioning and mind-mindedness, that is, that particularly offline maladaptive mentalizing is associated with lower levels of mentalizing during interaction in mothers with symptoms of depression. Post-hoc examination of the interaction effect of postpartum depression showed that this association was only evident in mothers with medium to high levels of depression. Findings and implications are discussed.
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Affiliation(s)
- Katrine I Wendelboe
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Anne C Stuart
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Johanne Smith-Nielsen
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Thea B Linkhorst
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Mette Skovgaard Væver
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
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2
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Oppenheim D, Koren-Karie N, Slonim M, Mottes-Peleg M, Sher-Censor E, Dolev S, Yirmiya N. Maternal and paternal insightfulness and reaction to the diagnosis in families of preschoolers with Autism spectrum disorder: associations with observed parental sensitivity and inter-parent interaction. Attach Hum Dev 2024; 26:22-40. [PMID: 38451115 DOI: 10.1080/14616734.2024.2326416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
Sensitivity among parents of children with Autism Spectrum Disorder (ASD) is based on parental insightfulness and on resolution regarding the child's diagnosis. This has been supported in studies of mothers, and we examined whether the same is true regarding fathers. Also, we asked whether parents' Insightfulness and Resolution tap general mentalization and therefore also be expressed in parent-parent interactions. Eighty preschooler boys with ASD and both of their parents participated. As expected, fathers who were more insightful and mothers who were more resolved were more sensitive. Contrary to expectations, no associations were found between fathers' resolution and mothers' insightfulness and their sensitivity. Associations were found between parental insightfulness and resolution and positive parent-parent interaction. The findings are the first to demonstrate the insightfulness-sensitivity link among fathers of children with ASD. Also, they suggest that both insightfulness and resolution involve general mentalization that is evident both in parent-child and parent-parent interactions.
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Affiliation(s)
- David Oppenheim
- School of Psychological Sciences and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Nina Koren-Karie
- School of Social Work and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Michal Slonim
- School of Psychological Sciences and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Michal Mottes-Peleg
- School of Psychological Sciences and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Efrat Sher-Censor
- School of Psychological Sciences and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Smadar Dolev
- Oranim Academic College of Education, Department of Early Childhood Education, Tivon, Israel
| | - Nurit Yirmiya
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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3
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Jin J, Goud R, Al-Shamali H, Dzunic A, Lyons T, Reeson M, Pazderka H, Dennett L, Polzin W, Wei Y, Silverstone PH, Greenshaw AJ. Early Mental Health Foundations: A Scoping Review of Reflective Functioning in Caregiver-Child Dyads. PSYCHIAT CLIN PSYCH 2023; 33:58-69. [PMID: 38764527 PMCID: PMC11082638 DOI: 10.5152/pcp.2023.22549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 05/21/2024] Open
Abstract
International public health strategies indicate a need for equitable resources for wellness in younger children and their caregivers. Reflective functioning, a proxy for emotional regulation abilities, is a key area in this domain. As an emerging area, reflective functioning has not been mapped comprehensively and requires systematic investigation. This review examines "what qualitative and quantitative evidence is there for the value of reflective functioning assessment and intervention studies in caregiver-child dyads?" This scoping review focused on data published to September 2021, focusing on caregivers of children ≤36 months of age (including Medline, PsycINFO, CINAHL, ERIC, Scopus, Web of Science, and Embase). Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were followed. From 5162 initial articles, 608 papers were screened for full text yielding a final 181 papers. Only 69 studies included multiple ethnicities. Seven of the 69 studies included at least 1 Indigenous person. No studies were conducted in low- to middle-income countries, and no studies reported data on gender identity. This review comprises a novel and comprehensive mapping of the reflective functioning literature in terms of both assessment and intervention studies. The present mapping of the reflective functioning literature indicates the importance of health disparities in caregiver-child dyads (these include gaps and needs for future research). In relation to gaps, studies of adverse childhood experience, consideration of equity, diversity, and inclusion, and global mental health are underrepresented. Future research is needed to provide information on the relevance of gender identity and low- to middle-income countries in relation to the impact on reflective functioning in this context.
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Affiliation(s)
- Jonathan Jin
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Rachel Goud
- University of Toronto, Temerty Faculty of Medicine, Toronto, Canada
| | - Huda Al-Shamali
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Anja Dzunic
- University of Alberta, School of Public Health, Edmonton, Canada
| | - Tirzah Lyons
- University of Alberta, Faculty of Education, Edmonton, Canada
| | - Matthew Reeson
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Hannah Pazderka
- Department of Psychiatry, University of Alberta, Edmonton, Canada
- Little Warriors Be Brave Ranch, Edmonton Alberta, Canada
| | - Liz Dennett
- JW Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Wanda Polzin
- Little Warriors Be Brave Ranch, Edmonton Alberta, Canada
| | - Yifeng Wei
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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Doiron KM, Stack DM, Dickson DJ, Bouchard S, Serbin LA. Co-regulation and parenting stress over time in full-term, very low birthweight preterm, and psycho-socially at-risk infant-mother dyads: Implications for fostering the development of healthy relationships. Infant Behav Dev 2022; 68:101731. [PMID: 35850046 DOI: 10.1016/j.infbeh.2022.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 05/03/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Abstract
From birth, mothers and infants co-regulate their interactions that are shaped by their socio-emotional development, relationship history, current circumstances, and goals. However, few studies have longitudinally explored co-regulation in the context of medical and psycho-social risk. The present 4-wave longitudinal study sought to shed light on factors associated with co-regulation over time in infants from 6- to 48-months. The objectives were to 1) identify differences in co-regulation among low- and at-risk infant-mother dyads, 2) explore changes in co-regulation over time, and 3) explore the associations between infant-mother co-regulation and parenting stress in these low- and at-risk groups over time. Participants included three groups of infant-mother dyads (full-term [FT], n = 48; very low birthweight/preterm [VLBW/preterm] born 26-32 weeks, weighing 800-1500 g, n = 61; psycho-socially at-risk where parents had histories of socioeconomic disadvantage, n = 54) followed longitudinally at 6-, 12-, 18-, and 48-months of age. Dyads engaged in a free play in their homes that was coded for co-regulation using Fogel, de Koeyer, Secrist, Sipherd, Hafen, and Fricke's (2003) Revised Relational Coding System (RRCS), and mothers reported on their level of parenting stress. Results from MANOVAs at each time point indicated significant differences between the groups at 18-months, with psycho-socially at-risk dyads engaging in more one-sided interactions than FT and VLBW/preterm dyads, and more dysregulation and miscommunication than VLBW/preterm dyads. Multi-level models of co-regulation revealed that dyads became progressively less synchronous from 6- to 12-months, followed by greater synchrony and mutual reciprocity from 12-months onwards. Parenting stress was associated with less synchrony and less mutual reciprocity amongst the at-risk groups. Maternal education was associated with greater engagement and girls tended to engage in more synchronous interactions than boys. Our results underscore the value and implications of considering background risk and concurrent parent perceptions in the development and reciprocity of parent-infant co-regulation and their subsequent relationships from infancy onwards.
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Affiliation(s)
- Kelly M Doiron
- Department of Psychology and Centre for Research and Human Development (CRDH), Concordia University, Canada.
| | - Dale M Stack
- Department of Psychology and Centre for Research and Human Development (CRDH), Concordia University, Canada.
| | - Daniel J Dickson
- Department of Psychology and Centre for Research and Human Development (CRDH), Concordia University, Canada
| | - Samantha Bouchard
- Department of Psychology and Centre for Research and Human Development (CRDH), Concordia University, Canada
| | - Lisa A Serbin
- Department of Psychology and Centre for Research and Human Development (CRDH), Concordia University, Canada
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Kolk TA, Nath S, Howard LM, Pawlby S, Lockwood-Estrin G, Trevillion K. The association between maternal lifetime interpersonal trauma experience and perceived mother-infant bonding. J Affect Disord 2021; 294:117-127. [PMID: 34280788 PMCID: PMC8424749 DOI: 10.1016/j.jad.2021.06.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Interpersonal traumas are common among expectant and new mothers and are found to have considerable impacts on women's mental health. These experiences may disrupt maternal perceptions of the mother-infant relationship, which is essential for healthy infant development, but findings are inconsistent. This study aims to explore associations between lifetime interpersonal traumas and their impact on self-reported mother-infant bonding. METHODS Secondary data analysis of a representative cohort of 453 women attending at a South London maternity service. Lifetime interpersonal trauma experience and its association with self-reported mother-infant bonding (Postpartum Bonding Questionnaire) was assessed in uni- and multivariable linear regressions, the latter adjusted to account for antenatal depressive and posttraumatic symptoms, measured using the Edinburgh Postnatal Depression Scale and Posttraumatic Stress Disorder Scale, and key sociodemographic risk factors. RESULTS Maternal lifetime trauma was not associated with perceived difficulties in mother-infant bonding at three months postnatal; however antenatal depressive symptoms, both with continuous EPDS score (0.33, 95% CI 0.17-0.50, p<0.001) and clinical cut-off ≥13 (4.26, 95% CI 2.02-6.49, p<0.001) were associated with self-reported bonding difficulties. LIMITATIONS The composite trauma measurement did not allow for a comprehensive assessment of individual trauma types. CONCLUSIONS There was no evidence for a link between maternal lifetime trauma experiences and self-reported bonding difficulties. However, an association between antenatal depressive symptoms and perceived postpartum bonding impairment was found. This highlights the importance of identification and treatment of depressive symptoms during pregnancy and offering women support in facilitating a positive mother-infant relationship.
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Affiliation(s)
- Tessel Annejo Kolk
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK..
| | - Selina Nath
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Louise Michele Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Susan Pawlby
- Division of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Georgia Lockwood-Estrin
- Henry Wellcome Building, Centre for Brain and Cognitive Development, Birkbeck College, 32 Torrington Square, London WC1E 7JL, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
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Ahrnberg H, Korja R, Scheinin NM, Nolvi S, Kataja EL, Kajanoja J, Hakanen H, Karlsson L, Karlsson H, Karukivi M. Maternal Alexithymic Traits Are Related to Lower Maternal Sensitivity and Higher Hostility in Maternal Caregiving Behavior-The FinnBrain Birth Cohort Study. Front Psychol 2021; 12:704036. [PMID: 34381404 PMCID: PMC8350116 DOI: 10.3389/fpsyg.2021.704036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The quality of parental caregiving behavior with their child plays a key role in optimal mother–infant interaction and in supporting child adaptive development. Sensitive caregiving behavior, in turn, requires the ability to identify and understand emotions. Maternal alexithymia, with difficulties in identifying and describing feelings or emotions, as well as a concrete way of thinking, could potentially complicate the quality of caregiving. In this study, we aim to explore the possible association between maternal alexithymic traits and the quality of maternal caregiving behavior. Methods: The study sample consisted of 158 mother–infant dyads within the FinnBrain Birth Cohort Study population with an available report of maternal alexithymic traits at 6 months postpartum and observational data on maternal caregiving behavior at 8 months postpartum. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20) including three alexithymia dimensions—Difficulty Identifying Feelings, Difficulty Describing Feelings (DDF), and Externally Oriented Thinking (EOT). Maternal caregiving behavior was assessed using the Emotional Availability Scale and in this study, all four parent dimensions (Sensitivity, Structuring, Non-intrusiveness and Non-hostility) were included. Maternal depressive and anxiety symptoms at 6 months postpartum were controlled for as potential confounders. In addition, background factors of mother's age and gestational weeks at the time of child birth, maternal educational level, monthly income and parity, as well as relationship status and the gender of the baby were assessed. Results: Maternal TAS-20 total score correlated negatively with Sensitivity (r = −0.169, p = 0.034) and with non-intrusiveness (r = −0.182, p = 0.022). In addition, maternal DDF correlated negatively with Sensitivity (r = −0.168, p = 0.035) and EOT with Non-hostility (r = −0.159, p = 0.047). Furthermore, in regression analyses with controlling for the associated background factors, maternal total score of alexithymic traits (p = 0.034, η2p = 0.029) and higher DDF (p = 0.044, η2p = 0.026) remained significantly associated with lower Sensitivity and higher EOT remained significantly associated with lower Non-hostility (p = 0.030, η2p = 0.030). Conclusions: In this explorative study we found preliminary evidence for the hypothesis that higher maternal alexithymic traits associate with lower maternal sensitivity and more hostile maternal caregiving behavior. Further studies are needed to explore these hypotheses and to investigate their possible implications for child development.
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Affiliation(s)
- Hanna Ahrnberg
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Psychology and Speech Language Pathology, University of Turku, Turku, Finland
| | - Noora M Scheinin
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Saara Nolvi
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Psychology and Speech Language Pathology, University of Turku, Turku, Finland.,Turku Institute for Advanced Studies, University of Turku, Turku, Finland
| | - Eeva-Leena Kataja
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Jani Kajanoja
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Hetti Hakanen
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Psychology and Speech Language Pathology, University of Turku, Turku, Finland
| | - Linnea Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Max Karukivi
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
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Feniger-Schaal R, Koren-Karie N. Using Drama Therapy to Enhance Maternal Insightfulness and Reduce Children's Behavior Problems. Front Psychol 2021; 11:586630. [PMID: 33551907 PMCID: PMC7854457 DOI: 10.3389/fpsyg.2020.586630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022] Open
Abstract
Maternal insightfulness or the capacity to see things from the child's point of view, is considered to be a crucial construct for therapeutic change. In the present study, we aimed to implement the knowledge gleaned from the studies on attachment theory and maternal insightfulness into clinical practice to create an intervention program for mothers of children-at-risk due to inadequate parental care. We used drama therapy to "practice" maternal insightfulness in more "experiential" ways, because the use of creative expressive means may be accessible and effective for the target population of the study and help improve maternal care. We used a manualized 10-week drama therapy-group intervention, focusing on the core concepts of maternal insightfulness: insightfulness, separateness, complexity, and acceptance. We used various dramatic means to explore and experience these components of maternal insightfulness. Forty mothers of children-at-risk took part in eight groups of parental insightfulness drama therapy (PIDT). To evaluate the efficacy of the intervention, we used the Insightfulness Assessment (IA) interview, which produces 10 scales and a final classification of PI and non-PI. The Child Behavior Check List (CBCL) was used to evaluate a change in children's behavior problems. The assessment took place at three time points: before the intervention (T1), right after the end of the intervention (T2), and 6 months following the intervention (T3). Results at T2 showed a significant improvement compared to T1 in some of the maternal insightfulness scales, but not in the maternal insightfulness categorical classification. At T3, there was a significant change in the classification of the mothers, from non-insightful to positively insightful. At T3, there was also a significant decline in the children's externalized and general behavioral problems. The results of this study contribute to an evidence-based practice of using drama therapy in the treatment of mothers and children at risk.
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Affiliation(s)
- Rinat Feniger-Schaal
- The Center for the Study of Child Development, University of Haifa, Haifa, Israel
- Graduate School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Nina Koren-Karie
- The Center for the Study of Child Development, University of Haifa, Haifa, Israel
- School of Social Work, University of Haifa, Haifa, Israel
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8
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Di Renzo M, Guerriero V, Zavattini GC, Petrillo M, Racinaro L, Bianchi di Castelbianco F. Parental Attunement, Insightfulness, and Acceptance of Child Diagnosis in Parents of Children With Autism: Clinical Implications. Front Psychol 2020; 11:1849. [PMID: 32849089 PMCID: PMC7427563 DOI: 10.3389/fpsyg.2020.01849] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/06/2020] [Indexed: 01/10/2023] Open
Abstract
Early parent-child relationships are an important factor influencing many domains of child development, even in the presence of autism. In this study, we investigated the associations between parent-child attunement during play, parental insightfulness, and parental acceptance of their child's diagnosis of an autism spectrum disorder. A sample of 50 parents (26 mothers and 24 fathers) of 26 children aged between 24 and 58 months were videotaped during parent-child play interactions and then interviewed about what they thought had gone through their child's head during the play interaction, and about their feelings and thoughts about their child's diagnosis. Play interactions were evaluated using a coding protocol to assess parental attunement. The results showed that parents who were more able to accept their child's diagnosis and to see things from their child's perspective were more likely to also be attuned during play interactions with their children. These findings highlight the importance of studying the parental ability of insightfulness and acceptance of their child diagnosis of ASD for the implementation of intervention programs for supporting parental attunement and improving the interactions between the parents and the children with autism spectrum disorders.
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Affiliation(s)
| | - Viviana Guerriero
- Institute of Orthophonology (IdO), Rome, Italy.,Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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Abstract
We open this introductory paper to the special issue with the theoretical and clinical roots of the insightfulness concept. Next, the Insightfulness Assessment (IA) is presented, followed by a review of key empirical findings supporting the IA. The central points in the papers in this special issue are reviewed next. These include the use of the IA with parents of children ranging in age from infancy to adolescence, its applicability outside the parent-child relationship (e.g. insightfulness toward a close friend), its use with high-risk mothers, and the usefulness of insightfulness both as a continuous and a categorical measure. The clinical applications of the IA are discussed, and we close with future directions for IA research.
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