Early Maternal Reflective Functioning and Infant Emotional Regulation in a Preterm Infant Sample at 6 Months Corrected Age

Parental Reflective Functioning on the Parent Development Interview: A narrative review of measurement, association, and future directions

A caregiver's capacity to mentalize is thought to be one of the most important features of secure parent-child relationships. Parental mentalizing can be measured using the Reflective Functioning (RF) coding system applied to the Parent Development Interview (PDI). In this narrative review, we summarize the research using this measure and synthesize what has been learnt about the predictors, correlates and sequelae of parental RF. Studies have consistently shown that PRF on the PDI is associated with both parent and child attachment and is an important factor in the intergenerational transmission of attachment. It is also related to the quality of parental representations, parent-child interactions, and child outcomes. While a number of social and clinical risk factors are associated with lower PRF, it is difficult to disentangle the unique contribution of each of these. We discuss these findings and present the direction of future work that is planned to expand and refine the PRF scale for the PDI.

Parental mentalising among mothers with intellectual disability or ADHD: Links with experiences of abuse, neglect and psychosocial risk

BACKGROUND

Parental mentalising difficulties are robustly linked to caregiving problems. Mothers with intellectual disability are at risk for caregiving problems, but knowledge on their parental mentalising abilities is lacking. The present study aimed to fill this gap.

METHOD

Thirty mothers with mild intellectual disability, and 61 comparison mothers with ADHD, were assessed for parental mentalising using the Parental Reflective Functioning Questionnaire. Contributions of intellectual disability, maternal exposure to childhood abuse/neglect and psychosocial risk to parental mentalising were examined through hierarchical regression analysis.

RESULTS

Mothers with intellectual disability had a heightened risk for parental mentalising difficulties, in the form of elevated prementalising. Intellectual disability and cumulative childhood abuse/neglect uniquely predicted prementalising among the mothers, whereas cumulative psychosocial risk added to the risk for prementalising specifically among mothers with intellectual disability.

CONCLUSIONS

Our findings support contextual models of caregiving, and suggest a need for mentalisation-based support for parents with mild intellectual disability.

Early psychosocial risk factors and postnatal parental reflective functioning

Psychosocial factors have been found to relate to parental reflective functioning (PRF), a parent's ability to mentalize about themselves and their child. Relations between maternal psychosocial risk factors and PRF were investigated in a community sample. A sample of mothers (n = 146) was assessed for risk factors when infants were 6 months, infant temperament was assessed using an observational measure, and PRF was assessed with the Parent Development Interview-Revised (PDI). PRF was measured again with the Parental Reflective Functioning Questionnaire (PRFQ) when children were 4 years (n = 105) and 5 years (n = 92), with an additional sample of mothers (n = 48) tested at these two timepoints. Results showed that in infancy, total maternal psychosocial risk related to lower PDI-PRF; regression analyses highlighted low socioeconomic status, unplanned pregnancy, and low maternal anxiety as independent predictors of lower PDI-PRF. PDI-PRF scores at 6 months did not relate to PRFQ scores, but PRFQ subscales showed stability over time from age 4-5. Results are discussed with regard to the impact of maternal psychosocial risk and infant temperament on PRF and the stability and concordance of PRF measures.

Emotion regulation in children (ERiC): A protocol for a randomised clinical trial to evaluate the clinical and cost effectiveness of Mentalization Based Treatment (MBT) vs Treatment as Usual for school-age children with mixed emotional and behavioural difficulties

BACKGROUND

The majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one's own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties.

MATERIALS AND METHODS

Children referred to CAMHS aged 6-12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6-8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children's social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks).

TRIAL REGISTRATION

Clinical trial registration: ISRCTN 11620914.

The association between deficiencies in paternal and maternal reflective functioning and anorexia nervosa symptomatology

BACKGROUND

A large theoretical body of knowledge exists emphasizing the importance of parental mentalizing in the context of anorexia-nervosa (AN). However, the empirical support to these assumptions is still scarce. The aim of the present study was to examine whether parents of patients with AN are characterized by a lower mentalizing ability, and whether it is associated with impaired mentalizing, AN symptomatology and eating disorder (ED) related psychological traits in the daughters.

METHODS

Thirty-two family triads (fathers, mothers, and daughters) of female adolescent and young adult inpatients with AN were compared with thirty-three non-clinical family triads (N = 195). The mentalizing ability of all the participants was assessed using semi-structured interviews and coded using the Reflective Functioning Scale (RFS). Self-report questionnaires were administered to the daughters to evaluate ED symptomatology and ED related psychological traits (e.g., low self-esteem, interpersonal insecurity, emotional dysregulation).

RESULTS

Decreased reflective functioning (RF) levels were found among mothers and fathers of patients with AN compared to their control peers. Examining the entire sample, clinical and non-clinical groups together, showed that both paternal and maternal RF were associated with the daughters' RF and each were found to have a significant and distinct contribution to the daughters' RF. Significant associations were found between lower levels of maternal and paternal RF and increased ED symptoms and ED related psychological traits. The use of a mediation model suggested a serial relationship in which low maternal and paternal RF contributes to the daughters' low RF, which in turn is associated with higher levels of psychological maladjustment, and ultimately contributes to the increased severity of ED symptoms.

CONCLUSIONS

The present results provide strong empirical support for theoretical models that suggest that deficits in parental mentalizing may represent important correlates of the presence and severity of ED symptoms in AN. Furthermore, the results highlight the relevance of fathers' mentalizing ability in the context of AN. Finally, clinical and research implications are discussed.

Examining a Complex Model Linking Maternal Reflective Functioning, Maternal Meta-Emotion Philosophies, and Child Emotion Regulation

Parental Reflective Functioning (PRF) refers to parents' ability to understand their children's behavior in light of underlying mental states such as thoughts, desires, and intentions. This study aimed to investigate whether maternal meta-emotion philosophies (i.e., emotion coaching, emotion dismissing) mediated the relation between maternal RF and child emotion regulation (ER). Additionally, children's genders and ages were examined as moderators of the associations between maternal RF and maternal meta-emotion philosophies. The sample comprises 667 Chinese mothers of children aged 4-6 years. Mothers completed questionnaires assessing their reflective functioning, emotion coaching and dismissing, and child emotion regulation. Results indicated both a direct link between maternal RF and child emotion regulation, as well as indirect pathways mediated by emotion coaching and dismissing. A child's gender and age also moderated the relations between maternal RF and meta-emotion philosophies. Specifically, the negative association between maternal pre-mentalizing modes and emotion coaching was stronger for mothers of girls than boys; whereas the negative association between maternal certainty of mental states and emotion dismissing, as well as the positive association between maternal interest and curiosity and emotion coaching were both stronger for mothers of younger children than older children. The findings suggest that emotion coaching and dismissing mediate the relation between maternal PRF and the emotion regulation of children.

The influence of maternal reflective functioning and parenting behavior on infant development in the context of perinatal intimate partner violence: a study protocol

BACKGROUND

Intimate partner violence (IPV) affects 25% of children under the age of five worldwide, yet the impact of perinatal IPV and its underlying mechanisms on infant development remains poorly understood. IPV indirectly affects infant development through the mother's parenting behavior, but research on maternal neuro and cognitive processes, such as parental reflective functioning (PRF), is scarce, despite its potential as an unfolding mechanism. The objective of our study, Peri_IPV, is to examine the direct and indirect pathways linking perinatal IPV and infant development. We will analyze the direct impact of perinatal IPV on mothers' neuro and cognitive parental reflective functioning (PRF) and parenting behavior during the postpartum period, the direct impact of perinatal IPV on infant development, and whether maternal PRF mediates the link between perinatal IPV and parenting behavior. We will also explore the mediation role of parenting behavior in the association between perinatal IPV and infant development and whether the impact of perinatal IPV on infant development occurs through the links between maternal PRF and parenting behavior. Finally, we will examine the moderation role of mother's adult attachment in the impact of perinatal IPV on maternal neuro and cognitive PRF and parenting behavior during the postpartum period, as well as on infant development.

METHODS

Our study will use a multi-method, prospective design to capture different levels of PRF, parenting behavior, and infant development. Three-hundred and forty pregnant women will participate in a 4-wave longitudinal study from the 3rd trimester of pregnancy to 12 months postpartum. In the 3rd trimester and 2 months postpartum, women will report on their sociodemographic and obstetric characteristics. In all assessment waves, mothers will complete self-reported measures of IPV, cognitive PRF, and adult attachment. At 2 months postpartum, women's neuro PRF will be monitored, and at 5 months postpartum, their parenting behavior will be assessed. The infant-mother attachment will be assessed at 12 months postpartum.

DISCUSSION

Our study's innovative focus on maternal neuro and cognitive processes and their impact on infant development will inform evidence-based early intervention and clinical practices for vulnerable infants exposed to IPV.

Cortisol reactivity and negative affect among preterm infants at 12 months during a mother-infant interaction task

The purpose of this study was to investigate correlates of preterm (PT) infant's cortisol reactivity and the association to infant negative affect, during a mother-infant interaction procedure. Participants included 48 infants born prematurely (gestational age < 37 weeks) and their mothers, assessed when infants were 12 months old corrected for prematurity. The examined variables comprised both neonatal and environmental dimensions including maternal interactive behavior. Infant negative affect and maternal interactive behavior were assessed with a standardized mother-infant interaction task. A baseline infant saliva sample was collected before the interaction began, and a second sample after the interaction episodes ended. Results revealed that decrease of infant's cortisol concentration was significantly associated with the exposure to more sensitive, and less intrusive maternal behaviors. However, once controlled for neonatal risk, family SES and maternal psychological distress, the associations were rendered non-significant. Although the association between cortisol reactivity and negative affect trended toward significance, maternal intrusiveness was the only significant predictor of observed infant negative affect. Findings suggest the importance of primary relational experiences on PT infants' early regulatory competencies.

Maternal childhood abuse and neglect predicts offspring development in early childhood: The roles of reflective functioning and child sex

BACKGROUND

Recent evidence suggests that offspring of mothers having been exposed to childhood abuse and neglect (CA&N) are at increased risk of developmental problems and that boys are more affected by maternal CA&N than girls. Since impairments in reflective functioning (RF) have been associated with maternal CA&N and offspring development, RF could represent a key mechanism in these intergenerational risk trajectories.

OBJECTIVE

This study evaluated mediating (RF) and moderating (child sex) mechanisms in the association between maternal CA&N and child development.

PARTICIPANTS AND SETTING

In a longitudinal setting, 111 mothers completed measures during pregnancy and between 11 and 36 months postpartum.

METHODS

CA&N and impairments in RF were assessed during pregnancy and offspring development was measured during the longitudinal follow-up using the Ages and Stages Questionnaires (ASQ-3). Child development was operationalized in two ways: using the global score at the ASQ-3 and using a dichotomous score of accumulation of delays across domains of development.

RESULTS

Structural equation modeling indicated that RF mediated the association between maternal CA&N and offspring development. Child sex moderated the association between CA&N and the clustering of developmental problems (Wald = 5.88, p = 0.02), with boys being particularly likely to accumulate developmental delays when their mother experienced CA&N (RR = 2.62). Accumulation of developmental problems was associated with impairments in maternal RF in girls and with maternal exposure to CA&N in boys.

CONCLUSIONS

Results provide novel insights on the role of mentalization and child sex in the association between maternal CA&N and child development.

Parental Mentalizing during Middle Childhood: How Is the Adoption of a Reflective Stance Associated with Child's Psychological Outcomes?

This exploratory cross-sectional study attempts to understand the mechanisms underlying the role of parental mentalizing in a child's psychological functioning during middle childhood by using Parental Reflective Functioning (PRF) and Parental Insightfulness (PI) constructs. The main aims are to examine the role of PI and PRF as processes capable of influencing a child's psychological functioning in terms of emotional-behavioral difficulties and social-emotional competencies. Eighty-six community parents (48 mothers, 38 fathers) and their 50 children in middle childhood (Mage = 10.10, SD = 1.13) participated in this study, recruited through a non-probabilistic sampling. The following measures were used to assess the aims of this study: Insightfulness Assessment, Parental Reflective Functioning Questionnaire, Child Behavior Checklist (CBCL) and Devereux Student Strengths Assessment (DESSA) questionnaires. Results showed that parental mentalizing was found to be significantly associated with both child's internalizing and externalizing symptoms and social-emotional competencies as reported by parents through the CBCL and DESSA questionnaires. This study may offer a contribution to the study of parental mentalizing during middle childhood, supporting the hypothesis that both parents' ability to understand their child's mental states could affect the child's psychological functioning. Clinical and theoretical implications are geared toward a family-based view with a specific focus on the importance of fostering in both parents a positive attitude toward mentalizing processes.

[Parental Mentalization and Early Parent-Child Interaction in Mothers with Affective Disorders or Borderline Personality Disorder: A Systematic Review]

The ability to mentalize is central in the context of the parent-child relationship.The parental competence to see the child'smental state as an independent individual is an essential prerequisite for perceiving and interpreting child signals appropriately.These abilities are crucial but not always available under elevated stress levels when confronted with a child's affects and parenting challenges. Despite the clinical and conceptual relevance of mentalization with borderline personality disorder (BPD) and affective disorders, the subject has rarely been systematically addressed in parents.This review provides a systematic overview of parental mentalization in mothers with affective disorders or BPD and its impact on the quality of maternal interactive behaviour. The findings generally revealed a negative association between mothers' parental mentalization and depression or BPD, which varied greatly depending on the mentalization constructs. Both psychiatric diagnosis and current severity of symptoms were found to be relevant. However, some positive aspects of mentalization were not markedly impaired. Further, a lowermentalizing abilitywas associatedwith reduced sensitive behaviour in depressedmothers. The results contribute to a better understanding of the association between mentalization and maternal psychopathology and help refine early interventions in parent-child settings.

Parental Perception of Child Vulnerability in Parents of Young Children

OBJECTIVE

Parental perception that one's child may be vulnerable to a threatening illness appears to be negatively associated with the child's socioemotional development. However, there are no studies that have analyzed the association of these dysfunctional parental perceptions on the emotional development of children who have not suffered a previous serious illness. The main objective of the present study was to study the relationship between parental perception of child vulnerability (PPCV) and children's socioemotional development, hypothesizing that PPCV is associated both directly and indirectly with children's socioemotional development through parental reflective functioning and parental competence.

METHODS

The study involved 433 mothers and 113 fathers of infants between 0 and 3 years.

RESULTS

PPCV was negatively associated with children's socioemotional development. Likewise, PPCV was indirectly and positively related to children's socioemotional development through the dimension of Interest and Curiosity of parental reflective functioning and parental competence.

CONCLUSIONS

The literature has shown that parental dysfunctional perceptions about the health of their children can be negatively associated with children's socioemotional development. However, if these concerns are associated with increased interest and curiosity about the mental states of the child, this may actually promote the child's socioemotional development.

The mediating role of parental embodied mentalizing in the longitudinal association between prenatal spousal support and toddler emotion recognition

Emotion recognition is an important developmental achievement in early childhood. Grounded in theoretical concepts of family systems theory and the spillover effect, the goal of the current study was to examine whether prenatal spousal support predicts toddler emotion recognition at 24 months, and whether this association is mediated by parental embodied mentalizing (PEM) at 6 months. PEM refers to the parent's capacity to understand the infant's mental states from his or her whole-body kinesthetic expressions and adjust their own kinesthetic patterns accordingly. One hundred and five families expecting their first child were included in the study. Results indicated that maternal PEM mediated the relationship between prenatal dyadic positive and overall support and toddler emotion recognition. Paternal PEM was not found to be related to either dyadic support or to toddler emotion recognition, and it did not mediate the relationship between the two. The findings of the current study support the importance of including both parents' embodied mentalizing and a systemic approach to illuminate child development. A significant clinical implication from this study is the usefulness of prenatal couple interventions to improve mutual support and communication as it can promote parents' parental mentalizing and ultimately the child's emotion recognition capacity.

Conceptualizing Emotion Regulation and Coregulation as Family-Level Phenomena

The ability to regulate one’s emotions is foundational for healthy development and functioning in a multitude of domains, whereas difficulties in emotional regulation are recognized as a risk factor for a range of adverse outcomes in childhood, adolescence, and adulthood. Caregivers play a key role in cultivating the development of emotion regulation through coregulation, or the processes by which they provide external support or scaffolding as children navigate their emotional experiences. The vast majority of research to date has examined coregulation in the context of caregiver–child dyads. In this paper, we consider emotion regulation and coregulation as family-level processes that unfold within and across multiple family subsystems and explore how triadic and whole family interactions may contribute to the development of children’s emotion regulation skills. Furthermore, we will examine the implications of a family-centered perspective on emotion regulation for prevention of and intervention for childhood emotional and behavioral disorders. Because emotion regulation skills undergo such dramatic maturation during children’s first several years of life, much of our focus will be on coregulation within and across the family system during early childhood; however, as many prevention and intervention approaches are geared toward school-aged children and adolescents, we will also devote some attention to later developmental periods.

Cognitive reappraisal training for parents of children with autism spectrum disorder

Parents of children with autism spectrum disorder (ASD) experience higher stress levels than those of typically developing children. The goal of the current study was to examine whether a mentalization-based intervention would enhance parental cognitive reappraisal, an adaptive form of emotion regulation associated with lower levels of stress. Findings from 27 parents who completed a short training indicated an improvement in cognitive reappraisal. In exploratory analyses, two different types of reappraisal were examined. The intervention-related improvement was found mainly with one type of reappraisal, namely reflective reappraisal that consist of cognitive reappraisal with mentalization characteristics. In light of the evidence indicating that high cognitive reappraisal and high reflective functioning are associated with quality caregiving, findings from the current study suggesting that a brief mentalization-based intervention supports ASD parents' cognitive reappraisal with mentalization characteristics are promising and warrant further investigation.

Parental Reflective Functioning as a Moderator of the Link Between Prematurity and Parental Stress

We examined group differences between parents, both mothers and fathers, of premature and full-term infants to determine whether they differed in their reports of subjective parenting stress and in their level of parental reflective functioning (PRF). We also tested whether each parent's reflective functioning moderated the links between birth status (prematurity vs. full-term) and parenting stress. A sample of 73 cohabiting, heterosexual Israeli families with a premature (28-36th week gestational age, N = 34) or full-term infant (37th week and above gestational age, N = 39) participated, comprising the two parents' groups. Infants' age averaged 7.07 months (SD = 1.28). Each parent completed the Parent Stress Inventory (PSI) individually to determine his/her subjective personal and childrearing stress levels. The Parent Development Interview (PDI-R2-S) was used to obtain each parent's PRF (self and child/relation-focused) level. Findings showed that the premature and full-term parents did not differ in their PSI scores or PRF levels. However, mothers' self-focused PRF moderated the link between prematurity and personal parenting stress, whereas fathers' self-focused PRF moderated the link between prematurity and childrearing parenting stress. Furthermore, fathers' and mothers' PRF operated differently in the premature and full-term parents' groups. The findings highlight the importance of mothers' and fathers' PRF in predicting parents' subjective stress in general and particularly in the case of infant prematurity. We discuss these findings and their relevance for preventive and therapeutic perinatal interventions.

Maternal mentalization and child emotion regulation: A comparison of different phases of early childhood

Parental reflective functioning refers to the parents' ability to reflect on the internal mental states of their children, which will make them respond more sensitively to their children´s need. The relation between parental reflective functioning and child emotion regulation has been considered a key factor in early childhood parenting but further research is needed about this relationship throughout child's development. The aim of this paper was to analyze this interaction considering the early childhood development stages. Three hundred and eighty one mothers of babies between 0 and 26 months of age participated in the study. The PRFQ and ASQ:SE-2 questionnaires were administered to assess parental reflective functioning and child emotion regulation, respectively. Results showed that maternal RF and child emotion regulation do not follow a linear process according to the childhood development stages, and also that the maternal PM dimension generates a conditional effect in children's emotion regulation. These results highlight the importance of paying attention to specific early childhood developmental stages to understand how maternal reflective functioning influences child´s ability to calm and adjust to her/his environment.

Prevention of Mental Health Difficulties for Children Aged 0-3 Years: A Review

The period of infancy and early childhood is a critical time for interventions to prevent future mental health problems. The first signs of mental health difficulties can be manifest in infancy, emphasizing the importance of understanding and identifying both protective and risk factors in pregnancy and the early postnatal period. Parents are at a higher risk of developing mental health problems during the perinatal period. An understanding of the evidence around prevention and intervention for parental anxiety and depression is vital to the process of prevention of early mental health disorders in infants and young children. Here we review the existing prevention and treatment interventions in the early years focusing on the period from conception to 3 years - the majority targeting parents in order to improve their mental health, and that of their infants. Elements of successful programs for parents include psychoeducation and practical skills training, as well as work on the co-parenting relationship, developing secure attachment, and enhancing parental reflective functioning. While both targeted and universal programs have produced strong effect sizes, universal programs have the added benefit of reaching people who may otherwise not have sought treatment. In synthesizing this information, our goal is to inform the development of integrated models for prevention and novel early intervention programs as early in life as possible.

Testing the Link Between Mothers' General Reflective Function Capacity and Adolescent Borderline Personality Features: Perceived Parenting Behaviors as a Potential Mechanism

Impairments in mothers' reflective function (RF), the ability to imagine the mental states of the self and others, underlies maladaptive parenting strategies, which have been associated with borderline personality disorder (BPD). The current study evaluated the association between mother's RF and adolescents' BPD and the mediating role of a range of parenting behaviors. Five hundred and thirty-one inpatient adolescents and their mothers participated in the current study. A multimethod assessment of BPD was used alongside mothers' self-reported quality of RF. Children completed three questionnaires about maternal parenting behaviors. There was no direct relation between mother's RF capacity and adolescents' BPD. However, mothers' adaptive certainty about mental states related to less severe BPD in adolescents, specifically through decreases in inconsistent punishment. Mothers' RF capacity predicted various parenting behaviors, which was associated with adolescents' BPD severity. Implications of findings for early intervention and prevention are discussed.

Observed Progression of Parents' Understanding of Preterm Infants' Behavioral Signs at 33 to 35 Weeks Corrected Age

BACKGROUND

Interventions aimed at improving parental understanding of preterm infants' behavioral signs have drawn increased attention in recent years. However, there are limited data regarding parents' actual perceptions of infants' behavior during parent-infant interactions while infants are in a light-sleep state.

PURPOSES

(1) To describe parental perceptions of infants' behavior at 33 to 35 weeks' corrected age during light-sleep and (2) to identify changes in parental perceptions of preterm infants' behavior over time.

METHODS

This study used a qualitative, longitudinal design based on observations and interviews. Three sets of parents and their infants born between 29 and 30 weeks' gestational age were observed up to 3 times during light sleep states when the infants were 33 to 35 weeks' corrected age. Parents were interviewed regarding their perceptions of infant behavior/growth once at the time of observation and once more within 2 weeks of the final observation. The findings are based on the observation of parents' perception-driven interactions with infants.

RESULTS

Four themes emerged describing the transition of parental perception that progresses to gain a better understanding of their infant's behavior through repeated interaction.

IMPLICATIONS FOR PRACTICE

The findings of this study inform caregivers in neonatal intensive care units regarding the unique experience of parent-infant dyads. This knowledge can help promote family-centered developmental care efforts in neonatal intensive care units.

IMPLICATIONS FOR RESEARCH

Further research should focus on studying a larger sample group to confirm the findings and refining strategies to incorporate the findings to enhance neonatal intensive care unit care.

Association between parental alexithymic traits and self-reported postnatal reflective functioning in a birth cohort population. Findings from the FinnBrain Birth Cohort Study

Parental reflective functioning (PRF) refers to a parent's effort to see his/her child as a separate individual person from early on, and to be curious of the child's own thoughts and feelings. Parenting abilities are affected by the parent's emotion regulation and emotional availability. Alexithymia as a personality construct with emotional deficits and poor imagination could potentially affect also PRF, but studies on parental alexithymia are still scarce. The aim of the present study was to examine the association between parental alexithymic traits and PRF, which to date has not been explored. As most of the parenting research concern only mothers, an additional aim was to study also fathers. The 20-item Toronto Alexithymia Scale (TAS-20) and the 14-item Parental Reflective Functioning Questionnaire (PRFQ-Fi) were filled by 1882 mothers and 994 fathers at six months postpartum as part of the FinnBrain Birth Cohort Study. A significant negative association between TAS-20 total score and PRFQ-Fi total score among both genders was found. The main alexithymia dimension responsible for this association was Externally Oriented Thinking. The results suggest that alexithymic traits indeed are related to parental reflective functioning, but more studies are needed to explore the direction of this relation.

Triadic interactions, parental reflective functioning, and early social-emotional difficulties

Early childhood is a critical period for social-emotional development; during this period, the child's immediate family is the system with the greatest influence on his or her development. The parents' capacity to reflect on the children's ability to process and interact within a social environment, called parental reflective functioning (RF), is considered an important factor in protecting children from highly prevalent social-emotional difficulties and may have a strong influence on children's long-term development.

OBJECTIVE

To describe and analyze the relationships among parents' RF, the quality of the mother-father-child triadic interaction, and children's social-emotional difficulties.

METHOD

A nonexperimental, cross-sectional, correlational study was conducted. Fifty mother-father-child triads, each in a current relationship that included at least one child aged 12-36 months, were evaluated. Sociodemographic background, triadic interaction, parental RF, and social-emotional difficulties were assessed.

RESULTS

Triadic interaction was found to have a significant effect on the child's social-emotional difficulties, explaining 9% of the variance. In addition, the mothers' RF had a significant influence on triadic interaction, explaining 19% of the variance. An exploratory finding showed that triadic interaction mediates the relationship between mothers' RF and children's social-emotional difficulties.

Parental Reflective Functioning correlates to brain activation in response to video-stimuli of mother-child dyads: Links to maternal trauma history and PTSD

Parental Reflective Functioning is a parent's capacity to infer mental states in herself and her child. Parental Reflective Functioning is linked to the quality of parent-child attachment and promotes parent-child mutual emotion regulation. We examined neural correlates of parental reflective functioning and their relationship to physical abuse. Participants were mothers with (n = 26) and without (n = 22) history of childhood physical abuse. Parental reflective functioning was assessed by coding transcripts of maternal narrative responses on interviews. All mothers also underwent magnetic resonance imaging while watching video clips of children during mother-child separation and play. Parental reflective functioning was significantly lower among mothers with histories of childhood physical abuse. When mothers without history of childhood physical abuse watched scenes of separation versus play, brain activation was positively correlated with parental reflective functioning in the ventromedial prefrontal cortex, and negatively associated with the dorsolateral prefrontal cortex and insula. These associations were not present when limiting analyses to mothers reporting abuse histories. Regions subserving emotion regulation and empathy were associated with parental reflective functioning; yet these regions were not featured in maltreated mothers. These data suggest that childhood physical abuse exposure may alter the psychobiology that is linked to emotional comprehension and regulation.

Influence of maternal reflective functioning on mothers' and children's weight: A follow-up study

Based on cross-sectional research linking poor reflective functionining (RF) to eating disorders, the current follow-up study tested whether maternal RF would explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. During pregnancy (Time 1 [T1]), 51 women were administered the Difficulties in Emotion Regulation Scale (DERS) and interviewed using the Adult Attachment Interview (AAI). Seven months after delivery (Time 2 [T2]), mother-baby dyads who remained in the study (n = 44) were videotaped (Feeding Scale) during their feeding interaction. Last (Time 3 [T3]), the weight of the 34 children who were still in the study was collected at 3 years of age. Maternal AAI-RF at T1 did not correlate with the DERS at T1 nor with the quality of the feeding interacions at T2. However, it correlated, significantly, with maternal body mass index (BMI) at T1, r = -.298, P = .034, and marginally significantly with baby's BMI at T3, r = -.296, P = .089. Moreover, multiple regression models showed a trend indicating that maternal AAI-RF might explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. These findings suggest that working on maternal mentalization might contribute to helping prevent childhood obesity from pregnancy.

Childhood experiences of maltreatment, reflective functioning and attachment in adolescent and young adult mothers: Effects on mother-infant interaction and emotion regulation

BACKGROUND

Maternal childhood experiences of maltreatment affect parenting and have consequences for a child's social-emotional development. Adolescent mothers have a higher frequency of a history of maltreatment than adult mothers. However few studies have analyzed the interactions between adolescent mothers with a history of childhood maltreatment and their infants.

OBJECTIVE

The aim of the study was to examine the effect of maternal childhood experiences of maltreatment on mother-infant emotion regulation at infant 3 months, considering both infant and mother individual emotion regulation and their mutual regulation.

PARTICIPANTS

Participants were 63 adolescent and young adult mother-infant dyads recruited at a hospital.

METHODS

The mothers were administered the Adult Attachment Interview to evaluate reflective functioning and attachment and the Childhood Experiences of Care and Abuse was used to evaluate maternal childhood experiences of maltreatment. Mother-infant interactions were coded with a modified version of the Infant Caregiver Engagement Phases.

RESULTS

Dyads with mothers with childhood maltreatment (vs dyads with mothers with no maltreatment) spent more time in negative emotional mutual regulation (p = .009) and less time in positive and neutral mutual emotion regulation (p = .019). Cumulative maternal childhood experiences of maltreatment were associated positively with mother and infant negative states at individual and dyadic level and with the AAI scales of Passivity and Unresolved Trauma (p < .05). The effect of cumulative maternal childhood experiences of maltreatment on mother-infant emotion regulation was direct and not mediated by maternal attachment and reflective function.

CONCLUSIONS

Maternal childhood experiences of maltreatment increase the risk connected to early motherhood, affecting mother-infant emotion regulation.

A non randomized mentalization intervention for parents of children with autism

Parents of children diagnosed with autism spectrum disorder (ASD) report higher levels of stress and other negative affective states than parents of typically developing children. One important resource in managing these heightened levels of negative affect is emotion regulation, which in turn depends upon the ability to recognize and understand one's own and others' mental states (referred to as mentalization or reflective functioning). In this study, parents of children with ASD either participated in a mentalization-based group intervention (N = 36) or a delayed treatment (N = 28). Compared to delayed treatment participants, parents in the mentalization-based group had increases in reflective functioning and in the belief that emotions can change. Moreover, they reported decreased behavioral and emotional symptoms in their children, and greater parental self-efficacy. These preliminary findings support previous studies, which have shown that mentalization-based interventions for parents lead to positive outcomes, and suggest that these findings may apply to a diverse population of parents such as those of children with broader autism phenotype or children with different neurological disorders. Further studies to evaluate the effects of the intervention are recommended. Autism Res 2019, 12: 1077-1086. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this study, parents of children with ASD participated in a group intervention designed to increase their awareness of mental states (their own and their children's) and to enhance their emotion regulation. Compared to delayed treatment parents, those in the intervention group showed increased awareness of developmental states, and reported increased belief that emotions can change and decreased levels of behavioral and emotional symptoms in their children.

Preterm-infant emotion regulation during the still-face interaction

Very-preterm (VPT), moderately-preterm (MPT), and full-term (FT) infants' emotion-regulation behaviors were assessed via the Still-Face procedure at a corrected age of four months. As a developmental task during the first year of life, emotion regulation is important for social and cognitive development. Although substantial evidence indicates that VPT infants exhibit emotion-regulation difficulties, little is known about MPT infants' emotion regulation capabilities, this group also possibly being at risk. The participants included 135 parent-infant dyads: 46 VPT (gestational age 24-32 weeks), 51 MPT (gestational age 32-34 weeks), and 38 FT (gestational age 37-41 weeks). The infants' affect, gaze-aversion, and self-comforting behaviors were coded. Preterm infants responded to parental still face in similar fashion to FT infants, displaying robust still-face and recovery effects. The preterm infants exhibited less developed emotion-regulation behaviors, however, manifested in less positive affect and more gaze aversion in the face-to-face and reunion episodes compared to FT infants. With respect to self-comforting behaviors, each group displayed a significantly different pattern of behaviors throughout the procedure, suggesting better emotion regulation skills among MPT infants compared to the VPT infants. The findings on gaze aversion and self-comforting behaviors could have implications for strategies to incorporate into intervention programs supporting development of emotion regulation skills.

Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It

In the last decade several studies have investigated the role of parental reflective functioning (RF), defined as the parental ability to understand his/her child’s mental states, on the child’s development. Herein, a narrative review on parental RF is presented aimed at (1) presenting an overview of the existing empirical studies, (2) pinpointing unrequited questions, and (3) identifying future research directions. Specifically, the current review focused on (a) the impact of parental RF on the quality of caregiving and the child’s attachment security, (b) the effect of parental RF on the child’s emotion regulation and the child’s RF, (c) maternal RF in women with a history of neglect and abuse, (d) the efficacy of mentalization-based clinical interventions, and (e) the recently developed Parental Reflective Questionnaire. The following terms “maternal RF,” “paternal RF,” “parental RF,” “parental mentalization,” “maternal mentalization,” and “paternal mentalization” were searched in titles, abstracts, and main texts using Medline, Web of Science, and Scopus databases. Next, a search in Mendeley was also conducted. Inclusion criteria comprised original articles if they refer to the RF Scale (Fonagy et al., 1998) and were published in an English language, peer-reviewed journal before July, 2016. According to exclusion criteria, dissertations, qualitative or theoretical papers, and chapters in books were not taken into account. The review includes 47 studies that, taken together, supported the notion that higher parental RF was associated with adequate caregiving and the child’s attachment security, whereas low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors. In addition, higher parental RF was associated with better mentalizing abilities in children. However, unexpected findings have emerged from the most recent randomized controlled trials that tested the efficacy of mentalization-based interventions in high risk samples of mothers, raising questions about the suitability of the verbal measures in capturing the mentalizing processes at the root of the parental capacity to be adequately responsive to the child’s emotional needs.