Effectiveness of the ATTACH™ program on Indigenous parents and their children exposed to intergenerational stress: pilot findings.

BackgroundChildren’s exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents’ capacity for insight into their child’s and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHTM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents’ RF in the domains of attachment, parenting quality, immune function, and children’s cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACHTM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions.MethodsThe study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHTM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire – 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACHTM implementation.DiscussionThe proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHTM in community agencies.Trial registrationName of registry: https://clinicaltrials.gov/. Registration number: NCT04853888. Date of registration: April 22, 2021.

Parental reflective functioning (PRF) is the ability of parents to understand their child's behavior in light of underlying mental processes; it is a core element in the parent-child relationship. RF is also considered crucial for self-regulation for both parents and their children. We investigated the relationship between improvement in PRF after DUET group intervention (a RF-based intervention) and improvement in the parent-child interaction, child RF, and child adjustment, and we examined whether these improvements were distinct for children with different temperamental traits (e.g., effortful control). Eighty-four parents completed the DUET program and were assessed before and after the intervention. PRF was measured using observation (mind-mindedness) and a questionnaire. Statistical analysis included hierarchical regression and moderation of regression analysis. Results showed that improvement in the parent-child interaction, child RF, and child behavioral problems were related to improvement in PRF. Furthermore, we found that child temperament acted as a moderator in the link between PRF and child RF, supporting a vantage sensitivity model, meaning that it was the more sensitive children who benefitted the most as a result of the positive change in their parents' RF. Clinical and future directions of this study are discussed.

IntroductionThe transition to parenthood is a high-risk period for many parents and is an important period for child development. Research has identified that parental mental health, reflective functioning (capacity to consider mental states of oneself and others) and coparenting (capacity to work together well as a parenting team) may be particularly significant predictors of later child outcomes, however these factors have seldom been considered together. The present study therefore aimed to investigate the relationship between these factors and the extent to which they predict child social emotional development.MethodsThree hundred and fifty parents of infants aged 0 to 3 years 11 months were recruited to complete an online Qualtrics questionnaire.ResultsResults indicate that both positive coparenting and parental reflective functioning (Pre-mentalizing and Certainty subscales) were found to significantly predict child development. General reflective functioning (Uncertainty subscale) predicted parental depression and anxiety, however unexpectedly, parental mental health was not a significant predictor of child development, but did predict coparenting. General reflective functioning (Certainty subscale) was also found to predict coparenting, which in turn was found to predict parental reflective functioning. We found an indirect effect of general reflective functioning (Certainty) on child SE development via parental reflective functioning (Pre-mentalizing). We also found an indirect effect of negative coparenting on child development via parental reflective functioning (Pre-mentalizing).DiscussionThe current results support a growing body of research highlighting the important role reflective functioning plays in child development and wellbeing as well as parental mental health and the interparental relationship.

This pilot study provides a preliminary evaluation of the newly adapted one-to-one version of Tuning in to Kids (TIK), using a randomised-controlled design. One hundred and seven parents of a child aged between four and ten with parent-identified behaviour problems participated. Parent emotion socialisation, parental reflective functioning (PRF), parent and teacher-reported externalising behaviour problems and parent-reported internalising (anxiety) problems were assessed at baseline and six-month follow-up. Parents who completed the TIK one-to-one intervention reported improved emotion socialisation practices, relative to waitlist-controls. Children of parents in the intervention group also experienced more clinically significant improvement to their externalising behaviour problems, and decreased anxiety symptoms. There were no significant changes to teacher-reported behaviour problems, or to PRF, however, there was a trend towards intervention parents experiencing improvements to one aspect of PRF – Pre Mentalising. TIK one-to-one shows promise as an effective intervention approach for parents and their children with behaviour problems. Further corroboration of these effects is needed with a larger sample. Abbreviations: Tuning in to Kids (TIK); Parental Reflective Functioning (PRF) Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12618000310268

ABSTRACTMaternal depressive symptoms are highly prevalent postpartum and have been shown to negatively impact maternal caregiving. The emotional response to infant crying has been shown to predict individual differences in the quality of caregiving behavior. Parental reflective functioning, that is, the ability to understand and reflect on the infant's mental states, may aid in understanding infant distress signals and thereby also regulating negative emotions in response to infant crying. Therefore, the first aim of the current study was to investigate differences in emotional responses to infant crying and parental reflective functioning in mothers with clinically relevant symptoms of depression compared to mothers without clinically relevant symptoms of depression and second to test whether an association between depressive symptoms and emotional responses to infant crying is mediated by parental reflective functioning. Mothers with infants between 1 and 12 months of age who participated in an online survey about the developing parent−infant relationship in Germany were included in the present study. Depressive symptoms, parental reflective functioning, and emotional responses to infant crying were assessed using the Patient Health Questionnaire (PHQ‐9), the Parental Reflective Functioning Questionnaire (PRFQ), and the My Emotions Questionnaire. A total of 25.1% (n = 148) of mothers reported clinically relevant depressive symptoms, whereas 74.9% (n = 441) reported no or only mild symptoms. Mothers with clinically relevant depressive symptoms showed increased emotional reactivity to infant crying and less optimal parental reflective functioning compared to mothers without clinically relevant depressive symptoms. Further, the association between maternal depressive symptoms and negative emotional responses like anxiety and frustration in response to infant crying was partly mediated by dimensions of parental reflective functioning. The findings indicate that the incorporation of parental reflective functioning in early parenting programs, particularly for mothers experiencing depressive symptoms or at risk for depression, may be a critical factor in promoting sensitive caregiving.

Speech and language skills are the determinants of all child development. Psychosocial factors are one of the most researched postnatal environmental factors, but most research only examines one of many psychosocial factors. In this research, 4 psychosocial factors will be researched. The purpose of this study was to determine the frequency of stimulation, quality of parent-child interaction, the intensity of the use of gadgets, and the duration of watching television as risk factors for speech and language delayed in children aged 24-48 months in Surabaya. This type of study was a case-control study in 122 children aged 24-48 months in 2 working areas of the Public Health Center in Surabaya. Data were analyzed by Chi-Square, contingency coefficient, and logistic regression test. The result showed that there was a relationship between the frequency of stimulation (p < 0.01), the quality of parent-child interaction (p < 0.01), the intensity of device use (p < 0.01), and television viewing duration (p < 0.01 ) with the risk of delayed speech and language development in children and the most dominant risk factor is the quality of parent-child interaction (OR 21,567). It can be concluded that frequency of stimulation, quality of parent-child interaction, the intensity of the use of gadgets, and duration of watching television are risk factors for delayed speech and language development in children aged 24-48 months, and the quality of parent-child interaction is the most influential risk factor.
 Keywords: speech and language development; children

This article draws on an evaluation of the effectiveness of the Nurturing Attachments group work program provided by AdoptionPlus for adoptive families in England. Twenty-nine adoptive families participated in a longitudinal quantitative study, completing questionnaires and validated measures before and after group attendance. The Nurturing Attachments program, informed by Dyadic Developmental Psychotherapy, was developed to help foster and adoptive parents strengthen their relationships with the child and support children who had experienced developmental traumas. Most parents were caring for children who were late placed and who had complex and overlapping difficulties. Post-training, parents reported increased confidence in their own parenting and statistically significant positive changes in self-efficacy and in their capacity for reflective functioning. However, unexpectedly, adoptive parents identified more children as having greater emotional and peer difficulties and fewer with symptoms of conduct disorders. This article focuses on the relationship between perceptions of adopted children’s behavior and parental reflective functioning (PRF) and self-efficacy. It explores whether improved reflective functioning, particularly curiosity, led to a better understanding of their child’s behaviors and thus an increased recognition of emotional distress. Recommendations for supporting adoptive parents, including the importance of supporting PRF, within a wraparound package of support during childhood and adolescence are made.

Parental child-focused reflective functioning (RF)-understanding children's behavior as a function of mental states-and parental empathy-understanding, resonating with, and feeling concern for children's emotions-have each been linked to sensitive caregiving and children's attachment security in separate studies, but they have been neither directly compared nor have researchers tested whether they interact in predicting child outcomes. In this article, we offer theoretical perspectives regarding differences between the constructs, potential points of connection, and ways in which these constructs may function together. Then we test these ideas empirically with 2 samples of mothers of school-age children, exploring their unique and interactive associations with parenting sensitivity, children's attachment security, and children's emotion regulation. In Study 1, mothers (N = 105) watched their children completing a stressor task (i.e., an impossible puzzle); mothers then answered interview questions, from which separate teams coded state-like RF and empathy. In Study 2, mothers (N = 72) completed the Parent Development Interview, coded separately for trait-like parental RF and empathy. Results of the 2 studies converged, revealing moderate positive associations between parental RF and empathy. Further, both RF and empathy were positively associated with specific child outcomes (e.g., attachment security); also, there were unique patterns of association (e.g., parental empathy was uniquely associated with child physiological regulation [neuroendocrine reactivity]) and evidence that critical levels of both are important (e.g., for supportive parenting, accuracy of emotion judgment). Parental RF and empathy might be related to each other and to distinguishable capacities that contribute to attachment and related outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parental reflective functioning (PRF) refers to a parent's ability to understand their own and their child's mental states and connect them to behaviors. This longitudinal study evaluated (1) associations among prenatal PRF, using the Pregnancy Interview, demographics, prenatal maternal depressive symptoms, and maternal-fetal attachment and (2) whether prenatal PRF predicted parenting quality assessed during unstructured and challenging mother-child interaction tasks beyond infancy, after controlling for cumulative risk. Data were collected in an urban community sample of women in the midwestern US. Prenatal PRF was positively associated with maternal educational attainment and negatively associated with cumulative demographic risk, but not with depressive symptoms or maternal-fetal attachment. Controlling for cumulative risk, hierarchical regressions showed that prenatal PRF was the sole significant predictor of positive parenting at 36 months, observed during a challenging teaching task but not during free play. Prenatal PRF did not predict negative parenting. These patterns persisted when analyses were repeated within a subsample of Black mothers, with PRF again being the sole significant predictor of positive parenting. Further attention to cultural variations in PRF and parenting in future research is warranted.

Parental reflective functioning is associated with tolerance of infant distress but not general distress: Evidence for a specific relationship using a simulated baby paradigm

Parental reflective functioning (PRF), a critical construct in the field of infant mental health, has been under investigated in non-WEIRD countries, where the majority of the world's infants are born. Studies from WEIRD contexts have demonstrated a relationship between socio-demographic and parental reflective functioning scores. This study used a mixed-methods concurrent exploratory research design to investigate relationships between socio-demographic factors and parental reflective functioning in a cohort of Black mothers living in Alexandra Township, South Africa. The study found relationships between parental reflective functioning and both abuse disclosure and father involvement in unexpected directions. Qualitative analysis of interview transcripts and intervention case notes highlighted the potential role of empowerment in the participants PRF scores. The findings highlight the central importance of considering the influence of power dynamics and social positioning when measuring parental reflective functioning for both research and clinical purposes.

Lasting Effects of an Interdisciplinary Home Visiting Program on Child Behavior: Preliminary Follow-Up Results of a Randomized Trial

Parental reflective functioning (PRF) describes a parent's capacity for considering both their own and their child's thoughts, feelings, and behaviors, which can help parents to guide interactions with children. Given the cognitive demands of keeping infants in mind whilst caregiving, we examined the association between aspects of executive function (i.e., working memory and set-shifting) and PRF (employing the Parental Reflective Functioning Questionnaire) in recent mothers. In Study 1 (N=50), we found that better working memory was associated with higher levels of maternal interest and curiosity in their child's feelings. In Study 2 (N=68), we found that visual working memory and set-shifting capacity were also associated with higher levels of maternal interest and curiosity in their child's thoughts and feelings. Our results provide preliminary support for the association between executive processes and maternal reflective functioning. The implications of these findings and important future directions are discussed, including advancing our understanding of executive processes and PRF to support the broader family system.

Background: Quality of parent-child interaction and its early experiences form the children's socio-cognitive and emotional development, while parental burnout is one of the factors that have negative effect on parent-child interactions and early childhood experiences and finally cause destructive behavioral problems like misbehaving with children in the family. Objectives: Accordingly, the present study aims to determine the relationship between parental burnout and the parent-child interaction and child abuse components. Methods: In this regard, 297 parents (mothers and fathers) along with 7 - 12 year old primary school students were selected from the community of parents of primary school children in Tabriz city; Parent-Child Relationship Scale (PCRS) by Pianta and Child Abuse Self-Report Scale by Mohammad Khani and Parental Burnout Scale by Roskam were used to measure the variables. Results: The results of regression analysis showed that there is a significant relationship between parental burnout and the components of parent-child interaction. They showed that the relationship between parental burnout and intimacy component is negative, while the relationship between parental burnout and conflict component is significant and positive. Conclusions: Therefore, it can be concluded that the parents' emotional status play a decisive role in forming the quality of their interaction with children, and parental burnout can have negative effects on the parent-child interaction quality.

BackgroundChildren in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent–child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being.MethodsThis is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4–17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists.DiscussionThis trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children.Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022.