Nurturing attachments parenting program: The relationship between adopters’ parental reflective functioning and perception of their children’s difficulties

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.

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

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.

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 (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.

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).

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.

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.

The Attachment and Child Health (ATTACH™) program is a 10-12-week mentalization-based parenting intervention designed to increase parental reflective function (PRF), promote secure attachment, increase parent/child interaction quality, and improve child development outcomes in families at risk of poor health outcomes due to intergenerational stressors such as poverty, domestic violence, substance use and depression. What is the effect of the ATTACH™ program on PRF, parent-child interaction quality, and child development in Indigenous participants who have experienced intergenerational stressors? Secondary analysis was performed on data collected from participating Indigenous dyads (n = 17) who provided complete data on the primary outcome in one of seven pilot trials which consisted of both randomized controlled trial (RCT) and quasi-experimental (QE) studies. This study utilised two-tailed paired t-tests (alpha = 0.05) to compare baseline and post-assessment scores on the Reflective Function Scale (RFS) obtained from transcribed and coded Parent Development Interviews (PDI), Parent-Child Interaction Teaching Scale (PCITS), Ages and Stages Questionnaire (ASQ-3), and Ages and Stages Questionnaire - Social Emotional (ASQ-SE) for all Indigenous participants who received the ATTACH™ program in both the RCT and QE pilots. We found significant improvements in Parental-, Child-, and Total RF scores (p = 0.023, p = 0.024, p = 0.015 respectively). There was also significant improvement in the PCITS clarity of cues (p = 0.040). The ATTACH™ program is a promising intervention that stands to counter the effect of intergenerational stressors on high-risk Indigenous parents' abilities to reflect on their own and their children's thoughts and feelings and may improve parent-child interaction quality.

IntroductionParental reflective function is the ability of a parent to attribute mental states to their child and to themselves. The Parental Reflective Functioning Questionnaire is widely used for the measurement of this construct, the adolescent version of which can be used by parents of children aged 12-18.ObjectivesThe aim of our research was to adapt the adolescent version of The Parental Reflective Functioning Questionnaire to the Hungarian language.MethodsIn our study 240 mothers completed the adolescent version of The Parental Reflective Functioning Questionnaire (PRFQ-A), and the Reflective Function Questionnaire (RFQ).ResultsConfirmatory factor analysis did not confirm the original three-factor structure. The principal component analysis resulted in a two-factor structure. Factors corresponded to the original questionnaire’s certainty in mental states (Alpha = .81) and interest and curiosity subscales (Alpha = .70). When analyzing the relationship between parental reflective function and reflective function, the subscales of the parental reflective function questionnaire were examined with two types of median coding in addition to polar coding. During the first median coding, the frequency of scores in the middle of the scales reflected optimal mentalization, while the frequency of extreme values on the scales corresponded to less favorable reflective functioning. With the second median coding, hypermentalization and hypomentalization subscales were also created. The second median transcoding proved to be the most suitable for capturing the relationship between RFQ and PRFQ-A.ConclusionsThe questionnaire proved to be a reliable measure on the Hungarian sample and we recommend using the additional subscales.DisclosureNo significant relationships.

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.

ABSTRACTObjectiveThis study aimed to investigate parental reactions to a diagnosis of Permanent Childhood Hearing Loss (PCHL) and the implications for engagement in medical investigations and early intervention services. The study sought to determine the impact of type of hearing loss, presence of parental depression or anxiety, and parental reflective function on timely engagement with services for children with bilateral PCHL.MethodQuestionnaires were completed by 27 parents of babies aged 3-5 months, diagnosed with bilateral hearing loss. Measures included the DASS 21, DMRF (Diamond Maternal Reflective Function Scale), and demographic items. Clinical charts were accessed six months later to ascertain timing of engagement with medical and early intervention services.Results86% of families attended all required medical appointments following diagnosis. Early intervention services were attended by 65.5% of families. Parental anxiety was the only significant factor in engagement with early intervention services. There was no impact of reflective functioning, parent education and additional medical needs of the child on engagement. The participants also had lower levels overall of anxiety and depression (compared to normative data) but higher levels of stress on the DASS.DiscussionWhile many factors may impact on the likelihood of timely attendance at medical appointments and engagement with early intervention services (EI), support needs to be tailored to each family to ameliorate any potential barriers and ensure that access is easily available, particularly when there may be parental anxiety. This study shows that higher levels of anxiety were significantly associated with decreased engagement with EI.