Better reflective functioning in mothers linked to longer joint attention with infants

High degree of uncertain reflective functioning in mothers with substance use disorder

Parental reflective functioning (RF) is often cited as an important domain in which mothers with addictions struggle in their roles as parents, though the links between addiction and RF remain unclear. Exposure to attachment trauma associated with parental mental illness and substance use is commonly associated with both addiction and lower RF. We thus examined how family history of parental mental illness and substance use may relate to the RF of mothers with addictions. One hundred ninety-four mothers in outpatient substance use treatment completed the Parent Development Interview and provided information about whether their mothers and fathers experienced mental illness or problems with substance use. Univariate ANOVAs revealed an interaction between family history of maternal mental illness and maternal substance use. Among mothers with a history of maternal substance use, those with a history of maternal mental illness had higher RF than those who had no history of maternal mental illness. Among mothers who did not report a family history of maternal mental illness, mothers who had a family history of maternal substance use exhibited significantly lower RF than mothers with no family history of maternal substance use. Exposure to paternal mental illness or substance use was not associated with mothers’ RF. These findings highlight the importance of disentangling the contributions of attachment trauma to mothers’ RF and utilizing interventions that support mothers’ capacity to reflect about how their early experiences of being cared for by a mother with a mental illness or addiction may impact their current caregiving behaviors.

AimsImpairments in reflective functioning are known to have adverse effects on the ability to display sensitive parenting as a caregiver. Several factors are associated with impairments in reflective functioning, such as impaired executive functioning and experienced trauma. We investigated how these factors contribute to an impaired reflective functioning style, such as pathological certain or uncertain reflective functioning. Extreme scores on these two subscales reflect two kinds of impairments in reflective functioning. We assessed executive functions, reflective functioning, and trauma in 43 mothers diagnosed with substance use disorders (SUD). MethodsCertain or uncertain reflective functioning were assessed using the Reflective Functioning Questionnaire 8 (RFQ-8). Executive functions and trauma were assessed by administering various questionnaires, interviews and neuropsychological tests. ResultsHigh uncertain reflective functioning was more than six times as common (odds ratio) in mothers reporting high amounts of trauma in childhood and adolescence compared with mothers reporting low amounts of trauma. Impaired executive functions were also significantly associated with high uncertain reflective functioning. Certain reflective functioning did, however, not show any significant associations. ConclusionWhen the SUD mothers give information about relational trauma in childhood and adolescence, it might therefore be worth investigating and addressing the potential tendency to have an uncertain reflective functioning style.

Although much is known about childhood anxiety disorders, the differential contributions by mothers and fathers to child anxiety is poorly understood. This study examined the relation between child anxiety and parental level of psychopathology, attachment style, and reflective functioning (RF). Thirty-eight clinically anxious children aged 7-12 years (55.3% female) referred for treatment and their parents (37 mothers, 34 fathers) participated in the study. Reflective functioning was coded based on Adult Attachment Interviews. Self-report questionnaires on attachment and psychopathology were administered. Paternal psychopathology, attachment avoidance, and attachment anxiety as well as maternal attachment anxiety were associated with child anxiety. Mothers had higher RF abilities than fathers. Lower levels of RF in mothers and higher levels of attachment avoidance in fathers explained 42% of the variance in anxiety levels of the child. Mothers and fathers may provide unique contributions to the development of child anxiety. The findings highlight the importance of considering fathers as well as mothers in research and treatment for childhood anxiety disorders.

ObjectivesExternalizing behavior problems are considered to be a serious impediment to a child’s development, and therefore it is important to identify their predictors. In this study, we investigated the connections between school-aged boys’ externalizing problems, the mother’s reflective functioning (RF) and the mother’s perception of her childhood relationship with her own caregivers.MethodsThe study sample comprised 39 school-age boys diagnosed with externalizing behavior problems together with their mothers. A child’s psychopathology was assessed using the Child Behavior Checklist and Teacher Report Form. Our assessment of the mothers’ mentalizing capacities was based on the Adult Attachment Interview and Reflective Functioning Scale. The perception of a mother’s childhood relationship with her parents was assessed using the Parental Bonding Instrument.ResultsThe analysis revealed that more severe cases of aggressive and rule-breaking behavior in boys were associated with lower RF in mothers, as well as with a mother’s perception of her childhood relationship with her own parents as less autonomous. More aggressive behavior in boys was also associated with a mother’s perception of herself as experiencing a higher degree of care from her father during her own childhood.ConclusionsThese are only preliminary findings and we have discussed them with a view to understanding the possible ways in which a mother’s RF and the intergenerational context of relationship quality are associated with externalizing behavior problems in middle childhood.

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.

In this study, we examined maternal reflective functioning as a bi-dimensional construct in a sample of 47 mothers with drug use disorders caring for infants and toddlers. We first tested a two-factor solution with scale items from the Parent Development Interview and confirmed the presence of two related but distinct dimensions: self-mentalization and child-mentalization. We then tested predictions that (a) self-mentalization would be associated with overall quality of maternal caregiving and that (b) child-mentalization would be associated with (i) maternal contingent behavior and (ii) child communication. Results partially supported hypotheses (a) and (bii). Unexpectedly, self-mentalization alone was associated with maternal contingent behavior. Findings suggest that self-mentalization may be a critical first step in improving mother-child relations involving mothers with drug use disorders. Implications for theory and practice are discussed.

Parental reflective functioning (PRF) is considered a key parental competence. Since most research on PRF has focused on infancy or the first years of life, there is a gap in our understanding of PRF among parents of older children. Therefore, we investigated PRF in mothers and fathers with preschool-aged children, examining associations between PRF, parent's romantic attachment, and observed parenting behavior. The sample comprised 50 mothers, 40 fathers, and their 5-year-old children. PRF was assessed using the parental reflective functioning questionnaire (PRFQ), parental romantic attachment was assessed using the experiences in close relationships scale-revised (ECR-R), and parenting behavior was assessed during a parent-child free-play interaction with the coding interactive behavior (CIB) coding system. Results showed that mothers scored higher on the interest and curiosity scale than fathers, indicating that mothers show a more active interest and curiosity in their child's mental states. Further, higher levels of attachment anxiety in fathers were associated with higher levels of pre-mentalizing modes. In mothers, higher levels of attachment avoidance were associated with lower levels of interest and curiosity. Finally, and unexpectedly, higher levels of interest and curiosity in mothers were associated with less sensitivity during free play. In summary, the study found meaningful associations between mothers' and fathers' romantic attachment and their PRF indicating a spill-over of their attachment strategies into their relationship with their child. Further, the study results suggest that very high levels of interest and curiosity in mothers reflect hypermentalizing.

AimsMothers with substance use disorders (SUD) often show impairments in parental reflective functioning (PRF), which may have adverse effects on their capacity for sensitive caregiving. Parenting personality is also associated with caregiving. However, no studies have investigated how these individual factors may contribute to variance in PRF in mothers with SUD. In this study PRF and personality were assessed in 43 mothers with SUD. MethodsPRF was assessed by the Parent Development Interview. Personality traits were assessed by the Revised Neuroticism-Extraversion-Openness Personality Inventory. ResultsThe results indicate that higher levels of the Openness trait are associated with better PRF. ConclusionMothers low in Openness may need more specific and situational training in interpreting mental states in their children. Highly open mothers with SUD will likely need more help distinguishing the child’s mental states from their own, and might need help to maintain mutuality and regulating the intensity of their responses to the child’s behavior.

Parental factors contribute to ADHD, partly in an etiological way and partly as moderators and mediators of child outcomes and treatment effects. An important aspect of parenting seems to be parental reflective functioning (PRF), defined as the parent's capacity to reflect upon his own and his child's internal mental experience. The studies on parenting factors linked to ADHD have not extensively investigated the role of PRF. Recent findings on interventions have begun to consider mentalization to promote empathy and emotion regulation in parents, but empirical studies assessing PRF are still scarce. The aim of this cross-sectional study was to compare specific familial and parental functioning characteristic between parents of children with attention deficit/hyperactivity disorder (ADHD) and parents of controls without ADHD. A clinical sample of 41 children with ADHD aged 8–11 years and their parents was compared with a matched, non-clinical sample of 40 children. Three aspects of parental functioning were investigated: parental symptomatology, parental alliances and PRF; children's differences in strength and difficulty profiles were also assessed. The results showed that families of children with ADHD had lower socioeconomic status, and both mothers and fathers of the same families reported higher scores for depression and lower PRF than did the control group; only mothers showed lower parental alliance. Logistic regression highlighted the fact that several of these familial and parental factors contributed to the increased risk of belonging to the clinical group, specifically both mothers' and fathers' depressive symptoms and lower PRF. These data represent new findings with potentially meaningful clinical implications for both assessment and intervention.

Adverse and adaptive childhood experiences are associated with parental reflective functioning in mothers with substance use disorder

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.

Mothers with a substance use disorder (SUD) have been found to exhibit heightened experience of stress and deficits in executive functioning (EF) and in parental reflective functioning (PRF). Although experiences of stress, EF and PRF are important for caregiving capacities; no studies have explored associations between the phenomena in mothers with SUD. This study aimed to examine the association between EF (working memory, inhibition, and cognitive flexibility) and different forms of stress (parental stress, general life stress, and psychological distress) in 43 mothers with SUD with infants. We further aimed to investigate whether PRF had a mediating function between EF and the experience of stress. The mothers completed self‐report questionnaires regarding experiences of different types of stress, and we also used neuropsychological tests to assess EF and a semistructured interview to assess PRF. Results identified problems in EF were associated with higher parental stress and psychological distress but not with general life stress. Cognitive flexibility contributed uniquely to variance in parental stress, whereas working memory was a unique contributor to variance in psychological distress. PRF had a mediating function between EF and parental stress and between EF and psychological distress. Findings highlight the importance of considering individual differences in PRF when targeting EF in interventions trying to reduce the experience of parental stress and psychological distress in mothers with SUD.

This paper presents a review of the processes involved in the development of the theory of mind in children through an intersubjective approach. More specifically, the development of the theory of mind was examined in the context of the child-caregiver attachment. For this purpose, studies examining the links between various theory of mind variables (e.g.: joint attention, symbolic play, language skills) and parent-child interaction variables (e.g.: maternal sensitivity, reflective functioning) were reviewed. In summary, variables pertaining to the parent-child relationship, reflective functioning and maternal sensitivity in particular, are argued to be the key determinants of a child’s affect regulation and self organization.

With the introduction of the Diagnostic and Statistical Manual of Mental Disorders-5th ed. (DSM-5) autism spectrum disorders (ASD) fall into the category of neurodevelopmental disorders. ASD is characterized by the inhibitory mechanisms responsible for social adaptation and emotional expression being underdeveloped, causing a child’s recognition and understanding of emotions to be impaired. Our study hypothesizes that early intervention using behavioral interventions such as Applied Behavior Analysis (ABA) and reflexive functions (RF) training on parents can improve the development of joint attention (JA), a cognitive precursor to the theory of mind (ToM) and mentalization processes. We considered a sample of 84 children aged between 20 and 30 months who had received a diagnosis of risk of autism spectrum disorder (level 1). The sample was divided into two groups of 42 subjects, in the first group we carried out a weekly behavioral parent training (PT) based only on ABA principles, while in the second group we carried out a weekly PT aimed at improving reflective functions and parental awareness according to a model inspired by the model based on emotional mirroring and mentalization of Fonagy. Our study shows that parents who are able to make sense of both their own mental state and that of their child can serve as a protective factor for the child’s development even in atypical developmental situations such as in ASD.