Children's Mental State Research Articles

Fluid resuscitation strategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups

Fluid resuscitation strategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups

Parental Reflectiveness, Posttraumatic Symptoms and Alcohol Use Disorder among Israeli Combat-Veteran Fathers.

Combat veterans are highly prone to develop Alcohol Use Disorder (AUD) following their release from duty, presumably due to high prevalence of prolonged aversive emotional symptoms such as Posttraumatic Stress Symptoms (PTSS). Parental Reflective Functions (PRF) and Parental Sense of Competence (PSOC) have been identified as key protective factors in predicting maternal functioning and well-being, yet little is known of its role among fathers, let alone combat veteran fathers. In this study we explored whether PRF and PSOC moderated the association between PTSS and AUD among 189 Israel Defense Forces (IDF) male combat veterans. Participants filled out validated measures assessing PTSS, PRF, PSOC and AUD. Results indicated that PTSS, as well as PRF’s “interest and curiosity regarding the child’s mental states” subscale, were positively correlated to AUD. In addition, PRF’s “certainty about child mental states” subscale moderated the association between PTSS and AUD, so that PTSS and AUD were significantly correlated for participants who reported average or high levels of certainty about their child’s mental states. This finding may imply that intrusive mentalizing (“hypermentalizing”) by veteran fathers may facilitate the association between PTSS and AUD, presumably by constituting a maladaptive mechanism for coping with the stressful uncertainty embedded in the parent–child relationship.

Security of attachment and trust beliefs in close others during middle childhood

AbstractThe study examined the relation between the security of attachment and trust beliefs in close others during middle childhood. In the study, 133 children (63 girls, Mage = 9.5 years) completed standardized measures of the security of attachment and three bases of trust beliefs in close others (reliability, honesty, and emotional). Correlational analyses showed that children's security of attachment was associated with emotional trust beliefs in close others only. A structural equation modelling analysis yielded a path between security of attachment and emotional trust beliefs in parents as a latent factor. In addition, there was a path between the latent factor and emotional trust beliefs in peers. Alternative models did not adequately fit the data. The findings were ascribed to the role of parent's emotional trustworthiness and children's mental state discourse in promoting the relation between children's security of attachment and their emotional trust beliefs in close others.

Examining Mothers' Childhood Maltreatment History, Parental Reflective Functioning, and the Long-Term Effects of the Minding the Baby® Home Visiting Intervention.

Research is needed to better understand how childhood maltreatment history affects parental reflective capacities, and whether early childhood interventions help mitigate these effects. We examined associations between childhood maltreatment and current parenting (parental reflective functioning, parenting behaviors) among mothers who participated in a follow-up study (N = 97) of the Minding the Baby® (MTB) randomized control trial. MTB is a home visiting program that aims to help mothers understand their child's mental states (feelings, intentions, needs) by promoting parental reflective functioning. Mothers retrospectively reported childhood maltreatment using the Childhood Trauma Questionnaire. Endorsing a higher number of childhood maltreatment subtypes was associated with less supportive/engaged parenting and higher pre-mentalizing modes, or difficulty with appropriately reflecting on the child's mental states. These relationships were not moderated by participation in the MTB intervention. However, exploratory analyses of individual maltreatment subtypes revealed that participation in MTB may mitigate the harmful effects of childhood emotional abuse on pre-mentalizing modes, specifically. Further research is needed to understand the mechanisms through which early childhood interventions may prevent intergenerational cycles of maltreatment.

Parental reflective function and children's attachment-based mental state talk as predictors of outcome in psychodynamic child psychotherapy.

Mentalization, operationalized as reflective function, is defined as the capacity to understand behavior in terms of mental states. Mentalization can be self-focused (i.e., mentalizing that focuses on one's own thoughts and feelings) or other-focused (i.e., mentalizing that focuses on others' thoughts and feelings). Some studies in adult psychotherapy show the importance of patients' mentalization capacity for treatment outcome; however, this has not yet been investigated in psychodynamic child psychotherapy. This study aimed to investigate whether baseline parental reflective function (PRF) and children's mental state talk (MST) predicted changes in emotional and behavioral problems in psychodynamic child psychotherapy. The sample included 60 Turkish school-age children (Mage = 7.90, SD = 1.35, 43.3% girls) with internalizing (18.3%), externalizing (5%), and comorbid (56.7%) problems, and 20% of the children were in the nonclinical range. The mothers were interviewed using the Parent Development Interview, which was coded for PRF (self- and child-focused). Children were administered an attachment-based story stem task, coded for MST (self- and other-focused). The Brief Problem Monitor was administered every month over the course of treatment for a total of 366 sessions. Multilevel modeling analyses indicated that mothers' child-focused PRF and children's self-focused MST predicted changes in problem behaviors. Parents' mentalization about their children and children's mentalization about their own internal states could be predictors of treatment response in psychodynamic child psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Children's theory of mind referencing and contribution to discourse during different book sharing contexts in preschool

Theory of Mind (ToM), defined as children's understanding of their own and others' minds, is a foundational social cognitive skill. Research showed the important role of adults' conversations during book sharing, focusing on mental states, for ToM development. Additionally, children's mental-state talk is rarely studied. The current study focused on several children's discourse characteristics: mental-state terms, references to false beliefs, questions, reactions and initiations, between a small group and their preschool teacher during different contexts of book sharing at preschool: (1) Storybook reading; (2) Storybook reconstruction, when teachers reconstructed the story with the children based on a wordless version of the same book; (3) Storybook telling of a wordless book based only on illustrations. In all three conditions the teachers received the book and read/looked through it prior to the interactions with the children. Our findings showed that children's discourse characteristics appeared more during telling than reconstruction and reading, and more during reconstruction than during reading. Our discussion highlights the particular contribution of wordless book contexts, without sticking to text, for enhancing children's mental-state references and their active participation in discussions on books with preschool teachers and peers.

Mind-mindedness and parenting stress in mothers of preterm and full-term infants: The moderating role of perceived social support.

The goal of this study was to examine the effects of preterm birth and maternal childbirth-related posttraumatic stress and parenting stress on maternal mind-mindedness (MM). The study also investigated the effects of perceived social support on parenting stress and MM. Sixty-five preterm (N=32) and full-term (N=33) mother-infant dyads were observed at 6 months. Measures of maternal MM were obtained from observations of mother-infant interaction. Mothers also provided ratings of their posttraumatic stress disorder (PTSD) symptoms, parenting stress, and perceived social support via an online survey. Experiencing a preterm birth did not affect mothers' use of mental state descriptors during mother-infant interaction. Neither childbirth-related posttraumatic stress nor parenting stress directly affected maternal ability to comment on the child's mental states appropriately. However, at medium and high levels of perceived social support, a negative association between parenting stress and MM was observed. Maternal perception of being emotionally supported by significant others promoted MM in mothers showing low or mild levels of parenting stress, but not in mothers experiencing high stress in parenting their infants. Results suggest that a proclivity to MM might be affected by the interaction between parenting stress and social support, rather than by childbirth-related variables, such as prematurity.

Dyadic Mirror

A parent's capacity to understand the mental states of both him/herself and the child is considered to play a significant role in various aspects of parent-child relationship-e.g., lowering parental stress and supporting cognitive development of the child. We propose Dyadic Mirror, a wearable smart mirror which is designed to foster the aforementioned parental capacity in everyday parent-child interaction. Its key feature is to provide a parent with a second-person live-view from the child, i.e., the parent's own face as seen by the child, during their face-to-face interaction. Dyadic Mirror serves as a straightforward cue that helps the parent be aware of (1) his/her emotional state, and (2) the way he/she would be now being seen by the child, thereby facilitate the parent to infer the child's mental state. To evaluate Dyadic Mirror under unconstrained parent-child interactions in real-life, we implemented the working prototype of Dyadic Mirror and deployed it to 6 families over 4 weeks. The participating parents reported extensive experiences with Dyadic Mirror, supporting that Dyadic Mirror has helped them be aware of their recurring but unconscious behaviors, understand their children's feelings, reason with the children's behaviors, and find self-driven momenta to better their attitude and expressions towards their children.

Theory of mind in Portuguese school children: An exploratory study

Introduction and objectivesTheory of mind (ToM) has been studied as well as children's mental states in relation to their everyday behaviour and is indispensable for skilled communication. Considering the importance of measuring ToM in school children, the aim of this exploratory investigation was to apply a preliminary Portuguese version of the ToM Picture Stories Task in a sample of school children aged from 6 to 8 years and to analyze the impact of individual differences (e.g. gender, parent's age, educational level, number of siblings) on task performance. PurposeThis article analyses ToM performance in a sample of 103 Portuguese school children in a public school. MethodTwo stories of the ToM Pictures Sequencing Task were used to assess ToM competence in a sample of 103 participants (54 females and 49 males) aged from 6 to 8 years. Individual differences (e.g., gender, number of siblings, parents educational levels and age) were also considered. ResultsThe results showed good performances in story 1, but not as good in story 2. Positive correlations were found between age and year of schooling and performance in ToM tasks. ConclusionFuture research is needed regarding the influence of cognitive and linguistic skills in high-order ToM skills in school children.

Attachment & Child Health (ATTACH) pilot trials: Effect of parental reflective function intervention for families affected by toxic stress.

Toxic stressors (e.g., parental violence, depression, low income) place children at risk for insecure attachment. Parental reflective function-parents' capacity to understand their own and their child's mental states and thus regulate their own feelings and behavior toward their child-may buffer the negative effects of toxic stress on attachment. Our objective was to test the effectiveness of the Attachment and Child Health (ATTACH) intervention, focusing on improving reflective function and children's attachment security, for at-risk mothers and children <36 months of age. Three pilot studies were conducted with women and children from an inner city agency serving vulnerable, low-income families and a family violence shelter. Randomized control trial (n = 20, n = 10 at enrollment) and quasi-experimental (n = 10 at enrollment) methods tested the effect of the ATTACH intervention on the primary outcome of reflective function scores, from transcribed Parent Development Interviews. Our secondary outcome was children's attachment patterns from Ainsworth's Strange Situation Procedure. Despite some attrition, mixed methods analysis of covariance and t tests revealed significant differences in maternal, child, and overall reflective function, with moderate effect sizes. While more children whose mothers received the ATTACH program were securely attached posttreatment, as compared with controls, significant differences were not observed, which may be due to missing observations (n = 5 cases). Understanding the effectiveness of programs like the ATTACH intervention contributes to improved programs and services to promote healthy development of children affected by toxic stress.

The influence of narrative competence on mental state talk in kindergarten and primary school children.

This study investigates the relationships between narrative competence and mental state talk at different age levels. Specifically, we explored whether a higher level of structure in narratives is associated with children's mental state talk, and whether this effect is moderated by age (kindergarten, lower and upper primary school). The participants in the study were 172 Italian children. The children were asked to tell a story and their productions were coded for narrative structural level and mental state talk. Data showed higher levels of narrative structure were associated with a higher frequency of emotional, cognitive, moral, and socio-relational terms. Results of the present study contributed to improve our understanding about how mental state talk and narrative competence are associated in different ways at different ages. This result suggests that children may develop in the ability to coordinate mental state talk and narrative structure as an effect of both, age and schooling. Statement of contribution What is already known on this subject? Theory of mind and language are interconnected. Theory of mind can be assessed through mental state talk. Mental state talk is elicited through narrative tasks. What does this study add? Narrative competence is associated with mental state talk. The first years of primary school seem to represent an important transition in children's development in narrative competence and MST. Children may develop in the ability to coordinate mental state talk and narrative structure as an effect of both, age and schooling.

Parent–child mentalizing in pediatric epilepsy

BackgroundChild psychopathology involves inappropriate or biased attributions of others' mental states (mentalizing), and parents' assessment of their children's mentalizing significantly predicts the latter's psychosocial outcomes. Behavioral difficulties are frequent in children with epilepsy (CWE) yet biased mentalizing and parental accuracy in understanding their child's mental states reasoning have not been addressed. MethodsThis study compared the performance of 34 CWE aged 9 to 16 years with 67 language age-matched controls on a biased mentalizing task. The task required children to infer on the mental states of peers in stories involving social scenarios. Responses were scored as positive, negative, or rational mentalizing attributions. To measure parental accuracy, a parent version was administered in the patient group that required a parent to identify their child's responses correctly. Relationships with the child's cognitive, behavioral, and epilepsy-related factors were examined. ResultsPatients made greater negative mental states attributions compared with control children. This negative mentalizing bias was accurately identified by parents and was associated with children's behavioral problems. Parental accuracy was reduced for patients with lower cognitive abilities. Parents did not accurately identify an overly positive (OP) bias in their child's mental states attributions. Children's positive response bias correlated with their lower executive function (EF) skills. Epilepsy factors predicted cognitive deficits but not biased mentalizing or behavioral problems. ConclusionBiased mentalizing characterizes social cognition in CWE with behavioral problems. Further investigation of the mentalizing biases and parental awareness of children's mental states reasoning is required to fully understand the greater psychosocial and behavioral difficulties found in CWE.

Associations Between Emotion Regulation and Parental Reflective Functioning.

Emotion regulation encapsulates the capability to successfully manage an ongoing emotional experience, particularly in social interactions, and thus may be especially significant to early parent-child relationships. In particular, the capacity to adjust emotions may support parental mentalization and reflective functioning - how parents think about their own and their child's mental states and how these mental states effect behavior. To examine this issue, we investigated the association between emotion regulation, emotion dysregulation, and parental reflective functioning in a maternal sample (N=97). We found that mothers with higher tendencies to suppress their emotions and who had more difficulties with emotion regulation engaged in greater levels of pre-mentalizing (i.e., a non-mentalizing mode). Mothers with poorer emotional awareness also evidenced less interest and curiosity in their child's mental states. Finally, mothers who reported greater difficulty setting goals also evidenced a reduced capacity to recognize that their infant's mental states are not directly observable. Taken together, our findings support the relationship between different aspects of emotion regulation and maternal reflective functioning, suggesting that emotion regulation should be integrated in empirical and intervention work that targets maternal mentalization.

The relations between self- and caregiver- focused reflective function and theory of mind in the context of borderline pathology in adolescence

Theory of mind (ToM) development is fostered by parent-child interactions characterized by accurate reflection on the child's mental states, or reflective function (RF), by the caregiver. Therefore, attachment-based RF is the foundation upon which children learn to reason about minds outside the attachment context (domain-general ToM). However, it is not known to what extent attachment-based RF of the self versus caregivers uniquely relates to domain-general ToM. Additionally, it is likely that for psychopathology associated with maladaptive parent-child dynamics (i.e., borderline pathology), domain-general ToM impairments are more strongly related to attachment-based RF disturbances. Therefore, the aim of the current study was to evaluate associations between domain-general ToM and attachment-based RF to determine whether RF of the self versus caregivers has unique relations to domain-general ToM. Second, we tested whether borderline pathology would moderate this relation. Among a sample of inpatient adolescents (N = 330 adolescents; Mage = 15.40, SD = 1.44), findings suggest that RF of the self uniquely relates to domain-general ToM and that this relation is strongest among adolescents with high levels of borderline pathology. Therefore, evidence supports theory regarding the association between attachment-based RF and domain-general ToM. Additionally, interpersonal disturbance observed in borderline pathology, even in adolescence, is related to attachment-based social-cognition.

Theory of mind is related to children's resource allocations in gender stereotypic contexts.

The present study investigated the relations between 4- to 6-year-old children's (N = 67) gender stereotypes, resource allocations, and mental state knowledge in gender-stereotypic contexts. Participants were told vignettes about female and male characters completing gender-stereotyped activities (making dolls or trucks). Children held stereotypic expectations regarding doll- and truck-making abilities, and these expectations predicted the degree of bias in their allocations of resources to the characters. Critically, children's performance on a Theory of Mind (ToM) Scale (Diverse Desires [DD], Contents False-Belief [FB], Belief-Emotion [BE]) was significantly related to their allocations of resources to individuals whose effort did not fit existing gender stereotypes (e.g., a boy who was good at making dolls). With increasing ToM competence, children allocated resources based on merit (even when the character's effort did not fit existing gender stereotypes) rather than based on stereotypes. The present results provide novel information regarding the emergence of gender stereotypes about abilities, the influence of stereotypes on children's resource allocations, and the role of ToM in children's ability to challenge gender stereotypes when allocating resources. (PsycINFO Database Record

Reflective functioning, physiological reactivity, and overcontrol in mothers: Links with school-aged children's reflective functioning.

Theorists argue that parental reflective functioning (PRF) is activated in response to emotions, potentially supporting parenting sensitivity even when arousal is high. That is, when parents become emotionally reactive when interacting with their children, those who can use PRF to understand their children's mental states should be able to parent sensitively, which, in turn, should promote children's ability to understand their own mental states. We test this theory by examining whether, in the face of physiological reactivity, mothers' PRF inhibits one form of parenting insensitivity, overcontrol (OC), and whether this process in turn predicts children's RF. A diverse sample of school-age children (N = 106, Mage = 10.27 years) completed a standardized failure paradigm while their mothers were asked to passively observe. Following the stressor, mothers and children independently completed interviews regarding the task, which were later coded for RF with respect to children's mental states. Mothers provided saliva samples before and after the stressor, and after the interview, which were later assayed for cortisol reactivity; maternal behavior during the stressor task was coded for OC. Among mothers with low levels of RF, greater increases in cortisol were associated with more displays of OC, whereas among mothers with high PRF, greater cortisol reactivity was associated with fewer OC behaviors. For low PRF mothers, higher reactivity and OC predicted lower children's PRF for their own experiences. The findings provide initial evidence for a protective function of PRF, and may point toward the importance of promoting PRF in intervention programs to reduce parental OC. (PsycINFO Database Record

MENTAL STATE LANGUAGE DEVELOPMENT: THE LONGITUDINAL ROLES OF ATTACHMENT AND MATERNAL LANGUAGE.

Maternal mental state language is thought to influence children's mental state language and sociocognitive understanding (e.g., theory of mind), but the mechanism is unclear. The current study examined the longitudinal development of mental state language in mother-child interactions. The methodology included assessments of the child and/or mother-child dyad at six time points between 12 to 52 months of the child's age. Measures determined child's attachment style and language abilities, and mental state language used by mother and child during a block-building task. Results showed that (a) mental state talk, including belief and desire language, increased over time; (b) there were differences between the type of mental state words used by the mother in insecure versus secure dyads; (c) there were differences in patterns of mental state words used in both mothers and children in insecure versus secure dyads; and (d) attachment appeared to exert a consistent influence over time.

A Comparison of Children's Ability to Read Children's and Adults' Mental States in an Adaptation of the Reading the Mind in the Eyes Task.

The ability to read mental states from subtle facial cues is an important part of Theory of Mind, which can contribute to children's daily life social functioning. Mental state reading performance is influenced by the specific interactions in which it is applied; familiarity with characteristics of these interactions (such as the person) can enhance performance. The aim of this research is to gain insight in this context effect for mental state reading in children, assessed with the Reading the Mind in the Eyes (RME) task that originally consists of pictures of adults' eyes. Because of differences between children and adults in roles, development and frequency of interaction, children are more familiar with mental state reading of other children. It can therefore be expected that children's mental state reading depends on whether this is assessed with children's or adults' eyes. A new 14 item version of the RME for children was constructed with pictures of children instead of adults (study 1). This task was used and compared to the original child RME in 6–10 year olds (N = 718, study 2) and 8–14 year olds (N = 182, study 3). Children in both groups performed better on the new RME than on the original RME. Item level findings of the new RME were in line with previous findings on the task and test re-test reliability (in a subgroup of older children, n = 95) was adequate (0.47). This suggests that the RME with children's eyes can assess children's daily life mental state reading and supplement existing ToM tasks.

Circumcision and its potential effects on children's mental health state

ObjectivesCircumcision is one of the oldest elective surgical interventions in the history of mankind. Though many studies have been conducted on the surgical complications of circumcision, the potential effects on the mental state of the children has not been satisfactorily reviewed. In this prospective study, we analyzed potential effects of circumcision on their mental state, anxiety levels and moods using updated scales. Material and methodsOne hundred and two male children aged between 6 and 8 and their families were included in the study. Children with their families completed sociodemographic data form Anxiety Sensitivity Index For Children, the Strengths and Difficulties Questionnaire (SDQ), Depression Scale for Children during the preoperative period. All children received oral 0.5mg/kg midazolam as a premedication before circumcision procedure. Circumcisions were performed under general anesthesia in the operating room. During the 6th week of the postoperative period, the children and their families were returned to the facility and parents were asked to complete the questionnaire again. ResultsMean score of the preoperative depression scale was statistically and significantly higher than the mean postoperative depression scale score (P=0.001; P<0.01). Pre-, and post-operative depression scale scores of the children with divorced parents showed a higher statistical significance higher than those of the children whose family togetherness was not broken (P=0.001; P<0.01). ConclusionBefore circumcision, in all children to be circumcised a tendency to depression and an increase in anxiety were observed regardless of the presence of subgroups. At the end of the study, it was found that low socioeconomic level, disrupted family dynamic, and/or the presence of mental disease in a parent could increase the predisposition to pre and post-operative depression. At this stage the main factor determining the level of anxiety is the procedure of circumcision itself.

Parental mentalizing as an indirect link between attachment anxiety and parenting satisfaction.

Attachment anxiety in parents is associated with lower quality parent-child relationships. An inhibited capacity to reflect on children's mental states, referred to as prementalizing, may reduce the pleasure parents derive from their relationships. In the current study, we explored the associations among attachment anxiety, prementalizing, and parenting satisfaction in two groups of participants randomly assigned either to reflect on a positive memory with their child (n = 150) or to reflect on a positive memory not involving their child (n = 150). Narratives were evaluated for positive content using two metrics: coder-rated positivity and frequency of positive emotion words. Results revealed that self-reported prementalizing operated indirectly to link attachment anxiety and self-reported parenting satisfaction for both groups. However, prementalizing only served as an indirect link between attachment anxiety and coded measures of positivity among participants who reflected on parenting experiences, suggesting the specificity of prementalizing in linking attachment anxiety and reduced positivity in the parenting role. The results have implications for understanding influences of attachment and mentalization on parents' perception of parent-child relationship quality. (PsycINFO Database Record