Parental Reflective Functioning Research Articles

A randomised-controlled pilot study of the one-to-one delivery of Tuning in to Kids: impact on emotion socialisation, reflective functioning, and childhood behaviour problems

ABSTRACT 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

32.4 A SCOPING REVIEW OF MINDFUL PARENTING RESEARCH

Mindful parenting has been shown to promote healthy parent-child relationships through: 1) parents/caregivers’ increased sensitivity and responsiveness to their children’s needs despite contextual and parenting-related stress; and 2) the promotion of their own well-being. The purpose of this presentation is to provide an overview of the empirical evidence regarding mindful parenting research and practice over the past 15 years. A scoping review was conducted to identify all peer-reviewed publications reporting on mindful parenting studies. Criteria were established to determine study inclusion in the scoping review and studies were then coded by a team of trained coders. The results of the mindful parenting review (n = 134 studies) revealed that approximately 60% of studies implemented a mindfulness or mindful parenting intervention, with others measuring basic levels of parent dispositional mindfulness or mindful parenting in relation to other aspects of parenting and child/family outcomes. The literature on parental reflective functioning was also reviewed (n = 96 studies) to compare and contrast findings with the mindful parenting literature. Many of the results provide evidence of convergent associations and impacts on positive parenting behaviors for both mindful parenting and parental reflective functioning approaches. Across the parenting literature reviewed, however, most studies lack diversity in their sample characteristics because participants were predominantly White and the emphasis was on mothers. Many studies were lacking in detail regarding provider qualifications and training. Synergistic effects may be achieved by employing both mindful parenting and reflective parenting approaches together. Additional community-based participatory research is needed to: 1) refine professional training models for clinicians; and 2) identify appropriate intervention adaptations for different racial/ethnic and cultural groups and people who are fathering.

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

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

Factor structure of the parental reflective functioning questionnaire and association with maternal postpartum depression and comorbid symptoms of psychopathology.

Parental reflective functioning (PRF) refers to the parent’s capacity to envision mental states in the infant and in themselves as a parent, and to link such underlying mental process with behavior, which is important for parenting sensitivity and child socio-emotional development. Current findings have linked maternal postpartum depression to impaired reflective skills, imposing a risk on the developing mother–infant relationship, but findings are mixed, and studies have generally used extensive methods for investigating PRF. The present study examined the factor structure and measurement invariance of the Danish version of the 18-item self-report Parental Reflective Functioning Questionnaire (PRFQ) in a sample of mothers with and without diagnosed postpartum depression. Moreover, the association between PRF and maternal postpartum depression in mothers with and without comorbid symptoms of personality disorder and/or clinical levels of psychological distress was investigated. Participants included 423 mothers of infants aged 1–11 months. Confirmatory factor analysis supported a three-factor structure of the PRFQ; however, item loadings suggested that a 15-item version was a more accurate measure of PRF in mothers of infants. Multi-group factor analysis of the 15-item PRFQ infant version indicated measurement invariance among mothers with and without diagnosed postpartum depression. Multinomial logistic regression showed that impaired PRF was associated with maternal psychopathology, although only for mothers with postpartum depression combined with other symptoms of psychopathology. These results provide new evidence for the assessment of maternal self-reported reflective skills as measured by a modified infant version of the PRFQ, as well as a more nuanced understanding of how variance in symptomatology is associated with impaired PRF in mothers in the postpartum period in differing ways.

Maternal Parenting Stress in the Face of Early Regulatory Disorders in Infancy: A Machine Learning Approach to Identify What Matters Most.

Objective: Early regulatory disorders (ERD) in infancy are typically associated with high parenting stress (PS). Theoretical and empirical literature suggests a wide range of factors that may contribute to PS related to ERD. The aim of this study was to identify key predictors of maternal PS within a large predictor data set in a sample of N = 135 mothers of infants diagnosed with ERD.Methods: We used machine learning to identify relevant predictors. Maternal PS was assessed with the Parenting Stress Index. The multivariate dataset assessed cross-sectionally consisted of 464 self-reported and clinically rated variables covering mother-reported psychological distress, maternal self-efficacy, parental reflective functioning, socio-demographics, each parent's history of illness, recent significant life events, former miscarriage/abortion, pregnancy, obstetric history, infants' medical history, development, and social environment. Variables were drawn from behavioral diaries on regulatory symptoms and parental co-regulative behavior as well as a clinical interview which was utilized to diagnose ERD and to assess clinically rated regulatory symptoms, quality of parent–infant relationship, organic/biological and psychosocial risks, and social–emotional functioning.Results: The final prediction model identified 11 important variables summing up to the areas maternal self-efficacy, psychological distress (particularly depression and anger-hostility), infant regulatory symptoms (particularly duration of fussing/crying), and age-appropriate physical development. The RMSE (i.e., prediction accuracy) of the final model applied to the test set was 21.72 (R2 = 0.58).Conclusions: This study suggests that among behavioral, environmental, developmental, parent–infant relationship, and mental health variables, a mother's higher self-efficacy, psychological distress symptoms particularly depression and anger symptoms, symptoms in the child particularly fussing/crying symptoms, and age-inappropriate physical development are associated with higher maternal PS. With these factors identified, clinicians may more efficiently assess a mother's PS related to ERD in a low-risk help-seeking sample.

Parental Reflective Functioning as a Moderator for the Relationship Between Maternal Depression and Child Internalizing and Externalizing Problems.

Parental Reflective Functioning (PRF) refers to parents’ capacity to view their child’s and their own behavior considering inner mental states, like thoughts, desires, and intentions. This study’s objective was to examine whether PRF acted as a moderator for the relationships between maternal depression and child internalizing and externalizing problems. The sample was comprised of 685 Iranian mothers with preschoolers (3 to 5 years old) and school-aged (6–10 years old) children. To assess PRF, the PRF questionnaire was used. Child internalizing and externalizing difficulties were assessed with the Child Behavior Checklist, and maternal depression was assessed with the Beck Depression Inventory- second version. Results indicated significant relationships between maternal depression and PRF (specifically pre-mentalizing and certainty in mental states). Also, mothers of school-aged children showed significantly higher levels of pre-mentalizing than mothers of preschoolers. Furthermore, certainty about mental states moderated the relationship between maternal depression and child externalizing behaviors in school-aged children. However, no moderating effect was found for pre-mentalizing or interest and curiosity in mental states in any age group.

Reflective functioning and empathy among mothers of school-aged children: Charting the space between.

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).

The outcome of an attachment-based infant mental health therapeutic play programme on infant temperament, parent-infant relationship & maternal reflective functioning

AimsIn the Philippines, there is a need for preventive, early intervention programs for perinatal and infant mental health. This is the first local study that investigated an attachment-based, therapeutic play programme (Baby Bonding) on infant temperament, parent-infant relationship and maternal reflecting functioning.BackgroundThis study was an effort towards bridging the “10/90 gap in infant mental health research” wherein 90% of the world's infants are born in low- middle-income countries (Population Reference Bureau, 2013b) and “only 10% of the worldwide spending on health research is directed towards the problems that primarily affect the poorest 90% of the world's population (Tomlinson et al., 2014).MethodPhase I involved local validation of the Parent-Rated Outcome Measures (PROM)- Infant Characteristics Questionnaire (ICQ), Mother Object Relations Scale (MORS) and Parental Reflective Functioning Questionnaire (PRFQ).Healthy mother-baby dyads, from the low socio-economic stratum, were screened using Parent Evaluation of Developmental Status (PEDS) and Hospital and Anxiety Depression Scale (HADS).Phase II carried out randomized controlled design wherein mother-baby dyads were enrolled either in the usual care group or the 6-weekly Baby Bonding intervention.Result102 mothers answered the PROM. Their responses constituted the training set of the study tools. Baseline responses of the mothers from the usual care (N = 51) and intervention (N = 53) groups formed the evaluation set for the Filipino- translated instruments. In both the training and evaluation sets, if certain identified questions were to be removed from the PROM, better and acceptable Cronbach values were consistently generated.There were no statistical differences on parent-infant relationship and reflective functioning between the usual care and intervention group. There was movement of the intervention group from high-challenging onto intermediate to low-levels of challenging temperament in the dull-dimension of the ICQ after 6 sessions. In comparison, infants in the control group remained in the high-challenging temperament after 6 weeks of usual care.ConclusionLinguistically validated study instruments (ICQ and MORS) provided accurate assessments of infant temperament and parent-child relationship. The Filipino-translated PRFQ has limited validity in evaluating parental reflective functioning (RF). “On-line” measures that video mother-baby interactions could have better captured changes in RF. As measured by the dull dimension of the ICQ, the Baby Bonding programme improved sociability of the infants (7 months or younger).

Parental reflective functioning and theory of mind acquisition: A developmental perspective.

This study investigated theory of mind (ToM) development in 83 children aged 3-5years and its associations with parental reflective functioning (PRF), using a multidimensional and developmental approach. Results showed that ToM dimensions (i.e., affective, belief-desire, and cognitive) gradually increased with age. All dimensions of PRF (i.e., prementalizing modes, certainty about mental states, and interest and curiosity in mental states) were associated with ToM dimensions, with different dimensions being differentially related to ToM, including age-related effects.

Improving the parent–child relationship and child adjustment through parental reflective functioning group intervention

ABSTRACT Parental reflective functioning (PRF) is a core element in the parent–child relationship. This study set out to investigate changes in PRF following the DUET program, a 12-week group intervention program. We proposed that the DUET intervention would enhance maternal reflective capacities, resulting in better mother-child emotional availability, better child self-regulation, and decreased child behavioral problems. Seventy mothers completed the DUET group intervention. Of these mothers, nine mothers were first allocated to the waiting-list group and thereafter were included in an intervention group. PRF was measured using observation (mind-mindedness) and an interview (PDI). Following the intervention, a significant improvement was evident in PRF, in parental beliefs about feeling, and in parental sense of efficacy. In addition, the mother–child interaction was more positive, child behavioral problems decreased, and child self-regulation increased. This improvement remained stable over a period of 6 months. Clinical and future directions of this study are discussed.

A Mixed-Methods Study of Two Modes of the Circle of Security

Purpose: This study compared the impact, challenges, and benefits of the Circle of Security-Parenting (COS-P) intervention across two delivery modes: group center-based (GCCOS-P) and individual home-based (IHCOS-P). Methods: This mixed-methods study compared the impact of the COS-P on parental reflective functioning and parental stress across two delivery modes: GCCOS-P ( n = 7) and IHCOS-P ( n = 7). It compared the challenges and benefits of each, from the qualitative perspectives of participants ( n = 2 IHCOS-P; n = 3 GCCOS-P) and facilitators ( n = 4). Results: Quantitative statistical analysis comparing pre- and postintervention measures suggest that each delivery mode was equally effective in reducing parental stress and generally noneffective with respect to parental reflective functioning. Challenges and benefits of each mode, inherent in the peer/shared learning environment of the GCOS-P and the individualized, flexible delivery of the IHCOS-P, were identified. Discussion: This study adds to knowledge about the widely utilized COS-P, highlighting challenges and benefits of two modes of delivery.

Parental mentalization: A critical literature review of mind-mindedness, parental insightfulness and parental reflective functioning

Parental mentalization captures the parent’s abilities to represent his/her child as a psychological agent and the parent’s proclivity to understand and interpret child’s behavior in terms of mental states. Under this label, the literature emphasizes three different constructs: mind-mindedness, parental reflective functioning and insightfulness. Presently, there is no integrative review addressing all three constructs comprehensively through a comparative analysis. Furthermore, there is some confusion as to where the concepts overlap and differ, how they are distinctively operationalized and which measures are used to tap into each one of them. To address this issue, this article aims to synthesize the literature in a critical manner, reviewing mind-mindedness, parental reflective functioning and insightfulness. This study identifies key theoretical and methodological aspects of parental mentalization constructs (e.g., definition and conceptualization, measurements, parental and child correlates, strengths and weaknesses). Moreover, the constructs are compared based on their similarities and differences regarding definition, conceptualization and measurements. Finally, the paper offers some directions for further research. This review informs research in the field by providing an integrative and comprehensive understanding of parental mentalization.

Various mentalizing concepts in mothers with postpartum depression, comorbid anxiety, and personality disorders.

Mentalization is defined as the human capacity to reflect upon one's own or others' behaviors in terms of underlying mental states and intentions. Several concepts of mentalizing exist, which differ in content, assessment, and clinical prediction. The present study examines the relationship between the three main concepts of mentalizing, namely, reflective functioning (RF), parental reflective functioning (PRF), and Mind-Mindedness (MM), in mothers with postpartum depression. It was hypothesized that mentalizing concepts differ in their convergent and divergent variance, as well as their clinical validity regarding comorbid anxiety and personality disorders (PDs). Fifty clinically referred mothers with postpartum depression and infants aged 3-10 months were examined by means of the Reflective Functioning Scale, Parental Reflective Functioning Questionnaire, and Mind-Mindedness Coding-System. No significant associations were found between RF and PRF, or between PRF and MM; higher RF was associated with more MM-nonattuned mind-related comments. Increased depression and anxiety were linked to lower PRF in terms of higher PRF-prementalizing. Lower RF, but not PRF, was associated with comorbid PDs. Specifically, obsessive-compulsive PD was associated to considerably fewer MM-nonattuned mind-related comments. Distinct concepts of mentalizing represent divergent competencies, differentially linked to maternal postpartum psychopathology.

Mothers’ parental mentalization, attachment dimensions and mother-infant relational patterns

ABSTRACT We examined the links between mothers’ prenatal attachment dimensions, parental mentalization and mother-infant relational patterns. The sample consisted of 68 mother-infant dyads. During pregnancy, mothers reported on attachment-related anxiety and avoidance. When the infants were three months old, the mothers’ parental reflective functioning (PRF) was assessed via the PDI-R2-S interview. Mothers-infant free play interactions were coded for maternal sensitivity and dyadic reciprocity and mothers’ utterances were coded for appropriate and non-attuned mind-mindedness (MM). Prenatal attachment anxiety was associated with less appropriate MM. Appropriate MM was associated with maternal sensitivity and mother-infant dyadic reciprocity. The models predicting maternal sensitivity and dyadic reciprocity from dimensions of the mothers’ prenatal anxiety/avoidance attachment, mediated by their PRF, appropriate and non-attuned MM, were significant. Univariate analyses revealed a significant direct link only between appropriate MM and mother-infant dyadic reciprocity. We discuss these results as well as the differences between the PRF and MM constructs.

Parent Relationship Satisfaction and Reflective Functioning as Predictors of Emotional Availability and Infant Behavior

Marital and parenting systems are likely to interact during the first year of an infant’s life. This study examines the longitudinal interrelations of relationship satisfaction and parental reflective functioning (PRF) and their predictive relations with later emotional availability (EA) and infant social-emotional behaviors (SEB) including skills as well as behavioral problems among first-time Finnish mothers and fathers (n = 556). The follow-up period was between three and 12 months. In addition to having direct effects, we examined a mediational model in which self-reports on PRF factors of interest and curiosity and appropriateness of reasoning would mediate the effects of previous relationship satisfaction to the parent and dyadic side of EA and infant SEB at 12 months. The results show significant stability for relationship satisfaction and PRF for both mothers and fathers as well as direct effects on EA and SEB. However, we found differences between mothers and fathers. For mothers, path analysis indicated support for a mediational model where earlier relationship satisfaction predicted later EA and infant problem behaviors also through the current level of PRF. For fathers, both relationship satisfaction and PRF had direct, but not mediated, effects, and on both infant problem behaviors as well as infant social competence. Together, despite these differences, focusing clinically on both relationship satisfaction and PRF may prove significant in preventing later relational and/or infant difficulties in SEB for both mothers and fathers.

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).

Infant mental health home visiting: intervention dosage and therapist experience interact to support improvements in maternal reflective functioning

ABSTRACT This study examined changes in parental reflective functioning (PRF) among mothers enrolled in Infant Mental Health-Home Visiting (IMH-HV) and explored whether parental risk, treatment dosage or therapist experience predicted change in PRF. Participants included 75 mothers and their children who were enrolled in IMH-HV delivered by Community Mental Health therapists. Results indicated significant improvements in PRF from baseline to 12-months. Maternal demographic and psychosocial risk, therapist experience and treatment dosage were not directly associated with changes in PRF. However, Mothers who received more treatment sessions from therapists with six or more years of experience demonstrated the greatest improvements in PRF, while mothers who received more treatment sessions from therapists who had been practicing IMH for less than 15 months showed a decline in PRF. Therapists working with very high-risk families may need specific training and ongoing reflective supervision over a period of years to promote improvement in PRF.

Tuning in to Kids: Clinical Case Studies from One-to-One Delivery

Children’s behavior problems are often underpinned by deficits in emotional competence and require intervention to prevent them from escalating into more serious and persistent difficulties. Parenting factors such as poor Parental Reflective Functioning (PRF) and non-supportive emotion socialization practices are negatively related to children’s emotional competence and are modifiable factors that can be targeted in parenting interventions. Tuning in to Kids (TIK) is an emotion-focused group parenting program that teaches parents skills in understanding and regulating their own emotions, and how to respond supportively to their children’s emotion to foster emotional competence. This paper describes a newly adapted one-to-one version of TIK. Using three case studies, this paper illustrates the program’s implementation, challenges, and outcomes for parents and their children with behavior problems. The structure and content of this adapted format of TIK is outlined, and each parent’s progression through the program including changes to their meta-emotion beliefs, emotion socialization practices, and PRF are discussed. Recommendations are provided to assist facilitators with delivering TIK in the one-to-one setting.

Връзката между родителската рефлексивна функция, привързаността и развитието на психопатология при децата

This article presents a theoretical overview of the relationship between parental reflective function, attachment style and the development of child psychopathology. The concept of parental reflective function was developed by Peter Fonaghi and his colleagues. Reflexive functioning is defined as the ability to imagine our mental states, emotions and desires, as well as those of others. The ability to interpret and integrate past relational experience is seen as a high capacity for parental reflection. Central constructs in the theory of attachment are: the sensitive response of the mother, the internal working models and representations, the quality of attachment and the sense of security. In the process of developing attachment, the child builds Internal working models, which are formed on the basis of real relationships and participate in building representations of relationships. Arieta Slade and her colleagues believe that higher levels of reflective functioning are associated with secure attachment in children and conversely lower levels of reflective functioning are associated with insecure attachment in children, such as mothers of children who resist and are disorganized, they have the lowest levels of reflective functioning. Low levels of reflective functioning allow the baby's adaptive mechanisms to be distorted and to develop the pathological ways of interaction with the parent.