Parental Reflective Functioning Research Articles

Contextual determinants of parental reflective functioning: Children with autism versus their typically developing siblings.

In this study, we examined parental reflective functioning using the Parental Developmental Interview when parents were talking about their interactions with their child with autism versus the child's typically developing siblings. Our sample included 30 parents who had a child between the ages of 3 and 18 years with a clinical diagnosis of autism spectrum disorder and at least one typically developing child. Findings indicated that parents exhibited significantly higher reflective functioning when interacting with their child with autism spectrum disorder versus the typically developing siblings, and the difference was moderated by parental self-efficacy.

Does your child need therapy? Maternal reflective functioning and perceived need for and use of child mental health treatment

ABSTRACT Interventions to improve reflective functioning (RF) are being delivered to parents of children with mental health needs, yet whether this population differs in RF is unknown. We examine if mothers with varying levels of child mental health (CMH) treatment need and use differ in RF in a community sample of 212 mothers. Participants completed measures of general RF, parental RF, children’s symptoms, perceived treatment need, treatment utilization, and perceptions of treatment efficacy at baseline and one year later. Low maternal RF was associated with elevated child symptoms, and a greater perceived need for treatment. Among mothers who believed their child needed services, those with low general RF were less likely to be utilizing services at baseline and in the next year. Mothers with lower parental RF also believed that CMH treatment was less effective. Findings support the use of RF-based interventions with parents identified because of their child’s mental health.

Association between parental alexithymic traits and self-reported postnatal reflective functioning in a birth cohort population. Findings from the FinnBrain Birth Cohort Study

Parental reflective functioning (PRF) refers to a parent's effort to see his/her child as a separate individual person from early on, and to be curious of the child's own thoughts and feelings. Parenting abilities are affected by the parent's emotion regulation and emotional availability. Alexithymia as a personality construct with emotional deficits and poor imagination could potentially affect also PRF, but studies on parental alexithymia are still scarce. The aim of the present study was to examine the association between parental alexithymic traits and PRF, which to date has not been explored. As most of the parenting research concern only mothers, an additional aim was to study also fathers. The 20-item Toronto Alexithymia Scale (TAS-20) and the 14-item Parental Reflective Functioning Questionnaire (PRFQ-Fi) were filled by 1882 mothers and 994 fathers at six months postpartum as part of the FinnBrain Birth Cohort Study. A significant negative association between TAS-20 total score and PRFQ-Fi total score among both genders was found. The main alexithymia dimension responsible for this association was Externally Oriented Thinking. The results suggest that alexithymic traits indeed are related to parental reflective functioning, but more studies are needed to explore the direction of this relation.

Triadic interactions, parental reflective functioning, and early social-emotional difficulties.

To describe and analyze the relationships among parents' RF, the quality of the mother-father-child triadic interaction, and children's social-emotional difficulties. A nonexperimental, cross-sectional, correlational study was conducted. Fifty mother-father-child triads, each in a current relationship that included at least one child aged 12-36 months, were evaluated. Sociodemographic background, triadic interaction, parental RF, and social-emotional difficulties were assessed. Triadic interaction was found to have a significant effect on the child's social-emotional difficulties, explaining 9% of the variance. In addition, the mothers' RF had a significant influence on triadic interaction, explaining 19% of the variance. An exploratory finding showed that triadic interaction mediates the relationship between mothers' RF and children's social-emotional difficulties.

Reflective function in first-time mothers and fathers: Association with infant temperament and parenting stress

ObjectiveInfant temperament is biologically determined. However, there is increasing proof that environmental factors may also have a relevant influence. The present study focuses on the role of parental reflective function (RF; Fonagy et al., 1998), that is, the psychological basis of emotion regulation. MethodsRF was assessed in 40 low-risk first-time parents during the seventh month of pregnancy, using the Adult Attachment Interview (AAI; Main, Goldwyn, & Hesse, 1984–2002). At the baby's sixth month, parents responded to the Infant Behavior Questionnaire–Revised (Gartstein & Rothbart, 2003), aimed to evaluate the child's perceived temperament and the Parenting Stress Index–SF (Abidin, 1995). Parents’ depression was measured with the Edinburgh Postnatal Depression Scale (EPDS; Benvenuti et al., 1999). ResultsNo difference was found between mothers and fathers regarding RF and depression scores. Self-reported depression was associated with lower scores of RF. Lower RF during pregnancy was associated with higher child dysfunctional interaction in both mothers and fathers. Also, lower maternal RF was associated with higher perceived infant sadness whereas lower paternal RF was associated with higher infant negative affectivity. ConclusionsEarly parenting programs should enhance maternal and paternal reflective functioning to promote sensitive caregiving behaviors and support the child's development.

Effect of the Attachment and Child Health Parent Training Program on Parent-Child Interaction Quality and Child Development.

Exposure to chronic stressors (poverty, addiction, family violence) in early life can derail children's development. Interventions focused on parental reflective function may promote parents' abilities to regulate their feelings and behaviors toward their children and buffer the impact of chronic stressors on children's development by nurturing high-quality parent-child interaction. To test the effectiveness of parental reflective function-focused intervention entitled Attachment and Child Health on parent-child interaction and child development. We conducted two pilots with vulnerable mothers and children <36 months. Randomized controlled trial (n = 20) and quasi-experimental (n = 10) methods tested the effect of Attachment and Child Health on parent-child interaction via Parent-Child Interaction Teaching Scale (PCITS) and on child development via Ages and Stages Questionnaire (ASQ-3) and Ages and Stages Questionnaire-Social Emotional (ASQSE). We employed analysis of covariance and t-tests to examine the outcomes. For randomized controlled trial, we found significant improvements in PCITS parent total, combined total, and cognitive growth fostering scores, and ASQ-3 personal-social scores post-intervention. For quasi-experimental study, we found significant improvements in PCITS combined total, sensitivity to cues, response to child's distress, and responsiveness to caregiver scores. Incorporating Attachment and Child Health contributed to effective programming for vulnerable families with young children.

Supplemental Material for When Do Mothers’ Executive Functions Contribute to Their Representations of Their Child’s Mind? A Contextual View on Parental Reflective Functioning and Mind-Mindedness

Supplemental Material for When Do Mothers’ Executive Functions Contribute to Their Representations of Their Child’s Mind? A Contextual View on Parental Reflective Functioning and Mind-Mindedness

The Recent Perspectives on the Intergenerational Transmission of Attachment: Parental Reflective Functioning

The Recent Perspectives on the Intergenerational Transmission of Attachment: Parental Reflective Functioning

One-year follow-up of The Incredible Years Parents and Babies Program: A pilot randomized controlled trial.

Background:The foundation of a healthy life begins in pregnancy and early adversity can have detrimental long-term consequences for affected children.Objective:This paper examines the effects of the Incredible Years Parents and Babies program (IYPB) at one-year follow-up when offered as a universal parenting intervention to parents with newborn infants.Method:We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to IYPB intervention (n = 76) or usual care (n = 36). The IYPB program is a group intervention with eight two-hour sessions. Follow-up outcomes collected a year after the intervention ended include parental stress, depression, well-being, reflective function, sense of competence, and child cognitive and socio-emotional development.Results:There were no intervention effects on any of the primary or secondary parent-reported outcomes at one-year follow-up when the children were 18 months old. When examining the lowest-functioning mothers in moderator analyses, we found that mothers assigned to the IYPB group reported significantly lower scores for the interest and curiosity subscale of the parent reflective function scale than control mothers (β=-1,07 [-2.09,-0.06]).Conclusion:We found no long-term effects of the IYPB when offered as a universal intervention for a relatively well-functioning group of parents with infants in a setting with a high standard of usual care. The intervention was developed for more vulnerable families in settings with a low level of universal care and the program may be effective for families in those circumstances.

The Impact of Children's Pre-Adoptive Traumatic Experiences on Parents.

For the last decade, children are adopted increasingly at an older age. Their pre-adoptive past can bare traumatic experiences consequent to abandonment, violence, or deprivation in birth family or orphanage. The objective of this study is to explore the impact of the child’s traumatic past on parental representations and subsequent parent-child interactions. The study includes 41 French parents who adopted one or more children internationally. Each parent participated to a semi-structured interview, focused on the choice of country, the trip to the child’s native country, the first interactions with the child, the knowledge of the child’s pre-adoptive history. The interviews were analyzed according to a qualitative phenomenological method, the Interpretative Phenomenological Analysis. Five themes emerged from this analysis: absence of affects in the narrative; denial of the significance of the child’s traumatic experiences; perceptions of the uncanny concerning the child; parental worry about traumatic repetition for the child; specific structure of the narrative. These extracted themes reveal a low parental reflective function when the child’s past is discussed. They highlight the impact of the child’s traumatic past on parents. Exploring the impact of the child’s traumatic experiences on adoptive parents enables professionals involved in adoption to provide an early support to these families and to do preventive work at the level of parental representations and family interactions.

Video feedback for parental sensitivity and attachment security in children under five years.

Video feedback for parental sensitivity and attachment security in children under five years.

The Role of Parental Reflective Functioning in the Relation between Parents’ Self-Critical Perfectionism and Psychologically Controlling Parenting Towards Adolescents

SYNOPSISObjective. Parental self-critical perfectionism has been identified as an important source of parents’ psychologically controlling parenting. Nevertheless, it remains unclear how this well-established association can be explained. This study aims to advance insight in the association between parental self-critical perfectionism and psychological control by addressing the role of parental reflective functioning among parents of adolescents. Design. This cross-sectional study included 268 adolescents (Mage = 15.14 years, 50.7% female), mothers (Mage = 45.83 years), and fathers (Mage = 47.77 years). Parents completed questionnaires assessing self-critical perfectionism, parental reflective functioning, psychologically controlling parenting, and their child’s problem behaviors. In addition, adolescents rated their parents’ use of psychological control. Results. Self-critical perfectionism related both directly and indirectly, via parents’ pre-mentalization, to psychological control among mothers and fathers. Most associations remained significant when controlling for adolescent problem behaviors. Conclusions. This incapacity to reflect on the adolescent’s mental world, and the tendency to make maladaptive attributions about the adolescent’s internal states, make parents with high levels of self-critical perfectionism vulnerable to rely on psychologically controlling parenting.

Parental Reflective Functioning correlates to brain activation in response to video-stimuli of mother–child dyads: Links to maternal trauma history and PTSD

Parental Reflective Functioning is a parent's capacity to infer mental states in herself and her child. Parental Reflective Functioning is linked to the quality of parent-child attachment and promotes parent-child mutual emotion regulation. We examined neural correlates of parental reflective functioning and their relationship to physical abuse.Participants were mothers with (n = 26) and without (n = 22) history of childhood physical abuse. Parental reflective functioning was assessed by coding transcripts of maternal narrative responses on interviews. All mothers also underwent magnetic resonance imaging while watching video clips of children during mother–child separation and play.Parental reflective functioning was significantly lower among mothers with histories of childhood physical abuse. When mothers without history of childhood physical abuse watched scenes of separation versus play, brain activation was positively correlated with parental reflective functioning in the ventromedial prefrontal cortex, and negatively associated with the dorsolateral prefrontal cortex and insula. These associations were not present when limiting analyses to mothers reporting abuse histories.Regions subserving emotion regulation and empathy were associated with parental reflective functioning; yet these regions were not featured in maltreated mothers. These data suggest that childhood physical abuse exposure may alter the psychobiology that is linked to emotional comprehension and regulation.

Parental Reflective Functioning in Mothers and Fathers of Children With ADHD: Issues Regarding Assessment and Implications for Intervention.

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.

Parental reaction to diagnosis of infant hearing loss

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.

The association between executive functioning and parental stress and psychological distress is mediated by parental reflective functioning in mothers with substance use disorder.

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.

Childhood obesity and parental reflective functioning: Is there a relation?

Background/ObjectiveIn recent decades, the prevalence of childhood obesity has increased, with the major implications for public health. However, the factors that contribute to obesity in children are still poorly understood. The present study aimed to investigate the role of parental reflective functioning (PRF) in childhood obesity. MethodIn a cross-sectional design, 120 sets of parents of 60 children (n = 30 with obesity, age range 6–11) were recruited by local paediatricians. Parents completed the Parental Reflective Functioning Questionnaire. Children's and parents’ weight (assessed by BMI), as well as their socio-economic status (SES), were assessed to explore the contribution of PRF in the prediction of children's weight, controlling for parents’ weight and SES. Resultst-test showed significant differences with medium effect sizes in BMI, SES and PRF between parents of children with and without obesity. The best model resulted from hierarchical multiple regression analyses and showed that mothers’ PRF predicted children's BMI above and beyond the prediction by parents’ BMI and SES. ConclusionsLow maternal PRF could be an important target for intervention strategies, highlighting the need to consider parental responses to children's emotions in the treatment of childhood obesity, particularly in parents with low SES and high BMI.

Video feedback intervention to enhance parental reflective functioning in primary caregivers of inpatient psychiatric children: protocol for a randomized feasibility trial

BackgroundChildren requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children’s behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent–child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service.MethodsThis is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver’s wellbeing and children’s general functioning will be reassessed.DiscussionThis study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial.Trial registrationClinicalTrials.gov, NCT03374904. Registered on 14 December 2017 (retrospectively registered).

Advancing Optimal Development in Children: Examining the Construct Validity of a Parent Reflective Functioning Questionnaire.

BackgroundParental reflective functioning (PRF) is the capacity parents have to understand their own mental states and those of their children, as well as the influence of those mental states on behavior. Parents with greater capacity for PRF are more likely to foster secure attachment with their children. The Parental Development Interview is a gold standard measure of PRF but is hampered by cost, training, and length of administration. The 18-item Parent Reflective Functioning Questionnaire (PRFQ-18) is a simpler option developed to capture 3 types of PRF: (1) prementalizing, (2) parent’s certainty, and (3) interest and curiosity surrounding a child’s mental state.ObjectiveThe aim of this study was to examine the factor structure and select psychometric properties of the PRFQ in a sample of Canadian parents.MethodsWe examined the factor structure and discriminant and construct validity of the PRFQ-18 among 306 parents (males=120 and females=186) across Canada; the age range of children was 0 to 12 years. Parents also completed Web-based measures of perceived stress, parental coping, parenting competence, and social support.ResultsA confirmatory factor analysis confirmed the hypothesized 3-factor structure of the PRFQ-18 providing evidence that the PRFQ-18 may be a useful and practical measure of PRF in Canadian adults and showed minor revisions may improve the suitability of the PRFQ-18 for assessing PRF.ConclusionsThese results add support for the construct validity of the PRFQ-18.

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

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