Parental reflective functioning is associated with tolerance of infant distress but not general distress: evidence for a specific relationship using a simulated baby paradigm

Parental Reflective Functioning 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.

Influence of maternal reflective functioning on mothers' and children's weight: A follow-up study

Based on cross-sectional research linking poor reflective functionining (RF) to eating disorders, the current follow-up study tested whether maternal RF would explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. During pregnancy (Time 1 [T1]), 51 women were administered the Difficulties in Emotion Regulation Scale (DERS) and interviewed using the Adult Attachment Interview (AAI). Seven months after delivery (Time 2 [T2]), mother-baby dyads who remained in the study (n = 44) were videotaped (Feeding Scale) during their feeding interaction. Last (Time 3 [T3]), the weight of the 34 children who were still in the study was collected at 3 years of age. Maternal AAI-RF at T1 did not correlate with the DERS at T1 nor with the quality of the feeding interacions at T2. However, it correlated, significantly, with maternal body mass index (BMI) at T1, r = -.298, P = .034, and marginally significantly with baby's BMI at T3, r = -.296, P = .089. Moreover, multiple regression models showed a trend indicating that maternal AAI-RF might explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. These findings suggest that working on maternal mentalization might contribute to helping prevent childhood obesity from pregnancy.

[Strengthening Attachment Competencies in Parents with Mental Illness: Adaptation and Pilot Testing of the Mentalization-Based Lighthouse Parenting Program]

Strengthening Attachment Competencies in Parents with Mental Illness: Adaptation and Pilot Testing of the Mentalization-Based Lighthouse Parenting Program Mentalizing describes the imaginative ability to understand human behaviour in terms of mental states. Parents with mental illnesses and experiences of early maltreatment frequently show impairments in mentalizing, which negatively impact their caregiving competences for the child. A number of mentalization-based programs to strengthen parental competences have been developed and most of them have been positively evaluated with regard to their efficacy. However, approaches which specifically aim to reach highly impaired families with children from different age groups and which can be implemented in psychiatric settings are currently lacking. The newly adapted mentalization-based Lighthouse-Parenting Program aims to fill this gap and strengthen competences of parents with a mental illness. The specific MBT-based stance, the structure and content of this new program are outlined and first results of a pilot test are presented. The program is a promising approach, which can easily be trained and implemented in existing mental health care systems. The Lighthouse-Parenting Program aims to improve the relationship between parent and child, to reduce parental stress and in the long-term to promote the child's development. A randomized controlled trial to evaluate the program's effectiveness is currently being planned.

Relations Between Parental Distress Intolerance, Adolescent Motives for Cigarette Use, and Adolescent Cigarette Smoking Levels

Background: A relatively large body of evidence indicates that coping motives for cigarette smoking are associated with a number of problematic outcomes (e.g., greater smoking frequency) among adolescents. Evidence also indicates that lower distress tolerance (or higher distress intolerance) is related to higher levels of coping motives for cigarette smoking among adults and adolescents. Therefore, it is critical to improve our understanding of factors that may increase the likelihood of smoking to cope among adolescents. In addition, evidence suggests that a number of parenting behaviors may affect adolescent smoking behavior. No work to date, however, has examined the relation between parental distress intolerance and adolescent smoking motives, or adolescent smoking behavior. Objective/methods: The current study involving adolescents (n = 46) and one of their parents aimed to address this gap in the literature by examining the association between parent-reported parental distress intolerance, self-reported adolescent motives for cigarette use, and self-reported adolescent cigarette smoking levels. Results: Results indicated that parental distress intolerance was related to greater adolescent coping motives for cigarette smoking, but not to other motives for adolescent cigarette use. Furthermore, results indicated that parental distress intolerance was indirectly associated with higher adolescent cigarette smoking levels through adolescent coping motives for cigarette smoking. Conclusions: Parental distress intolerance is associated with coping motives for adolescent cigarette smoking. This suggests parental emotional factors may be associated with adolescent cigarette use.

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

BACKGROUND

Parental 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.

OBJECTIVE

The aim of this study was to examine the factor structure and select psychometric properties of the PRFQ in a sample of Canadian parents.

METHODS

We 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.

RESULTS

A 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.

CONCLUSIONS

These results add support for the construct validity of the PRFQ-18.

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.

Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy

The purpose of this study was to test whether Parent-Child Interaction Therapy (PCIT), a widely used effective therapy for children's externalizing behaviors and parenting problems, was associated with improvements in parents' emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children's improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents' self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents' self-report of children's symptoms, parenting practices, and reflective functioning in the form of prementalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, prementalizing, and negative parenting practices were associated with improvement in children's symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents' perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children's externalizing behaviors.

Maternal positive responses to a distressed infant simulator predict subsequent negative affect in infants

Existing evidence indicates that maternal responses to infant distress, specifically more sensitive and less inconsistent/rejecting responses, are associated with lower infant negative affect (NA). However, due to ethical and methodological constraints, most existing studies do not employ methods that guarantee each mother will be observed responding to infant distress. To address such limitations, in the current study, a distressed infant simulator (SIM), programmed to be inconsolable, was employed to ensure that mothers (N = 150; 4 months postpartum) were observed responding to infant distress. Subsequently, maternal report of infant NA and an early aspect of regulatory capacity, sootheability, were collected at eight-months postpartum, and observational assessments of infant fear and frustration, fine-grained aspects of NA, were collected at 12-months of age. After controlling for infant sex, the proportion of time mothers spent using soothing touch during the SIM task was related to less overall maternal reported NA and sadness at eight-months postpartum. Similarly, greater use of touch was associated with less fear reactivity, and greater maternal use of vocalizations was related to lower infant frustration, at 12-months postpartum. Specific maternal soothing behaviors were not related to infant soothability at 8 months postpartum. Total time spent interacting with the SIM was not related to infant temperament, suggesting that type of soothing, not quantity of interactions with distressed infants, is important for reducing infant NA. The implications of these findings and important future directions are discussed.

Reflective Functioning on the Parent Development Interview: validity and reliability in relation to socio-demographic factors

The Reflective Functioning coding of the Parent Development Interview (PDI-RF) is a widely used method for assessing a caregivers' capacity for mentalization. However, little is known about its psychometric properties.The aim of this study was to examine the distributions and discriminant and criterion validity of the PDI-RF scale in relation to a number of demographic and socioeconomic factors.Mothers of infants and toddlers (N = 323) from low, medium, and high-risk samples were interviewed with the PDI and transcripts were coded for RF. Demographic and socio-economic data were recorded.The PDI-RF scale showed high inter-rater reliability, internal consistency, and criterion validity. Modest associations with some sociodemographic variables and PDI-RF were found, but together these only accounted for a small amount of variance in the measure, suggesting adequate discriminant validity. Overall, the scale had good psychometric properties, although some caveats for its use were identified.

What's going on in my baby's mind? Mothers' executive functions contribute to individual differences in maternal mentalization during mother-infant interactions

Maternal mentalization refers to a mother's capacity to understand mental-states of herself and her child and to regard her child as a psychological agent. In mother-infant interactions, this capacity is commonly conceptualized as maternal mind-mindedness, which can be divided into two dimensions: appropriate and nonattuned interpretations of the infants' mental-states. Appropriate mind-mindedness refers to interpretations that seem to be compatible with the infant's behaviors, whereas nonattuned mind-mindedness refers to noncompatible interpretations. The aim of this study was to investigate the cognitive mechanisms that contribute to mind-mindedness. Specifically, we investigated the role of executive functions in appropriate and nonattuned mind-mindedness, and the moderating roles of two infant-related factors, prematurity (as a stressful context) and child temperament (as a context of unpredictability and negative emotionality). To this end, mother-infant free play interactions were coded for mind-mindedness in a sample of 102 mothers and their 6-month-old infants (61 preterm, 41 full-term). When children were 66-months old, mothers completed cognitive tasks that assessed working memory updating, resistance to interference, response inhibition, and shifting. Appropriate mind-mindedness was positively associated with updating, and this link was stronger when infant temperament was rated as more difficult. Furthermore, among mothers of full-term infants, mothers' resistance to interference was negatively associated with nonattuned mind-mindedness. This link was not evident in the stressful context of premature birth. Mothers' response inhibition and shifting were not associated with either of the mind-mindedness dimensions. Implications on understanding variability in maternal mentalization during mother-infant interactions and the roles of executive functions in parenting are discussed.

A New Therapeutic Group To Help Women With Borderline Personality Disorder and Their Infants

OBJECTIVES

Few treatments have been described to treat the population of women with borderline personality structure who present in a dysregulated state with their infants. Therefore, a new treatment program was developed for this target group.

METHODS

A total of 45 women, who were identified clinically as meeting full or partial diagnostic criteria for borderline personality disorder (BPD) and having an infant younger than 3 years of age, were offered entry with their infant(s) into specialized dialectical behavior therapy groups, adapted to focus on parenting and the mother-infant relationship. Outcomes measured included maternal mood and anxiety, BPD functioning, parenting sense of competence, parental reflective functioning, and caregiver-infant interaction (CARE Index). Infants received high-quality child care while mothers attended each group, with dyadic reunions a further therapeutic focus each week.

RESULTS

A total of 29 women who met clinical or self-report measures for BPD and were offered group therapy began the program, 21 (72%) of whom completed the 24-week group program, with complete premeasures and postmeasures available for 20 dyads. Of the 20 women, 15 met full diagnostic criteria for BPD and 5 met partial criteria. Significant improvements were noted in maternal mood, with positive changes on 2 subscales of the Parental Reflective Function Questionnaire (prementalizing and increased curiosity in mental states); significant reductions in anxiety and BPD symptomatology were also observed. Only a medium effect size was found for parenting sense of competence, and in smaller numbers of participants as this scale was introduced later. It should particularly be noted that 15 dyads showed substantial change on the CARE Index, indicating improvement in dyadic relationships.

CONCLUSIONS

This innovative adaptation of mother-infant dialectical behavior therapy showed promising improvements in maternal BPD symptoms and caregiver-infant relationships. Given that the feasibility and safety of this method have been demonstrated, a more methodologically rigorous trial with further refinements appears warranted to help this troubled cohort of patients.

Maternal and paternal emotional contributions to children's distress tolerance: Relations to child depressive symptoms

In recent years, empirical studies have shown that the inability to tolerate distress is associated with a wide range of negative outcomes including eating addiction, drug abuse, alcohol use, and antisocial behavior in adults. However, few studies have examined family correlates of this ability in children. Also, past literature on child emotional competencies has mainly focused on documenting the linkages between mother and child and has neglected the role of fathers. Children (N = 54, M age = 10.15 years, SD = 1.02; 55.6% males) and their parents participated. Parents reported on their emotion regulation strategies and children reported on their depressive symptoms. Distress tolerance (DT) was assessed using the computerized distress tolerance task, the Behavioral Indicator of Resiliency to Distress. Children who were able to complete the BIRD had lower levels of depression. Analyses examining relations among father and mother emotion regulation and children's DT showed children's DT is more closely related to their mothers' than fathers' emotion regulation styles. These findings suggest that DT is an important construct in understanding children's psychopathology, but also that maternal emotion regulation is associated with children's distress tolerance.

Simulation-based research to improve infant health outcomes: Using the infant simulator to prevent infant shaking

Simulation is a technique that creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions. We will first provide an introduction to simulation in healthcare and describe the two types of simulation-based research (SBR) in the pediatric population. We will then provide an overview of the use of SBR to improve health outcomes for infants in health care settings and to improve parent-child interactions using the infant simulator. Finally, we will discuss previous and future research using simulation to reduce morbidity and mortality from abusive head trauma, the most common cause of traumatic death in infancy.

Attachment comes of age: adolescents' narrative coherence and reflective functioning predict well-being in emerging adulthood

This study investigated the effects of adolescents' attachment security and reflective functioning (RF) (assessed by the adult attachment interview [AAI]) in the prediction of well-being in adulthood. Adolescents (N = 79; M = 14.6 years old; SD = 3.5 years) completed the AAI at Time 1 (T1), which was subsequently coded for inferred attachment experiences, narrative coherence, and RF by three nonoverlapping teams of raters. Participants completed the Psychological General Well-being Index at T1 and 8 years later (Time 2, T2). Analyses showed that (a) both adolescent narrative coherence and RF were significant predictors of almost all indices of well-being at T2 in adulthood; (b) both narrative coherence and RF indirectly linked inferred loving parental care and T2 well-being; (c) when included in the same model, RF was a significant indirect effect linking inferred loving parental care and T2 well-being. These findings contribute to theory in suggesting that both RF and narrative coherence are predictive of subsequent psychological well-being and operate as links between inferred parental care and subsequent adjustment. Possible mechanisms underlying these findings are discussed.

Young adult couples' behavioral and physiological responses to the infant simulator: A preliminary illustration of coparenting

This exploratory application of the infant simulator with two couples is designed to illustrate individual reactivity and coparenting behaviors in young couples in serious relationships who do not yet have children. A 35-min protocol with standardized onsets and offsets of inconsolable baby cries was used to capture partner's individual behavioral and physiological responses as well as the couple's joint efforts to soothe the crying baby. Task feasibility was demonstrated by couples' persistent and wide-ranging efforts to calm the baby including rocking, feeding, changing, talking to the baby, and singing. Within-person fluctuations in ongoing heart rate (HR) and electrodermal activity (EDA) through the protocol suggested evidence of heightened physiological reactivity during baby crying compared to silence. During bouts of crying, higher HR also was evidenced when participants took the lead in caregiving as contrasted with assisting or busying themselves in another task. Behavioral observations indicated that this task elicited examples of coparenting behaviors including cooperation, support, undermining, and negotiating the division of labor. These preliminary pilot data demonstrate the potential of infant simulator paradigms with couples who are not yet pregnant but envision being future parents, and set the stage for future research to identify how individual and couple characteristics might impact reactions to shared baby caregiving.

Executive Functioning Predicts Reflective Functioning in Mothers

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.

A Home Visiting Parenting Program and Child Obesity: A Randomized Trial

BACKGROUND

Young children living in historically marginalized families are at risk for becoming adolescents with obesity and subsequently adults with increased obesity-related morbidities. These risks are particularly acute for Hispanic children. We hypothesized that the prevention-focused, socioecological approach of the "Minding the Baby" (MTB) home visiting program might decrease the rate of childhood overweight and obesity early in life.

METHODS

This study is a prospective longitudinal cohort study in which we include data collected during 2 phases of the MTB randomized controlled trial. First-time, young mothers who lived in medically underserved communities were invited to participate in the MTB program. Data were collected on demographics, maternal mental health, and anthropometrics of 158 children from birth to 2 years.

RESULTS

More children in the intervention group had a healthy BMI at 2 years. The rate of obesity was significantly higher (P < .01) in the control group (19.7%) compared with the intervention group (3.3%) at this age. Among Hispanic families, children in the MTB intervention were less likely to have overweight or obesity (odds ratio = 0.32; 95% confidence interval: 0.13-0.78).

CONCLUSIONS

Using the MTB program, we significantly lowered the rate of obesity among 2-year-old children living in low-socioeconomic-status communities. In addition, children of Hispanic mothers were less likely to have overweight or obesity at 2 years. Given the high and disproportionate national prevalence of Hispanic young children with overweight and obesity and the increased costs of obesity-related morbidities, these findings have important clinical, research, and policy implications.

Disciplinary Practices, Metaparenting, and the Quality of Parent-Child Relationships in African-American, Mexican-American, and European-American Mothers

Coercive responses to children's behavior are well recognized to be problematic for children's adjustment. Less well understood is how parental social cognition is linked to discipline. In this study we sought to link metaparenting - parents' thoughts about their parenting - to the use of coercive discipline. We predicted that mothers who engaged in more metaparenting, thus reflecting more deliberate parenting, would use corporal punishment less frequently and instead engage in non-coercive discipline. We also expected that mothers who engaged in more metaparenting would report closer relationships with their children. In order to assess a diverse sample, data were collected from approximately equal numbers of African-American, European-American, and Mexican-American mothers. Participants included 113 mothers with target children in three age groups, ranging from 2 to 12 years. The results indicated reports of corporal punishment as well as non-coercive discipline did not significantly differ across child sex and child age groups, but did differ significantly across race/ethnicity. Reports of frequency of metaparenting also differed across racial/ethnic groups; African-American mothers reported more metaparenting than European-American mothers on three of four subscales. Metaparenting was significantly related to reports of the mother-child relationship but in the opposite direction than predicted. Based on these results, future research directions linking parental social cognition to discipline are proposed.

Affective reactivity to cry sounds predicts young women's reactivity and behavior in a simulated caregiving task

Different populations of adults (experienced vs. inexperienced caregivers, men vs. women, abusive vs. nonabusive parents, etc.) have been reported to differ in their affective reactions to the sounds of infant crying. These differences are thought to impact caregiving behavior and, in some instances, to affect long-term outcomes for infants. There can be great intra-group variation, however, even when group differences are significant; modeling developmental process will require a finer grained approach. We have undertaken a pair of studies intended to validate the Negative Affect Scale (NA) from the PANAS as a measure of individuals' affective reactivity to cry sounds. In Study 1, 306 young women who were not yet mothers listened either to infant crying or to birdsong. The results supported the NA as a measure of reactivity to crying. In Study 2, a new sample of 301 young women listened to crying in a screening task; a group of "high reactors" (n = 21) and a group of "low reactors" (n = 22) then participated in a simulated caregiving situation. Individuals' affective reactivity to the caregiving simulation mirrored their affective reactivity in the screening task, and rates and overall organization of caregiving behavior differed between the groups. Changes in negative affect, then, appear to be both a result of infant crying and a determinant of some aspects of caregiving behavior. Further studies will extend these laboratory results to real infants and their caregivers, and further validate the NA as a measure of individual differences in reactivity to cry sounds.

PATERNAL AND MATERNAL REFLECTIVE FUNCTIONING IN THE WESTERN AUSTRALIAN PEEL CHILD HEALTH STUDY

While past research on the care of infants has been mostly with mothers, in recent times there has been a renewed attention to the father-infant relationship. This study examined differences between mother and father parental reflective functioning (PRF) or parental mentalizing; that is, the parental capacity to reason about their own and their children's behaviors by taking into consideration intentional mental states. Data were collected from 120 couples with a 1-year-old child who were participants in the West Australian Peel Child Health Study. Parental mentalizing was assessed using the Parental Reflective Functioning Questionnaire (PRFQ; Luyten, Mayes, Nijssens, & Fonagy, ). Results showed that mother and father mentalizing with their children was independent and that mothers scored slightly higher levels of mentalizing than did fathers. Paternal mentalizing was weakly associated with family income and father education, and was more strongly associated with family functioning than with maternal mentalizing. Implications for theorizing on PRF and fatherhood more generally are discussed.

The parental reflective functioning questionnaire: Development and preliminary validation

This paper reports on three studies on the development and validation of the Parental Reflective Functioning Questionnaire (PRFQ), a brief, multidimensional self-report measure that assesses parental reflective functioning or mentalizing, that is, the capacity to treat the infant as a psychological agent. Study 1 investigated the factor structure, reliability, and relationships of the PRFQ with demographic features, symptomatic distress, attachment dimensions, and emotional availability in a socially diverse sample of 299 mothers of a child aged 0-3. In Study 2, the factorial invariance of the PRFQ in mothers and fathers was investigated in a sample of 153 first-time parents, and relationships with demographic features, symptomatic distress, attachment dimensions, and parenting stress were investigated. Study 3 investigated the relationship between the PRFQ and infant attachment classification as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. Exploratory and confirmatory factor analyses suggested three theoretically consistent factors assessing pre-mentalizing modes, certainty about the mental states of the infant, and interest and curiosity in the mental states of the infant. These factors were generally related in theoretically expected ways to parental attachment dimensions, emotional availability, parenting stress, and infant attachment status in the SSP. Yet, at the same time, more research on the PRFQ is needed to further establish its reliability and validity.

REFLECTIVE FUNCTIONING AND PERSONALITY ORGANIZATION: ASSOCIATIONS WITH NEGATIVE MATERNAL BEHAVIORS

The aim of this study was to examine whether mothers who manifest insensitive and disconnected behaviors in interaction with their infants differ in terms of maternal reflective functioning (RF), personality organization, and histories of abuse. A total of 86 mother-infant dyads, 28 of them with histories of abuse, participated in the study. RF was assessed with the Adult Attachment Interview (C. George, N. Kaplan, & M. Main, 1985), and personality organization was assessed with the self-report Inventory of Personality Organization (M.F. Lenzenweger, J.F. Clarkin, O.F. Kernberg, & P.A. Foelsh, 2001; L. Normandin et al., 2002), before the birth of the baby. Maternal behaviors were assessed using the Disconnected and Extremely Insensitive Parenting measure when the infants were 15 to 18 months old. The results of multivariate analyses of covariance indicate that both RF and personality organization were associated with disconnected and extremely insensitive maternal behaviors. Mothers classified as presenting intrusive/aggressive behaviors had significantly lower RF as well as significantly more difficulties in personality organization, including reality testing, identity, and defense mechanisms. Withdrawn and disconnected maternal behaviors were associated with the combination of difficulties in mentalization and personality organization rather than difficulties in one specific area. In sum, the study provides new evidence regarding the importance of a mentalizing stance about early attachment relationships for the modulation of maternal behaviors, especially intrusive/aggressive behaviors.

Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It

In the last decade several studies have investigated the role of parental reflective functioning (RF), defined as the parental ability to understand his/her child’s mental states, on the child’s development. Herein, a narrative review on parental RF is presented aimed at (1) presenting an overview of the existing empirical studies, (2) pinpointing unrequited questions, and (3) identifying future research directions. Specifically, the current review focused on (a) the impact of parental RF on the quality of caregiving and the child’s attachment security, (b) the effect of parental RF on the child’s emotion regulation and the child’s RF, (c) maternal RF in women with a history of neglect and abuse, (d) the efficacy of mentalization-based clinical interventions, and (e) the recently developed Parental Reflective Questionnaire. The following terms “maternal RF,” “paternal RF,” “parental RF,” “parental mentalization,” “maternal mentalization,” and “paternal mentalization” were searched in titles, abstracts, and main texts using Medline, Web of Science, and Scopus databases. Next, a search in Mendeley was also conducted. Inclusion criteria comprised original articles if they refer to the RF Scale (Fonagy et al., 1998) and were published in an English language, peer-reviewed journal before July, 2016. According to exclusion criteria, dissertations, qualitative or theoretical papers, and chapters in books were not taken into account. The review includes 47 studies that, taken together, supported the notion that higher parental RF was associated with adequate caregiving and the child’s attachment security, whereas low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors. In addition, higher parental RF was associated with better mentalizing abilities in children. However, unexpected findings have emerged from the most recent randomized controlled trials that tested the efficacy of mentalization-based interventions in high risk samples of mothers, raising questions about the suitability of the verbal measures in capturing the mentalizing processes at the root of the parental capacity to be adequately responsive to the child’s emotional needs.

The parental reflective functioning questionnaire: Development and preliminary validation

This paper reports on three studies on the development and validation of the Parental Reflective Functioning Questionnaire (PRFQ), a brief, multidimensional self-report measure that assesses parental reflective functioning or mentalizing, that is, the capacity to treat the infant as a psychological agent. Study 1 investigated the factor structure, reliability, and relationships of the PRFQ with demographic features, symptomatic distress, attachment dimensions, and emotional availability in a socially diverse sample of 299 mothers of a child aged 0-3. In Study 2, the factorial invariance of the PRFQ in mothers and fathers was investigated in a sample of 153 first-time parents, and relationships with demographic features, symptomatic distress, attachment dimensions, and parenting stress were investigated. Study 3 investigated the relationship between the PRFQ and infant attachment classification as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. Exploratory and confirmatory factor analyses suggested three theoretically consistent factors assessing pre-mentalizing modes, certainty about the mental states of the infant, and interest and curiosity in the mental states of the infant. These factors were generally related in theoretically expected ways to parental attachment dimensions, emotional availability, parenting stress, and infant attachment status in the SSP. Yet, at the same time, more research on the PRFQ is needed to further establish its reliability and validity.

Parental reflective functioning and the neural correlates of processing infant affective cues

Parental reflective functioning refers to the capacity for a parent to understand their own and their infant's mental states, and how these mental states relate to behavior. Higher levels of parental reflective functioning may be associated with greater sensitivity to infant emotional signals in fostering adaptive and responsive caregiving. We investigated this hypothesis by examining associations between parental reflective functioning and neural correlates of infant face and cry perception using event-related potentials (ERPs) in a sample of recent mothers. We found both early and late ERPs were associated with different components of reflective functioning. These findings suggest that parental reflective functioning may be associated with the neural correlates of infant cue perception and further support the value of enhancing reflective functioning as a mechanism in parenting intervention programs.

Early Maternal Reflective Functioning and Infant Emotional Regulation in a Preterm Infant Sample at 6 Months Corrected Age

OBJECTIVE

This study investigated the influence of maternal reflective functioning (RF) on 6-month-old infants' emotional self-regulating abilities in preterm infant-mother dyads.

METHODS

25 preterm (gestational age 28-34.5 weeks) infants' affect, gaze toward mother, and self-soothing behaviors (thumb-sucking and playing with clothing) were measured during the still-face procedure at 6 months corrected age. Maternal RF was measured at 7-15 days post-delivery using the Parent Development Interview.

RESULTS

Infants with high RF mothers showed the most negative affect during the still-face episode (M = 21.33s, SE = 5.44), whereas infants with low RF mothers showed the most negative affect in the reunion episode (M = 18.14s, SE = 3.69). Infants with high RF mothers showed significantly more self-soothing behaviors when distressed (Ms > 14.5s) than infants with low RF mothers (Ms < 1s), p's < .01.

CONCLUSION

Maternal RF was associated with infants' self-regulating behavior, providing preliminary evidence for the regulatory role of maternal RF in preterm infants' emotion regulation capacity.

Investigating the association between parental reflective functioning and distress tolerance in motherhood

Parental reflective functioning, referring to the capacity of a parent to consider their child's mental states as they relate to their behavior, may support sensitive and adaptive parenting. We investigated the relationship between parental reflective functioning and tolerance of distress in a sample of recent mothers (N=59). Participants completed self-report measures of parental reflective functioning and distress tolerance, as well as two behavioral distress tolerance tasks. We also examined blood pressure and heart rate during the laboratory session. Mothers reporting more difficulty in recognizing and understanding their child's mental states displayed decreased tolerance of distress on our behavioral and self-report measures. Further, we found evidence of a relationship between these measures and assessments of peripheral physiology. These findings are discussed in the context of reflective functioning and distress tolerance in parenthood, and their implications for parenting interventions.

Emotion Regulation in Parenthood

Emotion regulation, defined as the capacity to influence one's experience and expression of emotion, is a complex skill now recognized to evolve throughout the lifetime. Here we examine the role of emotion regulation in parenthood, and propose that regulatory function during this period is distinct from the emotion regulation skills acquired and implemented during other periods of life. In this review, we consider the unique demands of caring for a child and recognize that parents have to maintain a regulated state as well as facilitate regulation in their child, especially early in development. We examine neurobiological, hormonal and behavioral shifts during the transition to parenthood that may facilitate parental regulation in response to infant cues. Furthermore, we consider how parents shape emotion regulation in their child, and the clinical implications of regulatory functioning within the parent-child relationship.

Widening the circle of security: a quasi-experimental evaluation of attachment-based professional development for family child care providers

This pilot program evaluation was undertaken to examine the effectiveness of an attachment-based, group professional-development experience, Circle of Security-Parenting, on family childcare (FCC) providers' psychological resources and self-efficacy in managing children's challenging behaviors and supporting children's socioemotional development. Licensed FCC providers with children actively in their care (n = 34) self-selected into the program, offered in English and Spanish through a regional support network for FCC providers; a comparison group of providers was recruited from the state database of licensed providers (n = 17). A significant Time × Group interaction was observed for self-efficacy in managing challenging behaviors, F(1, 46) = 30.59, p = .000, partial η(2) = .40, with participating providers' mean self-efficacy scores increasing, p = .000, d = .78, while comparison providers' decreased, p = .003, d = 1.40. Mean depressive symptoms decreased over time for both groups whereas job stress-related resources were stable over time in both groups. Patterns of association were found between providers' self-report of difficulties considering children's mental states and depressive symptoms, job stress resources, and self-efficacy. Limitations and implications for future research are reviewed, including the impact of conducting this work within an organized support network for FCC providers.

Parental reflective functioning: analysis and promotion of the concept for paediatric nursing

AIMS AND OBJECTIVES

To identify the definitional elements of parental reflective functioning and develop a framework for nurses to apply this concept in their clinical work with families.

BACKGROUND

In recent years, researchers have concluded that parental reflective functioning is a key mechanism in the development of child attachment security leading to lifelong mental and physical health benefits. Despite its clinical relevance, little has been published in the nursing literature on this concept.

DESIGN

Concept analysis.

METHODS

The Walker and Avant (2011, Strategies for theory construction in nursing. Prentice Hall, Upper Saddle River, NJ) method of concept analysis and the Whittemore and Knafl (Journal of Advanced Nursing, 52, 2005, 546) method of integrative review were used. A search of the literature published from 1989-2013 was conducted using edited texts and online databases - Scopus, CINAHL, PubMed and PsychInfo. Among the 85 sources, 31 empirical studies, 17 book chapters, 32 review papers and five case studies were identified concerning parental reflective functioning.

RESULTS

The concept of reflective functioning, defined as the capacity to envision the mental states of self and other, was first described in 1989 by Fonagy. Slade (Attachment and Human Development, 7, 2005, 269) expanded the concept specifically for parents (i.e. parental reflective functioning). Results of this concept analysis describe seven defining attributes and five antecedent conditions. Consequences of parental reflective functioning are related to a child's attachment early in life and behaviour later in life. A model case is provided to contextualise the concept. To date, there are three measures for parental reflective functioning.

CONCLUSIONS

While parental reflective functioning has been predominately featured in psychology and parenting interventions, the potential consequences of secure attachment and longer-term children's behavioural outcomes suggest that the concept has global implications for paediatric nurses and primary healthcare clinicians.

RELEVANCE TO CLINICAL PRACTICE

Parental reflective functioning offers exciting and promising opportunities for paediatric health and new approaches for those who provide paediatric health care.

Maternal and adolescent distress tolerance: the moderating role of gender

Distress tolerance is defined behaviorally as the ability to maintain goal-directed behavior while experiencing physical or psychological distress. Distress tolerance is closely related to emotion regulation and is a clinically relevant construct contributing to psychopathology across adults and adolescents, yet limited research has examined the development of this construct. A number of studies suggest the importance of parenting in the emergence of emotion regulation capacities in childhood and adolescence. In the current study, we utilize a behavioral measure of distress tolerance to examine whether maternal distress tolerance is related to adolescent distress tolerance, and whether this association differs as a function of gender. We also examine the influence of family emotional climate, namely maternal response to adolescent distress and adolescent attachment. Results indicate a significant maternal distress tolerance by adolescent gender interaction, such that maternal distress tolerance predicts adolescent distress tolerance in daughters, but not sons. The family emotional climate variables were unrelated to maternal or adolescent distress tolerance. Taken together, data indicate that maternal distress tolerance is significantly related to the distress tolerance of adolescent daughters and indicates the potential utility of addressing maternal distress tolerance in clinical work with adolescents.