Bridging the attachment transmission gap: The role of maternal mind-mindedness

Mind-mindedness and preschool children's behavioral difficulties: The moderating role of maternal parenting distress

Mind-mindedness (MM) is a caregiver's tendency to appreciate their infant's internal mental states. This longitudinal study investigated whether maternal MM (10 months) was linked with children's later behavioral problems (51 months) and the moderating role of maternal parenting distress (PD; 36 months) in a sample of 91 mother-infant dyads. Appropriate MM comments were coded from video-recorded, semi-structured play interactions between mothers and their infants; PD was obtained from maternal completion of the PD subscale of the Parenting Stress Index - Short Form (PSI-SF); and child internalizing and externalizing behavior problems were gathered from maternal report on the Strengths and Difficulties Questionnaire (SDQ). Moderated regression analyses revealed higher early appropriate MM was associated with significantly fewer internalizing emotional problems at 51 months among mothers with lower PD at 36 months, and higher early appropriate MM was associated with lower conduct problems at 51 months in mothers with higher PD at 36 months. Findings demonstrated the importance of considering nuanced contexts such as at-risk mothers and differential presentations of child difficulties in the analysis of the relationship between MM and child behavioral difficulties and the development of MM interventions.

Antenatal mind-mindedness and its relationship to maternal-fetal attachment in pregnant women

In this study, researchers aimed to investigate whether a relationship exists between maternal-fetal attachment (MFA) and antenatal mind-mindedness in a sample of Australian pregnant women (n = 43). Participants completed the Maternal Fetal Attachment Scale (MFAS) in their second and third trimester, and a modified 'describe your baby' interview with the inclusion of general prompts as a measure of antenatal mind-mindedness in their third trimester. Positive correlations were observed between mental comments, but not total predictions, made by women during the modified antenatal mind-mindedness task and MFAS scores at the second and third trimesters. An average of 6.07 total predictions and 1.30 mental predictions were made before prompts, increasing to 17.65 total comments and 6.58 mental comments after prompts. Prompts within the mind-mindedness task resulted in 42 participants making at least one mental prediction (M = 6.58). Our findings provide the first evidence for a relationship between MFA and antenatal mind-mindedness, and highlight the importance of considering mind-mindedness during pregnancy in the developing bond from mother to baby.

Stressed Mothers Receiving Infant Mental Health-Based Early Head Start Increase in Mind-Mindedness

Maternal mind-mindedness is a characteristic of supportive parenting and contributes to many positive social–emotional outcomes in early childhood. However, there is limited knowledge of mind-mindedness among parents experiencing parenting stress from low-income settings. This is a critical gap in evidence given the robust role of supportive parenting in children’s development and the capacity of home-based interventions to improve children’s outcomes through enhancing supportive parenting. This study examined: (1) maternal mind-mindedness, operationalized as mothers’ appropriate mind-related comments (MRC), across toddlerhood in mothers of toddlers who participated in infant mental health (IMH) based Early Head Start (EHS) services; and (2) whether parenting stress moderated EHS program effects on appropriate MRC over time. Data from a primarily White midwestern site in the United States were collected at study enrollment and when toddlers were 14-, 24-, and 36-months of age (N = 152; mothers M_age = 22.4 years, SD = 5.1; toddlers M_age = 14.4 months, SD = 1.3; 51% females). Data included parent-completed questionnaires and observed parent–child interactions, which were coded for MRC. Although there were no main effects of EHS programming on mothers’ appropriate MRC over time, multilevel growth curve modeling indicated that parenting stress moderated EHS effects on mothers’ appropriate MRC over time. Among mothers with greater parenting stress, those who received IMH-based EHS services demonstrated greater proportions of MRC over time as compared to mothers with greater stress in the control group. IMH-based parenting interventions that target parenting stress may promote appropriate MRC in low-income populations during toddlerhood.

Caregivers' mind-mindedness and rural left-behind young children's insecure attachment: The moderated mediation model of theory of mind and family status

BACKGROUND

China's rapid development and urbanization since the early 1980s have compelled many rural residents to move from rural to urban areas for work, leaving thousands of children at home.

OBJECTIVE

This study tested the mediating effect of children's theory of mind on the relationship between caregivers' mind-mindedness and their children's insecure attachment differently depending on the different family status (the moderator) of left-behind and non-left-behind.

PARTICIPANTS

The participants were 3 to 6 years old 74 left-behind children (LBHC) and 89 non-left-behind children (NLBHC).

SETTINGS

Participants were from rural counties of central China in Henan province that has experienced a large labor migration.

METHODS

A cross-sectional moderated mediation model linked mind-mindedness (independent variable) and insecure attachment (dependent variable) through the theory of mind (mediator) and family status (moderator: left-behind/non-left-behind), controlling for age, gender, and siblings.

RESULTS

First, LBHC scored higher on insecure-disorganized attachment than NLBHC. Second, the early childhood theory of mind mediated the relationship between the caregiver's mind-mindedness and young children's insecure attachment. Third, family status moderated the effects of the theory of mind on insecure attachment. The mediating role was established only for the left-behind family, and the lower theory of mind ability was associated with the greater insecure attachment of LBHC.

CONCLUSIONS

Our findings highlight the critical role of mind-mindedness, theory of mind, and family status in the attachment theory and clarify the association between different levels of young children's theory of mind and insecure attachment based on family status.

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

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

A randomized controlled trial comparing parent child interaction therapy - toddler, circle of security- parenting™ and waitlist controls in the treatment of disruptive behaviors for children aged 14-24 months: study protocol

BACKGROUND

It is common for toddlers to display disruptive behaviors (e.g., tantrums, aggression, irritability) but when these become severe and persistent they can be the start of a trajectory towards poor outcomes in childhood and adolescence. Parent Child Interaction Therapy - Toddler is an intervention model designed to meet the specific developmental needs of toddlers aged 12-24 months presenting with disruptive behaviors.

METHODS

This study will use a randomized controlled design to evaluate the efficacy of the Parent Child Interaction Therapy - Toddler intervention for children aged 14-24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior will be randomly allocated to either Parent Child Interaction Therapy - Toddler, Circle of Security- Parenting™ or a waitlist control group. Key parenting capacity outcome variables will include positive and negative parenting, parenting sensitivity, parental sense of competence in managing negative toddler emotions, parent sense of caregiving helplessness, parent mentalizing about the child, parent emotion regulation, child abuse potential and parental stress. Key outcome variables for children will include child social-emotional functioning (initiative, relationship functioning, self-regulation), child emotion regulation, child attachment security, and child behavior.

DISCUSSION

Delivered in the early intervention period of toddlerhood, Parent Child Interaction Therapy - Toddler has the potential to bring about significant and lasting changes for children presenting with early onset behavioral issues.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), 12618001554257 . Registered 24 September 2018 - retrospectively registered.

'Caring for children who have experienced trauma' - an evaluation of a training for foster parents

BACKGROUND

Foster children, mostly maltreated in their birth families, may be fostered by parents who know little about the impact of traumatic experiences.

OBJECTIVE

The present study investigated whether the training Caring for Children who Have Experienced Trauma for foster parents can break the negative circle of traumatic stress. The hypothesis was that improvement in parents' knowledge on trauma and mind-mindedness would be associated with a reduction of their parenting stress, children's post-traumatic stress symptoms, and behaviour problems.

METHOD

Forty-eight foster parents (n female = 35) participated in a pre-test (T1), post-test (T2), and follow-up (T3) assessment. Questionnaires on knowledge on trauma, parenting stress, child post-traumatic stress symptoms, the child's behaviour, and the evaluation of the training were administered. Parents' mind-mindedness was assessed using the describe-your-child interview.

RESULTS

Foster parents highly appreciated the training, their knowledge on child trauma increased at T2 and this growth persisted at T3. The parents who gained most knowledge experienced a small decrease in parenting stress at T2. Although the general mind-mindedness did not significantly change, foster parents' mind-mindedness with positive valence substantially increased at T2 and T3, while their mind-mindedness with neutral valence decreased. Foster parents' report on child PTSS declined at T3 compared to T2, but not compared to T1. No changes were found in children's behaviour as reported by the foster parents. The proportion of foster children receiving trauma-focused treatment increased at T2 and T3.

CONCLUSION

This study provides evidence that training in trauma-informed parenting can be effective in improving foster parents' knowledge on the impact of traumatic experiences and in increasing a positive mental representation of their foster child as well as in reducing children's post-traumatic symptoms.

Parent mind-mindedness, sensitivity, and infant affect: Implications for attachment with mothers and fathers

Previous research examining links between parenting and attachment has focused on behavioral aspects of parenting such as sensitivity. However, by assessing how parents reflect on infants' mental states (mind-mindedness) we gain a broader understanding of parenting and how it impacts attachment. Mothers, fathers, and their infants (N = 135) participated in the Still Face Paradigm (SFP) at 3-, 5-, and 7- months of age, and the Strange Situation with mothers at 12 months and fathers at 14 months. Parent sensitivity and infant affect were coded from the SFP and all videos were transcribed and later coded for parents' use of appropriate and non-attuned mind-mindedness toward their infants. Attachment with each parent was coded from the Strange Situation. Mixed effects models examined trajectories of parents' mind-mindedness in relation to parent sensitivity and infant affect across attachment groups. Significant differences between parent gender and attachment category were detected. Specifically, parents who were less sensitive were also less mind-minded toward insecure-avoidant infants; parents used more non-attuned mind-mindedness when infants had higher negative affect. Findings suggest that, in addition to parent sensitivity, parents' use of appropriate and non-attuned mind-mindedness during a parent-infant interaction provides insight into the developing attachment relationship for mothers and fathers.

Fathers' and Mothers' Early Mind-Mindedness Predicts Social Competence and Behavior Problems in Childhood

Parental mind-mindedness, the parent's propensity to treat the child as an intentional agent, has repeatedly shown to promote children's development of social understanding and secure attachment. Less is known about whether the impact of maternal and paternal mind-mindedness extends to children's social and behavior problems. We investigated the combined effect of mothers' and fathers' (N = 104) mind-mindedness at 4, 12, and 30 months on children's social competence and externalizing and internalizing behavior problems at 4.5 years. Besides, we examined the stability, continuity, parental concordance, and inter-parental differences in the use of mind-related comments. Appropriate mind-mindedness (i.e., correct interpretations of the child's mental states) and nonattuned mind-mindedness (i.e., misinterpretations of the child's mental states) were observed during parent-child free-play interactions. Social competence, internalizing and externalizing behavior problems were assessed using both parents' reports. Hierarchical multiple regression analyses showed that, at 12 months, infrequent use of appropriate mind-related comments of both parents predicted children's externalizing problems, while their frequent use of nonattuned comments predicted children's low social competence. Furthermore, mothers' frequent use of nonattuned comments at 12 and 30 months and fathers' nonattuned comments at 30 months predicted children's externalizing behavior. The findings suggest that both parents' low use of mind-related comments, and frequent misinterpretations of their child's mind, may act as risk factors for later social and behavior problems of their child.

THE MOTHER-CHILD ATTACHMENT PARTNERSHIP IN EARLY CHILDHOOD: SECURE BASE BEHAVIORAL AND REPRESENTATIONAL PROCESSES

The chapters in this monograph describe the transition of attachment representations from a predominantly sensorimotor, in the moment, experience for the infant/toddler to internalized, mental representations of attachment that are transportable to new social contexts, in which attachment figures may not be present. The chapters focus on means that parents use to help their child effect this transition in terms of both behavioral support for the child's secure base behavior and for cognitive skills that underlie the child's construction of mental models of attachment. The results cohere across studies and make a compelling case for Bowlby's notion that internal models of how attachment "works" are co-constructed through social processes during early childhood. Taken together, the results reported here constitute a milestone achievement for the attachment enterprise in terms of their theoretical and methodological rigor. These findings also justify Bowlby's confidence that cognitive psychology would become a critical disciplinary ally of attachment theory.

Exploring parental mentalization in postnatal phase with a self-report questionnaire (PRFQ): Factor structure, gender differences and association with sociodemographic factors. The Finn Brain Birth Cohort Study

The objective was to explore the preliminary functioning of a self-report questionnaire designed to assess parental reflective functioning (PRFQ, Luyten et al., 2009, unpublished manual) during early postnatal phase and with a large population-based sample. Parental reflective functioning (PRF) refers to parental capacity to focus on experience and feelings, within self, in the child and underlying observed reactions. Individual differences in PRF reportedly affect child attachment and socio-emotional development. Cost-effective tools to assess key areas of early parenting are needed for both research and clinical purposes. The factor structure of a 36-item version suitable for early postnatal phase was explored using population-based data from the Finn Brain Birth Cohort Study (425 mothers and 237 fathers). Exploratory and confirmatory factor analysis resulted in a 14-item version comprising four factors capturing relevant aspects of early PRF. The factor structure was further tested with separate participants from the cohort (1030 mothers and 422 fathers). Mothers tended to score higher than fathers in PRF. Among mothers, parity, age, and financial situation were associated with postnatal mentalization. Level of education was associated with postnatal mentalization in both genders. The 14-item PRFQ-Fi has potential to serve as a new screening tool for very early parenting.

Circle of Security-Parenting: A randomized controlled trial in Head Start

Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security-Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of "what works for whom" in attachment intervention.

Maternal mind-mindedness and toddler behavior problems: The moderating role of maternal trauma and posttraumatic stress

Maternal mind-mindedness (MM) reflects a caregiver's tendency to view a child as an individual with an independent mind. Research has linked higher MM with more favorable parenting and child adaptation. The aim of this study was to examine whether MM was associated with toddlers' behavior problems and competence, and the moderating role of trauma and posttraumatic stress disorder (PTSD) in a sample (N = 212) of adolescent mothers and their toddlers. MM was coded from maternal utterances during free play; mothers completed the University of California at Los Angeles Trauma and Posttraumatic Stress Disorder Reaction Index and reported on children's behavior problems and competence using the Brief Infant-Toddler Social and Emotional Assessment. The majority of mothers (84%) experienced trauma; 45% of these mothers met criteria for partial or full PTSD. Trauma was related to greater behavior problems, and PTSD moderated MM-child functioning relations. When mothers experienced full PTSD, there was no relation between MM and behavior problems. With child competence, when compared to children of mothers with no trauma exposure, children of mothers experiencing partial PTSD symptoms were more likely to have delays in competence when mothers made more MM comments. Results are discussed in light of how MM, in the context of trauma and PTSD, may affect parenting.

Maternal attachment and mind-mindedness: the role of emotional specificity

We explored the relation between maternal mind-mindedness (i.e., a mother's tendency to verbally refer to her infant's mental world through use of infant-directed mental state terms) and maternal attachment. Mothers (N = 76), classified prenatally as Autonomous, Dismissing, Preoccupied, and Unresolved using the Adult Attachment Interview (AAI), simulated speaking to their 6-month-old infants in positive and negative emotion contexts. Mothers' utterances were coded for frequency of use of emotion and cognition-related mind-minded terms. Results indicated a significant negative relation between coherence of mind scores on the AAI and emotion mind-mindedness in the positive emotion context. When differences between insecure attachment categories and mind-mindedness were explored, results indicated that mothers with Preoccupied attachments were significantly more likely to use emotion-related terms than mothers with Dismissing attachments and that these differences were most pronounced in the negative emotion context. A similar pattern was found for mothers with Unresolved attachments compared to those with organized (Autonomous, Dismissing, Preoccupied) attachment classifications, however use of emotion mind-minded terms did not differ by emotional context. Future research directions highlighting the importance of exploring the unique contribution of Preoccupied, Dismissing and Unresolved attachment and emotional context in the exploration of mind-mindedness are discussed.

Parents' self-reported attachment styles: a review of links with parenting behaviors, emotions, and cognitions

For decades, attachment scholars have been investigating how parents' adult attachment orientations relate to the ways in which they parent. Traditionally, this research has been conducted by developmental and clinical psychologists who typically employ the Adult Attachment Interview (AAI) to measure adult attachment. However, dating back to the mid-1990s, social and personality psychologists have been investigating how self-reported adult attachment styles relate to various facets of parenting. The literature on self-reported attachment and parenting has received less attention than AAI research on the same topic and, to date, there is no comprehensive review of this literature. In this article, we review more than 60 studies of the links between self-reported attachment styles and parenting, integrate the findings to reach general conclusions, discuss unresolved questions, and suggest future directions. Finally, we discuss the potential benefits to the study of parenting of collaborations among researchers from the developmental and social attachment research traditions.

Helping foster parents understand the foster child's perspective: a relational learning framework for foster care

The behaviour of children in foster care is influenced by a variety of factors including previous experiences of maltreatment and adverse parenting, as well as the impact of separation from birth parents and placement in care. These factors make it difficult for foster parents to accurately interpret the child's behavioural cues, a necessary precursor to sensitive parenting. The relational learning framework introduced in this article, drawing on attachment theory, facilitates the foster parents' access to some features of the child's mental representations, or internal working model, which may be pivotal in understanding the child's behaviour and therefore successfully managing it. Recent studies suggest that parents' ability to understand the child's psychological perspective, or mental state, is related to the child's cognitive and social development. This article presents a method to enhance the foster parents' understanding of the child's psychological perspective. The model is currently being evaluated for use with foster parents, mental health and social work practitioners.

Methodology and recruitment for a randomised controlled trial to evaluate the safety of wahakura for infant bedsharing

BACKGROUND

Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion worldwide has concentrated on avoidance of bedsharing, the indigenous Māori community in New Zealand has reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date there has been no assessment of the safety of this traditional sleeping device.

METHODS/DESIGN

This two arm randomised controlled trial is being conducted with 200 mother-baby dyads recruited from Māori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and 6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation, and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight. Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness, maternal wellbeing, attachment to baby, and maternal sleep patterns.

DISCUSSION

Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the range of SUDI prevention research being undertaken worldwide.

TRIALS REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered 16th November 2010.

Contributions of attachment theory and research: a framework for future research, translation, and policy

Attachment theory has been generating creative and impactful research for almost half a century. In this article we focus on the documented antecedents and consequences of individual differences in infant attachment patterns, suggesting topics for further theoretical clarification, research, clinical interventions, and policy applications. We pay particular attention to the concept of cognitive "working models" and to neural and physiological mechanisms through which early attachment experiences contribute to later functioning. We consider adult caregiving behavior that predicts infant attachment patterns, and the still-mysterious "transmission gap" between parental Adult Attachment Interview classifications and infant Strange Situation classifications. We also review connections between attachment and (a) child psychopathology; (b) neurobiology; (c) health and immune function; (d) empathy, compassion, and altruism; (e) school readiness; and (f) culture. We conclude with clinical-translational and public policy applications of attachment research that could reduce the occurrence and maintenance of insecure attachment during infancy and beyond. Our goal is to inspire researchers to continue advancing the field by finding new ways to tackle long-standing questions and by generating and testing novel hypotheses.

Attachment Security in Three-Year-Olds who Entered Substitute Care in Infancy

This study assessed relations among number of out-of-home placement changes, time in caregivers' care, caregiver type (i.e., foster parent, adoptive parent, kinship relation, and biological parent), child gender, and caregiver-child Emotional Availability (EA) as predictive of child attachment security when children were 3 years old in a sample of 104 caregivers and children. Children entered court-ordered care by six months of age. On average, children at the age of three spent 30 months with their caregivers, and nearly half of them were adopted by that time. Child attachment was assessed using the Attachment Q-set (Waters & Deane, 1985), and caregiver-child EA was assessed using the EA Scales, 4th edition (Biringen, 2008). Sixty-six percent of children at age 3 showed secure attachments with caregivers, and EA subscale scores were also relatively high on average. The study predictor variables of EA Caregiver Sensitivity, Child Responsiveness, and Child Involvement predicted attachment security, with girls more likely to be securely attached to their substitute caregivers at age three than boys. Study limitations and directions for future research are discussed.

An evaluation of the parents under pressure programme: a study protocol for an RCT into its clinical and cost effectiveness

BACKGROUND

Many babies in the UK are born to drug-dependent parents, and dependence on psychoactive drugs during the postnatal period is associated with high rates of child maltreatment, with around a quarter of these children being subject to a child protection plan. Parents who are dependent on psychoactive drugs are at risk of a wide range of parenting problems, and studies have found reduced sensitivity and responsiveness to both the infant's physical and emotional needs. The poor outcomes that are associated with such drug dependency appear to be linked to the multiple difficulties experienced by such parents.An increase in understanding about the crucial importance of early relationships for infant well-being has led to a focus on the development and delivery of services that are aimed at supporting parenting and parent-infant interactions. The Parents under Pressure (PuP) programme is aimed at supporting parents who are dependent on psychoactive drugs or alcohol by providing them with methods of managing their emotional regulation, and of supporting their new baby's development. An evaluation of the PuP programme in Australia with parents on methadone maintenance of children aged 3 to 8 years found significant reductions in child abuse potential, rigid parenting attitudes and child behaviour problems.

METHODS/DESIGN

The study comprises a multicentre randomised controlled trial using a mixed-methods approach to data collection and analysis in order to identify which families are most able to benefit from this intervention.The study is being conducted in six family centres across the UK, and targets primary caregivers of children less than 2.5 years of age who are substance dependent. Consenting participants are randomly allocated to either the 20-week PuP programme or to standard care.The primary outcome is child abuse potential, and secondary outcomes include substance use, parental mental health and emotional regulation, parenting stress, and infant/toddler socio-emotional adjustment scale.

DISCUSSION

This is one the first UK studies to examine the effectiveness of a programme targeting the parenting of substance-dependent parents of infants and toddlers, in terms of its effectiveness in improving the parent-infant relationship and reducing the potential for child abuse.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number Register: ISRCTN47282925.

Mind-mindedness in parents of pre-schoolers: a comparison between clinical and community samples

Mind-mindedness relates to parents' propensity to treat their young children as individuals with minds of their own. Research with community samples has demonstrated impressive findings regarding child development outcomes, leading to a suggestion that mind-mindedness should be considered in clinical interventions. This is the first mind-mindedness study to include parents of children referred to clinical services. A between group design (n=49) was used to investigate whether mind-mindedness differed between parents of a clinical group of pre-school children and parents of a community comparison group and to explore how mind-mindedness related to parental depression and stress, and child difficulties. The findings revealed that mind-mindedness was significantly lower in the clinical sample and was not related to depression in either group. In the clinical group mind-mindedness was related to parenting stress and in the community group it was related to children's emotional and behavioural difficulties. Overall these findings provide preliminary evidence that mind-mindedness may be an important construct to consider in pre-school clinical interventions.

Maternal and child characteristics as antecedents of maternal mind-mindedness

This article compares an expanded descriptive measure of maternal mind-mindedness to the original measure. We included assessments of the valence and richness of descriptions given by 106 mothers when asked to talk about their 18-month-old child (55 boys), in addition to assessing the proportion of mind-related descriptors. Contrary to previous findings, the proportion of mental descriptors was not associated with maternal sensitivity. However, the expanded measure revealed a significant positive link between positive mind-mindedness and maternal sensitivity, and between richness of the description and maternal sensitivity. We then investigated predictors of positive maternal mind-mindedness. Maternal state of mind regarding past attachment experiences, psychological adjustment, and perception of the child's temperament were considered. The findings revealed that attachment state of mind and parenting stress constitute independent predictors of positive mind-mindedness. These findings suggest that mind-mindedness is associated not only with parental state of mind but also to current factors related to parenthood.

Mothers' representations of caregiving and their adult children's representations of attachment: intergenerational concordance and relations to beliefs about mothering

Mothers (N= 35) and their adult children completed questionnaires and were interviewed in order to examine relationships between mothers' caregiving representations and their adult children's attachment representations, and relationships between attachment/caregiving representations and beliefs about mothering. Mothers' and their children's accounts of and present thinking about their past relationship were highly similar, indicating that the two parts develop concordant states of mind regarding their relationship. In contrast, there was no relationship between mothers' and their adult children's beliefs about mothering, suggesting that such beliefs are not simply passed on from generation to generation within families. Attachment/caregiving classification interacted with generation in influencing a belief that biological facts determine maternal behavior, young adults with preoccupied attachment being particularly prone to reject this idea. Attachment/caregiving classification also had a significant effect on participants' tendency to adhere to an idealized conception of mothering, this tendency being associated with a dismissive attachment/caregiving representation.

Links among antenatal attachment representations, postnatal mind–mindedness, and infant attachment security: A preliminary study of mothers and fathers

Antenatal attachment representations (Adult Attachment Interview classification and reflective function score) were assessed in 25 couples and 3 solo mothers. Infant-parent interaction was observed separately for mothers (N = 21) and fathers (N = 17) at 6 months postpartum, from which measures of parents' ability to comment accurately on their infants' internal states (mind-mindedness) were obtained. Infant-parent attachment security was assessed at 12 (mother, N = 18) and 15 (father, N = 15) months. Autonomous parental Adult Attachment Interview classification, higher reflective function, and infant-parent attachment security were associated with greater mind-mindedness, with effects stronger for fathers than for mothers. A preliminary longitudinal analysis suggested that parental mind-mindedness may help explain intergenerational transfer of attachment security.

Predictors of attachment styles of children in foster care: an attachment theory model for working with families

The purpose of this study was to examine the attachment styles of children in foster care and to use this information to inform clinical practice (N = 110). When examining the relationship between attachment style and child characteristics, no significant differences were found. A structural equation model hypothesizing the relation of individual characteristics, losses, and family contact to avoidant attachment was then tested. Results provided tentative support for the hypothesized model. Implications for therapists include being attentive to attachment injuries, and working to create safe therapeutic environments when working with families involved in the foster care system.