Does maternal reflective functioning mediate associations between representations of caregiving with maternal sensitivity in a high-risk sample?

Abstract

Although it is known that mothers with substance abuse disorders struggle to provide adequate parenting to their children, little is understood about the mechanisms behind this. This cross-sectional study uses an attachment perspective to examine whether reflective functioning mediates the relationship between mental representations of caregiving and maternal sensitivity, in an ethnically diverse sample of 142 substance-abusing mothers (M [SD] = 29.83 [5.79] years of age) and their toddlers (M [SD] = 24.04 [15.15] months of age). Data were baseline measures from two randomized controlled trials. The three variables of primary interest were positively correlated. As expected, there was a significant relationship between mental representations of caregiving and maternal sensitivity that was largely explained by reflective functioning. Confounding and alternate explanations were not supported by a secondary data analyses. The findings underscore the importance of reflective functioning in positive parenting within this high-risk population of mothers, and they provide support for the development of attachment-based interventions.

Evaluation of early relational disturbance in high‐risk populations: Borderline personality disorder features, maternal mental state, and observed interaction

“…Maternal mentalisation has been found to be associated with the quality of maternal caregiving and infant attachment security and shown to be a protective factor in the intergenerational transmission of attachment (Grienenberger et al., 2005; Slade et al., 2005). Some studies using high‐risk samples have found that parenting sensitivity mediates the relationship between RF and infant attachment (Stacks et al., 2014) and that RF mediates the relationship between maternal representations and caregiving sensitivity (Alvarez‐Monjarás, McMahon, & Suchman, 2019). However, few studies have focused on maternal mentalisation in mothers with BPD features.…”

Associations between parenting representations and behavior among young mothers and mothers with opioid use disorder

“…While other studies have shown that mothers with SUDs tend to have more negative representations of their child and the parent-child relationship (Alvarez-Monjarás et al, 2019;Suchman et al, 2018), none have specifically examined profiles related to the three WMCI classifications. In this paper, the largest proportion of mothers in the OUD sample were classified as having disengaged representations.…”

“…For example, in a sample of both psychiatric clinic-referred and nonreferred infants, mothers with representations characterized by higher levels of coherence and joy showed more sensitivity and less intrusiveness with their children, and also provided more support during a problem-solving task (Dollberg et al, 2010). Among mothers with substance use disorders (SUDs), those who had higher quality representations or showed improvement in representations over time demonstrated greater sensitivity with their young children (Alvarez-Monjarás et al, 2019;Suchman et al, 2018).…”

“…Parents with SUDs have difficulties with similar parenting behaviors, displaying less involvement with their children, sensitivity, emotional availability, and responsiveness to their children's cues as compared to parents without SUDs (Hatzis et al, 2017;Landi et al, 2011;Suchman & Luthar, 2000). Evidence suggests that mothers with SUDs can have difficulties forming positive, coherent representations (Alvarez-Monjarás et al, 2019;Suchman et al, 2018). Very little is known about the representations of young mothers.…”

Personality organization and maternal addiction: A structural-developmental psychodynamic contribution.

“…The quality (i.e., coherence, flexibility, and richness) of internal representations may also affect a mother’s capacity to make sense and adapt their own behavior to sensitively and appropriately respond to their child’s preverbal demands and mental states (Alvarez-Monjarás, McMahon, & Suchman, 2019; Fonagy, Gergely, & Target, 2007; Fonagy, Steele, Steele, Moran, & Higgitt, 1991). For instance, mothers with disengaged representations in the Adult Attachment Interview (George, Kaplan, & Main, 1985) tend to be less sensitive, more passive, and less encouraging, whereas those with more coherent representations engage in less negative (e.g., aggressive or intrusive) and more positive (e.g., warm or soothing) parenting practices (Slade, Belsky, Aber, & Phelps, 1999; Sokolowski, Hans, Bernstein, & Cox, 2007).…”