Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Barlow, Jane; Sleed, Michelle; Midgley, Nick

doi:10.1002/imhj.21896

Cited by 40 publications

(28 citation statements)

References 54 publications

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“…In addition, once the mother begins to understand her mental states, it will still take time for the child to shift their “expectation” of interactions. The longer they have adapted to a particular attachment template, the longer it may take to develop the confidence in using the parent as a source of comfort ( Stovall-McClough and Dozier, 2004 ; Barlow et al, 2021 ). It is also possible that children of mothers with severe PTSD symptoms did benefit from the intervention, but that these mothers were not reliable reporters of their infants’ symptoms early on and became more insightful as treatment progressed.…”

Section: Discussionmentioning

confidence: 99%

Maternal History of Adverse Experiences and Posttraumatic Stress Disorder Symptoms Impact Toddlers’ Early Socioemotional Wellbeing: The Benefits of Infant Mental Health-Home Visiting

et al. 2022

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BackgroundThe present study examined the efficacy of the Michigan Model of Infant Mental Health-Home Visiting (IMH-HV) infant mental health treatment to promote the socioemotional wellbeing of infants and young children. Science illuminates the role of parental “co-regulation” of infant emotion as a pathway to young children’s capacity for self-regulation. The synchrony of parent–infant interaction begins to shape the infant’s own nascent regulatory capacities. Parents with a history of childhood adversity, such as maltreatment or witnessing family violence, and who struggle with symptoms of post-traumatic stress may have greater challenges in co-regulating their infant, thus increasing the risk of their children exhibiting social and emotional problems such as anxiety, aggression, and depression. Early intervention that targets the infant–parent relationship may help buffer the effect of parental risk on child outcomes.MethodsParticipants were 58 mother–infant/toddler dyads enrolled in a longitudinal randomized control trial testing the efficacy of the relationship-based IMH-HV treatment model. Families were eligible based on child age (<24 months at enrollment) and endorsement of at least two of four socio-demographic factors commonly endorsed in community mental health settings: elevated depression symptoms, three or more Adverse Childhood Experiences (ACEs) parenting stress, and/or child behavior or development concerns. This study included dyads whose children were born at the time of study enrollment and completed 12-month post-baseline follow-up visits. Parents reported on their own history of ACEs and current posttraumatic stress disorder (PTSD) symptoms, as well as their toddler’s socioemotional development (e.g., empathy, prosocial skills, aggression, anxiety, prolonged tantrums).ResultsMaternal ACEs predicted more toddler emotional problems through their effect on maternal PTSD symptoms. Parents who received IMH-HV treatment reported more positive toddler socioemotional wellbeing at follow-up relative to the control condition. The most positive socioemotional outcomes were for toddlers of mothers with low to moderate PTSD symptoms who received IMH-HV treatment.ConclusionResults indicate the efficacy of IMH-HV services in promoting more optimal child socioemotional wellbeing even when mothers reported mild to moderate PTSD symptoms. Results also highlight the need to assess parental trauma when infants and young children present with socioemotional difficulties.

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Section: Discussionmentioning

confidence: 99%

Maternal History of Adverse Experiences and Posttraumatic Stress Disorder Symptoms Impact Toddlers’ Early Socioemotional Wellbeing: The Benefits of Infant Mental Health-Home Visiting

et al. 2022

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“…Such intervention may increase mothers' ability to represent their own and their child's psychological distress, and possible psychic conflicts, for example of approach/avoidance to abusive or otherwise violent caregivers, in mental states that they can describe in language. Interventions that support and model parental reflective functioning ( 91 ) may provide a foundation for more adaptive psychological functioning across generations. Additional forms of psychotherapy that encourage mind-body connection, such as arts therapies, mindfulness-based therapies may provide additional tools that address the mind-body split that seems to underlie somatization and somatoform disorders.…”

Section: Discussionmentioning

confidence: 99%

Families With Violence Exposure and the Intergenerational Transmission of Somatization

et al. 2022

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Introduction:Adults who have histories of childhood trauma have been noted to display greater somatization, dissociative symptoms and affect dysregulation. What happens in the parent-child relationship when those traumatized children become parents? A potential link to somatization in the child has been suggested by several prior studies. Children who have early attachment disturbances had more physical complaints if their mothers displayed less maternal sensitivity during observed parent-child interactions. Yet, the intergenerational link between maternal and child somatization has not been sufficiently explored in a longitudinal study in order to understand the potential impact of maternal trauma history and related psychopathology on subsequent child somatization and psychopathology.MethodsThis paper examined prospective, longitudinal data of 64 mother-toddler dyads (mean age = 2.4 years, SD = 0.7) who were later studied when children had a mean age of 7 years. Mothers with and without histories of interpersonal violence (IPV; physical/sexual abuse and/or family violence exposure) were included. Mothers with IPV histories were oversampled. Linear and Poisson regression models were used to test the associations between maternal IPV-related post-traumatic stress disorder (PTSD) with maternal somatization severity when children were toddlers, and between maternal somatization and maternal interactive behaviors with child somatization by maternal report and clinician-rated assessment at school-age.ResultsMaternal PTSD severity was significantly associated with increased maternal somatization severity (p = 0.031). Maternal somatization severity during the child's early childhood predicted both maternal report of child somatization (p = 0.011) as well as child thought problems (p = 0.007) when children were school-aged. No association was found between maternal somatization and child-reported psychopathology. The study did not find that maternal alexithymia, caregiving behaviors or child exposure to violence contributed significantly to the model examining the association between maternal and child somatization.ConclusionThe results are in line with the hypothesis of intergenerational transmission of somatization in the context of IPV and related maternal PTSD during formative early development. We interpret this as an expression of psychological distress from mother to child, as maternal trauma and pathology affect the caregiving environment and, thus, the parent–child relationship. The authors conclude with a discussion of implications for parent–infant and early childhood intervention.

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“…As such, our results may indicate that promoting adaptive PRF may enhance male veterans' resilience to AUD, presumably by providing alternative mechanisms for coping with the stressful uncertainty which is embedded in the parent-child relationship. Unfortunately, to date there is conflicting evidence concerning the efficacy of interventions designated to enhance PRF, whether by using mentalization-based therapy, early dyadic interventions or group therapy (Barlow et al, 2020;Camoirano, 2017;Lo & Wong, 2020). Future interventions should be adapted to suit parents who are combat veterans, embraced and assimilated by the Veteran Administration.…”

Section: Discussionmentioning

confidence: 99%

Parental Reflectiveness, Posttraumatic Symptoms and Alcohol Use Disorder among Israeli Combat-Veteran Fathers

Feingold

Zerach

2021

J Child Fam Stud

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Combat veterans are highly prone to develop Alcohol Use Disorder (AUD) following their release from duty, presumably due to high prevalence of prolonged aversive emotional symptoms such as Posttraumatic Stress Symptoms (PTSS). Parental Reflective Functions (PRF) and Parental Sense of Competence (PSOC) have been identified as key protective factors in predicting maternal functioning and well-being, yet little is known of its role among fathers, let alone combat veteran fathers. In this study we explored whether PRF and PSOC moderated the association between PTSS and AUD among 189 Israel Defense Forces (IDF) male combat veterans. Participants filled out validated measures assessing PTSS, PRF, PSOC and AUD. Results indicated that PTSS, as well as PRF's "interest and curiosity regarding the child's mental states" subscale, were positively correlated to AUD. In addition, PRF's "certainty about child mental states" subscale moderated the association between PTSS and AUD, so that PTSS and AUD were significantly correlated for participants who reported average or high levels of certainty about their child's mental states. This finding may imply that intrusive mentalizing ("hypermentalizing") by veteran fathers may facilitate the association between PTSS and AUD, presumably by constituting a maladaptive mechanism for coping with the stressful uncertainty embedded in the parent-child relationship. Keywords Combat veterans • Posttraumatic stress symptoms • Alcohol use disorder • Parental reflective functions • Parental sense of competence Highlights • Among Israeli combat-veteran fathers, posttraumatic symptoms were associated with alcohol use disorder.• Parental reflective functions moderated this association.• Significate association was observed in participants with average or high levels of certainty about their child's mental states.

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Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Cited by 40 publications

References 54 publications

Maternal History of Adverse Experiences and Posttraumatic Stress Disorder Symptoms Impact Toddlers’ Early Socioemotional Wellbeing: The Benefits of Infant Mental Health-Home Visiting

Maternal History of Adverse Experiences and Posttraumatic Stress Disorder Symptoms Impact Toddlers’ Early Socioemotional Wellbeing: The Benefits of Infant Mental Health-Home Visiting

Families With Violence Exposure and the Intergenerational Transmission of Somatization

Parental Reflectiveness, Posttraumatic Symptoms and Alcohol Use Disorder among Israeli Combat-Veteran Fathers

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