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Adverse and adaptive childhood experiences are associated with parental reflective functioning in mothers with substance use disorder
Abstract
Mothers with a substance use disorder (SUD) are at risk for maladaptive parenting practices, and have heightened likelihood of having experienced childhood adversity themselves. In addition, parental reflective functioning (PRF), a capacity underlying sensitive caregiving, is often low in mothers with SUD. This study examines the relationship between PRF and aversive (emotional, physical, sexual abuse and neglect) and adaptive (safety and competence) experiences, in dif- ferent developmental phases (early childhood, latency, and adolescence) in mothers with a SUD. A sample of 43 mothers with small children were interviewed with the Parental Developmental Interview to assess PRF, and they completed the Traumatic Antecedents Questionnaire regarding aversive and adaptive experiences. In addition, we used the Hopkins Symptoms Checklist-10 to control for mental health status and a battery of neuropsychological tests to control for executive functions. Results indicated that adaptive experiences in early childhood were positively related to PRF, and that experience of emotional abuse was negatively related to PRF. When separating the group of mothers in two sub-groups based on PRF level, results showed that mothers with negative to low PRF had significantly more experiences of adversities in early childhood and latency, and significantly less adaptive experiences in early childhood, latency and adolescence, compared to mothers with moderate to high PRF. In addition, mothers with adequate to high PRF reported experiencing significantly more types of adaptive experiences, and significantly less adversities compared to mothers with negative to low PRF. Results are discussed in relation to developmental trauma, resilience, epistemic trust and mistrust.
... These mothers may also be vulnerable to mentalising difficulties, stemming from aspects of the intellectual disability (e.g., Sappok et al., 2022), from experiences of abuse/neglect (Håkansson et al., 2018;Hammarlund et al., 2022) and from psychosocial stressors (McConnell et al., 2011;Wade et al., 2018). Yet, there is no empirical knowledge on parental mentalising in this population. ...
... Second, mentalising is a developmentally acquired skill, and its development can be severely affected by childhood exposure to abuse/neglect (e.g., Fonagy et al., 2023). Such effects often also extend to parenthood, with experiences of childhood abuse/neglect being associated with parental mentalising difficulties (e.g., Håkansson et al., 2018;Moser et al., 2019;San Cristobal et al., 2017). Crucially, experiences of childhood abuse are markedly overrepresented among mothers with intellectual disability (Hammarlund et al., 2022). ...
... Experiences of childhood abuse/neglect were extremely common among the mothers, and cumulative abuse/neglect predicted elevated prementalising, in line with previous research linking childhood abuse to parental mentalising difficulties (e.g., Håkansson et al., 2018;Moser et al., 2019). Taken together, these findings corroborate reports on marked overrepresentation of childhood abuse among mothers with intellectual disability, and the negative impact of such experiences on their caregiving abilities (Hammarlund et al., 2022). ...
Background: Parental mentalising difficulties are robustly linked to caregiving problems. Mothers with intellectual disability are at risk for caregiving problems, but knowledge on their parental mentalising abilities is lacking. The present study aimed to fill this gap.
Method: Thirty mothers with mild intellectual disability, and 61 comparison mothers with ADHD, were assessed for parental mentalising using the Parental Reflective Functioning Questionnaire. Contributions of intellectual disability, maternal exposure to childhood abuse/neglect and psychosocial risk to parental mentalising were examined through hierarchical regression analysis.
Results: Mothers with intellectual disability had a heightened risk for parental mentalising difficulties, in the form of elevated prementalising. Intellectual disability and cumulative childhood abuse/neglect uniquely predicted prementalising among the mothers, whereas cumulative psychosocial risk added to the risk for prementalising specifically among mothers with intellectual disability.
Conclusions: Our findings support contextual models of caregiving, and suggest a need for mentalisation-based support for parents with mild intellectual disability.
... Interview (Ensink et al., 2007) Adult Attachment Interview (George et al., 1996) with Reflective Function Scale (Fonagy et al., 1998 ...
... Three studies (27%) used the PRFQ (Luyten et al., 2017); however, each study only reported on one subdomain of the PRFQ (either the certainty domain or the prementalization). One study assessed a parent's reflective function with their own caregiver through the Adult Attachment Interview (George et al., 1996) with the Reflective Functioning Scale (Fonagy et al., 1998) applied. Only two of the 11 studies (18%) involved a measure of child attachment, with both using the Strange Situation paradigm (Ainsworth et al., 1978). ...
... Two of these studies examined overall childhood maltreatment scores, while the other two explored specific subtypes of childhood maltreatment. Håkansson et al. (2018) found a moderate-strong negative association between four subtypes of childhood maltreatment (emotional abuse, neglect, sexual abuse, physical abuse) and PRF, and that combined these subtypes explained 45% of the variance in PRF (see Table 2). However, this study also found that after controlling for mental health and executive function, only emotional abuse significantly predicted PRF. ...
Background:
Parental reflective function (PRF) is a candidate mechanism in the transmission of intergenerational trauma. This systematic review examined (1) the association between parental history of childhood maltreatment and PRF, (2) how PRF relates to attachment in children of parent survivors, and (3) whether PRF moderates the association between parental maltreatment history and child attachment.
Methods:
Ten databases were searched (from inception to 10th November 2021). Inclusion criteria were primary study, quantitative, parent participants, measures of childhood maltreatment, and postnatal PRF. Exclusion criteria were qualitative, intervention follow-up, gray literature, or a review study. Risk of bias was assessed using recommended tools. Data were narratively synthesized.
Results:
One-thousand-and-two articles were retrieved, of which eleven met inclusion criteria (N = 974 participants). Four studies found a significant association between parental childhood maltreatment and disrupted PRF, six did not, one found mixed results. One study reported the association between childhood maltreatment and attachment (nonsignificant results).
Discussion:
There is no clear evidence PRF is routinely disrupted in parent survivors, though there is high heterogeneity in studies. Future research should standardize design to better understand whether PRF is a candidate mechanism in intergenerational trauma.
Other:
PROSPERO CRD42020223594.
... The experience of childhood trauma has been studied most extensively in research examining individual differences in PRF in samples of parents with problematic substance use. Experiences of abuse and neglect are commonly seen in parents attending substance use treatment, with this documented most commonly in samples of mothers [23,24]. ...
... Further, there was a six times higher odds ratio for high uncertain reflective functioning (i.e., impairment in one's abilities to consider complex ways of understanding one's own and others' mental states) if mothers had experienced high levels of trauma in early childhood and adolescence, compared to mothers that had not. Håkansson et al. [24] further explored types of adaptive or adverse experience and found that abuse and neglect explained 45% of the variance in PRF. Emotional abuse, in particular, contributed to the explained variance in total PRF, when controlling for mental health status and cognitive factors. ...
... Emotional abuse, in particular, contributed to the explained variance in total PRF, when controlling for mental health status and cognitive factors. Håkansson et al. [24] suggested that emotional abuse may prevent a child from developing a coherent narrative of their experiences and insecure and/or unresolved states of mind regarding attachment. This can increase the risk of emotional dysregulation and hinder the development of adequate reflective capacity. ...
Purpose of Review
Chronic substance use among parents has been associated with poor family outcomes. Parental reflective function (PRF), which refers to the capacity to reflect on mental states (i.e., thoughts, feelings, desires) in relation to oneself and child, may be part of the mechanism that increases risk for child socio-emotional challenges associated with parental substance use.
Recent Findings
Parents in substance use treatment have lower levels of PRF than that seen in general community samples. Within this population, lower levels of PRF are seen in those who have experienced childhood abuse and neglect or those who perform lower on tasks of executive functioning. Intervention studies with parents with problematic substance use suggest that PRF is amenable to change. Further, changes in reflective functioning about oneself in the parenting role may be particularly related to improvements in parental sensitivity.
Summary
PRF may be part of the mechanism and an important target for understanding parenting and its intervention in the context of problematic parental substance use. Further study of this area is needed, and some directions to guide this work are provided.
... Among demographically diverse mothers and infants, Ensink and colleagues (2016) found no differences in reflective functioning between mothers with and without histories of childhood abuse, and Stacks and colleagues (2014) found no association between PRF and maternal childhood experiences of maltreatment or PTSD. In a study of pregnant women, reflective functioning partially mediated a relationship between childhood maltreatment history and psychological symptoms (Berthelot et al., 2019), and in a study of mothers with a substance use disorder, history of emotional abuse, but not physical abuse, sexual abuse, or neglect, was associated with lower PRF (Håkansson et al., 2018). When these researchers compared mothers with low vs. high PRF, however, they found that mothers with low PRF had significantly more experiences of adversity in early childhood. ...
... When these researchers compared mothers with low vs. high PRF, however, they found that mothers with low PRF had significantly more experiences of adversity in early childhood. Further, they found that adaptive experiences, or family strengths, during childhood were associated with high PRF in adulthood (Håkansson et al., 2018). ...
... Relationships between childhood experiences of maltreatment and PRF were largely not observed in past studies Håkansson et al., 2018;Stacks et al., 2014). used the Adult Attachment Interview and Håkansson et al. (2018) and Stacks et al. (2014) used the Parent Development Interview to evaluate reflective functioning, but these measures do not specifically differentiate the pathological thinking that characterizes pre-mentalizing (Slade et al., 2003). ...
Background:
Racism is a significant source of toxic stress and a root cause of health inequities. Emerging evidence suggests that exposure to vicarious racism (i.e., racism experienced by a caregiver) is associated with poor child health and development, but associations with biological indicators of toxic stress have not been well studied. It is also unknown whether two-generation interventions, such as early home visiting programs, may help to mitigate the harmful effects of vicarious racism.
Objective:
The purpose of this study was to examine associations between maternal experiences of racial discrimination and child indicators of toxic stress and to test whether relationships are moderated by prior participation in Minding the Baby (MTB), an attachment-based early home visiting intervention.
Methods:
Ninety-seven maternal-child dyads (n = 43 intervention dyads, n = 54 control dyads) enrolled in the MTB Early School Age follow-up study. Mothers reported on racial discrimination using the Experiences of Discrimination Scale. Child indicators of toxic stress included salivary biomarkers of inflammation (e.g., C-reactive protein, panel of pro-inflammatory cytokines), body mass index, and maternally reported child behavioral problems. We used linear regression to examine associations between maternal experiences of racial discrimination and child indicators of toxic stress and included an interaction term between experiences of discrimination and MTB group assignment (intervention vs. control) to test moderating effects of the MTB intervention.
Results:
Mothers identified as Black/African American (33%) and Hispanic/Latina (64%). In adjusted models, maternal experiences of racial discrimination were associated with elevated salivary interleukin-6 and tumor necrosis factor-α levels in children, but not child body mass index or behavior. Prior participation in the MTB intervention moderated the relationship between maternal experiences of discrimination and child interleukin-6 levels.
Discussion:
Results of this study suggest that racism may contribute to the biological embedding of early adversity through influences on inflammation, but additional research with serum markers is needed to better understand this relationship. Improved understanding of the relationships among vicarious racism, protective factors, and childhood toxic stress is necessary to inform family and systemic-level intervention.
... Among demographically diverse mothers and infants, Ensink and colleagues (2016) found no differences in reflective functioning between mothers with and without histories of childhood abuse, and Stacks and colleagues (2014) found no association between PRF and maternal childhood experiences of maltreatment or PTSD. In a study of pregnant women, reflective functioning partially mediated a relationship between childhood maltreatment history and psychological symptoms (Berthelot et al., 2019), and in a study of mothers with a substance use disorder, history of emotional abuse, but not physical abuse, sexual abuse, or neglect, was associated with lower PRF (Håkansson et al., 2018). When these researchers compared mothers with low vs. high PRF, however, they found that mothers with low PRF had significantly more experiences of adversity in early childhood. ...
... When these researchers compared mothers with low vs. high PRF, however, they found that mothers with low PRF had significantly more experiences of adversity in early childhood. Further, they found that adaptive experiences, or family strengths, during childhood were associated with high PRF in adulthood (Håkansson et al., 2018). ...
... Relationships between childhood experiences of maltreatment and PRF were largely not observed in past studies Håkansson et al., 2018;Stacks et al., 2014). used the Adult Attachment Interview and Håkansson et al. (2018) and Stacks et al. (2014) used the Parent Development Interview to evaluate reflective functioning, but these measures do not specifically differentiate the pathological thinking that characterizes pre-mentalizing (Slade et al., 2003). ...
Research is needed to better understand how childhood maltreatment history affects parental reflective capacities, and whether early childhood interventions help mitigate these effects. We examined associations between childhood maltreatment and current parenting (parental reflective functioning, parenting behaviors) among mothers who participated in a follow-up study ( N = 97) of the Minding the Baby® (MTB) randomized control trial. MTB is a home visiting program that aims to help mothers understand their child’s mental states (feelings, intentions, needs) by promoting parental reflective functioning. Mothers retrospectively reported childhood maltreatment using the Childhood Trauma Questionnaire. Endorsing a higher number of childhood maltreatment subtypes was associated with less supportive/engaged parenting and higher pre-mentalizing modes, or difficulty with appropriately reflecting on the child’s mental states. These relationships were not moderated by participation in the MTB intervention. However, exploratory analyses of individual maltreatment subtypes revealed that participation in MTB may mitigate the harmful effects of childhood emotional abuse on pre-mentalizing modes, specifically. Further research is needed to understand the mechanisms through which early childhood interventions may prevent intergenerational cycles of maltreatment.
... While no previous studies have examined this link in relation to PRF, self-esteem has been found to be reduced in those with 'low' as opposed to 'medium' reflective functioning in relation to their attachment figures, suggesting that higher RF may relate to better functioning with regard to self and other (Antonsen et al., 2016). Parental mentalization also appears to be inhibited or impaired by trauma, such as maternal history of childhood maltreatment (Håkansson et al., 2018;Luyten, Mayes et al., 2017), with adverse experiences in early childhood relating to lower PRF (Håkansson et al., 2018). Importantly, PRF has been found to moderate the relation between mothers' adverse childhood experiences and negative parenting behavior, showing the potential protective effect of high PRF (Kolomeyer et al., 2016). ...
... While no previous studies have examined this link in relation to PRF, self-esteem has been found to be reduced in those with 'low' as opposed to 'medium' reflective functioning in relation to their attachment figures, suggesting that higher RF may relate to better functioning with regard to self and other (Antonsen et al., 2016). Parental mentalization also appears to be inhibited or impaired by trauma, such as maternal history of childhood maltreatment (Håkansson et al., 2018;Luyten, Mayes et al., 2017), with adverse experiences in early childhood relating to lower PRF (Håkansson et al., 2018). Importantly, PRF has been found to moderate the relation between mothers' adverse childhood experiences and negative parenting behavior, showing the potential protective effect of high PRF (Kolomeyer et al., 2016). ...
Psychosocial factors have been found to relate to parental reflective functioning (PRF), a parent's ability to mentalize about themselves and their child. Relations between maternal psychosocial risk factors and PRF were investigated in a community sample. A sample of mothers (n = 146) was assessed for risk factors when infants were 6 months, infant temperament was assessed using an observational measure, and PRF was assessed with the Parent Development Interview-Revised (PDI). PRF was measured again with the Parental Reflective Functioning Questionnaire (PRFQ) when children were 4 years (n = 105) and 5 years (n = 92), with an additional sample of mothers (n = 48) tested at these two timepoints. Results showed that in infancy, total maternal psychosocial risk related to lower PDI-PRF; regression analyses highlighted low socioeconomic status, unplanned pregnancy, and low maternal anxiety as independent predictors of lower PDI-PRF. PDI-PRF scores at 6 months did not relate to PRFQ scores, but PRFQ subscales showed stability over time from age 4-5. Results are discussed with regard to the impact of maternal psychosocial risk and infant temperament on PRF and the stability and concordance of PRF measures.
... Studies have investigated the risk factors for poor PRF. Substance abuse and alcohol consumption during pregnancy (Cyr et al., 2010;Pajulo et al., 2012;Suchman et al., 2010), maternal/parental psychiatric illness (Condon & Corkindale, 1997;Perry et al., 2015), single parenthood (Huth-Bocks et al., 2004), low educational attainment (Pajulo et al., 2006;Rosenblum et al., 2008), high levels of stress/arousal (Bateman & Fonagy, 2008;Fonagy et al., 2018;Slade, Sadler, et al., 2005), mother's own insecure attachment (Luyten et al., 2010), and adverse childhood events (Håkansson et al., 2018;Yu et al., 2020) tend to be negatively associated with mentalizing, whereas some find no association (Stacks et al., 2022;Suardi et al., 2020). A study from 2014 consisting a diverse sample of women with or without a history of childhood maltreatment showed that concurrent depression symptoms positively correlated with mother's PRF (Stacks et al., 2014), where in contrast the study from Perry et al. (2015) concluded that prenatal PRF was significantly negatively correlated with depression. ...
... While some studies do show depression and P-PRF and PRF are not associated (Alismail, 2017), many studies have found these associations. Symptoms of depression (Condon & Corkindale, 1997;Huth-Bocks et al., 2004), anxiety (Bateman & Fonagy, 2012;Nolte et al., 2011) and adverse childhood events (Håkansson et al., 2018;Yu et al., 2020) feature deficits in mentalizing. Hence, assessing the interrelationship of these risk factors and RF, and screening for each of them in pregnancy, could identify women who should have special attention because of potential future mother-infant difficulties. ...
Parental reflective functioning (PRF) is the capacity to focus on feelings and experiences in oneself as a parent and in the child. Research has demonstrated that, the better the PRF the better outcomes for the child. This paper evaluated the Danish version of the prenatal parental reflective functioning questionnaire (P‐PRFQ). We used data from a cluster‐randomized trial of pregnant women recruited from Danish general practice. The sample included 605 mothers. Factor structure and internal consistency were investigated. Linear regression analysis was used to examine the associations between the P‐PRFQ score and the five most predictive variables. The confirmatory factor analyses supported the three‐factor model. The P‐PRFQ had moderate internal consistency. The regression analysis showed a decrease in the P‐PRFQ score with increasing age, increasing parity, current employment, better self‐reported health, lower anxiety score, and fewer negative life events with persistent impact. The directions of the associations between P‐PRFQ score and the predictive variables were opposite of what was hypothesized raising questions about whether the P‐PRFQ can be used as an early pregnancy screening tool assessing prenatal PRF. Further validation studies are required to assess the extent to which the P‐PRFQ truly measures reflective functioning.
... Given that "understanding of minds is hard without the experience of having been understood as a person with a mind" (Fonagy and Target, 2005, p. 334), we might anticipate that individuals whose caregivers were misattuned to their minds and emotions because of mental illness or substance use may grow into adults, have children, and struggle in their parental RF, with the potential for repeating maladaptive intergenerational patterns. This is evident in prior work demonstrating that, for mothers with addictions in particular, those who demonstrated poor RF had experienced significantly more adversity in childhood compared to mothers with moderate to high RF (Håkansson et al., 2018). ...
... Our cumulative risk hypothesis was not supported given the significant interaction effect where mothers who reported a family history of maternal substance use alone demonstrated lower RF than those who reported both maternal substance use and maternal mental illness. Further, counter to prior work denoting that greater adversity was related to poorer RF (Håkansson et al., 2018), among mothers in our sample who experienced a family history of maternal mental illness, family history of maternal substance use was surprisingly not associated with lower RF. While caution is warranted to not over-interpret these findings, we suggest some possible explanations and clinical implications that will require further investigation. ...
Parental reflective functioning (RF) is often cited as an important domain in which mothers with addictions struggle in their roles as parents, though the links between addiction and RF remain unclear. Exposure to attachment trauma associated with parental mental illness and substance use is commonly associated with both addiction and lower RF. We thus examined how family history of parental mental illness and substance use may relate to the RF of mothers with addictions. One hundred ninety-four mothers in outpatient substance use treatment completed the Parent Development Interview and provided information about whether their mothers and fathers experienced mental illness or problems with substance use. Univariate ANOVAs revealed an interaction between family history of maternal mental illness and maternal substance use. Among mothers with a history of maternal substance use, those with a history of maternal mental illness had higher RF than those who had no history of maternal mental illness. Among mothers who did not report a family history of maternal mental illness, mothers who had a family history of maternal substance use exhibited significantly lower RF than mothers with no family history of maternal substance use. Exposure to paternal mental illness or substance use was not associated with mothers’ RF. These findings highlight the importance of disentangling the contributions of attachment trauma to mothers’ RF and utilizing interventions that support mothers’ capacity to reflect about how their early experiences of being cared for by a mother with a mental illness or addiction may impact their current caregiving behaviors.
... As substances may have previously been the primary means for emotion regulation, becoming abstinent during pregnancy may leave them increasingly vulnerable to difficult emotions. Further, mothers with SUD tend to show decreased capacity for RF both pre-and post-partum (Suchman et al., 2010;Pajulo et al., 2012;Smaling et al., 2015;Håkansson et al., 2018a), often impaired by a history of severe trauma (Håkansson et al., 2018b;Suardi et al., 2020). Difficulties in making sense of the emotional turmoil evoked by pregnancy and addiction also make it hard to form a close affective relationship with the baby, already evident during pregnancy in lower prenatal attachment to the fetus (Alhusen, 2008). ...
... Similar to earlier findings (Suchman et al., 2010;Pajulo et al., 2012;Håkansson et al., 2018b) mothers with SUD generally showed very low levels of RF during pregnancy and post-partum in our sample. While the average level of RF in normative samples is 5, mothers with SUD in our sample showed an overall mean level below 4 for AAI-RF, and below 3 for preand post-natal PRF. ...
Mothers with prenatal substance use disorder (SUD) often show broad deficits in their reflective functioning (RF), implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF (AAI-RF), regarding parent's own childhood experiences, and parenting-focused RF (PRF) regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview (during pregnancy/pre-intervention), and with Parent Development Interview at 4 months (during intervention). Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months (post-intervention), and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions.
... In contrast, several other studies in clinical samples did report significant associations between histories of CM and lower RF or parental RF. The sample composition in these studies ranged from patients with personality disorders (Brune, Walden, Edel, & Dimaggio, 2016;Chiesa & Fonagy, 2014), patients with non-affective psychosis (Weijers et al., 2018) and a sample of substance abusing mothers (Hakansson, Watten, Soderstrom, Skarderud, & Oie, 2018). All these studies reporting RFtrauma linkages did not control for potentially confounding variables typically associated with RF, such as education or income, and consisted of samples of patients with severe psychiatric disorders, potentially introducing bias. ...
... This would imply that mentalization is relatively robust in the face of CM when such adverse environments are counterbalanced by positive and caring relationships. This hypothesis is supported by a recent study showing the protective role of adaptive experiences during childhood for parental RF in parents exposed to CM (Hakansson et al., 2018). Another possibility is that CM particularly alters mentalization in affectively hot (i.e., highly emotionally laden) contexts, and that the selfreport format of the instrument used to assess RF in the current study does not efficiently capture the nuanced impacts of trauma on mentalization. ...
Background:
Childhood maltreatment impacts parenting and has intergenerational consequences. It is therefore crucial to identify clinically responsive resilience-promoting factors in pregnant women and expecting men with history of childhood maltreatment. Mentalization, or reflective functioning, appears as a promising concept to understand risk and resilience in the face of childhood maltreatment.
Objective:
This study evaluated the multivariate relationship between exposure to childhood maltreatment, reflective functioning, psychological symptoms and parental attitude in expecting parents.
Methods:
Two hundred and thirty-five pregnant women and 66 expecting fathers completed self-report assessment measures of childhood trauma, reflective functioning, depression, post-traumatic stress disorder, parental sense of competence and antenatal attachment. Twenty-eight percent (n = 85) of the community sample reported personal histories of childhood maltreatment.
Results:
Structural equation modeling indicated that reflective functioning (a) partially mediated the association between childhood maltreatment and psychological symptoms during pregnancy and (b) independently predicted participants' perception of parental competence and psychological investment toward the unborn child.
Conclusion:
Overall, this study provides empirical evidence of the protective role of reflective functioning during the prenatal period in parents with histories of childhood maltreatment.
... For instance, we did not include details about SUD, such as preference for a particular substance or severity of dependence (Pajulo et al., 2012). We did not include specifics about mental health diagnosis, including post-traumatic disorder, or developmental trauma, both of which have been found to affect PRF, EF, and stress (Augusti & Melinder, 2013;Briere, Kaltman, & Green, 2008;Cromer & Sachs-Ericsson, 2006;Håkansson, Watten, Söderström, Skårderud, & Øie, 2018). Fourth, our sample size was rather small, although within the norms for this kind of study (Pajulo et al., 2012;Suchman, Decoste, Mcmahon, Rounsaville, & Mayes, 2011). ...
... Mothers with SUD are often considered particularly vulnerable in the parental role, in addition to being difficult to offer appropriate, customized interventions (Pajulo, Suchman, Kalland, & Mayes, 2006). They are also vulnerable to intergenerational transmission of risk (Håkansson et al., 2018;Kelly, Slade, & Grienenberger, 2005) and therefore are an important population to offer targeted effective interventions. The results of our study indicate that there are dynamic processes between EF, PRF, and the experience of stress. ...
Mothers with a substance use disorder (SUD) have been found to exhibit heightened experience of stress and deficits in executive functioning (EF) and in parental reflective functioning (PRF). Although experiences of stress, EF and PRF are important for caregiving capacities, no studies have explored associations between the phenomena in SUD mothers. This study aimed to examine the association between EF (working memory, inhibition and cognitive flexibility) and different forms of stress (parental stress, general life stress and psychological distress) in 43 SUD mothers with infants. We further aimed to investigate whether PRF had a mediating function between EF and the experience of stress. The mothers completed self‐report questionnaires regarding experiences of different types of stress and we also used neuropsychological tests to assess EF, and a semi‐structured interview to assess PRF. Results identified problems in EF were associated with higher parental stress and psychological distress, but not with general life stress. Cognitive flexibility contributed uniquely to variance in parental stress, while working memory was a unique contributor to variance in psychological distress. PRF had a mediating function between EF and parental stress, as well as between EF and psychological distress. Findings highlights the importance of considering individual differences in PRF when targeting EF in interventions trying to reduce the experience of parental stress and psychological distress in SUD mothers.
... Substance use affects mothers at neural level by altering the functioning of their stress-reward system and leading to passive and disengaged interactive behavior with their children (Rutherford & Mayes, 2019). Indeed, altered quality of dyadic interaction, such as decreased sensitivity (Hatzis, Dawe, Harnett, & Barlow, 2017;Hyysalo, Gastelle, & Flykt, 2022) and traumatic experiences that often inflict behavioral incoherence are common among these mothers (Hakansson et al., 2018). Together, the interaction difficulties and neural changes associated with substance use could transfer to unpredictable patterns of maternal sensory signals. ...
Both maternal substance use and unpredictability of her sensory signals may affect child development, but no studies have examined them together. We explored the unpredictability, frequency, and duration of maternal sensory signals in 59 mother-child dyads, 34 with and 25 without maternal substance use. We also examined the association between unpredictability of maternal signals and children’s cognitive development. Maternal sensory signals were evaluated with videorecorded dyadic free-play interactions at child age of 24 months. Children’s cognitive development was evaluated with Bayley-III at 24 months and with WPPSI-III at 48 months. We found no differences in sensory signals between substance-using and non-using mothers. Higher unpredictability of maternal sensory signals was associated with poorer child cognitive and language development at 24 months and with poorer nonverbal reasoning at 48 months. Unpredictability of maternal sensory signals may be a vital parenting aspect shaping children’s development, but more research is needed in high-risk groups.
... Thirty-one questions from the Adverse Childhood Experiences International Questionnaire (ACE-IQ; WHO, 2018) were used to document common childhood stressors such as abuse, neglect, IPV between parents, bullying, death or incarceration of a parent, guardian, or relative, and community violence such as civil unrest, gang violence, police brutality, or war. Previous studies have linked ACES, especially experiences of abuse and neglect to RF in mothers (Håkansson et al., 2018;Kolomeyer et al., 2016). The current study utilized the ACES-total severity score which is a sum of all types of adversities experienced with weighting for more frequent experiences (e.g., witnessing "many times"). ...
Reflective functioning (RF) has been found to be associated with mother-child interactions, but less is known about the association of fathers' self and child-focused RF and father-child relationships. Fathers who have histories of intimate partner violence (IPV) are known to have poor RF, which may impact their father-child interactions. The current study was designed to examine how types of RF are associated with father-child relationships. Pretreatment assessments and recorded, coded father-child play interactions were used to examine associations among fathers' history of adverse childhood experiences (ACES), RF and coded father-child play interactions in a sample of 47 fathers with a history of IPV use in the last 6 months with their coparent. Fathers' ACES and their child's mental states (CM) were associated with father-child dyadic play interactions. Fathers with greater ACES and higher scores on CM had the most dyadic tension and constriction during play interactions. Those with high ACES but low CM had scores similar to those with low ACES and low CM. These results indicate that fathers who have used IPV and have a history of significant adversity may benefit from interventions to increase their child-focused RF and further improve their interactions with their children.
... Findings suggest that an effect in the association could be hard to find when study samples show a limited range of PRF scores due to related psychosocial risk factors (Schechter et al., 2008). Low levels of PRF are commonly observed in high-risk samples such as mothers with substance abuse (Hakansson et al., 2018;Adams, 2020), leading to difficulties detecting statistical effects. Nonetheless, maternal adult RF has shown mediating effect on the link between maternal experience of childhood maltreatment and substance use severity (Macfie et al., 2020). ...
Background: Parental reflective functioning (PRF) refers to parents’ mental capacity to understand their own and their children’s behaviors in terms of envisioned mental states. As part of a broader concept of parental mentalization, PRF has been identified as one of the central predictors for sensitive parenting. However, the unique contribution of PRF to the quality of various parenting behaviors has not yet been addressed systematically. Thus, the present article provides a systematic overview of current research on the associations between PRF or its sub-dimensions and observed parenting behaviors in infancy and early childhood, while considering the influence of contextual factors.
Methods: The review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Systematic searches were carried out in five electronic databases. The eligibility and methodological quality of the identified studies were assessed using pre-defined criteria and a standardized checklist.
Results: Sixteen studies with moderate to high quality on a total of 15 parenting behaviors were included, the majority of which examined positive parenting behaviors, while negative parenting behaviors were rarely investigated. Most of the associations indicated a positive effect of PRF on parenting behavior, with mostly small-sized effects. The strength and direction of the associations varied depending on the dimensionality of PRF, observation settings, sample types, socioeconomic factors, and cultural background. Moreover, five assessment instruments for PRF and 10 observation instruments for parenting behaviors were identified.
Conclusion: In summary, PRF has shown a positive association with parenting quality. However, its complex interaction with further contextual factors emphasizes the need for differentiation of PRF dimensions and the consideration of the observation settings, assessment time points, psychosocial risks, and sample types in observational as well as intervention studies. Further high-quality studies with multivariate analyses and diverse study settings are required.
... Early changes in mentalization development may play a role in psychopathology resulting from emotional abuse and neglect. Several clinical studies have suggested that childhood maltreatment interferes with the development of mentalization in patients with personality disorders (Brüne et al., 2016;Chiesa and Fonagy, 2014), psychosis, and substance abuse (Håkansson et al., 2018;Weijers et al., 2018). Recently, Li et al. (2020) suggested that mentalization could mediate the relationship among emotional abuse, neglect, and depression. ...
Patients who have experienced emotional abuse and neglect often develop psychiatric disorders in adulthood. However, whether emotional abuse, neglect, and mentalization abilities relate to one another and the role of possible mediators of this relationship in psychiatric patients are still unknown. We evaluated the potential role of affective temperament as a mediator of the relationship between emotional abuse and neglect and mentalization. We performed a cross-sectional study of 252 adult psychiatric inpatients. The Childhood Trauma Questionnaire, Mentalization Questionnaire, and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were administered. Results showed a significant indirect effect of emotional abuse and neglect on scores on the Mentalization Questionnaire through the TEMPS-A (b = 0.25, 95% confidence interval [0.143-0.375]), demonstrating that affective temperament mediates the relationship among emotional abuse, neglect, and mentalization impairment in psychiatric patients. A careful evaluation of mentalization abilities in patients with psychiatric disorders and who have a history of emotional abuse and neglect is necessary for a better understanding of psychopathology and for the choice of therapeutic strategies.
... Positive experiences in childhood may also mediate associations between ACEs and parenting behaviors in adulthood. For example, having adaptive childhood experiences was associated with increased maternal sensitivity among mothers with substance abuse disorders who had experienced childhood adversity (Håkansson et al., 2018). In the current study, we focused on associations between ACEs and parenting attitudes specifically, as parenting attitudes and beliefs have been associated with parenting behaviors in a number of studies (e.g., Vittrup et al., 2006). ...
Theory and research indicate that adverse childhood experiences (ACEs) are linked to negative parenting attitudes and behaviors. We posit that protective and compensatory experiences (PACEs) in childhood buffer the negative effects of ACEs on later parenting. To test this premise, the present study examined associations between ACEs, PACEs, and attitudes towards nurturing and harsh parenting in an ethnically diverse sample of parents with children of various ages (N = 109; 65% mothers, 35% fathers; M age = 38). Parents completed a widely used parenting attitudes questionnaire and the ACEs and PACEs surveys. PACEs were negatively correlated with ACEs and positively correlated with nurturing parenting attitudes and parent income and education levels. Linear regression models indicate that higher PACEs, ACEs, and family income and less harsh parenting attitudes predict nurturing parenting attitudes. In contrast, higher ACEs and less nurturing attitudes were correlated with harsh parenting attitudes. As expected, moderation analyses indicated that the association between ACEs and harsh parenting attitudes was conditional upon the level of PACEs. When PACE scores were low (M – 1 SD), but not when PACE scores were average or high (M + 1 SD), ACEs were associated with harsh parenting attitudes, suggesting a buffering effect of PACEs on negative parenting attitudes. These findings support the importance of including protective as well as adverse childhood experiences when assessing the role of childhood experiences on parenting attitudes and practices. Implications of these findings for researchers and practitioners are discussed, as well as new directions for PACEs research using a cumulative protection approach.
... This is because the consequences of trauma are intensity-dependent; thus, there is a need to collect data on the number of traumatic events. Multiple traumas (2+) are an indicator of a more stressful situation and have a stronger effect on a wide range of psychosocial outcomes [59][60][61][62][63][64][65][66][67]. ...
Background:
Minorities' diminished returns (MDRs) refer to weaker effects of socioeconomic status (SES) indicators such as parental educational attainment and family income in generating tangible childhood outcomes for racial and ethnic minorities compared to the majority group, a pattern prevalent in the US. Our existing knowledge is minimal, however, about diminished returns of family SES on reducing exposure to childhood trauma.
Aim:
To determine if there was a difference between non-Hispanic whites (NHW) and non-Hispanic blacks (NHB) in the effect of SES on exposure to childhood trauma among children ages 8-11 years old.
Materials and methods:
In this cross-sectional study, we analyzed data from 4696 NHW or NHB American 8-11-year-old children who were participants in the Adolescent Brain Cognitive Development (ABCD) Study. The independent variables were parental educational attainment and family income. The primary outcome was exposure to 1 or 2+ childhood traumas, measured by the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) semi-structured interview. Polynomial regression was used for data analysis.
Results:
Parental education and family income had statistically significant protective (negative) effects on childhood trauma, indicating children from high income and highly educated families were exposed to a lower level of childhood trauma. However, race/ethnicity showed statistically significant interactions with parental education and family income on exposure to childhood trauma, indicating weaker protective effects of parental education and family income on reducing exposure to trauma for NHB compared to NHW children. Race-specific models showed protective effects of parental education and family income on exposure to childhood trauma for NHW but not NHB children.
Conclusion:
The protective effects of parental education and family income against exposure to childhood trauma are systematically diminished for NHBs compared to NHWs. To minimize the racial/ethnic health gaps, diminished returns of parental education and family income should be addressed. There is a need for programs and interventions that equalize not only SES but also the marginal returns of SES for ethnic groups. Such efforts require addressing structural and societal barriers that hinder NHB families from translating their SES resources into tangible outcomes. There is a need for studies that can minimize MDRs for NHB families, such that SES can similarly secure tangible outcomes in the presence of SES resources.
Objectives
Childhood maltreatment has a negative impact on a sense of parenting competition. However, its underlying mechanisms are still unknown. The present research aimed to investigate the roles of parental reflective functioning and social support as mediating factors in the relationship between childhood maltreatment and negative feeling of parenting competence.
Methods
A cross-sectional study was carried out on 489 parents of children aged 5 to 13 between October 23 and December 12, 2021, in Shiraz, Iran. Participants completed the Childhood Trauma Questionnaire (CTQ), Parenting Sense of Competence Scale (PSOC), Perceived Social Support Scale (PSSS), and Parental Reflective Functioning Questionnaire (PRFQ). Structural equation modeling (SEM) was applied using AMOS 22 to test our conceptual model.
Results
The results of structural equation modeling indicated that childhood maltreatment had a negative direct effect on the sense of parenting competence. Furthermore, childhood maltreatment had a negative indirect effect on the sense of parenting competence through both parental reflective functioning and perceived social support.
Conclusions
The findings suggested that increased exposure to childhood maltreatment may have decreased parental competence. However, the important role of parental reflective functioning and perceived social support in the relationship between childhood maltreatment and parenting competence should not be ignored. These results can have some implications for counselors working with parents with childhood trauma experiences.
La importancia del cuidado y bienestar de los niños, niñas y adolescentes, y especialmente aquellos que viven en situación de vulnerabilidad, han adquirido en los últimos años una dimensión de especial de parte de una amplia diversidad de profesionales, investigadores e incluso en cuanto a su consideración en políticas publicas. En esa dirección, este libro colectivo, que congrega el trabajo de investigadores y profesionales tiene por propósito aportar innovaciones metodológicas, reportes de investigaciones y discusiones teóricas para el mejoramiento de las practicas de intervención desarrolladas en el marco de las políticas publicas de infancia en Chile.
El uso de la mentalización para el abordaje del trauma complejo del desarrollo: aportes para una práctica clínica basada en la evidencia en Chile Introducción Cuando el maltrato y/o el abuso sexual infantil (ASI) se prolongan en el tiempo; cuando se da simultáneamente con otras formas de violencia; y cuando quienes ejercen esas victimizaciones son los(as) cuidadores(as) principales, nos encontramos ante una forma de trauma crónico, múltiple y de naturaleza rela-cional (Mitchell & Steele, 2020; Racine et al., 2020) que autores como Judith Herman (1992), Bessel van del Kolk (2005), Alexandra Cook (2005) o Julian Ford (2015), entre otros, han denominado trauma complejo del desarrollo. De acuerdo con Cook et al. (2007) las consecuencias de estas experiencias pueden ser devastadoras para niños, niñas y adolescentes (NNA), impactando áreas de su funcionamiento como el apego, los sistemas neuroendocrinos, las funciones ejecutivas, la regulación emocional, las creencias sobre el mundo, y la identidad; entre otras dimensiones de deterioro (Cloitre et al., 2013; Pérez, et al., 2020; van der Kolk et al., 2019). La severidad de la traumatización compleja desafía a los modelos habitua-les de intervención, tanto por los múltiples niveles de afectación que muestran
Maternal substance use has often been associated with insecure and disorganized child attachment. We evaluated this association with a meta-analysis of young children and, further, systematically reviewed mediating and moderating factors between maternal substance use and child attachment. We performed a systematic database search of quantitative English language studies on child attachment that included substance-using mothers and their children below 6 years of age. Eleven studies ( N = 1,841) met the inclusion criteria and were included in the meta-analysis of attachment security and seven ( N = 1,589) studies were included in the meta-analysis of attachment disorganization. We found that maternal substance use was negatively associated with secure attachment in children, but the effect size was small ( r = −.10). The association with disorganized attachment was not significant ( r = .15). Related to moderating and mediating factors ( k = 6), we found evidence on the role of teratogenic and sociological factors on child attachment. Most importantly, the impact of cumulative risks was vital. However, literature was scarce, and studies varied in risk of bias, leaving many unanswered questions on other potential factors underlying the development of attachment in these high-risk children. We discuss the results considering clinical implications and future directions.
Read-only link:
https://www.cambridge.org/core/journals/development-and-psychopathology/article/maternal-pre-and-postnatal-substance-use-and-attachment-in-young-children-a-systematic-review-and-metaanalysis/E637E89AB7908BBC189212BE58C8871E/share/6aa5688c2eb6203e178edbcfd71c71977fb5d658?fbclid=IwAR1BmAK3UHyQgd4MSXURLvw7w-IMxhuMRuPAluVhSnBnDcyF3B9sG5Ztatw
Aims
Mothers with substance use disorders (SUD) often show impairments in parental reflective functioning (PRF), which may have adverse effects on their capacity for sensitive caregiving. Parenting personality is also associated with caregiving. However, no studies have investigated how these individual factors may contribute to variance in PRF in mothers with SUD. In this study PRF and personality were assessed in 43 mothers with SUD.
Methods
PRF was assessed by the Parent Development Interview. Personality traits were assessed by the Revised Neuroticism-Extraversion-Openness Personality Inventory.
Results
The results indicate that higher levels of the Openness trait are associated with better PRF.
Conclusion
Mothers low in Openness may need more specific and situational training in interpreting mental states in their children. Highly open mothers with SUD will likely need more help distinguishing the child’s mental states from their own, and might need help to maintain mutuality and regulating the intensity of their responses to the child’s behavior.
Aims
Impairments in reflective functioning are known to have adverse effects on the ability to display sensitive parenting as a caregiver. Several factors are associated with impairments in reflective functioning, such as impaired executive functioning and experienced trauma. We investigated how these factors contribute to an impaired reflective functioning style, such as pathological certain or uncertain reflective functioning. Extreme scores on these two subscales reflect two kinds of impairments in reflective functioning. We assessed executive functions, reflective functioning, and trauma in 43 mothers diagnosed with substance use disorders (SUD).
Methods
Certain or uncertain reflective functioning were assessed using the Reflective Functioning Questionnaire 8 (RFQ-8). Executive functions and trauma were assessed by administering various questionnaires, interviews and neuropsychological tests.
Results
High uncertain reflective functioning was more than six times as common (odds ratio) in mothers reporting high amounts of trauma in childhood and adolescence compared with mothers reporting low amounts of trauma. Impaired executive functions were also significantly associated with high uncertain reflective functioning. Certain reflective functioning did, however, not show any significant associations.
Conclusion
When the SUD mothers give information about relational trauma in childhood and adolescence, it might therefore be worth investigating and addressing the potential tendency to have an uncertain reflective functioning style.
Aims
Having a substance use disorder (SUD) is associated with impaired reflective functioning (RF) or mentalizing, implying reduced capacity to reflect on internal mental states of the self and others. This has adverse effects on parenting and the child's development. High uncertain RF style prevents an adequate RF due to a concrete, rigid way of mentalizing. High certain RF style prevents adequate RF by making individuals too certain that their view of the world is the true and only one, thereby implying no need to mentalize others' state of mind. We investigated the degree of certain RF and uncertain RF in mothers with SUD with the recently developed screening measure Reflective Functioning Questionnaire-8 (RFQ). Further, we measured the concurrent validity of the RFQ and the more commonly used Parent Development Interview (PDI) measuring a one-dimensional scale of RF.
Methods
We used the RFQ-8 to investigate the degree of certain RF (RFQc) and uncertain RF (RFQu) in 43 mothers with SUD. We measured the concurrent validity of the RFQ and the more commonly used PDI.
Results
Our sample had considerably higher uncertain RF compared to certain RF. The RFQu was significantly negatively associated with maternal RF measured with the PDI, while the RFQc was not.
Conclusion
High degree of uncertain RF in mothers with SUD was associated with an impaired maternal RF (PDI). Administering the RFQ-8 before treatment might be an effective way to screen for uncertain RF deficit, pinpointing what should be the focus in the mentalization-based therapy.
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.
Having a substance use disorder (SUD) may adversely affect caregiving capacities. Reflective functioning (RF) and executive functioning (EF) are both important capacities for sensitive parenting, and are often impaired in a SUD. Only a few studies have explored the possible association between the two phenomena. In this study, we used a neuropsychological test battery to assess EF, and the Parent Development Interview to assess RF in a sample of mothers with a SUD (N = 43). Although parental RF (PRF) was associated with EF, when controlled for intelligence (IQ) and mental health, there was no significant association between EF and PRF. Mental health, however, showed a significant negative association with PRF. Splitting the group in two based on PRF level, mothers with a negative to low PRF exhibited more severe difficulties in SUD-related aspects, as well as in several EF components, compared to mothers with an adequate to high PRF, highlighting the association between EF and PRF. The results from this study contribute to enhance our understanding of the dynamics underlying vulnerability in PRF that mothers with small children may experience. We suggest EF to be a prerequisite for adequate PRF, and for interventions to be customized accordingly regarding parents with a SUD.
Developmental research on resilience is summarised and illustrated with a case example. Self-reflection, positive relationships, and agency foster resilience in the face of adversity. Attachment and resilience are related categories. The different patterns of attachment - secure, insecure-organised and insecure-disorganised - are manifest in different patterns of resilience, depending on prevailing environmental conditions. However, the greater the environmental adversity, the less will the resilience factors emerge. Clients tend to present for psychotherapy when resilience strategies have failed. The therapeutic relationship has neurochemical and relational characteristic mirroring the secure mother-infant bond. These foster mentalising, stress innoculation, affect co-regulation, self-esteem, and agency, forming the basis for enduring and more flexible resilience strategies.
There are many risk factors that make the transition to parenthood difficult, even in the best of circumstances. One such risk factor is the experience of parental childhood trauma, which has the potential to affect the parent/child relationship, both in terms of attachment style parental reflective functioning. This study aims to expand on the line of research concerned with the effects that trauma has once that child transitions into adulthood and into parenthood by looking at the role that the experience of trauma and adult attachment has in relation to parental reflective functioning. This study assessed mothers (N = 125) by using the CTQ (childhood experience of trauma), ECR (adult attachment), and the PRFQ (parental RF). Our study found that in the presence of physical neglect, insecure attachment had a particularly deleterious effect on maternal reflective functioning. This relationship was not as strong in the absence of physical neglect.
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.
It is unclear whether maltreatment types exert common or specific effects on mental health. In the current study, we aimed to systematically characterize the unique, shared and cumulative effects of maltreatment types on psychiatric symptoms, using data drawn from a community sample of high-risk youth (n = 204, M = 18.85). Analyses controlled for a range of potentially confounding variables, including socio-demographic variables, neighbourhood deprivation and levels of community violence exposure. Outcome measures included multi-informant reports of internalizing difficulties, as well as data on externalizing problems and trauma-related symptoms. We found that (i) consistent with previous studies, maltreatment types were highly interrelated and frequently co-occurred; (ii) symptom severity linearly increased with the number of maltreatment types experienced (more so for self-report vs informant ratings); and (iii) while most forms of maltreatment were significantly associated with mental health outcomes when examined individually, few unique effects were observed when modelling maltreatment types simultaneously, pointing to an important role of shared variance in driving maltreatment effects on mental health. Emotional abuse emerged as the main independent predictor of psychiatric symptomatology – over and above other maltreatment types – and this effect was comparable for males and females (i.e. no significant interaction with sex). Findings contribute to a better understanding of heterogeneity in individual responses to maltreatment.
Maltreatment-related childhood adversity is the leading preventable risk factor for mental illness and substance abuse. Although the association between maltreatment and psychopathology is compelling, there is a pressing need to understand how maltreatment increases the risk of psychiatric disorders. Emerging evidence suggests that maltreatment alters trajectories of brain development to affect sensory systems, network architecture and circuits involved in threat detection, emotional regulation and reward anticipation. This Review explores whether these alterations reflect toxic effects of early-life stress or potentially adaptive modifications, the relationship between psychopathology and brain changes, and the distinction between resilience, susceptibility and compensation. © 2016 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.
Unlabelled:
Individuals vary widely in their tendency to seek stimulation and act impulsively, early developing traits with genetic origins. Failures to regulate these behaviors increase risk for maladaptive outcomes including substance abuse. Here, we explored the neuroanatomical correlates of sensation seeking and impulsivity in healthy young adults. Our analyses revealed links between sensation seeking and reduced cortical thickness that were preferentially localized to regions implicated in cognitive control, including anterior cingulate and middle frontal gyrus (n = 1015). These associations generalized to self-reported motor impulsivity, replicated in an independent group (n = 219), and correlated with heightened alcohol, tobacco, and caffeine use. Critically, the relations between sensation seeking and brain structure were evident in participants without a history of alcohol or tobacco use, suggesting that observed associations with anatomy are not solely a consequence of substance use. These results demonstrate that individual differences in the tendency to seek stimulation, act on impulse, and engage in substance use are correlated with the anatomical structure of cognitive control circuitry. Our findings suggest that, in healthy populations, covariation across these complex multidimensional behaviors may in part originate from a common underlying biology.
Significance statement:
Impaired cognitive control may result in a tendency to seek stimulation impulsively and an increased risk for maladaptive outcomes, including substance abuse. Here, we examined the structural correlates of sensation seeking and impulsivity in a large cohort of healthy young adults. Our analyses revealed links between sensation seeking and reduced cortical thickness that were preferentially localized to regions implicated in cognitive control, including anterior cingulate and middle frontal gyrus. The observed associations generalized to motor impulsivity, replicated in an independent group, and predicted heightened alcohol, tobacco, and caffeine use. These data indicate that normal variability in cognitive control system anatomy predicts sensation seeking and motor impulsivity in the healthy populations, potentially increasing risk for substance use disorders.
The aim of this prospective study was to examine temporal pathways from mothers’ reflective functioning
(RF) through parenting to infant attachment measured more than 16 months later. Participants were
88 mother–infant dyads from demographically diverse backgrounds and included a group of mothers
with histories of childhood maltreatment. RF was assessed using the RF rating of the Adult Attachment
Interview before the birth of the baby. Parenting was assessed when the infants were 6 months old using
the Maternal Sensitivity scale, as well as when they were 16 months using the Disconnected and
Extremely Insensitive Parenting scale. Infant attachment was assessed when the infants were 16 months
old using the Strange Situation. As hypothesised, the study findings showed that mothers’ mentalization
regarding their own early attachment relationships was associated with later parenting and infant
attachment. Negative parenting behaviours explained the link between mothers’ RF about their own
attachment relationships and infant attachment disorganization. The findings suggest that mothers’
mentalization about their early attachment relationships has important implications in the transition to
becoming parents themselves. Mentalization appears to be particularly important in helping mothers
screen and inhibit negative parenting behaviours that would otherwise undermine infant attachment
security and organization.
Background:
Childhood emotional maltreatment (CEM) increases the likelihood of developing an anxiety disorder in adulthood, but the neural processes underlying conferment of this risk have not been established. Here, we test the potential for neuroimaging the adult brain to inform understanding of the mechanism linking CEM to adult anxiety symptoms.
Method:
One hundred eighty-two adults (148 females, 34 males) with a normal-to-clinical range of anxiety symptoms underwent structural and functional magnetic resonance imaging while completing an emotion-processing paradigm with facial expressions of fear, anger, and happiness. Participants completed self-report measures of CEM and current anxiety symptoms. Voxelwise mediation analyses on gray-matter volumes and activation to each emotion condition were used to identify candidate brain mechanisms relating CEM to anxiety in adulthood.
Results:
During processing of fear and anger faces, greater amygdala and less right dorsolateral prefrontal (dlPFC) activation partially mediated the positive relationship between CEM and anxiety symptoms. Greater right posterior insula activation to fear also partially mediated this relationship, as did greater ventral anterior cingulate (ACC) and less dorsal ACC activation to anger. Responses to happy faces in these regions did not mediate the CEM-anxiety relationship. Smaller right dlPFC gray-matter volumes also partially mediated the CEM-anxiety relationship.
Conclusions:
Activation patterns of the adult brain demonstrate the potential to inform mechanistic accounts of the CEM conferment of anxiety symptoms. Results support the hypothesis that exaggerated limbic activation to negative valence facial emotions links CEM to anxiety symptoms, which may be consequent to a breakdown of cortical regulatory processes.
Child maltreatment is a robust risk factor for internalizing and externalizing psychopathology in children and adolescents. We examined the role of disruptions in emotion regulation processes as a developmental mechanism linking child maltreatment to the onset of multiple forms of psychopathology in adolescents. Specifically, we examined whether child maltreatment was associated with emotional reactivity and maladaptive cognitive and behavioral responses to distress, including rumination and impulsive behaviors, in two separate samples. We additionally investigated whether each of these components of emotion regulation were associated with internalizing and externalizing psychopathology and mediated the association between child maltreatment and psychopathology. Study 1 included a sample of 167 adolescents recruited based on exposure to physical, sexual, or emotional abuse. Study 2 included a sample of 439 adolescents in a community-based cohort study followed prospectively for 5 years. In both samples, child maltreatment was associated with higher levels of internalizing psychopathology, elevated emotional reactivity, and greater habitual engagement in rumination and impulsive responses to distress. In Study 2, emotional reactivity and maladaptive responses to distress mediated the association between child maltreatment and both internalizing and externalizing psychopathology. These findings provide converging evidence for the role of emotion regulation deficits as a transdiagnostic developmental pathway linking child maltreatment with multiple forms of psychopathology.
A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r = .17) and peritraumatic dissociation the largest (weighted r = .35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD.
Importance
Several widely held beliefs about child abuse and neglect may be incorrect. It is most commonly assumed that some forms of abuse (eg, physical and sexual abuse) are more harmful than others (eg, emotional abuse and neglect); other assumptions are that each form of abuse has specific consequences and that the effects of abuse differ across sex and race.Objective
To determine whether widely held assumptions about child abuse and neglect are valid by testing the hypothesis that different types of child maltreatment (CM) actually have equivalent, broad, and universal effects.Design, Setting, and Participants
This observational study assessed 2292 racially and ethnically diverse boys (1254 [54.7%]) and girls (1038 [45.3%]) aged 5 to 13 years (mean [SD] age, 9.0 [2.0] years) who attended a research summer camp program for low-income, school-aged children from July 1, 1986, to August 15, 2012. Of these children, 1193 (52.1%) had a well-documented history of maltreatment. Analysis was conducted from September 25, 2013, to June 1, 2015.Main Outcomes and Measures
Various forms of internalizing and externalizing personality and psychopathologic traits were assessed using multiple informant ratings on the California Child Q-Set and Teacher Report Form as well as child self-reported depression and peer ratings of aggression and disruptive behavior.Results
Structural analysis showed that different forms of CM have equivalent psychiatric and behavioral effects, ranging from anxiety and depression to rule-breaking and aggression. We also found that nonsexual CM alters 2 broad vulnerability factors, internalizing (β = 0.185; SE = 0.028; P < .001) and externalizing (β = 0.283; SE = 0.023; P < .001), that underlie multiple forms of psychiatric and behavioral disturbance. We show that CM has comparable consequences for boys and girls of different races, and our results allowed us to describe a base rate and co-occurrence issue that makes it difficult to identify the unique effects of child sexual abuse. Conclusions and Relevance
Our findings challenge widely held beliefs about how child abuse should be recognized and treated—a responsibility that often lies with the physician. Because different types of child abuse have equivalent, broad, and universal effects, effective treatments for maltreatment of any sort are likely to have comprehensive psychological benefits. Population-level prevention and intervention strategies should emphasize emotional abuse, which occurs with high frequency but is less punishable than other types of child maltreatment.
Aim The aim of the present study was to describe the development of Families First, a new mentalization-based group intervention model for supporting early parenthood. The general aim of the intervention was to support well-functioning models of parenting and prevent transmission of negative parenting models over generations, and thus promote child development and overall family health.
In the Finnish society, great concern has aroused during the last decade regarding the well-being and mental health of children and adolescents. Increased number of divorces, poverty, substance abuse, and mental health problems among parents enhance the risk for child neglect and abuse. New effective, preventive, and health-promoting intervention tools are greatly needed to support families with young children. At present, the Families First intervention is being implemented in primary social and healthcare units all over Finland. Methods and findings This article will provide a theoretical understanding of the importance of parental mentalization for the development of the parent-child relationship and the development of the child as well as proposed mechanisms of actions in order to enhance mentalizing capacity. The cultural context will be described. The article will also provide a description of the scientific evaluation protocol of the intervention model. Finally, possible limitations and challenges of the intervention model are discussed.
The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as reflective function; RF) regarding relationships with attachment figures (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood.
Prior research involving parents (G1) and their adult children (G2) shows intergenerational continuity in positive parenting. Previous research, however, has not shown circumstances under which the typically modest effect size for intergenerational continuity is augmented or attenuated. Using a multigenerational data set involving 290 families, we evaluated 2 potential moderators of intergenerational continuity in positive parenting (i.e., beliefs about parenting efficacy and active coping strategies) drawn from prior theoretical work on predictors of parenting (Belsky, 1984). These personal resources of the second-generation (G2) parent interacted with G1 positive parenting to predict G2 parenting behavior. Beliefs about parental efficacy and active coping both compensated for low levels of G1 positive parenting by promoting G2 positive parenting when G1 parents were comparatively low on positive parenting. An alternative interpretation of this moderation is that G1 positive parenting compensated for low levels of these personal resources by promoting G2 positive parenting when G2 parents were comparatively low on parenting efficacy and effective coping. These findings indicate the different roles that these personal resources and a history of positive parenting appear to play in promoting a positive parenting environment for the next generation of children. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Preliminary data from some of the various treatment approaches outlined above suggest that they provide symptom relief as well as improvement in social competence and emotion management, and that they are consistently superior to nonspecific supportive therapies. These programs, however, are in an early phase of development and require refinement and adaptation for culturally and geographically diverse populations. Finally, there is consensus that interventions should build strengths as well as reduce symptoms. In this way, treatment for children and adolescents also serves as a prevention program against poor outcomes in adulthood.
Background
Early life stress (ELS) can compromise development, with higher amounts of adversity linked to behavior problems. To understand this linkage, a growing body of research has examined two brain regions involved with socio-emotional functioning- the amygdala and hippocampus. Yet empirical studies have reported increases, decreases, and also no differences within human and non-human animal samples exposed to different forms of ELS. Divergence in findings may stem from methodological factors and/or non-linear effects of ELS.
Methods
We completed rigorous hand-tracing of the amygdala and hippocampus in three samples of children who suffered different forms of ELS (i.e., physical abuse, early neglect, or low SES). In addition, interview-based measures of cumulative life stress were also collected with children and their parents or guardians. These same measures were also collected in a fourth sample of comparison children who had not suffered any of these forms of ELS.
Results
Smaller amygdala volumes were found for children exposed to these different forms of ELS. Smaller hippocampal volumes were also noted for children who suffered physical abuse or from low SES-households. Smaller amygdala and hippocampal volumes were also associated with greater cumulative stress exposure and also behavior problems. Hippocampal volumes partially mediated the relationship between ELS and greater behavior problems.
Conclusions
This study suggests ELS may shape the development of brain areas involved with emotion processing and regulation in similar ways. Differences in the amygdala and hippocampus may be a shared diathesis for later negative outcomes related to ELS.
We provide a theoretical and empirical basis for the claim that individual differences exist in developmental plasticity and that phenotypic plasticity should be a subject of study in its own right. To advance this argument, we begin by highlighting challenges that evolutionary thinking poses for a science of development and psychopathology, including for the diathesis-stress framework that has (fruitfully) guided so much empirical inquiry on developmental risk, resilience, and dysregulation. With this foundation laid, we raise a series of issues that the differential-susceptibility hypothesis calls attention to, while highlighting findings that have emerged over just the past several years and are pertinent to some of the questions posed. Even though it is clear that this new perspective on Person × Environment interaction is stimulating research and influencing how hypotheses are framed and data interpreted, a great many topics remain that need empirical attention. Our intention is to encourage students of development and psychopathology to treat phenotypic plasticity as an individual-difference construct while exploring unknowns in the differential-susceptibility equation.
Significance
Childhood poverty has been linked to emotion dysregulation, which is further associated with negative physical and psychological health in adulthood. The current study provides evidence of prospective associations between childhood poverty and adult neural activity during effortful attempts to regulate negative emotion. Adults with lower family income at age 9 exhibited reduced ventrolateral and dorsolateral prefrontal cortex activity and failure to suppress amygdala activation at age 24. Chronic stressor exposure across childhood mediated the relations between family income at age 9 and prefrontal cortex activity. The concurrent adult income, on the other hand, was not associated with neural activity. The information on the developmental timing of poverty effects and neural mechanisms may inform early interventions aimed at reducing health disparities.
The term reflective function (RF) refers to the psychological processes underlying the capacity to mentalize, a concept which has been described in both the psychoanalytic (Fonagy, 1989; 1991) and cognitive psychology literatures (e.g. Morton & Frith, 1995). Reflective functioning or mentalization is the active expression of this psychological capacity intimately related to the representation of the self (Fonagy & Target, 1995; 996; Target & Fonagy, 1996). RF involves both a self-reflective and an interpersonal component that ideally provides the individual with a well-developed capacity to distinguish inner from outer reality, pretend from ‘real’ modes of functioning, intra-personal mental and emotional processes from interpersonal communications. Because of the inherently interpersonal origins to how the reflective capacity develops and expresses itself, this manual refers to reflective functioning, and no longer of reflective-self functioning (see Fonagy, Steele, Moran, Steele, & Higgitt, 1991a), as the latter term is too easily reduced to self-reflection which is only part of what is intended by the concept.
Over the past decades, meta-analyses have failed to find almost any clinically meaningful differences in efficacy between the various evidence-based psychotherapies. This has led to the formulation of the so-called “Dodo bird verdict”, based on the Alice in Wonderland story, which argues that “all [psychotherapies] have won and all must have prizes”. Consequently, major figures in the field have questioned the notion that theory-specific techniques or interventions, such as addressing dysfunctional cognitions in cognitive-behavioral therapy, or the relationship between past and present in psychodynamic therapy, are mainly responsible for therapeutic outcome. They argue that, instead, factors that are common to effective treatments – providing the patient with hope and with a comprehensive theory that explains the patient’s complaints – would typically explain a greater proportion of the therapeutic outcome. This would be particularly the case if the therapist is able to establish a warm and empathic therapeutic relationship with the patient. Hence, the “Dodo bird” still looms unresolved over the field of psychotherapy (Budd & Hughes, 2009; Mansell, 2011). In this paper, I will attempt to set out a new, evolutionarily informed approach to the “Dodo bird” controversy, which we speculate may have implications for understanding psychopathology more generally.
This paper reviews recent theoretical, empirical, and clinical work related to parental reflective functioning (PRF) or parental mentalizing. PRF refers to the capacity of the parent to envision his or her child as being motivated by internal mental states such as feelings, wishes, and desires, and to be able to reflect on his or her own internal mental experiences and how they are shaped and changed by interactions with the child. This paper first briefly discusses the historical and theoretical background of this concept and its purported role in child development, with a focus on the development of child attachment, affect regulation, and mentalizing. It then reviews recent thinking and research in four areas: (1) the neurobiology underlying PRF, (2) the multidimensionality of PRF, (3) the relationship between PRF and trauma, and (4) the broader relevance of attention to internal mental states for the development of epistemic trust as the basis of an evolutionary inbuilt capacity for learning from and within social communication. It closes with a brief review of the background of, and empirical evidence supporting, interventions rooted in theoretical considerations concerning the importance of PRF, as well as suggested directions for future research and clinical practice. © 2017 Claudia Lament, Wendy Olesker, Paul Brinich and Rona Knight.
Parental mentalizing—recognizing that children are separate psychological entities, who have
their own thoughts, wishes, and intentions that motivate their behaviors—is traditionally considered
a verbal, linguistic capacity. This paper aimed to examine the relation between parental
verbal mentalizing (parental reflective function; PRF) and its nonverbal form—parental embodied
mentalizing (PEM)—and how both constructs contribute to parents’ subjective experience of
parenting, namely parental stress and coparental alliance. 68 mothers and their three-months-old
babies were observed to assess PEM, interviewed to code PRF, and completed self-reports of
coparental alliance and parental stress. PEM was found to be positively correlated with PRF.
Mediation analyses revealed that higher PEM, but not PRF, was associated with lower parental
stress, mediated by positive reports of coparental alliance. The findings support adopting a
multifaceted approach when studying parental mentalizing, both in terms of assessing parental
mentalizing beyond its verbal expressions to include also embodied aspects, as well as investigating
its impact beyond infant development to include the familial context within it operates.
Conceptual, empirical and clinical implications are discussed.
This article sets out the relevance of recent theoretical developments in the areas of mentalizing, attachment and epistemic trust in relation to group therapy. It begins with an account of the role of mentalizing in the attachment context in the development of epistemic trust—defined as trust in the authenticity and personal relevance of interpersonally transmitted knowledge about how the social environment works. It then explains the particular way in which this emphasis on social communication is pertinent to group therapy and its function as a training ground for mentalizing and the initial experimentation with the opening of epistemic trust in a social context. The article finishes with an account of how mentalization-based group work is undertaken.
Youth involved in the child welfare system experience multiple early adversities that can contribute to increased risk of substance use and delinquency. Although adverse childhood experiences (ACEs) have been associated with poorer behavioral outcomes among youth, less is known about the possible protective factors that may influence the relationship between early adversity and risk-taking behavior. This study examined whether protective adult relationships moderated the link between cumulative ACEs and substance use and delinquency after controlling for demographic characteristics in child welfare-involved youth. The sample included 1054 youth, ages 11–17, from the National Survey of Child and Adolescent Well-Being II who were in the first wave of data collection. Results showed that protective adult relationships moderated the relationship between ACEs and substance use, but not for delinquency. Specifically, under lower levels of protective adult relationships, cumulative ACEs related to increased substance use among youth. Implications for child welfare practices to target youths' support systems are discussed.
Epidemiologists and psychoanalysts have been equally concerned about the intergenera‐tional concordance of disturbed patterns of attachment. Mary Main's introduction of the Adult Attachment Interview (AAI) has provided the field with an empirical tool for examining the concordance of parental and infant attachment patterns. In the context of a prospective study of the influence of parental patterns of attachment assessed before the birth of the first child upon the child's pattern of attachment to that parent at 1 year and at 18 months, the Anna Freud Centre—University College London Parent‐Child Project reported a significant level of concordance between parental security and the infant's security with that parent. In the context of this study, a new measure, aiming to assess the parent's capacity for understanding mental states, was developed and is reported on in this paper. The rating of Reflective‐Self Function, based upon AAI transcripts, correlated significantly with infant security classification based on Strange Situation assessments. The philosophical background and clinical importance of the measure are discussed.
Epidemiologic studies of trauma highlight the imbalance between prevalence of psychiatric diagnoses and help seeking. We investigated prevalence and correlates of help seeking and self-medication in Norwegian adults with trauma history with a focus on common posttrauma outcomes of posttraumatic stress disorder (PTSD) and substance use disorders (alcohol or drug). Participants reporting at least 1 PTSD symptom (n = 307) were asked if they consulted with a doctor/another professional (help seeking) or used drugs/alcohol (self-medication) for trauma-related problems. PTSD, alcohol abuse or dependence (AUD), and drug use or dependence (DUD) were assessed via structured diagnostic interviews. Help seeking and self-medication were endorsed by 37.4% and 10.4% of the sample, respectively. As compared to the full sample, help seeking was endorsed at a greater rate in individuals with PTSD (χ2 = 8.59, p = .005) and at a lower rate in those with AUD (χ2 = 7.34, p < .004). Self-medication was more likely to be endorsed by individuals with PTSD than without PTSD (χ2 = 25.68, p < .001). In regression analyses, PTSD was associated with increased likelihood of self-medication (odds ratio [OR] = 4.56) and help seeking (OR = 2.29), while AUD was associated with decreased likelihood of help-seeking (OR = .29). When self-medication was included as a predictor, PTSD was no longer associated with help seeking, although AUD remained inversely associated. PTSD and AUDs have a nuanced relationship with formal help seeking as well as the use of substances to cope. Trauma-exposed individuals are likely engaging in adaptive and maladaptive coping strategies, the latter of which may be compounding distress.
About the time I started kindergarten, a researcher in a laboratory far away picked up a baby rat, handled it briefly, and returned it to the nest. The rat grew up to be resilient to stress, as did its brothers and sisters who were also handled. The effect was traced to changes in the brain's regulation of the body's stress and emotion systems. Thus was born the field of early experiences and stress. Years later, as a research assistant, I pondered why babies cried when uncontrollable toys made loud noises and stumbled into the same field of early experiences and stress. I have spent more than 35 years trying to use our vast knowledge of the neurobiology of stress and development in animals to understand how adverse care during early human development affects physical and mental health. This essay traces my own development as I have sought to understand the human chapter in this mammalian story.
Background:
Childhood maltreatment is the most important preventable cause of psychopathology accounting for about 45% of the population attributable risk for childhood onset psychiatric disorders. A key breakthrough has been the discovery that maltreatment alters trajectories of brain development.
Methods:
This review aims to synthesize neuroimaging findings in children who experienced caregiver neglect as well as from studies in children, adolescents and adults who experienced physical, sexual and emotional abuse. In doing so, we provide preliminary answers to questions regarding the importance of type and timing of exposure, gender differences, reversibility and the relationship between brain changes and psychopathology. We also discuss whether these changes represent adaptive modifications or stress-induced damage.
Results:
Parental verbal abuse, witnessing domestic violence and sexual abuse appear to specifically target brain regions (auditory, visual and somatosensory cortex) and pathways that process and convey the aversive experience. Maltreatment is associated with reliable morphological alterations in anterior cingulate, dorsal lateral prefrontal and orbitofrontal cortex, corpus callosum and adult hippocampus, and with enhanced amygdala response to emotional faces and diminished striatal response to anticipated rewards. Evidence is emerging that these regions and interconnecting pathways have sensitive exposure periods when they are most vulnerable.
Conclusions:
Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse. Childhood maltreatment exerts a prepotent influence on brain development and has been an unrecognized confound in almost all psychiatric neuroimaging studies. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex as they are discernible in both susceptible and resilient individuals with maltreatment histories. Mechanisms fostering resilience will need to be a primary focus of future studies.
Childhood resilience is the phenomenon of positive adaptation despite significant life adversities. While interest in resilience has burgeoned in recent years, considerable uncertainty remains regarding what research has revealed about this phenomenon. Integrated in this book are contributions from leading scientists who have studied children's adjustment across risks common in contemporary society. Chapters in the first half of the book focus on risks emanating from the family, and in the second half, on risks stemming from the wider community. The concluding chapter integrates the evidence presented to determine considerations for future research, and directions for interventions and social policies.
The aim of this study was to examine the impact of a maternal history of abuse on mother-infant interaction (emotional availability; EA) in infancy and early toddlerhood. Over an 18-month period, women giving birth to a child in the local obstetric units were screened using the Childhood Trauma Questionnaire. Women who reported moderate or severe sexual and/or physical abuse were included in the maltreatment group (n=58; MG) and compared with a non-maltreated comparison group (n=61; CG). EA was investigated under experimental conditions when the children were 5 and 12 months of age using the Emotional Availability Scales. While mother-child dyads in the MG showed only very discrete interactional alterations at an infant age of 5 months, their EA differed significantly from the CG at 12 months due to the lack of an increase in EA observed in the MG. Exploratory analyses showed an additional effect of emotional abuse on EA at 12 months. These data indicate that the period when child locomotion develops might represent a critical time window for mothers with a history of abuse. Our results constitute an advance in research on child abuse as they identify a possible time window of non-normative alteration in mother-child interaction. This period could be targeted by strategies to prevent intergenerational transmission of abusive experiences.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Childhood maltreatment is associated with increased risk of psychopathology, cognitive dysfunction, and impaired relationships, including parenting difficulties. In addition, according to recent studies, the consequences of childhood maltreatment may extend to the next generation. Difficulties with executive function have been linked to both child maltreatment and parenting, but rarely to both simultaneously. The purpose of this review is to propose a model examining executive function as a likely candidate for linking the distal factors of child maltreatment to parenting and subsequent child outcomes and to highlight relevant data for components of the model. This work may suggest new opportunities for targeting executive function as a viable target for interventions in the prevention of the transmission of risk.
Parental substance abuse is a serious problem affecting the well-being of children and families. The co-occurrence of parental substance abuse and problematic parenting is recognized as a major public health concern. This review focuses on 21 outcome studies that tested dual treatment of substance abuse and parenting. A summary of theoretical conceptualizations of the connections between substance abuse and parenting provides a backdrop for the review. Outcomes of the dual treatment studies were generally positive with respect to reduction of parental substance use and improvement of parenting. Research in this area varied in methodological rigor and needs to overcome challenges regarding design issues, sampling frame, and complexities inherent in such a high-risk population. This area of work can be strengthened by randomized controlled trials, use of mixed-methods outcome measures, consideration of parent involvement with child protective services, involvement of significant others in treatment, provision of concrete supports for treatment attendance and facilitative public policies.
Copyright © 2015 Elsevier Ltd. All rights reserved.
The current study sought to explicate the nature of the associations between mothers' childhood experiences of maltreatment, depressive symptoms, and children's mentalizing, with a particular interest in examining the effect mothers' histories of emotional maltreatment (EMT) may have on children's outcomes. Within this context, maternal EMT was examined as a moderator of the relationship between mothers' depressive symptoms and children's mentalizing. Further, the unique mediating role of maternal reflective functioning (RF), relative to women's more general mentalizing abilities, in explaining these processes was explored. Participants included 106 women with children 3-6 years of age. Questionnaires and interactive tasks were used to assess the variables under study. Findings revealed that maternal depressive symptoms and histories of physical, sexual, and emotional maltreatment were all associated with impaired mentalizing in offspring; however, after controlling for each form of abuse, EMT was the only maltreatment type that remained significantly associated with children's outcomes. EMT also emerged as a significant moderator of the relationship between maternal depressive symptoms and children's mentalizing, indicating that depressive symptoms only have detrimental effects on children's mentalizing when mothers' histories of EMT are high. These effects were transmitted via emotionally traumatized mothers' impairments in RF. Findings highlight the particularly pernicious effects of EMT for both survivors of abuse and their offspring and suggest that the cross-generational effects of maternal EMT are transmitted via mothers' impairments in RF. Implications for future research and parent-child interventions are discussed.
Co-morbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are common, difficult to treat, and associated with poor prognosis. This review aimed to determine the efficacy of individual and group psychological interventions aimed at treating comorbid PTSD and SUD, based on evidence from randomised controlled trials. Our pre-specified primary outcomes were PTSD severity, drug/alcohol use, and treatment completion. We undertook a comprehensive search strategy. Included studies were rated for methodological quality. Available evidence was judged through GRADE. Fourteen studies were included. We found that individual trauma-focused cognitive-behavioural intervention, delivered alongside SUD intervention, was more effective than treatment as usual (TAU)/minimal intervention for PTSD severity post-treatment, and at subsequent follow-up. There was no evidence of an effect for level of drug/alcohol use post-treatment but there was an effect at 5-7months. Fewer participants completed trauma-focused intervention than TAU. We found little evidence to support the use of individual or group-based non-trauma-focused interventions. All findings were judged as being of low/very low quality. We concluded that there is evidence that individual trauma-focused psychological intervention delivered alongside SUD intervention can reduce PTSD severity, and drug/alcohol use. There is very little evidence to support use of non-trauma-focused individual or group-based interventions.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Background and AimsTwin and family studies suggest that genetic influences are shared across substances of abuse. However, despite evidence of heritability, genome-wide association and candidate gene studies have indicated numerous markers of limited effects, suggesting that much of the heritability remains missing. We estimated (1) the aggregate effect of common single nucleotide polymorphisms (SNPs) on multiple indicators of comorbid drug problems that are typically employed across community and population-based samples, and (2) the genetic covariance across these measures.Participants2596 unrelated subjects from the “Study of Addiction: Genetics and Environment” provided information on alcohol, tobacco, cocaine, cannabis, and other illicit substance dependence. Phenotypic measures included: (1) a factor score based on DSM-IV drug dependence diagnoses (DD), (2) a factor score based on problem use (PU; i.e., 1+ DSM-IV symptoms), and (3) dependence vulnerability (DV; a ratio of DSM-IV symptoms to the number of substances used).FindingsUnivariate and bivariate Genome-wide complex trait analyses of this selected sample indicated that common SNPs explained 25-36% of the variance across measures, with DD and DV having the largest effects [h2SNP (CI) = 0.36 (0.11-0.62) and 0.33(0.07-0.58), respectively; PU =0.25 (-0.01-0.51)]. Genetic effects were shared across the three phenotypic measures of comorbid drug problems (rSNP; rDD-PU =0.92 (0.76-1.00), rDD-DV =0.97 (0.87-1.00), and rPU-DV =0.96 (0.82-1.00)).Conclusion
At least 20% of the variance in the generalized vulnerability to substance dependence is attributable to common single nucleotide polymorphisms. The additive effect of common single nucleotide polymorphisms is shared across important indicators of comorbid drug problems. This article is protected by copyright. All rights reserved.
Objective:
Disruptions in stress response system development have been posited as mechanisms linking child maltreatment (CM) to psychopathology. Existing theories predict elevated sympathetic nervous system reactivity after CM, but evidence for this is inconsistent. We present a novel framework for conceptualizing stress reactivity after CM that uses the biopsychosocial model of challenge and threat. We predicted that in the context of a social-evaluative stressor, maltreated adolescents would exhibit a threat pattern of reactivity, involving sympathetic nervous system activation paired with elevated vascular resistance and blunted cardiac output (CO) reactivity.
Methods:
A sample of 168 adolescents (mean age =14.9 years) participated. Recruitment targeted maltreated adolescents; 38.2% were maltreated. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during an evaluated social stressor (Trier Social Stress Test). Pre-ejection period (PEP), CO, and total peripheral resistance reactivity were computed during task preparation, speech delivery, and verbal mental arithmetic. Internalizing and externalizing symptoms were assessed.
Results:
Maltreatment was unrelated to PEP reactivity during preparation or speech, but maltreated adolescents had reduced PEP reactivity during math. Maltreatment exposure (F(1,145) = 3.8-9.4, p = .053-<.001) and severity (β = -0.10-0.12, p = .030-.007) were associated with significantly reduced CO reactivity during all components of the stress task and marginally associated with elevated total peripheral resistance reactivity (F(1,145) = 3.8-9.4; p = .053-<.001 [β = 0.07-0.11] and p = .11-.009, respectively). Threat reactivity was positively associated with externalizing symptoms.
Conclusions:
CM is associated with a dysregulated pattern of physiological reactivity consistent with theoretical conceptualizations of threat but not previously examined in relation to maltreatment, suggesting a more nuanced pattern of stress reactivity than predicted by current theoretical models.
The present study utilized longitudinal data from a community sample (n = 377; 166 trauma-exposed; 54% males; 73% non-Hispanic Caucasian; 22% Hispanic; 5% other ethnicity) to test whether pretrauma substance use problems increase risk for trauma exposure (high-risk hypothesis) or posttraumatic stress disorder (PTSD) symptoms (susceptibility hypothesis), whether PTSD symptoms increase risk for later alcohol/drug problems (self-medication hypothesis), and whether the association between PTSD symptoms and alcohol/drug problems is attributable to shared risk factors (shared vulnerability hypothesis). Logistic and negative binomial regressions were performed in a path analysis framework. Results provided the strongest support for the self-medication hypothesis, such that PTSD symptoms predicted higher levels of later alcohol and drug problems, over and above the influences of pretrauma family risk factors, pretrauma substance use problems, trauma exposure, and demographic variables. Results partially supported the high-risk hypothesis, such that adolescent substance use problems increased risk for assaultive violence exposure but did not influence overall risk for trauma exposure. There was no support for the susceptibility hypothesis. Finally, there was little support for the shared vulnerability hypothesis. Neither trauma exposure nor preexisting family adversity accounted for the link between PTSD symptoms and later substance use problems. Rather, PTSD symptoms mediated the effect of pretrauma family adversity on later alcohol and drug problems, thereby supporting the self-medication hypothesis. These findings make important contributions to better understanding the directions of influence among traumatic stress, PTSD symptoms, and substance use problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Clear evidence supports a genetic basis for substance use disorders (SUD). Yet, the search to identify individual gene contributions to SUD has been unsuccessful. Here, we argue for the study of endophenotypes within the frame of individual differences, and identify three high-order personality traits that are tied to specific brain systems and genes, and that offer a tractable approach to studying SUD. These personality traits, and the genes that moderate them, interact dynamically with the environment and with the drugs themselves to determine ultimately an individual's vulnerability or resilience to developing SUD.
Psychological maltreatment has been recognized as a major form of child abuse and neglect, standing alone in some cases and almost always embedded within or accompanying other forms of maltreatment. Expert opinion and research, particularly during the last 15 years, have provided sufficient clarification of theoretical orientations to and definitions of acts of psychological maltreatment to establish a common base from which researchers and practitioners can work toward greater understanding of this phenomena. Further progress requires increases in knowledge of the impact of psychological maltreatment on child victims. This article reviews research which has revealed possible and probable consequences of psychological maltreatment in its discrete forms and when associated with other types of child maltreatment. The broad range of findings is organized to clarify the types of impact found and special attention is given to their implications for the argument that psychological maltreatment is the core component of child abuse and neglect. Recommendations for further research are provided.