Catherine McMahon’s research while affiliated with Macquarie University and other places

Background Parent–Child Interaction Therapy—Toddler (PCIT-T) is an attachment-informed intervention model designed to meet the specific developmental needs of toddlers aged 12–24 months presenting with challenging behaviors. Methods This study used a randomized controlled design to evaluate outcomes of PCIT-T for children aged 14–24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior were randomly allocated to PCIT-T (intervention), an active control condition (Circle of Security– Parenting™; COS-P), or a non-treatment control condition (wait-list; WL). Outcomes were assessed at baseline (Time 1), post treatment/post waitlist (Time 2) and 4-month follow-up (Time 3). Results At follow-up, the PCIT-T group displayed the highest levels of parenting sensitivity and positive parental verbalizations, and the lowest levels of negative child-directed verbalizations and non-attuned mind-minded statements. Of the three groups, the PCIT-T group showed the greatest degree of change on these variables, followed by the COS-P group and then the non-treated controls. The PCIT-T group were also the only group to show significant within-group improvements in sensitivity, self-reported parental reflectiveness, empathy and emotional understanding, parent-reported child social competence, child internalizing problems, and general behavior issues. Significant reductions in parental stress, child externalizing behaviors and parenting behaviors were seen for both the PCIT-T and COS-P groups. Conclusions Delivered in the early intervention period of toddlerhood, Parent–Child Interaction Therapy—Toddler has the potential to bring about significant changes for children presenting with early onset behavioral issues. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), 12,618,001,554,257. Registered 24 September 2018 – retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001554257.

Using a cross-sectional design, this study explored attachment insecurity and disorganization (assessed using the Strange Situation Procedure) in 90 toddlers (aged 14–24 months) with and without autism traits and assessed the associations between autism traits (severity and profiles) and both developmental level and attachment classification. Our findings showed no significant differences between the rates of attachment insecurity or attachment disorganisation among toddlers with, and toddlers without, autism traits. However, among the toddlers with autism traits, those with a disorganised attachment were more likely to have autism traits of greater severity. While greater autism trait severity was associated with attachment disorganisation, it remains unclear whether this association is the result of children with autism traits having higher rates of attachment disorganisation or whether autism traits are being misinterpreted as attachment disorganisation indices.

Language ability has been associated with emotion regulation (ER) ability. Children on the autism spectrum have greater rates of language delays and lower ER ability. Despite this, autism traits have not been considered or controlled for in past research. This study therefore examined the association between language ability and ER in young children with and without autism traits. An exploratory analysis was also conducted to examine the types of ER strategies used by young children with autism traits compared with young children without such traits. Ninety mother–toddler dyads participated in the study. Results showed greater receptive language ability was significantly associated with greater parent-reported ER ability both when children with, and children without, autism traits were included in the sample. Furthermore, greater expressive language ability was significantly associated with greater observed ER but only when children with autism traits were excluded from the analysis. These findings have clinical implications for early intervention development for both children with and without autism traits.

Recognition of the protective value of secure parent–child relationships has prompted a growing interest in parenting interventions informed by attachment theory. Circle of Security Parenting (COS-P) is one such program, specifically designed for scalability. Although widely disseminated internationally, evidence for the effectiveness of COS-P is very limited. This non-randomized controlled effectiveness study was designed to help address this gap. A sample of 256 parents of children aged 0–6 years was recruited from four community child and family health organizations. Assessments were undertaken pre- and post-intervention for the treatment group (n = 201) and at comparable times for the waitlist control group (n = 55). Analysis of data for mothers (89% of sample) revealed a significant Time x Group interaction for six of the seven outcomes examined. Compared to mothers in the control condition, treatment group mothers reported significantly: (a) improved parental mentalizing and self-efficacy regarding empathy and affection toward the child; (b) reduced caregiving helplessness and hostility toward the child; and (c) reduced depression symptoms, at the end of COS-P treatment. There was no difference between groups for change in perceived child difficultness. Within-treatment-group analyses indicated that mothers with older children reported greatest reductions in caregiving helplessness, and mothers with probable clinical depression pre-intervention reported greatest reductions in hostility and depression symptoms. Improvements in other study outcomes did not differ by depression severity or child age. Exploratory analyses indicated that treatment group fathers showed the same pattern of change as mothers. Clinical implications and directions for future research are discussed.

Circle of Security Parenting (COS-P) is an attachment-theory-informed program for parents of infants and young children. Designed for scalability, COS-P has been widely adopted internationally. Evidence for the program's effectiveness is limited, however, restricting capacity to make informed decisions about program allocation, and threatening ongoing program funding. To help address this evidence gap, this qualitative study explored the experiences and perceptions of 20 COS-P facilitators and 14 parent recipients in Australia, where COS-P uptake has been particularly widespread. Thematic analysis of combined interview and focus group data revealed a perception that COS-P primarily changes the lens through which parents view (a) their child, (b) themselves in the parenting role, and (c) the parent-child relationship, and that this was a pathway to increased empathy, compassion, and parenting confidence. Participants identified four components that underpinned program impact: key content, skills practice, group processes, and facilitator support. Although COS-P was considered suitable for broad application, limitations were noted. Findings can guide clinical application of COS-P and inform empirical research.

Guild and colleagues (this issue) report results of a long-term follow up after a randomized trial of the effectiveness of an attachment-theory-informed psychotherapeutic intervention for mothers with depression and their toddlers. Their paper shows the intervention can increase the likelihood of secure attachment in children of depressed mothers and that secure attachment explains more optimal social-emotional functioning in middle childhood in the treated group. This commentary discusses the contribution of the paper by Guild and colleagues and their broader body of work to our evolving understanding of developmental processes underpinning social-emotional competence in children of depressed parents, and to several ongoing controversies in the field: 1) the relevance of attachment-theory-informed interventions in the context of maternal depression; 2) the evidence gap regarding the efficacy and effectiveness of attachment-theory-informed interventions, particularly with respect to sustained benefits; 3) cost-benefits of early interventions; and 4) the need for theory driven research that explains how and under what circumstances attachment is related to later child outcomes.

Background: Parenting interventions informed by attachment theory are an increasingly popular choice for clinical services that work with parents of babies and young children. Circle of Security Parenting (COS-P) is one such intervention, which has had extraordinary uptake internationally. Evidence for COS-P is very limited, however; there are few published studies, most with very small samples, and findings are mixed. This paper describes a multi-site evaluation of COS-P, designed to help address this evidence gap. Methods/Design: This is a non-randomized controlled effectiveness study of COS-P in four community child and family health settings. Participants are caregivers of children aged 6 years and under, who present to study sites with parenting challenges in the early parenting period. Participants are recruited through these sites, and allocated to either treatment or waitlist control condition based on their capacity to attend the next available COS-P group. Outcomes (changes in caregiving attitudes and capacities linked to child social and emotional development, and caregiver depression symptoms) are assessed at baseline and post-treatment/waitlist using self-report questionnaires (all participants), and a narrative interview and 5-min parent-child interaction (a sub-sample of participants). Additionally, potential moderators of the intervention (demographic, symptom severity) will be tested. Discussion: This is one of the first controlled evaluations of COS-P, and the first in Australia where COS-P dissemination has been particularly widespread. Results from this study will provide valuable information about the effectiveness of COS-P for caregivers with early parenting challenges, and will increase understanding of what works for whom.

Background While there is growing evidence demonstrating benefits of parent mentalization for child social and emotional development, few studies have examined parent mentalizing in clinical populations. This paper examines mind-mindedness (a parent’s tendency to represent their child in terms of mental states) in a sample of parents with a child with Autism Spectrum Disorder (ASD). We compared parent mind-mindedness about their child with ASD and a sibling in a similar age-range. We expected parents to use fewer and more negative mind-related descriptors of their child with ASD compared with the sibling. Method Fifty-four parents of children (aged 5–12 years) with ASD completed a survey asking them to “Describe your child” for the child with ASD and a sibling without ASD, with order of presentation randomized. Severity of ASD diagnosis was assessed using DSM-V criteria. Descriptions were coded for reference to child mental states and proportional scores calculated to control for verbosity. Results Parents used significantly fewer mind-related descriptors for their child with ASD compared with the sibling. Differences were moderated by ASD severity, with the largest differences apparent for parents whose child had severe ASD symptoms. Expected differences in negative descriptors were not found, but parents used significantly fewer positive and more neutral (often symptom-related) mind-related descriptors for their child with ASD. Conclusions These findings suggest that parent mentalization may be challenged in relation to children with ASD. Directions for future research and clinical implications are discussed.

Evidence suggests that parental mind-mindedness is important for children’s social-emotional development; however, almost all research exploring mind-mindedness has been conducted with families from Western backgrounds. The current study explored cross-cultural differences in mind-mindedness based on observed real-time interactions between urban Australian ( N = 50, M age = 30.34 years, SD = 3.14) and urban mainland Chinese ( N = 50, M age = 29.18 years, SD = 4.14) mothers and their toddlers (Australian: M age = 18.98 months, SD = 0.87; Chinese: M age = 18.50 months, SD = 2.25). Controlling for education, the Australian mothers used a higher proportion of appropriate mind-related comments and were less likely to use non-attuned mind-related comments than their Chinese counterparts, adjusting for total number of comments. Transcript analysis showed that the Australian mothers used more mental state terms referring to desires and preferences than Chinese mothers. Findings are discussed in relation to cultural influences in child-rearing goals, beliefs, and values and the need for cross-cultural validation of the mind-mindedness construct.