Mediation-Moderation Links Between Mothers' ACEs, Mothers' and Children's Psychopathology Symptoms, and Maternal Mentalization During COVID-19.

Research has suggested adverse childhood experiences (ACEs) as a transdiagnostic risk factor for a variety of affective disorders. They are also linked with a parent's tendency toward affect dysregulation and hyperarousal, which may interfere with parenting and children's wellbeing. On the other hand, maternal mentalization can serve as a moderating factor that can help parents regulate their arousal, shielding children during adverse circumstances. We studied the mediated links between ACEs and mothers' and children's psychopathology symptoms during COVID-19 to determine whether maternal mentalization and the child's age moderate these links. Using results from 152 Israeli mothers of children aged 3-12 years recruited during the month-long lockdown in Israel, we documented that the mothers' ACEs were linked with increased risk of depressive and anxiety symptoms and with children's internalizing and externalizing behaviors. Moreover, as hypothesized, the mothers' symptoms of depression and anxiety mediated the links between their ACEs and their children's internalizing behaviors. In addition, the mothers' mentalization skills and, in the case of their depressive symptoms, their child's age, moderated these indirect links. For mothers of young children (3-6 years old) with higher mentalization levels, the link between the mothers' ACEs and the children's behavior problems was weaker compared to mothers with low mentalization levels. For mothers of older children (6-12 years old), and only in the case of maternal depressive symptoms, higher levels of maternal mentalization were linked with more internalizing behaviors. We discuss the potential clinical implications of the findings.

Parental Reflective Functioning as a Moderator of the Link Between Prematurity and Parental Stress.

We examined group differences between parents, both mothers and fathers, of premature and full-term infants to determine whether they differed in their reports of subjective parenting stress and in their level of parental reflective functioning (PRF). We also tested whether each parent's reflective functioning moderated the links between birth status (prematurity vs. full-term) and parenting stress. A sample of 73 cohabiting, heterosexual Israeli families with a premature (28-36th week gestational age, N = 34) or full-term infant (37th week and above gestational age, N = 39) participated, comprising the two parents' groups. Infants' age averaged 7.07 months (SD = 1.28). Each parent completed the Parent Stress Inventory (PSI) individually to determine his/her subjective personal and childrearing stress levels. The Parent Development Interview (PDI-R2-S) was used to obtain each parent's PRF (self and child/relation-focused) level. Findings showed that the premature and full-term parents did not differ in their PSI scores or PRF levels. However, mothers' self-focused PRF moderated the link between prematurity and personal parenting stress, whereas fathers' self-focused PRF moderated the link between prematurity and childrearing parenting stress. Furthermore, fathers' and mothers' PRF operated differently in the premature and full-term parents' groups. The findings highlight the importance of mothers' and fathers' PRF in predicting parents' subjective stress in general and particularly in the case of infant prematurity. We discuss these findings and their relevance for preventive and therapeutic perinatal interventions.

Links between mothers' ACEs, their psychopathology and parenting, and their children's behavior problems-A mediation model.

Introduction: Children of mothers with a history of adverse childhoods are at greater risk of behavior problems. However, the mechanisms through which a mother's early adverse experiences (ACEs) are transmitted to her children need further study. Our goal was to examine a conceptual mediational model linking mothers' ACEs, maternal psychopathology symptoms, and parenting behaviors with children's internalizing and externalizing behaviors sequentially. Methods: A sample of 153 Israeli mothers of children ages 3-12 (52% girls) participated in the study, and most of the mothers (94.7%) were cohabiting with a spouse. Mothers completed online questionnaires about their early adverse experiences, psychopathology symptoms, parenting behavior, and their children's internalizing and externalizing behavior. Results: Results showed that mothers with higher ACE scores reported more maternal psychopathology symptoms and more internalizing behavior in their children. The mother's psychopathology in and of itself mediated the link between her ACEs and her child's internalizing and externalizing behavior. Moreover, an indirect sequential path emerged linking ACEs with the mother's psychopathology symptoms, which, in return, were linked with hostile parenting. Hostile parenting, in turn, was linked with children's internalizing and externalizing behavior. Discussion: These findings highlight the complicated and intertwined ways in which adverse experiences early in the mother's life might put her child's wellbeing at risk. The findings suggest that ACEs are linked to maternal affect dysregulation, which interferes with parenting, increasing the risk of behavior problems in children. The findings underscore the need to assess mothers' adverse history, psychological distress, and parenting behavior, and provide treatments that can reduce the intergenerational transmission of early adverse experiences.

Mothers' parental mentalization, attachment dimensions and mother-infant relational patterns.

We examined the links between mothers' prenatal attachment dimensions, parental mentalization and mother-infant relational patterns. The sample consisted of 68 mother-infant dyads. During pregnancy, mothers reported on attachment-related anxiety and avoidance. When the infants were three months old, the mothers' parental reflective functioning (PRF) was assessed via the PDI-R2-S interview. Mothers-infant free play interactions were coded for maternal sensitivity and dyadic reciprocity and mothers' utterances were coded for appropriate and non-attuned mind-mindedness (MM). Prenatal attachment anxiety was associated with less appropriate MM. Appropriate MM was associated with maternal sensitivity and mother-infant dyadic reciprocity. The models predicting maternal sensitivity and dyadic reciprocity from dimensions of the mothers' prenatal anxiety/avoidance attachment, mediated by their PRF, appropriate and non-attuned MM, were significant. Univariate analyses revealed a significant direct link only between appropriate MM and mother-infant dyadic reciprocity. We discuss these results as well as the differences between the PRF and MM constructs.

COVID-19, child's behavior problems, and mother's anxiety and mentalization: A mediated moderation model.

We examined the direct and indirect links between COVID-19, maternal anxiety symptoms, and child behavior problems as well as the mediation-moderation links of mothers' anxiety symptoms and mentalization skills with the prediction of child behavior problems. A sample of 140 Israeli mothers with preschool children comprised the study's two groups: A COVID-19 group (n = 53), recruited shortly after the pandemic outbreak, and a pre-COVID-19 group (n = 87), recruited prior to the pandemic. Mothers completed online questionnaires regarding their own anxiety symptoms (BSI anxiety subscale) and their children's internalizing and externalizing behaviors (CBCL). Maternal mentalization was assessed via the mind-mindedness representational procedure. Findings showed that mothers in the COVID-19 group experienced more anxiety symptoms and perceived their children as having more externalizing and internalizing behaviors compared to mothers in the pre-COVID-19 group. Mothers' anxiety symptoms mediated the effect of the pandemic on children's behaviors so that the higher the mothers' anxiety, the more externalizing and internalizing behaviors among the children. Mothers' mentalization moderated the association between the pandemic and the children's externalizing behaviors. Specifically, when mothers showed higher mentalization skills (higher mind-mindedness), the indirect effect of anxiety on the link between COVID-19 and children's externalizing behaviors was weaker compared to when mothers showed lower mentalization skills (lower mind-mindedness). The implications of these findings for preventive and treatment interventions that aim to reduce maternal anxiety and enhance mentalization skills to prevent children's behavior problems in the context of COVID-19 are discussed.

Mediation of Mothers' Anxiety and Parenting in Children's Behavior Problems during COVID-19.

The outbreak of COVID-19 is affecting the lives of millions of families around the world. The current study was carried out in Israel, following the pandemic's initial outbreak and during the resulting enforced quarantine, confining parents and children to their homes. A sample of 141 Israeli mothers with at least one child between the ages of 3 and 12 (M = 6.92, SD = 2.55) participated as volunteers. About half the sample (50.7%) consisted of girls. Most mothers were cohabiting with a spouse (93%). Mothers completed online questionnaires about their perceptions about the health and economic threats of COVID-19, availability of social support, their anxiety symptoms, hostile/coercive and supportive/engaged parenting behavior, and their children's behavior problems. Results showed expected significant associations between the mothers' reports about having little social support, their anxiety symptoms, hostile/coercive and supportive/engaged parenting behavior, and children's externalizing problems. Likewise, expected significant associations were found between mothers' perceptions about the health and economic threats of COVID-19, their anxiety symptoms, hostile/coercive parenting behavior, and children's internalizing and externalizing problems. Importantly, maternal anxiety and hostile/coercive parenting behavior mediated the associations between lack of support, negative perceptions about the health and economic threats of COVID-19, and children's behavior problems. These findings stress the importance of mothers' mental health and parenting behaviors for children's socioemotional adaptation in the context of COVID-19. Implications of the findings for family interventions intended to help parents and children at this time are suggested.

Mediating and moderating links between coparenting, parental mentalization, parents' anxiety, and children's behavior problems.

The goal of this study is to integrate family systems theory, reflected in the construct of coparenting, with the attachment theory's concept of mentalization and how they are linked with children's behavior problems. We investigate the direct, indirect, and moderating links between mothers' and fathers' perceived coparenting, parental mentalization, and children's externalizing and internalizing behavior in the context of parents' general anxiety. Our sample consists of 78 cohabiting, heterosexual Israeli couples and their 3- to 5-year-old children. Both parents independently completed self-report questionnaires regarding their general anxiety, coparenting experiences and children's externalizing and internalizing behavior and were individually interviewed to assess their mind-mindedness. Actor-partner interdependent model extended for mediation analysis (APIMeM) revealed a direct actor and partner effect of parents' general anxiety on perceived coparenting and on the child's externalizing and internalizing behavior, and an indirect actor effect via coparenting, in the case of the child's externalizing behavior. In all models tested, the links were similar for mothers and fathers. Regression analysis with a PROCESS macro showed that maternal mind-mindedness, but not paternal mind-mindedness, moderated the direct link between parents' general anxiety and the child's externalizing behavior. Findings demonstrate the significant impact of fathers' and mothers' anxiety on the family system and on children in particular. We discuss the importance of coparenting as an executive subsystem in the family and of maternal mentalization as a buffer against the negative impact of parents' general anxiety on the child and suggest their potential contribution for prevention and treatment interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Factors contributing to continuity and discontinuity in child psychopathology from infancy to childhood: An explorative study.

This study examined the psychopathology and socioemotional functioning of school-aged children treated during infancy and a comparison group of children without symptoms or treatment history. Our goal was to identify the factors associated with the continuity of psychopathology from infancy to childhood. The sample comprised 54 Israeli children, 30 with treatment history as infants in an infant mental health clinic and 24 with no treatment history. A 2 × 2 study design, with treatment history (treated/non-treated) and current psychiatric diagnosis (diagnosed vs. non-diagnosed), was used and group differences in children's psychopathology (Development and Well-Being Assessment (DAWBA)), socioemotional functioning (Vineland Adaptive Behavior Scales-Second Edition (VABS-II)), maternal stress (Parenting Stress Index-Short Form (PSI/SF)) and psychopathology (Symptom Checklist-90-Revised (SCL-90-R)), family functioning (Family Assessment Device (FAD)), and mother-child relational patterns (Coding Interactive Behavior (CIB)) were assessed. We found no differences between the previously treated and non-treated groups in the rate of given Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnosis. However, there was an interactive effect of treatment history × current psychiatric diagnosis, with the highest level of maternal stress in mothers of children exhibiting both early and late emotional and/or behavioral symptoms. Implications of these findings for identifying children and families at risk for continued child psychopathology and the importance of early parent-child psychotherapy interventions are discussed.

Social anxiety and sensitivity to social-rank features in male faces.

BACKGROUND AND OBJECTIVES: Evolutionary theories propose that socially anxious individuals are especially sensitive to social-rank signals, presumably at the expense of the attunement to signals of affiliation. Despite this theoretical claim, few empirical attempts examined the association between social anxiety (SA) and sensitivity to specific features of social-rank and affiliation. This study aims to fill this gap. METHOD: Participants (N = 67) completed two tasks in which two emotionally neutral computer-generated male faces of the same character were presented side-by-side. In the Social-Rank-Sensitivity Task, the faces within each pair differed in their level of dominance and, in the Affiliation-Sensitivity Task, the faces differed in their level of trustworthiness. The participants' task was to decide which of the two faces looked more dominant or friendly. RESULTS: There were no differences in accuracy between high- and low-SA participants in the Affiliation-Sensitivity Task. In contrast, high-SA participants were more accurate than low-SA participants in the Social-Rank-Sensitivity Task. No group differences were found in decision latencies in either task. LIMITATIONS: Limitations of the study are that a non-clinical sample was used and that only computer-generated male faces were considered. CONCLUSIONS: Our findings suggest that SA is related to an enhanced ability to discriminate faces based on social-rank features. Examining sensitivity to facial cues signaling social-rank and affiliation may help to specify the nature of social threat sensitivity in SA.

The importance of parental verbal and embodied mentalizing in shaping parental experiences of stress and coparenting.

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.

Early Parental Adaptation, Prenatal Distress, and High-Risk Pregnancy.

OBJECTIVES: To examine the examined the effects of high risk pregnancy and prenatal distress on parental postnatal adaptation. METHODS: A sample of 111 expecting parents, consisting of 32 high risk pregnancy (HRP) mothers and 21 spouses and 36 matched low risk pregnancy (LRP) mothers and 22 spouses completed reports of depression symptoms (BDI) and pregnancy related concerns prenatally. At three months postpartum, parent-infant direct observations and reports of parenting alliance (PAI), stress (PSI-SF), satisfaction and efficacy (PSOC) were gathered. Data was analyzed with GLM multivariate analyses and the actor-partner interdependence model. RESULTS: Parents' prenatal BDI predicted postnatal parental stress. BDI and concerns predicted postnatal satisfaction, but only for mothers. Mother's concerns predicted low maternal and high paternal parenting alliance. Partner effect was found so that high concerns predicted high reports of parenting alliance by spouse. Mean-group differences were found between HRP and LRP during parent-infant observations, so that HRP parents displayed lower sensitivity and reciprocity. CONCLUSIONS: Prenatal distress, and to some degree high risk pregnancy, are risk factors that may interfere with the early formation of parent-infant relationship. Clinical implications of these findings are presented.

Cognitive and developmental outcome of conservatively treated children with congenital hyperinsulinism.

BACKGROUND: Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infants. Its management can be extremely complicated, and may involve medical therapy and surgery. The mainstay of the treatment is to maintain normoglycemia, since hypoglycemia during infancy can have severe neurological consequences. OBJECTIVE: To assess the cognitive and developmental levels and the adaptive skills achieved by children with CHI who were treated medically over the past decade. SUBJECTS AND METHODS: Fourteen children with CHI, under the age of 10 years, who received medical treatment only, underwent a physical and neurological examination and standardized assessments that included the Bayley Scale of Infant and Toddler Development, 3rd Edition, or Kaufman Assessment Battery for Children, the Vineland Adaptive Behavior Scales and the Achenbach Child Behavior Checklist (CBCL) parent questionnaire form. RESULTS: Twelve children (86%) achieved normal range scores in the cognitive and development assessments (Bayley Scale of Infant and Toddler Development or Kaufman Assessment Battery for Children). Only two showed cognitive achievements below the normal range. The Vineland questionnaire, which was based on parental report, showed below normal adaptive skills in eight patients (57%). CONCLUSIONS: In contrast to previous studies showing a high prevalence of neurodevelopmental difficulties in children with congenital hyperinsulinism, our study showed normal cognitive achievements in most children. This may be attributed to the earlier recognition and better management of the disease in the past decade.

The expression and regulation of anger in toddlers: relations to maternal behavior and mental representations.

Anger is an intense and adaptive approach emotion that undergoes significant development during the toddler years. We assessed the expression of anger and the strategies toddlers use to regulate it in relation to maternal behavior and mental representations. Seventy-four toddlers were observed in three anger-eliciting paradigms: toy removal (TR), still-face (SF), and delayed gratification (DG). Anger expression and three clusters of regulatory behaviors were micro-coded: putative regulatory behaviors, attention manipulation, and play behaviors. Maternal relational style was coded for sensitivity and intrusiveness, and mental representations of the mother-child relationship were assessed for joy and anger. Children expressed the most anger during the TR, less during the SF, and minimally during the DG. Use of putative regulatory behaviors was highest during the SF, whereas during the TR children employed newly acquired skills, such as focused attention and substitutive play, in the service of anger regulation. Anger expression and regulation were differentially related to the negative and positive components in the mother's behavior and representations, and maternal intrusiveness moderated the relations between angry representations and the degree of child anger during the SF. Results are consistent with dynamic models of emotions and accord with perspectives that emphasize the role of sensitive parenting in facilitating emotion regulation.

Family functioning and interactive patterns in the context of infant psychopathology.

Family functioning and mother-infant relational patterns were examined in 38 clinic-referred infants and 34 matched non-referred infants. Referred infants were diagnosed with the Diagnostic Classification for Zero to Three. On the family level, referred families showed significantly lower family functioning in all domains of emotional and instrumental communication, regardless of the specific infant's diagnoses. On the dyadic level, referred mothers were more intrusive and their infants were more withdrawn during dyadic interactions. Clinic-referred mothers reported higher levels of phobia and depression. Global family functioning was predicted by the infant's clinical status, maternal intrusiveness, and maternal psychopathology. Infant mental health clinicians need to address both family level and dyadic level of functioning, regardless of the reason for the infant's referral.

Maternal representations, infant psychiatric status, and mother-child relationship in clinic-referred and non-referred infants.

To examine the relations between maternal representations, infant socio-emotional difficulties, and mother-child relational behavior, 49 clinic-referred infants and their mothers were compared to 30 non-referred controls. Clinic-referred infants' psychiatric status was determined with the DC 0-3-R classification of Zeanah and Benoit (Child Adolesc Psychiatry Clin N Am 4:539-554, 1995) and controls were screened for socio-emotional difficulties. Mothers were interviewed with the parent development interview (Aber et al. in The parent development interview. Unpublished manuscript, 1985) and dyads were observed in free play and problem-solving interactions. Group differences emerged for maternal representations and relational behaviors. Representations of clinic-referred mothers were characterized by lower joy, coherence, and richness, and higher anger experienced in the mother-infant relationship compared to controls. During free play, clinic-referred mothers showed lower sensitivity and higher intrusiveness and provided less adequate instrumental and emotional assistance and support during problem solving. Referred children showed lower social engagement during free play. Associations were found among maternal representations, maternal interactive behavior, child social engagement, and the child's ability to self-regulate during a challenging task. These findings provide empirical support for theoretical and clinical perspectives suggesting a reciprocal link between maternal negative representations and mother and child's maladaptive behaviors in the context of early socio-emotional difficulties and mental health referrals.

Sustained withdrawal behavior in clinic-referred and nonreferred infants.

To examine the relations between infants' sustained withdrawal behavior and children's mental health status and maternal and child relational behavior, 36 clinic-referred and 43 control infants were evaluated. Families were visited at home, mother-child free play and feeding interactions were videotaped, and mothers completed self-report measures. Interactions were coded for sustained withdrawal using the Alarm Distress Baby Scale (ADBB; Guedeney and Fermanian, 2001) and for global relational patterns with the Coding of Interactive Behavior (CIB; Feldman, 1998). Higher ADBB scores were found for the referred group, with many infants (38.9% ) scoring above the clinical cutoff (vs. 11.6% in the control group). More negative relational patterns were found for the withdrawn group in terms of higher maternal intrusiveness, lower reciprocity, and lower child involvement. Associations were found between maternal and child behavior during play and feeding and child sustained withdrawal behavior at play. Sustained withdrawal also was associated with unpredictable child temperament and lower sense of parental self-efficacy. Maternal depressive symptoms were higher in the referred group and correlated with maternal and child relational patterns. The findings contribute to the construct and discriminant validity of the CIB and the ADBB coding systems, and suggest that sustained withdrawal may serve as a risk indicator for early socioemotional disorders.