Maternal and paternal insightfulness and reaction to the diagnosis in families of preschoolers with Autism spectrum disorder: associations with observed parental sensitivity and inter-parent interaction.

Sensitivity among parents of children with Autism Spectrum Disorder (ASD) is based on parental insightfulness and on resolution regarding the child's diagnosis. This has been supported in studies of mothers, and we examined whether the same is true regarding fathers. Also, we asked whether parents' Insightfulness and Resolution tap general mentalization and therefore also be expressed in parent-parent interactions. Eighty preschooler boys with ASD and both of their parents participated. As expected, fathers who were more insightful and mothers who were more resolved were more sensitive. Contrary to expectations, no associations were found between fathers' resolution and mothers' insightfulness and their sensitivity. Associations were found between parental insightfulness and resolution and positive parent-parent interaction. The findings are the first to demonstrate the insightfulness-sensitivity link among fathers of children with ASD. Also, they suggest that both insightfulness and resolution involve general mentalization that is evident both in parent-child and parent-parent interactions.

Parental insightfulness is associated with mother-father-child interactions among families of preschoolers with an Autism Spectrum Disorder diagnosis.

BACKGROUND: Parental insightfulness underlies parental sensitive behavior and is associated with secure attachment among Typically Developing (TD) children and also among children with Autism Spectrum Disorder (ASD). Moving beyond the parent-child dyad, a study of TD children and their parents linked mothers' and fathers' combined insightfulness to triadic interactions. The goal of the current study was to examine this association in families with children with ASD. The hypothesis was that the interactions in families in which both parents are insightful will be more cooperative than in families in which only one or neither parent was insightful. METHODS: Eighty preschooler boys with ASD and both of their parents participated in the study. Parental insightfulness was assessed employing the Insightfulness Assessment (IA) and mother-father-child interactions were observed and coded employing the Lausanne Triadic Play (LTP) procedure. RESULTS: As expected, families in which both parents were insightful displayed higher parental coordinated support in the LTP than families in which one or neither parent was insightful, controlling for children's IQ and severity of symptoms. Children's engagement with their parents was associated with their IQ and severity of symptoms but not with parental insightfulness. CONCLUSIONS: The importance of considering paternal, in addition to maternal insightfulness as a foundation for parental coordinated support in family interactions, is discussed, as well as the contribution of the LTP in assessing family interactions with children diagnosed with ASD.

The Protective Effects of Parent-Child Emotion Dialogues for Preschoolers Exposed to Intimate Partner Violence.

Exposure to intimate partner violence (IPV) during early childhood is associated with self-regulation difficulties. Caregivers can facilitate children's self-regulation through emotion-focused conversations about past experiences, buffering downstream effects. However, caregivers experiencing violence may avoid distressing emotions activated by such conversations. This paper explores two different models of relational stress responses, one involving indirect effects (i.e. spillover effects) and the other moderation (i.e. buffering effects). Mothers (n = 117), oversampled for violence exposure, self-reported on IPV and participated in an emotional reminiscing task with children (aged 3-5 years); narratives were coded for maternal sensitive guidance. Maternal sensitive guidance was related to children's self-regulation. Sensitive guidance did not have indirect effects in the association between IPV exposure and children's self-regulation, but did buffer the association between physical IPV and self-regulation; this pattern did not hold for psychological IPV. Results suggest sensitive guidance during reminiscing may promote self-regulation in contexts of high IPV.

Attachment to fathers and mothers in preschoolers with an Autism Spectrum Disorder diagnosis.

We examined whether the Strange Situation Procedure (SSP) is applicable not only for assessing children with Autism Spectrum Disorder (ASD) and their mothers but also with their fathers. Forty preschoolers with ASD were observed in the SSP with their mothers and 39 with their fathers. Unexpectedly, the SSP was found to be not applicable (NA) to 25% of the SSPs with fathers because levels of attachment behavior were minimal, but all SSPs with mothers were codable. NA children had lower cognitive functioning and more severe symptoms than those not so coded. Insecure children with their fathers had more severe symptoms than secure children, but were not different in their cognitive functioning. No associations between attachment with mother and severity of symptoms/cognitive functioning were found. Attachment was unrelated to parents' distress or Broad Autism Phenotype. The study raises questions regarding the applicability of the SSP with fathers of children with ASD.

Disrupted maternal communication and attachment disorganization in children with autism spectrum disorder.

We examined whether disrupted maternal communication, which is associated with disorganized attachment in typically developing children, is also associated with disorganized attachment in children with ASD. The attachments of 45 boys with ASD and maternal disruption were assessed in the Strange Situation Procedure. Analyses revealed a link between low cognitive functioning and resistant/ambivalent and disorganized attachment, and children's functioning was therefore controlled. Contrary to expectations, mothers of children with disorganized attachments did not show more disrupted communication than mothers of children with organized attachments. However, the 4-way attachment breakdown showed that the mothers of disorganized and ambivalent/resistant children had higher disruption scores than mothers of secure and avoidant children. The findings suggest that the expected associations between maternal disruption and attachment disorganization apply to children with ASD as well, but raise questions whether disrupted behavior is a unique antecedent of disorganized attachment or also of resistant/ambivalent attachment.

Mothers' insightfulness regarding their children's inner world: associations with mothers' history of sexual abuse and lack of resolution of the trauma.

The study examined the insightfulness of mothers who experienced Childhood Sexual Abuse (CSA). Based on attachment theory, we hypothesized that mothers who experienced CSA will be less insightful than those who did not experience CSA, and that state of mind with no marked signs of lack of resolution of the trauma can buffer against its negative effects. The insightfulness of 30 mothers who experienced CSA and 30 demographically matched mothers but with no CSA was assessed using the Insightfulness Assessment. Mothers' lack of resolution of the trauma was assessed using the Adult Attachment Interview. In addition, maternal psychopathology was assessed using the Brief Symptom Inventory. As hypothesized, mothers who experienced CSA were less insightful than mothers who did not experience CSA. In addition, mothers who experienced CSA but who were not unresolved were more insightful than those who were unresolved, and no different than mothers who did not experience CSA. These results expand our understanding regarding the risk embedded in parenting in light of unresolved traumatic past and the importance of resolution as a buffer.

Maternal mind-mindedness and its association with attachment: the case of Arab infants and mothers in Israel.

We examined the association between maternal Mind-Mindedness (MM) and secure attachment in an Arab sample in Israel. Seventy-six infant-mother dyads were observed during free play to assess maternal MM and in the Strange Situation Procedure to assess attachment. Mothers of secure infants were hypothesized to use more appropriate and fewer non-attuned mind-related comments than mothers of insecure infants. The results showed that mothers of secure infants used more appropriate mind-related comments than mothers of disorganized infants, with no significant differences compared to mothers of ambivalent infants. Also, mothers of secure infants used less non-attuned mind-related comments than both mothers of disorganized infants and mothers of ambivalent infants. In addition, the findings showed that: (1) mothers of secure infants were most likely to show the combination of high appropriate and low non-attuned mind-related comments; (2) mothers of disorganized infants were most likely to show the combination of high non-attuned and low appropriate mind-related comments; and (3) a nonsignificant trend indicated that mothers of ambivalent infants were most likely to show a combination of high appropriate and high non-attuned mind-related comments.The findings support the relevance of MM in an Arab sample.

Mother-Adolescent Dialogues and Adolescents' Behavior Problems in a Multicultural Sample: The Mediating Role of Representations.

This study examined whether the link between higher maternal sensitive guidance of emotional dialogues and fewer adolescent behavior problems is mediated by adolescents' more coherent representations of their mothers. The study also explored the consistency of this model across families from varied cultural backgrounds. Participants were 143 Jewish-Israeli mother-adolescent dyads from three cultural groups: immigrants from the Former Soviet Union, immigrants from Western countries, and native-born Israelis. Maternal sensitive guidance was observed during mother-adolescent dialogues about emotional experiences. Adolescents' representations were assessed via their narratives regarding their mother and their relationship. Examiners reported adolescents' behavior problems. Results indicated that across cultural groups adolescents' more coherent representations partially mediated the association between higher maternal sensitive guidance and fewer adolescent behavior problems.

Parental insightfulness: retrospect and prospect.

We open this introductory paper to the special issue with the theoretical and clinical roots of the insightfulness concept. Next, the Insightfulness Assessment (IA) is presented, followed by a review of key empirical findings supporting the IA. The central points in the papers in this special issue are reviewed next. These include the use of the IA with parents of children ranging in age from infancy to adolescence, its applicability outside the parent-child relationship (e.g. insightfulness toward a close friend), its use with high-risk mothers, and the usefulness of insightfulness both as a continuous and a categorical measure. The clinical applications of the IA are discussed, and we close with future directions for IA research.

Adolescent insightfulness toward a close friend: its roots in maternal insightfulness and child attachment in infancy.

Two antecedents of the insightfulness of adolescents into a close friend's experience were examined: The insightfulness of the mother and the attachment of the child, both measured when the adolescent was an infant. We hypothesized that both antecedents would be associated with adolescent insightfulness. Maternal insightfulness was assessed using the Insightfulness Assessment (IA) in which mothers are interviewed about their children's thoughts and feelings after viewing short video segments of their interactions with their children, and infant attachment was assessed using the Strange Situation Procedure. Adolescent insightfulness was assessed using an adaptation of the IA in which the adolescents were interviewed about their friend's thoughts and feelings after viewing short video segments of their interactions with them. As predicted, the results showed that adolescents were more likely to show insightfulness toward their friend when their mothers had been insightful toward them when they were infants and when they had secure attachment with their mothers. When both predictors were considered together, maternal insightfulness remained predictive of adolescent insightfulness but infant attachment was no longer significant.

Maternal insightfulness protects against the detrimental effects of postpartum stress on positive parenting among at-risk mother-infant dyads.

The current study evaluated whether maternal insightfulness can buffer the negative influence of postpartum stressful life events on maternal parenting behaviors. Participants were 125 mother-infant dyads (55% boys) who present a subsample of a larger longitudinal study on maternal maltreatment during childhood and its impact on peripartum maternal adjustment. Women were primarily white and middle class. At 4 months postpartum, mothers reported on the stressful life events experienced after the child's birth and current depressive symptoms. At 6 months postpartum, maternal parenting quality was assessed using videotaped mother-infant interactions and maternal insightfulness was evaluated using the Insightfulness Assessment. Insightfulness significantly moderated the effect of postpartum stressful events on maternal parenting behaviors. Mothers who were insightful displayed high levels of positive parenting during interactions with their infant regardless of the amount of stressful life events experienced. In contrast, mothers classified as non-insightful showed less positive parenting as they experienced more stressful life events. Findings highlight the protective role of maternal insightfulness in the face of postpartum stress, and suggest that efforts to enhance insightfulness during the early postpartum period may be particularly relevant for women in high-risk contexts.

Mother-child emotion dialogues: the disrupting effect of maternal history of communal sleeping.

The study examined associations between mothers' upbringing background (kibbutz vs. home) and maternal-sensitive guidance of emotional conversations with their preschool children; children's cooperation and exploration; and the coherence of their conversations. Using a quasi-experimental design, 112 children and their mothers (72 kibbutz raised, 40 home) completed the Autobiographical Emotional Event Dialogue. We hypothesized that maternal kibbutz upbringing would be associated to lower levels of mothers' sensitive guidance of the conversations, children's lower cooperation and exploration, and lower overall coherence. Results showed no upbringing-related differences for the mothers, but significant differences were found for the children, with children of kibbutz-raised mothers showing less cooperation and exploration, and lower levels of coherence for these dyads. The role of maternal background in shaping the interaction with their child is discussed.

Would you like to play together? Adults' attachment and the mirror game.

Why is it easy for some people to play together and difficult for others? In this interdisciplinary pilot study, we looked at dyadic interaction in motion as a paradigm to explore the expression of attachment in adulthood. We used a device that gives simple, quantitative and automated indicators for the quality of interaction while playing the mirror game. Forty-seven participants played the mirror game with the same gender-matched expert players. In addition, participants were interviewed on the Adult Attachment Interview to assess their quality of attachment. Using high resolution kinematic measures, we found that secure attachment was correlated with high complexity of the game and low synchrony compared to insecure attachment. The findings suggest that security of attachment is related to a more exploratory and less rigid game than insecure-dismissing attachment. These preliminary findings imply that high resolution analysis of simple movement interaction could carry information about attachment behavior.

Stability and change in resolution of diagnosis among parents of children with autism spectrum disorder: Child and parental contributions.

The contribution of change over time in parent and child characteristics to parents' resolution of child's diagnosis was examined among 78 mothers and fathers of children with autism spectrum disorder. Children's characteristics (e.g., mental age and severity of symptoms), parental characteristics (e.g., attachment-related anxiety and stress level), and parents' resolution of their child's diagnosis (resolved vs. unresolved) were examined at Time 1, and reassessed 3 years later at Time 2. Results indicated a deferential contribution of change in parent and child characteristics among mothers and fathers. An increase in child symptom severity and in maternal attachment-related anxiety, as well as longer durations of time since receiving the diagnosis, significantly predicted maternal resolved status at Time 2. Conversely, none of the changes in children's or paternal characteristics predicted paternal resolved status at Time 2. Results are discussed in relation to child and parental contributions to resolution, the differences in the adjustment and well-being of mothers and fathers of children with autism spectrum disorder, parental growth following receiving the diagnosis, and the need for intervention components specific to parental resolution and attachment-related anxiety.

It takes two to talk: longitudinal associations among infant-mother attachment, maternal attachment representations, and mother-child emotion dialogues.

Research on the attachment-dialogue link has largely focused on infant-mother attachment. This study investigated longitudinal associations between infant-mother attachment and maternal attachment representations and subsequent mother-child emotion dialogues (N = 50). Maternal attachment representations were assessed using the Adult Attachment Interview when children were 3 months, infant-mother attachment was assessed using the Strange Situation Procedure at 13 months, and mother-child emotion dialogues were assessed using the Autobiographical Emotional Events Dialogue at 3.5 years. Consistent with past research, the three organized categories of infant-mother attachment relationships were associated with later mother-child emotion dialogues. Disorganized attachment relationships were associated with a lack of consistent and coherent strategy during emotion dialogues. Autonomous mothers co-constructed coherent narratives with their children; Dismissing and Preoccupied mothers created stories that were less narratively organized. Although the Unresolved category was unrelated to classifications of types of mother-child discourse, mothers' quality of contribution to the dialogues was marginally lower compared to the quality of their children's contributions to the emotion discussion. Secure children showed highest levels of child cooperation and exploration. Autonomous mothers displayed highest levels of maternal sensitive guidance during emotion dialogues. We provide preliminary evidence for role reversal in dialogues between Preoccupied and Unresolved mothers and their children.

The insightfulness assessment: measuring the internal processes underlying maternal sensitivity.

In her description of sensitive mothers, Ainsworth described not only maternal behaviors but also the internal processes underlying such behavior, including the capacity to "see things from the child's point of view". Ainsworth assessed this capacity from her extensive observations of mothers interacting with their infants, from records of mothers' talk to the babies, and from brief interviews about their babies. Attachment researchers following Ainsworth focused primarily on observations of maternal sensitive behavior, however, and the processes underlying such behavior were mostly inferred from the mothers' behavior. The Insightfulness Assessment (IA), a video replay procedure in which mothers are interviewed regarding their children's thoughts and feelings after they watch brief video clips of their children, was developed to assess systematically and directly the mother's ability to take the child's perspective. This paper uses examples from the IA to show how it captures many of the internal processes underlying caregiving behavior which Ainsworth described. Data supporting the IA's validity is reviewed, which suggest that the IA can complement observations of mothers' caregiving behavior in order to obtain a more comprehensive assessment of maternal sensitivity.

Emotion dialogues of foster caregivers with their children: the role of the caregivers, above and beyond child characteristics, in shaping the interactions.

The study examined foster caregivers' sensitive guidance of conversations about emotional themes in a sample of foster caregivers living in Family Group Homes. Thirty caregivers were observed with two out of the several children under their care: one that was nominated by the Family Group Home's social worker as the most challenging child in the Family Group Home, and one that was nominated as the least challenging child. Based on attachment theory that argues that mothers possess a central role in shaping the interaction with the child by adapting their caregiving to the child's individual characteristics (Bowlby, 1982), we argued that caregivers' sensitivity will reflect the differences between the caregivers and not the differences between the children. We therefore hypothesized that the caregivers would show similar levels of sensitive guidance regarding their children, irrespective of the level of difficulty the children presented. The results supported our hypotheses by showing that caregivers' sensitive guidance of the conversations was similar across the most and least challenging children. The results highlight the importance of the caregiver in shaping the interactions with their children regardless of the degree to which the child is challenging.

Maternal sensitivity mediates the link between maternal insightfulness/resolution and child-mother attachment: the case of children with Autism Spectrum Disorder.

This study examined the hypothesis that maternal sensitivity mediates the association between maternal Insightfulness/Resolution and child attachment in a sample of preschool age boys with Autism Spectrum Disorders. This study used the Insightfulness Assessment to assess insightfulness and the Reaction to Diagnosis Interview to assess mothers' resolution. Maternal sensitivity was assessed from mother-child play observations, and the security of children's attachment was assessed using the Strange Situation Procedure. The results supported the mediation model, and their implications for attachment research, research on intervention in autism, and clinical work are discussed.

Quality of Mother-child Dialogue About Emotional Events, Coping and Posttraumatic Stress Symptoms Among Children Exposed to Interpersonal Trauma.

Children exposed to traumatic events are at increased risk for developing symptoms of a Post-Traumatic Stress Disorder. Children often discuss emotional, and therefore also traumatic, events in their lives with their parents, and the quality of these discussions can facilitate coping and further development. The study aim was 1) to explore whether the association between the quality of dialogue between mothers and children about emotional events and children's posttraumatic stress symptoms (PTSS) might be indirectly linked through children's adaptive coping skills, and 2) whether this association differed when discussing different negative emotions. 169 mother-child dyads with interpersonal trauma-exposure (86% domestic violence, 14% mother and/or child sexually abused) participated in the Autobiographical Emotional Events Dialogue (AEED). Quality of mother-child emotion dialogue, captured in maternal sensitive guidance and child cooperation, and approach-oriented coping were coded from transcripts. PTSS was measured with the Child Behavior Checklist. Lower quality of mother-child emotion dialogue was associated with less approach-oriented coping and more symptoms of posttraumatic stress. There was an indirect effect of approach-oriented coping with angry feelings linking quality of mother-child emotion dialogue and child PTSS. Children's symptoms of posttraumatic stress were reflected in the quality of mother-child dialogues about traumatic and other emotional events. Findings support that dialogues about emotional events may be a promising target for intervention with children exposed to trauma.

Parental Mentalizing during Middle Childhood: How Is the Adoption of a Reflective Stance Associated with Child's Psychological Outcomes?

This exploratory cross-sectional study attempts to understand the mechanisms underlying the role of parental mentalizing in a child's psychological functioning during middle childhood by using Parental Reflective Functioning (PRF) and Parental Insightfulness (PI) constructs. The main aims are to examine the role of PI and PRF as processes capable of influencing a child's psychological functioning in terms of emotional-behavioral difficulties and social-emotional competencies. Eighty-six community parents (48 mothers, 38 fathers) and their 50 children in middle childhood (Mage = 10.10, SD = 1.13) participated in this study, recruited through a non-probabilistic sampling. The following measures were used to assess the aims of this study: Insightfulness Assessment, Parental Reflective Functioning Questionnaire, Child Behavior Checklist (CBCL) and Devereux Student Strengths Assessment (DESSA) questionnaires. Results showed that parental mentalizing was found to be significantly associated with both child's internalizing and externalizing symptoms and social-emotional competencies as reported by parents through the CBCL and DESSA questionnaires. This study may offer a contribution to the study of parental mentalizing during middle childhood, supporting the hypothesis that both parents' ability to understand their child's mental states could affect the child's psychological functioning. Clinical and theoretical implications are geared toward a family-based view with a specific focus on the importance of fostering in both parents a positive attitude toward mentalizing processes.