Parenting experiences and outcomes among former adolescent mothers: A mixed methods study.

The purpose of this explanatory sequential mixed methods study was to examine parenting outcomes and experiences over time among marginalized adolescent mothers enrolled in randomized clinical trials (RCT) between 2002 and 2016 testing Minding the Baby® (MTB), an early home visiting program. The quantitative phase examined associations between measures of maternal experiences and parenting outcomes from 71 participants 2-8 years since RCT completion. MTB mothers reported less hostile parenting and fewer child behavior problems. The sequential qualitative phase involved interviews with a subsample (n = 31) and revealed six themes about their personal and parenting maturation. Through integration of quantitative and qualitative data, we generated metainferences, revealing a nuanced understanding of participants' experiences. Integrated findings revealed the complex personal and parenting experiences among former adolescent mothers during their developmental phases of emerging and early adulthood. Findings inform clinical and research approaches to promote personal growth and positive parenting outcomes over time among women who began childbearing in adolescence.

Parental Reflective Functioning on the Parent Development Interview: A narrative review of measurement, association, and future directions.

A caregiver's capacity to mentalize is thought to be one of the most important features of secure parent-child relationships. Parental mentalizing can be measured using the Reflective Functioning (RF) coding system applied to the Parent Development Interview (PDI). In this narrative review, we summarize the research using this measure and synthesize what has been learnt about the predictors, correlates and sequelae of parental RF. Studies have consistently shown that PRF on the PDI is associated with both parent and child attachment and is an important factor in the intergenerational transmission of attachment. It is also related to the quality of parental representations, parent-child interactions, and child outcomes. While a number of social and clinical risk factors are associated with lower PRF, it is difficult to disentangle the unique contribution of each of these. We discuss these findings and present the direction of future work that is planned to expand and refine the PRF scale for the PDI.

Looking back to light the path forward: Ghosts in the Nursery revisited.

The infant health movement was launched nearly 50 years ago with the publication of the now classic paper, Ghosts in the Nursery: A psychoanalytic approach to the problems of impaired infant-mother relationships, written by Selma Fraiberg, Edna Adelson, and Vivian Shapiro (1975). This paper offers us lessons for infant mental health practice that have been proven true time and again over the last 50 years. These lessons both underscore the factors essential to clinical progress across a range of interventions, and remind us of the significant challenges we face in these times of massive, global trauma and oppression, extreme economic hardship, and systemic racism. This commentary reviews the key lessons of Fraiberg and her colleagues' classic paper, addresses some of the challenges inherent in retaining the breadth and substance of Fraiberg's model in contemporary practice, and proposes a model for conceptualizing infant and early childhood mental health practice that is geared toward building the relational foundations of reflection (Slade, 2023).

Hace casi cincuenta años que el movimiento de salud infantil se inició con la publicación del ahora clásico ensayo Fantasmas en la guardería: Un acercamiento sicoanalítico a los problemas de relaciones infante-madre deterioradas, escrito por Selma Fraiberg, Edna Adelson y Vivian Shapiro (1975). Fantasmas en la guardería nos ofrece lecciones para la práctica de la salud mental infantil cuya validez ha sido demostrada una y otra vez a lo largo de los últimos 50 años. Estas lecciones enfatizan los factores que son esenciales para el progreso clínico a lo largo de una gama de intervenciones. Ellos también nos recuerdan los retos significativos que enfrentamos en estos tiempos de trauma y opresión global masivas, adversidades económicas extremas y racismo sistémico. Este comentario revisa las lecciones claves del clásico ensayo de Freiberg y sus colegas, se ocupa de algunos de los desafíos inherentes para mantener la amplitud y sustancia del modelo de Freiberg en la práctica contemporánea y propone un modelo para la conceptualización de la práctica de salud mental infantil y la temprana niñez, el cual está dirigido a establecer los cimientos de la reflexión con base en la relación (Slade, 2023) en la práctica clínica.

Le mouvement de la santé du nourrisson a été lancé il y a cinquante ans avec la publication d'un article désormais classique intitulé Fantômes dans la chambre d'enfants: Une approche psychanalytique des problèmes des relations enfants-mères déficientes, écrit par Selma Fraibert, Edna Adelson et Vivian Shapiro (1975). Fantômes dans la chambre d'enfants nous offre des leçons pour la pratique de santé mentale du nourrisson qui se sont avérées vraies au fil des 50 dernières années. Ces leçons soulignent les facteurs essentiels au progrès clinique au travers d'une gamme d'interventions. Elles nous rappellent également les défis importants auxquels nous faisons face à cette époque de trauma et d'oppression massive globale, de difficultés économiques extrêmes et de racisme systémique. Ce commentaire passe en revue les leçons clés de l'article classique de Fraibert et ses collègues, en adressant certains des défis inhérents à la nécessité de retenir l'ampleur et la substance du modèle de Fraiberg dans la pratique contemporaine et en proposant un modèle pour la conceptualisation de la pratique de santé mentale du nourrisson et de la petite enfance qui soit axé sur la construction de fondations relationnelles sur la réflexion (Slade 2023) dans la pratique Clinique.

Participation in an Attachment-Based Home Visiting Program Is Associated with Lower Child Salivary C-Reactive Protein Levels at Follow-Up.

OBJECTIVE: Exposure to early childhood adversity is associated with an increased risk for physiological disruption, including increased inflammation. Early interventions that support the mother-child relationship have been shown to potentially buffer negative psychosocial outcomes related to early adversity, but it is unclear whether these interventions have long-term biological effects. We evaluated whether prior participation in Minding the Baby® (MTB), an attachment-based home visiting intervention for young mother-infant dyads living in underserved communities, is associated with lower child salivary inflammatory biomarkers compared with controls at follow-up. METHODS: Ninety-seven maternal-child dyads (n = 43 intervention and n = 54 controls) enrolled in a follow-up study of the MTB randomized controlled trial, an average of 4.6 years after RCT completion. Children provided salivary specimens. We used adjusted linear regression to examine the relationship between MTB participation and child salivary inflammatory biomarkers (C-reactive protein [CRP], interleukin [IL]-1ß, IL-6, IL-8, and TNF-α). RESULTS: Children were on average 6.6 years old, 48% female, and identified as non-Hispanic/Latino Black/African American (34%) and Hispanic/Latino (63%). Participation in MTB was associated with lower salivary CRP levels (ß = -0.31, SE = 0.28, p = 0.003) compared with controls. Participation in MTB was not associated with salivary cytokine levels. DISCUSSION: Participation in an intensive two-generation home visiting intervention such as MTB may reduce salivary inflammatory biomarkers associated with early childhood adversity. Replication and further research are needed to improve the understanding of the potential for early childhood interventions to buffer the biological embedding of early adversity.

Bringing a mentalizing framework to understanding mothers with addiction: The groundbreaking work of Nancy E. Suchman.

Nancy Suchman is remembered as a pioneer whose mentalization-based intervention-Mothering from the Inside Out (MIO)-transformed the treatment of parents struggling with substance use disorders. Specifically, Suchman's work highlighted the neural mechanisms underlying substance use disorders and identified the promotion of parental mentalizing as a key therapeutic focus in enhancing early parent-child relationships. Her work transformed parenting support models for this population of parents. Several randomized controlled trials (RCT) show the effectiveness of MIO in promoting parental reflective functioning (PRF) and positive relational outcomes in parents with substance use disorders and their children. Suchman's MIO model has since been extended to parenting in many contexts. She is also remembered as a generous colleague, a gifted researcher and clinician, and an inspiration to generations of researchers and practitioners working with parents who aspire to raise healthy, secure children despite multiple challenges and adversities. This special issue compiles the work of researchers inspired by Suchman as they carry on her legacy in examining aspects of parental mentalization. Collectively, the research presented yields confirmation of MIO core assumptions, offers new insights into roles of positive sentiment and savoring in mentalization processes, and presents evaluations of MIO in multiple contexts and with new adaptations.

A Nancy Suchman se le recuerda como una pionera cuya intervención basada en la mentalización-Cuidados Maternales de Dentro hacia Afuera (MIO)- transformó el tratamiento de progenitores luchando con trastornos de uso de sustancias. Específicamente, el trabajo de Suchman enfatizó los mecanismos neurales subyacentes en los trastornos de uso de sustancias e identificó el promover la mentalización del progenitor como un enfoque terapéutico clave para mejorar las tempranas relaciones progenitor-niño. Su trabajo transformó los modelos de apoyo a la crianza para este grupo de progenitores. Varios ensayos controlados al azar muestran la eficacia del MIO en cuanto a promover el funcionamiento con reflexión del progenitor y los resultados de una positiva relación en progenitores con trastornos de uso de sustancias y sus niños. El modelo MIO de Suchman desde su creación ha sido expandido a la crianza en muchos contextos. A ella también se le recuerda como una colega generosa, una investigadora y profesional clínica talentosa y como una inspiración para generaciones de investigadores y practicantes profesionales que trabajan con progenitores que aspiran a criar niños saludables y seguros, a pesar de múltiples retos y circunstancias adversas. Este número especial recopila el trabajo de investigadores inspirados por Suchman a medida que ellos continúan el legado en cuanto a examinar aspectos de la mentalización del progenitor. Colectivamente, la investigación presentada aporta la confirmación de las suposiciones centrales del MIO, ofrece nuevas ideas acerca del papel del sentimiento positivo y el aprecio detenido en los procesos de mentalización, y presenta evaluaciones del MIO en contextos múltiples y con nuevas adaptaciones.

Nous honorons et nous souvenons de Nancy Suchman en tant que pionnière dont l'intervention basée sur la mentalisation - le Maternage de l'Intérieur, en anglais Mothering from the Inside Out (MIO) - a transformé le traitement de parents aux prises avec la toxicomanie. Plus particulièrement le travail de Suchman a mis en lumière les mécanismes neuronaux sous-jacents aux troubles lié à l'usage d'une substance et il a aussi identifié la promotion de la mentalisation parentale comme une cible thérapeutique clé pour l'amélioration des relations précoces parent-enfant. Son travail a transformé les modèles de soutien parental pour cette population de parents. Plusieurs essais contrôlés randomisés montrent l'efficacité du MOI pour la promotion du fonctionnement de réflexion parental et des résultats relationnels positifs pour des parents ayant un trouble lié à l'usage d'une substance et leurs enfants. Le modèle MOI de Suchman a depuis été étendu au parentage dans de nombreux contextes. Nous nous souvenons aussi de Nancy Suchman comme étant une collègue généreuse, une chercheuse et une clinicienne talentueuse et une inspiration pour des générations de chercheurs et professionnels travaillant avec des parents qui aspirent à élever des enfants sécures, en bonne santé, malgré de grands défis et l'adversité à laquelle ils peuvent faire face. Ce numéro spécial compile le travail de chercheurs du monde entier, inspiré par Suchman, alors qu'ils perpétuent son héritage en examinant des aspects de la mentalisation parentale. Collectivement ces recherches compilées ici proposent la confirmation des hypothèses principales du MOI, offrent de nouvelles perspectives quant aux rôles du sentiment positif et du fait de savourer dans les processus de mentalisation et présentent des évaluations du MOI dans des contextes multiples et avec de nouvelles adaptations.

Minding the Baby versus usual care: study protocol for a quasi-cluster-randomized controlled study in Denmark of an early interdisciplinary home-visiting intervention for families at increased risk for adversity.

BACKGROUND: Inequality in health can have profound effects on a child's opportunities later in life. To prevent these downstream effects in families at increased risk of adversity, programs are needed to provide support and improve well-being across several domains. The present trial is aimed at assessing the effectiveness of the Minding the Baby® (MTB) home visiting intervention in improving the mother-child relationship, parental reflective functioning, well-being, and mental health, as well as child development and well-being in families at known risk of adverse health, relational, and developmental outcomes. METHODS: The study is a pragmatic, prospective, quasi-cluster-randomized controlled trial in which seven Danish municipalities were randomized to MTB training in either 2018 or 2019. A total of 250 pregnant women at increased risk of adversity will be recruited (75 care as usual families and 175 intervention families). Care as usual families will be recruited before and after the MTB training. The MTB intervention is an attachment-based, interdisciplinary home visiting intervention offered from the third trimester of pregnancy until the child is 2 years old. The participants are assessed at baseline, and when the infant is 3, 12, and 24 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior scale applied to video recordings of mother-infant interactions. Secondary outcomes include parent-child interaction, parental reflective functioning, parental mental health, maternal satisfaction, parental stress, and child development and well-being. The treatment effect is estimated as a fixed effect using a binary indicator of MTB treatment, and cluster-robust standard errors based on wild bootstrap are used for inference. DISCUSSION: This is the first trial of MTB in a Scandinavian context and will include the largest sample yet in a trial of MTB. The trial is expected to contribute to knowledge about the effect of early support for pregnant women, their infants, and their families at increased risk of adversity. TRIAL REGISTRATION: ClinicalTrials.gov NCT03495895 . The study was registered on April 12, 2018.

Examining Mothers' Childhood Maltreatment History, Parental Reflective Functioning, and the Long-Term Effects of the Minding the Baby® Home Visiting Intervention.

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.

School age effects of Minding the Baby-An attachment-based home-visiting intervention-On parenting and child behaviors.

Multiple interventions have been developed to improve the caregiver-child relationship as a buffer to the effects of early life adversity and toxic stress. However, relatively few studies have evaluated the long-term effects of these early childhood interventions, particularly on parenting and childhood behaviors. Here we describe the early school-age follow-up results of a randomized controlled trial of Minding the Baby ® (MTB), a reflective, attachment-based, trauma-informed, preventive home-visiting intervention for first-time mothers and their infants. Results indicate that mothers who participated in MTB are less likely to show impaired mentalizing compared to control mothers two to eight years after the intervention ended. Additionally, MTB mothers have lower levels of hostile and coercive parenting, and their children have lower total and externalizing problem behavior scores when compared to controls at follow-up. We discuss our findings in terms of their contribution to understanding the long-term parenting and childhood socio-emotional developmental effects of early preventive interventions for stressed populations.

Maternal Experiences of Racial Discrimination, Child Indicators of Toxic Stress, and the Minding the Baby Early Home Visiting Intervention.

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.

Assessing reflective functioning in prospective adoptive parents.

The capacity for reflective functioning (RF) or mentalizing of adoptive parents is hypothesized to play an important role in fostering socio-emotional development in adopted children. This paper reports on the development and preliminary validation of the Adoption Expectations Interview (AEI), a semi-structured interview to assess RF in prospective adoptive parents. The AEI was developed based on the Pregnancy Interview, Parent Development Interview, and Working Model of the Child Interview, three interviews that have been used to assess RF in biological parents, to capture RF before child arrival in prospective adoptive parents. In a sample of 96 prospective adoptive parents, the Reflective Functioning Scale, as applied to the AEI (AEI-RFS) showed good reliability, with strong correlations between the different demand items, high internal consistency, and good to excellent inter-rater reliability. A principal component analysis yielded one component, suggesting that the items measured a unidimensional factor. Preliminary evidence for the construct validity of the AEI-RFS was demonstrated by significant associations between the AEI-RFS and well-validated measures of mentalizing, attachment dimensions, and interpersonal functioning.

Hostile/Helpless maternal representations in pregnancy and later child removal: A pilot study.

This article presents the results of a small pilot study examining links between Hostile/Helpless (HH) representations of caregiving in pregnancy and later child removal by child protective services. The sample was drawn from a replication study of the Minding the Baby® attachment-based home-visiting intervention conducted in the United Kingdom, serving young first-time mothers in under resourced communities. The HH classification system (Lyons-Ruth et al.) was adapted for use with the Pregnancy Interview (PI) (Slade); 26 PIs were assessed (coders blinded) in a sample that included 13 mothers whose infants were removed from custody due to anticipated or documented maltreatment within 2 years of childbirth, and 13 mothers who did not have their infants removed. Mothers whose infants were removed from their custody had significantly higher HH scores than mothers of infants who were not removed from their care (F(1, 24) = 14.500, p < .001), and the relation between overall HH classification and infant removal status was also significant (χ2 (1, N = 26) = 12.462, p < .001). Results suggest that prenatal maternal caregiving representations may predict postnatal relationship disruptions, and indicate the need for larger studies further testing this prenatal approach to maltreatment risk assessment in at-risk populations.

Este artículo presenta los resultados de un pequeño estudio piloto que examina las conexiones entre las representaciones Hostiles/Indefensas de la prestación de cuidado durante el embarazo y más tarde cuando los servicios de protección a la niñez han separado al niño. El grupo muestra fue seleccionado de un estudio de replicación de la intervención Cuidando al Bebé (Minding the Baby® -MTB) de visita a casa con base en la afectividad, llevada a cabo en el Reino Unido para servirles a madres jóvenes en comunidades de pocos recursos. El sistema de clasificación Hostil/Indefensa (HH) (Lyons-Ruth et al., 1995-2005) se adaptó para el uso con la Entrevista del Embarazo (PI) (Slade, 2011); se evaluaron 26 entrevistas PI (los codificadores lo hicieron de manera ciega), de un grupo muestra que incluía 13 madres cuyos infantes fueron separados de su custodia debido al anticipado o documentado maltrato dentro de los 2 años anteriores al parto, y 13 madre cuyos infantes no habían sido separados. Las madres cuyos infantes habían sido separado de su custodia presentaron significativamente más altos puntajes HH que las madres de infantes no separados del cuidado materno (F(1, 24) = 14.500, p < .001), y la relación entre la clasificación general HH y la condición de separación del infante fue también significativa (c2(1, N = 26) = 12.462, p < .001). Los resultados sugieren que las representaciones prenatales del cuidado materno pudieran predecir las interrupciones de la relación postnatal, y apuntan a la necesidad de estudios más comprensivos que continúen examinando este acercamiento prenatal a la evaluación del riesgo de maltrato en grupos bajo riesgo.

Cet article présente les résultats d'une petite étude pilote examinant les liens entre les représentations Hostile/Impuissant du mode de soin durant la grossesse et plus tard durant le retrait de l'enfant par les services de protection de l'enfance. Cet échantillon a été retiré d'une étude de réplication de l'intervention sur l'attachement et faite à domicile Minding the Baby (MTB), faite au Royaume Unis, servant de jeunes mères n'ayant pas eu d'enfant auparavant dans des communautés n'ayant pas beaucoup de ressources. Le système de classification HI suivant les initiales en français Hostile/Impuissant (Lyons-Ruth et al., 1995-2005) a été adapté pour une utilisation durant l'Entretien de Grossesse (abrégé selon le français EG ici, Slade, 2011). 26 EG ont été évalués (codage à l'aveugle) dans un échantillon qui a inclus 13 mères dont les bébés avaient été retirés de leur garde pour maltraitance documentée ou anticipée dans les deux ans après la naissance, et 13 mères dont les bébés n'avaient pas été retirés. Les mères dont les bébés avaient été retirés de leur garde avaient des scores HI bien plus élevés que les mères de bébés n'avaient pas été retirés de leur garde (F(1, 24) = 14,500, p <,001), et la relation entre la classification générale HI et le statut de retrait du bébé était aussi importante (c2(1, N = 26) = 12,462, p <,001). Les résultats suggèrent que les représentations de mode de soin maternel prénatal peuvent prédire des perturbations de la relation postnatale, et indiquent le besoin d'études plus grandes testant plus profondément cette approche prétanale de l'évaluation de risque de maltraitance chez des populations à risque.

Minding the Baby®: Enhancing parental reflective functioning and infant attachment in an attachment-based, interdisciplinary home visiting program.

In this article, we describe the results of the second phase of a randomized controlled trial of Minding the Baby (MTB), an interdisciplinary reflective parenting intervention for infants and their families. Young first-time mothers living in underserved, poor, urban communities received intensive home visiting services from a nurse and social worker team for 27 months, from pregnancy to the child's second birthday. Results indicate that MTB mothers' levels of reflective functioning was more likely to increase over the course of the intervention than were those of control group mothers. Likewise, infants in the MTB group were significantly more likely to be securely attached, and significantly less likely to be disorganized, than infants in the control group. We discuss our findings in terms of their contribution to understanding the impacts and import of intensive intervention with vulnerable families during the earliest stages of parenthood in preventing the intergenerational transmission of disrupted relationships and insecure attachment.

Reflective Functioning on the Parent Development Interview: validity and reliability in relation to socio-demographic factors.

The Reflective Functioning coding of the Parent Development Interview (PDI-RF) is a widely used method for assessing a caregivers' capacity for mentalization. However, little is known about its psychometric properties.The aim of this study was to examine the distributions and discriminant and criterion validity of the PDI-RF scale in relation to a number of demographic and socioeconomic factors.Mothers of infants and toddlers (N = 323) from low, medium, and high-risk samples were interviewed with the PDI and transcripts were coded for RF. Demographic and socio-economic data were recorded.The PDI-RF scale showed high inter-rater reliability, internal consistency, and criterion validity. Modest associations with some sociodemographic variables and PDI-RF were found, but together these only accounted for a small amount of variance in the measure, suggesting adequate discriminant validity. Overall, the scale had good psychometric properties, although some caveats for its use were identified.

Associations Between Maternal Experiences of Discrimination and Biomarkers of Toxic Stress in School-Aged Children.

OBJECTIVE: To examine associations between maternal experiences of discrimination and child biomarkers of toxic stress in a multiethnic, urban sample of mothers and children (4-9 years). METHODS: Data were drawn from a cross-sectional study of maternal-child dyads (N = 54) living in low-income neighborhoods in New Haven, Connecticut, USA. Mothers reported experiences of discrimination. Noninvasive biomarkers of toxic stress were collected to assess neuroendocrine (hair cortisol), immune (salivary cytokines, c-reactive protein), and cardiovascular (blood pressure) functioning in children. RESULTS: Maternal experiences of discrimination were associated with increased log-transformed salivary interleukin-6 (IL-6) levels in children (ß = 0.15, p = 0.02). CONCLUSIONS: Vicarious racism, or indirect exposure to discrimination experienced by caregivers, is associated with poor health outcomes for children. Immune pathways may be a biological mechanism through which racial discrimination "gets under the skin," but additional research is needed to fully understand these relationships. Uncovering the physiological mechanisms linking vicarious racism with child health is an important step towards understanding possible early roots of racial and ethnic health inequities.

The neuroscience of attachment: implications for psychological therapies.

Recent advances in attachment-informed relational neuroscience point to possible mechanisms of action of psychological therapies, with implications for effective practice.Declaration of interestNone.

Maternal Adverse Childhood Experiences, Family Strengths, and Chronic Stress in Children.

BACKGROUND: Researchers have demonstrated that maternal adverse childhood experiences (ACEs), such as abuse and neglect, are associated with prenatal risk factors and poor infant development. However, associations with child physiologic and health outcomes, including biomarkers of chronic or "toxic" stress, have not yet been explored. OBJECTIVES: The purpose of this study was to examine the associations among past maternal experiences, current maternal posttraumatic stress disorder (PTSD) symptoms, and children's indicators of exposure to chronic stress in a multiethnic sample of mothers and children at early school age (4 to 9 years). METHODS: This cross-sectional study included maternal-child dyads (N = 54) recruited from urban community health centers in New Haven, Connecticut. Mothers reported history of ACEs, family strengths, and current PTSD symptoms. Child measures included biomarkers and health and developmental outcomes associated with chronic stress. Correlational and regression analyses were conducted. RESULTS: Childhood trauma in mothers was associated with higher systolic blood pressure percentile (ρ = .29, p = .03) and behavioral problems (ρ = .47, p = .001) in children, while maternal history of family strengths was associated with lower salivary interleukin (IL)-1ß (ρ = -.27, p = .055), salivary IL-6 (ρ = -.27, p = .054), and body mass index z-scores (ρ = -.29, p = .03) in children. Maternal PTSD symptoms were associated with more child behavioral problems (ρ = .57, p < .001) and higher odds of asthma history (ρ = .30, p = .03). DISCUSSION: Results indicate that past maternal experiences may have important influences on a child's health and affect his or her risk for experiencing toxic stress.

Associations Between Maternal Caregiving and Child Indicators of Toxic Stress Among Multiethnic, Urban Families.

INTRODUCTION: Our purpose was to examine associations between maternal caregiving and child indicators of toxic stress among multiethnic, urban families with children of early school age. METHOD: We conducted an exploratory cross-sectional analysis of 54 maternal-child dyads. Mothers reported on parenting behaviors and parental reflective functioning (PRF). Child indicators of toxic stress included hair/salivary biomarkers, anthropometric characteristics, and maternally reported health and behavior. RESULTS: Hostile/coercive parenting behaviors were associated with child externalizing behavioral problems (r = 0.43, p = .001, but lower interleukin (IL) 6 levels (r = 0.31, p = .03). High PRF was associated with fewer child emergency department visits (ρ = -0.43, p = .009), whereas impaired PRF was associated with more behavioral problems (ρ = 0.52, p < .0001). DISCUSSION: PRF and supportive parenting behaviors may protect against toxic stress among vulnerable families, but additional research is needed to better understand these relationships. Resources are available to help clinicians screen for family risk factors and model responsive caregiving in pediatric settings.

Costs of Not Getting to Know You: Lower Levels of Parental Reflective Functioning Confer Risk for Maternal Insensitivity and Insecure Infant Attachment.

Parental reflective functioning (PRF) is a robust predictor of parenting sensitivity and secure infant attachment, but its assessment requires extensive resources, limiting its integration into research and clinical practice. The Mini-Parent Reflective Functioning Interview (Mini-PRFI) assesses the parent's capacity to mentalize for his/her 6-month-old infant (rated using the PRF coding system; Slade et al., 2004, PRF coding system and Slade REF, Unpublished protocol, New York, NY: The City University of New York). In the current study, we examined whether Mini-PRFI scores were associated with theoretically related constructs; to establish a point of comparison, we evaluated links between Mini-PRFI scores alongside RF assessed from the Adult Attachment Interview (AAI). Mother-infant dyads (N = 88) completed the AAI before the birth of the infant, the Mini-PRFI and an interaction task (rated for insensitive parental behavior) when infants were 6 months old, as well as the Strange Situation Procedure when infants were 16 months old. Mini-PRFI scores were strongly positively associated with AAI RF and negatively associated with maternal insensitivity. Mini-PRFI scores predicted infant attachment organization (secure/insecure, organized/disorganized) at 16 months, and this effect was mediated by parenting insensitivity. These findings suggest that the Mini-PRFI predicts theoretically related attachment constructs, demonstrating the promise of the Mini-PRFI to increase the accessibility of interview-based PRF measurements to clinicians and researchers.

Attachment and psychotherapy.

Attachment theory provides a model for understanding (1) development within the context of the child's primary, and formative relationships, and (2) an adult's orientation toward lifelong intimate connections, social relationships, and autonomous exploration. Psychotherapy researchers have linked measures of patient attachment with therapeutic alliance, process, and outcomes. Studies of ruptures and discourse analysis distinguish in-session behaviors associated with different patterns of insecure attachments, and identify distinct ways of working with them. The therapist's own attachment organization and mentalizing capacity also play a significant role in therapeutic success. The key tenets of attachment-informed psychotherapy are: (1) the therapist-patient attachment relationship is central to promoting change, (2) the in vivo recognition of attachment dynamics during therapy guides formulation and intervention, and (3) therapy can reshape attachment dynamics.