The Relationship Between Parental Reflective Function, Attachment and Development of Child Psychopathology

This article presents a theoretical overview of the relationship between parental reflective function, attachment style and the development of child psychopathology. The concept of parental reflective function was developed by Peter Fonaghi and his colleagues. Reflexive functioning is defined as the ability to imagine our mental states, emotions and desires, as well as those of others. The ability to interpret and integrate past relational experience is seen as a high capacity for parental reflection. Central constructs in the theory of attachment are: the sensitive response of the mother, the internal working models and representations, the quality of attachment and the sense of security. In the process of developing attachment, the child builds Internal working models, which are formed on the basis of real relationships and participate in building representations of relationships. Arieta Slade and her colleagues believe that higher levels of reflective functioning are associated with secure attachment in children and conversely lower levels of reflective functioning are associated with insecure attachment in children, such as mothers of children who resist and are disorganized, they have the lowest levels of reflective functioning. Low levels of reflective functioning allow the baby's adaptive mechanisms to be distorted and to develop the pathological ways of interaction with the parent.

Convergent Validity of Three Measures of Reflective Function: Parent Development Interview, Parental Reflective Function Questionnaire, and Reflective Function Questionnaire

Reflective function (RF) is defined as an individual’s ability to understand human behavior in terms of underlying mental states including thoughts, feelings, desires, beliefs, and intentions. More specifically, the capacity of parents to keep their child’s mental states in mind is referred to as parental RF. RF has been linked to adult mental health and parental RF to children’s mental health and development. The gold standard measure of RF is the interview-based Reflective Functioning Scale (RFS) applied to the Parent Development Interview (PDI) or Adult Attachment Interview (AAI), which while well validated, is time-and labor-intensive to administer. Given the increasing need for reliable, valid, and rapid RF assessment in wide-ranging settings, two alternative measures were considered including the Reflective Function Questionnaire (RFQ) and Parental Reflective Function Questionnaire (PRFQ). We determined the convergent validity of these measures in comparison with the PDI-rated RFS. A sample of mothers and fathers (n = 150) was drawn from a sub-study of the ongoing Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort when their children were 42–60 months of age. Pearson correlations and multiple linear regression was conducted, followed by splitting the sample to compute Cohen’s kappas measures of agreement. Two subscales of the PRFQ correlated significantly (p < 0.05) with the gold standard PDI-rated RFS, providing evidence for convergent validity. As a brief multidimensional measure of parental RF, the PRFQ offers an alternative for measurement of RF in large-scale studies of parental development and child health.

Peri-partum psychosis: How does parental reflective function affect the quality of mother-infant interaction?

Introduction: The purpose of this exploratory study was to examine the impact of peri-partum psychosis on parental reflective function and quality of mother-infant interaction in a South African sample at high risk of developing attachment difficulties. Besides the effects of physical separation, attachment difficulties may arise from other maternal factors, such as a lack of reflective capacity or negative symptoms affecting the warmth with which a mother interacts with her child. This study examined the quality of mother-infant interaction to determine how the presence of psychotic symptoms during pregnancy or shortly after delivery affects aspects like maternal sensitivity, child social involvement and dyadic engagement. Ultimately, the study aimed to investigate the association between psychosis, parental reflective functioning and quality of parent-infant interaction.Methods: The study followed a descriptive, observational design. Mothers were recruited if they experienced psychotic symptoms during pregnancy or within the first 6 months postpartum. Demographic information and psychiatric history were collected. Parental reflective function was assessed by the Parent Development Interview (PDI), and the quality of mother-infant interaction in an unstructured play interaction was coded using the Coding Interactive Behaviour (CIB).Results: Eight participants aged between 22 and 44 years, with diagnoses of bipolar disorder, schizophrenia and MDD with psychosis, were recruited. Parental reflective functioning showed significant variation with scores approaching and exceeding ordinary reflective functioning, typically found in non-clinical populations. At the time of the play interaction, infants were aged between 6 and 10 months. Play interactions were mostly parent-led, with some surprising findings, such as a lower than anticipated frequency of parental negative affect, moderate maternal sensitivity and wide variation in scores for infant withdrawal.Conclusion: The results found in this small sample of mothers with peri-partum psychosis have presented unexpected results, both in terms of higher than anticipated capacity for parental reflective functioning and aspects of the quality of interaction with their infants. Possible implications for future interventions will be discussed.