1
Parental Mind-Mindedness in Adoptive Families: Transactional Mechanisms and Treatment Implications
M. A. J. Zeegers, Msc Supervision: dr C. Colonnesi
University of Amsterdam
Graduate School of Child Development and Education June, 2015
2 Dankwoord
Het huidige onderzoek is het laatste project dat ik afrond in het kader van de research master Child Developement and Education. Ik begon de research master vanuit de interesse om te onderzoeken (en ontdekken) welke ouderlijke eigenschappen voedingsbodem zijn voor een gezonde kindontwikkeling. Na twee scripties over mind-mindeness weet ik dat dit nog steeds mijn absolute drijfveer is voor de sociale wetenschap.
Cristina, onzettend bedankt voor alle begeleiding de afgelopen twee (en een halve) jaren. Je bent een betrokken docent geweest en ik kon met jouw inhoudelijke feedback altijd goed uit de voeten. Het is een cliché om te zeggen dat ik veel van jou wetenschappelijke kwaliteiten en kennis heb geleerd, maar het is wel voor de volle honderd procent waar. Je hebt me wegwijs gemaakt in de wereld van de sociale wetenschap; tips en adviezen als het gaat om mijn schrijfstijl, congressen, publicaties, ‘concurrerende’ onderzoeksgroepen. Erg waardevol. Ik kijk uit naar onze samenwerking tijdens mijn geheel aan mind-mindedness gewijde project!
3 Abstract
Internationally adopted children more often experience attachment insecurity within the relationship with a caregiver. As a result, adoptive parents report more child behavioral problems compared to biological parents, and adoptees are referred to mental health services more frequently than their non-adopted counterparts. Basic Trust (BT) is an attachment oriented intervention, aimed to enhance an important facilitator of attachment security, namely parental mind-mindedness (MM), which was measured during a short ‘describe-your-child’ interview. Mind-minded parents tend to treat their child as an individual agent with autonomous internal states. The current study 1) examined relations between paternal and maternal MM and parenting stress, child behavioral problems and adoption-related factors, such as the age during placement and time spent within the adoptive home, and 2) evaluated whether the BT treatment reduced child behavioral problems and parenting stress and improved parental MM. Results indicated that parental MM was determined to a greater extent by the length of time adoptees and their adoptive parents spent together than the age of the child, highlighting a transactional framework of parental MM in adoptive families. Also, child internalizing and externalizing problems decreased after the treatment. The dynamic background of parental MM as well as implications for the role of mothers and fathers in attachment interventions are discussed.
4
Parental Mind-Mindedness in Adoptive Families: Transactional Mechanisms and Treatment Implications
Adopted Children at Risk
Internationally adopted children have to master an extra set of developmental tasks concerning their social-emotional development compared to their biological counterparts (Havermans, Verheule, & Prinsen, 2012). Prior to their adoption, they have often received less sensitivity and responsiveness to their basic physical and emotional needs due to for instance institutionalization (Pace & Zavattini, 2011). Also, adopted children have to process adverse experiences or traumas from their early childhood, cope with the loss of their birth family and culture, handle the change of caregiving environment and get attached to new parents and siblings (Havermans et al., 2012). As a consequence, adopted children, more often than biological children, are referred to mental health services because of attachment problems (van den Dries, Juffer, Van IJzendoorn, & Bakermans-Kranenburg, 2009). Especially late-placed adoptees (adopted after 12 months of age) are at risk for insecure attachment (van den Dries et al., 2009).
Attachment refers to the emotional bond of the child towards its caregiver, which is based on the child’s need for security and protection by a caregiving figure (Bowlby, 1969). From the work of Ainsworth, Blehar,Waters, and Wall (1978) we have learned that children differ in the degree to which they feel secure within the relationship with their caregivers. Securely attached children trust that their emotional and physical needs are seen, understood and responded to by a caregiving figure in an appropriate way. They have internalized the caregiver as a secure base from which they feel free to explore the environment and a safe haven to return to when comfort is needed (Ainsworth & Bell, 1970; Bowlby, 1969; Malekpour, 2007). Positive effects of secure attachments may in particular be observed in
5
harmonious parent-child relationships, effective emotion regulation abilities, positive identity formation and more satisfying close friendships (Cassidy, 1994; Fonagy, Gergely, Jurist, & Target, 2004; Sroufe, Egeland, Carlson, & Collins, 2005). On the contrary, insecurely
attached children have internalized the caregiver as unattainable or unpredictable, resulting in ambivalent, avoidant or disorganized personal interchanges in the relationship with the caregiver (Ainsworth et al., 1978; van IJzendoorn, Schuengel, & Bakermans-Kranenburg, 1999). Among others, increased levels of externalizing behavioral and emotional problems are known adverse effects of insecure attachments in children (Colonnesi et al., 2011; Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Hoeve, Stams, van der Put, van der Laan, & Gerris, 2012). As the basic trust in caregiving figures is hampered by experiences, such as neglect, abuse and institutionalization prior to adoption, a significant part of internationally adopted children face the challenge of constructing a sense of trust in their social environment.
Facilitators of Child Attachment Security
Because of the high frequency of attachment problems within the population of
adopted children, post-adoption care and treatments are generally aimed at establishing secure attachment relationships between the child and the adoptive parent(s)
(Bakermans-Kranenburg, Van IJzendoorn, & Juffer, 2003, 2005). The first known facilitator of attachment security is sensitive parenting (Ainsworth et al., 1978; Atkinson et al., 2000; van IJzendoorn & de Wolff, 1997; de Wolff & van IJzendoorn, 1997). Parental sensitivity entails parents’ capacity to perceive and infer the meaning behind the child’s signals, which is translated into appropriate responding to these signals, such as picking up an infant when crying (Ainsworth, Bell, & Stayton, 1974). When children experience that their social initiatives successfully create a reciprocal interchange with their parent, they will develop a basic trust in themselves
6
(i.e., in their capacity to influence themselves and their environment) and in others (i.e., that the other person has notion of their individual needs (Lieberman, Silverman & Pawl, 2000; McDonough, 2000). This, in turn, provides the basis of children’s secure attachment bond. The meta-analyses of Bakermans et al. (2003, 2005) showed that interventions aimed at improving parental sensitivity were effective in enhancing children’s secure attachment relationships with parents. However, the effect sizes were found to be small. This corresponds to the meta-analytic study of de Wolf and van IJzendoorn (1997), in which small overall effects of parental sensitive behavior on child attachment were reported. These latter findings left researchers to elaborate on the refinement of the construct in order to understand what parent-child mechanisms facilitate children’s attachment security (Fonagy, Steele, Steele, Moran, & Higgitt, 1991; Meins, Fernyhough, Russell & Clark-Carter, 1998; Meins, 1999). One of such refinements is parental mind-mindedness (MM). This concept refers to parents’ proclivity to treat their child as an individual with autonomous feelings, thoughts, intentions and desires (i.e., a mental agent; Meins et al., 1998). During infancy and
toddlerhood parental MM is operationalized by the amount of appropriate mental state references parents make during free-play interactions with their child (Meins Fernyhough, Fradley & Tuckey, 2001). In older children, MM is assessed by evaluating the extent to which parents focus on internal states (e.g., emotions, cognition, desires) when describing their child (Meins et al., 1998). MM closely relates to the concept of ‘mentalization’ which refers to one’s general ability to understand that mental states underlie behaviors of oneself and others (Allen & Fonagy, 2006; Sharp & Fonagy, 2008). However, MM concerns specifically
parents’ general tendency to make an educated correct (appropriate) guess on the internal states underlying their child’s behaviors. Hence, MM entails the mentalizing capacity of the parent regarding the child.
7
MM differentiates from parental sensitivity in the representational aspect. While the latter may be viewed as parents’ responsiveness towards the child’s behavioral signals and cues, whereas MM refers to the awareness and reflectiveness of the child’s mind-states (Meins et al., 2002). Howe (2006) highlights that this reflection of the mind supports “that children get in touch with their feelings, recognize them, consider their impact on self and others, and begin to process them in a more reflective, conscious, regulated way”. Hence, MM enables the formation of an autonomous identity and adequate affect regulation, which is often lacking in children with attachment-related behavioral problems (Calkins & Hill, 2007). Although MM and sensitivity are discriminate, the two constructs relate to each other. That is, parents with a mind-minded stance are likely to also display sensitive parenting behaviors (Meins et al., 2001; 2002). The constructs, however, have shown separate effects on child attachment. Mind-minded parenting predicted a secure parent-child attachment over and above sensitive parenting in the study of Meins et al. (2001), indicating that MM uniquely contributes to a healthy child-caregiver relationship. Further studies have confirmed that age appropriate mental representations of the child support attachment security (Arnott & Meins 2007; Demers, Bernier, Tarabulsy, & Provost, 2010; Laranjo, Bernier, & Meins, 2008; Lundy 2003; Meins et al., 2012). Furthermore, Bernier and Dozier (2003) found evidence that MM partly explains the intergenerational transmission of attachment in a group of foster parents and their children. These findings yield implications for the integration of MM in attachment-based interventions (Howe, 2006).
Next to attachment security, MM has been examined in relation to several other aspects of child development and parenting, such as children’s theory of mind, child behavioral problems and parenting stress (e.g., Colonnesi et al., 2015; McMahon & Meins, 2012; Meins et al., 2003; Meins, Centifanti, Fernyhough, & Fishburn, 2013; Walker et al., 2011). In two studies it was reported that higher levels of MM related to lower parenting
8
stress in a clinical and non-clinical sample of biological families (McMahon & Meins, 2012; Walker et al., 2011). Moreover, mind-minded parents have shown to report less behavioral problems in non-clinical samples (Meins et al., 2013; Walker et al., 2011). The importance of MM in relation to child psychopathology has been scarcely considered in parenting research. Furthermore, to our concern there is only one study considering MM within foster families (Bernier & Dozier, 2003).
MM Research Within Adoptive Samples
MM should be investigated within adoptive families for at least two reasons. Firstly, mind-minded parenting may be more difficult for adoptive parents compared to biological parents (Kelly & Salmon, 2014). Although disclosure on the child’s medical history is often provided by adoption agencies, adoptive parents often have fewer information on what their child experienced in caregiving relationships prior to adoption (“Obtaining background”, 2012). Detailed information on how the social environment responded to the child’s primary states like hunger, discomfort and fear is unavailable to the new parents. This suggests that adoptive parents have a rather difficult task of understanding behaviors that are fed by internal states related to past caregiving experiences (e.g., controlling behavior because of fear of losing the availability of the caregiver). Schofield and Beek (2005) reported in a qualitative study that adoptive parents who formed theories about the child’s pre-adoption past in order to explain present behaviors were more reflective and supported the child’s behavior
management after adoptive placement. This study underlines the notion that emphatic skills are important for adoptive parents. Bernier and Dozier (2003) conducted a study on MM in relation to attachment security including 64 fostered children and their mothers. They found that during the MM interview the amount of mind-related comments made by foster mothers was 23 percent. This is similar to proportions of MM within clinical samples of biological
9
families (Walker, Wheatcroft, & Camic, 2011). This underlines that MM may be a caregiving characteristic which is substantial but at the same time extra challenging for non-biological parents.
A second interest of research on MM within adoptive families is that this population provides an opportunity to investigate the transactional framework of mind-minded parenting. Although MM is thought to be a rather stable characteristic, the interplay with child factors has been less examined (Colonnesi et al., 2015). Adoption is a form of natural
quasi-experiment (Van IJzendoorn, Juffer, & Klein Poelhuis, 2005), which enables the possibility to examine if parents’ mentalizing abilities in adoptive parents are affected by child factors, such as the age of placement and the length of time that the caregiver and child build their
relationship. Insights in these mechanisms may help to understand more about the dynamics of parental mind-mindedness, which in turn may be helpful for mental health workers in adoption care.
MM and Treatment: Basic Trust
The promoting function of MM on attachment security may yield important
implications for clinical treatment. Basic Trust (BT) is a Dutch attachment oriented treatment developed by Polderman (1998) aimed at reducing children’s emotional and behavioral problems by enhancing specific parenting skills necessary to provide children with a secure base. Basic Trust is the first treatment, to our knowledge, which is focused specifically on parents’ mind-mindedness with the support of video feed back methods (VFB; Havermans et al., 2012). The BT intervention consists of five to eight treatment sessions and entails a
stepwise method in which parents learn a specific way of interacting with their child, enabling a secure setting in which the child feels seen and understood (Polderman, 1998).
10
children’s sense of basic trust by seeking proximity to their child, observing and non-verbal mirroring behaviors and interpreting behaviors in a meaningful way. Hence, the treatment aims to improve parents’ more general sensitivity skills, which involve reciprocity,
synchronicity, stimulation, emotional support and a positive stance (Meins et al., 2001). The second step includes parents’ verbalization of the child’s behaviors or an appropriate
interpretation of the child’s inner states (i.e., MM). With the support of the video-taped interaction, parents are stimulated to make an informed guess on underlying states and explicate this to the child. Also, parents practice with being mind-minded in a neutral way (without the presence of an emotionally charged tone). This helps the child to become conscious and accepting of inner experiences without internalizing negative connotations, ultimately enabling effective self-regulation skills (Scher, 2001; Schore & Schore, 2008). During the third step, after naming the child’s inner states, parents give their own perception of the situation (e.g., “you want to show me the puzzle you finished, I am very curious”). This is assumed to provide children with frequent self-other representations, which is helpful for children’s social and emotion understanding (Carpendale & Lewis, 2004; Colonnesi, Zeegers, Hondius, & Bögels, 2015).
Havermans et al. (2012) explain that the use of VFB during treatment for adoptive families is helpful in guiding secure parent-child interactions. Parents can verify if their thoughts on their child’s behaviors correspond with what is seen during the analysis of interactional patterns on a micro-level. Also, possible contrasts are brought to light between parents’ notions of their responding to the child’s behaviors as opposed to what they see on video. The use of VFB within parenting treatments shows divergent effects on child
development and parenting behaviors (Juffer, Bakermans-Kranenburg, & van Ijzendoorn, 2008). Bakermans-Kranenburg et al. (2003) performed a meta-analysis in which they reported that VFB methods were favorable in enhancing parental sensitivity, but not the intended child
11
attachment security. Fukkink (2008), however, did found a dual-level effect of VFB as he reported that after VFB training parents were more skilled to guide adequate interactions with their child and children showed less behavior problems. This meta-analysis indicates that VFB can enhance parenting skills, which in turn enables healthy child development.
In the study of Colonnesi et al. (2012), the approach of BT was evaluated in a sample of 20 adopted children with behavioral problems. They found positive medium-to-large changes between pretest and posttest in children’s insecure attachments to their mothers and disorganized attachments to both their parents. Furthermore, mothers and fathers reported that their child’s conduct problems decreased after the program. However, Colonnesi et al. (2012) did not find alterations in parents’ sensitivity. The authors discussed that possibly parental MM was altered by the treatment, but this facilitator of attachment insecurity was not taken into account in their study. Hence, the presumed working mechanism of the BT treatment might still be considered in research.
BT targets aims to improve the quality of the parent-child relationship for both mother-child and father-child dyads. Colonnesi et al. (2013) found differential effects of the BT training reported by mothers and fathers. They described that mothers but not fathers reported higher levels of secure attachment relationships after the BT intervention. According to previous work of among others Bowlby (1969), Lewis and Lamb (2003) and Bögels and Phares (2008), mothers and fathers have different but complementary roles in child-rearing practices. Mothers generally show higher levels of emotional support and sensitivity, whereas fathers stimulate children’s exploration and autonomy (Barnett, Deng, Mills-Ounce,
Willoughby, & Cox, 2008;Bögels & Restifo, 2014; McKinney & Renk, 2008; Simons & Conger, 2007; Möller, Majdandžić, De Vente, & Bögels, 2013). Moreover, mothers talk more about emotions compared to fathers (Fivush, Brotman, Buckner, & Goodman, 2000). As mothers tend to display more sensitive behaviors, BT may relate to a greater extent to
12
mothers’ caregiving practices compared to fathers’. The main aim of the Basic Trust program is to enhance sensitive behaviors and mind-mindedness of the parents. Possibly mothers and fathers require different treatment approaches when it comes to changing dynamics in the infant-caregiver bond. In the present study we therefore take into account paternal and maternal MM and parenting stress before and after treatment.
The Present Study
The present study includes three main research aims. The first aim was to contribute to knowledge on the transactional mechanisms concerning parental MM and adoption-related child factors. We explored associations between MM and the child’s age of placement and length of time spent within the adoptive family (controlling for child age and gender). Only one study has been conducted that related parental sensitivity or sensitivity-related factors, to time spent in the adoptive home, showing that observed maternal sensitive responsiveness decreased with time, probably because parenting became more stressful in the transition from early to middle childhood (Stams, Juffer, Van IJzendoorn, & Hoksbergen, 2001). On the basis of the study of Stams et al. (2001) a negative association between MM and child age and time spent within the adoptive home could be implied in the current study. However, as outlined earlier, adoptive parents possibly have less difficulties with being mind-minded when their child is older. That is, children’s behaviors driven by pre-adoption internalized experiences may require more time to fathom for the adoptive parent. Hence, adoptive parents may be better in describing their child in terms of mental states when they are older. Because of these divergent expectations we did not specify directions regarding the relations among MM, time spent in the adoptive home and child age.
Secondly, we explored associations between MM and parental reports of parenting stress and children’s internalizing and externalizing problems prior to the BT treatment. We also considered whether mothers and fathers differed in MM and reports of parenting stress.
13
On the basis of prior studies targeting biological populations, negative associations between MM and reports of behavioral problems and parenting stress were expected (McMahon & Meins, 2012; Meins et al., 2003; Meins, Centifanti, Fernyhough, & Fishburn, 2013; Walker et al., 2011).
The last aim of the present study was to evaluate an MM focused treatment (BT) by examining whether behavioral problems and parenting stress decreased after the training. Moreover, following the implications of Colonnesi et al. (2012), we tested whether MM was improved after treatment. We hereby considered whether perceived changes in these outcome measures differed between mothers and fathers.
Methods
Participants
A total of 31 adoptive families participated in the current study. These families were enrolled in the BT treatment because the adoptive parents reported child behavioral and attachment problems. Selection criteria for the current study were: 1) the child’s international adoptive placement, 2) age between 2 and 12 years old and 3) the completion of the MM measurements at the pre-test. The sample of 31 families was used to analyze the first two study aims. Not all families were available for the post-test because treatment was still on-going. This left 13 families for the evaluation of the BT treatment from pre- to posttest (the third study aim).
A total of 18 boys and 13 girls were included in the analysis, of which 20 children were considered late-placed (adopted after 12 months of age), and 11 were early-placed. Descriptive statistics concerning the age and the age at placement of the early-placed and late-placed groups are displayed in Table 1. Fathers showed a mean age of 43.65 years (SD = 3.45; range = 35 - 49) and mothers 42.90 (SD = 4.14; range = 34 - 48) at pretest. Families had primarily middle to higher socioeconomic backgrounds. The average educational level of
14
parents was fairly high: mother M = 3.80, SD = 0.89 and fathers M = 4.00, SD = 1.05 (on a scale from 1: primary education to 5: university).
Table 1
Means, Standard Deviations and Ranges for Child Factors of Early- and Late-Placed Children
Child factors Early-placed (< 12 months) Late-placed ( > 12 months)
N M (SD) Range N M (SD) range
Age (months) 11 92.00 (27.90) 49 - 136 20 87.05 (31.64) 32 - 151 Age during placement
(months)
11 4.85 (2.75) 1 - 11 20 31.00 (10.76) 14 - 49 Length of time spent
within family (months)
11 81.83 (27.79) 43 - 132 20 53.84 (29.15) 14 - 108
Procedure
Basic Trust (BT) is a Dutch national organization of independent certified therapists specialized in attachment-focused treatment (“Basic Trustmethode”, n.d.). The therapists operate from their own treatment practice throughout different counties of the Netherlands. Every therapist followed an extensive 1 to 1.5 year training program in order to gain expertise in working with the BT method. Parents were referred to BT treatment when their child displayed behavioral problems and/or socio-emotional problems and the problems were indicative of an insecure attachment. For instance, because the child had experienced adverse caregiving experiences in early childhood (e.g., abuse, institutionalization, separation from the birth parent). During an intake, prior to the start of the treatment, the therapist discussed the specific background and issues regarding the behaviors of the child. The parents filled in the Attachment Insecurity Screening Inventory (AISI; Wissink et al., in press). This inventory is a caregiver-report on the child’s attachment behaviors with 20 closed questions on a 6-point Likert scale and 10 open questions. The background information and the clinical scores on the AISI provided an indication for the appropriateness of the BT treatment. Also, during the
15
intake a 10-minute free-play interaction of every parent-child dyad was videotaped in order to analyze possible insecure attachment dynamics of the dyad.
When the family continued with the BT treatment, parents received an information brochure about the BT research and were invited to participate in the current study including three separate testing times: 1) a pretest, during the intake, 2) a posttest, within two weeks after the end of the treatment and 3) a follow-up, 6 months after the end of the treatment. After agreement, informed consents were signed.
During each testing phase, parents filled in questionnaires, and were videotaped during free-play interactions with their child and an interview. Pretest was conducted before the start of the first session by the BT counselor at the treatment practice. Posttest and follow-up were performed by independent trained researchers of the University of Amsterdam during home-visits. The current study received permission from the ethical committee of the University of Amsterdam in February 2014 (Code: 2014-CDE-3395).
The BT Treatment Procedure
The BT treatment procedure consisted of, on average, 8 training sessions at the treatment practice and a consult by phone after the training. During all sessions both parents were present. In the first session the counselor discussed the results from the questionnaires with the parents. In addition, the counselor and parents set up treatment aims and analyzed a short fragment of the free-play interaction which was videotaped during the intake session. The second session took place with all family members present. Family interaction was recorded on videotape for 10 minutes and parents received information on the significance and practice of MM. Also, in order to practice MM in the home environment, parents received home-assignments including the training of stepped BT method during 10 minutes per day. The video recording of the second session was critically evaluated on a micro-level during the third session without the presence of the child. This routine was repeated until the treatment
16
aims were reached (e.g., behavior problems diminished). Instruments
Behavior and social-emotional problems. At all testing times parents completed the Child Behavior Checklist 1.5-5 or 6-18 (CBCL; Achenbach & Rescorla, 2000, 2001). These are standardized measures of child emotional and behavioral problems reported by caregivers of children aged 1.5 to 5 years old or 6 to 18 years old. Parents rate their child’s behaviors of the past 6 months using a 3-point scale (0 = not true, 1 = somewhat or sometimes true, 2 = very true or often true). The CBCL 1.5-5 and 6-18 yield 99 and 120 items respectively which reflect DSM-IV (APA, 2000) oriented subscales. Also, both questionnaires yield sum scores on internalizing behaviors, externalizing behaviors and overall behavioral difficulties. A T score of 65 or below are considered to fall within the normal range, 65–70 within the borderline clinical range, and a T score above 70 indicates parents’ clinically significant concerns.
The CBCL/1.5-5 and the CBCL/6-18 demonstrated excellent reliability and validity in the initial study of Achenbach and Rescorla (2000, 2001). There is no Dutch validation of the CBCL/1.5-5 to date. The construct validity of the Dutch CBCL/6-18 was satisfactory
according to a review of the Dutch ‘Commissie van Testaangelegenheden van het NIP’ (COTAN) in 2013. The committee judged the reliability of the CBCL/6-18 as insufficient because too little validation research was conducted in the Netherlands (“Child Behavior Checklist”, n.d.). However, a study of Ivanova et al. (2007) showed that the correlated syndrome structure of the CBCL/6-18 fit well when tested separately in 30 societies, including the Netherlands.
In the current study the overall internalizing and externalizing scales were used as outcome measures. Both parents filled in the questionnaire on their child’s behavior. Correlations between reports of mothers and father were high (internalizing problems: .74;
17
externalizing problems: .79). Therefore, the average score of both parents combined was used in the analyses.
Parental Mind-mindedness. Parental MM was assessed with an interview in which parents were asked a single question (i.e., “Can you describe [child’s name] for me?”; Meins et al., 1998). Independent observers were trained to transcribe and code MM following the coding manual of Meins and Fernyhough (2010). MM was measured as the proportion of mind-related attributes used by the parent during the description. The mind-related
descriptions were further categorized by the type of internal state to which the parent referred. Categories in the original coding manual of Meins and Fernyhough were: 1) mental
descriptions (e.g., intelligence, curiosity, humorous), 2) emotions, 3) interests (e.g., she likes to read about history), and 4) the child’s preferences, needs or desires (e.g., he would like to have a little brother). Because in the Dutch language similar words are used to verbalize interests and preferences, the independent coders were not able to reliably code the third and fourth category (e.g., “hij vindt schoolwerk leuk; hij houdt vooral van lezen”). Therefore the categories 3 and 4 were combined into a single category. The not mind-related descriptions were divided into three categories: 1) descriptions of the child’s behavior, 2) physical descriptions of the child (e.g., he has brown hair), and 3) a category for all other comments made by the parent. After this, the emotional nature of every comment (mind-related and not mind-related) was coded as positive, neutral or negative. This coding related only to the content of each comment and not the manner of expression by the parent (e.g., an angry voice or happy facial expression).
A total of 15 percent of the interactions at each measurement time was randomly selected to calculate the inter-rater agreement amongst the coders. For the classification of mind-related versus not mind-related comments inter-rater agreement was excellent (Fleis, 1981): к = .93 (fathers) and к = .89 (mothers). Agreement regarding the categorization of the
18
mind-related descriptions was also good: к = .80 (fathers) and к = .78 (mothers). With respect to the emotional nature of parents’ mental representations, correlations (Spearman’s rho) were calculated. This showed a fluctuating inter-rater agreement: positive MM: r = .79 (fathers) and r = .90 (mothers); neutral MM: r = .61 (fathers) and r = .36 (mothers), and negative MM: r = .76 (fathers) and r = .60 (mothers). Because of the divergent reliability, we did not take into account the emotional classifications of parental MM.
Parents showed different elaboration styles during the mind-mindedness interview Some parents gave short descriptions of their child while other parents discussed their child’s characteristics extensively (duration of interview: M = 3.05, SD = 1.31, range: 1.05 – 8.54). To control for the length of the interview, the amount of mind-related comments were calculated and divided by the total amount of comments the parent made during the whole interview. The proportion of the total amount of mind-related comments made during the interview were used in the statistical analysis. Because of the small sample size, the amount of variables used in the analysis were kept to a minimum, preventing multiple-testing bias
(Tabacknick & Fidell, 2013).
Parenting Stress. Parenting stress was assessed with with the Dutch questionnaire ‘De Opvoedingsbelasting Vragenlijst’ (OBVL; Vermulst, Kroes, De Meyer, Van Leeuwen, & Veerman, 2011). The OBVL relates to the Parenting Stress Index (Abidin, 1995) because it measures parenting characteristics and the quality of the parent-child interactions. The questionnaire has been translated among others in the Arabic, Turkish, English, French, and Spanish language. A total of 57 items measure 5 separate domains of parenting stress and : 1) the caregiver-child relationship (10 items; the degree to which the caregiver experiences this relationship as problematic), 2) parenting competence (12 items; the degree to which the caregiver perceives to possess enough parenting skills), 3) depressive states (12 items; the degree to which a caregiver is content with him-/herself and life conditions), 4) role
19
limitations (11 items; the degree to which a caregiver perceives the parental role as a
containment on their own freedom), and 5) health complaints (12 items; the degree to which a caregiver feels physically unhealthy). To indicate the overall level of perceived parenting stress, the scores on the separate subscale are aggregated into a single score. The
questionnaire was validated by Vermulst et al. (2011). Confirmatory factor analysis showed high factor loadings and a satisfactory fit for the five subscales (range Chronbach’s α = .74 to .84) and the total parenting stress scale (Chronbach’s α = .89). In the current study, the total parenting stress score was used with internal consistency reliabilities ranging from α = .60 (pretest) to α = .70 (posttest), indicating sufficient reliability of this scale (see Table 2). Table 2
Chronbach’s Alpha Total Scores Parenting Stress Questionnaire (OBVL)
Pretest Posttest OBVL Parenting stress Total Mothers Fathers .61 .60 .64 .70
Data-Reduction and Preliminary Analyses
` Data preparation. A total of 31 families were included in the analyses of association among the pre-test variables, and 12 families were available for the pre-/post-test analysis. The MM interviewed was conducted with all parents during the pre-test. However, 4 parents did not fill in the questionnaires on parenting stress or child behavioral problems during the pre-test. Analyses with and without the families with missing values did not yield different results, therefore all preliminary selected families remained in the analysis.
Data distribution. With regards to the data distribution, skewness and kurtosis levels and visual graphs (histograms) were analyzed. The absolute values of the skewness and kurtosis levels were less than three times the associated standard error for all variables with the exception of 1 variable (pre-test paternal MM concerning the child’s emotional states).
20
Inspections of z-scores showed that an extreme score for 1 parent (z-score > 3.29, Tabachnick & Fidell, 2013). This father only commented on the child’s emotions and not on other internal states. Because this extreme value could significantly influence the statistical relations
between the variables, the univariate outlier was given a raw score one unit larger than the next most extreme score (Tabachnick & Fidell, 2013). After this, the paternal MM variable no longer showed a skewed distribution.
Data analysis. With regard to the first two aims of the study, Pearson’s product moment correlation coefficients were used to analyze the relationship between MM and parenting stress, child behavioral problems, age during placement and length of time spent within the family. This latter variable was calculated by subtracting the age during adoptive placement from the age of the child during the pre-test of this study. In addition, linear regression analyses were performed to test the specific hypothesis that length of time spent in the adoptive family predicted paternal and maternal MM over and above the age of the child. Lastly, paired t-tests were used to test pre-test differences on MM between mothers and fathers.
The third aim was to evaluate treatment effects within a group of 13 families. Although distributions of the post-test variables appeared normal, we could not make an informed guess about the distribution of the data in the population because of the small sample size (N < 30; Agresti & Franklin, 2008; Gibbons & Chakraborti, 2010). Therefore, non-parametric tests were performed to test the treatment effects. The Wilcoxon’s signed rank test was used to examine differences from pre-test to post-test on the variables child
behavioral problems, parenting stress and MM.
21 Results
The descriptive statistics of the variables used in the analyses are displayed in Table 3.
Table 3
Means, Standard Deviations and Ranges for MM, Child Problems, and Parenting Stress
Pretest Posttest N M (SD) Range N M (SD) Range Mind-mindedness total Mothers Fathers 33 30 .36 (.12) .29 (.13) .17 - .59 .04 - .60 13 13 .40 (.14) .34 (.18) .10 -.64 .09 - .59 CBCL Internalizing problems 26 60.25 (8.32) 39 – 76 12 52.154 (10.88) 41 – 68 Externalizing problems 26 60.12 (9.34) 34 – 77 12 50.15 (9.86) 34 – 67 OBVL Parenting stress Mothers Fathers 29 26 70.52 (2.25) 71.04 (2.44) 64 – 74 65 – 77 10 11 71.60 (1.58) 72.46 ( 1.81) 68 – 74 71 - 76
Aim 1. Relations Between Parental MM, Parenting Stress, Child Internalizing and Externalizing Problems and Control Variables
Prior to the main analyses, it was checked whether parental MM, parenting stress and parental reports of child behavioral problems were associated with age and gender of the child, age at placement in the adoptive family and the child’s length of the stay in their
adoptive family. The results of the Pearson’s R correlational analysis are displayed in Table 4. Mothers’ total MM score was significantly related to the length of stay in the adoptive family, but not to the age of the child, suggesting that some unique variance of maternal MM was related to the time that adoptees and their mothers have known each other. To further investigate this assumption, a linear regression analysis was performed with child age and length of time spent within family as predictors. A significant regression equation was found,
22
R2 = .23, F(2, 24) = 3.548, p = .03. However, child age and length of time spent in adoptive family did not contribute uniquely to mothers’ mind-mined stance (β child age = -.10, p = .75; β time in family: = .55, p = .08). The beta coefficients of the variables do indicate a larger contribution of time spent within family compared to child age.
Mothers and fathers reported more internalizing but not externalizing problems when their child spent a longer period in time within the adoptive family. They also significantly reported more internalizing problems when their child was older. Interestingly, an
independent t-test showed that the group of late-placed children showed less internalizing problems compared to children who were early-placed (t (24) = 2.38, p < .05, Mearly = 64.41, SD = 6.07, Mlate = 57.20, SD = 8.58).
Lastly, rates of parenting stress were higher when children spent a shorter amount of time within the adoptive family (rmothers = .42, p < .05; rfathers = .33, p < .10). Fathers but not mothers showed higher levels of parenting stress when their child was adopted at an older age (rfathers = .42, p < .05).
Aim 2. Associations Between MM, Parenting Stress and Reports of Child Internalizing and Externalizing Problems
Table 5. presents the correlations between MM, parenting stress and child behavioral problems. No significant correlations were found. The related-sample Wilcoxon Signed Rank Test showed no significant differences between mothers and fathers in reports of parenting stress, t(27) = 1.18, p = 0.25. Differences between paternal and maternal MM were also non-significant, t(29) = -2.02, p = 0.05. However, a total of 36 percent of the comments of mothers were mind-related as opposed to 29 percent paternal mind-related comments, suggesting that mothers in the current sample were slightly more focused on the child’s mind.
23 Table 4
Correlations (Pearson’s R two-tailed) Between Child Gender, Child Age, Age of Placement and Length of Stay in the Adoptive Family
MM Total Score Parenting stress Child
internalizing problems
Child
Externalizing problems
mothers fathers mothers fathers Child Gender -.08 -.27 .29 -.12 -.26 .07 Age of child (months) .18 .07 -.24 -.12 .48* .08 Age of placement (months) -.15 .15 .21 .42* -.25 -.26 Length of stay in adoptive family (months) .39* .04 -.42* -.33+ .61** .24 + < .10, * p < .05, ** p < .01 Table 5.
Correlations (Pearson’s R) Between MM and Parenting Stress and Reports of Child Internalizing and Externalizing Problems
Parenting stress Child internalizing problems Child externalizing problems MM total Mothers Fathers .06 -.11 .22 .04 .05 -.38 MM mental states Mothers Fathers .24 .05 -.14 .11 -.02 .03 MM emotions Mothers Fathers -.23 .13 .34 -.32 .26 -.22 MM preferences/interests Mothers Fathers -.09 -.12 -.05 .06 -.11 -.03 *p < .05, ** p < .01
24
Aim 3. Differences in MM, Parenting Stress and Child Behavior Problems Before and After Treatment
Results of the related-sample Wilcoxon Signed Rank Test showed that internalizing and externalizing behavioral problems significantly decreased after treatment, Zinternalizing = -2.08, p = 0.04, Zexternalizing = -2.91, p = 0.01. Figure 1 and 2 entail a graphical display of the average decline before and after treatment. No significant treatment effects were found for MM and reports of parenting stress, Z mothers = 9.00, p = .68; Z fathers = 9.00, p = .13.
With regards to the presumed working mechanism of the treatment (i.e., the improvement of parental MM), no significant increase in parental MM was found after
treatment, Z mothers = 44.00, p = .48; Z fathers = 37.00, p = .72) However, both mothers and father displayed an increase of 4 percent in mind-related comments.
Figures 1 and 2
Pre- and posttest differences in child internalizing and externalizing problems. 60 52 0 10 20 30 40 50 60 70 Internalizing problems
Internalizing problems
Pre-test Post-test 60 51 0 10 20 30 40 50 60 70 Externalizing problemsExternalizing problems
Pre-test Post-test25 Discussion
In the current study relations among parental MM, child factors, parenting stress and child behavioral problems were examined in a sample of adoptive families. Furthermore, it was evaluated whether an MM oriented treatment improved levels of parental MM, child internalizing and externalizing problems and parenting stress. Most important findings in the current study were that the length of time that the child spent within the adoptive family related to maternal MM, but was not a unique predictor of MM. Also, the length of time spent within the family was negatively associated with parenting stress and child internalizing problems. We found that fathers but not mothers showed more parenting stress when their child was placed in the adoptive home after 12 months. Lastly, with regards to the evaluation of the treatment effects, we reported that internalizing and externalizing problems decreased after treatment. No significant treatment effects were found for parenting stress and MM.
An interesting finding in this study is the significant association between the length of time children spent within their family and maternal MM, whereas no significant correlation was found between MM and child age. Although time spent within family did not uniquely predict maternal MM, these results suggest that time is necessary for non-biological mothers to construct an understanding of their child’s inner perceptions. The adopted children in this study were referred to treatment because of attachment-related behavior and emotional problems. As outlined in the introduction, the specific background that nourished the child’s attachment insecurity prior to adoption is often unknown to adoptive parents. Moreover, children with attachment problems may show behaviors driven by experiences internalized early in life which are difficult to fathom for the environment. Time may enable adoptive mothers to gain more appreciation of their child’s mind. This notion might be strengthened by the significant association found between parent reports of internalizing (not externalizing) problems, and time spent within the adoptive family. Although possibly child age is a
26
confounding factor for this relationship as well (i.e., older children express more emotional problems), the association between internalizing problems and time spent in family was sufficiently larger compared to child age. This suggests that parents may become more aware of child emotional problems when they have spent a longer amount of time with their child. The length of time spent between adoptive parents and their children has not been examined yet in relation to child and parenting characteristics. However, some studies have considered the role of parents’ daily time spent with their biological children. Among others Fitzgerald, Zucker, Maguin, and Reider (1994) concluded that mothers and father who spent more time with their child during the day showed more maternal and paternal concordance on reports of child behavioral problems. This indicates that time may be an important dynamic factor that shapes the relationship between an adoptive parent and his/her adopted child.
We found no evidence that adoptive parents may have difficulties with representing their child’s inner states. Walker et al. (2011) discussed that a ratio of .40 on mental state references during the MM interview may be considered as typical within community samples and .20 within clinical samples. In the current study mothers showed an average of .36 before treatment and .40 after treatment, which is in line with proportions found in community samples (Lok & McMahon, 2006; Meins et al., 1998, 2003; Walker et al., 2011). Fathers showed proportions of .29 before and .34 after treatment. Bernier and Dozier (2003) reported a ratio of .23 for a group of foster mothers in the United States, which is substantially smaller than the ratio reported in our study. However, the population of foster parents differs from the population of adoptive parents. For instance, the participants in the current study differed in multiple background variables from the study of Bernier and Dozier (2003), among others the socioeconomic status of the parents in our study was fairly higher. The current study is in line with the perspective that family structure does not matter for the quality of parenting aspects, as outlined the study of Landsford, Ceballo, Abbey, and Stewart (2001). They reported that
27
the quality of parent-child relationships does not differ between families with different
structures (i.e. biological, adoptive, single-parent, stepfamily households). In the current study this was in particular true for adoptive mothers who showed no difference in MM from
community samples.
Contrary to our expectations we did not find associations between parenting stress and MM. Previous research using both clinical and non-clinical samples found that parents with high levels of MM reported less parenting stress (MacMahon & Meins, 2012; Walker, Wheatcroft & Camic, 2006). However, we should interpret our results with caution as the current group of parents showed on average a clinical score on the parenting stress
questionnaire, with little variance in the scores. It is possible that the lack of variation on the parenting stress score in combination with the small sample size caused difficulties in exposing linear relationships between MM and parenting stress. Therefore, we are careful drawing strong conclusions on the relation between parenting stress and MM in adoptive families.
It is also possible that the relationship between MM and parenting stress operates in a different way within adoptive parents compared to biological parents. Although we know that a meaningful interpretation of behaviors is linked to less parenting stress in biological parents (Deater-Deckard, 1998; Harrison & Sofronoff, 2002; MacMahon & Meins, 2012), factors related to adoption may be interfering with this intercommunication for adoptive parents. Adoption-related concerns, such as the awareness of child trauma experiences or genetic impairments (e.g., mental disorders of the biological parent), may overrule the impact of parental mentalization skills, at least in the beginning of the child’s integration within the new family. This notion corresponds to our result that parents were less stressed when they had spent more time with their child.
28
With regards to the evaluation of the treatment, we found significant treatment effects for externalizing and internalizing behavioral problems. Also, parental MM increased after treatment, although this increase was not statistically significant. One possibility is that the small sample used to evaluate the treatment effects may yield too little power to find
significant effects (Field, 2009). Another possible explanation for these results may be found in the operationalization of MM. The BT treatment is focused on parents’ naming of the child’s inner states during online interactions. Because all children in this study were older than 2.5 years, MM was assessed through an interview in which parents were asked to describe their child and not through observing online interaction. Post-treatment
measurements were conducted within weeks after the ending of the last treatment sessions. Parents might need more time to gather a more in-depth and mind-minded description of their child, which does not exclude that these parents have not become more MM during online interactions with their children. We therefore recommend that future studies on the alteration of MM during parenting treatment should include observational data in order to examine mechanisms of change.
A third explanation for the lack of increase in MM after treatment is that it is not likely to be altered with a brief treatment, as MM has shown to be a stable feature throughout the first three years of children’s lives, (Arnott & Meins, 2008; Colonnesi et al., 2015; Meins, Fernyhough, Arnott, Leekam, & Turner, 2011) and is determined by parent’s own
internalizations of attachment relationships (Arnott & Meins, 2007). In this view MM may be seen as a moderator of positive treatment effects instead of a mediator. This means that parents who show higher levels of MM prior to the start of the treatment, are more likely to carry out sensitivity- and attachment focused interventions successfully. The current study lacks the design to investigate a moderating function of MM, yielding implications for future research.
29
Parenting stress slightly but not significantly increased after treatment. The BT treatment is not focused on reducing stress levels, but we hypothesized that stress levels would decrease if parents improved their ability to take a representational stance (e.g., MacMahon & Meins, 2006). An explanation for our finding is that parents showed parenting stress scores within the upper area of the clinical range. Possibly inordinate high levels of stress may be less likely to be altered by a short treatment procedure. Also, the BT procedure incorporates psycho-education on attachment relationships, which includes education on of the impact of a lack of basic trust on children. Moreover, it is emphasized during treatment that adoptive parents need a set of extra caregiving qualities to help them construct a new trust in primarily their caregivers (Havermans et al. 2012; Polderman, 1998). Between treatment sessions parents actively practice at home with naming the inner states of the child. The awareness of their role in the improvement of their child’s attachment relationship may explain why parents did not report less parenting stress shortly after treatment. Follow-up research (e.g., after six months) would provide more information on the course of the parenting stress levels after treatment.
Treatment effects concerning parenting stress and levels of MM were not different between mothers and fathers. Although we found indications that fathers in the current study were a little less mind-minded, both parents gained similar levels of MM after treatment. We expected that in line with the study of Colonnesi et al. (2012), possibly fathers were less reached by the content of the treatment program, which was mainly focused on presumed maternal parenting styles (i.e., sensitivity). Adoptive mothers show relatively more
involvement, including spending more time with their adopted child during the first years in life (Stams, 1998). However, we did not find presumptive evidence that mothers were
affected differently by the BT treatment. The difference between mothers and father found by Colonnesi et al. (2012) included reports on child attachment security. Attachment security
30
was not assessed in the current study, which could explain the differential results. In sum, this study suggests that BT may relate to both mothers and fathers in an equally effective way. In the current study validated and well-known instruments were used to assess the parent and child measures. Trained independent coders showed high inter-rater agreement on mind-related comments, indicating that MM was measured in an accurate and reliable way. The present study also has some important limitations including primarily the possible instability of the results because of the small sample size. However, despite the small sample size, significant decreases were found in child internalizing and externalizing problems, indicating that the Basic Trust method is successful in reducing child behavioral difficulties. A second limitation includes the lack of a control group to measure whether the effects were due to actual elements of the BT treatment. Lastly, the context in which the assessments of MM took place limits the validity of the current study. That is, parents were interviewed by the therapist at the treatment practice prior to the start of the treatment. Post-tests took place during home-visits. Although the research assessment was clearly distinguished from the treatment sessions by the therapist, parents may have been influenced by the setting in which the interview took place. For instance, parents may have produced more negative comments on the child’s behavior and mental states because they felt they had to express their concerns to the therapist or explain what child characteristics induced the registration for therapy. We recommend that future study include pre- and post-tests conducted by independent
researchers.
Conclusion
The current study highlighted important dynamics concerning adoptive parents’ ability to represent their child’s inner world. Although adoptive parents show similar levels of MM compared to community samples, the child’s time spent in the new adoptive home may be an important dynamic factor that shapes the relationship between an adoptive parent and his/her
31
adopted child. The current study also indicates that parental MM may be an important characteristic to focus on in attachment oriented treatment, as after the MM oriented BT treatment child internalizing and externalizing problems decreased.
References
Abidin, R.R. (1995). Parenting Stress Index (PSI) manual (3rd ed.). Odessa, FL: Psychological AssessmentResources, Inc.
Achenbach, T.M., & Rescorla, L.A. (2000). Manual for the ASEBA Preschool forms and Profiles. Burlington, VT: University of Vermont Department of Psychiatry.
Achenbach, T.M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms and Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.
Agresti, A., & Franklin, C. (2008). Statistics: The art and science of learning from data (2nd ed.). Upper Saddle River, NJ: Pearson Higher Education.
Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and separation:
Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49-67.
Ainsworth, M.D.S., Bell, S.M., & Stayton, D.J. (1974). Infant–mother attachment and social development: Socialization as a product of reciprocal responsiveness to signals. In M.P.M. Richards (Ed.), The integration of a child into a social world. London: Cambridge University Press.
Ainsworth, M.D. S., Blehar, M. C., Waters, E. and Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale NJ: Lawrence Erlbaum
32
Allen, J.G., & Fonagy, P. (2006). Handbook of mentalization-based treatment. Chichester, UK: John Wiley.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Arnott, B., & Meins, E. (2007). Links among antenatal attachment representations, postnatal mind-mindedness, and infant attachment security: A preliminary study of mothers and fathers. Bulletin of the Menninger Clinic, 71., 132–149.
Bakermans-Kranenburg, M.J., Van Ijzendoorn, M.H., & Juffer, F. (2003). Less Is More: Meta-Analyses of Sensitivity and Attachment Interventions in Early Childhood. Psychological Bulletin, 129(2), 195–215.
Bakermans-Kranenburg, M.J., Van Ijzendoorn, M.H., & Juffer, F. (2005). Disorganized infant attachment and preventive interventions: A review and meta-analysis. Infant Mental Health Journal, 26, 191-216.
Barnett, M. A., Deng, M., Mills-Ounce, W. R., Willoughby, M., & Cox, M. (2008). Interdependence of parenting of mothers and fathers of infants. Journal of Family Psychology, 22, 561–573.
Basic Trustmethode. (n.d.). Retrieved from http://www.nji.nl/nl/Databanken/Databank Effectieve-Jeugdinterventies/Erkende-interventies/Basic-Trustmethode
Bernier, A., & Dozier, M. (2003). Bridging the attachment transmission gap: The role of maternal mind-mindedness. International Journal of Behavioral Development, 27, 355-365.
Bögels, S. M., & Phares, V. (2008). Fathers' role in the etiology, prevention and treatment of child anxiety: A review and new model. Clinical Psychology Review, 28, 539-528. Bogels, S.M., & Restifa, K. (2014). An Evolutionary Perspective on Parenting and
33
Parenting Stress. In: Mindful Parenting. A Guide for Mental Health Practitioners. New York: Springer Science.
Bowlby, J. (1969). Attachment. Attachment and Loss: Vol. 1. Loss. New York: Basic Books.
Calkins, S. D., & Hill, A. (2007). Caregiver influences on emerging emotion regulations; Biological and environmental transactions in early development. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 229–248). New York: The Guilford Press.
Carpendale, J. I. M., & Lewis, C. (2004). Constructing an understanding of mind: The development of children's social understanding within social interaction. Behavioral and Brain Sciences, 27, 79-96.
Cassidy, J. (1994). Emotion regulation: influences of attachment relationships Monographs of
the Society for Research in Child Development, 59, 228-249.
Child Behavior Checklist (CBCL). (n.d.). Retrieved from
http://www.nji.nl/nl/Databanken/Databank-Instrumenten-en-Richtlijnen/Child
Behavior-Checklist-(CBCL)
Colonnesi, C., Draijer, E. M., Stams, G. J. J. M., Van der Bruggen, C. O., Bögels, S. M., & Noom, M. J. (2011). The relation between attachment and child anxiety: a meta analytic review. Journal of Clinical Child and Adolescent Psychology, 40, 630-645.
Colonnesi, C, Wissink, I.B., Noom, M.J., Asscher, J.J., Hoeve, M.. Stams, G. J. M., Polderman,N., & Kellaert-Knol, M.G. (2012) Basic Trust: An Attachment-Oriented Intervention Based on Mind-Mindedness in Adoptive Families. Research on Social Work Practice, 10-12-2012.
34
Colonnesi, C., Zeegers, M. A. J., Hondius, W., & Bögels, S.M. (2014). Children’s Social Understanding and Fathers’ and Mothers’ Mind-Mindedness as Predictors of Children’s Theory of Mind in Childhood. Submitted.
Demers, I., Bernier, A., Tarabulsy, G. M., & Provost, M. A. (2010). Mind-mindedness in adult and adolescent mothers: Relations to maternals sensitivity and infant
attachment. International Journal of Behavioral Development, 34, 529-537.
De Wolff, M.S., & Van IJzendoorn, M.H. (1997). Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment. Child Development, 68, 571-591.
Field, A.P. (2009). Discovering statistics using SPSS: and sex and drugs and rock 'n' roll. London: Sage publications.
Fivush, R., Brotman, M., Buckner, J. P., & Goodman, S. H. (2000). Gender differences in parent–child emotion narratives. Sex Roles, 42, 233–253.
Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2004). Affect regulation, mentalization, and the development of the self (2nd ed.). New York: Other Press.
Fonagy, P., Steele, H., Moran, G., Steele, M., & Higgitt, A. (1991a). The capacity for
understanding mental states: the reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 13, 200-217.
Fonagy, P., Steele, P., Steele, H., Higgitt, A. and Target, M. (1994) ‘The theory and practice of resilience’, Journal of Child Psychology and Psychiatry, 35, 231–57.
Fonagy, P., Steele, H., Steele, M., & Holder, J. (1997). Attachment and theory of mind: Overlapping constructs? Association for Child Psychology and Psychiatry Occasional Papers, 14, 31–40.
35
Gibbons, J.D., & Chakraborti, S (2010). Nonparametric Statistical Inference. Boca Raton: Taylor & Francis/CRC Press.
Havermans, A, Verheule, C, & Prinsen, B. (2012). Gehechtheid in beeld. Handleiding video interactiebegeleiding voor professionals in de adoptiezorg. Amsterdam: SWP.
Hoeve, M., Stams, G.J.J.M., Van der Put, C.E, Dubas, J.S., Van der Laan, P.H., & Gerris, R. M.. (2012) A meta-analysis of attachment and juvenile delinquency. Journal of Abnormal Child Psychology, 40, 771-785.
Juffer, F., Bakermans-Kranenburg, M., & van Ijzendoorn, M. (2008). Promoting Positive Parenting. An Attachment Based Intervention. New York: Taylor and Francis group.
Fearon, R.M.P., Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H., Lapsley, A., & Roisman, G.I. (2010). The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: A meta-analytic study. Child Development, 81, 435-456.
Fitzgerald, H. E., Zucker, R. A., Maguin, E, T. & Reider, E.. E. (1994). Time spent with child and parental agreement about ratings of child behavior. Perceptual and Motor Skills, 79, 336-338.
Fleiss, J. L. (1981). Statistical methods for rates and proportions. New York: Wiley.
Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2004). Affect regulation, mentalization, and the development of the self (2nd ed.). New York: Other Press.
Fonagy, P., Steele, M., Moran, G., Steele, H., & Higgitt, A. (1991). The capacity for
understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 13, 200–216.
36
Fukkink, R.G. (2008). Video feedback in widescreen: A meta-analysis of family programs. Clinical Psychology Review, 28, 904-916.
Howe, D. (2006). Developmental attachment psychotherapy with fostered and adopted children. Child and Adolescent Mental Health, 11, 128–134.
Ivanova, M. Y., Achenbach, T. M., Dumenci, L., Rescorla, L. A., Almqvist, F., Bilenburg, et
al. (2007). Testing the 8-syndrome structure of the Child Behavior Checklist in 30
societies. Journal of Clinical Child and Adolescent Psychology, 36, 405–417.
Kelly, W., & Salmon, K. (2014). Helping foster parents understand the foster child’s perspective: A relational learning framework for foster care, Clinical Child Psychology, 19, 535-547.
Laranjo, J., Bernier, A, & Meins, E. (2008). Associations between maternal mind-mindedness and infant attachment security: Investigating the mediating role of maternal
sensitivity. Infant Behavior & Development, 31(4), 688–695.
Lewis, C. N., & Lamb, M. E. (2003). Fathers’ influences on children’s development. The
evidence from two-parent families. European Journal of Psychology of Education,
18, 211-228.
Lieberman, A.F., Silverman, R., & Pawl, J.H. (2000). Infant-parent psychotherapy: Core concepts and current approaches. In C. Zeanah (Ed.), Handbook of infant mental
health 2nd ed., pp. 485–493. New York: Guilford Press.
Lieberman, A.F. (2003). The treatment of attachment disorder in infancy and early childhood: Reflections from clinical intervention with later adopted foster care children,
37
Lok, S. M., & McMahon, C. A. (2006). Mothers’ thoughts about their children: Links between mindmindedness and emotional availability. British Journal of Developmental Psychology, 24, 477–488.
Lundy, B.L. (2003). Father– and mother–infant face-to-face interactions: Differences in mind-related comments and infant attachment? Infant Behavior & Development, 26, 200–212.
MacMahon, C., & Meins, E. (2012). Mind-mindedness, parenting stress, and emotional availability in mothers of preschoolers. Early Childhood Research Quarterly, 27, 245
252.
Malekpour, M (2007). Effects of attachment on early and later development. The British Journal of Developmental Disabilities, 105, 81-95.
McDonough, S.C. (2000). Interaction guidance: An approach for difficult to engage families. In C. Zeanah (Ed.), Handbook of infant mental health 2nd ed., pp. 485–493. New York: Guilford Press.
McKinney, C. & Renk, K. (2008). Differential parenting between mothers and fathers: Implications for late adolescents. Journal of Family Issues, 29, 806-827. Meins, E. (1999). Sensitivity, security, and internal working models: Bridging the transmission gap. Attachment & Human Development, 1, 325–342.
Meins, L., Centifanti, L.C.M., Fernyhough, C. & Fishburn S. (2013). Maternal mind mindedness and children’s behavioral difficulties: Mitigating the impact of low socioeconomic status. Journal of Abnormal Child Psychology 41, 543-553. Meins, E., & Fernyhough, C. (2010). Mind-mindedness coding manual, Version 2.0. Unpublished manuscript. Durham University, Durham, UK.
38
Meins, E., Fernyhough, C., Arnott, B., Leekam, S., & Turner, M. (2011). Mother- versus infant-centered correlates of maternal mind-mindedness in the first year of life. Infancy, 16, 137–165.
Meins, E., Fernyhough, C., de Rosnay, M., Arnott, B., Leekam, S. R., & Turner, M. (2012). Mind-mindedness as a multidimensional construct: Appropriate and nonattuned mind-related comments independently predict infant–mother attachment in a socially diverse sample. Infancy, 17, 393–415.
Meins, E., Fernyhough, C., Fradley, E., & Tuckey, M. (2001). Rethinking maternal sensitivity: Mothers’ comments on infants’ mental processes predict security of attachment at 12 months. Journal of Child Psychology and Psychiatry, 42, 637–648.
Meins, E., Fernyhough, C., Russell, J. & Clark-Carter, D. (1998). Security of attachment as a predictor of symbolic and mentalising abilities: A longitudinal study. Social
Development, 7, 1-24.
Meins, E., Fernyhough, C., Wainwright, R., Clark-Carter, D., Das Gupta, M., Fradley, E., & Tuckey, M. (2003). Pathways to understanding mind: Construct validity and
predictive validity of maternal mind-mindedness. Child Development, 74, 1194–1211. Meins, E., Fernyhough, C., Wainwright, R., Das Gupta, M., Fradley, E. & Tuckey, M.
(2002). Maternal mind-mindedness and attachment security as predictors of theory of mind understanding. Child Development, 73(6), 1715-1726.
Möller, E. L., Majdandžić, M., De Vente, W., & Bogels, S. M. (2013). The evolutionary basis of sex differences in parenting and its relationship with child anxiety in Western societies. Journal of Experimental Psychopathology, 4, 88-117.
