Prenatal Reflective Functioning as a Predictor of Substance-Using Mothers' Treatment Outcome: Comparing Results From Two Different RF Measures

Abstract

Mothers with prenatal substance use disorder (SUD) often show broad deficits in their reflective functioning (RF), implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF (AAI-RF), regarding parent's own childhood experiences, and parenting-focused RF (PRF) regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview (during pregnancy/pre-intervention), and with Parent Development Interview at 4 months (during intervention). Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months (post-intervention), and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions.

Observed Emotional Availability<bold> (EA) in the Early Months and Adolescence and Self-Reported EA at Any Age: A Narrative Review</bold>

“…Again, using the same sample, mothers with SUD were lower on each of the EA dimensions, as compared to non-using mothers with obstetric risk. Using the same sample, Flykt et al (2022) and Isosävi et al (2016) found that neither maternal attachment nor her reflective functioning, both measured with AAI prenatally, predicted mother-infant interaction quality at 4 months. However, reflective functioning measured with AAI was predictive of improvements in EA following the intervention (4 and 12 months) and most clearly in the negative interactions picked up by the nonintrusiveness and nonhostility scales.…”

“…Otherwise, there was no link with any of the EA dimensions in either the group of autonomous substance abusing mothers or those who were autonomous nonusing but at obstetric risk, which may raise the question of how "autonomous" and "substance abusing" may be quite different than "autonomous" in a normative sample. Based on Flykt et al (2022) study, it may also be that acute substance use problems (as prenatal measure was conducted pre-treatment, when many of the mothers were just in the process of trying to give up substances) may hinder the usual links between AAI and EA, although they might become visible later. It is possible that more research is needed on the AAI-EA link in high-risk samples, as the meaning of "autonomous" and the meaning of "emotionally available" may be quite different in one or both evaluation systems.…”

Parental mentalising among mothers with intellectual disability or ADHD: Links with experiences of abuse, neglect and psychosocial risk

“…A growing body of research supports these proposals. For instance, higher parental mentalising has been prospectively linked to higher maternal sensitivity (Ensink et al, 2019;Farrow & Blissett, 2014;Flykt et al, 2022), and randomised controlled or clinical trials indicate that interventions targeting parental mentalising can increase maternal sensitivity (e.g., Salo et al, 2019;Suchman et al, 2017Suchman et al, , 2018 and reduce parenting stress (Adkins et al, 2022;Sieverson et al, 2021). With regard to child development, prospective studies have found that higher parental mentalising fosters secure child attachment (e.g., Ensink et al, 2019;Gagné et al, 2021;Meins et al, 2012), and meta-analytic findings indicate that these effects are both direct and indirect (i.e., via sensitivity; Zeegers et al, 2017).…”