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Parental Reflective Functioning is a parent's capacity to infer mental states in herself and her child. Parental Reflective Functioning is linked to the quality of parent-child attachment and promotes parent-child mutual emotion regulation. We examined neural correlates of parental reflective functioning and their relationship to physical abuse. Participants were mothers with (n = 26) and without (n = 22) history of childhood physical abuse. Parental reflective functioning was assessed by coding transcripts of maternal narrative responses on interviews. All mothers also underwent magnetic resonance imaging while watching video clips of children during mother-child separation and play. Parental reflective functioning was significantly lower among mothers with histories of childhood physical abuse. When mothers without history of childhood physical abuse watched scenes of separation versus play, brain activation was positively correlated with parental reflective functioning in the ventromedial prefrontal cortex, and negatively associated with the dorsolateral prefrontal cortex and insula. These associations were not present when limiting analyses to mothers reporting abuse histories. Regions subserving emotion regulation and empathy were associated with parental reflective functioning; yet these regions were not featured in maltreated mothers. These data suggest that childhood physical abuse exposure may alter the psychobiology that is linked to emotional comprehension and regulation.

The aim of this study was to examine associations between maternal mentalization, interactive behavior, and child symptoms in families in which mothers suffer from interpersonal violence-related posttraumatic stress disorder (IPV-PTSD). Fifty-six mothers and children (aged 12-42 months) including mothers with a diagnosis of IPV-PTSD were studied. Mentalization was measured by the Parental Reflective Functioning (PRF) Scale. Interactive behavior during free-play was measured via the CARE-Index. Child symptoms were measured by the Infant-Toddler Social and Emotional Assessment (ITSEA). Data analyses included non-parametric correlations and multiple linear regression. Results showed that lower IPV-PTSD and higher Maternal Reflective Functioning (MRF) were related to greater maternal sensitivity. Lower MRF and greater controlling behavior were related to child dysregulation. MRF was found to be lower in the subgroup of IPV-PTSD when the child's father was the perpetrator of IPV. Both MRF and interactive behavior are thus likely to be important targets for intervention during sensitive periods of early social-emotional development.

Human and animal models suggest that maternal hormonal and physiological adaptations during pregnancy shape maternal brain functioning and behavior crucial for offspring care and survival. Less sensitive maternal behavior, often associated with psychobiological dysregulation and the offspring’s behavioral and emotional disorders, has been observed in mothers who have experienced adverse childhood experiences. Strong evidence shows that children who are exposed to domestic violence (DV) are at risk of being abused or becoming abusive in adulthood. Yet little is known about the effect of childhood exposure to DV on the expecting mother, her subsequent caregiving behavior and related effects on her infant. Thus, the present study examined the association of maternal exposure to DV during childhood on prenatal maternal attachment, maternal heart rate reactivity to an infant-crying stimulus and post-natal infant emotional regulation. Thirty-three women with and without exposure to DV during childhood were recruited during the first trimester of pregnancy and followed until 6-month after birth. The Maternal Antenatal Attachment Scale (MAAS) was used to measure prenatal attachment of the mother to her fetus during the second trimester of pregnancy, maternal and fetal heart rate reactivity to an infant-crying stimulus was assessed at the third trimester of pregnancy, and the Infant Behavior Questionnaire-Revised (IBQ-R) was used to assess infant emotional regulation at 6-months. Results showed that pregnant women that were exposed to DV during childhood had a poorer quality of prenatal attachment of mother to fetus, regardless of whether they also experienced DV during adulthood. In addition, maternal exposure to DV during childhood was associated with increased maternal heart rate to infant-crying stimulus and worse infant emotional regulation. These findings highlight the importance of prenatal screening for maternal exposure to DV during childhood as a risk factor for disturbances in the development of maternal attachment, dysfunctional maternal behavior and infant emotion dysregulation.

The aim of this study was to examine the relationship of maternal interpersonal violence-related posttraumatic stress disorder (IPV-PTSD), associated neural activity in response to mother-child relational stimuli, and child psychopathology indicators at child ages 12-42 months and one year later. The study tested the hypothesis that decreased maternal neural activity in regions that subserve emotion regulation would be associated with child symptoms associated with emotional dysregulation at both time points. Functional magnetic resonance imaging of 42 mothers with or without violence-exposure and associated IPV-PTSD were assessed. Their child's life-events and symptoms/behaviors indicative of high-risk subsequent PTSD diagnosis on a maternal-report questionnaire were measured one year later. Maternal IPV-PTSD severity was significantly associated with decreased ventromedial prefrontal cortex (vmPFC) activation in response to mother-child relational stimuli. Maternal IPV-PTSD severity and decreased vmPFC activation were then significantly associated with a child attachment disturbance at 12-42 months and symptoms/behaviors one year later, that were correlated with emotional dysregulation and risk for child PTSD. Maternal IPV-PTSD and child exposure to IPV were both predictive of child PTSD symptoms with maternal IPV-PTSD likely mediating the effects of child IPV exposure on child PTSD symptoms. These findings suggest that maternal IPV-PTSD severity and associated decreased vmPFC activity in response to mother-child relational stimuli are predictors of child psychopathology by age 12-42 months and one-year later. Significant findings in this paper may well be useful in understanding how maternal top-down cortico-limbic dysregulation promotes intergenerational transmission of IPV and related psychopathology and, thus should be targeted in treatment.

Women who have experienced interpersonal violence (IPV) are at a higher risk to develop posttraumatic stress disorder (PTSD), with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and impaired social behavior. Previously, we had reported impaired maternal sensitivity and increased difficulty in identifying emotions (i.e. alexithymia) among IPV-PTSD mothers. One of the aims of the present study was to examine maternal IPV-PTSD salivary cortisol levels diurnally and reactive to their child’s distress in relation to maternal alexithymia. Given that mother-child interaction during infancy and early childhood has important long-term consequences on the stress response system, toddlers’ cortisol levels were assessed during the day and in response to a laboratory stressor. Mothers collected their own and their 12-48 month-old toddlers’ salivary samples at home three times: 30 min after waking up, between 2-3 pm and at bedtime. Moreover, mother-child dyads articipated in a 120-min laboratory session, consisting of 3 phases: baseline, stress situation (involving mother-child separation and exposure to novelty) and a 60-min regulation phase. Compared to non-PTSD controls, IPV-PTSD mothers -but not their toddlers-, had lower morning cortisol and higher bedtime cortisol levels. As expected, IPV-PTSD mothers and their children showed blunted cortisol reactivity to the laboratory stressor. Maternal cortisol levels were negatively correlated to difficulty in identifying emotions. Our data highlights PTSDIPV-related alterations in the HPA system and its relevance to maternal behavior. Toddlers of IPV-PTSD mothers also showed an altered pattern of cortisol reactivity to stress that potentially may predispose them to later psychological disorders.

It is known that increased circulating glucocorticoids in the wake of excessive, chronic, repetitive stress increases anxiety and impairs Brain-Derived Neurotrophic Factor (BDNF) signaling. Recent studies of BDNF gene methylation in relation to maternal care have linked high BDNF methylation levels in the blood of adults to lower quality of received maternal care measured via self-report. Yet the specific mechanisms by which these phenomena occur remain to be established. The present study examines the link between methylation of the BDNF gene promoter region and patterns of neural activity that are associated with maternal response to stressful versus non-stressful child stimuli within a sample that includes mothers with interpersonal violence-related PTSD (IPV-PTSD). 46 mothers underwent fMRI. The contrast of neural activity when watching children—including their own— was then correlated to BDNF methylation. Consistent with the existing literature, the present study found that maternal BDNF methylation was associated with higher levels of maternal anxiety and greater childhood exposure to domestic violence. fMRI results showed a positive correlation of BDNF methylation with maternal brain activity in the anterior cingulate (ACC), and ventromedial prefrontal cortex (vmPFC), regions generally credited with a regulatory function toward brain areas that are generating emotions. Furthermore we found a negative correlation of BDNF methylation with the activity of the right hippocampus. Since our stimuli focus on stressful parenting conditions, these data suggest that the correlation between vmPFC/ACC activity and BDNF methylation may be linked to mothers who are at a disadvantage with respect to emotion regulation when facing stressful parenting situations. Overall, this study provides evidence that epigenetic signatures of stress-related genes can be linked to functional brain regions regulating parenting stress, thus advancing our understanding of mothers at risk for stress-related psychopathology.

Post-traumatic stress disorder (PTSD) is a disorder that involves impaired regulation of the fear response to traumatic reminders. This study tested how women with male-perpetrated interpersonal violence-related PTSD (IPV-PTSD) differed in their brain activation from healthy controls (HC) when exposed to scenes of male-female interaction of differing emotional content. Sixteen women with symptoms of IPV-PTSD and 19 HC participated in this study. During magnetic resonance imaging, participants watched a stimulus protocol of 23 different 20 s silent epochs of male-female interactions taken from feature films, which were neutral, menacing or prosocial. IPV-PTSD participants compared with HC showed (i) greater dorsomedial prefrontal cortex (dmPFC) and dorsolateral prefrontal cortex (dlPFC) activation in response to menacing vs prosocial scenes and (ii) greater anterior cingulate cortex (ACC), right hippocampus activation and lower ventromedial prefrontal cortex (vmPFC) activty in response to emotional vs neutral scenes. The fact that IPV-PTSD participants compared with HC showed lower activity of the ventral ACC during emotionally charged scenes regardless of the valence of the scenes suggests that impaired social perception among IPV-PTSD patients transcends menacing contexts and generalizes to a wider variety of emotionally charged male-female interactions.

Prior research has shown that mothers with Interpersonal Violence-related Posttraumatic Stress Disorder (IPV-PTSD) report greater difficulty in parenting their toddlers. Relative to their frequent early exposure to violence and maltreatment, these mothers display dysregulation of their hypothalamic pituitary adrenal axis (HPA-axis), characterized by hypocortisolism. Considering methylation of the promoter region of the glucocorticoid receptor gene NR3C1 as a marker for HPA-axis functioning, with less methylation likely being associated with less circulating cortisol, the present study tested the hypothesis that the degree of methylation of this gene would be negatively correlated with maternal IPV-PTSD severity and parenting stress, and positively correlated with medial prefrontal cortical (mPFC) activity in response to video-stimuli of stressful versus non-stressful mother-child interactions. Following a mental health assessment, 45 mothers and their children (ages 12-42 months) participated in a behavioral protocol involving free-play and laboratory stressors such as mother-child separation. Maternal DNA was extracted from saliva. Interactive behavior was rated on the CARE-Index. During subsequent fMRI scanning, mothers were shown films of free-play and separation drawn from this protocol. Maternal PTSD severity and parenting stress were negatively correlated with the mean percentage of methylation of NR3C1. Maternal mPFC activity in response to video-stimuli of mother-child separation versus play correlated positively to NR3C1 methylation, and negatively to maternal IPV-PTSD and parenting stress. Among interactive behavior variables, child cooperativeness in play was positively correlated with NR3C1 methylation. Thus, the present study is the first published report to our knowledge, suggesting convergence of behavioral, epigenetic, and neuroimaging data that form a psychobiological signature of parenting-risk in the context of early life stress and PTSD.

LES TROUBLES PRECOCES DU COMPORTEMENT SONT-ILS L’EXPRESSION D’UNE PSYCHOPATHOLOGIE SPECIFIQUE ? L’utilisation clinique de la Classification diagnostique 0-3 dans le cadre d’une etude sur les troubles precoces du comportement en cours dans notre service de psychiatrie de l’enfant a Geneve a permis de mieux caracteriser la psychopathologie presentee par cette population. Ces enfants sont majoritairement porteurs d’un diagnostic primaire de trouble des affects, alors que leurs symptomes sont de nature et d’intensite diverses. Ce diagnostic, de nature relationnelle, confirme le role determinant des interactions parents/enfant dans l’emergence des difficultes comportementales a l’âge prescolaire. De plus, la categorie diagnostique la plus frequente dans notre recherche, le “ Trouble mixte de l’expression emotionnelle ”, revele la presence chez ces enfants d’aspects depressifs de forte intensite frequemment masques par un tableau clinique marque surtout par l’opposition, l’agitation, les difficultes d’attention ou l’agressivite. Sont egalement evoquees les difficultes rencontrees lors de l’utilisation de la Classification diagnostique 0-3. Des illustrations cliniques de differents contextes d’emergence des troubles precoces du comportement sont proposees. Ces illustrations demontrent que ces troubles peuvent etre associes a des diagnostics de severite variable et que ces enfants sont frequemment exposes a un risque interactionnel eleve, d’ou la necessite d’une intervention therapeutique precoce centree sur les interactions parents/enfant et sur la qualite des projections parentales.

Maternal interpersonal violence-related post-traumatic stress disorder (IPV-PTSD) is known to be associated with impairment of a mother's capacity to participate in mutual emotion regulation during her child's first years of life. This study tested the hypothesis that maternal difficulty in identifying feelings in self and other, as an important dimension of the construct of alexithymia, together with maternal IPV-PTSD, would be negatively associated with maternal sensitivity. Maternal sensitivity to child emotional communication is a marker of maternal capacity to engage in mutual regulation of emotion and arousal. Following diagnostic interviews and administration of the Toronto Alexithymia Scale, 56 mothers and their toddlers (ages 12-42 months) were filmed during free-play and separation/novelty-exposure. Observed maternal sensitivity was coded via the CARE-Index. Maternal IPV-PTSD severity, difficulty in identifying emotions, and lower socio-economic status were all associated with less maternal sensitivity, and also with more maternal controlling and unresponsive behavior on the CARE-Index.

Resume Introduction Nombre d’enfants nes prematurement ont des difficultes attentionnelles et des comportements d’hyperactivite qui sembleraient lies aux deficits des fonctions executives. Objectif Examiner si le suivi propose au niveau national en Suisse aux enfants nes prematurement permet la detection des problemes executifs. Methodes Quarante-neuf enfants nes avant 29 semaines de gestation et examines entre 5 et 6 ans dans le cadre du suivi neurodeveloppemental standard comprenant l’evaluation cognitive avec les trois echelles du K-ABC (Kaufman Assessment Battery for Children), les processus mentaux composites (PMC), sequentiels et simultanes, et l’evaluation du comportement (SDQ pour Strenghts and Difficulties Questionnaire). Les fonctions executives ont ete evaluees par des epreuves neuropsychologiques supplementaires testant l’attention, l’inhibition, la memoire de travail et par un questionnaire parental (BRIEF pour Behaviour Rating Inventory of Executive Function). La valeur discriminative des epreuves standard (K-ABC et SDQ) pour les troubles executifs a ete examinee. Resultats Si l’echelle PMC discriminait peu les resultats obtenus aux tests neuropsychologiques, un score inferieur a 85 aux processus sequentiels etait associe a une diminution significative des capacites attentionnelles. Le questionnaire SDQ permettait egalement une bonne discrimination des enfants presentant des difficultes explorees par le BRIEF. Conclusion Une analyse fine des resultats obtenus lors du suivi standard permet de cerner les difficultes des enfants nes prematurement : un resultat faible au niveau des processus sequentiels semble predicteur de performances attentionnelles deficitaires. Les difficultes comportementales en lien avec les troubles executifs semblent bien depistees par le SDQ. Il est important de detecter ces enfants, de les suivre avec des epreuves specifiques si necessaire et de favoriser des mesures de soutien.

INTRODUCTION A significant proportion of prematurely born children encounter behavioral difficulties such as attention deficit or hyperactivity which could be due to executive function disorders. AIMS To examine whether the standard neurodevelopmental assessment offered to premature children in Switzerland recognizes executive function disorders. METHODS The study population consisted of 49 children born before 29 weeks of gestation who were examined between 5 and 6 years of age with a standard assessment with additional items to assess executive functioning. Children with severe neurodevelopmental impairment were excluded (mental retardation cerebral palsy autism). Standard assessment consisted in the Kaufman Assessment Battery for Children (K ABC) which comprises three subscales: sequential processes (analysis of sequential information) simultaneous processes (global analysis of visual information) and composite mental processes (CMP) (result of the other two scales) as well as a behavioral evaluation using the standardized Strengths and Difficulties Questionnaire (SDQ). Executive functioning was assessed with tasks evaluating visual attention divided attention and digit memory as well as with a specialized questionnaire the Behavior Rating Index of Executive Functions (BRIEF) which evaluates several aspects of executive function (regulation attention flexibility working memory etc). RESULTS Children were divided according to their results on the three K ABC scales (85) and the different neuropsychological tasks assessing executive function were compared between the groups. The CMP did not differentiate children with executive difficulties whereas a score < 85 on the sequential processes was significantly associated with worse visual and divided attention. There was a strong correlation between the SDQ and the BRIEF questionnaires. For both questionnaires children receiving psychotherapy had significantly higher results. Children who presented behavioral problems assessed with the SDQ presented significantly higher scores on the BRIEF. CONCLUSION A detailed analysis of the standard neurodevelopmental assessment allows the identification of executive function disorders in premature children. Children who performed below 85 on the sequential processes of the K ABC had significantly more attentional difficulties on the neuropsychological tasks and therefore have to be recognized and carefully followed. Emotional regulation had a strong correlation with behavioral difficulties which were suitably assessed with the SDQ recognized by the families and treated.

This pilot study explores the effects of a brief individual psychoanalytic therapy on perinatal depressive symptoms. This intervention is based on the Geneva's mother-infant intervention model. A sample of 129 pregnant women was recruited in Geneva (Switzerland) and screened for depressive symptoms with two instruments: the 'Edinburgh postnatal depression scale' (EPDS) and the 'Dépistage anténatal de la dépression postnatale'. A group of 40 women presenting depressive symptoms (treatment group) participated in a four-session intervention called 'Psychotherapy centred on parenthood (PCP)'. It consists in two antenatal and two postnatal sessions and is focussed on changing problematic representations of parenthood. This treatment group was compared to a control group of 88 women without depressive symptoms and following the usual obstetrical care. The main outcome measure was EPDS at 3 and 6 months after delivery. The 'Global assessment functioning scale' was administered at the end of each therapeutic session. The 'Parent-infant relationship global assessment scale' was administered at the two postnatal sessions in order to explore if PCP was also effective in preventing the potential negative effects of depression on mother-infant relationship. Results show that in the treatment group (N = 31), EPDS scores dropped from 12.8 to 4.8; none of these women met the EPDS cut-off score of 12 at 3 and 6 months postpartum. Mother-infant relationship was well adapted for all 31 dyads at the end of the intervention. These results suggest that PCP is a promising intervention for treating perinatal depression and helping mothers engaging in parenting.

Video feedback has been integrated into several therapeutic approaches as a way of engaging parents to focus on interactive behavior to reinforce positive interactions and to identify areas of noncontingent behavior. This article reviews the technical and theoretical contributions of the most important video feedback-based interventions that are currently used with families that include young children.

Background: Methylation of the serotonin 3A receptor gene (HTR3A) has been linked to child maltreatment and adult psychopathology. The present study examined whether HTR3A methylation might be associated with mothers' lifetime exposure to interpersonal violence (IPV), IPV-related psychopathology, child disturbance of attachment, and maternal neural activity. Methods: Number of maternal lifetime IPV exposures and measures of maternal psychopathology including posttraumatic stress disorder (PTSD), major depression and aggressive behavior (AgB), and a measure of child attachment disturbance known as “secure base distortion” (SBD) were assessed in a sample of 35 mothers and children aged 12–42 months. Brain fMRI activation was assessed in mothers using 30-s silent film excerpts depicting menacing adult male-female interactions versus prosocial and neutral interactions. Group and continuous analyses were performed to test for associations between clinical and fMRI variables with DNA methylation. Results: Maternal IPV exposure-frequency was associated with maternal PTSD; and maternal IPV-PTSD was in turn associated with child SBD. Methylation status of several CpG sites in the HTR3A gene was associated with maternal IPV and IPV-PTSD severity, AgB and child SBD, in particular, self-endangering behavior. Methylation status at a specific CpG site (CpG2_III) was associated with decreased medial prefrontal cortical (mPFC) activity in response to film-stimuli of adult male-female interactions evocative of violence as compared to prosocial and neutral interactions. Conclusions: Methylation status of the HTR3A gene in mothers is linked to maternal IPV-related psychopathology, trauma-induced brain activation patterns, and child attachment disturbance in the form of SBD during a sensitive period in the development of self-regulation.

Prior research has shown that mothers with Interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) report greater difficulty in parenting their toddlers. Relative to their frequent early exposure to violence and maltreatment, these mothers display dysregulation of their hypothalamic pituitary adrenal axis (HPA-axis), characterized by hypocortisolism. Considering methylation of the promoter region of the glucocorticoid receptor gene NR3C1 as a marker for HPA-axis functioning, with less methylation likely being associated with less circulating cortisol, the present study tested the hypothesis that the degree of methylation of this gene would be negatively correlated with maternal IPV-PTSD severity and parenting stress, and positively correlated with medial prefrontal cortical (mPFC) activity in response to video-stimuli of stressful versus non-stressful mother-child interactions. Following a mental health assessment, 45 mothers and their children (ages 12-42 months) participated in a behavioral protocol involving free-play and laboratory stressors such as mother-child separation. Maternal DNA was extracted from saliva. Interactive behavior was rated on the CARE-Index. During subsequent fMRI scanning, mothers were shown films of free-play and separation drawn from this protocol. Maternal PTSD severity and parenting stress were negatively correlated with the mean percentage of methylation of NR3C1. Maternal mPFC activity in response to video-stimuli of mother-child separation versus play correlated positively to NR3C1 methylation, and negatively to maternal IPV-PTSD and parenting stress. Among interactive behavior variables, child cooperativeness in play was positively correlated with NR3C1 methylation. Thus, the present study is the first published report to our knowledge, suggesting convergence of behavioral, epigenetic, and neuroimaging data that form a psychobiological signature of parenting-risk in the context of early life stress and PTSD.