Parent group and reflective functioning
Research type
Research Study
Full title
Can a short, parent-focused intervention for parents of children with eating disorders affect parental reflective functioning and how does this affect the child's clinical outcomes?
IRAS ID
282561
Contact name
CECILY DONNELLY
Contact email
Sponsor organisation
Imperial College London
Clinicaltrials.gov Identifier
20HH6411, DOCUMAS
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Parental reflective functioning is the ability to hold a child’s mental state in mind. It is associated with parental satisfaction, positive parenting and quality of caregiving, important factors for a child’s development of social skills and emotional health. Parental reflective functioning is also associated with children’s own ability to mentalise and may serve as a protective factor against mental illness. Research has previously looked at how parent interventions can improve reflective functioning and that change is reflected in positive changes for children. None have looked at whether this applies to parents of children with EDs. In 2012, an early intervention programme for parents was established in a Tier 3 child and adolescent ED service. This group has many components of a mentalisation-focused group therapy, and aims to increase parent confidence, knowledge and skills. This current study aims to investigate whether parental reflective functioning changes over time as a result of an intervention, who is more likely to change, and what this means for their child’s clinical outcomes.
• Parents of children currently receiving treatment from designated ED services are invited by clinicians to join the parent group, which runs for six weeks.
• Any parent that has been invited to the parent group and has agreed to attend all 6 sessions may take part.
• Parents that are receiving psychological input from other services (either for themselves or for other children), are excluded from the study.
• Participants are asked to complete a set of questionnaires at the first session of the parent group, the final session of the parent group and six weeks after the final parent group session.
• Clinicians will provide data including child’s %mBMI at start, finish and post parent group, parent’s attendance at the parent group and child’s diagnosis.
Lay summary of study results:The study recruited 38 parents of 27 adolescents between November 2021 and January 2023. Completion rates were high, with 38 parents participating at Time 1 (baseline) and 33 parents at Time 3 (six weeks post-parent group). The sample consisted of 14 fathers and 24 mothers, predominantly married (79%) and educated to at least undergraduate level (65%). Most parents identified as White, with a minority reporting current or past mental health symptoms and medication use. Regarding the adolescents, nearly all were diagnosed with Anorexia Nervosa, with one case of Avoidant Restrictive Food Intake Disorder. The majority were female, white British, and had reached puberty, with ages ranging from 11 to 17 years old and a mean age of 15.2 years. Across the three time points, there were 18 participants at Time 1, 13 at Time 2, and 11 at Time 3, with some participants declining to complete subsequent measures.
Over the study period, we monitored changes in how parents and adolescents with eating disorders perceived and understood emotions and thoughts. Parents became more confident in their ability to understand their child's emotions and thoughts, particularly if they initially struggled with uncertainty. Additionally, they showed improvements in recognizing and managing their own emotions throughout the study period. Adolescents also demonstrated progress in their understanding of emotions and thoughts, alongside notable improvements in their eating disorder symptoms, including weight gain.Despite these positive changes, because of the small sample sizes, we were unable to determine conclusively how much a parent's improved understanding impacted their child's clinical progress. It was also not possible to predict whether changes in parent’s understanding was predicted by autistic traits or the severity of their child’s eating disorder at baseline. These findings underscore the complexity of the relationship between parental understanding and adolescent eating disorder outcomes, highlighting the need for further research to elucidate these dynamics.
REC name
South Central - Hampshire A Research Ethics Committee
REC reference
21/SC/0072
Date of REC Opinion
2 Jun 2021
REC opinion
Further Information Favourable Opinion