In biological families, parental reflective functioning (PRF), or the parents’ capacity to envision their child as being motivated by internal mental states, is known to facilitate the development of the child’s theory of mind (ToM). Very few studies have investigated the relation between PRF and ToM in adoptive families, and none have simultaneously investigated the role of pre- and post-adoptive PRF. The present study is the first to examine relations between pre-adoptive reflective functioning (RF), post-adoptive PRF and children’s ToM acquisition in a sample of internationally adopted children and their adoptive parents (48 children; 14 girls and 34 boys). Specifically, we investigated whether the relation between pre-adoptive RF and ToM was mediated by PRF assessed when children were aged 3.5–4 years, and whether these relations were moderated by age at adoption, which served as a proxy for early adversity. Results indicated that none of the PRF dimensions mediated the relation between pre-adoptive RF and ToM. However, pre-adoptive RF and PRF both independently predicted ToM. Moreover, age at adoption moderated these associations, with both pre-adoptive RF and dimensions of PRF assessed at child age 3.5–4 years being related to ToM only in children who were adopted at an older age (≥18 months).
Theory of Mind (ToM) development of adopted children is often challenged by difficult early life events.
Adoptive parents’ reflective functioning (PRF), the capacity to envision the child as being motivated by mental states, might foster the development of ToM.
This study is the first to investigate the impact of both pre-adoptive and post-adoptive PRF in internationally adopted children’s ToM acquisition.
Pre-adoptive RF and post-adoptive interest in child mental states was related to ToM, but only in children adopted at the age of 18 months or older.
Post-adoptive non-mentalizing of adoptive parents was related to weaker child ToM abilities, independent of age at adoption.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Adkins, T., Luyten, P., & Fonagy, P. (2018). Development and preliminary evaluation of Family Minds: A mentalization-based psychoeducation program for foster parents. Journal of Child and Family Studies, 27(8), 2519–2532. https://doi.org/10.1007/s10826-018-1080-x.
Adkins, T., Reisz, S., Hasdemir, D., & Fonagy, P. (2021). Family Minds: A randomized controlled trial of a group intervention to improve foster parents’ reflective functioning. Development and Psychopathology, 1–15. https://doi.org/10.1017/s095457942000214x.
Aldrich, N. J., Chen, J., & Alfieri, L. (2021). Evaluating associations between parental mind-mindedness and children’s developmental capacities through meta-analysis. Developmental Review, 60, 100946 https://doi.org/10.1016/j.dr.2021.100946.
Anis, L., Perez, G., Benzies, K. M., Ewashen, C., Hart, M., & Letourneau, N. (2020). Convergent validity of three measures of reflective function: Parent Development Interview, Parental Reflective Function Questionnaire, and Reflective Function Questionnaire. Frontiers in Psychology, 11, 3385 https://doi.org/10.3389/fpsyg.2020.574719.
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. https://doi.org/10.1521/bumc.2007.71.2.132.
Askeland, K. G., Hysing, M., La Greca, A. M., Aarø, L. E., Tell, G. S., & Sivertsen, B. (2017). Mental health in internationally adopted adolescents: A meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 56(3), 203–213. https://doi.org/10.1016/j.jaac.2016.12.009.
Bammens, A.-S., Adkins, T., & Badger, J. (2015). Psycho-educational intervention increases reflective functioning in foster and adoptive parents. Adoption & Fostering, 39(1), 38–50. https://doi.org/10.1177/0308575914565069.
Benbassat, N., & Priel, B. (2012). Parenting and adolescent adjustment: The role of parental reflective function. Journal of Adolescence, 35(1), 163–174. https://doi.org/10.1016/j.adolescence.2011.03.004.
Bora, E. (2021). A meta-analysis of theory of mind and ‘mentalization’ in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment? Psychological Medicine, 51(15), 2541–2551. https://doi.org/10.1017/S0033291721003718.
Borelli, J. L., Cohen, C., Pettit, C., Normandin, L., Target, M., Fonagy, P., & Ensink, K. (2019). Maternal and child sexual abuse history: An intergenerational exploration of children’s adjustment and maternal trauma-reflective functioning. Frontiers in Psychology, 10, 1062 https://doi.org/10.3389/fpsyg.2019.01062.
Camras, L. A., Perlman, S. B., Fries, A. B. W., & Pollak, S. D. (2006). Post-institutionalized Chinese and Eastern European children: Heterogeneity in the development of emotion understanding. International Journal of Behavioral Development, 30(3), 193–199. https://doi.org/10.1177/0165025406063608.
Colvert, E., Rutter, M., Kreppner, J., Beckett, C., Castle, J., Groothues, C., Hawkins, A., Stevens, S., & Sonuga-Barke, E. J. S. (2008). Do theory of mind and executive function deficits underlie the adverse outcomes associated with profound early deprivation? Findings from the English and Romanian adoptees study. Journal of Abnormal Child Psychology, 36(7), 1057–1068. https://doi.org/10.1007/s10802-008-9232-x.
Cooke, D. (2015). Rasch analysis of the Parental Reflective Functioning Questionnaire: A critical examination of data from a non-clinical sample of mothers and fathers with a one-year-old child [Unpublished doctoral dissertation] Curtin University.
Costa-Cordella, S., Luyten, P., Cohen, D., Mena, F., & Fonagy, P. (2021). Mentalizing in mothers and children with type 1 diabetes. Development and Psychopathology, 33(1), 216–225. https://doi.org/10.1017/S0954579419001706.
De Roo, M., Wong, G., Rempel, G. R., & Fraser, S. N. (2019). Advancing optimal development in children: Examining the construct validity of a Parent Reflective Functioning Questionnaire. JMIR Pediatrics and Parenting, 2(1), e11561 https://doi.org/10.2196/11561.
Denham, S. A. (1986). Social cognition, prosocial behavior, and emotion in preschoolers: Contextual validation. Child Development, 57(1), 194–201. https://doi.org/10.2307/1130651.
Devine, R. T., & Hughes, C. (2018). Family correlates of false belief understanding in early childhood: A meta-analysis. Child Development, 89(3), 971–987. https://doi.org/10.1111/cdev.12682.
Ensink, K., Berthelot, N., Bernazzani, O., Normandin, L., & Fonagy, P. (2014). Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale. Frontiers in psychology, 5, 1471 https://doi.org/10.3389/fpsyg.2014.01471.
Fishburn, S., Meins, E., Greenhow, S., Jones, C., Hackett, S., Biehal, N., Baldwin, H., Cusworth, L., & Wade, J. (2017). Mind-mindedness in parents of looked-after children. Developmental Psychology, 53(10), 1954–1965. https://doi.org/10.1037/dev0000304.
Flavell, J.H., Botkin, P.T., Fry, C.L., Wright, J.C., & Jarvis, P.E. (1968). The development of communication and role-taking skills in children. Wiley.
Fonagy, P., & Luyten, P. (2016). A Multilevel Perspective on the Development of Borderline Personality Disorder. In D. Cichetti (Ed.), Developmental Psychopathology (pp. 1-67). Wiley. https://doi.org/10.1002/9781119125556.devpsy317.
Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective-functioning manual, version 5.0, for application to adult attachment interviews [Unpublished manuscript]. University College London.
Fries, A. B. W., & Pollak, S. D. (2004). Emotion understanding in postinstitutionalized Eastern European children. Development and Psychopathology, 16(2), 355–369. https://doi.org/10.1017/s0954579404044554.
Garfield, J. L., Peterson, C. C., & Perry, T. (2001). Social cognition, language acquisition and the development of the theory of mind. Mind & Language, 16(5), 494–541. https://doi.org/10.1111/1468-0017.00180.
Håkansson, U., Watten, R. G., Söderström, K., & Øie, M. G. (2019). The association between executive functioning and parental stress and psychological distress is mediated by parental reflective functioning in mothers with substance use disorder. Stress and Health, 35(4), 407–420. https://doi.org/10.1002/smi.2868.
Harris, P. L., Johnson, C. N., Hutton, D., Andrews, G., & Cooke, T. (1989). Young children’s theory of mind and emotion. Cognition and Emotion, 3(4), 379–400. https://doi.org/10.1080/02699938908412713.
Hoff, E. (2006). How social contexts support and shape language development. Developmental Review, 26(1), 55–88. https://doi.org/10.1016/j.dr.2005.11.002.
Hogrefe, G. J., Wimmer, H., & Perner, J. (1986). Ignorance versus false belief: A developmental lag in attribution of epistemic states. Child Development, 57(3), 567–582. https://doi.org/10.2307/1130337.
Hwa-Froelich, D. A., Matsuo, H., & Becker, J. C. (2014). Emotion identification from facial expressions in children adopted internationally. American Journal of Speech-Language Pathology, 23(4), 641–654. https://doi.org/10.1044/2014_ajslp-14-0009.
Hwa-Froelich, D. A., Matsuo, H., & Jacobs, K. (2017). False belief performance of children adopted internationally. American Journal of Speech-Language Pathology, 26(1), 29–43. https://doi.org/10.1044/2016_ajslp-15-0152.
Julian, M. M. (2013). Age at adoption from institutional care as a window into the lasting effects of early experiences. Clinical Child and Family Psychology Review, 16(2), 101–145. https://doi.org/10.1007/s10567-013-0130-6.
León, E., Steele, M., Palacios, J., Román, M., & Moreno, C. (2018). Parenting adoptive children: Reflective functioning and parent-child interactions. A comparative, relational and predictive study. Children and Youth Services Review, 95, 352–360. https://doi.org/10.1016/j.childyouth.2018.11.009.
Luyten, P., Campbell, C., Allison, E., & Fonagy, P. (2020). The mentalizing approach to psychopathology: State of the art and future directions. Annual Review of Clinical Psychology, 16, 297–325. https://doi.org/10.1146/annurev-clinpsy-071919-015355.
Luyten, P., & Fonagy, P. (2018). The stress–reward–mentalizing model of depression: An integrative developmental cascade approach to child and adolescent depressive disorder based on the Research Domain Criteria (RDoC) approach. Clinical Psychology Review, 64, 87–98. https://doi.org/10.1016/j.cpr.2017.09.008.
Luyten, P., Mayes, L. C., Nijssens, L., & Fonagy, P. (2017). The parental reflective functioning questionnaire: Development and preliminary validation. Plos One, 12(5), e0176218 https://doi.org/10.1371/journal.pone.0176218.
Luyten, P., Nijssens, L., Fonagy, P., & Mayes, L. C. (2017). Parental reflective functioning: theory, research, and clinical applications. Psychoanalytic Study of the Child, 70(1), 174–199. https://doi.org/10.1080/00797308.2016.1277901.
Luyten, P., Slade, A., Mayes, L., Vliegen, N., Casalin, S., Kempke, S., & Tang, E. (2008). Adoption Expectations Interview. Unpublished protocol. KU Leuven.
Malcorps, S., Vliegen, N., Nijssens, L., Tang, E., Casalin, S., Slade, A., & Luyten, P. (2021). Assessing reflective functioning in prospective adoptive parents. Plos One, 16(1), e0245852 https://doi.org/10.1371/journal.pone.0245852.
Meins, E., 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(4), 543–553. https://doi.org/10.1007/s10802-012-9699-3.
Merz, E. C., & McCall, R. B. (2010). Behavior problems in children adopted from psychosocially depriving institutions. Journal of Abnormal Child Psychology, 38(4), 459–470. https://doi.org/10.1007/s10802-009-9383-4.
Midgley, N., Alayza, A., Lawrence, H., & Bellew, R. (2018). Adopting Minds—a mentalization-based therapy for families in a post-adoption support service: preliminary evaluation and service user experience. Adoption & Fostering, 42(1), 22–37. https://doi.org/10.1177/0308575917747816.
Midgley, N., Ensink, K., Lindqvist, K., Malberg, N., & Muller, N. (2017). The development of mentalizing. In Mentalization-based treatment for children: A time-limited approach. American Psychological Association. https://doi.org/10.1037/0000028-002.
Miller, B. C., Fan, X., Grotevant, H. D., Christensen, M., Coyl, D., & Van Dulmen, M. (2000). Adopted adolescents’ overrepresentation in mental health counseling: Adoptees’ problems or parents’ lower threshold for referral. Journal of the American Academy of Child and Adolescent Psychiatry, 39(12), 1504–1511. https://doi.org/10.1097/00004583-200012000-00011.
Nijssens, L., Luyten, P., Malcorps, S., Vliegen, N., & Mayes, L. (2021). Parental reflective functioning and theory of mind acquisition: A developmental perspective. British Journal ōf Developmental Psychology, 39(4), 584–602. https://doi.org/10.1111/bjdp.12383.
Nolte, T., Bolling, D. Z., Hudac, C. M., Fonagy, P., Mayes, L., & Pelphrey, K. A. (2013). Brain mechanisms underlying the impact of attachment-related stress on social cognition. Frontiers in Human Neuroscience, 7, 816–816. https://doi.org/10.3389/fnhum.2013.00816.
Pajulo, M., Tolvanen, M., Karlsson, L., Halme‐Chowdhury, E., Öst, C., Luyten, P., Mayes, L., & Karlsson, H. (2015). The prenatal parental reflective functioning questionnaire: exploring factor structure and construct validity of a new measure in the Finn Brain Birth Cohort Pilot Study. Infant Mental Health Journal, 36(4), 399–414. https://doi.org/10.1002/imhj.21523.
Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42(1), 185–227. https://doi.org/10.1080/00273170701341316.
Priel, B., Melamed-Hass, S., Besser, A., & Kantor, B. (2000). Adjustment among adopted children: The role of maternal self-reflectiveness. Family Relations, 49(4), 389–396. https://doi.org/10.1111/j.1741-3729.2000.00389.x.
Redfern, S., Wood, S., Lassri, D., Cirasola, A., West, G., Austerberry, C., Luyten, P., Fonagy, P., & Midgley, N. (2018). The Reflective Fostering Programme: Background and development of a new approach. Adoption & Fostering, 42(3), 234–248. https://doi.org/10.1177/0308575918790434.
Robinson, P., Skårderud, F., & Sommerfeldt, B. (2019). Eating Disorders and Mentalizing. In P. Robinson, F. Skårderud, & B. Sommerfeldt (Eds.), Hunger: Mentalization-based Treatments for Eating Disorders (pp. 35-49). Springer International Publishing. https://doi.org/10.1007/978-3-319-95121-8_3.
Rosso, A. M., Viterbori, P., & Scopesi, A. M. (2015). Are maternal reflective functioning and attachment security associated with preadolescent mentalization. Frontiers in Psychology, 6, 1134 https://doi.org/10.3389/fpsyg.2015.01134.
Schechter, D. S., Suardi, F., Gex-Fabry, M., Moser, D. A., & Serpa, S. R. (2016). The role of maternal prementalizing modes of functioning and low-range RF in the development of child traumatic stress within a context of violence exposure. Journal of the American Academy of Child & Adolescent Psychiatry, 55(10), 320 https://doi.org/10.1016/j.jaac.2016.07.349.
Schiborr, J., Lotzin, A., Romer, G., Schulte-Markwort, M., & Ramsauer, B. (2013). Child-focused maternal mentalization: A systematic review of measurement tools from birth to three. Measurement, 46(8), 2492–2509. https://doi.org/10.1016/j.measurement.2013.05.007.
Schwarzer, N.-H., Nolte, T., Fonagy, P., & Gingelmaier, S. (2021). Mentalizing and emotion regulation: Evidence from a nonclinical sample. International Forum of Psychoanalysis, 30(1), 34–45. https://doi.org/10.1080/0803706X.2021.1873418.
Slade, A. (2005). Parental reflective functioning: An introduction. Attachment & Human Development, 7(3), 269–281. https://doi.org/10.1080/14616730500245906.
Slade, A., Grunebaum, L., Huganir, L., & Reeves, M. (2007). The Pregnancy Interview-revised. City College of New York.
Steele, H., & Steele, M. (2008). On the origins of reflective functioning. In F. N. Bush (Ed.), Mentalization: Theoretical considerations, research findings, and clinical implications. (pp. 133-158). Analytic Press.
Steele, M., Henderson, K., Hodges, J., Kaniuk, J., Hillman, S., & Steele, H. (2007). In the best interests of the late-placed child: a report from attachment representations and adoption outcome study. In L. Mayes, P. Fonagy, & M. Target (Eds.), Developmental science and psychoanalysis: Integration and innovation (pp. 159–182). Karnac Books.
Steele, M., Hodges, J., Kaniuk, J., & Steele, H. (2009). Mental Representation and Change: Developing Attachment Relationships in an Adoption Context. Psychoanalytic Inquiry, 30(1), 25–40. https://doi.org/10.1080/07351690903200135.
Tang, E., Bleys, D., & Vliegen, N. (2018). Making sense of adopted children’s internal reality using narrative story stem techniques: A mixed-methods synthesis. Frontiers in Psychology, 9, 1189 https://doi.org/10.3389/fpsyg.2018.01189.
Tarullo, A. R., Bruce, J., & Gunnar, M. R. (2007). False belief and emotion understanding in post-institutionalized children. Social Development, 16(1), 57–78. https://doi.org/10.1111/j.1467-9507.2007.00372.x.
Tarullo, A. R., Youssef, A., Frenn, K. A., Wiik, K., Garvin, M. C., & Gunnar, M. R. (2016). Emotion understanding, parent mental state language, and behavior problems in internationally adopted children. Development and Psychopathology, 28(2), 371–383. https://doi.org/10.1017/S095457941500111X.
Taubner, S., Hörz, S., Fischer-Kern, M., Doering, S., Buchheim, A., & Zimmermann, J. (2013). Internal structure of the Reflective Functioning Scale. Psychological Assessment, 25(1), 127–135. https://doi.org/10.1037/a0029138.
van den Dries, L., Juffer, F., van Ijzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2009). Fostering security? A meta-analysis of attachment in adopted children. Children and Youth Services Review, 31(3), 410–421. https://doi.org/10.1016/j.childyouth.2008.09.008.
van Ijzendoorn, M. H., Dijkstra, J., & Bus, A. G. (1995). Attachment, intelligence, and anguage: A meta-analysis. Social Development, 4(2), 115–128. https://doi.org/10.1111/j.1467-9507.1995.tb00055.x.
Verhoeven, L., & Vermeer, A. (2001). Taaltoets Alle Kinderen: Handleiding. CITO.
Wellman, H. M., & Woolley, J. D. (1990). From simple desires to ordinary beliefs: The early development of everyday psychology. Cognition, 35(3), 245–275. https://doi.org/10.1016/0010-0277(90)90024-E.
Weisleder, A., & Fernald, A. (2013). Talking to Children Matters: Early Language Experience Strengthens Processing and Builds Vocabulary. Psychological Science, 24(11), 2143–2152. https://doi.org/10.1177/0956797613488145.
Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: Representation and constraining function of wrong beliefs in young children’s understanding of deception. Cognition, 13(1), 103–128. https://doi.org/10.1016/0010-0277(83)90004-5.
We would like to thank all adoptive families and research assistants involved in the Leuven Adoption Study; their continuing support and commitment allowed us to follow the development of adoptive families for more than 10 years.
All authors contributed to the study conception and design. Processing and coding of the interviews was done by Liesbet Nijssens and Saskia Malcorps; data analyses were performed by Saskia Malcorps. The first draft of the manuscript was written by Saskia Malcorps, and edited and reviewed by Patrick Luyten and Nicole Vliegen. All authors read and approved the final manuscript.
The Leuven Adoption Study is funded in part by the Flemish agency Kind en Gezin (https://www.kindengezin.be/) with an annual grant of €7,000 rewarded to NV from 2009 to 2021. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The study received no other external funding.
Conflict of Interest
The authors declare no competing interests.
This study was performed in line with the principles of the Declaration of Helsinki. The Leuven Adoption Study was approved by the Social and Societal Ethics Committee of the University of Leuven (KU Leuven) in 2008, 2013 and 2021.
Written informed consent was obtained from the parents to participate in the study and use group-level data for publication.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Malcorps, S., Vliegen, N., Nijssens, L. et al. The Role of Parental Reflective Functioning for Theory of Mind Development in Internationally Adopted Children. J Child Fam Stud 32, 272–287 (2023). https://doi.org/10.1007/s10826-022-02482-z
- Theory of Mind
- Parental mentalizing
- Reflective functioning
- Early adversity