Associations between maternal representational risk and long-term child behavioral outcomes in minding the baby

The early identification of disruptions in caregiver–child relationships is an imperative for mental health and social welfare services because maladaptive caregiving is associated with negative child outcomes, and early detection enables prevention and intervention efforts. Caregiving representations, namely parents’ perceptions, expectations, and subjective experience of parenting and of their child, are central organizers of caregiving behavior, and high-risk representations have been associated with disorganized attachment and its sequelae, including child psychopathology. The recently validated Assessment of Representational Risk coding system (Sleed et al., 2021) has enabled the detection of specific elements of caregiving representations that are associated with heightened risk for parent–child dyads, addressing the need for a clinically valid and accessible method for assessing markers of representational risk in parent interviews. This study reports associations between maternal representational risk and long-term child outcomes in a sample (N = 75) of mothers and children who participated in the Minding the Baby™ (MTB) program, an attachment-based, trauma-informed, home-visiting intervention for first-time mothers and infants at heightened risk for attachment difficulties. Data were collected as part of two randomized controlled trials and a subsequent follow-up study of MTB. Results indicate that mothers who participated in MTB had significantly lower levels of representational risk, and that representational risk, in turn, significantly predicted later child behavior problems at follow-up. Clinical implications for prevention and intervention services, as well as future directions for research in risk assessment and outcome measurement, are discussed.