Name: assessing the coherence of parents' short narratives regarding their child using the five-minute speech sample procedure
Uploaded: 2019-09-19T14:45:00
Duration: 7 min 56 s
Description: Watch this Scientific Journal Video about Assessing the Coherence of Parents' Short Narratives Regarding their Child Using the Five-Minute Speech Sample Procedure at JoVE.com

This research was supported by the National Institute of Health Grant 1R03HD065036-01A and the National Science Foundation Grant 1628820 awarded to Tuppett M. Yates and Efrat Sher-Censor and the Herta and Paul Amir Faculty of Social Science, the University of Haifa, Israel. The author would like to thank Dr. Smadar Dolev for taking part in the film.

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The author has nothing to disclose.

Four of our previous studies examined both the coherence and EE in parents&#39; FMSS (Davidovitch, M., 2018)29,30,32. Separate coding teams rated FMSS-Coherence and FMSS-EE. Three of these studies showed that FMSS-Coherence and the criticism component of FMSS-EE were significantly negatively correlated, although the associations were small to moderate (Davidovitch, M., 2018)29,32. The fourth study did not find a significant association between FMSS-Coherence and EE-criticism30. In addition, the four studies showed that FMSS-Coherence is not significantly associated with other components of FMSS-EE, namely, emotional overinvolvement and positive comments. Furthermore, FMSS-Coherence had a unique contribution to the explained variance of child adjustment indices. In one study, FMSS-EE was associated with mothers&#39; reports of preschoolers&#39; behavior problems while FMSS-Coherence was associated with observers&#39; reports of the preschoolers&#39; behavior problems32. In another study, only FMSS-Coherence and not FMSS-EE was associated with preschoolers&#39; descriptions of parents in play narratives29; Finally, in two studies FMSS-Coherence contributed to the explained variance of toddlers&#39;30 and school aged children&#39;s (Davidovitch, M., 2018) externalizing behavior problems, as reported by the mother, above and beyond the contribution of FMSS-EE. Taken together, these results suggest that FMSS-Coherence is distinct from FMSS-EE and point to the added value of assessing the coherence of parents&#39; FMSS in relation to the traditional EE coding.
Researchers who wish to use FMSS-Coherence should take into consideration the following. Administrating the FMSS as the first measure of the research procedure is vital, as any measure administered prior to the FMSS may color parents&#39; narratives. It is also important that the parent will be alone in the room with the interviewer, without the presence of other family members, to allow the parent to speak freely about the child.
Minimal interaction between the parent and the interviewer during the FMSS is critical. FMSS research suggests that the vast majority of parents are able to complete the task of speaking uninterruptedly about their child for 5 min. Yet, researchers of high risk families, such as homeless parents35 and mothers of twins who gave birth before the age of 2023 suggest to provide a series of standardized prompts when parents experience difficulties in narrating for 5 min (e.g., &#34;In what ways would you like your child to be different?&#34;; &#34;What is your child like in comparison with other children the same age?&#34; 23). These studies examined only FMSS-EE. As such prompts explicitly invite the parent to narrate about varied aspects of the child&#39;s characteristics, it may lead to higher scores in the elaboration and complexity components of coherence and influence the final coherence score. Research is required to compare results obtained with and without additional prompts. Such studies conducted with high- and low-risk families may indicate whether there are benefits in using such modified protocol for evaluating parents&#39; FMSS-Coherence, and if so, in which contexts.
Finally, coding the six subscales (focus, elaboration, separateness, concern, acceptance/rejection and complexity) before rating the final coherence score is warranted to improve coding quality. To date, studies have looked only at the final coherence score. Nevertheless, future research with large-scale samples may examine whether the profile of strengths and difficulties parents are showing in their FMSS, as reflected in their scores on the six subscales, are related to distinct parenting behaviors and child outcomes (e.g., parents who provide a meager FMSS versus parents who show a high level of concern). Such an approach may be particularity useful in clinical settings, as it may facilitate tailoring individualized interventions that meet the specific difficulties parents expressed in their FMSS36.
FMSS-Coherence is a promising method for research of the parent-child relationship and other close relationships. Nevertheless, two limitations should be noted. First, validation of the method in countries other than the United States and Israel is required. Second, as the FMSS includes only a single broad question, it can be easily adapted to different contexts. As shown above, FMSS-Coherence can be used not only for interviewing parents about their children, but also for interviewing them about their romantic partner (River, L., et al., 2019) and for interviewing adolescents about their parents34. However, extending the use of the FMSS-Coherence method to other relational contexts should be done with caution. For example, FMSS-Coherence may be less applicable for assessing the quality of relationships that do not involve caregiving. In addition, prior EE research documented the validity of the FMSS-EE and the TMSS-EE (i.e., Three-Minute Speech Sample-EE) for children aged 6 years and up, who were asked to narrate about their parents37 or siblings38. Narrative skills, and abstract and critical thinking, which are vital for narrating coherently, develop significantly during the transition from childhood to adolescence39,40. Thus, the FMSS-Coherence method may not be applicable to children younger than mid-adolescence.
Additional research is needed to address the following issues. The first future direction involves examining whether parents&#39; FMSS-Coherence is associated with parents&#39; sensitivity and child attachment, the main outcomes of parents&#39; narrative coherence examined in attachment research that used lengthy interview protocols12,14,15,16. Support for the link between FMSS-Coherence and mothers&#39; sensitivity comes from the study described above of mothers of children diagnosed with ASD31. Although the results of this study are promising, replication is needed with mothers of typically developing children. Second, although varied participants&#39; characteristics were examined in prior FMSS-Coherence research29,30,31,32,33,34, whether personality characteristics of parents shape the coherence of their FMSS awaits future research. Third, future studies would benefit from examining not only mothers&#39; but also fathers&#39; FMSS-Coherence and their association with paternal sensitivity and child socio-emotional adaptation. Fourth, most studies used the dichotomized coherent versus incoherent categories (e.g.31,32,33). This is in line with attachment research that typically uses a two-step coding procedure that begins with continuous scales and ends with classifying parents into categories that are used in data analyses12,13,14,15,16. The notion underlying this approach is that coherent narratives and incoherent narratives are qualitatively different4. However, growing evidence from attachment research41 as well as a few FMSS-Coherence studies30,34 suggest that the variation underlying FMSS-Coherence may be distributed continuously. Thus, additional studies are needed with large samples that would allow examination of individual differences among parents who narrate coherently and among parents who narrate incoherently and their associations with parenting quality and child&#39;s outcomes.

Attachment theory suggests that the coherence of parents&#8217; narratives, namely the extent to which parents provide clear, consistent and multifaceted portrayals of their child, is of particular importance for learning about the emotional climate of the parent-child relationship1,2. According to this view, the coherence of parents&#8217; narratives captures the coherence of their internal representations (i.e., feelings, attributions and expectations) of the child. Parents&#8217; representations are defined as complex information processing rules that guide parents&#8217; interpretation of their child&#8217;s behavior as well as parents&#8217; behavior toward the child1,3, and consequently shape child adjustment.
Some parents process information regarding their child in a flexible manner. Their representations of the child are presumably undistorted and include strengths as well as challenging aspects of the child&#39;s characteristic and the parent-child relationship. When asked to narrate regarding the child, these parents would presumably provide multifaceted and integrated (i.e., coherent4) descriptions of the child and their relationship. Importantly, parents&#8217; coherent representations are thought to facilitate an accurate interpretation of the child&#8217;s signals as well as prompt and appropriate responses to the child (i.e., sensitive caregiving5). This in turn contributes to the child&#8217;s sense of security and competence as well as better self-regulation6,7.
Other parents process information regarding their child in a distorted way, and construct incoherent representations, which could take different forms, such as unilateral representations that are negative and overemphasize the child&#8217;s weaknesses, overwhelmed with concern, colored by difficulties in separateness from the child, idealizing or poorly integrated. Such representations are presumably mirrored in incoherent narratives that are unidimensional and/or inconsistent. Incoherent representations may hamper accurate interpretation of the child&#8217;s signals and lead to parents&#8217; insensitive caregiving in terms of emotional detachment, hostility, rigidity and harshness, or overprotectiveness and intrusiveness1,2,4. The child in turn, might internalize the incoherent representations of the parent8, construct negative expectations regarding close relationships, learn to restrict or exaggerate emotional expressions in relational contexts9, and experience poorer socio-emotional adjustment10,11.
Attachment research supports to these notions7,9,10,11. Yet, extant methods to assess the coherence of parents&#8217; narratives involve labor intensive semi-structured interviews12. These include the Adult Attachment Interview13, in which parents are asked to narrate about their early attachment experiences, and the Working Model of the Child Interview14, the Parent Developmental Interview15 and the Insightful Assessment16,17, in which parents are invited to narrate regarding their child. Due to their length and costs, the employment of these methods in large-scale research and practice with parents is relatively limited. To overcome this drawback, this paper introduces a new method for assessing the coherence of parents&#8217; short narratives elicited using the FMSS procedure.
The FMSS procedure was developed by the psychoanalyst and researcher Louis Gottschalk and his colleagues18,19. The researchers argued that although the procedure is brief, it maximizes the projection and expression of internal psychological states, response sets and attitudes as it requires narrating without the aid of prompts or responses from the interviewer18. Adult psychiatry researchers have embraced this procedure and have been using it to evaluate the quality of the relationships formed between mentally ill patients and their caregivers. In this context, a caregiver is invited to talk about the mentally ill relative and their relationship, and the FMSS is coded for expressed emotion (FMSS-EE20), namely caregivers&#8217; statements of criticism and emotional overinvolvement toward the relative. FMSS-EE is effective in indexing poor quality of caregiver-patient relationships and predicting patients&#8217; maladaptation and relapse risk21,22. Over the past three decades developmental and pediatric researchers have adopted the FMSS-EE method. The FMSS-EE coding was adapted to the context of parenting young children, for example, by adding the assessment of parents&#8217; positive comments regarding the child and the parent-child relationship (see references for examples23,24,25). Research on parents of children from infancy through adolescence have shown that FMSS-EE is related to parenting quality and is associated with and predicts the socio-emotional adjustment of the child26,27.
Attachment and FMSS-EE research have developed separately. Thus, EE research does not examine the coherence of the FMSS. To assess the coherence of parents&#8217; FMSS, the Insightful Assessment rating scales17 have been recently adapted to be used with the FMSS. This paper presents the protocol for collecting parents&#8217; FMSS and coding FMSS-Coherence. Results of studies that used the FMSS-Coherence method are described. Finally, directions for future research with FMSS-Coherence and issues that should be taken into consideration by researchers who plan to use FMSS-Coherence are discussed.

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			<td height="20" style="height:20px;width:183px;">A voice recorder</td>
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			<td height="21" style="height:21px;">A stop-watch</td>
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			<td height="20" style="height:20px;">A word processing software</td>
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assessing the coherence of parents' short narratives regarding their child using the five-minute speech sample procedure

Valid and efficient measures for assessing the quality of parent-child relationships are needed to facilitate research and evidence-based practice with parents. This paper focuses on such a method, namely Five-Minute Speech Sample-Coherence (FMSS-Coherence). In this method, a parent is asked to speak for five uninterrupted minutes about her/his child and their relationship. The resulted narrative is coded for coherence, namely the extent to which the parent provides&#160;in the narrative&#160;a clear, consistent, multidimensional and well-supported portrayal of the child. FMSS-Coherence is based on attachment research that shows that the coherence of parents&#8217; narratives is indicative of the quality of the parent-child relationship and child adjustment. It overcomes the limitations of attachment narrative measures which are typically labor intensive. FMSS-Coherence is less nuanced than extant attachment narrative measures. Yet, studies of families from different cultural backgrounds, across different child ages and in the context of typically developing children as well as children with special needs suggest that coherence can be reliably evaluated using the FMSS procedure. Furthermore, parents&#8217; FMSS-Coherence is associated with parenting quality and children&#8217;s socio-emotional adjustment. Thus, it holds promise for researchers and practitioners who seek a relatively time- and cost-effective method for assessing the coherence of parents&#8217; narratives regarding their child.

Interrater reliability 
Interrater reliability of the FMSS-Coherence scores ranged from very good to excellent across prior studies. ICC of the continuous scores ranged between 0.86 and 0.95 29,30, and Kappa ranged between 0.83 and 1.0031,33.
FMSS-Coherence, observed parenting and child adjustment 
In support of the notion that parents&#39; coherent narratives are associated with more sensitive caregiving, a study of mothers and young children with ASD attending special education schools indicated that mothers who provided coherent FMSS showed higher emotional availability during observed play interaction with their child as compared with mothers who provided incoherent FMSS. In other words, mothers who provided coherent FMSS were more sensitive, provided more appropriate structuring, and were less intrusive when interacting with their child31&#160;(see Figure 1).
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/60025/60025fig1.jpg" /> 
Figure 1: Mothers&#39; mean emotional availability to their child with ASD by mothers&#39; FMSS-Coherence. Error bars represent standard errors of the mean (p &#60; 0.05). <a href="https://www.jove.com/files/ftp_upload/60025/60025fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
In line with the notion offered by attachment researchers that parents&#39; representations are internalized by their children, preschool children whose mothers provided incoherent FMSS showed more negative depictions of the parent-child relationship in their play-narratives than children whose mothers provided coherent FMSS29. Finally, as expected, parents&#39; coherent FMSS are related to better socio-emotional adjustment of their children. The coherence of mothers&#39; FMSS is associated with fewer behavioral problems of their toddlers30, preschoolers32&#160;and school-aged children (Davidovitch, M., 2018). In addition, mothers&#39; FMSS-Coherence predicts a decrease in externalizing behavior problems, an increase in ego resiliency, and an increase in peer acceptance from preschool to first grade among children with self-regulation difficulties33.
Applying the FMSS-Coherence method to other relational contexts 
Recent findings point to the utility of FMSS-Coherence in research of other close relationships. A study in which pregnant mothers provided FMSS regarding the father-to-be found that lower coherence of the FMSS was associated with mothers&#39; childhood maltreatment experiences, and this link was mediated by mothers&#39; post-traumatic stress disorder (PTSD) symptoms (River, L., Castillo, M., Narayan, A., Sher-Censor, E., Lieberman, A., 2019). In another study in which adolescents provided FMSS regarding their mothers, adolescents&#39; coherent FMSS mediated the association between higher maternal sensitive guidance, observed during mother-adolescent dialogue on autobiographic emotional events, and fewer behavior problems of the adolescents, as reported by adolescents&#39; examiners34. This result is in line with attachment theory notion that when the child receives sensitive caregiving, she/he would construct coherent representations of the relationship with the caregiver, which in turn would facilitate better adjustment of the child8,9,10,11.
FMSS-Coherence and participants&#39; characteristics 
To support the notion that FMSS-Coherence captures quality of the relationship, FMSS-Coherence studies controlled for several participants&#39; characteristics. These included mother and child age29,30,31,32,33, birth order29,30,31,32,33, child gender29,30,31,32,33, marital status29,32,33, mothers&#39; and adolescents&#39; receptive vocabulary and/or education level29,30,31,32,33, family socioeconomic status29,30,32,33, maternal psychological distress, economic distress and health condition31, and adaptive behavior of children with ASD31. Of these characteristics, only mothers&#39; receptive vocabulary and education level&#160;were significantly related to mothers&#39; FMSS-Coherence and adolescent gender was related to adolescents&#39; FMSS-Coherence, with girls showing higher levels of coherence than boys. Notably, the associations of FMSS-Coherence with observed parenting and child socio-emotional adjustment were significant when controlling for these characteristics30,31,32,33. Finally, studies suggest that FMSS-Coherence is valid among ethnic minorities and immigrant families (in the US: Hispanic and Black32; in Israel: Arab-Israelis31; and immigrants from the Former Soviet Union and Western countries34).

Watch this Scientific Journal Video about Assessing the Coherence of Parents' Short Narratives Regarding their Child Using the Five-Minute Speech Sample Procedure at JoVE.com

Assessing the Coherence of Parents' Short Narratives Regarding their Child Using the Five-Minute Speech Sample Procedure

This paper introduces a method for assessing the coherence of parents' short narratives regarding their child and their relationship using the five-minute speech sample procedure.

Valid and efficient measures for assessing the quality of parent-child relationships are needed to facilitate research and evidence-based practice with ...

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