اثربخشی مداخلهٔ مبتنی‌بر الگوی گفتمان مادر- کودک بر کاهش مشکلات برونی‌سازی و بازنمایی ذهنی منفی از مادر و افزایش انسجام روایتی کودکان دارای مشکلات برونی‌سازی

زمینه و هدف: در رابطهٔ مادر-کودک، ارتباط گفتمانی در شکل‌گیری یا کاهش مشکلات کودکان موثر تشخیص داده شده است. هدف پژوهش حاضر بررسی اثربخشی مداخلهٔ مبتنی‌بر الگوی گفتمان مادر-کودک تدوین‌شده، بر کاهش مشکلات برونی‌سازی، کاهش بازنمایی ذهنی منفی از مادر و افزایش انسجام روایتی کودکان دارای مشکلات برونی‌سازی بود. روش‌ بررسی: پژوهش حاضر نیمه‌آزمایشی و از نوع طرح‌های پیش‌آزمون، پس‌آزمون و پیگیری با گروه گواه بود. جامعهٔ آماری را 26 زوج مادر-کودک، دارای کودکان 4تا6 سال با مشکلات برونی‌سازی در مهدکودک‌های سازمان بهزیستی شهر تهران در سال 1397 تشکیل دادند که به‌طور دردسترس انتخاب شدند. بعد از همگن‌کردن براساس متغیرهای جمعیت‌شناختی، شرکت‌کنندگان به‌طور تصادفی در یک‌گروه 14نفرهٔ آزمایشی و یک‌گروه 12نفرهٔ گواه قرار گرفتند. گروه‌ها به‌‌وسیله‌ٔ فهرست رفتاری کودک (آخنباخ و رکسورلا، 2001) و مجموعهٔ داستان‌های مک‌آرتور (امد و همکاران، 2003) ارزیابی شدند. عنوان بسته‌ٔ آموزشی مداخلهٔ تدوین‌شده در این پژوهش «مداخلهٔ مبتنی‌بر الگوی گفتمان مادر-کودک» بود که اعتبار آن به تایید پنج نفر از متخصصان دارای دکتری تخصصی روان‌شناسی رسید. جلسات مداخله در 7 جلسهٔ دوساعته و به‌صورت هفتگی برای گروه آزمایش اجرا شد. در ‌تحلیل آماری از تحلیل واریانس با اندازه‌گیری مکرر و آزمون تعقیبی بونفرونی در نرم‌افزار spss نسخۀ 22 استفاده شد. سطح معناداری آزمون‌ها 0/05 درنظر گرفته شد. یافته‌ها: اثرات تعاملی زمان و گروه نشان داد مداخله برای هر سه متغیر مشکلات برونی‌سازی (0/001>p)، بازنمایی ذهنی منفی از مادر (0/001>p) و انسجام روایتی کودک (0/020=p) معنادار بود. در سه متغیر ذکرشده تفاوت بین مراحل پیش‌آزمون و پس‌آزمون (0/05>p) و پیش‌آزمون و پیگیری (0/05>p) معنادار بود؛ اما بین مراحل پس‌آزمون و پیگیری معنا‌دار نبود که نشان‌دهنده‌ٔ ماندگاری تاثیر مداخله است. نتیجه‌گیری: بستهٔ مداخله‌ای مبتنی‌بر الگوی گفتمان مادر-کودک که در این پژوهش تدوین شده است، منجربه کاهش مشکلات برونی‌سازی، کاهش بازنمایی ذهنی منفی از مادر و افزایش انسجام روایتی کودکان دارای مشکلات برونی‌سازی می‌شود.

the effects of mother-child discourse in externalizing problems, the negative mental representation of mother and child, and the narrative coherence of children with externalizing problems

background & objectives: externalizing problems are associated with numerous unpleasant consequences, i.e., among the most frequent reasons for children’s referral to mental healthcare centers. various factors were proposed respecting this issue’s etiology, ranging from genetic to environmental and familial features. however, mother-child interactions, and especially the mother-child discourse during preschool can impact the formation or reduction of numerous problems in such children. as per different theories, the components of the mother-child discourse are related to the child’s mental representations of attachment as well as the child’s narrative coherence ability. however, few interventions focusing on children’s behavioral problems have particularly addressed the significance of mother-child discourse. therefore, the present study aimed to investigate the effects of a formulated intervention based on the mother-child discourse model on reducing externalizing problems by reducing negative mental representations and increasing the narrative coherence of children with externalizing problems.methods: this was a quasi-experimental study with a pretest-posttest-follow-up and a control group design. the statistical population of the study consisted of 4- to 6-year-old children with externalizing problems in the kindergartens of the welfare organization of tehran city, iran, and their mothers in 2018. twenty-six mother-child couples whose children had externalizing problems were selected using the convenience sampling method. after homogenization based on demographic variables (children’s age & gender, and the educational level & occupation of the mothers), they were randomly divided into two groups; 15 couples were assigned per group. at the end of the study, 3 couples in the experimental group (n=12 couples( and 4 couples in the control group )n=11 couples( were excluded. the inclusion criteria of the research for the mothers included having a diploma and the lack of anxiety disorders and depression based on the diagnostic and statistical manual of mental disorders, 5th edition (dsm-5); for children, the same was an age range of 4 to 6 years, receiving a score within the range of externalizing problems (65-69) according to the child behavior checklist (cbc; achenbach & rescorla, 2001), and not taking psychiatric drugs. then, the children were assessed by the cbc concerning externalizing problems. moreover, the macarthur story stem battery (emde et al., 2003) was applied to examine the negative mental representations of attachment and narrative coherence in them. furthermore, the intervention sessions were entitled intervention based on mother-child discourse, i.e., a short-term approach to reduce externalizing problems in children. this package was prepared under the supervision of child psychologists; the content validity method was used to validate the package. the study was conducted in seven 2-hour weekly sessions with 4 sessions for mothers and 3 sessions for the mothers and children. repeated-measures analysis of variance (anova) and bonferroni posthoc test were used for data analysis in spss at the significance level of 0.05.results: the repeated-measures anova data revealed that the main effect of time was significant on externalizing problems (p<0.001), the negative mental representation of attachment to the mother (p<0.001), and the child’s narrative coherence (p=0.020). moreover, the main effect of intergroup was significant on externalizing problems (p=0.040) and the negative mental representation of attachment to the mother (p<0.001). accordingly, the mean scores of the experimental and control groups were significantly different; however, children’s narrative coherence was not significantly different between the two groups, suggesting that the change over time was the same for both study groups. besides, the intervention for externalizing problems (f1.22=116.89, p<0.001, ƞ=0.84), the negative mental representation of attachment to the mother (f1.22=165.00, p<0.001, ƞ=0.82), and the child’s narrative coherence (f1.22=5.90, p<0.020, ƞ=0.21) were significant. in terms of externalizing problems, the difference between pretest and posttest stages (p<0.001), and pretest and follow-up steps (p<0.001) was significant; however, there was no significant difference between the posttest and follow-up stages, indicating the persistence of the intervention (p=0.460). respecting negative mental representation, the difference between pretest and posttest stages (p<0.001) and pretest and follow-up steps (p<0.001) was significant; however, there was no significant difference between the posttest and follow-up stages, reflecting the persistence of the intervention effects (p=0.170). there was a significant difference between pretest and posttest (p=0.010) and pretest and follow-up stages (p=0.040) in narrative coherence; however, there was no significant difference between the posttest and follow-up stages, demonstrating the persistence of the intervention effects (p=0.560).conclusion: according to the present research results, the intervention based on the mother-child discourse model was useful for reducing externalizing problems, reducing negative mental representations, and increasing the narrative coherence of children with externalizing problems.