Seeing the Child Within: A Randomized Controlled Trial of Reflective Functioning Intervention for Parents of Autistic Children

Abstract

Parents of autistic children often face elevated emotional demands and challenges in interpreting their child's inner experience. Parental reflective functioning (PRF), the capacity to understand behavior in terms of underlying mental states, is considered a key mechanism in fostering emotionally attuned and adaptive caregiving. Despite its importance, few interventions directly target PRF, and fewer still have tested brief, group-based formats designed for broad accessibility. We conducted a randomized controlled trial to evaluate a brief, virtual PRF intervention delivered via Zoom to 249 parents of autistic children. Participants were randomly assigned to either an intervention group (n = 129) or a waitlist control group (n = 130), and completed assessments at baseline and postintervention. PRF was measured using a standardized interview, while self-report questionnaires assessed parenting self-efficacy, beliefs about emotional malleability, depressive symptoms, and child adaptive functioning. Generalized estimating equations revealed significant time-by-group interactions favoring the intervention group across several outcomes. Relative to controls, intervention participants reported greater gains in reflective functioning, parenting self-efficacy, and emotional beliefs, alongside improvements in children's communication and conceptual adaptive functioning. Effects were most pronounced among parents of younger children. Within the intervention group, additional follow-up assessments indicated sustained benefits on workshop-specific outcomes. Findings support the feasibility and efficacy of brief, scalable PRF-based programs for caregivers of autistic children. To our knowledge, this is the first randomized trial to demonstrate that a short, online, parent-focused intervention can enhance reflective parenting and promote emotional and relational benefits in this population.