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Functional magnetic resonance imaging (fMRI) has increasingly been employed to establish whether there is a specific brain neural network dedicated to maternal responsiveness. We undertook systematic review and meta-analysis of all studies in which healthy new mothers were exposed to visual stimuli of own versus other infants to determine the quality of evidence for a dedicated maternal neural network. Systematic literature review revealed a pattern of specific neural responses commonly induced by visual infant paradigms. Brain areas consistently reported as activated in mothers in response to own versus unknown infant included the left thalamus, bilateral pre-central gyrus, left limbic lobe, uncus, amygdala and left caudate. These regions are implicated in reward, attention, emotion processing and other core social cognitive skills. Meta-analysis, however, revealed a more limited subset of brain areas activated in mothers specifically in response to their own versus unknown infant and suggested considerable inter-study variability. Further work is needed if functional imaging is to become an objective tool for the assessment of neural pathways associated with distinct patterns of maternal care behaviour. Such a tool would be invaluable in developing biomarkers of neural activity associated with healthy maternal care and for monitoring treatment/intervention effects of costly parenting interventions.

This review aims to consider evidence for the impact of maternal psychopathology on the child's attachment to the mother, and the role of this in mediating the known transmission of developmental and clinical risk to children. The studies reviewed focus on mothers with depression and psychotic disorder. A number of studies (mainly of mothers with depression) demonstrate an association between insecure/disorganised infant attachments and severe maternal psychopathology, whether chronic or current, in the presence of comorbid disorder, maternal insecure or unresolved attachment state of mind, trauma/loss, or low parenting sensitivity. Whether such effects last into middle childhood, however, is unclear. Our understanding of the role of attachment in determining developmental trajectories in this group is at an early stage. Some evidence suggests that attachment may have a role in mediating the intergenerational transmission of internalizing and other problems in this group, although the presence of co-occurring contextual risk factors may account for the variability in findings. A multifactorial longitudinal approach is needed to elucidate such factors. However, the current literature highlights which subgroups are likely to be vulnerable and provides an evidence-based rationale for taking an attachment-based approach to intervention in this group.

This review evaluates empirical studies that have attempted to improve observed mother-infant relationships in order to inform a potential approach for mothers with schizophrenia, a growing group of vulnerable families where mothers are known to have relational difficulties. Parenting intervention studies in: (1) mothers with a mental disorder; (2) other vulnerable groups were reviewed. Only interventions that empirically evaluated observations of mother-child interaction or child attachment were included, and their potential usefulness for mothers with schizophrenia was examined. Nine studies involved mothers with mental disorder; none involved mothers with psychotic disorder specifically. Overall, approaches that emphasise the mother-child dyad, such as sensitivity-focused behavioural techniques and toddler-parent psychotherapy, were most efficacious for improving maternal sensitivity/child attachment. Although individual psychological therapies are the more conventional treatment, little current evidence suggests that mother-infant relations improve with symptom reduction. The usefulness of the available evidence for informing interventions with mothers with schizophrenia is discussed in the context of their clinical needs. Feasibility studies are needed, which provide a focus on enhancing maternal sensitivity directly within a multi-level support package.