The ERiC trial at the Anna Freud Centre is testing a brief mentalisation-based approach aimed at helping children with mixed emotional and behavioural difficulties, highlighting a shift towards emotion regulation-focused care.
Children who arrive in mental health clinics often do not fit neatly into one diagnosis. Anxiety can sit alongside anger, withdrawal can coexist with disruptive behaviour, and sadness may spill into conflict at home and at school. That reality is what the Emotion Regulation in Children trial, or ERiC, is designed to address, according to the Anna Freud Centre and a clinical protocol published by researchers. The study is testing a brief form of Mentalization-Based Treatment for children aged 6 to 12 who have mixed emotional and behavioural difficulties.
Rather than organising care around a single disorder, the approach focuses on emotion regulation as a shared process that may underlie several problems at once. Midgley and colleagues describe the intervention as a way of helping children and parents understand behaviour in terms of thoughts, feelings and intentions. The aim is to improve how children manage emotion and how families respond to it together.
That emphasis reflects a wider concern in child mental health. A narrative systematic review of mentalisation-based interventions for middle childhood found 29 different approaches for children aged 6 to 12 and their carers, but it also noted that much of the evidence base remains thin. Many studies were small, of limited quality, or failed to measure child mentalising and child-reported outcomes, underscoring the need for stronger trials.
Mentalisation is the ability to interpret behaviour in terms of underlying mental states. In practice, that can mean helping a child move from “my mother shouted because she hates me” to a more tentative understanding that she may have been frightened, stressed or overwhelmed. For parents, it can mean seeing defiance not only as provocation but possibly as shame, fear or emotional overload. The ERiC model is built on the idea that this kind of reflective stance can make it easier to regulate emotion and reduce reactive conflict.
The family context matters because children’s regulation is not purely individual. Parents often help name feelings, interpret events and calm distress, and the trial’s treatment model works directly with that relationship. Research cited in the source material suggests that parental reflective functioning is linked to children’s internalising and externalising symptoms, although that does not mean parents cause those difficulties. The point, rather, is that family stress, poverty, parental mental ill health, trauma and wider pressures can all shape how well adults are able to keep a reflective mindset.
The trial itself is substantial. According to the protocol, it plans to recruit 320 children and their parents or carers, with families randomly assigned to Mentalization-Based Treatment or treatment as usual. The intervention is intended to be brief, usually six to eight sessions, and delivered in ordinary child and adolescent mental health services rather than a specialist research unit. Clinicians receive training and supervision, and the study will assess whether staff from different professional backgrounds can deliver the model reliably.
Early evidence remains suggestive rather than decisive. The review by Midgley and colleagues found a range of mentalisation-informed work for children, but only a minority of studies reported outcomes robustly. A separate randomised trial has now examined the approach in 222 children and their families, measuring internalising and externalising problems, emotion regulation, parenting stress and related outcomes. Even so, the broader message from the literature is cautious: the framework looks promising, but the field still needs well-powered studies before strong claims can be made.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
