Foster Parents Ability to Mentalize Reduces Parent/Child Dysfunctional Interactions for Those Parents with More ACEs

Background: There has been much research on the negative impact of adverse childhood experiences (ACEs) on adult mental health. Within parenting research, studies have shown that the more ACEs parents have, the greater the developmental risk to their children, including an increase in emotional and behavioral difficulties. Adults with unresolved trauma can struggle with parenting and are at a greater risk of abusing/neglecting their children. Mentalization is a cognitive skill that involves the ability to tease out the mental states in self and other, and has the potential to help mitigate the risks associated with having parental ACEs. Foster parents who have low mentalizing skills are more likely to be triggered negatively by their foster children and thus parent in an insensitive manner. Therefore, mentalization would be an important skill to have when caring for traumatized children. A randomized controlled trial (RCT) of a parental mentalizing intervention found that the number of parental ACEs positively correlated to foster parent/child dysfunctional interactions. For this study, we hypothesized that a parent’s ability to mentalize would mediate this relationship.

Methods: The data used for this secondary analysis was collected as part of an RCT of a psychoeducation mentalizing intervention for foster parents, conducted from January 2017 to April 2018 in Texas (N=61). Mediation and linear regression analyses were conducted to examine the relationship between scores on the ACEs, the Parental Reflective Function Questionnaire and the Parent/Child Dysfunctional Interaction scale of the Parenting Stress Index.

Results: Results indicated that foster parents’ ACEs were indirectly related to parenting stress from parent/child dysfunctional interactions through a parent’s ability to mentalize. First, higher ACEs were significantly related to lower parental mentalizing (a = .206, p < .001), and lower parental mentalizing was significantly related to more parent/child dysfunctional interactions (b = 7.42, p < .001). A 95% bias-corrected confidence interval based on 10,000 bootstrap samples indicated that the indirect effect (ab = 1.53) was entirely above zero (.624 to 2.84) and therefore statistically significant. Once the mediator (parent mentalizing) was added, parent ACEs no longer predicted parent/child dysfunctional interactions (c = 1.10, p = .09). This means relationship between foster parent ACEs and parent/child dysfunctional interactions was completely mediated by parental mentalization.

Conclusions and Implications: From these results, we can infer that for foster parents with a history of childhood trauma, stress around parent/child dysfunctional interactions can be regulated via their ability to mentalize. Thus, a parent can have a high number of ACEs, but if their mentalizing skills are good, then this significantly lowers the chances of having such distressful interactions. These results support the use of parenting interventions that increase mentalizing skills for foster parents who have a history of childhood trauma, as it has the potential to increase their parental resilience and capacity to regulate relational stress that often accompanies foster children who have been through trauma, abuse or neglect. This has the potential to positively impact both foster child wellbeing and placement stability.