Parents' Adverse Childhood Experiences Matter: A Moderation Analysis of the Association between Parental Pre-Mentalization and Child Emotional and Behavioral Difficulties

Background: Children experiencing emotional and behavioral difficulties (EBD) is a significant public health concern as childhood EBD increases risks for compromised school performance, delinquency and crimes, and lifelong mental illness. Research suggests that children living with parents who experienced past trauma are more likely to develop EBD. Attachment theory suggests that one aspect of parenting – parental pre-mentalization – will contribute to child’s EBD. Parental pre-mentalization refers to parents’ distorted ways of interpreting their child’s subjectivity as malevolent. Understanding the association between parents’ own trauma histories, parental pre-mentalization, and child EBD can provide implications for addressing intergenerational effects of trauma.

Methods: We collected data from 202 online parent participants via Amazon Mechanical Turk – an online data collection platform increasingly used by social scientists. Parents’ trauma histories were assessed by the 10-item Adverse Childhood Experiences (ACEs) Questionnaire that measures the occurrence of childhood adversity in the respondents’ first 18 years of life. Parental pre-mentalization was measured by the 6-item pre-mentalization subscale of the Parental Reflective Functioning Questionnaire. Child EBD was assessed by the 20-item Problem Severity Subscale of the Ohio Youth Problem, Functioning, and Satisfaction Scales. A multiple regression analysis was conducted to examine the association between parental pre-mentalization and child EBD, which was followed by a moderation analysis to test the hypothesis that the negative effect of parental pre-mentalization on child EBD would be exacerbated among parents who had a higher level of ACEs (ACEs >= 4), compared to parents experiencing lower or no ACEs (ACEs < 4). Relevant covariates included child age and gender, as well as parents’ gender, race, age, education, household income, and marital status.

Results: About 53 % of the parent participants reported their boys’ outcomes and 47% reported girls’. The average child age was 10.9. Almost 71 % of the parents were Caucasian Americans, 6.4 % African Americans, 5.4 % Hispanic Americans, 13.4 % Asian Americans, and 3.5 % biracial or multiracial. The mean age of parents was 38, with more mother figures (56.3 %) than father figures, and 80 % of the participants were married. About 31% parents experienced ACEs >= 4 and the top three prevalent ACEs experienced by parents in this sample were emotional abuse, parental separation/divorce, and having a family member with mental health problems/suicidal attempts. After controlling covariates, results from multiple regression analyses suggested that parental pre-mentalization was positively associated with child EBD (β = 0.29, p = 0.002). A significant interaction effect was identified (β = 0.67, p < 0.001), suggesting a stronger negative effect of parental pre-mentalization on child EBD among parents who experienced 4 or more ACEs.

Conclusion and Implications: This study suggested that reducing parental pre-mentalization can effectively prevent child EBD. The mentalization-based intervention, which was originally developed for treating patients with borderline personality disorder, can be tailored to decrease parental pre-mentalization. This mentalization-based intervention will be more beneficial to children whose parents have higher levels of childhood adversity. Child behavioral health services models should be trauma-informed and family-focused to improve child well-being.