Adverse childhood experiences (ACEs) can compromise parents’ ability to form supportive and attuned parent-child relationships, and mentalizing may be a critical conduit linking ACEs to perceived relational strain, a core dimension of parenting stress. Foster parents may be especially vulnerable due to elevated ACE exposures and the demands of parenting children with complex needs in high-stakes caregiving contexts. Despite these risks, research examining how ACEs influence perceived relational strain through mentalizing remains limited in foster families. Data was obtained from a randomized controlled trial (RCT) of a psychoeducational mentalizing intervention for 89 foster parents. A mediation analysis tested mentalizing as an indirect influence on links between parental ACEs and perceived relational strain (as a key dimension of parenting stress). ACEs were associated with increased pre-mentalizing scores, reflecting a reduction in mentalizing capabilities (b = 0.098, p < .05), which in turn was associated with higher levels of perceived relational strain (b = 8.61, p < .001). Bootstrapping (with 5,000 samples) confirmed a statistically significant indirect effect (b = 0.84, 95% CI [0.06, 1.62], p = .034). The contributions of ACEs and mentalizing to perceived relational strain were asymmetrical; ACEs explained 5% of the variance in mentalizing (R² = 0.05), whereas ACEs and mentalizing together explained 31.6% of the variance in parenting stress (R² = 0.316). Sensitivity analyses supported the temporal ordering of variables through longitudinal design. This study highlights the importance of mentalizing capacity as a critical pathway linking ACEs to perceived relational strain in this sample of foster families.
Adverse childhood experiences (ACEs) have enduring effects on the capacity to engage in healthy relationships across the lifespan, with particular implications for parenting (Anderson, 2017; Narayan et al., 2021). This issue is especially salient in foster care, a system designed to provide stability and developmental recovery for children who have experienced significant adversity (Goemans et al., 2016). However, foster children face disproportionately high rates of emotional and behavioral difficulties, shaped not only by the adversity that led to removal from their families of origin but also by ongoing disruptions within the foster care system itself (Goemans et al., 2016; Turney & Wildeman, 2017). Placement instability, caregiver turnover, and ongoing stress undermine opportunities for consistent, secure attachment relationships - which are critical for mitigating developmental risk (Harden, 2004; Connell et al., 2006). While foster care can be a protective context, foster parents may face substantial barriers to effective parenting. For example, foster parents report higher levels of parenting stress compared to biological parents (Bergsund et al., 2020), likely reflecting the demands of parenting traumatized children and managing associated emotional and behavioral disorders (Bergsund et al., 2020; Gabler et al., 2018). Importantly, foster parents themselves may carry high levels of adversity: several studies suggest that foster parents report more ACEs than the general population (Adkins et al., 2020; Lange et al., 2019). ACEs may compromise caregivers’ relational functioning by increasing vulnerability to parenting stress and shaping perceptions of strain or dissatisfaction in the parent-child relationship (Lange et al., 2019; Weistra et al., 2025). Within the parenting stress framework, such perceptions are conceptualized as relational strain, reflecting the parent’s sense of tension, low reciprocity, and emotional distance in interactions with their child (Abidin, 1995; González-López et al., 2024).
ACEs are also implicated in reduced mentalizing, which is a key relational capacity involving the ability to understand a child’s behaviors in terms of underlying thoughts, feelings, and needs (Fonagy & Target, 1997; Treat et al., 2019). Mentalizing supports sensitive, non-reactive caregiving and is associated with stronger parent–child relationships, secure attachment, and positive child outcomes (Camoirano, 2017; Smaling et al., 2017). Both ACEs and parenting stress (including the relational strain component) have been linked to reduced mentalizing ability (Camoirano, 2017; Vismara et al., 2021), suggesting that foster parents with high ACEs may be doubly disadvantaged in managing the relational demands of caregiving. Despite these compounding risks, research examining how foster parents’ ACEs contribute to parenting stress/relational strain, especially through mechanisms like mentalizing, is scarce. This study addresses that gap by testing a mediation model framed by developmental psychopathology and attachment theories (Cicchetti & Toth, 1995; Bowlby, 2004), in which foster parents’ ACEs predict perceived relational strain (a relational dimension of parenting stress), both directly and indirectly through mentalizing capacity. In doing so, this work advances a theory-driven understanding of how early childhood adversity affects later caregiving processes and offers clinically relevant insights for improving support and intervention efforts for foster families.
ACEs, Parenting Stress, and Mentalizing
ACEs refer to exposure to one or more of 10 adverse childhood events before age 18, including: emotional, physical, and sexual abuse, emotional and physical neglect, domestic violence, substance abuse in the home, a caregiver with mental illness, parental separation/divorce, and incarceration of a household member (Felitti et al., 1998). ACEs are linked to a broad range of adult physical and mental health outcomes (Merrick et al., 2018) and have consistently been correlated with problematic parenting experiences and suboptimal child outcomes (Hughes & Cossar, 2016; Hugill et al., 2017). Parenting stress, defined as the stress arising from caregiving in contexts where demands exceed available internal and external resources (Abidin, 1990), is associated with a history of ACEs such that dose-response relationships between total ACEs and parenting stress have been documented even when controlling for socioeconomic factors (Lange et al., 2019; Steele et al., 2016). Within this multidimensional construct, the Parent-Child Dysfunctional Interaction (PCDI) subscale of the Parenting Stress Index captures a distinct relational facet of stress: the parent’s perception of low reciprocity, dissatisfaction, and tension in interactions with their child (Abidin, 1995; González-López et al., 2024). We refer to this aspect as perceived relational strain (PRS), which reflects the parent’s sense that the relationship with the child is strained, unfulfilling, or emotionally distant.
ACEs may contribute to such relational strain by reducing caregivers’ psychological and physiological resources through long-term disruptions to stress-response systems and emotion regulation (Deighton et al., 2018; MacMillan et al., 2009). Reduced coping capacity and heightened reactivity can increase the likelihood of tense, conflictual, or emotionally disengaged interactions, thereby amplifying parenting stress in adulthood (Pereira et al., 2012). In turn, these dynamics are linked to caregiving behaviors characterized by reduced empathy, over-reactivity, harsh or inconsistent discipline, and strained emotional communication (Bailey et al., 2012; Bergsund et al., 2020; Treat et al., 2019). Such relational patterns have been implicated in poorer child outcomes, including lower executive functioning, compromised working memory, internalizing and externalizing behaviors, conduct problems, hyperactivity, and diminished overall health (Adkins et al., 2020; de Cock et al., 2017; Lê-Scherban et al., 2018; Mak et al., 2020; Treat et al., 2019). Despite higher levels of both ACEs and parenting stress among foster parents (Bergsund et al., 2020; Lange et al., 2019), few studies have explicitly examined how ACEs contribute to PRS and parenting stress broadly in this population.
Parental mentalizing refers to the caregiver’s ability to recognize the child as a distinct psychological entity with unique thoughts, feelings, wishes, and intentions (Shai et al., 2017; Slade et al., 2005). Research indicates that parental mentalizing is closely associated with caregiving quality and children’s attachment security (Camoirano, 2017). For instance, one study found that mothers with higher mentalizing scores during pregnancy demonstrated more positive parenting behaviors in free-play and teaching interactions with their six-month-old infants (Smaling et al., 2016). Another study comparing women with and without childhood trauma revealed that mentalizing was associated with parenting sensitivity, which subsequently correlated with infant attachment security (Stacks et al., 2014). Although mentalizing is a fundamental component of healthy parent-child interactions, both parental ACEs and parenting stress are linked to reduced mentalizing abilities (Camoirano, 2017; Ensink et al., 2014; Vismara et al., 2021). For example, a study of 124 mothers with day care-aged children and moderate to low socioeconomic status found that experiences of neglect or abandonment during the mothers’ childhoods correlated with lower mentalizing abilities (San Cristobal et al., 2017). Similarly, a study examining parenting stress and mentalizing in 40 parent-infant dyads identified a strong correlation between lower mentalizing abilities and both higher dysfunctional parent-child interactions and elevated parenting stress (Vismara et al., 2021).
While mentalizing is often more challenging for parents with high parenting stress or ACE histories, evidence suggests that effective mentalizing can still occur under these conditions, promoting positive developmental outcomes for children. For instance, Fonagy and colleagues (1994) reported that among mothers with trauma and deprivation histories, those who maintained adequate mentalizing capacities had children classified as securely attached. Researchers hypothesize that parents’ ability to process and mentalize their own trauma may enhance their capacity to mentalize effectively with their children (Camoirano et al., 2017). This body of research implies that mentalizing is a skill that can be developed and may rely significantly on each individual’s relationship with past trauma (Allen, 2013; Camoirano et al., 2017; Fonagy et al., 1993). Despite elevated rates of ACEs and parenting stress among foster parents, and evidence linking both ACEs and parenting stress to reduced mentalizing, few studies have tested mentalizing as a potential mechanism linking ACEs to perceived relational strain, a core dimension of parenting stress. Given the dual burden of early adversity and high caregiving demands faced by foster parents, understanding this mechanism is essential for developing trauma-informed approaches that stabilize foster care placements and promote child well-being. This work is crucial to promote healthy social-emotional development in foster children who comprise a population that faces disproportionate risk in significant developmental and life outcomes compared to children in the general population (Leve et al., 2012).
Theory and Current Study
This study is guided by developmental psychopathology and attachment theories (Cicchetti & Toth, 1995; Bowlby, 2004), which posit that early adversity can disrupt foundational developmental processes, including the formation of secure attachment relationships and the maturation of social-cognitive capacities such as mentalizing. These disruptions may impair relational functioning in adulthood and compromise caregiving sensitivity. As presented in Fig. 1, the present study builds on this framework and models mentalizing capacity as an indirect pathway linking ACEs to perceived relational strain - a relational dimension of parenting stress reflecting tension, emotional distance, and dissatisfaction in the parent-child relationship. Accordingly, this research addresses three questions: (1) to what extent are foster parents’ ACEs associated with their mentalizing capacity? (2) are foster parents’ ACEs related to their current parenting stress, particularly perceived relational strain in interactions with their children? (3) does foster parents’ mentalizing capacity mediate the association between ACEs and perceived relational strain? This exploratory study is intended to generate hypotheses and build theory regarding modifiable relational mechanisms in foster families. By identifying mentalizing as a potentially modifiable mediator, this work contributes to a testable developmental model that can inform future longitudinal and intervention research. Strengthening foster parents’ mentalizing capacities may enhance relational quality within foster families and create conditions that promote developmental recovery in children who have already faced disruptions in early attachment relationships.
Fig. 1
Mediation Model Hypothesizing the Effect of Parental Mentalization on Associations between ACEs and Perceived Relational Strain
The data for the present study were collected in the state of Texas in the United States (U.S.). In the U.S. child welfare system, children may be placed in foster care when state agencies determine that they cannot safely remain in their current caregiving environment. Foster care involves placement with licensed foster parents who provide family-based, out-of-home care under state supervision. Placements are often temporary and may involve uncertainty regarding duration, reunification, or permanency outcomes (Child Welfare Information Gateway, n.d.; Font & Gershoff, 2020). The sample consisted of 89 licensed foster and adoptive parents recruited through foster care agencies in Texas, collectively caring for 85 children in their homes. Participants’ mean age was approximately 43 years, with ages ranging from 22 to 76 years. The sample was predominantly female (68%, n = 61) and included 32% males (n = 28). Most participants identified as White (72%), while 22% identified as Hispanic, and 11% as Black. This was a highly educated group, with 89% having attended at least some college. On average, participants had nearly four years of experience as foster parents, with experience ranging up to 24 years (see Table 1 for additional demographics). Note that data related to children in foster care has been anonymized to protect their confidentiality.
Procedure
Data for this secondary analysis was obtained from a randomized controlled trial (RCT) of a psychoeducational mentalizing intervention for foster parents, conducted from January 2017 to April 2018 (Adkins et al., 2022) l. Foster parents were recruited via the Texas Department of Family and Protective Services, the state authority for foster care, as well as private child-placing agencies. To participate, foster parents were required to (a) hold an active foster parent license in Texas, and (b) have at least one foster or adopted child aged 4 or older in their home. Please see the work of Adkins and colleagues (2022) for a full description of the study protocol. Data for this study came from the baseline assessment at time point one and the post-intervention assessment at time point two. The current study was determined to be exempt from human subjects review by the University of Texas at Austin IRB.
Measures
Adverse Childhood Experiences (ACEs)
ACEs were assessed at time-point one with the Adverse Childhood Experiences (ACEs) questionnaire (Felitti et al., 1998). This scale consists of 10 questions screening for experiences before the age of 18 consisting of physical, emotional, or sexual abuse, physical or emotional neglect, and household dysfunction including divorce, domestic violence, substance use, or incarceration of a household member. Participants were asked to respond yes/no to each question and items were summed with total scores ranging from 0 to 10. Retrospective reports of ACEs have demonstrated good to excellent test-retest reliability (Dube et al., 2003) and the scale demonstrated adequate internal consistency in this sample (α = 0.79).
Parental Mentalizing
Parental mentalizing, specifically Pre-Mentalizing (PM), was assessed at time-point one using the Parental Reflective Functioning Questionnaire (PRFQ; Luyten et al., 2017), a brief self-report measure designed to evaluate parents’ capacity to understand behavior in terms of underlying mental states. The PRFQ consists of 18 items organized into three subscales: Pre-Mentalizing, Certainty about Mental States, and Interest and Curiosity in Mental States. The PRFQ has demonstrated reliability and validity across various parent populations, including low- and high-functioning mothers of infants and both mothers and fathers of typically developing children. Factor analyses confirm a three-factor structure, consistently replicated across samples, with good internal consistency (α = 0.70–0.82; Luyten et al., 2017). The Pre-Mentalizing (PM) subscale, was used in this study and it captures a cognitive-affective process shaping how parents interpret and respond to their child’s behavior. Non-mentalizing, defensive modes are characterized by rigid, “black-or-white” thinking and psychic equivalence where internal feelings are perceived as absolute truths, limiting flexibility and perspective-taking (Fonagy et al., 2004). Caregivers with high PM scores may interpret a child’s behavior in rigid terms or misattribute understandings of the child’s behavior. High PM scores reflect difficulty holding in mind both the parent’s and child’s internal experiences, often manifesting as a tendency to interpret the child’s behavior in distorted or overly personal ways (e.g., “My child cries around strangers to embarrass me”) (Fonagy et al., 2004; Krink et al., 2018; Luyten et al., 2017). Items are rated on a 7-point Likert scale, ranging from 1 (strongly disagree) to 7 (strongly agree). Mean scores were calculated across the six items of the PM subscale. In this sample PM demonstrated adequate reliability (α = 0.70).
Perceived Relational Strain (PRS) and Parenting Stress
Perceived relational strain was assessed at time-points one and two using the Parent–Child Dysfunctional Interaction (PCDI) subscale of the Parenting Stress Index–Short Form (PSI-SF; Abidin, 1995). The PSI-SF is a 36-item abbreviated version of the full 120-item PSI that evaluates parenting stress across three domains: Parental Distress, Difficult Child, and Parent–Child Dysfunctional Interaction. The PCDI subscale (12 items) captures the parent’s perception of relational tension, emotional distance, and dissatisfaction in interactions with their child. Items reflect disappointment in the parent role, low perceived reciprocity from the child, and strained or unfulfilling parent-child interactions. This construct represents subjective appraisal of the quality of the parent-child relationship. Responses were recorded on a 7-point Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Example items include “My child doesn’t seem to learn as quickly as most children.” Item scores were summed, with higher totals indicating greater perceived relational strain (range = 12–84). Following Abidin’s (1995) guidelines, scores below 20 reflect low concern, scores between 20 and 30 fall within the typical range, and scores above 31 indicate relational difficulties. The PSI-SF and its subscales have demonstrated strong reliability and validity across diverse populations, including inner-city, low socioeconomic, rural, and Hispanic parents (Abidin, 1995, 2012; Aracena et al., 2016; Barroso et al., 2016; Lee et al., 2016). Internal consistency for the PCDI subscale in this sample was excellent (α = 0.91).
Analytic Plan
Descriptive statistics were employed to characterize the sample and data normality was evaluated through tests of outliers, multivariate skewness, and kurtosis (Mardia, 1970). Following Kim (2013), only cases of severe non-normality, defined as skewness > |2| and kurtosis > |6|, were addressed. Next, to assess that treatment and control groups were equivalent, t-tests and Pearson chi-square tests were conducted on the demographic variables (age, gender, race, marital status, and educational attainment). Spearman’s rank order correlation was used to test the relationships between demographic variables and the main variables of interest including parental ACEs, pre-mentalizing (PM), and perceived relational strain (PRS). Pearson correlations were conducted to examine relationships between parental ACEs, PM, and PRS. A series of mediation analyses were conducted following Hayes’s (2009, 2018) product-of-coefficients approach, which evaluates mediation by testing the statistical significance of the indirect effect, calculated as the product of the predictor–mediator association (a path) and the mediator–outcome association (b path), using bootstrap resampling. First, a cross-sectional mediation model was tested to examine whether PM had an indirect effect on the relationship between parental ACEs and PRS at time-point one. To strengthen the robustness of the primary findings, two sensitivity analyses were then conducted to support the temporal ordering of the initial mediation model. To evaluate the hypothesized directional pathway over time, a longitudinal mediation analysis was performed using a smaller sub-sample (n = 54) with data on ACEs and PM collected at time-point one and PRS measured at time-point two. This sub-sample was limited due to attrition, as only a subset of participants completed the relevant measures at both time points. To account for potential confounding, intervention exposure was included as a covariate in this model. Second, a reverse order mediation model was tested with data from time-point one to further assess temporal precedence, in which PM was specified as the outcome and PRS as the mediator. Mediation analyses were conducted using Hayes’ PROCESS macro (version 4.0, model 4; Hayes, 2009, 2018) with 5,000 bootstrap samples and 95% confidence intervals to estimate the indirect effects. Statistical significance for correlations were set at p < .05. All analyses were conducted using SPSS version 29 (IBM Corp, 2022) and Stata (StataCorp, 2023).
Results
Variable Characteristics and Correlations
As displayed in Table 1, this sample of foster parents had an average of 1.38 ACEs and 15% of the sample reported four or more ACEs. The average pre-mentalizing score was 2.11 out of a possible 7 points, and parenting stress was on the high-end of typical ranges with an average score of 28.6. As presented in Table S1, t-tests and Pearson chi-square tests confirmed that there were no statistically significant demographic differences between participants in the intervention and control groups. The results of Spearman’s rank order correlation determined that none of the demographic variables (age, gender, race, marital status, and educational attainment) were significantly associated with ACEs, PM, and PRS (p > .05) therefore they were excluded from subsequent analyses. As displayed in Table 2, the results of Pearson’s correlations demonstrated statistically significant positive correlations between parental ACEs and pre-mentalizing (PM) (r = .22) and perceived relational strain (PRS) (r = .24), and between PM and PRS (r = .55).
Table 1
Demographic Characteristics of Foster Parents & Foster Children
Characteristics
Foster Parents
(n = 89)
Children
(n = 85)
Gender
Female
61 (68%)
45 (54%)
Male
28 (32%)
39 (46%)
Ethnicity/Race?
White
62 (72%)
---
Black/African American
9 (11%)
---
Hispanic
9 (11%)
---
Asian
1 (1%)
---
Native American
1 (1%)
---
Multi-Ethnic
4 (5%)
---
Marital Status
---
Married
61 (70%)
---
Single
24 (28%)
---
Living w/ partner
2 (2%)
---
Educational Level
High School
9 (11%)
---
Some college
25 (29%)
---
Bachelors
30 (35%)
---
Graduate School
22 (26%)
---
Number of ACEs
0
39 (44%)
1
20 (22%)
2
9 (10%)
3
8 (9%)
4+
13 (15%)
Range
M (SD)
Foster child age
1 mo. to 17.5 years
6.7 years
Time as foster child
1 mo. to 4.7 years
9.9 months
Time as foster parent
1 mo. to 24 years
3.8 years
Foster parent age (years)
22 to 76 years
43.4 (9.89)
Parental ACEs
0–9
1.38 (1.94)
Pre-Mentalizing
1–5
2.11 (0.84)
Perceived Relational Strain
12–70
28.65 (14.04)
Demographic data on children in foster care has been anonymized for confidentiality
Table 2
Pearson’s Correlations of ACEs, Pre-Mentalizing, and Parenting Stress
1
2
3
ACEs
--
Pre-Mentalizing
0.22*
--
Perceived
Relational Strain
0.24*
0.55**
--
N = 85. *p < .05, **p < .01
Mediation Analyses
A mediation analysis was conducted to test whether the association between parental ACEs and perceived relational strain could be explained by the parents’ mentalizing abilities with data from time-point one. As presented in Fig. 2; Table 3, ACEs were associated with increased pre-mentalizing scores, reflecting a reduction in mentalizing abilities (b = 0.098, p < .05), which in turn were associated with greater perceived relational strain (b = 8.61, p < .001). After accounting for the mediator (pre-mentalizing), the direct effect of ACEs on perceived relational strain was not statistically significant (b = 0.86, p = .20), with a 95% confidence interval of [-0.44, 2.16], indicating a mediation effect. Bootstrapping with 5,000 samples confirmed a statistically significant indirect effect (b = 0.84, 95% CI [0.06, 1.62], p = .034), indicating that the effect of ACEs on perceived relational strain was at least partially transmitted through pre-mentalizing. As presented in Table 3, approximately 49.4% of the total effect of ACEs on perceived relational strain was mediated via pre-mentalizing (calculated as ab/ab + c′). While ACEs explained only 5% of the variance in mentalizing (R² = 0.05), the overall model (i.e. ACEs and mentalizing together) explained 31.6% of the variance in perceived relational strain (R² = 0.316), with the majority of explanatory power attributable to pre-mentalizing (the mediator).
Fig. 2
Mediating Effect of Parental Mentalization on ACEs and Perceived Relational Strain
Two sensitivity analyses were conducted to support the temporal ordering of the initial mediation model. The first sensitivity analysis tested a longitudinal mediation model where ACEs and pre-mentalizing were measured at time-point one and perceived relational strain was measured at time-point two. In a smaller sample (n = 54) and controlling for exposure to the mentalizing intervention, ACEs were positively associated with pre-mentalizing (b = 0.12) but did not reach statistical significance (p = .053). PM at time-point one was significantly associated with perceived relational strain (b = 6.43, p < .001) at time-point two. Bootstrapping with 5,000 samples demonstrated an indirect effect of pre-mentalizing on the relationship between ACEs and perceived relational strain with a similar effect size as in the primary analyses (b = 0.77) that did not quite reach statistical significance (95% CI [-0.15, 1.69], p < .10). In the second sensitivity analyses to examine the ordering of variables, data from time-point one was used in a mediation model where the mediator and the outcome variables were reversed. In this model, ACEs were significantly associated with perceived relational strain (b = 1.70, p = .025), and perceived relational strain was significantly associated with pre-mentalizing (b = 0.03, p < .001). However, the indirect effect of perceived relational strain on the relationship between ACEs and pre-mentalizing, assessed with 5,000 bootstraps, had a small effect (b = 0.05) that was not statistically significant (95% CI [-0.02, 0.12], p = .13) compared to the relatively larger indirect effect (b = 0.84, p = .034) of pre-mentalizing on the relationship between ACEs and perceived relational strain in the original model.
Discussion
Guided by developmental psychopathology and attachment theories, this study tested a mediation model in which foster parents’ ACEs were hypothesized to influence perceived relational strain, as a core dimension of parenting stress, both directly and indirectly through parental mentalizing capacity. While associations between ACEs and parenting stress are well documented, few studies have examined these dynamics within foster families, a population uniquely positioned at the intersection of early adversity and high relational demands. This study extends existing knowledge by focusing on foster caregivers and contributes new insights by testing a theoretically informed mediation model that has not previously been examined in this context. As an exploratory and theory generating effort, this work aims to clarify potential relational mechanisms linking ACEs to parents’ perceptions of relational strain, offering testable hypotheses for future longitudinal and intervention research and identifying modifiable targets for strengthening parent-child relationships in foster families.
Research questions one and two explored the relationships between foster parents’ ACEs, mentalizing abilities, and perceived relational strain. In this sample of foster parents, 15% reported four or more ACEs, compared to 13% in the original ACE study (Felitti et al., 1998) and 15.8% of adults in a more recent nationally representative U.S. sample (Merrick et al., 2018). These findings suggest that foster parents may have a similar or slightly higher prevalence of exposure to childhood adversity than the general U.S. population, highlighting the importance of examining the impact of ACEs on caregiving capacity in this high-stakes parenting context. As expected, higher ACEs were associated with poorer mentalizing capabilities, indicated by elevated pre-mentalizing scores. This outcome aligns with prior research linking ACEs or childhood maltreatment to diminished mentalizing capabilities in parents (Camoirano et al., 2017; Ensink et al., 2014; San Cristobal et al., 2017), and in broader adult populations, including individuals with physical and mental health symptoms (Wagner-Skacel et al., 2022) and therapists in training (Klasen et al., 2019). Higher ACEs were also positively associated with increased perceived relational strain (as a core dimension of parenting stress), aligning with existing evidence of these associations across diverse populations including mothers in home visiting programs (Ammerman et al., 2013), community samples (Pereira et al., 2012; Steele et al., 2016), low-income populations (Lange et al., 2019), and Asian immigrant parents (Yoon et al., 2021). Our findings extend prior work by confirming the relationships between ACEs and mentalizing, and ACEs and parenting stress within a sample of relatively experienced foster parents. Foster parents are typically trained and have voluntarily committed to supporting children with complex needs (De Wilde et al., 2019). These findings suggest that despite this preparation, a history of ACEs may still undermine key relational and parenting capacities, pointing to the need to consider foster parents’ trauma histories when designing support systems that promote sustained, effective caregiving.
Research question three examined whether foster parents’ mentalizing abilities mediated the relationship between ACEs and perceived relational strain. Mentalizing capacities had a statistically significant indirect effect on the relationship between parental ACEs and perceived relational strain, mediating nearly half (49.4%) of the total effect of ACEs on perceived relational strain, indicating a substantial indirect effect. This finding supports the possibility that diminished mentalizing may be a key pathway through which ACEs compromise the parenting environment. While prior research has documented associations between ACEs and parenting stress (Lange et al., 2019; Weistra et al., 2025), this study contributes novel evidence by testing and supporting a theoretically derived mediation model in which mentalizing serves as a critical psychological link. This finding aligns with developmental psychopathology and attachment theories (Cicchetti & Toth, 1995; Bowlby, 2004), which emphasize how early relational trauma can disrupt internal representations of self and others, ultimately weakening the caregiver’s ability to respond with sensitivity to a child’s emotional needs (Fonagy et al., 1993; Fonagy & Target, 1997; Narayan et al., 2021).
The results of the statistical mediation analysis demonstrated that both ACEs and mentalizing influenced perceived relational strain, but their contributions were notably asymmetrical. ACEs explained only 5% of the variance in mentalizing (R² = 0.05), while the full model (including both ACEs and mentalizing) explained 31.6% of the variance in perceived relational strain (R² = 0.316). This suggests that while ACEs exerted a statistically significant influence on caregivers’ mentalizing abilities, it was mentalizing - rather than the adversity history - that more directly predicted perceived relational strain in this sample. These findings support the possibility that disrupted mentalizing is a critical conduit through which adversity affects caregiving, and may point to a modifiable treatment target to improve parent-child relationships in foster families. Prior intervention studies have documented improvements in mentalizing capacity in adults and parent participants. Mentalizing interventions have been implemented for adults in psychotherapy (Luyten et al., 2024) and in high-risk parenting contexts (Stob et al., 2020). Recently, Adkins and colleagues (2022) delivered a six-week psychoeducational mentalizing intervention to the sample of foster parents in the current study and found a significant reduction in pre-mentalizing (d = 0.71), indicating improved mentalizing capacities. Such findings suggest that the ability to mentalize is not fixed but modifiable, and that targeted interventions may enhance caregivers’ mentalizing, even in populations with elevated adversity exposure.
Foster parents in the U.S. are often required to complete pre-service training and ongoing education, however, these requirements vary considerably by state. Despite this training, current evidence indicates that many foster parents experience gaps between the demands of caring for children with complex needs and the levels of guidance, resources, and support offered by the child welfare system (Mersky et al., 2015). The current findings suggest that incorporating mentalizing-informed assessment, psychoeducation, and practice into foster parent training may be beneficial, particularly for caregivers with elevated adversity histories. Brief mentalizing assessments could help identify caregivers who may be at greater risk for experiencing relational strain and facilitate targeted support. Importantly, strengthening caregivers’ mentalizing capacities may have cascading benefits beyond individual parent–child interactions. Improved mentalizing may reduce parenting stress and burnout, enhance placement stability, and support foster parent retention, all of which are ongoing challenges within foster care systems. By supporting caregivers’ ability to hold both their own and children’s internal experiences in mind, mentalizing-focused supports may promote more sustained and effective caregiving, ultimately benefiting children, caregivers, and the broader child welfare system. The possibility of these beneficial effects signals an important area for future research.
The weaker link between ACEs and mentalizing, compared to the stronger association between mentalizing and parenting stress in this mediation model, suggests that other moderators may influence how ACEs affects caregivers’ mentalizing, highlighting directions for future research. Some parents with high ACE scores retain strong mentalizing, which protects child outcomes (Fonagy et al., 1994; Stacks et al., 2014). Scholars argue that the ability to mentalize after childhood maltreatment may depend significantly on an individual’s relationship with their past trauma (Allen, 2013; Camoirano et al., 2017; Fonagy et al., 1993). Fonagy and colleagues (1993) suggest that maladaptive defenses to cope with the psychic pain associated with childhood abuse can inhibit the development of mentalizing abilities within close relationships. Other scholars assert that the capacity to mentalize one’s own experiences of childhood abuse is crucial for parents’ ability to mentalize effectively with their children (Allen, 2013; Ensink et al., 2014). Other key variables that may impact mentalizing after ACEs include emotion regulation and stress responsivity (Doba et al., 2022; Wagner-Skacel et al., 2022). These findings point to promising areas for future inquiry that may lead to the identification of additional leverage points for preserving or restoring mentalizing in the aftermath of ACEs.
Limitations
While this study provides critical data demonstrating the role of ACEs and mentalizing in parenting stress in a sample of foster parents, there are some limitations to consider. Firstly, these analyses were exploratory and intended to generate theory and testable hypotheses for future research. While grounded in a robust theoretical framework, the study was not designed to provide definitive causal conclusions but to illuminate potential mechanisms for further longitudinal or intervention study. Secondly, while mediation analyses are meant to demonstrate causal pathways, the primary data were cross-sectional, and thus the results cannot confirm causality. To address this, two sensitivity analyses examined the temporal ordering of variables. A longitudinal mediation model using a smaller sub-sample with ACEs and mentalizing temporally separated from the outcome, parenting stress, provided preliminary support for the hypothesized direction of effects over time. Although the indirect effect in this model did not reach conventional levels of statistical significance (p < .10), the effect size (b = 0.77) closely matched that of the primary cross-sectional model (b = 0.84), lending credibility to the proposed temporal pathway. Additionally, a reverse mediation model tested whether parenting stress predicted mentalizing. The indirect effect in this alternative model was small and non-significant, and the tight confidence interval suggested that any such effect, is likely negligible. Together, these analyses strengthen confidence in the hypothesized direction of effects. Other limitations include biases related to convenience sampling. All the foster parents in this sample were experienced and voluntarily engaged in a parenting intervention. The lack of variability in foster parenting experience levels leaves open the possibility that a more diverse sample would have yielded different results; less experienced foster parents may have reported less mentalizing and more parenting stress or vice versa. The small sample size and biased recruitment strategies prevent generalizability of results to all foster parents. Future work should engage in recruiting larger samples of foster parents and conduct longitudinal mediation analyses to contextualize the results of this study.
Conclusion
This study highlights the importance of foster parents’ mentalizing capacity as a critical pathway linking ACEs to perceived relational strain, as a core dimension of parenting stress. While ACEs were only modestly associated with mentalizing, mentalizing emerged as a key predictor of parent-child dysfunctional interactions, emphasizing its relevance as both a marker for risk and a potential target for intervention. These findings, grounded in developmental psychopathology and attachment theory, support a nuanced understanding of how early adversity may compromise caregivers’ relational capacities. Continued research using longitudinal and experimental methods is needed to further clarify these pathways and inform trauma-informed support strategies for foster families.
Declarations
Conflict of Interests
This study was supported by the National Institute of Child Health and Human Development under award numbers T32HD007081 and P2CHD042849. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. There are no conflicts of interest to disclose.
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