An Investigation of the Impact of Childhood Trauma on Quality of Caregiving in High Risk Mothers: Does Maternal Substance Misuse Confer Additional Risk?

  • Denise HatzisEmail author
  • Sharon Dawe
  • Paul Harnett
  • Natalie Loxton
Original Article


The quality of caregiving is often compromised when mothers have co-occurring difficulties such as substance misuse and problems associated with extreme emotional dysregulation. These, in turn, are associated with poor child outcomes. The aim of the current study was twofold. First, to investigate the potential differences in risk factors associated with poor child outcome by comparing three groups: substance misusing mothers (Substance Misusing Mothers; SMM); mothers matched on demographic characteristics (Matched Comparison Mothers; MCM) and mothers recruited from the community (Matched Control Comparison; MCC). Second, to investigate the underlying mechanisms which are associated with poor child outcome by testing a mediated moderation model to ascertain (i) whether environmental risk and borderline psychopathology was a mediator between maternal childhood trauma and quality of caregiving and (ii) maternal substance misuse status moderated outcome. There were no significant differences found between the SMM and MCM groups on the key variables, but significant differences on all variables for both SMM and MCM compared to CCM. The moderated mediation analysis found that while there was significant mediation of environmental risk and borderline pathology between maternal childhood trauma and child outcome, this was not moderated by maternal substance abuse status. The importance of environmental-risk as a mechanism leading to reduced caregiving quality suggest treatment programs need to consider targeting these factors in high risk families.


Substance high-risk Emotional availability Environmental risk Borderline personality 



The Denise Hatzis gratefully acknowledges receiving a Griffith University Postgraduate Research Scholarship that was awarded to her (2011-2014; CRICOS Provider Number: 00233E), to support candidature in the Doctor of Philosophy in Clinical Psychology (062206F) in the School of Applied Psychology.

Compliance with Ethical Standards

Conflict of interest

All Author declares that they have no conflict of interest.

Ethical Approval

Study was conducted in accordance with APA ethical standards and approved by Griffith University Human Ethics (Protocol GU Reference No: PSY/34/13/HREC) and Human Research Ethics Committee Metro North Hospital and Health Services (Protocol Reference No: HREC/14/QPCH/249).

Supplementary material

10578_2019_886_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)


  1. 1.
    Salo S, Kivisto K, Korja R, Biringen Z, Tupola S, Kahila H et al (2009) Emotional availability, parental self-efficacy beliefs, and child development in caregiver–child relationships with buprenorphine-exposed 3-year-olds. Parenting 9(3–4):244–259Google Scholar
  2. 2.
    Eiden R (2001) Maternal substance use and mother–infant feeding interactions. Infant Ment Health J 22(4):497–511Google Scholar
  3. 3.
    Howard J, Beckwith L, Espinosa M, Tyler R (1995) Development of infants born to cocaine-abusing women: biologic/maternal influences. Neurotoxicol Teratol 17(4):403–411Google Scholar
  4. 4.
    Espinosa M, Beckwith L, Howard J, Tyler R, Swanson K (2001) Maternal psychopathology and attachment in toddlers of heavy cocaine-using mothers. Infant Ment Health J 22(3):316–333Google Scholar
  5. 5.
    LaGasse LL, Messinger D, Lester BM, Seifer R, Tronick E, Bauer CR et al (2003) Prenatal drug exposure and maternal and infant feeding behaviour. Arch Dis Child Fetal Neonatal Ed 88(5):F391–F399Google Scholar
  6. 6.
    Tronick E, Messinger D, Weinberg MK, Seifer R, Shankaran S, Wright LL et al (2005) Cocaine exposure is associated with subtle compromises of infants’ and mothers’ social–emotional behavior and dyadic features of their interaction in the face-to-face still-face paradigm. Dev Psychol 41(5):711–722Google Scholar
  7. 7.
    Sarfi M, Smith L, Waal H, Sundet JM (2011) Risks and realities: dyadic interaction between 6-month-old infants and their mothers in opioid maintenance treatment. Infant Behav Dev 34(4):578–589Google Scholar
  8. 8.
    Salo S, Politi J, Tupola S, Biringen Z, Kalland M, Halmesmaki E et al (2010) Early development of opioid-exposed infants born to mothers in buprenorphine-replacement therapy. J Reprod Infant Psychol 28(2):161–179Google Scholar
  9. 9.
    Neuspiel DR, Hamel SC, Hochberg E, Greene J, Campbell D (1991) Maternal cocaine use and infant behavior. Neurotoxicol Teratol 13(2):229–233Google Scholar
  10. 10.
    Ukeje I, Bendersky M, Lewis M (2001) Mother–infant interaction at 12 months in prenatally cocaine exposed children. Am J Drug Alcohol Abuse 27(2):203–224Google Scholar
  11. 11.
    Uhlhorn SB, Messinger DS, Bauer CR (2005) Cocaine exposure and mother–toddler social play. Infant Behav Dev 28(1):62–73Google Scholar
  12. 12.
    Hatzis D, Dawe S, Harnett P, Barlow J (2017) Quality of caregiving in mothers with illicit substance use: a systematic review and meta-analysis. Subst Abuse 11:1–15Google Scholar
  13. 13.
    Minnes S, Singer LT, Kirchner HL, Satayathum S, Short EJ, Min M et al (2008) The association of prenatal cocaine use and childhood trauma with psychological symptoms over 6 years. Arch Womens Ment Health 11(3):181–192Google Scholar
  14. 14.
    Sansone RA, Sansone LA (2011) Substance use disorders and borderline personality: common bedfellows. Innov Clin Neurosci 8(9):10–13Google Scholar
  15. 15.
    Dawe S, Loxton NJ (2004) The role of impulsivity in the development of substance use and eating disorders. Neurosci Biobehav Rev 28(3):343–351Google Scholar
  16. 16.
    Hatch SL (2007) Economic stressors, social integration, and drug use among women in an inner city community. J Drug Issues 37(2):257–280Google Scholar
  17. 17.
    Ammerman RT, Shenk CE, Teeters AR, Noll JG, Putnam FW, Van Ginkel JB (2013) Multiple mediation of trauma and parenting stress in mothers in home visiting. Infant Ment Health J 34(3):234–241Google Scholar
  18. 18.
    Bert SC, Guner BM, Lanzi RG (2009) The influence of maternal history of abuse on parenting knowledge and behavior. Fam Relat 58(2):176–187Google Scholar
  19. 19.
    Lyons-Ruth K, Bureau J-F, Easterbrooks MA, Obsuth I, Hennighausen K, Vulliez-Coady L (2013) Parsing the construct of maternal insensitivity: distinct longitudinal pathways associated with early maternal withdrawal. Attach Hum Dev 15(5–6):562–582Google Scholar
  20. 20.
    DeOliveira C, Wolfe V, Bailey H (2004) In: Children CfRoVAWa (ed) The effect of childhood maltreatment on the parent–child relationship: project summary. CANADA Centre for Research on Violence Against Women and Children, LondonGoogle Scholar
  21. 21.
    Mielke EL, Neukel C, Bertsch K, Reck C, Mohler E, Herpertz SC (2016) Maternal sensitivity and the empathic brain: influences of early life maltreatment. J Psychiatr Res 77:59–66Google Scholar
  22. 22.
    Beck JG, Grant DM, Clapp JD, Palyo SA (2009) Understanding the interpersonal impact of trauma: contributions of PTSD and depression. J Anxiety Disord 23(4):443–450Google Scholar
  23. 23.
    Fonagy P, Target M, Gergely G, Allen JG, Bateman AW (2003) The developmental roots of borderline personality disorder in early attachment relationships: a theory and some evidence. Psychoanal Inq 23(3):412–459Google Scholar
  24. 24.
    White H, Flanagan TJ, Martin A, Silvermann D (2011) Mother–infant interactions in women with borderline personality disorder, major depressive disorder, their co-occurrence, and healthy controls. J Reprod Infant Psychol 29(3):223–235Google Scholar
  25. 25.
    Crandell LE, Patrick MPH, Hobson RP (2003) ‘Still-face’ interactions between mothers with borderline personality disorder and their 2-month-old infants. Br J Psychiatry 183(3):239–247Google Scholar
  26. 26.
    Hans SL, Bernstein VJ, Henson LG (1999) The role of psychopathology in the parenting of drug-dependent women. Dev Psychopathol 11(04):957–977Google Scholar
  27. 27.
    Newman L, Stevenson CS, Bergman LR, Boyce P (2007) Borderline personality disorder, mother–infant interaction and parenting perceptions: preliminary findings. Aust N Z J Psychiatry 41(7):598–605Google Scholar
  28. 28.
    Cyr C, Euser EM, Bakermans-Kranenburg M, van Ijzendoorn MH (2010) Attachment security and disorganization in maltreating and high-risk families: a series of meta-analyses. Dev Psychopathol 22(1):87–108Google Scholar
  29. 29.
    Chapple CL (2003) Examining intergenerational violence: violent role modeling or weak parental controls? Violence Vict 18(2):143–162Google Scholar
  30. 30.
    Widom CS, Czaja SJ, Dutton MA (2008) Childhood victimization and lifetime revictimization. Child Abuse Negl 32(8):785–796Google Scholar
  31. 31.
    Widom CS, White HR (1997) Problem behaviours in abused and neglected children grown up: prevalence and co-occurrence of substance abuse, crime and violence. Crim Behav Ment Health 7(4):287–310Google Scholar
  32. 32.
    Cancian M, Slack K, Yang M (2010) In: Poverty IfRo (ed) The effect of family income on risk of child maltreatment. Discussion Paper No. 1385-10. University of Wisconsin, MadisonGoogle Scholar
  33. 33.
    Sedlak AJ, Mettenburg J, Basena M, Petta I, McPherson K, Greene A et al (2010) National incidence study of child abuse and neglect (NIS-4): report to Congress. U.S. Department of Health and Human Services, Administration for Children and Families, Washington, DCGoogle Scholar
  34. 34.
    Bornstein MH, Hahn CS, Suwalsky JTD, Haynes OM (2011) Maternal and infant behavior and context associations with mutual emotion availability. Infant Ment Health J 32(1):70–94Google Scholar
  35. 35.
    Bernstein D, Fink L (1998) Childhood Trauma Questionnaire: A retrospective self-report manual San Antonio. The Psychological Corporation, TXGoogle Scholar
  36. 36.
    Bernstein D, Ahluvalia T, Pogge D, Handelsman L (1997) Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. J Am Acad Child Adolesc Psychiatry 36(3):340–348Google Scholar
  37. 37.
    Bernstein D, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K et al (1994) Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 151(8):1132–1136Google Scholar
  38. 38.
    Paivio SC, Cramer KM (2004) Factor structure and reliability of the Childhood Trauma Questionnaire in a Canadian undergraduate student sample. Child Abuse Negl 28(8):889–904Google Scholar
  39. 39.
    Bernstein D, Stein J, Newcomb MD, Walker E, Pogge D, Ahluvalia T et al (2003) Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl 27(2):169–190Google Scholar
  40. 40.
    Morey LC (1991) Personality assessment inventory. PAR Psychological Assessment Resources, Inc, LutzGoogle Scholar
  41. 41.
    Gardner K, Qualter P (2009) Reliability and validity of three screening measures of borderline personality disorder in a nonclinical population. Personal Individ Differ 46(5–6):636–641Google Scholar
  42. 42.
    Trull TJ, Stepp SD, Solhan M (2006) Borderline personality disorder. In: Hersen M, Thomas JC (eds) Comprehensive handbook of personality and psychopathology: adult psychopathology, vol 2. Wiley, HobokenGoogle Scholar
  43. 43.
    Trull TJ (1995) Borderline personality disorder features in nonclinical young adults: 1. Identification and validation. Psychol Assess 7(1):33–41Google Scholar
  44. 44.
    Sameroff A, Seifer R, Baldwin A, Baldwin C (1993) Stability of intelligence from preschool to adolescence: the influence of social and family risk factors. Child Dev 64(1):80–97Google Scholar
  45. 45.
    Evans GW, Li D, Whipple SS (2013) Cumulative risk and child development. Psychol Bull 139(6):1342–1396Google Scholar
  46. 46.
    Lovibond SH, Lovibond PF (1995) Manual for the Depression, Anxiety Stress Scale. Psychology Foundation Monograph, SydneyGoogle Scholar
  47. 47.
    Zimet GD, Dahlem NW, Zimet SG, Farley GK (1988) The multidimensional scale of perceived social support. J Pers Assess 52(1):30Google Scholar
  48. 48.
    Biringen Z (2008) The Emotional Availability (EA) Scales, 4th edn., BoulderGoogle Scholar
  49. 49.
    Dixon L, Browne K, Hamilton-Giachritsis C (2005) Risk factors of parents abused as children: a mediational analysis of the intergenerational continuity of child maltreatment (Part I). J Child Psychol Psychiatry 46(1):47–57Google Scholar
  50. 50.
    Herman JL (1989) Childhood trauma in borderline personality disorder. Am J Psychiatry 146(4):490–495Google Scholar
  51. 51.
    Perry N, Newman LK, Hunter M, Dunlop A (2015) Improving antenatal risk assessment in women exposed to high risks. Clin Child Psychol Psychiatry 20(1):84–105Google Scholar
  52. 52.
    Fraser JG, Harris-Britt A, Thakkallapalli EL, Kurtz-Costes B, Martin S (2010) Emotional availability and psychosocial correlates among mothers in substance-abuse treatment and their young infants. Infant Mental Health Journal. 31(1):1–15Google Scholar
  53. 53.
    Macfie J, Swan SA (2009) Representations of the caregiver–child relationship and of the self, and emotion regulation in the narratives of young children whose mothers have borderline personality disorder. Dev Psychopathol 21(3):993–1011Google Scholar
  54. 54.
    Fritz MS, Mackinnon DP (2007) Required sample size to detect the mediated effect. Psychol Sci 18(3):233–239Google Scholar
  55. 55.
    Faul F, Erdfelder E, Buchner A, Lang A-G (2009) Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160Google Scholar
  56. 56.
    Aguinis H, Beaty J, Boik R, Pierce C (2005) Effect size and power in assessing moderating effects of categorical variables using multiple regression: a 30-year review. J Appl Psychol 90(1):94–107Google Scholar
  57. 57.
    Hayes AF (2013) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. The Guilford Press, New YorkGoogle Scholar
  58. 58.
    Hayes AF, Rockwood NJ (2017) Regression-based statistical mediation and moderation analysis in clinical research: observations, recommendations, and implementation. Behav Res Ther 98:39–57Google Scholar
  59. 59.
    Eiden R, Godleski S, Colder CR, Schuetze P (2014) Prenatal cocaine exposure: the role of cumulative environmental risk and maternal harshness in the development of child internalizing behavior problems in kindergarten. Neurotoxicol Teratol 44:1–10Google Scholar
  60. 60.
    Kettinger LA, Nair P, Schuler ME (2000) Exposure to environmental risk factors and parenting attitudes among substance-abusing women. Am J Drug Alcohol Abuse 26(1):1–11Google Scholar
  61. 61.
    Nair P, Schuler ME, Black MM, Kettinger L, Harrington D (2003) Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development. Child Abuse Negl 27(9):997–1017Google Scholar
  62. 62.
    Suchman N, McMahon TJ, Slade A, Luthar S (2005) How early bonding, depression, illicit drug use, and perceived support work together to influence drug-dependent mothers’ caregiving. Am J Orthopsychiatry 75(3):431–445Google Scholar
  63. 63.
    Fuchs A, Möhler E, Resch F, Kaess M (2015) Impact of a maternal history of childhood abuse on the development of mother–infant interaction during the first year of life. Child Abuse Negl 48:179–189Google Scholar
  64. 64.
    Sadler LS, Slade A, Close N, Webb DL, Simpson T, Fennie K et al (2013) Minding the baby: enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home visiting program. Infant Ment Health J 34(5):391–405Google Scholar
  65. 65.
    Suchman N, DeCoste C, Castiglioni N, Legow N, Mayes L (2008) The mothers and toddlers program: preliminary findings from an attachment-based parenting intervention for substance-abusing mothers. Psychoanal Psychol 25(3):499–517Google Scholar
  66. 66.
    Dawe S, Harnett P (2007) Reducing potential for child abuse among methadone-maintained parents: results from a randomized controlled trial. J Subst Abuse Treat 32(4):381–390Google Scholar
  67. 67.
    Barlow J, Sembi S, Parsons H, Kim S, Petrou S, Harnett P et al (2018) A randomized controlled trial and economic evaluation of the parents under pressure program for parents in substance abuse treatment. Drug Alcohol Depend 194:184–194Google Scholar
  68. 68.
    Valentino K (2017) Relational interventions for maltreated children. Child Dev 88(2):359–367Google Scholar
  69. 69.
    Wekerle C, Wall A-M, Leung E, Trocmé N (2007) Cumulative stress and substantiated maltreatment: the importance of caregiver vulnerability and adult partner violence. Child Abuse Negl 31(4):427–443Google Scholar
  70. 70.
    Maxwell SE, Cole DA, Mitchell MA (2011) Bias in cross-sectional analyses of longitudinal mediation: partial and complete mediation under an autoregressive model. Multivar Behav Res 46(5):816–841Google Scholar
  71. 71.
    Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40(3):879–891Google Scholar
  72. 72.
    Hill J (2009) Developmental perspectives on adult depression. Psychoanal Psychother 23(3):200–212Google Scholar
  73. 73.
    Fusco RA (2015) Socioemotional problems in children exposed to intimate partner violence: mediating effects of attachment and family supports. J Interpers Violence 32(16):2515–2532Google Scholar
  74. 74.
    Fusco RA, Fantuzzo JW (2009) Domestic violence crimes and children: a population-based investigation of direct sensory exposure and the nature of involvement. Child Youth Serv Rev 31(2):249–256Google Scholar
  75. 75.
    Quinlivan JA, Evans SF (2005) Impact of domestic violence and drug abuse in pregnancy on maternal attachment and infant temperament in teenage mothers in the setting of best clinical practice. Arch Womens Ment Health 8(3):191–199Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Applied PsychologyGriffith UniversityBrisbaneAustralia
  2. 2.Australian Centre for Child ProtectionUniversity of South AustraliaAdelaideAustralia
  3. 3.School of PsychologyUniversity of QueenslandSt Lucia, BrisbaneAustralia

Personalised recommendations