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Family issues in child anxiety: Attachment, family functioning, parental rearing and beliefs
Abstract
Family studies have found a large overlap between anxiety disorders in family members. In addition to genetic heritability, a range of family factors may also be involved in the intergenerational transmission of anxiety. Evidence for a relationship between family factors and childhood as well as parental anxiety is reviewed. Four groups of family variables are considered: (I) attachment; (II), aspects of family functioning, such as marital conflict, co-parenting, functioning of the family as a whole, and sibling relationships; (III) parental rearing strategies; and (IV) beliefs that parents hold about their child. The reviewed literature provides evidence for an association between each of these family factors and child anxiety. However, there is little evidence as yet that identified family factors are specific to child anxiety, rather than to child psychopathology in general. Moreover, evidence for a relationship between child anxiety and family factors is predominantly cross-sectional. Therefore, whether the identified family factors cause childhood anxiety still needs to be investigated. Further research that investigates mechanisms mediating the relationship between family factors and child anxiety is also called for. Finally, parental beliefs are identified as important predictors of parental behaviour that have largely not been investigated in relation to child anxiety disorders.
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“Researchers seeking to improve outcomes of CBT for anxious youth have looked to parenting behavior, such as intrusive or controlling parenting and family accommodation (adjustments made to routines or actions to ease the child’s anxiety), as potential targets for optimization given that these caregiver variables have been shown to contribute to children’s anxiety symptoms [7,8].”
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“…of children with an AD might also be afraid to express negative emotions, as they may underestimate the emotion regulation abilities of their child with an AD and perceive the child as extremely vulnerable, thereby discouraging the expression of emotions (Bögels and Brechman-Toussaint 2006).”
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“High levels of parenting warmth and consistency are documented protective factors, whereas high levels of parental hostility, rigidity, or overcontrol are risk factors for youth internalizing symptoms (Bögels & Brechman-Toussaint, 2006).”
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BackgroundParental Rearing, Attachment, and Social Anxiety in Chinese Adolescents
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“Apart from a shared genetic makeup, the overlap between parent and child anxiety may be due to environmental factors, such as parental modeling of anxious behaviors (Bögels and Brechman-Toussaint, 2006).”
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Aminabadi, N. A., Sohrabi, A., Oskouei, S. G., & Ajami, B. A. (2011) · The Journal of Contemporary Dental Practice · doi:10.5005/jp-journals-10024-1039 · Cited by 28
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“In fact, parenting behaviors play signi fi cant roles in the optimization of child development (Bögels and Brechman-Toussaint 2006).”
BackgroundParenting Behaviors of Mothers and Fathers of Preschool Age Children with Internalizing Disorders
Otto, Y., Kolmorgen, K., Sierau, S., Weis, S., von Klitzing, K., & Klein, A. M. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-015-0242-3 · Cited by 27
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“As has been noted in the review of the literature by Bögels and Brechman-Toussaint,[8] two major problems that have occurred in many previous studies of perceived parental interpersonal behaviors (such as parental rejection, overcontrol, and attachment behaviors) and adolescent anxiety is that the studies have been p…”
BackgroundResultInfluentialApetroaia, A., Hill, C. E., & Creswell, C. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.059 · Cited by 23
“Finally, negative parental behaviours, such as criticism or rejection, are hypothesised to promote a perception of the world as threatening and prevent children from learning to manage emotions adaptively (e.g., Bögels and Brechman-Toussaint, 2006).”
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Parental and Family Factors as Predictors of Threat Bias in Anxious Youth
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“…relationship between controlling parenting behaviors and anxiety symptoms in their children (Barrett et al., 2002; Brown & Whiteside, 2008; Bӧgels & Brechman-Toussaint, 2006; Hudson & Rapee, 2001; Laurin et al., 2015; McLeod et al., 2007; Muris et al., 2000, 2003; Pereira et al., 2014; Van Der…”
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“There is also evidence that family functioning is associated with anxiety disorders (Bogels & Brechman-Toussaint, 2006 ).”
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Garcia, K. M., Carlton, C. N., & Richey, J. A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.614318 · Cited by 33
“Children of overcontrolling mothers display lower self-autonomy needed to develop perceived control over their environment (29), thereby increasing the likelihood of fear in social situations (22).”
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“This suggests that those variables play their role in the etiology and maintenance of childhood anxiety (Bögels and Brechman-Toussaint, 2006; McLeod et al., 2007), but based on this study, not in the referral of those children.”
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“Based on their review of this research, Bögels and Brechman-Toussaint (2006) suggest that factors such as parent-child attachment, marital conflict, sibling domination, and parental beliefs and cognitions are associated with child anxiety, although the exact nature of each association is not clear.”
BackgroundMethodTreatment of childhood anxiety disorders: what is the place for antidepressants?
Muris, P. (2011) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2012.642864 · Cited by 24
“, anxious rearing, overprotection), which primarily take place within the context of the family [12].”
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“Parent–child discrepancies highlight the utility of capturing both child and parent perceptions of parental rearing behaviours concurrently [1, 24], especially as the discordance between informants may reflect more than methodological error and may in fact be particularly important in predicting child outcomes and/or…”
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“Caregivers’ communication with their children regarding emotions (i.e., ES), influences the ways in which children learn to respond to life events and self-regulate (Bögels & Brechman-Toussaint, 2006).”
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“Children, who tend to be sensitive to parents’ signals (De Vente et al., 2011), may watch the actions of their anxious parents and imitate their behaviors (Bögels & Brechman-Toussaint, 2006).”
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“…support for the association between parental overinvolvement and childhood anxiety disorders, although results have been somewhat less consistent regarding the relationship between parental negativity and childhood anxiety (Bogels & Brechman-Toussaint, 2006; McLeod, Wood, & Weisz, 2007, 2011).”
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“Though family functioning is generally associated with fewer anxiety symptoms (Bogels & Brechman-Toussaint, 2006), we did not find a significant association between positive family factors and anxiety symptoms.”
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“This clinging behavior might provoke irritation in parents [ 10 ], in which case the AD precedes this parental attitude.”
BackgroundInfluentialAnxiety among adolescents and its affect on orthodontic compliance
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“Due to limited evidence related to association between parental rearing and childhood anxiety as rated by children, there is no definitive conclusions about this aspect of the literature (Bogels & Brechman-Toussaint, 2006; Wood, McLeod, Sigman, Hwang & Chu, 2003).”
BackgroundHistory and theoretical underpinnings of exposure therapy
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“The clinical translation is that youths’ anxiety is maintained by parent use of negative reinforcement (e.g., Bögels & Brechman-Toussaint, 2006; Marks, 1987; McLeod et al., 2007; Silverman & Kurtines, 1996).”
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“In addition, Bögels and Cawthorpe’s findings suggested insecure parent–child attachment is harmful to adolescents’ interpersonal relations, increasing the risk of social anxiety and depression (Bögels & Brechman-Toussaint, 2006; Cawthorpe et al., 2004).”
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“Parental displays of threatening behaviors and overprotection have been associated with interpretation biases and anxious responses in offspring (Bögels and Brechman-Toussaint 2006; Viana et al. 2012).”
BackgroundBreinholst, S., Tolstrup, M., & Esbjørn, B. H. (2018) · Child and Adolescent Mental Health · doi:10.1111/camh.12269 · Cited by 17
Attachment and Reflective Functioning in Anxious and Non-anxious Children: A Case-Controlled Study
Breinholst, S., Esbjørn, B. H., & Steele, H. (2018) · Journal of Child and Family Studies · doi:10.1007/s10826-018-1106-4 · Cited by 18
“Although, currently some risk factors have been addressed, including the attachment relationship between child and parents (Bögels and Brechman-Toussaint 2006), there is still a need for systematic research that address these in a methodologically rigorous manner.”
BackgroundWiedemann, A. M., Vogel, D., Voß, C., Nusseck, M., & Hoyer, J. (2019) · Psychology of Music · doi:10.1177/0305735618817877 · Cited by 17
The Relationship Between Parenting and Anxiety in Emerging Adulthood
Smout, A., Lazarus, R. S., & Hudson, J. L. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10037-8 · Cited by 17
How the Rich Get Riskier: Parenting and Higher-SES Emerging Adults' Risk Behaviors
Romm, K. F., Barry, C. M., & Alvis, L. M. (2020) · Journal of Adult Development · doi:10.1007/s10804-020-09345-1 · Cited by 17
Brubaker, L., & Udell, M. A. R. (2022) · Animal Cognition · doi:10.1007/s10071-022-01694-6 · Cited by 25
“In general, these findings are consistent with broader development research, where parenting behavior is thought to have a large influence on attachment style (Bögels and Brechman-Toussaint 2006; Karavasilis et al. 2003; Maccoby and Martin 1983), social behavior (Hastings et al.”
BackgroundResultInfluentialExpressed Emotion Displayed by the Mothers of Inhibited and Uninhibited Preschool-Aged Children
Cunningham, N. R., Kennedy, S. J., & Rapee, R. M. (2010) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410903532668 · Cited by 18
“More recent research has begun to support these retrospective reports with laboratory-based direct observations of parent–child interactions, and this research has been conducted with participants selected on the basis of both clinical anxiety symptomatology and withdrawn, inhibited behaviors (Bogels & Brechman-Toussa…”
BackgroundLundkvist-Houndoumadi, I., Thastum, M., & Nielsen, K. (2016) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104515615641 · Cited by 16
“…issues is supported by earlier studies, which have suggested that inappropriate parental beliefs about parents’ own self-efficacy and that of their child, as well as an inconsistent parenting style, may contribute to youths’ anxiety (Bögels & Brechman-Toussaint, 2006; Ginsburg & Schlossberg, 2002).”
ResultÖzyurt, G., Gencer, Ö., Öztürk, Y., & Özbek, A. (2016) · Journal of Child and Family Studies · doi:10.1007/s10826-015-0343-z · Cited by 16
“When associated with parental factors like anxious modeling, over controlling parenting style, child vulnerability factors, such as temperament, cognitive style, female gender and age play an important role in the etiology and maintenance of childhood anxiety (Bögels and Brechman-Toussaint 2006; Craske 2003; Rapee et…”
BackgroundLiu, J., Shi, Y., Xie, S., Xing, L., Wang, L., Li, W., & Zhao, X. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.01.067 · Cited by 16
Jansen, M., van Doorn, M. M., Lichtwarck‐Aschoff, A., Kuijpers, R., Theunissen, H., Korte, M., van Rossum, J., Wauben, A., & Granic, I. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-16 · Cited by 18
Associations Between Anxiety Symptoms and Child and Family Factors in Pediatric Obesity
Lim, C. S., Espil, F. M., Viana, A. G., & Janicke, D. M. (2015) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000225 · Cited by 16
Anxiety in Individuals with ASD: Prevalence, Phenomenology, Etiology, Assessment, and Interventions
van Steensel, F. J. A., Bögels, S. M., Magiati, I., & Perrin, S. G. (2013) · Springer eBooks · doi:10.1007/978-1-4614-4788-7_31 · Cited by 18
Self-citationFinding gene-environment interactions for generalised anxiety disorder
Gregory, A. M., Lau, J. Y. F., & Eley, T. C. (2008) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-007-0785-4 · Cited by 17
Eisen, A. R., Sussman, J. M., Schmidt, T., Mason, L., Hausler, L. A., & Hashim, R. L. (2011) · Springer eBooks · doi:10.1007/978-1-4419-7784-7_17 · Cited by 18
Parent and child distress after war exposure
Lai, B. S., Hadi, F., & Llabre, M. M. (2014) · British Journal of Clinical Psychology · doi:10.1111/bjc.12049 · Cited by 16
Rivers, A. S., Russon, J., Winston-Lindeboom, P., Ruan-Iu, L., & Diamond, G. (2021) · Journal of Youth and Adolescence · doi:10.1007/s10964-021-01524-x · Cited by 12
Kazmierski, K. F. M., Borelli, J. L., & Rao, U. (2022) · Journal of Social Issues · doi:10.1111/josi.12525 · Cited by 17
Esbjørn, B. H., Breinholst, S., Kriss, A., Hald, H., & Steele, H. (2015) · Attachment & Human Development · doi:10.1080/14616734.2015.1093699 · Cited by 15
“Attachment constructs and their prediction of anxiety Although insecure attachment has generally been associated with anxiety in childhood (Bögels & Brechman-Toussaint, 2006), a recent meta-analysis suggests that this association is small (Groh et al., 2012).”
BackgroundFriendship network influence on the development of internalizing symptoms during adolescence
Veed, G. J., McGinley, M. M., & Crockett, L. J. (2018) · Journal of Applied Developmental Psychology · doi:10.1016/j.appdev.2018.09.002 · Cited by 17
Anxiety‐related disorders: An overview
Riordan, D. M., & Singhal, D. (2018) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.14167 · Cited by 23
Djumingin, S., Weda, S., & Juanda, J. (2019) · International Journal of Education and Practice · doi:10.18488/journal.61.2019.71.1.9 · Cited by 14
Ye, B., Lau, J. T. F., Lee, H. H., Yeung, J. C. H., & Mo, P. K. H. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283662 · Cited by 22
“A review conducted by Bögels & Brechman-Toussaint revealed that poor family functioning such as marital conflict, and co-parenting and parental rearing strategies, predicted child anxiety [68].”
Background
Metadata
- Authors
- Bögels, S. M., & Brechman-Toussaint, M. L.
- Affiliations
- University of Amsterdam (NL)
- Corresponding author
- Bögels, Susan M.
- ORCID
- Bögels, Susan M.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2006-11
- Volume
- 26
- Issue
- 7
- Pages
- 834-856
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W1966079923
- Cited by
- 708
- References
- 173
- Citations by year
- 2026: 23 · 2025: 37 · 2024: 30 · 2023: 33 · 2022: 30 · 2021: 29 · 2020: 37 · 2019: 42 · 2018: 29 · 2017: 50 · 2016: 42 · 2015: 52 · 2014: 47 · 2013: 48 · 2012: 33
- FWCI
- 26.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- EPubDev Repository (submittedVersion)
- RUNE (Research UNE) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Keywords
- childhood anxiety, family factors, attachment, family functioning, parental beliefs, intergenerational transmission of anxiety, parental anxiety, marital conflict, co-parenting, sibling relationships, child psychopathology
- MeSH terms
- Adolescent, Anxiety Disorders, Attitude, Child, Psychology, Child, Child Rearing, Child, Preschool, Cognition, Family, Family Relations, Female, Humans, Infant, Male, Object Attachment, Perception, Risk Factors, Parenting
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