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The significance of insecure and disorganized attachment for children's internalizing symptoms: a meta-analytic study
Abstract
This meta-analytic review examines the association between attachment and internalizing symptomatology during childhood, and compares the strength of this association with that for externalizing symptomatology. Based on 42 independent samples (N = 4,614), the association between insecurity and internalizing symptoms was small, yet significant (d = 0.15, CI 0.06∼0.25) and not moderated by assessment age of internalizing problems. Avoidance, but not resistance (d = 0.03, CI −0.11∼0.17) or disorganization (d = 0.08, CI −0.06∼0.22), was significantly associated with internalizing symptoms (d = 0.17, CI 0.03∼0.31). Insecurity and disorganization were more strongly associated with externalizing than internalizing symptoms. Discussion focuses on the significance of attachment for the development of internalizing versus externalizing symptomatology.
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“Meta-analyses have shown that, in general, children with insecure and disorganized attachment have greater risk for concurrent and later internalizing and externalizing difficulties (Fearon et al. 2010, Groh et al. 2012) and psychiatric disorders in adulthood (Raby et al. 2018).”
From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Groh et al. 2012
In the citing paper
“Based on a meta-analysis of attachment studies primarily concerned with samples examined in infancy and early childhood, including both community and clinical samples, Groh and colleagues (Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012) reported small but significant associations between attachment insecurity and internalizing problems, with avoidant patterns most closely”
From Prospective Relations between Family Conflict and Adolescent Maladjustment: Security in the Family System as a Mediating Process (2015) · cites this paper as Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012
In the citing paper
“They also reported that attachment insecurity was more strongly associated with externalizing than internalizing symptoms (see also Groh et al., 2012).”
From Prospective Relations between Family Conflict and Adolescent Maladjustment: Security in the Family System as a Mediating Process (2015) · cites this paper as Groh et al., 2012
In the citing paper
“These types of attachment have commonly been linked to a catalogue of internalizing and externalizing behaviours (Colennessi et al. 2014;Groh et al. 2012;Jinyao et al. 2012).”
From The effects of paternal depression on child and adolescent outcomes: A systematic review (2016) · cites this paper as Groh et al. 2012
In the citing paper
“In its absence, neurodevelopment may be undermined, making that person more vulnerable to further environmental insults and subsequent development of both internalizing [36] and externalizing [37] behavioral problems, including anxiety, depression, substance misuse, maladaptive eating patterns, sexual risk behavior, and suicidality.”
From Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? (2020) · cites this paper as [36]
In the citing paper
“Parental sensitivity is important for a range of child outcomes, including the formation of a secure attachment relationship between infants and their parents, social competence, regulatory capacities, and lower stress levels (e.g. [22–28]).”
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“First, the relationship between attachment in childhood and developmental outcomes is less strong than may be expected from some traditional assumptions within attachment theory (Fearon et al. 2010, Groh et al. 2012, Madigan et al. 2013).”
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BackgroundGroh, A. M., Fearon, R. M. P., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Roisman, G. I. (2017) · Child Development Perspectives · doi:10.1111/cdep.12213 · Cited by 512
Self-citationGroh, A. M., Fearon, R. P., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., Steele, R. D., & Roisman, G. I. (2014) · Attachment & Human Development · doi:10.1080/14616734.2014.883636 · Cited by 495
“Analogous to our previous meta-analyses (Fearon et al., 2010; Groh et al., 2012), we conducted four separate meta-analyses on the social competence construct: one for the relation between attachment security and social competence, one for the relation between avoidance and social competence, one…”
BackgroundMethodResultInfluentialSelf-citationMadigan, S., Brumariu, L. E., Villani, V., Atkinson, L., & Lyons-Ruth, K. (2016) · Psychological Bulletin · doi:10.1037/bul0000029 · Cited by 397
“Finally, following some previous metaanalyses focused primarily on the infancy period (Fearon et al., 2010; Groh et al., 2012; Madigan et al., 2013), we will examine effects associated with each type of attachment insecurity (avoidance, ambivalence, and disorganization).”
InfluentialCassidy, J., Jones, J. D., & Shaver, P. (2013) · Development and Psychopathology · doi:10.1017/s0954579413000692 · Cited by 353
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“com insecurities nonspecifically contribute to many types of psychopathologies.(41,54) Our findings highlight the complexity of screening and care in this population in which externalized and internalized disorders are associated and complexly entangled.”
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The effects of paternal depression on child and adolescent outcomes: A systematic review
Sweeney, S., & MacBeth, A. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.05.073 · Cited by 257
“These types of attachment have commonly been linked to a catalogue of internalizing and externalizing behaviours (Colennessi et al. 2014; Groh et al. 2012; Jinyao et al. 2012).”
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Self-citationExposure to unpredictable maternal sensory signals influences cognitive development across species
Davis, E. P., Stout, S. A., Molet, J., Vegetabile, B., Glynn, L. M., Sandman, C. A., Heins, K., Stern, H. S., & Baram, T. Z. (2017) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1703444114 · Cited by 211
“In contrast, unpredictable maternal care leads to the development of an insecure or, in the extreme, disorganized attachment relationship (8).”
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Adult attachment representations and depressive symptoms: A meta-analysis
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“For example, Groh et al. (2012) identified only two studies that examined disorganization and clinical depression, and even though they had a strong association, this finding was not interpreted due to the small sample size.”
InfluentialBreastfeeding and Its Relation to Maternal Sensitivity and Infant Attachment
Tharner, A., Luijk, M. P. C. M., Raat, H., van IJzendoorn, M. H., Bakermans‐Kranenburg, M. J., Moll, H. A., Jaddoe, V. W. V., Albert Hofman, D., Verhulst, F. C., & Tiemeier, H. W. (2012) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e318257fac3 · Cited by 183
Self-citationCummings, E. M., Koss, K. J., & Davies, P. T. (2015) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-014-9926-1 · Cited by 176
“They also reported that attachment insecurity was more strongly associated with externalizing than internalizing symptoms (see also Groh et al., 2012).”
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“Metaanalytic research has confirmed that securely attached children show more social competence and fewer externalizing and internalizing behavior problems than insecurely attached children [9, 10, 11].”
BackgroundSelf-citationCircle of Security–Parenting: A randomized controlled trial in Head Start
Cassidy, J., Brett, B. E., Gross, J. T., Stern, J. A., Martin, D. R., Mohr, J. J., & Woodhouse, S. S. (2017) · Development and Psychopathology · doi:10.1017/s0954579417000244 · Cited by 167
“Beyond EF, substantial research has linked secure child attachment to reduced risk for internalizing and externalizing problems, as noted above (for reviews, see Cicchetti, Toth, & Lynch, 1995; DeKlyen & Greenberg, 2016; Fearon et al., 2010; Groh et al., 2012).”
BackgroundBeijersbergen, M. D., Juffer, F., Bakermans‐Kranenburg, M. J., & van IJzendoorn, M. H. (2012) · Developmental Psychology · doi:10.1037/a0027442 · Cited by 165
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Dalgaard, N. T., Todd, B. K., Daniel, S. I. F., & Montgomery, E. (2015) · Attachment & Human Development · doi:10.1080/14616734.2015.1113305 · Cited by 183
“The latter seems theoretically implausible, but in a recent meta-analyses based on 42 independent samples (N= 4.614) Groh, Roisman, van IJzendoorn, Bakermans ‐ Kranenburg, and Fearon (2012) insecure attachment was found to be significantly more strongly related to externalizing problems than to…”
InfluentialKoehn, A. J., & Kerns, K. A. (2017) · Attachment & Human Development · doi:10.1080/14616734.2017.1408131 · Cited by 162
Early Attachment Network with Mother and Father: An Unsettled Issue
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Attachment in institutionalized children: A review and meta-analysis
Lionetti, F., Pastore, M., & Barone, L. (2015) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.02.013 · Cited by 181
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“Jones et al., 2018). However, as we discuss later, there is scope for the improvement of self-report measures. 4.2. Is attachment distributed categorically or continuously? The four-category ABCD paradigm has held a central place in attachment theory and measurement approaches. In our review, interview and projective…”
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Hayes, L. J., Goodman, S. H., & Carlson, E. A. (2012) · Attachment & Human Development · doi:10.1080/14616734.2013.743256 · Cited by 137
Kok, R., Linting, M., Bakermans‐Kranenburg, M. J., van IJzendoorn, M. H., Jaddoe, V. W. V., Albert Hofman, D., Verhulst, F. C., & Tiemeier, H. W. (2013) · Child Psychiatry & Human Development · doi:10.1007/s10578-013-0369-7 · Cited by 150
Self-citationEffectiveness of interventions in preventing disorganized attachment: A meta-analysis
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Paetzold, R. L., Rholes, W. S., & Kohn, J. L. (2015) · Review of General Psychology · doi:10.1037/gpr0000042 · Cited by 125
“In a comparison of internalizing and externalizing behaviors, Groh et al. (2012) note that disorganized attachment appears to be significantly more strongly related to externalizing than internalizing behaviors.”
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“insecure attachment relationship with parents increases the risk of developing internalizing and externalizing disorders (Fearon et al. 2010; Groh et al. 2012; Kerns et al. 2011; Kerns and Brumariu, 2014; O’Connor et al. 2014).”
BackgroundAttachment and Temperament in the Early Life Course: A Meta-Analytic Review
Groh, A. M., Narayan, A. J., Bakermans‐Kranenburg, M. J., Roisman, G. I., Vaughn, B. E., Fearon, P. R. M., & van IJzendoorn, M. H. (2016) · Child Development · doi:10.1111/cdev.12677 · Cited by 127
Self-citationThe relationship between parenting and internalizing behaviours of children: a systematic review
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“Hammen and Rudolph (2003) state that 80% of children experiencing a Major Depressive episode will experience a relapse within 5–7 years. Furthermore, anxiety disorders that are first diagnosed in childhood that are left untreated may turn into chronic anxiety in adolescence and adulthood (Albano, Chorpita, & Barlow, 2…”
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Insecure attachment during infancy predicts greater amygdala volumes in early adulthood
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“…despite evidence from infancy studies showing that avoidant children are at greater risk of presenting behavior problems (Fearon et al. 2010; Groh et al. 2012; Madigan et al. 2012), we found that, in general, this group was less likely to show clinical levels of externalizing behavior…”
BackgroundInfluentialAttention to Faces Expressing Negative Emotion at 7 Months Predicts Attachment Security at 14 Months
Peltola, M. J., Forssman, L., Puura, K., van IJzendoorn, M. H., & Leppänen, J. (2015) · Child Development · doi:10.1111/cdev.12380 · Cited by 93
“Meta-analytic data indicate that while attachment disorganization shows only a negligible association with later internalizing symptoms (e.g., anxiety and depression; Groh et al., 2012), disorganized attachment is associated with later externalizing symptoms (e.”
Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review
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“Consistent with other recent metaanalyses (e.g., Colonnesi et al. 2011; Groh et al. 2012), moderators were only interpreted if there were at least four studies in each category.”
ResultMaternal depression and infant attachment security: A meta‐analysis
Barnes, J., & Theule, J. (2019) · Infant Mental Health Journal · doi:10.1002/imhj.21812 · Cited by 125
Working toward anti-racist perspectives in attachment theory, research, and practice
Stern, J. A., Barbarin, O. A., & Cassidy, J. A. (2021) · Attachment & Human Development · doi:10.1080/14616734.2021.1976933 · Cited by 132
“…in diverse samples show that secure attachment predicts a host of positive outcomes, such as lower rates of psychopathology (Fearon et al., 2010; Groh et al., 2012); emotional and physiological self-regulation of stress (Calkins & Leerkes, 2011; Cassidy, 1994; Cassidy et al., 2013); social…”
BackgroundLewis‐Morrarty, E., Degnan, K. A., Chronis-Tuscano, A. M., Pine, D. S., Henderson, H. A., & Fox, N. A. (2014) · Child Development · doi:10.1111/cdev.12336 · Cited by 113
“In two recent metaanalyses, Groh et al. (2012) and Madigan, Atkinson, Laurin, and Benoit (2013) reported significant though modest (ds = 0.15 and 0.37, respectively) associations between insecure attachment and internalizing symptoms.”
BackgroundResultInfluentialChildhood separation anxiety and the pathogenesis and treatment of adult anxiety.
Milrod, B., Markowitz, J., Gerber, A., Cyranowski, J., Altemus, M., Shapiro, T., Hofer, M., & Glatt, C. T. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13060781 · Cited by 90
Haltigan, J. D., Roisman, G. I., & Fraley, R. C. (2012) · Development and Psychopathology · doi:10.1017/s0954579412000260 · Cited by 105
“…that may account for effects of early experience on outcomes such as externalizing and internalizing symptomatology given the different ways in which studies control (or fail to control) for relevant confounds (for discussions of these issues, see Fearon et al., 2010; and Groh et al., 2012).”
BackgroundInfluentialSelf-citationInfant Attachment, Parenting Stress, and Child Emotional and Behavioral Problems at Age 3 Years
Tharner, A., Luijk, M. P. C. M., van IJzendoorn, M. H., Bakermans‐Kranenburg, M. J., Jaddoe, V. W. V., Albert Hofman, D., Verhulst, F. C., & Tiemeier, H. W. (2012) · Parenting · doi:10.1080/15295192.2012.709150 · Cited by 103
“These findings converge with earlier studies in clinical and at-risk samples (Lyons-Ruth & Jacobvitz, 2008), and the absence of a meta-analytic association between disorganization and internalizing problems across normal and clinical samples (Groh et al., 2012).”
BackgroundResultInfluentialSelf-citationBornstein, M. H. (2016) · Wiley eBooks · doi:10.1002/9781119125556.devpsy405 · Cited by 111
A meta-analytic review of parenting interventions in foster care and adoption
Schoemaker, N. K., Wentholt, W. G. M., Goemans, A., Vermeer, H. J., Juffer, F., & Alink, L. R. A. (2019) · Development and Psychopathology · doi:10.1017/s0954579419000798 · Cited by 113
“…disorganized attachment (Van den Dries et al., 2009), but also because an insecure disorganized attachment puts these children at an additional risk of developing behavior problems and psychopathology (Fearon et al., 2010; Groh et al., 2012; Sroufe et al., 2005; van IJzendoorn et al., 1999).”
BackgroundBorelli, J. L., Cohen, C. T., Pettit, C., Normandin, L., Target, M., Fonagy, P., & Ensink, K. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01062 · Cited by 96
“In other words, although insecure or disorganized attachment in and of itself is associated with negative mental health outcomes in children (see Groh et al., 2012 for a review; Mikulincer and Shaver, 2012), perhaps insecure IWMs protect children from the maladjustment that could stem from their…”
Backgroundvan der Voort, A., Juffer, F., & Bakermans‐Kranenburg, M. J. (2014) · Journal of Children s Services · doi:10.1108/jcs-12-2013-0038 · Cited by 94
Self-citationChild‐father attachment in early childhood and behavior problems: A meta‐analysis
Deneault, A., Bakermans‐Kranenburg, M. J., Groh, A. M., Fearon, P. R. M., & Madigan, S. L. (2021) · New Directions for Child and Adolescent Development · doi:10.1002/cad.20434 · Cited by 91
“…previous meta-analyses on child-mother attachment provide evidence in support of attachment theory’s central claim regarding the long-term repercussions of relationships in early childhood, as the magnitude of the associations did not decrease with age (Fearon et al., 2010; Groh et al., 2012).”
BackgroundMethodResultInfluentialSelf-citationDagan, O., Schuengel, C., Verhage, M. L., van IJzendoorn, M. H., Sagi‐Schwartz, A., Madigan, S., Duschinsky, R., Roisman, G. I., Bernard, K., Bakermans‐Kranenburg, M. J., et al. (2021) · New Directions for Child and Adolescent Development · doi:10.1002/cad.20450 · Cited by 97
Self-citationLetourneau, N., Tryphonopoulos, P., Giesbrecht, G., Dennis, C.-L., Bhogal, S., & Watson, B. (2015) · Infant Mental Health Journal · doi:10.1002/imhj.21525 · Cited by 87
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“In line with earlier studies (Booth-LaForce and Oxford 2008; Groh et al. 2012; Verhoeven et al. 2012), we did not find evidence for differential developmental models of internalizing behavior for boys and girls.”
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The early care environment and DNA methylome variation in childhood
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“Disorganized attachment is also associated with an increased risk of later psychopathology (Fearon et al., 2010; Groh et al., 2012; Scholtens, Rydell, Bohlin, & Thorell, 2014).”
Evolutionary Foundations of Developmental Psychopathology
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Self-citationThe Security Scale as a measure of attachment: meta-analytic evidence of validity
Brumariu, L. E., Madigan, S. L., Giuseppone, K. R., Abtahi, M. M., & Kerns, K. A. (2018) · Attachment & Human Development · doi:10.1080/14616734.2018.1433217 · Cited by 74
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“Insecure parent–child attachments, in turn, are associated with higher risk of children developing internalizing and externalizing behavior problems that may persist into later life [31,32].”
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Fonagy, P., Campbell, C., & Luyten, P. (2023) · Brain Sciences · doi:10.3390/brainsci13030459 · Cited by 104
“In relation to internalizing symptoms, the association with attachment was considerably weaker, with avoidant children being found to be most at risk [14].”
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“Sharp, Fonagy, and Allen (2012) developed a theoretical model in which they argue that the social cognition patterns associated with attachment insecurity –perceptions of the self as unlovable and of others”
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“…sensitive care and harmonious interactions with their mothers are more likely to be socially adapted and use more effective emotion regulation strategies than their peers who experienced less supportive mother–child interactions (e.g., Fearon et al., 2010; Groh et al., 2012; NICHD, 2006).”
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“As for internalizing behaviors, Groh et al. (2012) reported a significant, albeit modest (d = .15, k = 42, N = 4,614) relationship between mother-child attachment insecurity and internalizing problems.”
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“Insecure or disorganized attachments, in turn, place children at greater risk for internalizing and externalizing behavior problems than secure attachments (5, 6).”
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Developmental risk factors in generalized anxiety disorder and panic disorder
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“It is important to point out that Groh et al. (2012) included only studies with early behavioral measures of attachment in their review, whereas Brumariu and Kerns (2010) had a broader focus on attachment assessed by different measures (behavioral representational and self-report) from early…”
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A constructive replication of the association between the oxytocin receptor genotype and parenting.
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“Keywords parenting; genetic; evocative rGE; oxytocin; OXTR Parenting practices vary dramatically across individuals (Belsky, 1984, 2011), and do so with long-term consequences for their offspring (Fearon, Bakermans-Kranenburg, van Ijzendoorn, Lapsley, & Roisman, 2012; Groh et al., 2012).”
BackgroundVanTieghem, M., Gabard-Durnam, L. J., Goff, B., Flannery, J., Humphreys, K. L., Telzer, E. H., Caldera, C., Louie, J., Shapiro, M., Bolger, N. P., et al. (2017) · Development and Psychopathology · doi:10.1017/s0954579417000153 · Cited by 56
“…Humphreys et al. 2015), the current study focuses on internalizing symptoms, given previous literature that has highlighted the role of both affective processing and attachment security in the risk for internalizing disorders (i.e., anxiety and depression; Groh et al., 2012; Madigan et al., 2013).”
BackgroundResult
Metadata
- Authors
- Groh, A. M., Roisman, G. I., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Fearon, R. P.
- Affiliations
- University of Illinois Urbana-Champaign (US)
- University of Leiden
- University of Reading
- Corresponding author
- Groh, Ashley M
- Venue
- Child Development
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-03-01
- Volume
- 83
- Issue
- 2
- Pages
- 591-610
- ISSN
- 0009-3920 (ISSN-L)
- 1467-8624
- OpenAlex
- W2118748762
- Semantic Scholar
- 1aaa3cc6768aac1af795b29740f57ac8c88a734e
- Cited by
- 638
- References
- 96
- Citations by year
- 2026: 27 · 2025: 28 · 2024: 40 · 2023: 34 · 2022: 48 · 2021: 74 · 2020: 80 · 2019: 56 · 2018: 40 · 2017: 55 · 2016: 54 · 2015: 43 · 2014: 33 · 2013: 14 · 2012: 11
- FWCI
- 4.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Child Development (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- insecure attachment, disorganized attachment, internalizing problems, externalizing problems, childhood, attachment avoidance, child psychopathology
- MeSH terms
- Adaptation, Psychological, Age Factors, Anxiety Disorders, Child, Child Behavior Disorders, Child, Preschool, Defense Mechanisms, Depressive Disorder, Female, Humans, Internal-External Control, Male, Personality Assessment, Personality Disorders, Social Behavior Disorders, Somatoform Disorders, Statistics as Topic, Reactive Attachment Disorder
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