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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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Penner, F., Vanwoerden, S., Borelli, J. L., & Sharp, C. (2019) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-019-00589-4 · Cited by 5
“…have shown that secure attachments are associated with healthier psychosocial functioning, whereas insecure attachments are associated with internalizing problems (Groh et al. 2012) and both insecure and disorganized attachment are associated with externalizing problems (Fearon et al. 2010).”
BackgroundFathers in Child Psychotherapy
von Klitzing, K., & White, L. O. (2020) · Springer eBooks · doi:10.1007/978-3-030-51027-5_37 · Cited by 5
Understanding and Evaluating the Moral World in Infancy
Hamlin, J. K., & Sitch, M. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108351959.028 · Cited by 6
Rooksby, M., Folco, S. D., Tayarani, M., Vo, D.-B., Huan, R., Vinciarelli, A., Brewster, S. A., & Minnis, H. (2021) · PLoS ONE · doi:10.1371/journal.pone.0240277 · Cited by 5
“Observing young children with their parents in SSP and in clinic waiting rooms, and observing doll behaviour in the doll-play MCAST or on the computer screen, secure attachment seemed to be characterised by smooth and fairly rapid movement to reduce the distance between child and mummy (doll).”
MethodInfluentialInterpersonal trust in adolescents with psychiatric disorders and borderline pathology
Graves, M., Penner, F., & Sharp, C. (2021) · Scandinavian Journal of Child and Adolescent Psychiatry and Psychology · doi:10.21307/sjcapp-2021-020 · Cited by 6
“It may also be due to insecure attachment styles and more difficult relationships with parents that have been associated with psychopathology during childhood and adolescence (62,63).”
BackgroundLeblanc, É., Dégeilh, F., Beauchamp, M. H., & Bernier, A. (2022) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-022-00987-0 · Cited by 5
Mohamed, A. R., Sterkenburg, P. S., Yeatman, J. G., van Rensburg, E., & Schuengel, C. (2022) · Journal of Intellectual Disabilities · doi:10.1177/17446295221104614 · Cited by 7
Zdebik, M. A., Pascuzzo, K., Bureau, J., & Moss, E. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.933213 · Cited by 9
Attachment and mentalization in contemporary psychodynamic psychotherapy
Debbané, M. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813373-6.00003-9 · Cited by 6
Support from the Start: effective programmes from birth to two years
Sutton, C., Murray, L., & Glover, V. A. S. (2012) · Journal of Children s Services · doi:10.1108/17466661211213643 · Cited by 5
Juffer, F., Finet, C., Vermeer, H. J., & van den Dries, L. (2015) · Praxis der Kinderpsychologie und Kinderpsychiatrie · doi:10.13109/prkk.2015.64.10.774 · Cited by 5
Ditmar, M. F. (2010) · Elsevier eBooks · doi:10.1016/b978-0-323-06561-0.00002-1 · Cited by 7
Preschool Children Without 7-repeat DRD4 Gene More Likely to Develop Disorganized Attachment Style
Graffi, J., Moss, E., Jolicoeur‐Martineau, A., Moss, G., Lecompte, V., Pascuzzo, K., Babineau, V., Green, C. G., Mileva‐Seitz, V. R., MINDE, K. K., et al. (2015) · McGill Science Undergraduate Research Journal · doi:10.26443/msurj.v10i1.120 · Cited by 5
Bolten, M. I. (2018) · Springer eBooks · doi:10.1007/978-3-662-57369-3_4 · Cited by 5
Turning Points in the Assessment and Clinical Applications of Individual Differences in Attachment
Crittenden, P. M., Spieker, S. J., & Farnfield, S. (2021) · Oxford University Press eBooks · doi:10.1093/obo/9780199828340-0271 · Cited by 6
Eirich, R., Pador, P., Watt, J., Racine, N. M., Lyons‐Ruth, K., & Madigan, S. L. (2024) · Infant Mental Health Journal · doi:10.1002/imhj.22115 · Cited by 4
Early Predictors of the Childhood Dysregulation Profile: A Systematic Review
Vitkauskaite, E., & Bilgin, A. (2026) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-026-00557-7 · Cited by 4
“The association between these factors and the development of childhood DP symptoms may be explained by their potential impact on the formation of secure attachment with parents (Bilgin & Wolke, 2020), which in turn has been linked to the emergence of DP symptoms (Groh et al., 2012).”
Schmidt, F., Fiorini, G. P., da Costa, A. A., Brenner, E. B., Bittencourt, L. Z., & Ramires, V. R. R. (2022) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2022.2090212 · Cited by 5
“Although the present study did not aim to investigate causal relations, our results reinforce the theoretical assumption of insecure attachments as a risk factor for the development of psychopathology (Groh et al., 2012).”
BackgroundResultInfluentialMarci, T., Moscardino, U. M. M., Santona, A. M. R., Lionetti, F., Pastore, M., & Altoè, G. (2020) · Assessment · doi:10.1177/1073191120978813 · Cited by 4
“However, it does not allow to directly measure insecurity (i.e., anxiety and avoidance), which has been shown to contribute to a number of maladjustment outcomes in both infancy and middle childhood (Cassidy & Shaver, 2016; Groh et al., 2012).”
BackgroundSchröder, M., Seker, S., d’Huart, D., İzat, Y., Bolten, M. I., Schmeck, K., & Schmid, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192315458 · Cited by 4
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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