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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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BackgroundWarmuth, K. A., Cummings, E. M., & Davies, P. T. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01158-x · Cited by 4
Lemieux, N., & Bisaillon, C. (2022) · Devenir · doi:10.3917/dev.214.0341 · Cited by 4
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Twinship as a protective factor against behavioural and emotional problems at preschool age
Tirkkonen, T. T., Joskitt, L., Kunelius, A., Huhtaniska, M., Ebeling, H. E., & Moilanen, I. K. (2015) · Early Child Development and Care · doi:10.1080/03004430.2015.1066783 · Cited by 4
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BackgroundProblèmes de comportement chez l’enfant victime d’agression sexuelle: Le rôle de l’attachement.
Zephyr, L., Cyr, C. P., Hébert, M., Bernier, A., & Beaudoin, G. (2014) · Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement · doi:10.1037/a0037592 · Cited by 4
Bizzi, F., Locati, F., Parolin, L. A. L., Shmueli‐Goetz, Y., & Brusadelli, E. (2022) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2022.586 · Cited by 4
“These findings add to the current debate suggesting that the relationship between attachment and developmental outcomes is complex and not always as strong as may be expected (Fearon et al., 2010; Groh et al., 2012; Madigan et al., 2016; Luyten et al., 2020).”
BackgroundBosmans, G., Dujardin, A., Vandevivere, E., Braet, C., & Kerns, K. A. (2014) · Wiley eBooks · doi:10.1002/9781118775349.ch11 · Cited by 4
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“From the adolescent’s perspective, parental burnout and psychological control introduce developmental threats that undermine their sense of predictability, emotional safety, and personal agency 25,30 .”
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Bisaillon, C., Bureau, J., & Moss, E. (2017) · Revue de psychoéducation · doi:10.7202/1039256ar · Cited by 10
“…et plus particulièrement désorganisé, constitue un facteur de risque pour la mésadaptation et la psychopathologie (voir la méta-analyse de Groh et al., 2012; Lyons-Ruth et Jacobvitz, 2008), et ce, surtout pour les troubles extériorisés (Fearon, Bakermans-Kranenburg, van IJzendoorn,…”
BackgroundKurbatfinski, S., Woo, J., Ntanda, H. N., Giesbrecht, G. F., & Letourneau, N. L. (2024) · Children · doi:10.3390/children11081022 · Cited by 3
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“Another meta-analysis of 42 samples ( N = 4,614) reported a weak but significant relation between infant disorganization and internalizing behavior problems and a stronger relation with externalizing behavior (Groh et al., 2012).”
InfluentialDelamain, H., Saunders, R., Tanzer, M., Luyten, P., Fonagy, P., & Campbell, C. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.12.033 · Cited by 3
“More specifically, it is important to note that insecure attachment and childhood trauma, independently, have also been associated with poor mental health outcomes (Fearon et al., 2010; Groh et al., 2012, 2014).”
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Söner, O., & Duru, H. (2025) · British Journal of Guidance and Counselling · doi:10.1080/03069885.2024.2438169 · Cited by 3
“…attachment has a protective function that prevents the development of mental problems that negatively a ff ect mental health (Colonnesi et al., 2011; Groh et al., 2012; Madigan et al., 2013), on the other hand, insecure parental attachment leads to the development of depression and anxiety…”
Social circuits under developmental threat: Bridging rodent and human neuroscience
Murgueitio, N., Propper, C. B., & Sheridan, M. A. (2025) · Developmental Review · doi:10.1016/j.dr.2025.101228 · Cited by 4
Li, Z., Hygen, B. W., Widaman, K. F., Berg‐Nielsen, T. S., Wichstrøm, L., & Belsky, J. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01013 · Cited by 3
VII. DEVELOPMENTAL TRAJECTORIES OF CHILDREN’S EMOTIONAL REACTIVITY AFTER THE BIRTH OF A SIBLING
Kuo, P. X., Volling, B. L., Gonzalez, R., Oh, W., & Yu, T. (2017) · Monographs of the Society for Research in Child Development · doi:10.1111/mono.12313 · Cited by 3
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“…and retrospective studies confirm the connection between attachment history and social and psychological development (e.g. Sroufe et al, 2010; Groh et al, 2012), and a substantial proportion of the Probation Service caseload is known to have experienced loss, abuse and neglect in their early…”
BackgroundJayaraman, S., & Smith, L. B. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108351959.020 · Cited by 2
Maurer, D. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108351959.006 · Cited by 3
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“…& Roisman, 2010; Lyons-Ruth et al., 1993), while changes in affective processing may help explain the high prevalence of internalizing behavioral disorders (e.g., anxiety, depression, suicidality; Bos et al., 2011; Colonnesi et al., 2011; Groh et al., 2012) in insecurely attached individuals.”
BackgroundIX. DEVELOPMENTAL TRAJECTORIES OF CHILDREN’S SOMATIC COMPLAINTS AFTER THE BIRTH OF A SIBLING
Beyers-Carlson, E. E. A., Stevenson, M. M., Gonzalez, R., Oh, W., Volling, B. L., & Yu, T. (2017) · Monographs of the Society for Research in Child Development · doi:10.1111/mono.12315 · Cited by 4
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“Although the observed relationship between insecure attachment and problem behaviors is often statistically significant, the associated effect size tends to be modest (Groh et al., 2012; Madigan, Atkinson, Laurin, & Benoit, 2013).”
BackgroundVI. DEVELOPMENTAL TRAJECTORIES OF CHILDREN’S ANXIETY AND DEPRESSION AFTER THE BIRTH OF A SIBLING
Thomason, E., Oh, W., Volling, B. L., Gonzalez, R., & Yu, T. (2017) · Monographs of the Society for Research in Child Development · doi:10.1111/mono.12312 · Cited by 4
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BackgroundAttachment: normal development, individual differences, and associations with experience
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Ethiopian Adoptees’ Experiences of Attachment after Adoption in Australia: A Qualitative Study
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BackgroundHayne, H., & Herbert, J. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108351959.012 · Cited by 1
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BackgroundResultvan der Asdonk, S., Kesarlal, A. R., Schuengel, C., Draaisma, N., de Roos, C., Zuidgeest, K., Rippe, R. C. A., & Alink, L. R. A. (2022) · Trials · doi:10.1186/s13063-022-06902-9 · Cited by 4
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“In addition, parental rejection has been linked to numerous negative outcomes in children, such as behavioral problems, depression (Rohner & Britner, 2002; Rohner et al., 2003), psychological maladaptation (Groh et al., 2012), and low levels of playfulness (Hong et al., 2017).”
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“…and externalizing symptoms (Carl-son, 1998; Granqvist et al., 2017; Groh et al., 2017), and insecure attachment to predict internalizing and externalizing problems (Bel-sky et al., 2010; Brumariu & Kerns, 2010; Fearon et al., 2010; Mad-igan et al., 2013) and mental illness (Groh et al., 2012).”
Katz, D., Sellers, T., Labella, M. H., & Dozier, M. (2024) · Attachment & Human Development · doi:10.1080/14616734.2024.2420784 · Cited by 2
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“…one at risk for subsequent psychopathology, particularly depressive or anxiety disorders (Brumariu & Kerns, 2010; Di Pentima et al., 2019a, 2019b; Groh et al., 2012; Kullik & Petermann, 2013), externalizing disorders up to delinquent behavior (Di Pentima & Ramelli, 2020; Di Pentima et al.,…”
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“For example, three distinct meta-analyses suggest that the AQS has about twice the predictive power of the SSP with respect to child internalizing problems (Groh et al., 2012), externalizing problems (Fearon et al., 2010), and social competence (Groh et al., 2014).”
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“2013), which potentially result in children’s ill-preparation for organized environments such as school (Fearon et al. 2010; Pasco Fearon & Belsky 2011; Groh et al. 2012).”
BackgroundII. METHODS AND PROCEDURES FOR THE FAMILY TRANSITIONS STUDY
Oh, W., Volling, B. L., Gonzalez, R., Rosenberg, L., & Song, J. (2017) · Monographs of the Society for Research in Child Development · doi:10.1111/mono.12308 · Cited by 3
X. DEVELOPMENTAL TRAJECTORIES OF CHILDREN’S SLEEP PROBLEMS AFTER THE BIRTH OF A SIBLING
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“, & Fearon, P. (2002). Infant–mother attachment security, contextual”
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Yamada, Y., Kanazawa, H., & Kuniyoshi, Y. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108351959.001 · Cited by 3
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“(2014) and Hockaday (2018) found no association between security of attachment and behavior problems of the foster child, but research in the regular population points to insecure attachment relationships increasing the risk for behavioral problems (Fearon et al., 2010; Groh et al., 2012).”
BackgroundInfluentialShah, S., Laplante, D. P., Atkinson, L. R., & Wazana, A. D. (2022) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000817 · Cited by 5
“Insecure attachment predicts aggression and other antisocial behaviours, associations that strengthens with age and are present regardless of socioeconomic status (SES) or whether symptoms meet clinical thresholds [8].”
BackgroundTouati, C. D., Miljkovitch, R., Sirparanta, A., Ahmad, S., Toléon, C., & Deborde, A.-S. (2023) · Children and Youth Services Review · doi:10.1016/j.childyouth.2023.107040 · Cited by 3
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Mitić, M., Woodcock, K. A., Amering, M., Krammer, I., Stiehl, K. A. M., Zehetmayer, S., & Schrank, B. (2020) · doi:10.31234/osf.io/kry65 · Cited by 3
The Development of Touch Perception and Body Representation
Bremner, A. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108351959.009 · Cited by 3
Gilbert, M. C., & Blakey, R. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.649868 · Cited by 2
“This finding supports previous research, which states that highly avoidant adults seek distance when their partner is distressed and are less inclined to become involved in their problems (Groh et al., 2012; Paetzold et al., 2015).”
BackgroundResultHill, J., Wright, N., Sharp, H. M., Pickles, A. R., & Steele, H. (2023) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2023.1143125 · Cited by 1
Kim, N., 김, 민., Kim, K., 김, 주., & 한, 경. (2023) · Journal of Family Relations · doi:10.21321/jfr.28.2.169 · Cited by 1
Obi-Obasi, O., Cano, K., & Sharp, C. (2023) · Journal of Personality Disorders · doi:10.1521/pedi.2023.37.6.751 · Cited by 1
Belastung, Fürsorge und Entwicklung
Zimmermann, J., & Kindler, H. (2023) · Springer eBooks · doi:10.1007/978-3-662-66900-6_12 · Cited by 1
Mohammed, A., & Alonso‐Arbiol, I. (2024) · Journal of Adolescence · doi:10.1002/jad.12304 · Cited by 1
Lee, C., Park, S., & Lee, J. (2024) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbae065 · Cited by 1
“…may lead to insecure and disorganized attachment among children; these attachment styles, in turn, may be associated with externalizing (e.g., aggressive or oppositional) and internalizing behavior (e.g., depressive symptoms) in later childhood and beyond (Fearon et al., 2010; Groh et al., 2012).”
BackgroundContributions of Attachment and Cognitive Functioning on ADHD Symptoms in Children
Wylock, J.-F., Borghini, A., Delvenne, V., & Slama, H. (2024) · Child Psychiatry & Human Development · doi:10.1007/s10578-024-01784-1 · Cited by 1
“Meta-analysis have shown that insecure styles, especially disorganized attachment, are associated with externalizing and internalizing disorders [29, 38] and systematic reviews have also found an association between attachment patterns and ADHD symptoms [57, 69].”
Paquette, D., Dubois‐Comtois, K., Cyr, C. P., Bigras, M., Bacro, F., Couture, S., & Lemelin, J. (2025) · Journal of Child and Family Studies · doi:10.1007/s10826-024-02975-z · Cited by 2
“Mother-child attachment insecurity was modestly associated with inter-nalizing behaviors (speci fi cally avoidance) in one meta-analysis (Groh et al., 2012) and with externalizing behaviors (with each insecure category) in a second meta-analysis (Fearon et al., 2010).”
Zvara, B. J., Mills-Koonce, R., Propper, C. B., Grewen, K., Pearson, B. L., & Stuebe, A. M. (2025) · Developmental Psychobiology · doi:10.1002/dev.70086 · Cited by 1
A developmental psychopathology model of social anxiety
Gazelle, H., Rubin, K. H., & Brendgen, R. M. (2026) · Social Anxiety · doi:10.1016/b978-0-443-14146-1.00012-7 · Cited by 1
Wu, G., Eades, C. E., & Hoyle, L. P. (2026) · Journal of Medical Internet Research · doi:10.2196/93848 · Cited by 1
Bahm, N. I. G., Duschinsky, R., & Hesse, E. (2016) · Attachment & Human Development · doi:10.1080/14616734.2016.1181096 · Cited by 2
Toussaint, E., Bacro, F., & Schneider, B. (2021) · L’Année psychologique · doi:10.3917/anpsy1.212.0045 · Cited by 4
Amso, D., & Tummeltshammer, K. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108351959.007 · Cited by 1
Early Knowledge About Space and Quantity
Newcombe, N. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108351959.015 · Cited by 1
West, D. (2021) · VUBIR (Vrije Universiteit Brussel) · doi:10.1177/03085759211055359 · Cited by 1
Venta, A. C., & Marshall, K. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00045-5 · Cited by 1
Pentima, L. D., Toni, A., & Attili, G. (2021) · MALTRATTAMENTO E ABUSO ALL INFANZIA · doi:10.3280/mal2021-002006 · Cited by 1
Behavioral Changes in Preschool- and School-Age Korean Children: A Network Analysis
Goh, E.-K., & Jeon, H. J. (2022) · Children · doi:10.3390/children9050677 · Cited by 1
“Early in life, unstable attachment predicts both internalization [49,50] and externalization symptoms [51].”
Background
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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