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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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“E.g., the Strange Situation Procedure (SSP) is a widely used laboratory-based assessment designed for infants and it measures attachment by observing responses to brief scenarios of separations and reunions with the caregiver [7, 11].”
Procaccia, R., & Segre, G. (2025) · MALTRATTAMENTO E ABUSO ALL INFANZIA · doi:10.3280/mal2025-002003
Sanaty, M., Pournesaei, G. S., & Pirbazari, M. M. (2025) · Mental Wellness · doi:10.4081/mw.2025.26
“11 From the perspective of Adlerian individual psychology, a child’s birth order ( e.g ., first-born, middle child, last-born, or only child) directly affects their experience of rivalry, their need for attention, and the way they express emotions.”
Predicting Adolescent Anxiety with Childhood Attachment Disruptions: A Systematic Review
Sulaiman, N., & Shahid, R. (2025) · Journal of Early Childhood Care and Education (JECCE) · doi:10.30971/jecce.v9i1.2577
Veilleux, K., Terradas, M. M., Puentes‐Neuman, G., Didier, O., & Labonté, M. (2025) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2025.100608
Matheson, K. M., de Schaetzen, C., Li, A., Sheridan, N., Holahan, A.-L. V., Tighe, A. B., Salamatmanesh, M., Vloet, M., Cloutier, P., Helleman, A., et al. (2025) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-025-00981-7
Pre-adoption Experiences and Attachment Disorders in Portuguese Adopted Children
Pereira, L., Baptista, J., Magalhães, E., Soares, J., & Barbosa‐Ducharne, M. (2025) · Child & Youth Care Forum · doi:10.1007/s10566-025-09904-1 · Cited by 1
“These patterns, particularly disorganization, have been associated with increased vulnerability to later socioemotional difficulties and elevated risk for mental health prob - lems (e.g., Groh et al., 2012).”
Barron, M. C., Venta, A. C., Sharp, C., & Mercado, A. (2025) · Attachment & Human Development · doi:10.1080/14616734.2025.2594981
“Disorganization reflects the collapse of an organized strategy in the face of “unsolvable fear,” where the attachment figure is simultaneously a source of comfort and alarm (Cassidy & Mohr, 2001; Duschinsky, 2018; Groh et al., 2012; van Ijzendoorn et al., 1999).”
Additional file 1 of Maternal interpersonal problems and attachment security in adolescent offspring
Kerr, S., Penner, F., Ilagan, G. S., Choi-Kain, L. W., & Sharp, C. (2022) · Figshare · doi:10.6084/m9.figshare.20208260
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Ertmann, R. K., Bang, C. W., Kriegbaum, M., Væver, M. S., Kragstrup, J., Siersma, V., Wilson, P., Lutterodt, M. C., & Smith‐Nielsen, J. (2021) · Figshare · doi:10.6084/m9.figshare.13521153
Gao, H., & Wang, Z. (2026) · Journal of Youth and Adolescence · doi:10.1007/s10964-026-02323-y
“In contrast, adolescents who perceived parental rejection may suffer insecure attach - ments (Hughes et al., 2005) and impaired self-esteem and feelings of worthiness, eventually leading to psychosocial maladaptation and poor personality development (Groh et al., 2012).”
Aran, P., Lewis, A. J., Watson, S., Werner, E., & Galbally, M. (2026) · Maternal and Child Health Journal · doi:10.1007/s10995-025-04198-0 · Cited by 1
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Novo, A. (2020) · doi:10.70675/e1320cc8z8d3cz45a1za78bzdcce36e1f105
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Özcan, A. V. (2026) · Sakarya University Journal of Education · doi:10.19126/suje.1735709
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“Furthermore, variables reported to be correlated with attachment classification (Colonnesi et al., 2011; Fearon et al., 2010; Groh et al., 2012) were assessed (all in their German versions): anxiety (State Trait Anxiety Inventory for Children/STAI-K; Spielberger & Gorsuch, 1973; Unnewehr et al.,…”
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“Overall, a robust meta-analysis con fi rmed modest to moderate associations between insecure/ disorganised attachment and externalising problems (Fearon et al., 2010) and ES (Groh et al., 2012).”
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“…studies with children from biological families, indicates that attachment security functions as a protective factor against the development of externalizing symptoms (Groh et al., 2012, 2017), longitudinal evidence from foster care samples suggests the possibility of bidirectional relationships.”
Bager-Mariscal, D., Molins, F., González‐Sala, F., Talmón-Knuser, F., & Lacomba‐Trejo, L. (2026) · Adolescents · doi:10.3390/adolescents6030036
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Self-citationSun, J., Yin, Y., Xie, M., Xu, P., & Li, Y. (2026) · BMC Psychology · doi:10.1186/s40359-026-04670-8
“Conversely, children exposed to insensitive parenting may develop insecure attachments, negatively impacting their beliefs and expectations about relationships [46].”
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“…and externalizing difficulties, lower aggression, better emotional regulation, higher self-esteem, stronger social competence, and better overall well-being (Brumariu & Kerns, 2010; Fearon et al., 2010; Groh et al., 2012; Kobak et al., 2015; Madigan et al., 2016; Oldfield et al., 2016).”
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Ghossain, D. (2014) · UCL Discovery (University College London)
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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