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Attachment and Reflective Functioning in Anxious and Non-anxious Children: A Case-Controlled Study

Abstract

Anxiety is a prevalent psychiatric disorders. Theoretically, attachment insecurity is associated with the development of clinical anxiety. Few studies have examined this empirically. The current study investigates possible differences in attachment security and the related construct reflective functioning (Developmental Perspective, Theory of Mind, and Diversity of Feeling) in a case-controlled design between an index group of clinically anxious children (n = 111) and a control group of non-anxious children (n = 111) matched on age and gender. Clinical interviews established anxiety, attachment, and reflective functioning. No significant differences in attachment classification or Developmental Perspective emerged; however, index children had significantly poorer ratings on Theory of Mind and Diversity of Feeling. Insecure attachment might be a global risk factor rather than a risk factor for anxiety. Poorer scores on Theory of Mind and Diversity of Feeling might reflect genuinely lower abilities, or be results of the cognitive strategies applied by anxious children.

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References

  • Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood anxiety disorders. Child Psychopathology, 2, 279–329.

    Google Scholar 

  • Astington, J. W., & Jenkins, J. M. (1995). Theory of mind development and social understanding. Cognition & Emotion, 9, 151–165.

    Article  Google Scholar 

  • Bodden, D. H., Dirksen, C. D., & Bögels, S. M. (2008). Societal burden of clinically anxious youth referred for treatment: A cost-of-illness study. Journal of Abnormal Child Psychology, 36, 487–497.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bögels, S. M., & Brechman-Toussaint, M. L. (2006). Family issues in child anxiety: Attachment, family functioning, parental rearing and beliefs. Clinical Psychology Review, 26(7), 834–856.

    Article  PubMed  Google Scholar 

  • Bögels, S., & Phares, V. (2008). Fathers’ role in the etiology, prevention and treatment of child anxiety: A review and new model. Clinical Psychology Review, 28(4), 539–558.

    Article  PubMed  Google Scholar 

  • Bosquet, M., & Egeland, B. (2006). The development and maintenance of anxiety symptoms from infancy through adolescence in a longitudinal sample. Development and Psychopathology, 18, 517–550.

    Article  PubMed  Google Scholar 

  • Bowlby, J. (1973). Attachment and loss. Vol. 2: Separation: Anger and anxiety. London, UK: Pimlico.

    Google Scholar 

  • Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-cultural Psychology, 1, 185–216.

    Article  Google Scholar 

  • Brumariu, L. E., & Kerns, K. A. (2010). Parent-child attachment and internalizing symptoms in childhood and adolescence: A review of empirical findings and future directions. Development and Psychopathology, 22, 177–203.

    Article  PubMed  Google Scholar 

  • Carlson, E. A., Jacobvitz, D., & Sroufe, L. A. (1995). A developmental investigation of inattentiveness and hyperactivity. Child Development, 66(1), 37–54.

    Article  PubMed  Google Scholar 

  • Cassidy, J., & Berlin, L. J. (1994). The insecure/ambivalent pattern of attachment: Theory and research. Child Development, 65, 971–991.

    Article  PubMed  Google Scholar 

  • Chandler, M., Astington, J. W., Harris, P. L., & Olson, D. R. (1988). Doubt and developing theories of mind. Developing Theories of Mind, 1, 387–414.

    Google Scholar 

  • Cicchetti, D., & Sroufe, L. A. (2000). Editorial: The past as prologue to the future: The times, they’ve been a-changin. Development and Psychopathology, 12, 255–264.

    Article  PubMed  Google Scholar 

  • Colonnesi, C., Draijer, E. M., Stams, G. J., Van der Bruggen, C. O., Bogels, S. M., & Noom, M. J. (2011). The relation between insecure attachment and child anxiety: A meta-analytic review. Journal of Clinical Child and Adolescent Psychology, 40, 630–645.

    Article  PubMed  Google Scholar 

  • Copeland, W. E., Angold, A., Shanahan, L., & Costello, E. J. (2014). Longitudinal patterns of anxiety from childhood to adulthood: The great smoky mountains study. Journal of the American Academy of Child & Adolescent Psychiatry, 53, 21–33.

    Article  Google Scholar 

  • Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.

    Article  PubMed  Google Scholar 

  • Cunha, M., Soares, I., & Gouveia, J. P. (2008). The role of individual temperament, family and peers in social anxiety disorder: A controlled study. International Journal of Clinical and Health Psychology, 8, 631–655.

    Google Scholar 

  • Escobar, M. J., Rivera-Rei, A., Decety, J., Huepe, D., Cardona, J. F., & Canales-Johnson, A., et al. (2013). Attachment patterns trigger differential neural signature of emotional processing in adolescents. PLoS ONE, 8, e70247.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fonagy, P. (2003). The development of psychopathology from infancy to adulthood: The mysterious unfolding of disturbance in time. Infant Mental Health Journal, 24, 212–239.

    Article  Google Scholar 

  • Fonagy, P., Redfern, S., & Charman, T. (1997). The relationship between belief-desire reasoning and a projective measure of attachment security (SAT). British Journal of Developmental Psychology, 15, 51–61.

    Article  Google Scholar 

  • Fonagy, P., Steele, M., Steele, H., Moran, G. S., & Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12, 201–218.

    Article  Google Scholar 

  • Fonagy, P., & Target, M. (1997). Attachment and reflective function: Their role in self-organization. Development and psychopathology, 9, 679–700.

    Article  PubMed  Google Scholar 

  • Ford, T., Goodman, R., & Meltzer, H. (2003). The British child and adolescent mental health survey 1999: The prevalence of DSM-IV disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1203–1211.

    Article  PubMed  Google Scholar 

  • Frances, A. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association.

  • George, C., Kaplan, N., & Main, M. (1985). The Berkeley adult attachment interview. Unpublished protocol. Berkeley: Department of Psychology, University of California.

    Google Scholar 

  • Groh, A. M., Roisman, G. I., van IJzendoorn, M. H., Bakermans‐Kranenburg, M. J., & Fearon, R. (2012). The significance of insecure and disorganized attachment for children’s internalizing symptoms: A meta‐analytic study. Child Development, 83(2), 591–610.

    PubMed  Google Scholar 

  • Hesse, E. (2008). The Adult Attachment Interview: Protocol, method of analysis, and empirical studies. In J. Cassidy & P.R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications. 2nd ed. (pp. 552–598). New York, NY, US.: Guilford press.

    Google Scholar 

  • Kerns, K. A., & Brumariu, L. E. (2014). Is insecure parent–child attachment a risk factor for the development of anxiety in childhood or adolescence? Child Development Perspectives, 8(1), 12–17.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Chiu, W.T ., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kessler, R. C., & Wang, P. S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115–129.

    Article  PubMed  Google Scholar 

  • Kriss, A., Steele, H., & Steele, M. (2012). Measuring attachment and reflective functioning in early adolescence: An introduction to the friends and family interview. Research in Psychotherapy: Psychopathology, Process and Outcome, 15, 87–95.

    Google Scholar 

  • Madigan, S., Atkinson, L., Laurin, K., & Benoit, D. (2013). Attachment and internalizing behavior in early childhood: A meta-analysis. Developmental Psychology, 49(4), 672.

    Article  PubMed  Google Scholar 

  • Muris, P., Mayer, B., Freher, N. K., Duncan, S., & van den Hout, A. (2010). Children’s internal attributions of anxiety-related physical symptoms: Age-related patterns and the role of cognitive development and anxiety sensitivity. Child Psychiatry & Human Development, 41, 535–548.

    Article  Google Scholar 

  • Psouni, E., & Apetroaia, A. (2014). Measuring scripted attachment-related knowledge in middle childhood: the Secure Base Script Test. Attachment and Human Development, 16(1), 22–41.

    Article  PubMed  Google Scholar 

  • Petersen, T., & Elklit, A. (2013). Attachment styles and PTSD in adolescents in three Nordic countries. Open Journal of Epidemiology, 3(02), 62.

    Article  Google Scholar 

  • Silverman, W. K., Albano, A. M., & Barlow, D. H. (1996). Manual for the ADIS-IV-C/P. New York: Psychological Corporation.

    Google Scholar 

  • Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV:Child and parent versions. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 937–944.

    Article  Google Scholar 

  • Steele, H., & Steele, M. (2005). The construct of coherence as an indicator of attachment security in middle childhood: The friends and family interview. In K. A. Kerns & R. A. Richardson (Eds.), Attachment in middle childhood (pp. 137–160). New York, NY, US: Guilford Press.

    Google Scholar 

  • Van IJzendoorn, M.H., Schuengel, C., & Bakermans-Kranenburg, M.J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–250.

    Article  PubMed  Google Scholar 

  • Vasey, M. W., & Dadds, M. R. (2001). An introduction to the developmental psychopathology of anxiety. In M. W. Vasey & M. R. Dadds (Eds.), The developmental psychopathology of anxiety (pp. 3–26). New York: Oxford University Press.

  • Walczak, M., Esbjørn, B. H., & Breinholst, S. (2017). Attachment as a predictor of non response to CBT treatment in children with anxiety disorders. Attachment & Human Development, 19(No. 6), 635–653.

    Article  Google Scholar 

  • Wechsler, D. (1991). WISC-III: Wechsler intelligence scale for children. TX, USA: Psychological Corporation San Antonio.

    Google Scholar 

  • Wellman, H. M. (1991). From desires to beliefs: Acquisition of a theory of mind. In Andrew Whiten (Ed), Natural theories of mind: Evolution, development and simulation of everyday mindreading (pp. 19–38). Cambridge, MA, US: Basil Blackwell.

    Google Scholar 

  • Wellman, H. M (2002). Understanding the psychological world: Developing a theory of mind. In U. Goswami (Ed.), Handbook of childhood cognitive development (pp. 167–187). Oxford, UK: Blackwell.

  • Woodward, L.J., & Fergusson, D.M. (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1086–1093.

    Article  Google Scholar 

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Author contributions

S.B. designed the content of the paper and conducted all the analyses in collaboration with H.S. S.B. has collected the data and written the first draft and all the following versions of the paper. B.H.E. was involved in study design and data collection, and has discussed, written, commented, and offered her suggestions on all versions of the paper, and has approved the final manuscript. H.S. has discussed the results and content of the paper. He offered his comments on all the versions of the paper, and approved the final manuscript.

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Correspondence to Sonja Breinholst.

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The authors declare that they have no conflict of interest.

Ethical Approval

The study complied with all ethical standards regarding research conducted on childhood samples. The Ethical Review Board of the Department of Psychology, University of Copenhagen approved the study.

Informed Consent

Written informed consent was obtained from all participating parents, and assent was obtained from participating children.

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Breinholst, S., Hoff Esbjørn, B. & Steele, H. Attachment and Reflective Functioning in Anxious and Non-anxious Children: A Case-Controlled Study. J Child Fam Stud 27, 2622–2631 (2018). https://doi.org/10.1007/s10826-018-1106-4

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  • DOI: https://doi.org/10.1007/s10826-018-1106-4

Keywords

  • Anxiety
  • Attachment
  • Child development
  • Case-controlled study
  • Reflective functioning