Running head: ATTACHMENT AND ANXIETY
The Relationship between Caregiver-Child Attachment and Anxiety
Vicki Pederson
University of Calgary
EDPS650, Spring 2013
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The Relationship between Caregiver-Child Attachment and Anxiety
Attachment is a relational construct that can be described as an enduring affectionate
bond that unites two or more people across time and context. According to Bowlby’s theory of
attachment, attachments are the result of a mutual regulatory process established between
caregivers and infants that emerge from the time of birth (Easterbooks, Bartlett, Beeghly, &
Thompson, 2012). Anxiety disorders are widely recognized as among the most common
psychiatric disorders affecting children and adolescents, and yet the disorders are not well
understood (Albano, Choripita, & Barlow, 2003). The purpose of this paper is to describe and
review the research related to caregiver-child attachment and anxiety, and to evaluate the
possible role that a caregiver-child attachment plays in the development of childhood anxiety
disorders.
Attachment Theory
Attachment can be described as the dependency relationship a child develops towards his
or her primary caregiver. While early attachment research focused on the mother-infant
relationship, it is now accepted that children can form multiple attachment relationships that
include parents, grandparents, siblings, and alternate caregivers (Pearce, 2009). John Bowlby
was a leading researcher in the 1950s and is the predominant reference regarding attachment
theory. According to Bowlby, attachment relationships play a key role in the child’s
development, perception of relatedness with others, concept of self, and life experiences (Pearce,
2009). Attachment is a system that promotes the proximity between child and caregiver and
serves the purpose of protecting the child from danger. The infant shows specific behaviours to
encourage the caregiver to come close. When caregivers are sensitive to the infant’s behaviours,
the infant perceives the caregiver as a safe haven and a secure base from which to explore.
Characteristics of a secure attachment include infants’ confident exploration and secure base
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behaviour in the caregivers’ company, as well as the ability to be readily soothed when upset or
fearful (Easterbrooks et at., 2012). While the majority of infants in all cultures exhibit secure
attachment, some infants develop attachment that reflects distrust or uncertainty regarding the
responsiveness of the caregiver. Insecure attachments are generally referred to as avoidant or
resistant. Insecure-avoidant infants and children lack a strong emotional connection to their
caregiver, appear detached, may avoid or ignore others, and rarely initiate affectionate gestures
(Pearce, 2009). Insecure-resistant infants and children are characterized by being excessively
clingy towards their caregiver, distressed during separation, often inconsolable upon the return of
their caregiver, and exhibit a mixture of dependency and resistance (Pearce, 2009). In a 30-year
longitudinal study carried out to examine the effects of early attachment styles on the social,
emotional, and behavioural development of a child, Sroufe (2005) suggested that variations in
infant-caregiver attachment are related to outcomes only probabilistically, and only in the
context of other complex development systems and processes. That is, attachment is not the
cause of certain outcomes, but can have a role in initiating pathways of development related to
social relatedness, emotional regulation, or arousal modulation (Sroufe, 2005).
Anxiety
As mentioned previously, anxiety is one of the most prevalent forms of psychopathology
in children and youth. A substantial amount of research has been done on the etiology of child
anxiety disorders. Several risk factors have been identified in the development of child anxiety,
including temperament, genetics, negative learning experiences, family functioning, parental
rearing, and insecure child-parent attachment relationships (Colonnesi, Draijer, Stams, Van der
Bruggen, Bogels, & Noom, 2011). It is important to distinguish between anxiety symptoms and
anxiety disorders. Anxiety symptoms are reactions of fear to a perceived degree of danger that
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everyone can experience (Colonnesi et al., 2011). Anxiety is typified by tension, apprehension,
and worry, and may manifest without the presence of actual danger (Muris, 2007). An anxiety
disorder may develop when anxiety symptoms persist, become more intensive, and interfere with
everyday functioning (Colonnesi et al., 2011). Children can be diagnosed with any of the nine
anxiety disorders listed in the DSM-IV-TR which are: separation anxiety disorder, panic disorder,
agoraphobia, generalized anxiety disorder, social phobia, specific phobia, obsessive-compulsive
disorder, posttraumatic stress disorder, and acute stress disorder (American Psychiatric Associate
[APA], 2000). For the remainder of this paper, the term “anxiety” will refer to anxiety symptoms
and not an actual diagnosed disorder, and the term “anxiety disorder” will be used to include any
one of the nine anxiety disorders. While each disorder has its own list of core symptoms and
diagnostic criteria, they all must be observed over a certain period of time, and the disturbance
must cause clinically significant distress or impairment to the child’s social, emotional, or
academic functioning.
Anxiety is a normal part of development in childhood and adolescence. Anxiety can serve
an adaptive purpose in the developing child. In infants, anxiety behaviours (e.g. crying) triggered
by brief separations promote the proximity with the caregiver, therefore serving an evolutionary
purpose of protecting the infant from harm (Warren, Huston, Egeland, & Sroufe, 1997). Also,
moderate amounts of stress in children cause brief physiological responses (e.g. increased heart
rate and blood pressure) that when occur in the context of stable and supportive relationships,
help the child to develop a sense of mastery and self-control (Easterbrooks et al., 2012).
However, anxiety is more often associated with negative outcomes. When compared to nonanxious children, anxious children consistently show impairments in social, emotional, and
school functioning (Muris, 2007). This may include, but is not limited to: chronic somatic
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complaints, repeated refusal to attend activities or events, repeated requests to leave the
classroom, refusal to attend school, compromised academic performance, or being fearful to ask
the teacher for help (APA, 2000).
Attachment Theory and Anxiety
Framework
As discussed previously, insecure child-caregiver attachment relationships are one of
several risk factors that have been identified in the development of anxiety disorders in
childhood. Bowlby originally hypothesized a link between attachment insecurity and childhood
anxiety. Bowlby suggested that intense separation anxiety is rooted in the child’s uncertainty
about the availability of the attachment figure (Warren et al., 1997). Secure infants are confident
in their caregivers’ availability; therefore, their attachment system is only activated in truly
dangerous situations. However, because insecure infants lack confidence in their caregivers’
availability, their attachment system may be chronically activated, even in situations with little
danger (Manassis, 2001). This repeated experience of separation distress can be considered one
of the earliest forms of anxiety (Warren et al., 1997). This can then lead to developing a
dysfunctional mental representation known as an internal working model that children form
about the self, other people, relationships, and the world which influences cognition, behaviour,
and emotional regulation (Easterbrooks et al., 2012). As a result, children may have overly
cautious behaviour, view themselves as unworthy or incapable, or view the world as unsafe or
unpredictable, all of which may perpetuate anxiety. Insecurely attached children may exaggerate
expressions of distress in order to increase and maintain proximity to their caregivers (Colonnesi
et al., 2011). It is important to note that attachment theory and anxiety development is not a
causation relationship. An insecure child –caregiver attachment is viewed as a risk factor in the
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development of anxiety disorders in children. An initial condition, such as an insecure
attachment, can be viewed as playing a role in initiating a developmental pathway (Warren et al.,
1997).
Research
Much research has been done in examining the relationship between child-caregiver
attachment and anxiety disorders in children and youth. Warren et al. (1997) studied 172
adolescents aged 17.5 years of age who had participated in mother-child attachment assessments
at 12 months of age. This study was conducted midway through a 30-year longitudinal study
termed the Minnesota Parent-Child Project on attachment and overall child development. They
found that more children with anxiety disorders were, as infants, classified as insecure-resistant.
Results indicated this insecure-resistant attachment doubled the risk of developing an anxiety
disorder, and was a better predictor of adolescent anxiety disorders than other risk factors such as
maternal anxiety or child temperament (Warren et al., 1997).
Bar-Haim, Dan, Eshel, & Sagi-Schwartz (2007) conducted a similar 11-year longitudinal
study that examined attachment relationships and anxiety at 11 years of age. While they found
that anxiety symptoms around social and school anxiety were higher among children who had
been classified as insecure-resistant at 12 months of age, their study did not reveal significant
differences in the frequency of anxiety disorders. They hypothesized their findings may have
differed from Warren el al. (1997) due to cultural difference, (Isreal vs. United States), age
differences (11 year olds vs. 17.5 year olds), and socioeconomic status (at-risk vs. normal
population). The differences between the two studies highlight the importance of being critical in
regards to drawing conclusions about possible relationships among attachment and anxiety.
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Despite the differences between these two particular studies, other research tends to demonstrate
associations between attachment and anxiety.
When conducting a meta-analysis on 46 studies of attachment relationships and anxiety,
Colonnesi et al. (2011) found that insecure attachment and anxiety proved to be moderately
associated, with a medium effect size of r =.30. Analyses also revealed that insecure-resistant
attachment had a stronger relationship with the development of anxiety than other attachment
relationships. They compared data based on nationality and found that studies conducted in
Europe showed a stronger relationship between insecure attachment and anxiety then did studies
conducted in the United States and Canada. When taking into account the results found in
research, insecure attachment is suggested as being a potential risk factor in the development of
anxiety in children and adolescents.
Implications
Understanding the interaction between child-caregiver relationships and anxiety allows
for professionals, whether teachers, counselors, or school psychologists, to implement effective
strategies and interventions. According to the developmental pathway theory, variations of
attachment (and other factors) can set a child along a pathway which can be influenced be
outside changes (Sroufe, 2005). These changes could include early intervention support that
would help to promote positive attachment and allow for a healthy development in anxiety for
the child. Early intervention supports could include parenting classes aimed at promoting a
positive infant-caregiver attachment or social supports to help lower socioeconomic families.
If anxiety has become problematic for a child or adolescent, understanding that the child
may have come from a place of insure attachment is an integral part of the intervention process
(Warren et al., 1997). With this knowledge, the therapist or teacher must provide a secure base
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before implementing interventions by accepting and respecting the child, being patient, as well
as sympathetic. Involving the parent in the intervention process as much as possible can also be
beneficial for older children (Manassis, 2001). As for specific strategies, Warren et al. (1997)
suggested intervention strategies that included teaching children ways of soothing themselves
and how to accept comfort from others.
Discussion
The purpose of this paper was to analyze the relationship between child-caregiver
attachment and the development of anxiety in children and youth. In doing so, this paper
analyzed the possible role that an insecure attachment may play in this development, including
both positive and negative aspects of anxiety. Research has focused primarily on the attachment
between child and mother. The role of paternal attachment, or attachment with other figures such
as siblings and grandparents, is vastly under-researched, specifically with how it may influence
the development of anxiety problems in children. Early insecure attachment styles have been
found to be correlated with later problems in anxiety in children and youth. However, it is critical
to understand that attachment is only one of many risk factors that may place the child on a
particular developmental pathway, and that insecure attachment does not cause childhood
anxiety disorders. In gaining an understanding of the relationship between attachment and
anxiety, a teacher, school psychologist, or therapist may be better able to provide prevention or
intervention strategies to help support children and youth.
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References
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