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Infant-mother attachment and behavior problems in healthy and chronically ill preschoolers

  • Susan Goldberg (a1), Andrew Gotowiec (a2) and Robert J. Simmons (a1)


Analysis of longitudinal data for 145 children [51 healthy, 40 with cystic fibrosis (CF), and 54 with congenital heart disease (CHD)] was conducted: (a) to ascertain whether behavioral problems evident in older medically compromised children would be reported as early as 2–3 years-of-age; and (b) to test theoretical predictions concerning the role of infant-mother attachment in the etiology of behavior problems. As predicted, children with a medical diagnosis received higher scores from parents on the Child Behavior Checklist (CBCL), primarily on the Internalizing scale. Reports of somatic symptoms did not account for this effect. Contrary to predictions, children with CHD were reported to have more behavior problems than those with CF. Secure attachment was associated with lower CBCL scores for internalizing problems regardless of medical status. The increase in behavior problem reports associated with insecure attachment was shown to reflect an effect of avoidance rather than insecurity per se. The importance of distinguishing effects of different types of insecurity and the need for meta-analytic strategies to do so is emphasized.


Corresponding author

Susan Goldberg, Psychiatric Research Unit, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8.


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Achenbach, T. M. (1992). Manual for the child behavior checklist/2–3 and 1992 profile. Burlington, VT. University of Vermont, Department of Psychiatry.
Achenbach, T. M., Edelbrock, C., & Howell, C. T. (1987). Empirically based assessment of the behavioral/emotional problems of 2- and 3-year-old children. Journal of Abnormal Child Psychology, 629650.
Ainsworth, M. D. S., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.
Arend, R., Gove, F., & Sroufe, L. A. (1979). Continuity of individual adaptation from infancy to kindergarten: A predictive study of ego-resilience and curiosity in preschoolers. Child Development, 950959.
Bates, J. E., Maslin, G. A., & Frankel, K. A. (1985). Attachment security, mother-child interaction and temperament as predictors of behavior problem ratings at age three years. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research Child Development, 50(1–2), Serial No. 209.
Bowlby, J. (1969). Attachment and loss: Volume 1 Attachment. New York: Basic Books.
Bowlby, J. (1973). Attachment and loss: Volume 2 Separation, anxiety and anger. New York: Basic Books.
Bowlby, J. (1980). Attachment and loss: Volume 2 Loss. New York: Basic Books.
Cadman, D., Boyle, M., Szatmari, P., & Offord, D. R. (1987). Chronic illness disability and mental and social well-being: Findings of the Ontario Child Health Study. Pediatrics, 79, 805813.
Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1989). Disorganized/disoriented attachment relationships in maltreated infants. Developmental Psychology, 25, 525531.
Cassidy, J., & Kobak, R. R. (1988). Avoidance and relevance to other defensive processes. In Belsky, J. & Nezworski, T. (Eds.), Clinical implications of attachment (pp. 300326). Hillsdale, NJ: Erlbaum.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155159.
Erickson, M. F., Sroufe, L. A., & Egeland, B. (1985). The relationship between quality of attachment and behavior problems in a preschool high-risk sample. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development, 50(1–2), Serial No. 209.
Fagot, B. T., & Kavanagh, K. (1990). The prediction of antisocial behavior from avoidant attachment classifications. Child Development, 61, 864873.
Goldberg, S. (1992, 03). Attachment and physical health in medically compromised infants. In Goldson (Chair), Non-organic failure to thrive. Invited symposium conducted at the International Conference on Infant Studies, Miami, FL.
Goldberg, S., Corter, C., Lojkasek, M., & Minde, K. (1990). Prediction of behavior problems in fouryear olds born prematurely. Development and Psychopathology, 2, 1530.
Goldberg, S., Simmons, R. J., Neuman, J., Campbell, K., & Fowler, R. S. (1991). Congenital heart disease, parent stress, and infant-mother attachment. Journal of Pediatrics, 119, 661666.
Goldberg, S., Washington, J., Morris, P., Fischer-Fay, A., & Simmons, R. J. (1990). Early diagnosed chronic illness and mother-child relationships in the first two years. Canadian Journal of Psychiatry, 35, 726733.
Greenberg, M. T., Speltz, M. L., DeKlyen, M. C., & Endriga, M. C. (1991). Attachment security in pre-schoolers with and without externalizing problems: A replication. Development and Psychopathology, 3, 413430.
Lavigne, J., & Faier-Routman, J. (1992). Psychological adjustment to pediatric physical disorders. Journal of Pediatric Psychology, 17, 133158.
Lewis, M. (1991). Psychiatric assessment of infants, children, and adolescents. In Lewis, M. (Ed.), Child and adolescent psychiatry (pp. 447463). Baltimore, MD: Williams & Wilkins.
Lewis, M., Feiring, C., McGuffog, C., & Jaskir, J. (1984). Predicting psychopathology in six-yearolds from early social relations. Child Development, 55, 123136.
Lyons-Ruth, K., Alpern, L., & Repacholi, B. (1993). Disorganized infant attachment classification and maternal psychosocial-problems as predictors of hostile aggressive behavior in the preschool classroom. Child Development, 64, 572585.
Lyons-Ruth, K., Connell, D., Grunebaum, H., & Botein, S. (1990). Infants at social risk: Maternal depression and family support services as mediators of infants' development and security of attachment. Child Development, 61, 8598.
Main, M., & Hesse, E. (1990). Parents' unresolved traumatic experiences are related to infant disorganized/disoriented attachment status: Is frightened or frightening parental behavior the linking mechanism? In Greenberg, M. T., Cicchetti, D., & Cummings, E. M. (Eds.), Attachment in the preschool years (pp. 161184). Chicago: University of Chicago.
Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development, 50(1–2), Serial No. 209.
Main, M., & Solomon, J. (1986). Discovery of an insecure-disorganized/disoriented attachment pattern. In Brazelton, T. B. & Yogman, M. W. (Eds.), Affective development in infancy (pp. 95124). Norwood, NJ: Ablex.
Neuman, J., & Goldberg, S. (1990, 04). Temperament and attachment: health and illness. Poster presented at the International Conference on Infant Studies, Montreal, PQ.
Offord, D. R., Boyle, M. H., Fleming, J. E., Munroe Blum, H., & Rae-Grant, N. I. (1989). Ontario Child Health Study: Summary of selected results. Canadian Journal of Psychiatry, 34, 483491.
Radke-Yarrow, M., Cummings, E. M., Kuczynski, L., & Chapman, M. (1985). Patterns of attachment in two- and three-year-olds in normal families and families with parental depression. Child Development, 56, 591615.
Renken, B., Egeland, B., Marvinney, D., Mangelsdorf, S., & Sroufe, L. A. (1989). Early childhood antecedents of aggression and passive-withdrawal in early elementary school. Journal of Personality, 57, 257279.
Speltz, M. L., Greenberg, M. T., & DeKlyen, M. C. (1990). Attachment in preschoolers with disruptive behavior: A comparison of clinic referred and non-problem children. Development and Psychopathology, 2, 3146.
van Ijzendoorn, M. H., Goldberg, S., Kroonenberg, P. M., & Frankel, O. (1992). The relative effects of maternal and child problems on the quality of attachment: A meta-analysis of attachment in clinical samples. Child Development, 63, 840858.
van Ijzendoorn, M. H., & Kroonenberg, P. M. (1988). Cross-cultural patterns of attachment, a meta-analysis of the strange situation. Child Development, 59, 147156.
Weiland, S. K., Pless, I. B., & Roghmann, K. J. (1992). Chronic illness and mental health problems in pediatric practice: Results from a survey of primary care providers. Pediatrics, 89, 445449.


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