Associations Between Early Childhood Parent–Child Attachment and Internalizing/Externalizing Symptoms: A Systematic Review and Narrative Synthesis

Abstract

This systematic review aimed to provide a narrative synthesis of associations between the early childhood (i.e., preschool and early school age) attachment classification systems and internalizing and externalizing symptoms measured from preschool age through adolescence. The review was pre-registered with PROSPERO (#CRD42017073417) and followed PRISMA guidelines. Of the 9,312 records screened, 34 articles comprising 15 samples were included in the review. Findings across studies suggest consistent associations between insecure early childhood attachment and both internalizing and externalizing symptoms during the preschool and school-age/middle childhood periods, with children classified as disorganized/controlling being at heightened risk. There is insufficient evidence to confirm associations with (pre)adolescent externalizing and internalizing symptoms. Future directions for research and clinical implications are discussed.

Keywords:

• early childhood
• externalizing symptoms
• internalizing symptoms
• parent–child attachment
• preschool
• systematic review

Disclosure statement

The authors have no conflicts of interest to declare.

Additional information

Funding

This work was supported by awards from the Canadian Institute of Health Research (Frederick Banting and Charles Best Canada Graduate Scholarships awarded to SB [GSD-164166] and MO [GSD-134896]), the Natural Sciences and Engineering Research Council of Canada (awarded to RPR [RGPIN-2015-06813]), the Social Sciences and Humanities Research Council of Canada (Joseph-Armand Bombardier Canada Graduate Scholarship awarded to AAD [752-2017-1866] and Operating Funds awarded to JFB [410-2009-0724, 435-2013-0230]), the Lillian Meighen Wright Foundation (Maternal-Child Health Graduate Scholarships awarded to SB and MO), the Louise and Alan Edwards Foundation (Postdoctoral Fellowship in Pediatric Pain awarded to JM), and the LaMarsh Center for Child and Youth Research (awarded to MO). SB and MO are trainee members of the Pain in Child Health strategic training initiative.