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Disorganized Attachment in Early Childhood: Meta-Analysis of Precursors, Concomitants, and Sequelae

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Disorganized Attachment in Early Childhood: Meta-Analysis of Precursors, Concomitants, and Sequelae Development and Psychopathology, 11 (1999), 225±249 Copyright 1999 Cambridge University Press Printed in the United States of America Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae MARINUS H. VAN IJZENDOORN, CARLO SCHUENGEL, AND MARIAN J. BAKERMANS±KRANENBURG Leiden University Abstract During the past 10 years nearly 80 studies on disorganized attachment involving more than 6,000 infant±parent dyads have been carried out. The current series of meta-analyses have established the reliability and discriminant validity of disorganized infant attachment. Although disorganized attachment behavior is necessarily difficult to observe and often subtle, many researchers have managed to become reliable coders. Furthermore, disorganized attachment shows modest short- and long-term stability, in particular in middle class environments, and it is not just a concomitant of constitutional, temperamental, or physical child problems. The predictive validity of disorganized attachment is established in terms of problematic stress management, the elevated risk of externalizing problem behavior, and even the tendency of disorganized infants to show dissociative behavior later in life. In normal, middle class families, about 15% of the infants develop disorganized attachment behavior. In other social contexts and in clinical groups this percentage may become twice or even three times higher (e.g., in the case of maltreatment). Although the importance of disorganized attachment for developmental psychopathology is evident, the search for the mechanisms leading to disorganization has just started. Frightening parental behavior may play an important role but it does not seem to be the only causal factor involved in the emergence of disorganized attachment. An important developmental milestone in ev- during the first year of life infants learn to ery child's life is the formation of an attach- deal with stressful circumstances and negative ment bond to the parent (Sroufe, 1988). In at- emotions in organized manners. Avoidantly tachment theory, it has been proposed that attached infants are suggested to minimize the expression of negative emotions in the pres- ence of a parent whom they would have ex- This paper is based on an invited contribution to the ex- perienced to be rejecting or ignoring such pert meeting of the National Institute of Mental Health (NIMH) on ªAssessment of Infant and Toddler Mental emotions. Ambivalently attached infants are Health: Advancing a Research Agenda by Integrating Ba- considered to maximize the expression of sic and Clinical Approaches,º Bethesda, October 6±7, negative emotions and the display of attach- 1997. The authors acknowledge the statistical assistance ment behaviors, in order to draw the attention of Dr. Pieter Kroonenberg and the thoughtful comments of their supposedly inconsistently responsive of the reviewers on an earlier version of this paper. We are grateful to the authors of the primary studies who parent. They may remain passively or angrily provided us with additional raw data, and to Dr. Mary focused on their parent even when the envi- Main and Dr. Karlen Lyons±Ruth who commented on ronment calls for exploration and play (Main, earlier versions of this paper in detail. 1990). In a stressful situation, securely at- Address correspondence and reprint requests to: Mar- tached infants may express their distress to inus H. van Ijzendoorn, Center for Child and Family Studies, Leiden University, P.O. Box 9555, 2300 RB the parent who would be able to provide com- Leiden, The Netherlands; E-mail: Vanijzen@rulfsw. fort and to serve as a safe base for exploration leidenuniv.nl. (Ainsworth, Blehar, Waters, & Wall, 1978; 225 226 M. H. van Ijzendoorn, C. Schuengel, and M. J. Bakermans±Kranenberg Dozier & Kobak, 1992). Securely attached eral concrete behavioral indices that in and of children are suggested to strike a balance be- themselves qualify the infant for a disorga- tween seeking proximity to their attachment nized attachment classification. Contradictory figure and their inclination to explore the behavior, misdirected or stereotypical behav- wider environment. These three ªorganizedº ior, stilling and freezing for a substantial attachment strategies (A, B, and C; Ainsworth amount of time, and direct apprehension or et al., 1978) may be considered as adaptive to even fear of the parent are behavioral indices the infants' environments, and each is sup- of disorganized attachment in particular when posed to allow for a maximum of proximity they occur in stressful circumstances in the to the specific attachment figure whose be- presence of the parent and with a sufficient havior to stress or distress is anticipated degree of intensity (Main & Solomon, 1990). (Main, 1990). Contradictory behavior, for example, can be The concept of ªdisorganizedº attachment observed when the infant shows indifference emerged from the systematic inspection of upon mother's return after excessive distress about 200 cases from various samples that during separation. Misdirected behavior may were difficult to classify in one of the three consist of seeking proximity to the stranger organized attachment categories (Main & Sol- instead of the parent after separation. Stereo- omon, 1986). In particular, in studies on mal- typical behavior concerns, for example, the treated infants, the limits of the traditional repeated pulling of hair with a dazed expres- Ainsworth et al. (1978) coding system be- sion in a context in which the child is clearly came apparent because many children with stressed and the parent is available. Freezing an established background of abuse or ne- means that the child, unable to choose be- glect nevertheless had to be forced into the tween seeking proximity or avoiding the par- secure category (Carlson, Cicchetti, Bar- ent, stops moving for several moments as if nett, & Braunwald, 1989). Common denomi- in trance and dissociated from the regular nator of the anomalous cases appeared to be thought processes (Hesse & Main, in press; the (sometimes momentary) absence of an or- Main & Morgan, 1996). Apprehension means ganized strategy to deal with the stress of the showing fear of the parent immediately upon Strange Situation procedure. Disorganized at- return after a brief separation, for example by tachment therefore may be defined nega- a hand-to-mouth movement. Disorganized at- tivelyÐagainst the background of how chil- tachment behaviors are not just bizarre and dren with organized strategies deal with a incoherent; they are considered to be indica- stressful situation in the presence of their par- tors of an experience of stress and anxiety ent or other caregiver (Main, 1990). Disorga- which the child cannot resolve because the nized attachment can be described as the parent is at the same time the source of fright breakdown of an otherwise consistent and as well as the only potential haven of safety. organized strategy of emotion regulation. In the face of this paradoxical situation, the Whether secure or insecure, every child may infants' organized strategy to deal with stress show disorganization of attachment depend- is expected to fall apart (Main & Hesse, ing on the earlier child rearing experiences 1990). The essence of disorganized attach- (Main & Hesse, 1990). In some cases, the dis- ment is fright without solution (Hesse & organization of attachment is so predominant Main, in press). that a secondary, organized strategy cannot be Maltreating parents, for example, are sup- detected. Disorganization of attachment is posed to create disorganized attachment in usually considered a type of insecure attach- their infants because they confront their in- ment, independent of the secondary classifica- fants with a pervasive paradox: they are po- tion. tentially the only source of comfort for their Although disorganized attachment behav- children, whereas at the same time they iors are most easily defined in opposition to frighten their children through their unpredict- organized attachment strategies, the Main and able abusive behavior. The parent is thought Solomon (1990) coding system provides sev- to be a source of fear for the child and at the Meta-analysis on disorganized attachment 227 same time the only attachment figure who can or Down's children (Vaughn, Goldberg, At- provide relief from distress. The incompatible kinson, & Marcovitch, 1994), and the coding behaviors of flight and proximity seeking are system explicitly requires the exclusion of proposed to lead to temporary breakdown of this potential cause (Main & Solomon, 1990; organized attachment behavior. Disorganiza- Pipp±Siegel, Siegel, & Dean, 1997). Third, tion of attachment, however, does not only we hypothesize that the antecedents of disor- occur in families with a maltreating parent but ganized attachment are related to specific be- has also been found to develop when the par- havioral and mental problems in the parents ent is struggling with unresolved loss of an such as maltreatment, unresolved loss or trau- attachment figure or with other traumatic ex- ma, depression, and marital discord, which periences (see Van Ijzendoorn, 1995, for a re- may confront the child with an attachment view). Main and Hesse (1990) speculate that figure who is unpredictably frightening. Dis- otherwise ªnormalº parents with unresolved organized attachment is not just the conse- loss may show behavior that is frightening for quence of insensitive parenting. Fourth, we their infantsÐagainst their
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