Parenting: Science and Practice

This article was downloaded by: [McMaster University]
On: 10 November 2014, At: 10:51

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Parenting: Science and Practice

Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/hpar20
Infant Attachment, Parenting Stress, and

Child Emotional and Behavioral Problems
at Age 3 Years
b c
Anne Tharner , Maartje P. C. M. Luijk , Marinus H. van IJzendoorn
d e f
, Marian J. Bakermans-Kranenburg , Vincent W. V. Jaddoe ,
f f a
Albert Hofman , Frank C. Verhulst & Henning Tiemeier
a
Erasmus Medical Center, Department of Child and Adolescent
Psychiatry/Psychology , P.O. Box 2060, 3000 CB , Rotterdam , The
Netherlands
b
Erasmus University Medical Center and Leiden University
c
Erasmus University
d
Erasmus University and Leiden University
e
Leiden University
f
Erasmus University Medical Center
Published online: 13 Sep 2012.
To cite this article: Anne Tharner , Maartje P. C. M. Luijk , Marinus H. van IJzendoorn , Marian J.
Bakermans-Kranenburg , Vincent W. V. Jaddoe , Albert Hofman , Frank C. Verhulst & Henning Tiemeier
(2012) Infant Attachment, Parenting Stress, and Child Emotional and Behavioral Problems at Age 3
Years, Parenting: Science and Practice, 12:4, 261-281, DOI: 10.1080/15295192.2012.709150
To link to this article: http://dx.doi.org/10.1080/15295192.2012.709150
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Conditions of access and use can be found at http://www.tandfonline.com/page/terms-
and-conditions
Downloaded by [McMaster University] at 10:51 10 November 2014
PARENTING: SCIENCE AND PRACTICE, 12: 261–281, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 1529-5192 print / 1532-7922 online
DOI: 10.1080/15295192.2012.709150
Infant Attachment, Parenting Stress, and Child

Emotional and Behavioral Problems at Age
3 Years
Anne Tharner, Maartje P. C. M. Luijk, Marinus H. van IJzendoorn,
Marian J. Bakermans-Kranenburg, Vincent W. V. Jaddoe, Albert
Hofman, Frank C. Verhulst, and Henning Tiemeier
SYNOPSIS
Objective. To examine the role of infant attachment classification and parenting stress for tod-
dler emotional and behavior problems. Design. Participants were 606 infant–mother dyads
who took part in a population-based cohort study in the Netherlands. Infant–mother attach-
ment classification was assessed using the Strange Situation Procedure when the children
were 14 months old. At 18 months, parenting stress was measured with the Dutch ver-
sion of the Parenting Stress Index. When the children were 3 years old, both mothers and
fathers completed the Child Behavior Checklist. Results. Infant attachment moderated the
effect of parenting stress on child emotional and behavior problems. Parenting stress was
related to more aggression and attention problem behaviors in insecurely attached children,
but not in securely attached children. Moreover, higher parenting stress was associated with
more withdrawal problem behaviors in insecurely attached children, in particular in insecure-
resistant and in disorganized children. Conclusion. In the presence of an insecure attachment
relationship, more parenting stress is related to more (internalizing) withdrawal problem behav-
ior and to more (externalizing) aggression and attention problems. Attachment security in
infancy buffers the influence of parenting stress on child emotional and behavior problems.
INTRODUCTION
The importance of early attachment relationships for the socio-emotional development

of children, one of the central tenets of attachment theory (Bowlby, 1969/1982), has been
demonstrated in numerous studies over the past 30 years (for a review, see DeKlyen &
Greenberg, 2008). Individual differences in attachment quality have important implica-
tions for later adjustment. Secure attachment in infancy is related to social competence
and resilience (e.g., Belsky & Fearon, 2002; Edwards, Das Eiden, & Leonard, 2006;
NICHD ECCRN, 2006), whereas insecure and especially disorganized attachment are
associated with the development of emotional and behavior problems (McCartney,
Tresch Owen, Booth, Clarke-Stewart, & Lowe Vandell, 2004; for a review, see Guttmann-
Steinmetz & Crowell, 2006). A meta-analysis of 5,947 participants from 69 studies
confirmed that there is a modest but robust effect (combined effect size d = .31) of early
attachment insecurity on externalizing problems (Fearon, Bakermans-Kranenburg, Van
IJzendoorn, Lapsley, & Roisman, 2010). Less is known about the association between
infant attachment and internalizing problems in early childhood, most likely because
262 THARNER ET AL.
internalizing symptoms are more difficult to measure at a young age than externaliz-
ing problems. Brumariu and Kerns (2010) recently reviewed 19 studies and concluded
that there is mixed evidence for an association between infant attachment insecurity and
internalizing problems in children under the age of 10 years. Studies investigating inter-
nalizing problems in general found less strong associations than studies that focused
specifically on childhood anxiety and depressive symptoms. Brumariu and Kerns (2010)
remarked that these conclusions are based on few studies, and that more longitudi-
nal studies are needed to confirm and elaborate these findings. In a meta-analysis
on 42 samples with 4,614 participants, Groh, Roisman, Van IJzendoorn, Bakermans-
Kranenburg and Fearon (2012) found that attachment insecurity and disorganization
were less strongly associated with internalizing than with externalizing behavior prob-
lems. In the current longitudinal study, we further investigate the association of infant
attachment and externalizing and internalizing symptoms in 3-year-olds, with a spe-

cial focus on the specific emotional and behavioral problems as assessed by the Child
Behavior Checklist (CBCL) syndrome scales.
It has been suggested that attachment might be especially important for later emo-
tional and behavioral problems in the context of other risk factors (Brumariu & Kerns,
2010; Dallaire & Weinraub, 2007; Fearon et al., 2010). We examined the association of
infant-mother attachment and parenting stress with child externalizing and internal-
izing problems at 3 years of age. It is well documented that children are affected by
stressors in the family context that may range from chronic stresses such as poverty
(Cyr, Euser, Bakermans-Kranenburg, & Van IJzendoorn, 2010), severe life events such
as the experience of intimate partner violence (Huth-Bocks & Hughes, 2008), to more
minor but continuous everyday hassles (Crnic, Gaze, & Hoffman, 2005). Parenting
stress is typically conceptualized as challenging situations within the parent–child rela-
tionship that are created by expectations and behavior of parents and their children
(Crnic et al., 2005). Parenting stress is specifically related to childrearing, as opposed
to more general contextual family stress such as low socioeconomic status (SES), and it
is rather common in young parents (Crnic et al., 2005; Spijkers, Jansen, & Rijneveld,
2011). Several studies have shown that general family stress is related to externaliz-
ing and internalizing problems (Crnic et al., 2005; Huth-Bocks & Hughes, 2008; Costa,
Weems, Pellerin, & Dalton, 2006), but our focus is on specific parenting or childrearing
stresses.
The quality of early attachment relationships might be especially important for chil-
dren who grow up in stressful environments. Young infants are not yet able to deal
with stressful situations on their own, and therefore rely on a caregiver to help them
modulate their stress. It has been argued that children develop adaptive or maladap-
tive emotion-regulation strategies within their early attachment relationships, and that
these strategies affect the way they respond to stressful situations in the future (Carlson,
1998; Sroufe, 1996; Sroufe, Egeland, Carlson, & Collins, 2005; for a review, see Weinfield,
Sroufe, Egeland, & Carlson, 2008). Based on previous experiences, securely attached
infants are confident that their caregiver will be available in stressful situations to help
them deal with the stress, which provides them with an effective coping mechanism.
Insecure-avoidant and insecure-resistant children are less able to use the parent as a
source of comfort to deal with stress. Their attachment relationship is characterized
by anger, mistrust, anxiety, and fear as a consequence of unresponsive or inconsis-
tently responsive behavior of the caregiver (Ainsworth, Blehar, Waters, & Wall, 1978;
Bretherton, 1985). For disorganized children, the parent is thought to be a potential
source of comfort and a source of fear at the same time (Hesse & Main, 2006; Madigan
ATTACHMENT, PARENTING STRESS, AND BEHAVIOR PROBLEMS 263
et al., 2006; Main & Solomon, 1990). Due to this paradoxical situation, the coping
mechanism of disorganized children fails in stressful situations, and they experience
“fright without solution” (Main & Solomon, 1990). The lack of an effective coping strat-
egy that accompanies organized insecure and disorganized attachment may interfere
with stress-regulation and increase the risk of emotional and behavior problems in the
context of other risk factors (Cassidy, 1994; Greenberg, Speltz, DeKlyen, & Jones, 2001;
Guttman-Steinmetz & Crowell, 2006).
Indeed, the strongest associations between infant attachment and emotional and
behavior problems have been found in high-risk samples, when children were exposed
to multiple stressors in the family environment, such as poverty, marital problems of the
parents, or parental psychopathology. For example, the Minnesota Parent-Child Project,
a longitudinal study of the development of children in a high-risk sample of mainly
young, single mothers, showed that insecure attachment at 12 and 18 months increased
the risk of emotional and behavior problems for preschoolers up to adolescence (for a
review, see DeKlyen & Greenberg, 2008). Disorganized attachment, which is considered
the most insecure form of attachment, has been shown to be an important predic-
tor of later emotional and behavior problems in high-risk contexts (e.g., Lyons-Ruth,
Easterbrooks, & Cibelli, 1997; for a review, see Lyons-Ruth, 1996; for a meta-analysis,
see Van IJzendoorn, Schuengel, & Bakermans-Kranenburg, 1999).
In low-risk samples, the association between infant attachment and internalizing and
externalizing problems is not always found (for a review, see DeKlyen & Greenberg,
2008). Within the large low-risk cohort of the NICHD ECCRN Study, infant attachment
insecurity predicted negative developmental outcomes, not by itself, but in combination
with other risk factors (Belsky & Fearon, 2002; Dallaire & Weinraub, 2007; McCartney
et al., 2004). Insecure attachment was related to later behavior problems, less social
competence, and worse cognitive performance only in the presence of contextual risk
factors that also occur in non-clinical, population-based samples, such as low social sup-
port, low marital quality, and low educational level (Belsky & Fearon, 2002). Likewise,
insecurely attached children had a higher risk of anxiety symptoms only in families
that experienced a large number of stressful life events (Dallaire & Weinraub, 2007).
Disorganized attachment at 15 months was, however, directly related to externalizing
and internalizing symptoms at age 3, even in this low-risk sample (McCartney et al.,
2004).
Different patterns of insecure attachment may be differentially related to specific
kinds of emotional and behavior problems (for a review, see DeKlyen & Greenberg,
2008; Weinfield et al., 2008). Bowlby (1973) argued that avoidant children, who have
been repeatedly rejected by their caregiver, have learned that the expression of anger
only pushes the caregiver further away. Therefore, they would redirect their anger
toward the environment, resulting in aggressive and hostile behavior. By contrast, over-
protective parenting, which has been related to resistant attachment, may be more likely
to elicit chronic anxiety and vigilance in the child. Fearon and colleagues (2010) found
meta-analytical support for a small but significant association between avoidant attach-
ment and externalizing behavior problems (effect size d = .12), but not for resistant
attachment. However, they noted that the association between avoidant attachment
and externalizing behavior problems should be considered with caution, because the
fail-safe number to reduce the effect to non-significance was below the Rosenthal
(1991) criterion. These findings indicate the need for more research in large samples
with enough power to detect possible differences between the various attachment
classifications.
264 THARNER ET AL.
Brumariu and Kerns (2010) concluded in their narrative review that resistant but
not avoidant attachment is associated with more internalizing problems and anxiety in
studies that did not assess disorganized attachment. This association is not consistently
found when attachment disorganization is taken into account. The empirical evi-
dence for the negative effect of disorganized attachment on children’s socio-emotional
development is clearer. Disorganized attachment is assumed to be a risk factor for
both externalizing and internalizing problems. Fearon and colleagues (2010) found a
significant association between disorganized attachment and externalizing problems
(d = .18), and Brumariu and Kerns (2010) reviewed several studies showing a link
between disorganization and internalizing problems. However, in their meta-analysis
on attachment and internalizing symptoms, Groh and colleagues (2012) found little
evidence for a strong association between disorganized attachment and internalizing
behavior problems, but it remains unclear whether attachment disorganization should

be considered a risk factor for specific forms of internalizing problem behavior.
The researchers in the current study examined the association between infant–mother
attachment and children’s socio-emotional adjustment in the presence or absence of
parenting stress. We posited that the main effects of parenting stress and attach-
ment security on internalizing and externalizing problems are qualified by interactions
between parenting stress and attachment. Three specific hypotheses were tested. First,
we expected that attachment security would buffer the impact of parental childrearing
stress on emotional and behavior problems. Second, we hypothesized that higher levels
of parenting stress would be related to externalizing problems in insecure-avoidant chil-
dren, and to internalizing problems in insecure-resistant children. Third, we expected
that in disorganized infants, higher levels of parenting stress would be related to
internalizing as well as externalizing problems. Our study is unique in that the large
non-clinical sample enabled us to test with sufficiently powerful statistical analyses
associations between the four main attachment classifications and specific forms of
socio-emotional problems (i.e., the CBCL syndrome scales).
METHOD
Sample
The current investigation is embedded within the Generation R Study, a prospective
study investigating growth, development, and health from fetal life into young adult-
hood in a population-based birth cohort in Rotterdam, the Netherlands. Pregnant res-
idents of the study area with a delivery date between April 2002 and January 2006 were
eligible for the study, and were approached via midwives and obstetricians at their first
prenatal visit in routine care. A total of 9,778 mothers were enrolled in the study. Data
were collected on mothers and their partners during and after pregnancy, and later
also on preschool children using questionnaires, physical and ultrasound examinations
during pregnancy, and biological samples. In a subgroup of the Generation R cohort
(N = 1,106 children), additional detailed measurements of the child’s development
were obtained after birth, using physical and ultrasound examinations as well as
interviews and behavioral observations. Eligibility criteria for participation in this focus
study were (1) Dutch national origin, meaning that the children, their parents, and
their grandparents were all born in the Netherlands; and (2) a delivery date between
February 2003 and August 2005. Eligible participants were approached by phone, and
invited for additional measurements at the research center. Participants of the focus
study were subsequently approached by mail and phone, and invited for each mea-
surement wave. The study was conducted in accordance with the ethical standards for
human experimentation established by the Declaration of Helsinki, and was approved
by the Medical Ethical Committee of the Erasmus Medical Center, Rotterdam. More
information about the study design can be found elsewhere (Jaddoe et al., 2010).
Of the 989 pregnant women originally included in the focus study, 881 infant–parent
dyads (89%) participated in the 14-month visit. The remaining participants could not be
contacted or did not participate for various reasons (e.g., no time, too much of a hassle to
come to the research center, etc.). To facilitate participation, families could choose which
parent accompanied the child during the visit. If both parents were present, we asked
the parent who spent more time with the child to participate in the assessment of attach-
ment. In 737 cases, the mother participated. The remaining dyads (infant–father) were
omitted for the current study. Sixteen of the infant–mother dyads had to be excluded
because video material could not be coded due to technical problems (e.g., recording
equipment did not work), or procedural reasons (e.g., the mother failed to complete the
protocol). Attachment classification with the mother was available for 721 infants who
were eligible for this study. Information about parenting stress at 18 months and child
emotional and behavior problems at 3 years from at least one parent was available for
606 of these infants. If only one parent completed the CBCL, the child was included
using the available data as provided by that parent (n = 66 only mother; n = 17 only
father). Hence, the current study sample consisted of the 606 children (84% of the eligi-
ble). Non-response analyses revealed that there were somewhat fewer single mothers in
the current study sample (3.7%) than in the group without data on parenting stress or
child emotional and behavior problems at 3 years (9.1%, p < .05), and that the current
sample included more firstborn children (63.9% versus 47.8%, p < .05). The two groups
did not differ regarding the child’s gender, birth parameters, distribution of attachment
classifications, number of siblings, income, maternal age, or maternal psychopathology.
Characteristics of the children and mothers of the current sample are displayed in
Table 1. Gender was distributed evenly: 50% of the children were girls. A majority of the
children (64%) were firstborn. Birth parameters were normal with a mean gestational
age at birth of 40 weeks, an average birth weight of 3,517 grams, and a mean 5-min
APGAR score of 9.6. The distribution of attachment security and disorganization at
14 months was comparable to what is typically found in other normal Western, non-U.S.
samples (Van IJzendoorn et al., 1999). However, there were slightly more insecure-
resistant children (15.5%), and slightly fewer insecure-avoidant children (13.5%) in the
current sample than in the normative non-U.S. sample described by Van IJzendoorn and
colleagues (1999; 10.3% insecure-resistant, p < .01; 20.2% insecure-avoidant, p < .01).
Almost half of the children had one sibling when they were 3 years old; only 2% had
more than two siblings. This is typical for indigenous Dutch families in the Netherlands
with a mean of 1.8 children per family (http://www.nationaalkompas.nl/bevolking/
geboorte/zijn-er-verschillen-naar-etniciteit/, 2010). Socioeconomic status (SES) was
high; only 7.3% of families earned less than the monthly modal salary in the Netherlands
and more than 60% of the women were higher educated (i.e., had completed at least
3 years of higher vocational or academic education). Almost all mothers were married
or living with a partner; less than 5% were single parents. Only 6.4% of the women
had moderate levels of postnatal depression (score > 10 on the Edinburgh Postnatal
Depression Scale; Pop, Komproe, & Van Son, 1992). Maternal depressive and anxious
266 THARNER ET AL.
TABLE 1
Sample Characteristics
Child Characteristics
Gender, % girls 50.00

First born, % yes 63.90
Mean gestational age at birth in weeks (SD) 40.05 (1.66)
Mean birth weight in grams (SD) 3,517.75 (535.25)
Mean APGAR 1 minute singletons (SD) 9.60 (0.72)
Mean age at SSP in months (SD) 14.64 (0.87)
Attachment classification
%B 48.70
%A 13.50
%C 15.00
%D 22.80
Number of siblings at age 3
%0 27.40
%1 56.50
%2 14.00
% >2 2.00
Maternal Characteristics
Mean age at intake in years (SD) 31.95 (3.713)

Household income per month, % ≤ 1,600C 7.3
Marital status, % married or living with partner 96.30
Educational level
% primary .80
% secondary 32.30
% higher 66.90
Mean score Edinburgh Postnatal Depression Inventory (SD) 3.86 (3.36)
Mean score depression Brief Symptom Inventory at 3 years (SD) .09 (.23)
Mean score anxiety Brief Symptom Inventory at 3 years (SD) .14 (.25)
Mean score hostility Brief Symptom Inventory at 3 years (SD) .15 (.23)
symptoms as well as hostile behavior as measured with the Brief Symptom Inventory
(De Beurs, 2004; Derogatis, 1993) at 3 years postpartum were below the average reported
for non-clinical populations.
Procedure
Participants received postal questionnaires at 20 weeks of pregnancy to obtain back-
ground variables such as educational level, family income, maternal age, and marital
status. Midwives or gynecologists provided information about birth weight and gender
of the child. At 14 months after birth, infants and their parents visited the Generation
R research center for a 1.5-hr examination. At the beginning of this visit, assess-
ments of attachment were conducted. When the infants were 18 months old, mothers
completed a self-report questionnaire concerning parenting-related stress. Information
about emotional and behavior problems of the child was obtained at age 3 years from
the mother and the mother’s partner (usually the child’s biological father). The question-
naire at 3 years also included a question about the number of other children younger
than 18 years living in the household. Adult participants did not receive rewards for
participation. Children received a small gift after every visit, such as a toy or a book.
Measures
Infant–mother attachment. Parent–infant dyads were observed in the Strange Situation
Procedure (SSP; Ainsworth et al., 1978) when the infant was about 14 months old,
(M = 14.7, SD = .9). The SSP is a widely used and well-validated procedure to mea-
sure the quality of the attachment relationship. The procedure consists of eight episodes
of 3 min each, and is designed to evoke mild stress in the infant to trigger attachment
behavior evoked by the unfamiliar lab environment, a female stranger entering the room
and engaging with the infant, and the parent leaving the room twice (Ainsworth et al.,
1978). The SSP used in the current study included all these stimuli, but we shortened
the two episodes occurring before the first separation (mother and child alone in the
room; introduction of the stranger) and the two separation episodes each by one min to
make the entire procedure fit into the tight time schedule of the visit, keeping the critical
reunion episodes intact. Elsewhere, we showed that this slightly abbreviated SSP is a
valid window on the infant–parent attachment (see Luijk et al., 2010).
Attachment behavior was coded from DVD recordings according to the Ainsworth
et al. (1978) and Main and Solomon (1990) coding systems by two reliable coders, trained
at the University of Minnesota. Inter-coder agreement was calculated on 70 SSPs that
were coded by both coders. For ABCD classification, inter-coder agreement was 77%,
κ = .63; agreement on disorganization was 87%, κ = .64. Eight percent of the cases were
discussed with one of two expert coders (MHvIJ or MJB-K) and classifications were
assigned after consensus was reached. In our analyses, we used attachment divided
into four classifications: secure (B), insecure-avoidant (A), insecure-resistant (C), and
disorganized (D). We also used the split between secure (B) versus insecure (A, C, D)
classifications, and we contrasted the secure group against each of the insecure groups:
B versus A, B versus C, and B versus D.
Parenting stress. The level of stress in the parent–child dyad was assessed by the
Nijmeegse Ouderlijke Stress Index-Kort (NOSIK; De Brock, Vermulst, Gerris, & Abidin,
1992), the Dutch version of the Parenting Stress Index-Short Form (PSI-SF; Abidin, 1983).
The NOSIK consists of 25 items rated on a 4-point Likert scale, covering two domains:
parenting stress related to parent factors, and parenting stress related to child factors.
In the present analyses, we used only the 11 items of the parent domain including ques-
tions such as, “Parenthood of this child is harder than I thought.” or “I often do not
understand my child.” to reduce the risk of reversed causality. The parent domain
reflects the perception of stress due to being a parent and having the responsibility
of rearing a child that might sometimes be more difficult to handle than expected or
wished for by the parent. It may be interpreted as childrearing stress as opposed to
more general contextual family stress, such as low SES. Childrearing stress is not neces-
sarily associated with the quality of the parent–child attachment relationship. Because
temperament is independent of attachment (Vaughn, Bost, & Van IJzendoorn, 2008;
Van IJzendoorn & Bakermans-Kranenburg, in press), securely attached children with a
difficult temperament may create some stress for the parent because of the child’s tem-
perament. In accordance with the manual (De Brock et al., 1992), scores were summed
and divided by the number of completed items with a maximum of 25% missing (at least
9 out of 11 items answered). Higher scores indicate higher levels of stress. Reliability
and validity of the NOSIK are satisfactory (De Brock et al., 1992). In the current study,
internal consistency for the 11 items of the parenting domain was Cronbach’s α = .63.
268 THARNER ET AL.
Continuous scores (n = 669, M = .46, SD = .24) were z-standardized. Outliers (> 3.29
n = 9, < −3.29 n = 0) were excluded. After exclusion of outliers, NOSIK scores were
distributed normally.
Child emotional and behavior problems. Information about child emotional and behav-
ior problems at 3 years of age was obtained with the CBCL for toddlers (CBCL1.5–5;
Achenbach & Rescorla, 2000). The CBCL is a widely used questionnaire with 99 items
concerning the child’s behavior in the previous two months. Each item is scored as
0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often
true. Seven empirically-based syndrome scales were identified: emotionally reac-
tive, anxious/depressed, somatic complaints, withdrawn, sleep problems, attention
problems, and aggressive behavior (Achenbach & Rescorla, 2000). The sum of the item
scores on the first four syndrome scales results in the broadband scale “Internalizing.”
The item scores on the attention problems and the aggressive behavior scales are added
to create the broadband scale “Externalizing.” Higher scores indicated more problems.
In the current study, we combined mother and father scores to minimize possible
reporter bias. The mean of the mothers’ scores tended to slightly differ from the part-
ners’ scores. To create an aggregated mean score, we first z-standardized scores of
the mothers and of their partners separately to achieve the same mean and standard
deviation. We then added the scores and divided them by 2 (Amone-P’Olak, Burger,
Huisman, Oldehinkel, & Ormel, 2011). Standardized scores higher than 3.29 or lower
than −3.29 were considered outliers, and were excluded from the analyses (Field, 2009;
Tabachnick & Fidell, 2001). The number of excluded outliers differed per scale, rang-
ing from n = 2 on the somatic complaints scale to n = 7 on the emotionally reactive
scale and the externalizing scale. Internal consistencies of the syndrome scales were
acceptable with Cronbach’s α ranging from .63 for somatic complaints to .90 for aggres-
sive behavior. The broadband scales showed high internal consistencies, internalizing
α = .84 and externalizing α = .91.
Covariates
We adjusted our analyses for other potential sources of family stress to partial out
contextual stress which might affect the parent. Analyses were adjusted for the fol-
lowing covariates: maternal age, maternal education, low family income, marital status,
gestational age at birth, birth weight, child gender, and the number of children under
18 years of age living in the household. Educational level was divided into three
categories reflecting the highest education finished by the mother: primary (primary
school), secondary (high school), and higher education (college or university). Low fam-
ily income was defined in accordance with the official definition in the Netherlands as
1,600 Euros or less income after taxes per month.
Statistical Analyses
We first tested to find out if there was an association between childrearing stress
and attachment classification using univariate analyses of variance, with infant attach-
ment classification as the independent factor, and z-standardized NOSIK scores as the
dependent factor. To assess the effect of infant-mother attachment classification and
childrearing stress on child emotional and behavior problems at age 3 years, we then
conducted multivariate analyses of covariance with CBCL internalizing problems and
externalizing problems as dependent variables. First, we tested the four-way attach-

ment classification contrast (A insecure-avoidant, B secure, C insecure-resistant, and D
disorganized), and the secure (B) versus insecure (A, C, D) contrast. We then repeated
the analyses including the interaction term of attachment classification and childrearing
stress in the model. Second, we examined the effects of infant–mother attachment clas-
sification and childrearing stress on more specific emotional and behavior problems
indicated by the CBCL syndrome scales. Analyses were conducted unadjusted and
adjusted for the following contextual stress factors: child gender and age at birth, mater-
nal age, educational level and marital status, as well as low family income, and the
number of children under the age of 18 living in the household.
RESULTS
The four attachment classifications did not differ in level of childrearing stress: secure
(n = 322) M = −.04, SD = .87; insecure-avoidant (n = 89) M = −.05, SD = .74; insecure-
resistant (n = 101) M = −.06, SD = .88; disorganized (n = 148) M = −.06, SD = .83,
F(3, 656) = .50, p = .68. Mean scores on the CBCL subscales as reported by the mother
and the father as well as correlations of the aggregated subscale mean scores with
parenting stress scores are displayed in Table 2.
CBCL Internalizing and Externalizing Problems

Main effects. We tested the main effects of infant-mother attachment classification
and childrearing stress on externalizing and internalizing problems using Multivariate
Analyses of Covariance (MANCOVA). Childrearing stress was related to both internal-
izing problems, F(1, 575) = 13.18, p < .01, partial N2 = .02 and externalizing problems,
TABLE 2
Mean CBCL Subscale Scores as Reported by Mother and Father at Age 3 Years, and Correlations of
Aggregated Scores with NOSIK
Aggregated Score, Correlation with

Mother Report Father Report z-standardized NOSIK
CBCL Subscale N M (SE) N M (SE) N M (SE) N Pearson R
Emotional reactive 617 1.37 (.07) 560 1.53 (.07) 629 −.05 (.03) 596 .17∗∗
Anxious depressed 617 .69 (.05) 561 .83 (.05) 631 −.02 (.03) 569 .07
Somatic complaints 617 1.34 (.06) 562 1.28 (.06) 634 −.04 (.03) 596 .08
Withdrawn 617 .74 (.04) 562 .84 (.05) 630 −.06 (.03) 592 .11∗∗
Sleep problems 617 1.55 (.08) 559 1.61 (.08) 630 −.05 (.03) 593 .06
Attention problems 617 1.30 (.06) 562 1.62 (.07) 632 −.03 (.03) 596 .13∗∗
Aggressive behavior 617 6.38 (.19) 561 7.17 (.21) 631 −.05 (.03) 595 .18∗∗
Total internalizing 617 4.15 (.16) 562 4.49 (.18) 631 −.05 (.03) 595 .14∗∗
Total externalizing 617 7.68 (.24) 561 8.78 (.26) 630 −.05 (.03) 595 .18∗∗
Note. Means are weighted means, allowing for a maximum of 25% missing per subscale.
SE = standard errors of mean. Aggregated mean score: mother and father report were first z-standardized,
then summed and divided by two. Correlations calculated with z-standardized aggregated mean scores of
mother and father report and z-standardized NOSIK scores.
∗ p < .05. ∗∗ p < .01.
270 THARNER ET AL.
F(1, 575) = 15.95, p < .01, partial N2 = .03. Post hoc regression analyses adjusted for
child gender and age at birth, maternal age, educational level and marital status, as
well as low family income and the number of children under the age of 18 living in the
household showed that higher levels of childrearing stress at 18 months were related
to more internalizing problems at age 3 (B = .15, SE = .03, p < .01, R2 = .04), as well
as to more externalizing problems (B = .16, SE = .04, p < .01, R2 = .03). Children with
secure, insecure-avoidant, insecure-resistant, and disorganized attachment relationships
did not differ in internalizing, F(3, 575) = .74, ns, or externalizing scores, F(3, 575) = .84,
ns, when they were 3 years old. All other attachment classification contrasts were non-
significant as well (data not shown). Results of unadjusted and adjusted analyses were
essentially the same.
Interaction effects. The interaction between four-way attachment classifications and

childrearing stress on internalizing, F(3, 572) = 1.56, and externalizing problems,
F(3, 572) = 2.19, did not reach significance (p > .05). Similar results were found in
unadjusted analyses.
CBCL Syndrome Scales

Main effects. We repeated the MANCOVA as described above to assess main and
interaction effects of childrearing stress and infant attachment on specific emotional and
behavior problems as measured by the syndrome scales of the CBCL (Tables 3a and 3b).
Infant–mother attachment classification (four-way) was associated with child attention
problems, F(3, 565) = 3.22, p < .05, partial N2 = .02. Avoidant children had significantly
more attention problems (M = .45, SE = .33) than securely attached children (M = .12,
SE = .31, p < .05), resistant children (M = .18, SE = .32, p < .05), and disorganized chil-
dren (M = −.12, SE = .07, p < .01). Childrearing stress was related to emotional reactivity
(F[1, 565] = 13.13, p < .01, partial N2 = .02), withdrawn behavior (F[1, 565] = 8.41, p < .01,
partial N2 = .02), attention problems (F[1, 565] = 9.10, p < .01, N2 = .02), and aggressive
behavior (F[1, 565] = 11.41, p < .01, partial N2 = .02). Post hoc analyses showed that more
childrearing stress was related to more emotional reactivity (B = .14, SE = .03, p < .01,
R2 = .03), more withdrawn behavior (B = .10, SE = .03, p < .01, R2 = .01), more attention
problems (B = .11, SE = .01, p < .05, R2 = .02), and more aggressive behavior (B = .146,
SE = .04, p < .01, R2 = .03). Results of unadjusted and adjusted analyses were essentially
the same.
Interaction effects. For withdrawn behavior, we found a significant interaction effect of
secure versus insecure attachment classification and childrearing stress (F[3, 567] = 8.91,
p < .01, partial N2 = .02; see Table 3a). More specifically, the interaction effect of secure
versus resistant attachment and childrearing problems on withdrawn behavior was sig-
nificant (F[1, 361] = 4.83, p < .05, partial N2 = .01), and the interaction of secure versus
disorganized attachment and childrearing stress on withdrawn behavior was significant
(F [1, 401] = 9.81, p < .01, partial N2 = .02). Post hoc analyses showed that childrearing
stress was not related to withdrawn behavior in securely attached children (B = .03,
SE = .04, ns). In the group of insecurely attached children, however, more childrearing
stress was related to more withdrawn behavior (B = .20, SE = .05, p < .01, R2 = .05;
see Figure 1). More specifically, more childrearing problems were related to more with-
drawn behavior in insecure-resistant children (B = .25, SE = .09, p < .05, R2 = .05), and
in disorganized children (B = .25).
TABLE 3A
Main and Interaction Effects of Infant Attachment Classification and Childrearing Stress on CBCL Internalizing Subscales at Age 3 Years
Emotionally Withdrawn
Reactive Anxious Depressed Somatic Complaints Sleeping Problems Behavior
N F N2 p F N2 p F N2 p F N2 p F N2 P
Infant attachment: B vs. non-B 287/296 .15 .00 .70 .43 .00 .51 .32 .00 .57 .04 .00 .84 2.63 .01 .11
Childrearing stress (NOSIK, z-score) 12.91 .02 .00 2.19 .00 .14 2.28 .00 .14 1.80 .00 .18 8.44 .02 .00
Interaction term: BvsnonB∗ NOSIK 2.04 .00 .12 .45 .00 .50 .26 .00 .61 .72 .00 .40 8.91 .02 .00
Infant attachment: B vs. A 287/75 .39 .00 .53 .72 .00 .40 .00 .00 .99 .17 .00 .68 .27 .00 .61
Childrearing stress (NOSIK, z-score) 4.44 .01 .04 .75 .00 .39 .30 .00 .59 2.06 .01 .15 .21 .00 .65
Interaction term: BvsA∗ NOSIK .24 .00 .62 .00 .00 .95 .78 .00 .38 .07 .00 .79 .01 .00 .91
Infant attachment: B vs. C 287/90 1.06 .00 .31 1.72 .00 .19 .01 .00 .93 .40 .00 .53 1.68 .01 .20
Childrearing stress (NOSIK, z-score) 4.49 .01 .04 .39 .00 .53 1.38 .00 .24 1.46 .00 .23 2.05 .01 .15
Interaction term: BvsC∗ NOSIK .53 .00 .47 .05 .00 .83 .46 .00 .50 .43 .00 .52 4.83 .01 .03
Infant attachment: B vs. D 287/131 .50 .00 .48 .14 .00 .71 1.26 .00 .26 .21 .00 .65 1.97 .01 .16
Childrearing stress (NOSIK, z-score) 7.53 .02 .01 2.65 .01 .13 1.80 .00 .18 1.43 .00 .23 4.63 .01 .03
Interaction term: BvsD∗ NOSIK 1.96 .01 .16 1.33 .00 .25 .49 .00 .48 1.00 .00 .32 9.81 .02 .00
Note. Results of MANCOVA. N2 = partial eta squared; p = p-value. Syndrome scale scores of the CBCL were entered as dependent variables. Different attach-
ment classifications, child gender, family income, educational level, and marital status were entered as independent factors. Separate analyses were conducted
for each attachment contrast. Age of the mother (z-score), gestational age (z-score), and number of siblings were entered as covariates. N represents the number
of children with a secure versus the several insecure classifications. Interaction terms were calculated in MANCOVA as the product of centralized attachment
classification scores (secure = −1, respective insecure classification = 1) and NOSIK z-scores.
271
272 THARNER ET AL.
TABLE 3B
Main and Interaction Effects of Infant Attachment Classification and Childrearing Stress on CBCL
Externalizing Subscales at Age 3 Years
Attention Problems Aggressive Behavior
N F N2 p F N2 P
Infant attachment: B vs. non-B 287/296 .68 .00 .41 .00 .00 .99
Child rearing stress (NOSIK, z-score) 8.83 .02 .00 11.38 .02 .00
Interaction term: BvsnonB∗ NOSIK 4.17 .01 .04 3.99 .01 .04
Infant attachment: B vs. A 287/75 5.95 .02 .02 .22 .00 .64
Interaction term: BvsA∗ NOSIK 1.58 .01 .21 3.68 .01 .06
Infant attachment: B vs. C 287/90 .04 .00 .84 .05 .00 .83
Interaction term: BvsC∗ NOSIK 1.49 .00 .22 1.73 .01 .19
Infant attachment: B vs. D 287/131 .45 .00 .50 .21 .00 .65
Interaction term: BvsD∗ NOSIK 2.66 .01 .10 .72 .00 .40
Note: Results of MANCOVA. N2 = partial eta squared, p = p-value. Syndrome scale scores of the CBCL
were entered as dependent variables. Different attachment classifications, child gender, family income, edu-
cational level, and marital status were entered as independent factors. Separate analyses were conducted for
each attachment contrast. Age of the mother (z-score), gestational age (z-score), and number of siblings were
entered as covariates. N represents the number of children with a secure versus the several insecure classifica-
tions. Interaction terms were calculated in MANCOVA as the product of centralized attachment classification
scores (secure = −1, respective insecure classification = 1) and NOSIK z-scores.
FIGURE 1
The effect of childrearing stress on withdrawn behavior in securely and insecurely attached 3-year-olds
(data taken from unadjusted regression analyses conducted separately in the two attachment groups).
FIGURE 2
The effect of childrearing stress on attention problems in securely and insecurely attached 3-year-olds
For attention problems, we found a significant interaction effect of secure versus inse-
cure attachment classification and childrearing stress, F(1, 567) = 4.17, p < .05, partial
N2 = .01 (see also Table 3b). Post hoc analyses showed that more childrearing stress was
related to more attention problems in insecurely attached children (B = .18, SE = .06,
p < .01, R2 = .04), but not in securely attached children (B = .05, SE = .05, ns). These
results are illustrated in Figure 2.
For aggressive behavior, we found a similar significant interaction effect of secure
versus insecure attachment classification and childrearing stress, F(1, 567) = 3.99,
p < .05, partial N2 = .01 (see also Table 3b). Post hoc analyses showed that more
childrearing stress was related to more aggressive behavior in insecurely attached chil-
dren (B = .25, SE = .06, p < .01, R2 = .07), but not in securely attached children (B = .08,
SE = .06, ns). These results are illustrated in Figure 3.
DISCUSSION
The current study shows that more childrearing-related parenting stress predicts more
emotional and behavioral problems in 3-year-old children. Furthermore, insecure-
avoidant children display more attention problems than children from the other
attachment categories. For disorganized attachment, however, we found no main effect
on behavior problems. The most important effects of attachment were found in inter-
actions with childrearing stress. Our findings suggest that secure attachment buffers
the negative effects of parental childrearing stress on children’s emotional and behav-
ior problems; childrearing-related stress only predicted socio-emotional problems in
insecurely attached children, but not in securely attached children.
274 THARNER ET AL.
FIGURE 3
The effect of childrearing stress on aggressive behavior in securely and insecurely attached 3-year-olds
More specific examination of the internalizing domain showed that childrearing-

related parenting stress predicted more emotional reactivity and more withdrawn
behavior. However, the association between childrearing stress and withdrawn behav-
ior was only found in disorganized and insecure-resistant children, but not in insecure-
avoidant or securely attached children. In the externalizing domain, we found that
childrearing-related parenting stress predicted more attention problems as well as more
aggressive behavior. Again, these associations were only found in insecurely attached
children, but not in securely attached children.
Our findings that childrearing-related parenting stress is related to emotional and
behavior problems in insecurely attached, but not in securely attached children, accords
with the idea that infant attachment might best be regarded as a risk or protective factor
that affects child development in interaction with other risk factors (Belsky & Fearon,
2002; Greenberg, 1999). This role of infant attachment for child development has pre-
viously been shown in the context of severe contextual risk factors, such as parental
psychopathology or single parenthood (for a review, see DeKlyen & Greenberg, 2008),
but the current study demonstrates that the same is true in the context of more nor-
mative, everyday parenting stresses related to childrearing (Abidin, 1983; Crnic et al.,
2005).
Securely attached children seem to be better able to deal with childrearing stress
of the parent than insecure children. It has been suggested that, in general, securely
attached children are more effective in coping with stress because of their mental rep-
resentation of a parent being available when needed to cope with distress and anxiety
(Carlson, 1998; Sroufe et al., 2005; Weinfield et al., 2008). Secure attachment may also
buffer the effects of childrearing stress on child problem behavior because, despite their
parents’ stronger feelings of stress, secure children are able to trust their parents and to
rely on them for support when needed. Childrearing stress is not related to attachment
security in our study, and we speculate that child characteristics such as a difficult tem-
perament are responsible for parental feelings of stress related to childrearing. Because
temperament is not associated with attachment security (Van IJzendoorn & Bakermans-
Kranenburg, in press), secure attachment acts as a buffer, whereas insecure attachments
should be considered a risk factor on top of the parental feelings of stress, and this
double risk may lead to elevated levels of behavior problems. Alternatively, stressed
(and sensitive) parents of securely attached children might perceive and feel more stress
arising from their childrearing responsibilities when they have a child with a difficult
temperament, but in the long run they manage to cope with those feelings and to keep
the child’s inclination to show behavior problems in check. Further follow-up within
Generation R will shed more light on this alternative interpretation.
It has been argued that the different types of insecure attachment might be differ-
entially related to specific types of emotional and behavior problems (Bowlby, 1973;
Brumariu & Kerns, 2010; Fearon et al., 2010). Resistant attachment is assumed to be
related to internalizing problems, and avoidant attachment to behavior problems of a
more externalizing nature (Bakermans-Kranenburg & Van IJzendoorn, 2009; DeKlyen
& Greenberg, 2008; Weinfield et al., 2008). The current study only partly confirms
these assumptions; we found that insecure-avoidant children had more externaliz-
ing problems, in particular, attention problems. However, we found no evidence that
insecure-resistant children had more internalizing problems than the other insecure
categories. Resistant attachment thus is not a privileged predictor of internalizing
problems, which concurs with the outcome of a recent meta-analysis by Groh et al.
(2012).
Disorganized attachment is generally considered the most insecure type of attach-
ment, and is assumed to be more strongly associated with externalizing problems than
other types of insecure attachment (Green & Goldwyn, 2002) but not with internal-
izing symptoms (Groh et al., 2012). The importance of disorganized attachment as
a risk factor for socio-emotional problems has been demonstrated in several studies
conducted in high-risk samples (Lyons-Ruth, 1996; Lyons-Ruth et al., 1997; for meta-
analyses, see Fearon et al., 2010; Van IJzendoorn et al., 1999). In the current study, we
found a combined effect of attachment disorganization and childrearing-related par-
enting stress on withdrawn behavior in contrast with secure children. These findings
converge with earlier studies in clinical and at-risk samples (Lyons-Ruth & Jacobvitz,
2008), and the absence of a meta-analytic association between disorganization and inter-
nalizing problems across normal and clinical samples (Groh et al., 2012). In our study,
disorganized attachment did not show unique predictive power for (internalizing or
externalizing) behavior problems compared to the other insecure categories. These find-
ings fit with the results of two recent meta-analyses (Fearon et al., 2010; Groh et al.,
2012).
Our findings also concur with results of Belsky and Fearon (2002), who in the
population-based sample of the NICHD ECCRN study found that insecure-avoidant
and not disorganized 3-year-olds had more externalizing behavior problems than
securely attached children. Belsky and Fearon (2002) argued that the young age of the
participants may explain the absence of an effect of disorganization, because many other
studies have examined older children. In their recent report on older children in the
same longitudinal sample, Fearon and Belsky (2011) showed that with age the asso-
ciation between disorganized attachment and externalizing behaviors emerges more
strongly, especially under conditions of contextual risks. In general, the risk status of
276 THARNER ET AL.
disorganized attachment may become more clearly visible in families that have to cope
with strong environmental stressors as is characteristic of high-risk samples, such as the
Minnesota longitudinal sample (Sroufe et al., 2005).
In accordance with earlier findings (Crnic et al., 2005; Gutermuth et al., 2005;
Huth-Bocks & Hughes, 2008), high levels of childrearing–related parenting stress pre-
dicted more socio-emotional problems in 3-year-olds. Contrary to what is assumed by
cumulative risk theories (Greenberg, 1999; Rutter, 1999), childrearing stress was related
to higher scores on four out of seven CBCL syndrome scales, even when other important
risk factors were controlled. More childrearing-related parenting stress predicted more
emotional reactivity and more withdrawn behavior in the internalizing domain. In the
externalizing domain, more childrearing-related parenting stress predicted more atten-
tion problems and aggressive behavior in 3-year-olds. The mechanisms underlying the
effect of parenting stress on child emotional and behavior problems are much debated.
It is intuitively appealing to think that parenting stress affects the parent’s behavior,
which in turn affects child behavior. However, several studies found no support for this
hypothesis (Crnic et al., 2005; Gutermuth et al., 2005; Huth-Bocks & Hughes, 2008). It has
been suggested that, instead, exposure to a stressed parent may have a direct dysregulat-
ing effect for the child’s stress response which in turn results in emotional and behavior
problems (Huth-Bocks & Hughes, 2008). Also, as Huth-Bocks and Hughes (2008) sug-
gested, the effect of parenting stress on the child may be mediated by factors other than
parenting behavior, such as perceived social support. Unfortunately, the current study
was not suited to test whether or not the effect of parenting stress on child behavior is
mediated by parental behavior.
In the current study, childrearing-related parenting stress did not predict anxious-
depressed symptoms, sleeping problems, or somatic complaints. It should be noted that
these internalizing problems are known to be hard to measure reliably in children as
young as in our sample, and these scales had the lowest reliability of the syndrome
scales. Alternatively, anxious-depressed symptoms and somatic complaints might not
be affected by childrearing-related parenting stress but by other factors; for example,
children of depressed parents are found to have more depressive symptoms, which may
be due to depressed parental behavior, but also to underlying shared genetic factors (for
a review, see Goodman & Gotlib, 1999).
The main effect of parenting stress that we found in the current study was qualified by
interactions with attachment quality, although the effect sizes were comparatively small.
Effects of this magnitude can nevertheless be informative about the etiology of child
socio-emotional problems, and may be important for prevention or treatment efforts.
In medical science, effect sizes of a magnitude between R2 = .01 and R2 = .04 are some-
times considered “dramatic,” as pointed out by Dallaire and Weinraub (2007). They note
that an experiment on the effect of aspirin in reducing heart attacks was prematurely
terminated based on an effect size of R2 = .0011, because it was considered unethical to
exclude some of the patients from this treatment.
In the current study, the parent-domain subscale of the NOSIK is interpreted as a
measure of childrearing-related stress of the parent (Abidin, 1995). However, it is also
conceivable that our measure of parenting stress at least partly reflects child behavior
problems or aspects of the parent–child relationship. The NOSIK is based on the PSI-SF,
which was originally conceptualized as consisting of three sub-scales: Parental Distress,
Parent-Child Dysfunctional Interaction, and Difficult Child (Abidin, 1995). This struc-
ture was based on a factor analysis conducted in a low-risk sample similar to ours.
In the current study, we used the items of the Parental Distress scale as an index of par-
enting stress, which is considered to reflect the stress experienced by the parent due to
childrearing, as opposed to the relationship aspect (Dysfunctional Interaction subscale)
and the child aspect (Difficult Child subscale) of parental stress. This interpretation of
the Parental Distress subscale has been confirmed in later studies using diverse samples
(Whiteside-Mansell et al., 2007; Díaz-Herrero, López-Pina, Pérez-López, de la Nuez, &
Martínez-Fuentes, 2011, Reitman, Currier, & Stickle, 2002). In addition, Reitman and
colleagues (2002) showed that other measures of child behavior problems were most
strongly related to the Difficult Child subscale, whereas child oppositionality did not
add to the explained variance in the Parental Distress scale. These findings support the
idea that the association between parenting stress at 18 months and child emotional
and behavior problems at 3 years does not merely reflect a continuation of difficult
child behavior. Finally, the absence of an association between parenting stress and
infant–parent attachment indicates that the parental stress assessment is not merely an
index of parent–infant dysfunctional interactions.
Although childrearing-related parenting stress at 18 months was associated with
emotional and behavioral problems at 3 years, this association does not imply causality.
It is conceivable that stressed mothers experience their child as more difficult, or that
mothers of difficult children experience more stress. Even with the current longitudi-
nal study design, we could not completely eliminate the possibility of reverse causality.
In this context, another limitation of this study is the lack of concurrent parenting stress
measures. Parenting stress might have changed from 18 to 36 months, and concurrent
levels of childrearing-related stress of the parent might affect their perception of the
child’s behavior. Related to this issue, reporter-bias should always be considered in
studies using self-report data. We tried to minimize this bias by using two sources of
information (mothers and fathers) in assessing child emotional and behavior problems.
The fact that infant-mother attachment was observed also reduces the likelihood that the
associations were biased in this way. Future studies might use observational measures
of child emotional and behavior problems as well as concurrent measures of parenting
stress.
The current sample is low risk even for a population-based sample, as indicated
by a high SES and low psychopathology. Selective non-response further increased this
low-risk status, as families that remained in the sample were of still higher SES than
families that had to be excluded due to missing data. Yet, the distribution of attach-
ment classification was comparable to what the meta-analysis of Van IJzendoorn and
colleagues (1999) reported for normal non-U.S. Western studies. Also, families with
high childrearing-related parenting stress did not differ from families with low par-
enting stress regarding other potential sources of family stress such as SES, family
income, maternal age, number of siblings, child birth weight, and gestational age at
birth as indicators of birth complications. These findings indicate that our measure
of parenting stress is not merely a measure of general contextual stress. The low rate
of psychopathology makes it more likely that our measure of parenting stress taps
childrearing-related problems within the parent–child dyad that are independent of
general parental distress. It should also be noted that in our low-risk sample, children’s
emotional and behavioral problems were mostly in the non-clinical range. Yet, the par-
ents of children with higher scores on the CBCL experienced the behavior of these
children as more problematic at a very young age, which might be reason for concern
and for monitoring their further development.
278 THARNER ET AL.
This study showed that even in an otherwise low-risk context, childrearing-related

parenting stress and attachment security affect the socio-emotional development of chil-
dren. Parenting stress and insecure attachment might be considered risk factors for
later internalizing and externalizing problems, whereas secure attachment buffers the
negative effects of childrearing stress on child problems, in particular on withdrawn,
attention, and aggressive behavior problems.
IMPLICATIONS FOR PRACTICE, APPLICATION, AND POLICY
The current study showed in a large sample of low-risk families that parenting stress
is related to emotional and behavioral problems in 3-year-olds with an insecure attach-
ment relationship. Attachment security buffers these negative effects of parental stress
on child development. It has previously been shown in high risk and clinical sam-
ples that insecure attachment is a developmental risk factor, whereas secure attachment
might be a protective factor. The current findings indicate that the same is true in the
context of more normative, everyday parenting stresses related to childrearing. Even in
low-risk families, parenting stress and the parent–child relationship may be important
targets or indicators for interventions to reduce children’s socio-emotional problems.
Future research might explore the possibility of using intervention programs that foster
attachment security (Juffer, Bakermans-Kranenburg, & Van IJzendoorn, 2008) to make
children more resilient to the negative effects of normative stressors.
ADDRESSES AND AFFILIATIONS
Henning Tiemeier, Erasmus Medical Center, Department of Child and Adolescent

Psychiatry/Psychology, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail:
h.tiemeier@erasmusmc.nl. Anne Tharner is at the Erasmus University Medical Center
and Leiden University; Maartje P. C. M. Luijk is at Erasmus University; Marinus H. van
IJzendoorn is at Erasmus University and Leiden University; Marian J. Bakermans-
Kranenburg is at Leiden University; and Vincent W. V. Jaddoe, Albert Hofman, and
Frank C. Verhulst are at the Erasmus University Medical Center.
ACKNOWLEDGEMENTS
The Generation R Study is conducted by the Erasmus Medical Center Rotterdam in close
collaboration with the Faculty of Social Sciences of the Erasmus University Rotterdam,
the Municipal Health Service Rotterdam area, the Rotterdam Homecare Foundation,
and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR), Rotterdam.
We gratefully acknowledge the contribution of general practitioners, hospitals, mid-
wives, and pharmacies in Rotterdam. The first phase of the Generation R Study is made
possible by financial support from the Erasmus Medical Center Rotterdam, the Erasmus
University Rotterdam, and the Netherlands Organization for Health Research and
Development (Zon Mw). Marinus van IJzendoorn and Marian Bakermans-Kranenburg
were supported by the Netherlands Organization for Scientific Research (SPINOZA
prize and VICI award, respectively).
REFERENCES
Abidin, R. R. (1983). Parenting stress index: Manual, administration booklet, [and] research update. Charlottesville,
VA: Pediatric Psychology Press.
Abidin, R. R. (1995). Parenting stress index (3rd ed.): Professional manual. Lutz, FL: Psychological Assessment
Resources.
Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms and profiles. Burlington:
University of Vermont, Research Center for Children, Youth, & Families.
Ainsworth, M. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the
strange situation (vol. xviii). Oxford, UK: Lawrence Erlbaum.
Amone-P’Olak, K., Burger, H., Huisman, M., Oldehinkel, A. J., & Ormel, J. (2011). Parental psychopathology
and socioeconomic position predict adolescent offspring’s mental health independently and do
not interact: The TRAILS study. Journal of Epidemiology and Community Health, 65, 57–63. doi:
10.1136/jech.2009.092569
Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H. (2009). The first 10,000 adult attachment interviews:
Distributions of adult attachment representations in clinical and non-clinical groups. Attachment & Human
Development, 11(3), 223–263. doi: 10.1080/14616730902814762
Belsky, J., & Fearon, R. M. P. (2002). Infant-mother attachment security, contextual risk, and early
development: A moderational analysis. Development and Psychopathology, 14, 293–310. doi: 10.1017/
S0954579402002067
Bowlby, J. (1969/1982). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.
Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation, anxiety, and anger. New York: Basic Books.
Bretherton, I. (1985). Attachment theory: Retrospect and prospect. Monographs of the Society for Research in Child
Development, 50(1/2), 3–35.
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. doi: 10.1017/S0954579409990344
Carlson, E. A. (1998). A prospective longitudinal study of attachment disorganization/disorientation. Child
Development, 69(4), 1107–1128. doi: 10.1111/j.1467-8624.1998.tb06163.x
Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. Monographs of the Soceity for
Research in Child Development, 59(2–3), 228–249.
Costa, N. M., Weems, C. F., Pellerin, K., & Dalton, R. (2006). Parenting stress and childhood psychopathology:
An examination of specificity to internalizing and externalizing symptoms. Journal of Psychopathology and
Behavioral Assessment, 28(2), 113–122. doi: 10.1111/j.1467-8624.1998.tb06163.x
Crnic, K. A., Gaze, C., & Hoffman, C. (2005). Cumulative parenting stress across the preschool period:
Relations to maternal parenting and child behaviour at age 5. Infant and Child Development, 14, 117–132.
doi: 10.1002/icd.384
Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H. (2010). Attachment security
and disorganization in maltreating and high-risk families: A series of meta-analyses. Development and
Psychopathology, 22, 87–108. doi: 10.1017/S0954579409990289
Dallaire, D. H., & Weinraub, M. (2007). Infant-mother attachment security and children’s anxi-
ety and aggression at first grade. Journal of Applied Developmental Psychology, 28, 477–492. doi:
10.1016/j.appdev.2007.06.005
De Beurs, E. (2004). Brief Symptom Inventory, Handleiding (Manual). Leiden, The Netherlands: Pits Publishers.
De Brock, A. J. L. L., Vermulst, A. A., Gerris, J. R. M., & Abidin, R. R. (1992). Nijmeegse Ouderlijke Stress Index.
Lisse: Swets en Zeitlinger.
DeKlyen, M., & Greenberg, M. T. (2008). Attachment and psychopathology in childhood. In J. Cassidy & P. R.
Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 637–665). New York: The
Guilford Press.
Derogatis, L. R. (1993). Brief Symptom Inventory (BSI): Administration, scoring and procedures manual (3rd ed.).
Minneapolis, MN: National Computer Systems.
Díaz-Herrero, A., López-Pina, J. A., Pérez-López, J., de la Nuez, A. G. B., & Mártinez-Fuentes, M. T. (2011).
Validity of the Parenting Stress Index-Short Form in a sample of Spanish fathers. The Spanish Journal of
Psychology, 14(2), 990–997. doi: 10.5209/rev_SJOP.2011.v14.n2.44
Edwards, E. P., Das Eiden, R., & Leonard, K. E. (2006). Behavior problems in 18- to 36-month old children of
alcoholic fathers: Secure mother-infant attachment as a protective factor. Development and Psychopathology,
18(2), 395–407. doi: 10.1017/S0954579406060214
280 THARNER ET AL.
Fearon, P. R. M., Bakermans-Kranenburg, M. J., Van IJzendoorn, M. H., Lapsley, A. M., & Roisman, G. I.
(2010). The significance of attachment and disorganization in the development of children’s externalizing
behavior: A meta-analytic study. Child Development, 81(2), 435–456. doi: 10.1111/j.1467-8624.2009.01405.x
Fearon, P. R. M., & Belsky, J. (2011). Infant-mother attachment and the growth of externalizing prob-
lems across the primary-school years. Journal of Child Psychology and Psychiatry, 52(7), 782–791. doi
10.1111/j.1467-8624.2009.01405.x
Field, A. (2009). Discovering statistics using SPSS (3rd ed.). London: Sage.
Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal
depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106(5), 1071–1083.
doi: 10.1097/01.AOG.0000183597.31630.db
Goodman, S. H., & Gotlib, I. H. (1999). Risk for psychopathology in the children of depressed mothers: A devel-
opmental model for understanding mechanisms of transmission. Psychological Review, 106(3), 458–490. doi:
10.1037/0033-295X.106.3.458
Green, J., & Goldwyn, R. (2002). Annotation: Attachment disorganization and psychopathology: New findings
in attachment research and their potential implications for developmental psychopathology in childhood.
Journal of Child Psychology and Psychiatry, 43(7), 835–846. doi: 10.1111/1469-7610.00102
Greenberg, M. T. (1999). Attachment and psychopathology in childhood. In J. Cassidy & P. R. Shaver (Eds.),
Handbook of attachment: Theory, research and clinical applications (pp. 469–496). New York: The Guilford Press.
Greenberg, M. T., Speltz, M. L., DeKlyen, M., & Jones, K. (1999). Correlates of clinic referral for early conduct
problems: Variable- and person-oriented approaches. Development and Psychopathology, 13, 255–276.
Groh, A. M., Roisman, G. I., Van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Fearon, R. M. P. (2012).
The significance of insecure and disorganized attachment for children’s internalizing symptoms: A meta-
analytic study. Child Development, 83(2), 591–610. doi: 10.1111/j.1467-8624.2011.01711.x
Gutermuth, A. L., Anthony, B. J., Glanville, D. N., Naiman, D. Q., Waanders, C., & Shaffer, S. (2005). The
relationship between parenting stress, parenting behaviour and preschoolers’ social competence and
behaviour problems in the classroom. Infant and Child Development, 14, 133–154. doi: 10.1002/icd.385
Guttmann-Steinmetz, S., & Crowell, J. A. (2006). Attachment and externalizing disorders: A developmen-
tal psychopathology perspective. Journal of the American Academy of Child and Adolescent Psychiatry, 45(4),
440–451. doi: 10.1097/01.chi.0000196422.42599.63
Hesse, E., & Main, M. (2006). Frightened, threatening, and dissociative parental behavior in low-risk sam-
ples: Descripton, discussion, and interpretations. Development and Psychopathology, 18(2), 309–343. doi:
10.1017/S0954579406060172
Huth-Bocks, A. C., & Hughes, H. M. (2008). Parenting stress, parenting behavior, and children’s adjustment in
families experiencing intimate partner violence. Journal of Family Violence, 23, 243–251. doi: 10.1007/s10896-
007-9148-1
Jaddoe, V. W., Van Duijn, C. M., Van der Heijden, A. J., Mackenbach, J. P, Moll, H. A., Steegers, E. A. P.,
. . . Hofman, A. (2010). The Generation R study: Design and cohort update 2010. European Journal of
Epidemiology, 25, 823–841. doi: 10.1007/s10654-010-9516-7
Juffer, F., Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H. (2008). Promoting positive parenting: An
attachment-based intervention. Mahwah, NJ: Lawrence Erlbaum.
Luijk, P. C. M., Saridjan, N., Tharner, A., Van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Jaddoe, V. W.,
. . . Tiemeier, H. (2010). Attachment, depression and cortisol: Deviant patterns in insecure-resistant and
disorganized infants. Developmental Psychobiology, 52(5), 441–452. doi: 10.1002/dev.20446
Lyons-Ruth, K. (1996). Attachment relationships among children with aggressive behavior problems: The role
of disorganized early attachment patterns. Journal of Consulting and Clinical Psychology, 64(1), 64–73. doi:
10.1037/0022-006X.64.1.64
Lyons-Ruth, K., Easterbrooks, M. A., & Cibelli, C. D. (1997). Infant attachment strategies, infant mental
lag, and maternal depressive symptoms: Predictors of internalizing and externalizing problems at age 7.
Developmental Psychology, 33(4), 681–692. doi: 10.1037/0012-1649.33.4.681
Lyons-Ruth, K., & Jacobvitz, D. (2008). Attachment disorganization: Genetic factors, parenting contexts, and
developmental transformation from infancy to adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of
attachment: Theory, research, and clinical applications (2nd ed., pp. 666–697). New York: The Guilford Press.
Madigan, S., Bakermans-Kranenburg, M. J., Van IJzendoorn, M. H., Moran, G., Pederson, D. R., &
Benoit, D. (2006). Unresolved states of mind, anomalous parental behavior, and disorganized attachment:
A review and meta-analysis of a transmission gap. Attachment & Human Development, 8(2), 89–111. doi:
10.1080/14616730600774458
Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized-disoriented during the
Ainsworth Strange Situation. In M. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the
preschool years: Theory, research and intervention (pp. 121–160). Chicago: University of Chicago Press.
McCartney, K., Tresch Owen, M., Booth, C. L., Clarke-Stewart, A., & Lowe Vandell, D. (2004). Testing a mater-
nal attachment model of behavior problems in early childhood. Journal of Child Psychology and Psychiatry,
45(4), 765–778. doi: 10.1111/j.1469-7610.2004.00270.x
National Institute of Child Health and Human Development Early Child Care Research Network (NICHD
ECCRN). (2006). Infant-mother attachment classification: Risk and protection in relation to changing
maternal caregiving quality. Developmental Psychology, 42(1), 38–58. doi: 10.1037/0012-1649.42.1.38
Pop, V. J., Komproe, I. H., & Van Son, M. J. (1992). Characteristics of the Edinburgh Postnatal Depression Scale
in The Netherlands. Journal of Affective Disorders, 26(2), 105–110. doi: 10.1016/0165-0327(92)90041-4
Reitman, D., Currier, R. O., & Stickle, T. R. (2002). A critical evaluation of the Parenting Stress Index-Short
Form (PSI-SF) in a Head Start population. Journal of Clinical Child and Adolescent Psychology, 31(3), 384–392.
doi: 10.1207/S15374424JCCP3103_10
Rosenthal, R. (1991). Meta-analytic procedures for social research. Newbury Park, CA: Sage.
Rutter, M. (1999). Psychosocial adversity and child psychopathology. British Journal of Psychiatry, 174, 480–493.
doi: 10.1192/bjp.174.6.480
Spijkers, W., Jansen, D. E. M. C., & Rijneveld, S. A. (2011). The impact of area deprivation on par-
enting stress. The European Journal of Public Health, 1–6. Advance Access published October 22. doi:
10.1093/eurpub/ckr146
Sroufe, L. A. (1996). Emotional development: The organization of emotional life in the early years. Cambridge Studies
in Social and Educational Development. New York: Cambridge University Press.
Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2005). The development of the person: The Minnesota
study of risk and adaptation from birth to adulthood. New York: Guilford Press.
Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (5th ed.). Boston: Allyn & Bacon.
Van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (in press). Temperament, attachment, and the dif-
ferential susceptibility hypothesis. In M. Zentner & R. L. Shiner, Handbook of temperament. New York:
Guilford.
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(2), 225–249.
Vaughn, B. E., Bost, K. E., & Van IJzendoorn, M. H. (2008). Attachment and temperament: Additive and inter-
active influences on behavior, affect, and cognition during infancy and childhood. In J. Cassidy & P. R.
Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (pp. 192–217). New York:
Guilford Press.
Weinfield, N. S., Sroufe, L. A., Egeland, B., & Carlson, E. (2008). Individual differences in infant-caregiver
attachment: Conceptual and empirical aspects of security. In J. Cassidy & P. R. Shaver (Eds.), Handbook of
attachment: Theory, research and clinical applications (pp. 78–102). New York: The Guilford Press.
Whiteside-Mansell, L., Ayoub, C., McKelvey, L., Faldowski, R. A., Hart, A., & Shears, J. (2007). Parenting
stress of low-income parents of toddlers and preschoolers: Psychometric properties of a short form of the
Parenting Stress Index. Parenting: Science and Practice, 7(1), 26–56. doi: 10.1080/15295190709336775

Parenting: Science and Practice

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Parenting: Science and Practice

Uploaded by

Copyright:

Available Formats

This article was downloaded by: [McMaster University]

On: 10 November 2014, At: 10:51

Parenting: Science and Practice

Infant Attachment, Parenting Stress, and

To link to this article: http://dx.doi.org/10.1080/15295192.2012.709150

PLEASE SCROLL DOWN FOR ARTICLE

Infant Attachment, Parenting Stress, and Child

Hofman, Frank C. Verhulst, and Henning Tiemeier

The importance of early attachment relationships for the socio-emotional development

attachment and externalizing and internalizing symptoms in 3-year-olds, with a spe-

behavior problems, but it remains unclear whether attachment disorganization should

Gender, % girls 50.00

Mean age at intake in years (SD) 31.95 (3.713)

externalizing problems as dependent variables. First, we tested the four-way attach-

CBCL Internalizing and Externalizing Problems

Aggregated Score, Correlation with

CBCL Subscale N M (SE) N M (SE) N M (SE) N Pearson R

Interaction effects. The interaction between four-way attachment classifications and

CBCL Syndrome Scales

Attention Problems Aggressive Behavior

More specific examination of the internalizing domain showed that childrearing-

This study showed that even in an otherwise low-risk context, childrearing-related

IMPLICATIONS FOR PRACTICE, APPLICATION, AND POLICY

ADDRESSES AND AFFILIATIONS

Henning Tiemeier, Erasmus Medical Center, Department of Child and Adolescent

You might also like