Child anxiety: the conceptual link and respective roles of attachment security and sense of control

Abstract

There has been growing research attention on the topic of child anxiety

applying the theoretical framework of Attachment Theory, and the results have been

encouraging so far with consistent findings on the positive association between

insecure attachment and child anxiety. Child anxiety has also been associated with a

diminished sense of control with extensive empirical evidences. Nevertheless,

despite the rich empirical support on the associations between insecure attachment

and child anxiety, and between diminished sense of control and child anxiety, the

potential pathways of anxiety transmission remain largely unclear. In their

discussion on the development of child anxiety, Chopita and Barlow (1998) proposed

a conceptual link between attachment security and sense of control, even though it

has not been followed up with empirical studies. Since available empirical evidences

have validated the role of attachment security and sense of control in the

development of child anxiety, it will be conceptually meaningful to investigate the

potential link between attachment security and sense of control, and their respective

and interactive roles in the development of child anxiety. The current study also

aspires to improve understanding on the relationships between parental anxiety,

parent’s and child’s sense of control, and child anxiety within the context of children

undergoing elective surgeries.

Children of 151 parents were about to receive elective surgeries participated

in this study. Among these parents, 59 of them have children reached age 6 or above

and all these children also participated in the current study. Information from 144

parents (95.36%) and 51 children (86.44%) was used for subsequent analyses.

Information from 7 parents (4.64%) and 8 children (13.56%) was excluded from

further analyses as they filled in less than 30% of the questionnaire items.

Findings from present study showed children with insecure attachment and/or

high external LOC experienced increased anxiety in preoperative period. The

findings are consistent with existing literature. Children with insecure attachment

were also found to espouse a higher level of external LOC. Besides, regression

analyses showed that attachment security moderated the relationships between

child’s external LOC and anxiety. Results also support the notion that secure

attachment could be a protective factor against child anxiety development.

Moreover, mediation analyses indicated child’s LOC mediated the relationship

between parental and child anxiety, thereby supporting the mediation model by

Chopita and Barlow.

From a theoretical standpoint, findings from current study provided initial

support on the linkage between attachment security and sense of control. Child’s

external LOC as a potential pathway for intergenerational transmission of anxiety

was also supported. The findings also bear significant clinical implications.

Specifically, early screening and identification of children with insecure attachment

and external LOC would allow more effective allocation of resources targeting at

anxiety management in preoperative setting. Besides, taking into consideration the

impact of parental anxiety, intervention for child anxiety including components for

parental anxiety management should be emphasized.