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Maltreated children in out-of-home care: The relation between attachment quality and internalizing symptoms

Ashley A Chesmore1, Lindsey M Weiler1, Lisa J Trump1

  • 1Department of Family Social Science, University of Minnesota, 1985 Buford Avenue, 290 McNeal Hall, Saint Paul, MN 55108.

Journal of Child and Family Studies
|September 29, 2025
PubMed

Insights

Children in out-of-home care with better attachment to biological parents and substitute caregivers experience fewer internalizing symptoms. Attachment quality significantly predicts reduced anxiety and depression, highlighting its importance for maltreated children.

Area of Science:

  • Child Psychology
  • Developmental Psychology
  • Clinical Psychology

Background:

  • Maltreated children in out-of-home care face high risks for poor caregiver relationships and internalizing symptoms.
  • The extent to which relationship quality explains internalizing symptoms beyond maltreatment factors is unclear.

Purpose of the Study:

  • To examine the relationship between attachment quality with biological and substitute caregivers and internalizing symptoms in maltreated children.
  • To determine if attachment quality explains variance in internalizing symptoms beyond demographics, maltreatment type, and care factors.
  • To investigate potential moderation effects of substitute caregiver attachment on the association between biological parent attachment and internalizing symptoms.

Main Methods:

  • A sample of 493 maltreated children (aged 9-11) recently placed in out-of-home care participated.
  • Hierarchical regression models were used to analyze the associations between attachment quality and internalizing symptoms.
  • Child-reported attachment quality with both biological parents and substitute caregivers was assessed.

Main Results:

  • Greater attachment quality with both biological parents and substitute caregivers was associated with significantly fewer child-reported anxiety and depression symptoms.
  • Attachment quality with each caregiver type independently explained a significant proportion of the variance in children's internalizing symptoms.
  • No statistically significant moderation effect was found for substitute caregiver attachment on the relationship between biological parent attachment and internalizing symptoms.

Conclusions:

  • Attachment quality with both biological parents and substitute caregivers is crucial for reducing internalizing symptoms in maltreated children.
  • Clinical interventions should prioritize enhancing attachment security between children and both sets of caregivers.
  • These relationships individually contribute to children's emotional well-being, independent of other factors.

Keywords:
Attachmentfoster careinternalizing symptomsmaltreatmentpreadolescents

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