Systematic review of parent-child attachment security in pediatric physical chronic illness

Area of Science:

• Pediatric Psychology
• Developmental Psychology
• Clinical Child Psychology

Background:

• Pediatric chronic illnesses pose significant challenges to child development and family dynamics.
• Parent-child attachment security is hypothesized to be a key factor in resilience and coping for these children.
• Limited research exists on the specific associations between attachment security and pediatric chronic illness.

Purpose of the Study:

• To systematically review and synthesize existing literature on parent-child attachment security in pediatric physical chronic illness populations.
• To examine the relationship between attachment security and child outcomes, including resilience, coping, and adjustment.
• To identify potential protective and risk factors related to attachment in this population.

Main Methods:

• A systematic literature search was conducted following PRISMA 2020 guidelines in February 2025.
• Twenty-three studies (cross-sectional and longitudinal) were included in the synthesis.
• Attachment security was assessed using structured observations, interviews, and self-report measures.

Main Results:

• No consistent mean-level differences in attachment security were found between clinical and healthy groups, though some illness-specific groups showed higher insecure attachment rates.
• Insecure attachment correlated with increased emotional, behavioral, and psychosocial difficulties.
• Secure attachment was associated with stress buffering and improved treatment adherence, with parent-level factors influencing child attachment and outcomes.

Conclusions:

• Attachment security functions as both a protective and risk factor for children with chronic illnesses.
• Further research is needed to address methodological limitations and explore illness-specific factors.
• Findings suggest the importance of developing attachment-based interventions for children with chronic conditions.