Attachment Styles in Maltreated Children:

A Comparative Study
Ricky Finzi, PhD
Tel Aviv University and Geha Psychiatric Hospital
Orna Cohen, PhD
Tel Aviv University
Yafa Sapir, PhD
Ministry of Labor and Social Affairs, Israel
Abraham Weizman, MD
Geha Psychiatric Hospital, Felsenstein Medical Research Center, and Tel
Aviv University

ABSTRACT: The study compares the emotional impact of maltreatment on the attach-
ment styles in three groups of children aged 6–12 years: children of drug-user fathers
(n = 76), physically abused children (n = 41), neglected children (n = 38); non-abused/
non-neglected children (n = 35)—control group. The secure style characterized 52% of
the children of drug-user fathers and the insecure style characterized the other 48%
(anxious/ambivalent or avoidant); physically abused children were characterized mainly
by the avoidant attachment style, and neglected children by the anxious/ambivalent
style. The conclusion is that physically abused children are at risk of antisocial behavior
and sustained suspicion towards others; neglected children are at risk of social with-
drawal, social rejection and feelings of incompetence, and children of drug-user fathers
may be at risk of behavioral problems and drug use in adolescence.

KEY WORDS: Attachment Styles; Physically Abused Children; Neglected Children;

Children of Drug User Father.

Introduction

The trauma of living in the shade of parental maltreatment affects

not only the daily functioning of children, but also the entire course

Address correspondence to R. Finzi, PhD, Bob Shapell School of Social Work, Tel Aviv
University, Ramat Aviv, Tel Aviv 69978, Israel; e-mail: rikifnz@post.tau.ac.il.

Child Psychiatry and Human Development, Vol. 31(2), Winter 2000

 2000 Human Sciences Press, Inc. 113
114 Child Psychiatry and Human Development

of their development. Studies have shown that emotional, cognitive,

behavioral and social disorders accompany these children into adoles-
cence and adulthood.1,2,3,4,5 It applies to all types of maltreatment,
though their specific sequelae vary. Each type of maltreatment con-
tains its particular emotional and behavioral correlates6 and requires
a different type of intervention.
This study aimed to distinguish attachment styles in several groups
of maltreated children—children of drug-user fathers, physically
abused and neglected children. The attachment theory describes the
impact of the child-parent affectionate bond on the child’s personality
and behavioral organization and provides insights into the implica-
tions of parental maltreatment on the development of psychopath-
ology.7,8,9,10,11

Children of Drug-User Parents

Recently, children whose parents misuse drugs have been recognized

as a high-risk population. This was due to a high rate of subjection to
neglect and abuse,12,13,14,15,16,17 and to a chaotic child-rearing environ-
ment.18 These children may be subjected to psychosocial developmental
impairments and emotional and behavioral problems.16,19,20,21,22 There are
substantive reports on psychological effects of in utero chemical expo-
sure in infants and toddlers20 and on adolescent offspring of drug-
users (for prediction of drug addiction). However, data on effects of
parental drug use on the personality and psychosocial competence of
offspring are scarce.20 The few available reports indicate that in school
age children impairments in socioemotional development are signifi-
cantly higher than the normal levels of internalizing and externalizing
behavior problems.16 These children have been described as more ag-
gressive, impulsive, depressed and anxious.23,24 They are withdrawn
and detached with low self-esteem25,26 and show symptoms of hyperac-
tivity and inattention.27 Moreover, most of the studies concentrated
on parenting by drug-user mothers20 and not on children of drug-user
fathers. Some empirical evidence indicates that the levels of aggres-
sion in sons of substance-abusing fathers are significantly higher than
in sons of non-drug-user fathers.28 This manifests more disruptive be-
havior disorders and anxiety19 and more behavioral and learning prob-
lems at school.27,29
Ricky Finzi, Orna Cohen, Yafa Sapir, and Abraham Weizman 115

Physically Abused and Neglected Children

There are more research reports on physically abused children and

neglected children than on children of drug-user parents. Physically
abused children are described as more aggressive.30,31,32 Their interac-
tions with peers are characterized by more verbal and physical aggres-
sion.33,34,35 They are less compliant and more impulsive than neglected
children, with acting-out behavior36,37 and lack of concern or empathy
towards distress of peers.38 Physically abused infants demonstrated
high levels of negative effect,36 whereas neglected infants were effec-
tively blunted.39 In pre-schoolers, neglected children were more with-
drawn from social interaction with peers,31,33,36,40 easily victimized,35
more dependent, anxious and unpopular and possessed less social
competence.36 Wodarski et al.41 noted that socioemotional adjustment
of physically abused children appears to become more problematic
with age, whereas the pervasive social and emotional problems of
young neglected children may be somewhat neutralized at school as
they grew up.

The Attachment Theory

Bowlby42,43 theorized that the nature and quality of the attachment

relationship are largely determined by a “secure base” of emotional
availability and responsiveness of the caregiver to the child’s needs.43
Bowlby7 claims that the development of internalized representations
of others and the self (termed as “internal working models”) in infants
form the repertoire of behavioral skills and affective responses, which
will reflect, reinforce and modify these representations in subsequent
interactions.7,44
Ainsworth et al.45 operationalized the attachment theory. Based on
structured laboratory observations of infants and their caregivers,
they proposed taxonomy of three main attachment styles—secure,
avoidant, and anxious/ambivalent. The secure attachment is charac-
terized by comfort with closeness and separateness, the avoidant at-
tachment by distance and excessive self-reliance, and the anxious/am-
bivalent attachment by seeking contact and inability to endure even
short periods of separation alternating with anger.
Bowlby7 suggested that the nature of internalized early experiences
with caregivers form the prototype for later relationships. Ainsworth46
116 Child Psychiatry and Human Development

claimed that attachment patterns between mother and child can be

extrapolated to individual differences in later life, since individual at-
tachment styles leave a distinct mark on all emotional relationships
that contain an attachment component. Thus, children with secured
attachment will experience less fear in new situations, develop better
problem solving abilities, show more cooperation in interpersonal rela-
tionships, more ego resiliency47,48 and better cognitive performance.49
Children characterized by an anxious/ambivalent style, which may re-
flect a history of inconsistent maternal responsiveness, will be with-
drawn and vulnerable to threats of separation in subsequent social
situations.50,51,52 Avoidant behavior, which is a defense strategy against
prolonged unresponsiveness to the infant’s attachment needs,52 mater-
nal rejection53 and maternal hostility, will lessen the child’s anxiety
and anger.54 Later, it may lead to emotional insulation, lack of empa-
thy, and antisocial and aggressive behavior.7,35,47,51,53
Toth and Cicchetti55 provided substantial evidence that the non-
optimal relationships manifested in maltreated school-age children
suggests the presence of a “maladaptive pathway” from insecure at-
tachment in the early years to the development of negative represen-
tational models of relationship figures in late childhood.

Attachment Styles and Child Maltreatment

The attachment theory provides several postulates, from which

hypotheses can be drawn to explain the behavior of maltreated chil-
dren. Attachment relationships are fundamental to the individual
functioning at all ages54 and each attachment style affects several ar-
eas (e.g., social skills, functional/dysfunctional relationships, affect
regulation, coping in stress situations).48,52 The primary purpose of at-
tachment—promoting the protection and survival of the young—is
risked by maltreatment. Children, who experience maltreatment from
an early age may adopt similar coping strategies in life and expect the
same maltreatment in new future relationships. New figures on which
maltreated children impose their internal working models include
teachers, peers, therapists and others.55,56
Studies of physically abused and neglected children, in context of
the attachment theory, show that physically abused children (age 1 to
4 years) are insecurely attached to their mothers1,57,58 exhibiting, in
particular, the avoidant pattern.54 In their study, Egeland and Sroufe59
found that all the physically abused infants belonged to the avoidant
Ricky Finzi, Orna Cohen, Yafa Sapir, and Abraham Weizman 117

group and 50% of the neglected infants to the anxious/ambivalent

group. Youngblade and Belsky60 classified most of the neglected chil-
dren as anxious/ambivalent. Gauthier et al.,2 studied undergraduates
(average age 19 years) who had been physically abused or neglected
in childhood, and reported that physical abuse was significantly re-
lated to the avoidant attachment style. George61 relates more avoid-
ance and more approach-avoidance conflict to abused infants. Among
the few investigations on attachment impairments in infants of drug-
user parents, no substantial research was done on the developmental
outcomes in children, in terms of attachment style. The present work
is based on the assumption of coherence in individual development
and a direct link between early experiences and future social and per-
sonality organization.62,63 Thus, the attachment classification can also
be related to developmental outcomes in the social domain.35
The aim of the present study was to examine the emotional out-
comes of drug-user father parenting, by focusing on its impact on the
child’s attachment patterns. Attempts were made to overcome difficul-
ties of separating the mental health risk to the child from family vio-
lence or neglect,20,25 by comparing children of a drug-user father with
physically abused and neglected children. We hypothesized that phys-
ically abused children are characterized mostly by the avoidant at-
tachment style, neglected children by the anxious/ambivalent style,
and children of a drug-user father by an insecure attachment style—
either avoidant or anxious/ambivalent.

Method

Sample

One hundred and ninety children, aged 6–13 years (mean = 9.77, SD = 1.81)
participated in the study. They were divided into four groups: group 1—76
children whose father was a drug-user; group 2—41 physically abused chil-
dren; group 3—38 children who experienced parental neglect; group 4—35
children who were not abused or neglected. One-way analysis of variance
(ANOVA) revealed no significant differences in age between the groups
[F(3,172) = 1.85; p > .05]. The sample included more boys (57.8%) than girls
(42.2%), but gender distribution was similar in all four groups—χ2 = 3.32;
df = 3; p > .05.
The children of drug-user fathers were recruited by social workers em-
ployed at outpatient units for the treatment of drug victims, from referrals of
the last two months. All the fathers used “hard drugs,” namely heroin and
cocaine, alone or combined with another drug, and had completed the first
118 Child Psychiatry and Human Development

part of a rehabilitation program (detoxification). The welfare system reports

indicated that children in this group did not suffer physical abuse or neglect,
or have been prenatally exposed, since the mothers were not drug addicts.
Abused and neglected children were approached two to six months after the
first protective intervention of the State Child Protection Officers. The officers
selected children who were designated by law as “victims of severe and pro-
longed abuse and neglect.” Following verification through records of the wel-
fare department, self-reports on abuse or neglect were received from all chil-
dren.
Physical abuse was defined by the National Center on Child Abuse and
Neglect64 as “acts of commission that involve either demonstrable harm or
endangerment to the child.” Current parental abuse was reported verbally by
children in group 2, except for five who reported that the abuse was recently
reduced by the Child Protection Officers (evidence of burn, bruises and frac-
tures from being kicked or hit very hard, sometimes with serious objects were
observed).
Neglect was defined as “acts of omission, implying lack of proper parental
control or guardianship.”64 Specific elements of neglect included “lack of ade-
quate food, clothing, shelter, supervision; abandonment, necessary medical
care, immoral environment and lack of adequate schooling.”65 Children re-
ported that current neglect was expressed in lack of parental concern to main-
tain adequate physical, health and educational conditions. Since the legal pro-
cedure was only at the beginning, all the abused and neglected children still
lived at home, and only two alleged perpetrators have been removed from
their home two months before the administration of the questionnaire.
This type of recruitment yielded mostly children of low socio-economic sta-
tus (SES), as defined by parental income (local tax level) and area of residence
(classified by the Ministry of Education). Non-maltreated (control group) chil-
dren were recruited from the same residential area, by approaching parents
of children attending the same (state) elementary schools as the maltreated
children. Nevertheless, significant differences were found between the groups:
86.6% of the neglected children came from low-income families, compared
with 56.1% of the abused children, 33.9% of the children of drug-user fathers
and only 2.9% of the non-maltreated children. To examine whether the differ-
ences between the groups were confounded by the SES, ANCOVA was per-
formed with SES serving as the covariance. The results of this analysis were
similar to the ANOVA.

Instruments

Attachment Style Classification Questionnaire.66 This instrument is an ad-

aptation of the Hebrew version questionnaire of the classification of attach-
ment styles in adults67 of Hazan and Shaver’s68 for children. The question-
naire contains 15 items, divided into three factors. Each factor describes one
of the three attachment styles, extrapolated from Bowlby’s theory: secure,
anxious/ambivalent and avoidant. Each child is classified according to the fac-
tor in which he/she had the highest score. The psychometric properties and
concurrent validity of the questionnaire were evaluated in 232 elementary
school children, half boys and half girls (mean 9.2, SD = 2.1 years). Results
Ricky Finzi, Orna Cohen, Yafa Sapir, and Abraham Weizman 119

indicated a mean level of reliability (α = .69–.81). Confirmatory factor analy-

sis revealed that loading items of the avoidant style was higher than .50 in
all case. Loading of two items (5, 6) of the anxious/ambivalent style was above
40 and the others above .50. Loading of two items (10, 15) of the secure style
was low, and of the others, higher than .50. The test-retest stability after
two weeks was in the high range (r = .87–.95). The concurrent validity was
evaluated by means of Pearson’s correlation with the children’s scores in the
Trait Anxiety Inventory,69 Child Depression Inventory,70 and Child Suicidal
Potential Scales for Aggression.71,72 Low depression, anxiety, and aggression
levels characterized children of the secure style, high depression and anxiety
levels characterized children of the avoidant or anxious/ambivalent style and
high aggression level characterized children of the avoidant style. Distribu-
tion of the styles among the latency age children was similar to that found in
previous studies of adults,68 infants and toddlers.73

Procedure

A written informed consent was obtained from all parents. The objectives
of the study were explained to the children, who were asked to volunteer. All
the children agreed to answer the questionnaires.

Results

One-way ANOVA yielded significant differences among the four

groups in the attachment styles [F(9,426) = 27.11); p < .001]. Table 1
shows the means and standard deviations among the groups and the
results of Univariate ANOVA for each attachment style. Paired
Scheffe comparisons by attachment styles revealed that group 2 had
a significantly lower score than the other three groups in the secure
factor, but the highest score in the avoidant factor, which was followed
by groups 1, 3 and 4, respectively. The anxious/ambivalent factor
scores in group 3 were significantly higher than in the other three
groups (Table 1).
Each child was classified into one of the three styles, according to
his or her highest score in the attachment factors. Figure 1 presents
the frequency distribution of each of the three attachment styles (se-
cure, avoidant, anxious/ambivalent) among the four groups. Chi-
square analysis demonstrated significant differences between the
groups (α2 = 116.84; df = 6; p < .001). The highest frequency of the
avoidant style was among physically abused children (85.4%), the anx-
ious/ambivalent style among neglected children (73.7%) and the se-
cure attachment style among non-maltreated children (68.6%). The
frequency of the secure attachment style was highest among children
120 Child Psychiatry and Human Development

Table 1
Means and Standard Deviations of Attachment Factors

Anxious/
Secure Avoidant Ambivalent

Mean SD Mean SD Mean SD

Drug-user father (1) 3.45 .45 2.41 .56 3.94 .51

(n = 76)
Physically abused (2) 2.74 .55 3.89 .66 2.74 .72
(n = 41)
Neglected (3) 3.52 .58 3.06 .62 3.04 .86
(n = 38)
Non-maltreated (4) 3.77 .55 2.59 .52 2.79 .83
(n = 35)
F(3,177) 26.84** 46.67** 20.96**
Scheffe 4 > 1,2,3* 2 > 1 > 2,4* 3 > 1,2,4*

*p < .05*; **p < .001.

Figure 1. Frequencies of attachment styles among the four groups

Ricky Finzi, Orna Cohen, Yafa Sapir, and Abraham Weizman 121

of drug-user fathers (52.2%), followed by the anxious/ambivalent

(25.4%) and the avoidant style (22.4%). MANOVA was performed to
determine whether differences were related to gender or age. No sig-
nificant interactions were found for Group × Gender or Group × Age.

Discussion

A comparative study on the attachment styles in children of drug-

user fathers, physically abused children and neglected children was
conducted to improve our understanding of the specific impact of dif-
ferent types of maltreatment on their emotional world. Non-mal-
treated children served as a control group. Physically abused children
were characterized mostly by the avoidant attachment style and ne-
glected children by the anxious/ambivalent attachment style. Fifty-
two percent of the children with a drug-user father were characterized
by the secure attachment style and 48% by the anxious/ambivalent or
avoidant attachment style. Most of the non-maltreated children
(68.6%) were characterized by the secure attachment style. This divi-
sion can be explained by the emotional experience of these children in
their families. When the parent is a drug-user, the child’s needs and
well being become secondary to the parent’s needs, around whom the
entire family life revolves.15,21 The parental model implies impulsive-
ness and inability to delay gratification or cope with frustration.25,74,75
Rapidly cycling moods of drug addicts are difficult to apprehend and
cause constant anxiety to the child, who must anticipate when the
parent is likely to become violent or self-destructive. These feelings
are intensified when the child is unable to comprehend cognitively the
source triggering the mood, and may attribute it to his or her own
inadequacies. Furthermore, witnessing a parent losing control over a
bodily function or consciousness is frightening and shameful for the
child.25 Often, the main defense mechanism of the family is total de-
nial of the addiction, its extent, or its impact on the family, especially
on children.21,25 Learning from an early age to keep the family secret,
because drug use is illegal, may cause feelings of isolation and fear of
peer rejection25 and inaccessibility to treatment. The chaotic environ-
ment, often combined with unrealistic expectations and perceptions of
the parents to the child’s needs and behaviors,21 may push the child
to take a parental role, sometimes taking care of himself or herself or
siblings, or parenting the parent.76,77 Children learn to repress their
122 Child Psychiatry and Human Development

own wishes, feelings (especially anger) and needs, becoming expert

readers of the emotional state of their addicted parent.25
Our findings are partly in agreement with those of Ronding et al.78
who examined the attachment patterns of 18-month prenatally drug-
exposed children. They classified 39% as secure, 50% as avoidant, and
11% as anxious/ambivalent. However, secure group was described as
being frail, maintaining less robust secure organization than normally
expected. We suggest that the 52.2% of the secure children may belong
to a subgroup defined by Cook77 as “super kids,” or children with os-
tensibly excellent functioning that stems from blurred family bound-
aries.76
Relationship between the non-addicted mother and the child should
also be considered in the evaluation. In these cases, the mother, al-
though she may be in a state of psychological distress, can serve as a
buffer against the effect of the addicted father on the psychosocial
development of the child. Rothebaum et al.79 reported that unlike
mother-child relationships, father-child relationships do not predict
later behavioral problems. Likewise, Kandel26 (1990) found support
only for the link between maternal drug use and child behavior prob-
lems, explained by the poor parenting that characterized mostly the
mothers, whereas fathers practiced less punitive discipline and
showed greater involvement in activities with the children. Brook et
al.80 found that the personality of a drug-user mother, and child-rear-
ing practices were more important than drug use or the personality of
the father. These factors were reflected in regressed behavior and anx-
iety of the children. It is noteworthy that in our study, drug-user fa-
thers identified and recognized their addiction and its effect on the
family, and already participated in a rehabilitation program.
Physically abused children are both loved and hated by their par-
ents, and bear the physical signs of this ambivalence.3,81 Their bonding
love and proximity experiences are mixed with violence and threat,
and their attachment figure is both the natural provider of protection
and a source of danger.82,83 Confused by their contradictory feelings of
love and hate,84 abused children may either beware of proximity3 or
exclude the representation of the “bad” unloving parent from their
awareness.44 In the latter case, parents’ violence evokes rage, but the
children cut off, repress or falsify it53 to minimize his/her hurt.38 The
avoidance could be viewed as a way to suppress the recognition and
expression of their emotional vulnerability.53,85 It prevents them from
processing information that may trigger attachment behavior7 or min-
imizes the activation of such behavior, which may have dangerous
Ricky Finzi, Orna Cohen, Yafa Sapir, and Abraham Weizman 123

consequences.86 George61 interpreted the avoidant movements of phys-

ically abused infants as a way to maintain control over their own pro-
spective reactions to the parents. Their anger may later turn into anti-
social behavior.53 Pianta et al.87 suggested that abused children learn
not only the role of the victim, but also the role of victimizer.
The emotional experience of neglected children is mostly of inconsis-
tency, rejection and being ignored. It causes them existential anxiety
and longing for proximity and security,85,88,89 thus increasing their ex-
aggerated dependence and lack of autonomy, creating later problems
of passive withdrawal.50 Other studies support the link we found be-
tween neglect, inconsistent and low maternal responsiveness and the
anxious/ambivalent pattern of attachment.50 These children are un-
skilled in meeting the developmental tasks involved in the formation
of peer relationships and might find themselves again unsatisfied and
victims of rejection because of the lack of a consistent, continuous, and
long-lasting pattern of reciprocity.35,50,54
In non-abused/non-neglected children, 68.6% demonstrated a secure
attachment style, a distribution similar to that described in previous
studies in infants6,73 and in adults.68
Despite our circumspection, differences in SES found among the
three study groups, the groups of abused, neglected and children of
drug-user fathers included only those known to the social services. It
is unclear whether the socio-economic factor distorted our findings.
However, Aber et al.90 showed that the impaired social-emotional de-
velopment manifested by abused or neglected children far exceeds the
impact of poverty and reliance on welfare services per se. Despite the
attempt to distinguish between the sequelae of maltreatment, some
overlaps might have occurred, because it is known that the social ser-
vices reports are not always accurate.
In assessing the impact of maltreatment on the emotional and social
functioning of children, were limited to attachment styles, a variable
considered crucial, and not to the sole aspect of personality traits. Fur-
ther research is needed to improve our understanding of other person-
ality traits, such as affect regulation, defense mechanisms, and resil-
iency, or specific symptomatology.

Summary

The study compares the emotional impact of maltreatment on the

attachment styles in three groups of children aged 6–12 years: chil-
124 Child Psychiatry and Human Development

dren of drug-user fathers (n = 76), physically abused children (n = 41),

neglected children (n = 38); non-abused/non-neglected children (n =
35)—control group. Whereas the secure style characterized 52% of
drug-user fathers’ children, the insecure style characterized the other
48% of the children (anxious/ambivalent or avoidant); physically
abused children were characterized mainly by the avoidant attach-
ment style, and neglected children by the anxious/ambivalent style.
The findings indicate that dysfunctional strategies adopted by chil-
dren in their family are also manifested in other social relationships.
Physically abused children, characterized by the avoidant attachment
style, are at risk of antisocial behavior and sustained suspicion toward
others. Neglected children, characterized by the anxious/ambivalent
attachment style, are at risk of withdrawn passivity, social rejection
and feelings of personal incompetence. Although half the children of
drug-user fathers were characterized by the secure attachment style,
longitudinal studies are needed to estimate their functioning in ado-
lescence, because this subgroup is at high risk of drug addiction and
behavioral problems.
This study suggests that in cases of exposure to parental drug mal-
treatment the crucial risk factors for psychopathology in children are
mainly the associated abuse and neglect. A better prognosis could be
expected when the mother’s parental capacity has been proved to be
adequate and the father was the drug-user.

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