The Relation between Attachment and Psychological Problems in Ghanaian Youth
Marijn Scheltens (11018550)
Bachelor thesis Talent program
University of Amsterdam
Teacher: Anouk Spruit
Date: 14-01-2019
Abstract
Current study focused on the relation between attachment and psychological problems in Ghanaian children (aged 10-22 years old). Also, it investigated the differences in attachment and psychological problems in Ghanaian children from an orphanage and the community. The questionnaire IPPA was used to measure attachment and the SDQ to measure psychological problems. Outcomes revealed a high correlation between attachment and psychological problems (r = -.534 ; p < 0,01), indicating that more secure attachment relationships were associated to less psychological problems in this sample. No significant differences in attachment and psychological problems between orphanage and community children were found. Implications for theory and practice are discussed.
Keywords: attachment theory, psychological problems, Ghana, African children, orphanage, community
The Relation between Attachment and Psychological Problems in Ghanaian Youth Introduction
Psychological problems have a high prevalence and negative impact on people’s lives (Kessler et al., 2012; Thomas, & Segal, 2006). This highlights the importance of
understanding the cause of these problems (Kessler et al., 2012). An important cause of psychological problems is insecure attachment (Madigan, Atkinson, Laurin, & Benoit, 2013). Attachment has been widely investigated in Western setting, but recent African literature on this topic is scarce. More specifically, there is no recent literature available about this subject in Ghana (Wan, Danquah, & Mahama, 2017). For this reason, current study focuses on children in Ghana and answers two research questions. The first question investigates the relation between attachment and psychological problems in Ghanaian children. The second one elaborates on the difference in attachment and psychological problems between Ghanaian children from an orphanage and children from the community.
An estimated 241 million children around the world struggle with psychological problems (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015). Furthermore, prevalence and persistence of severe psychological problems is high amongst adolescents (i.e. one in five adolescents are confronted with this) (Kessler et al., 2012; UNICEF, 2018-2019).
Psychological problems are subdivided into externalizing and internalizing problems. This division is pointed out by the direction wherein the symptoms are expressed. Externalizing disorders are expressed outwardly, for example in antisocial behaviour and aggression. Internalizing disorders are aimed inwardly and can express themselves in the form of worry and anxiety. The most common examples of internalizing disorders are depression and anxiety (Cardinale & Marsh, 2015). These disorders can be disabling and severe and are associated with negative economic, social and personal impacts (Thomas, & Segal, 2006).
Because of the high prevalence and big impact on people’s lives, it is interesting to acquire more knowledge about psychological problems and its possible relationship with other problems among adolescents. There are several factors that can cause psychological problems. Nevertheless, the focus in current study will be on attachment, since the literature indicates that insecure attachment relationships in early life are strongly associated with externalizing and internalizing problems (Madigan, Atkinson, Laurin, & Benoit, 2013). Attachment is defined as an affectional bond that a baby forms to his primary caregiver (e.g. mother figure) over a longer period of time. Adolescents who classified themselves as avoidantly or ambivalently attached (i.e. insecurely attached), displayed higher levels of internalizing- and externalizing symptoms than adolescents who classified themselves as securely attached (Muris, Meesters, & van den Berg, 2003). Moreover, a longitudinal study conducted by Buist, Dekovic, Meeus & van Aken (2004) reported reciprocal negative effects between insecure attachment and both internalizing and externalizing problem behaviour. Hence, insecure attachment seems to be an important predictor for psychological problems.
One of the pioneers in the field of attachment is John Bowlby (Bowlby, 1969; 1982). He introduced the attachment theory, which states that the sense of self is mostly dependant on the intimate attachment relationships in life, especially with the primary caregivers. Such relationships are determined by the unique patterning and quality of interaction that endure over time (Bowlby, 2012). Thus, attachment relationships between infants and caregivers refer to the quality of reciprocal dyadic affect. Infant-caregiver attachments are considered a prototype for later relationship experiences (Englund, & Sroufe, 1992). Furthermore, they exercise a formative influence on the young child’s developing personality (Sroufe, 1989). As mentioned earlier, insecure attachment relationships can result in negative developmental outcomes, such as psychological problems (Madigan, Atkinson, Laurin, & Benoit, 2013).
Additionally, Bowlby suggested in his ethological-evolutionary attachment theory that an attachment relationship between an infant and their protective caregiver is the outcome of evolution (Trivers, 1974). Likewise, there is an ethologically innate bias for a baby to become attached (Simpson & Belsky, 2008). Therefore, he reasoned, a core element of attachment theory is the universality in infants to become attached, regardless of their cultural niche (Mesman, van IJzendoorn, & Sagi-Schwarz, 2016). This theorized universality is an
interesting aspect of Bowlby’s view on attachment theory and will be further investigated in current study.
Developmental psychologist Mary Ainsworth started doing research on this topic as well. In Uganda she began to create the famous tripartite classificationsystem of infant-mother attachment relationships, whereby ‘secure’, ‘insecure ambivalent/resistant’ and ‘insecure avoidant’ attachment are distinguished. She described how it was not the caregivers warmth that seemed to differentiate between the attachment classifications, but rather the mother’s amount of caregiving and her excellence as an informant about the baby (i.e. observing the baby’s emotions)(Ainsworth, 1967). The Uganda study provided all the main ingredients for the following decades of attachment research. It gave theoretical background about attachment and the role of parental sensitivity. Moreover, it increased understanding of predicting differences in the quality of attachment (Mesman, van IJzendoorn, &
Sagi-Schwarz, 2016).
Despite the fact that much research has focused on attachment and psychological problems, this seems to be much limited to the Western culture. Except for Ainsworth’s Uganda study in the late 50s, recent studies focusing on similar themes in Africa are scarce. Furthermore, it has even been questioned whether the assumptions underlying attachment theory make sense in some non-western contexts (Heine, & Ruby, 2010). Very little is known about attachment patterns and its psychological outcomes in Africa and no published studies
of attachment in Ghana exist (Wan, Danquah, & Mahama, 2017). It is important to investigate attachment and its relation with psychological problems in the African continent for several reasons. First, to attain more understanding about the ethology of mental health problems in African children. Second, to have a better understanding of the mental condition of Ghanaian children. Finally, it is important to replicate Western research in other cultural contexts, for there is a lack of scientifically grounded replication research (Palus, 2018).
In addition, it is important to understand differences between children who grow up in the community with their families versus children who grow up in orphanages. Concern about the wellbeing of orphaned children is increasing (Stahili, 2017; Havens, 2017). Reason for this concern is the fact that orphan children are exposed to multiple stressors: they may have cared for their parents, witnessed their deaths and grieved about the loss (Olley et al., 2003). Furthermore, living in an orphanage is a risk factor for a child’s development. Research conducted by Johnson, Browne, & Hamilton-Giachritsis (2006) revealed that young children placed in institutional care (i.e. orphanages) are at risk of harm in terms of attachment disorders and developmental delays in behavioural, cognitive and social domains. These findings suggest that the lack of a one-to-one relationship with a primary caregiver is a major cause of harm to these children (Johnson, Browne, & Hamilton-Giachritsis, 2006).
Another reason for this concern is the growing notion that volunteer tourism at
orphanages is damaging for the children living there. Volunteer tourism allows participants to travel to different countries and engage with the local community, including orphanages (Havens, 2017). Unfortunately, the altruism showed by these volunteers can actually harm these children. Recent research shed light on some possible negative consequences of this tourism for the children living at those orphanages, such as attachment disorders, abuse, and family separation (Havens, 2017).
Despite these concerns, there are some positive considerations. Children living in the orphanage in current study generally have good housing and facilities, whereas children from families in the community tend to live in poorer conditions concerning housing, food and money. This could decrease risk factors for children living at the orphanage. On the other hand, a positive aspect for community children is that they mostly live together with their primary caregivers. This is a protective factor for these children in terms of attachment. Considering these points and the primary mentioned literature, it is interesting to investigate this diverse group of African children.
The Current Study
The current study aims to fill in two important gaps in the literature. The first main research question focuses on the relation between attachment and psychological problems in Ghanaian children. Considering the outcomes of research mentioned earlier and Bowbly’s notion that attachment theory is universal, a substantial relation between attachment and psychological problems is expected for Ghanaian children. The second research question focuses on the difference in attachment and psychological problems in children from an orphanage and children from the local community. Based on the literature concerning
negative implications of living in orphanages, it is expected that children from the orphanage are more insecurely attached than children from the community and therefore also have higher scores on psychological problems.
Method Participants
The participants (N = 53, including 27 males, 26 females) ages range from 10-22 years (Mage = 14.79, SD = 3.00). Approximately half (n = 26) of the participants live in the Save Our Live (SOLA) orphanage and the other half (n = 27) is from the community, both in Anwiankwanta, Ashanti Region of Ghana, West-Africa. The participants reported their living
situation: 26 of the participants stated to live with a nanny, 13 live with their mother, six with their father, four with a guardian and four live with both their father and mother. All of the participants are originally from Ghana and currently live there.
Procedure
The sample was recruited via the YETS (Youth Empowerment Through Sports) program, which is a program that aims to empower disadvantaged children by means of sports, education and social integration (Ottens et al., 2017). YETS is located at the basketball field at the ground of the SOLA orphanage. The Ghanaian coaches of the team helped in the recruitment (i.e. selecting and motivating the children to participate). They explained the purpose of the study and were available for answering objective questions about the study or the questionnaires. The selection criteria consisted of two aspects. First, the age of the children. Second, half of the sample needed to consist of children from SOLA and the other half from the community.
The surveys were taken in the months June and July 2018 in the participants place of residence, Anwiankwanta. The participants gave active informed consent about the usage of their information for this research, which included writing the date and their signature. Before the start of the research, informed consent was retrieved from the manager alias active
guardian of the orphanage to acquire information from the SOLA children. Furthermore, parents of the community children gave passive consent, which included that after filling in the questionnaire, community children received a letter to give to their parents with an explanation of the research and an option to withdraw from the investigation. The
questionnaires were taken in the class room in the school at the parcel of the orphanage, both SOLA and community children took the questionnaires at this place. This class room was quite remote from the orphanage, which meant the participants could not get disturbed by the other children while filling in the questionnaire. The participants mastered the English
language well enough to understand the English questions. Before the start of the
questionnaires, the participants were informed that the data will be handled anonymously and only for research purposes. The administration of the questionnaires took approximately 20 to 30 minutes per participant.
Instruments
Measuring attachment. First, the questionnaire ‘Inventory of Parent and Peer Attachment’ (IPPA) was utilized (Armsden & Greenberg, 1987). The IPPA is designed to assess the affective-cognitive dimension of attachment. It provides an indication of experienced security in the relationship with specific attachment figures (Buist, Deković, Meeus, & van Aken, 2004). Because current study focuses on attachment with caregivers, only the questionnaire for parental attachment was utilized. Several reviews concerning parent-child attachment instruments concluded that the IPPA is a valid and reliable measure (Lopez, & Gover, 1993; Lyddon, Bradford, & Nelson, 1993). In line with Bowbly’s
attachment theory, this questionnaire measures psychological security derived from
relationships with parents. The IPPA is a self-report questionnaire with a five point Likert-scale response format. For each Likert-scale, items are included to assess three aspects of
attachment, including trust, communication and alienation (Gullone, & Robinson, 2005). The IPPA counts a total of 25 items. One example of an item is: ‘My mother respects my
feeling’. There are five answer possibilities; ‘Almost Never or Never True’, ‘Not Very Often True’, ‘Sometimes True’, ‘Often True’ or ‘Almost Always or Always True’. In current study, reliability for the IPPA is satisfactory (Cronbach’s alfa = .708).
Measuring psychological problems. Second, the psychological adjustment of the children was measured with the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 2001). The SDQ includes five subscales (i.e. emotional symptoms, conduct problems, hyperactivity-inattention, peer problems and the prosocial behaviour) with each five items,
which results in a total of 25 items. The SDQ can be completed by parents, teachers and children themselves (Goodman, 2001). One example of an item is: ‘I am easily distracted, I find it difficult to concentrate’. There are three answer options: ‘Not True’, ‘Somewhat True’ or ‘Certainly True’. Higher scores on the prosocial behaviour subscale reflect more strengths on that particular domain, whereas high scores on the other four subscales reflect more
difficulties (Muris, Meesters, & van den Berg, 2003). In the analysing of the SDQ, the manual prescribes to delete the five prosocial items. This results in the fact that the outcome of the SDQ indicates only ‘difficulties’ (Youthinmind, 2016). The reliability for current sample, minus the prosocial subscale, is satisfactory (Cronbach’s alfa = .634).
Data Analyses Plan
In order to answer both research questions, the data were analysed in SPSS.
Information of all 53 participants was utilized in the analyses. There were some missing data, which indicated that participants did not answer some items in the questionnaires (e.g.
because they did not understand the question). This happened ten times at the IPPA (0,75% of all answers) and twelve times at the SDQ (1% of total answers). The mean score per question was filled in automatically by SPSS for these missing answers. Furthermore, some items in both questionnaires needed to be recoded. Specifically, five positively stated items from the SDQ were mirrored (i.e. 1 was changed into 3 for these items and 3 into 1)(Goodman, 2001). Besides, in line with the original IPPA manual, a total of ten negative items in the IPPA were recoded (Armsden & Greenberg, 1987). In order to answer the first research question
concerning the relation between attachment and psychological problems, the correlation was calculated over the complete data set. For the secondary research question concerning the difference between SOLA and community children, an independent sample t-test was executed to assess whether the two groups differ in attachment and psychological problems.
Results
Correlation between the IPPA and SDQ was high (r = -.534 ; p < 0,01), indicating that more secure attachment relationships were associated to less psychological problems in this sample.
Table 1
Group Statistics and T-test.
Live in N Mean Std. Deviation T Df Sig. IPPA SOLA 26 93.598 11.252 -.602 51 .550
Com. 27 95.408 10.628
SDQ SOLA 26 31.582 4.580 .455 51 .651
Com. 27 30.940 5.630
Results concerning the mean and standard deviation of both groups for the IPPA and SDQ are reported (See Table 1). In order to compare these means, the independent sample t-test was conducted. Results indicate that the scores for the IPPA and the SDQ did not differ between children from SOLA and children from the community (See Table 1).
Discussion
This research investigated two questions in a sample of Ghanaian children. The first question focused on the relation between attachment and psychological problems. This relation was affirmed multiple times in Western research. Current study confirms the relation between attachment and psychological problems for the Ghanaian context, with a high correlation (r = -.534 ; p < 0,01), yielding support to the claim that this is a relation that is valid across cultures. Second research question concerned the difference between attachment and psychological problems between the children from the SOLA orphanage and from the community. The results show that the difference in means for IPPA and SDQ yielded no significant results, indicating that more secure attachment relationships were associated to less
psychological problems. In order to furtherly interpret the results, some literature will be discussed, starting with the first research question.
Several studies showed that children who have loving, intimate attachment relationships with their parents or primary caregivers are less likely to develop problem behaviour and consequently that low quality of attachment is associated with higher levels of problem behaviour (LeCroy, 1988; Barnes & Farrell, 1992; Dekovic, 1999). This relationship was established in Western research multiple times, but not recently in African context. Moreover, as mentioned earlier, there are no recent published studies in Ghana about this topic (Wan, Danquah, & Mahama, 2017). Research is mainly limited to the US and Europe, which makes studies in the African continent relevant. Current study provides strong support for the earlier mentioned literature and Bowlby’s theory that attachment is universal for different cultures, not only Western. Furthermore, this research provides evidence against the notion that attachment theory is not applicable to non-Western contexts (Heine, & Ruby, 2010). This provides interesting indications into further research concerning psychological treatments and practices in non-western, especially African, contexts.
Second research question focused on the difference between attachment and
psychological problems between the children from the orphanage and from the community. Outcomes reveal that there is no significant difference between these two groups. This is not in line with the expectation that predicted the SOLA group to be more insecurely attached than the community and therefore to have more psychological problems. Possible explanation for this result could be that 47 of the 53 participants joined the YETS program, which focuses on empowering disadvantaged children to have a more positive position in the society. This empowerment is achieved by sports, education and social integration. In this program, the basketball coaches of the team serve as a role model and a ‘shoulder to cry on’ (Ottens et al., 2017). Especially the children from the orphanage are expected to benefit from this individual
support, in terms of better attachment (e.g. to a coach as caregiver) and therefore less psychological problems. From this perspective, it is an encouraging result that attachment outcomes do not differ, which could indicate that YETS had improved this.
Another alternative explanation for this result is the fact that some children from the orphanage are not really orphans. As it is unclear how many children from SOLA are really orphans, it cannot be assessed to which extent this has distorted the outcomes of current research. Nevertheless, it is quite a common phenomenon in orphanages. It appears that 80% or children that live in African orphanages have at least one parent (Wijngaarden, 2018). Often these children have been placed here because of parental poverty. Parents consider an orphanage a good option for their child, for they will get food and education there
(Wijngaarden, 2018). For example, in Rwanda, a third of the ‘orphaned children’ are in regular contact with their relatives, thus many could be cared for by their extended families (the Economist, 2017). Nevertheless, the quality range of African orphanages is broad. The orphanage in current study had quite a high standard compared to the living environment of others in the community, according to the observations of the researcher. For example, the orphanage provided a reasonably healthy meal three times a day, supplied clothes for the children and paid for the children’s education. However, this is an exception to the rule. A majority of orphanages have a strongly negative, if not damaging effect on the children they harbour (the Economist, 2017). However, the fact that the SOLA children may still be in contact with their families could explain the absence of difference in terms of attachment between the two groups in this sample. Substantial differences in the lives of SOLA and community children became apparent by the researcher. The community children had poorer housing conditions and sometimes had to skip school in order to work, thus providing enough money for their family. However, as mentioned before, these children generally lived together with family members. To specify, half of them lived together with their mother, six with their
father, four with both mother and father and four with a guardian, who was probably also a family member. The factors mentioned above reduce differences between SOLA and community children.
The current study had some limitations. First, the questionnaires that were used to assess attachment and psychological problems in Ghanaian children were not validated for this group. These questionnaires were mostly developed and validated in Western setting. Even though the internal consistency for this sample was satisfactory for both questionnaires, the scores should be interpreted with caution. Second, during the taking of the questionnaires it occurred that children explained the meaning of some items to each other in Twi, their local language. The researcher did not speak this language, so she does not know to what extent these explanations were accurate. Furthermore, some of the children distracted each other, or did not know the meaning of the items and tried to peak at their neighbour’s questionnaire. This could have resulted in a decline in reliability of the given answers.
Another limitation of current research could be that almost the entire research group, including the community children, was recruited via the YETS program, so not randomly. This could have influenced the second research question, for this poses a methodological obstacle in finding a reliable difference between the two groups in this study. Because the YETS program aims to improve the societal position of the children, outcomes may not be generalizable to the population of Ghana. Future research could replicate current study in another part of Africa and in a more varied sample, to investigate whether the outcomes remain the same. Replication of the second research question in another orphanage with ‘real’ orphans, without such an empowerment program and in a less privileged orphanage could be interesting (the Economist, 2017).
Nevertheless, despite these limitations, this research filled in important gaps in the literature. Current study is a replication research, for it investigates a relation that has been
topic of research many times in Western countries, but not in the African continent. Recently, Scientific American (Palus, 2018) shed light on the lack of thorough replication research and appealed to scientists to increase their focus on this domain of research. Outcomes of current research are therefore valuable for the scientific database, for it adds to the replication research concerning the themes that are investigated, but focuses on a country that has not been topic of scientific research often. Future research could focus on psychological treatments and practices in non-western, especially African, contexts.
Altogether, this study offers important practical implications. First, current research revealed that attachment can play an important role in psychological problems in Ghanaian children. Consequently, the attachment of a child must be taken into account during
diagnostics in Ghanaian setting. Second, in the development of mental health programs in Ghana, the parent-child attachment relationship should get attention.
Concluding, current study is a valuable contribution to the field of attachment research and its relation with psychological difficulties in Ghanaian context. It concluded that
attachment and psychological problems are associated, also in this non-western context. The available literature about similar topics is about Western contexts and the available studies in Africa did not focus on Ghana yet. In addition, this study provided interesting insight in the minimal difference between children who live in a Ghanaian orphanage in comparison to children that live with their primary caregivers in the community. Follow-up research in a setting where ‘real’ orphans without an empowerment program are compared with community children might be valuable. This could answer the question whether outcomes of this study are caused by the bias in the sample: almost all children participated in the YETS program and the amount of ‘real’ orphans is unclear. However, a connection between attachment and mental health is strongly supported in Ghanaian context. This makes current study a valuable
addition to the scientific database and also provides support for empowerment programs that improve attachment.
References
Ainsworth, M. D. S. (1967). Infancy in Uganda: Infant care and the growth of love.
Baltimore: Johns Hopkins University Press.
Armsden, G. C., & Greenberg, M. T. (1987). The Inventory of Parent and Peer Attachment
(IPPA): Relationships to well-being in adolescence. Journal of Youth and
Adolescence, 16, 427-454. doi:10.1007/BF02202939
Barnes, G. M., & Farrell, M. P. (1992). Parental support and control as predictors of
adolescent drinking, delinquency, and related problem behaviors. Journal of Marriage and the Family, 54, 763–776
Blair, M., Stewart-Brown, S., Waterston, T., & Crowther, R. (2003). Child public health. Oxford: Oxford University Press. doi: doi.org/10.1093/eurpub/cki185
Bowlby, J. (1969/1982). Attachment and Loss, Volume 1, Attachment, Basic Books, New York.
Bowlby, J. (2012). The making and breaking of affectional bonds. Routledge.
Buist, K. L., Deković, M., Meeus, W., & van Aken, M. A. (2004). The reciprocal relationship between early adolescent attachment and internalizing and externalizing problem behaviour. Journal of adolescence, 27(3), 251-266.
doi:10.1016/j.adolescence.2003.11.012
Cardinale, E. M., & Marsh, A. A. (2015). Impact of Psychopathy.
Dekovic, M. (1999). Risk and protective factors in the development of problem behaviour during adolescence. Journal of Youth and Adolescence, 28, 667–685.
The Economist. (August, 2017). Closing African orphanages may be less heartless than it seems. Retrieved from https://www.economist.com/middle-east-and
Englund, M., & Sroufe, L. A. (1992). Predicting peer competence and peer relationships in childhood from early parent-child relationships. Family-peer relationships: Modes of linkage, 77. Hillsdale, NJ: Erlbaum.
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40(11), 1337 1345. doi:10.1097/00004583-200111000-00015
Gullone, E., & Robinson, K. (2005). The inventory of parent and peer attachment—Revised (IPPA‐R) for children: a psychometric investigation. Clinical Psychology &
Psychotherapy: An International Journal of Theory & Practice, 12(1), 67-79. doi: 10.1002/cpp.433
Havens, H. (2017). The Harms of Orphanage Voluntourism: Misperceptions among Volunteers (Doctoral dissertation, Columbia University).
Heine, S. J., & Ruby, M. B. (2010). Cultural psychology. Wiley Interdisciplinary Reviews: Cognitive Science, 1(2), 254-266.
Johnson, R., Browne, K., & Hamilton-Giachritsis, C. (2006). Young children in institutional care at risk of harm. Trauma, Violence, & Abuse, 7(1), 34-60. doi:
10.1177%2F1524838005283696
Kessler, R.C., Avenevoli, S., Costello, E.J., Georgiades, K., Green, J.G., Gruber, M.J.,
Merikangas, K.R. (2012). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Su plement. Archives of General Psychiatry 69, 372–380. doi:10.1001/ archgenpsychi try.2011.160
Lahey, B. B., Rathouz, P. J., Van Hulle, C., Urbano, R. C., Krueger, R. F., Applegate, B., & Waldman, I. D. (2008). Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology. Journal of abnormal child psycho
ogy, 36(2), 187-206. doi:10.1007/s10802-007-9169-5
LeCroy, C. W. (1988). Parent–adolescent intimacy: Impact on adolescent functioning. Adolescence, 23(89), 137–147
Lopez, F. G., & Gover, M. R. (1993). Self-report measures of parent–adolescent attachment and separation individuation: A selective review. Journal of Counseling and
Development, 71, 560–569.
Lyddon, W. J., Bradford, E., & Nelson, J. P. (1993). Assessing adolescent and adult attachment: A review of current self-report measures. Journal of Counseling and Development, 64(2), 237–243.
Madigan, S., Atkinson, L., Laurin, K., & Benoit, D. (2013). Attachment and internalizing behavior in early childhood: A meta-analysis. Developmental psychology, 49(4), 672.
doi:10.1037/a0028793
Meltzer, H., Gatward, R., Goodman, R., & Ford, T.(2000). Mental health of children and adolescents in Great Britain. London: Office for National Statistics.
doi:10.1080/0954026021000046155
Mesman, J., van IJzendoorn, M. H., & Sagi-Schwarz, A. (2016). Cross-cultural patterns of attachment. Handbook of Attachment: Theory, Research, and Clinical Applications, third ed. Guilford, New York, NY, 852-877.
Muris, P., Meesters, C., & van den Berg, S. (2003). Internalizing and externalizing problems as correlates of self-reported attachment style and perceived parental rearing in normal adolescents. Journal of Child and family Studies, 12(2), 171-183.
Olley B, Gxamza F, Seedat S, Theron H, Taljaard J, Reid E, Reuter H and Stein DJ (2003) Psychopathology and coping in recently-diagnosed HIV/AIDS patients — the role of gender. South African Medical Journal (SAMJ) 93: 928–931
YETS Methodiek 2017. Stichting YETS Foundation, Schiedam.
Palus, S. (October, 2018). Make Research Reproducible. State of the World’s Science. Scientific American. doi:10.1038/scientificamerican1018-56
Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual Research Review: A meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345 365. doi:10.1111/jcpp.12381
Thomas, J. C., & Segal, D. L. (Eds.). (2006). Comprehensive Handbook of Personality and Psychopathology, Personality and Everyday Functioning (Vol. 1). John Wiley & Sons.
UNICEF. (2018-2019). Measurement of Mental Health among Adolescents (MMHA) Roadmap 2018-2019. Retrieved from https://data.unicef.org/wp
content/uploads/2018/05/MMHA-Roadmap.pdf
Simpson, J. A., & Belsky, J. (2008). Attachment theory within a modern evolutionary framework. Handbook of attachment: Theory, research, and clinical applications, 2, 131-157.
Sroufe, L. A. (1989). Relationships. Self, and individual adaptation. In A.J. Sameroff & R. M. Emde (Eds.) Relationship disturbances in early childhood: A developmental approach (pp. 70- 96). New York: Basic.
Stahili. "The Harm of Growing up in Institutional Care." Stahili Foundation. May 03, 2017. Retrieved on December 11, 2018. http://www.stahili.org/harm-growing-institutional care/.
Vogels, A. G. C., Siebelink, B. M., Theunissen, M. H. C., Wolff, M. D., & Reijneveld, S. A. (2011). Vergelijking van de KIVPA en de SDQ als signaleringsinstrument voor problemen bij adolescenten in de Jeugdgezondheidszorg. Leiden: TNO.
Wan, M. W., Danquah, A. N., & Mahama, S. (2017). Child‐caregiver Attachment
Representations in a Non‐Western Context: The Feasibility and Cultural Equivalence of Story Stems in Urban Ghana. Social Development, 26(1), 59-79.
doi:10.1111/sode.12196
Wijngaarden, M. (November, 2018). Buitenlandse stages in een weeshuis zijn schadelijk voor kinderen. EenVandaag, Actueel.
Youthinmind. (2016). Scoring the SDQ. Retrieved from:
