Attachment Disorder


These reference pages are divided into the subjects below. Visit the INDEX to see other subject areas. You are welcome to use the INPUT facility to add references, material or other comment.


Attachment is as basic a life requirement as the more traditionally cited food, shelter, and clothing.  Attachment involves a state of mutual dependence felt by individuals, experienced but not necessarily manifested behaviorally. Attachment provides a sense of rootedness. Genuine attachment experiences are vital for sound development; in fact, for mental health and life everywhere. Attachment behaviours , as contrasted to feelings of attachment, are really frantic efforts to obtain close attachment.

From Maier, H. W. Development Group Care of Children and Youth. New York: Haworth Press. p22


More and more children are failing to develop secure attachments to loving, protective caregivers. These children are left without the most important foundation for healthy development. They are flooding our child welfare system with an overwhelming array of problems – emotional, behavioral, social, cognitive, developmental, physical and moral – and growing up to perpetuate the cycle with their own children. Research has shown that up to 80% of high risk families (abuse and neglect, poverty, substance abuse, domestic violence, history of maltreatment in parents’ childhood, depression and other psychological disorders in parents) create severe attachment disorders in their children. Since there are one million substantiated cases of serious abuse and neglect in the U.S. each year, the statistics indicate that there are 800,000 children with severe attachment disorder coming to the attention of the child welfare system each year. This does not include thousands of children with attachment disorder adopted from other countries.
Disrupted and anxious attachment not only leads to emotional and social problems, but also results in biochemical consequences in the developing brain. Infants raised without loving touch and security have abnormally high levels of stress hormones, which can impair the growth and development of their brains and bodies. The neurobiological consequences of emotional neglect can leave children behaviorally disordered, depressed, apathetic, slow to learn, and prone to chronic illness. Compared to securely attached children, attachment disordered children are significantly more likely to be aggressive, disruptive and antisocial. Teenage boys, for example, who have experienced attachment difficulties early in life, are three times more likely to commit violent crimes. Disruption of attachment during the crucial first three years can lead to what has been called "affectionless psychopathy", the inability to form meaningful emotional relationships, coupled with chronic anger, poor impulse control, and a lack of remorse.

Attachment disorder is transmitted intergenerationally. Children lacking secure attachments with caregivers commonly grow up to be parents who are incapable of establishing this crucial foundation with their own children. Instead of following the instinct to protect, nurture and love their children, they abuse, neglect and abandon. The situation is out of control. Consider the following:

The number of children seriously injured by maltreatment quadrupled from 1986 (140,000) to 1993 (600,000).
Three million cases of maltreatment were investigated by Child Protective Services in 1995. Over one million were confirmed as serious abuse and/or neglect with risk for continued maltreatment. Surveys indicated the actual number of cases are 10 to 16 times higher.
Child Protective Services are unable to handle the vast increases; only 28% of seriously maltreated children were evaluated in 1993 compared to 45% in 1986.
Children who begin their lives with compromised and disrupted attachment are at risk for serious problems as development unfolds:

Low self-esteem.
Needy, clingy or pseudoindependent.
Decompensate when faced with stress and adversity.
Lack of self-control.
Unable to develop and maintain friendships.
Alienated from and oppositional with parents, caregivers, and other authority figures.
Antisocial attitudes and behaviors.
Aggression and violence.
Difficulty with genuine trust, intimacy and affection.
Negative, hopeless and pessimistic view of self, family and society.
Lack empathy, compassion and remorse.
Behavioral and academic problems at school.
Perpetuate the cycle of maltreatment and attachment disorder in their own children when they reach adulthood.

Traits and symptoms
Attachment disorder affects all aspect of a child’s functioning. A child may display some combination of the following primary symptoms:
Behavior: oppositional and defiant, impulsive, destructive, lie and steal, aggressive and abusive, hyperactive, self-destructive, cruel to animals, irresponsible, fire setting.
Emotions: intense anger and temper, sad, depressed and hopeless, moody, fearful and anxious (although often hidden), irritable, inappropriate emotional reactions.
Thoughts: negative beliefs about self, relationships, and life in general ("negative working model"), lack of cause-and-effect thinking, attention and learning problems.
Relationships: lacks trust, controlling ("bossy"), manipulative, does not give or receive genuine affection and love, indiscriminately affectionate with strangers, unstable peer relationships, blames others for own mistakes or problems, victimizes others/victimized.
Physical: poor hygiene, tactilely defensive, enuresis and encopresis, accident prone, high pain tolerance, genetic predispositions (e.g., depression, hyperactivity).
Moral/Spiritual: lack of faith, compassion, remorse, meaning and other prosocial values, identification with evil and the dark side of life.

From: Attachment Treatment and Training Institute, PLLC


Reactive Attachment Disorder DSM-IV
A markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age five, as evidenced by either:

Inhibited Type: persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g. responds to caregivers with approach, avoidance, and resistance to comforting, or frozen watchfulness); or

Disinhibted Type: diffuse attachment as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g. excessive familiarity with relative strangers or lack of selectability of attachment figures).
Experts in the field of attachment make reference to particular characteristics, or symptoms found in children with RAD.

From:  2002 Pediatric Behavioral Health Resources

The following readings and other relevant material are accessible on this site:

What does it take to care ?

Attachment and Youth at risk

Establishing meaningful contacts with children and youth

No-touch Policy

“All he wants ... ”

Difficult behaviours

Attachment and attachment behaviors.

Native Wisdom on Belonging

Mary Ainsworth: Our guide to attachment research  


Attachment Disorders

Ainsworth, Frank. (1997). Place as a source of attachment and identity across the life course. Journal of Child and Youth Care Work. 12-13. pp. 58-67.
The concept of place attachment and the bonding of people to places relates to the way individual and communal aspects of identity are shaped by the sociophysical environment. This paper refers to child and adult populations; indigenous peoples, migrants, and refugees; former residents of institutional programs and the homeless. It is argued that for all these populations security and identity are influenced by place attachment, which is a form of attachment that warrants our close attention.

Ainsworth, M., S. Bell, et al.
(1971). Individual differences in strange-situation behavior of one-year-olds. The origins of human social relations. H. Schaffer. New York, Academic Press: 17-57.

Ainsworth, M. (1973). The development of infant-mother attachment. Review of child development research. B. Caldwell and H. Ricciuti. Chicago, University Press. 3: 1-99.

Ainsworth, M., M. C. Blehar, et al. (1978). Patterns of attachment: A psychological study of strange situation. Hillsdale, NJ, Erlbaum.

Ainsworth, M. (1989). “Attachments beyond infancy.” American Psychologist 44: 709-716.

Association, A. P. (1987). Diagnostic and statistical manual of mental disorders. Washington, D.C., Author.

Association, A. P. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, D.C., American Psychiatric Association. Research and Therapy. Encino, CA, Phillips Graduate Institute. 5: 83-98

Beek, Mary . (1999).
Parenting children with attachment difficulties: Views of adoptive parents and implications for post-adoption services Adoption and fostering, 23/1. pp.16-23.
A growing number of children placed for adoption are found to have attachment difficulties. Such difficulties can be profound, leading to disruptive behaviour which adoptive parents often find hard to cope with and understand. As Mary Beek contends in this paper, one of the challenges for adoption agencies is to offer such families appropriate support. In examining a project carried out by the Norfolk-based Adoption and Family Finding Unit's post-adoption service, she demonstrates how specialised help involving parents and post-adoption social workers can dramatically improve the quality of care for adopted children – and indeed the quality of life for all the family. She also underlines the value of attachment theory as a tool for helping adoptive parents understand their children's behaviour.

Belsky, J. and R. Isabella
(1988). Maternal, infant, and social-contextual determinants of attachment security. Clinical applications of attachment. J. Belsky and T. Nezworski. Hillsdale, NJ, Lawrence Erlbaum Associates, Inc.: 41-94.

Belsky, J. (1999). Modern evolutionary theory and patterns of attachment. Handbook of attachment: Theory, research and clinical applications. J. Cassidy and P. Shaver. New York, The Guilford Press: 141-161.

Belsky, J. (1999). Interactional and contextual determinants of attachment security. Handbook of attachment: Theory, research, and clinical applications. J. Cassidy and P. Shaver. New York, The Guilford Press: 249-264.

Berlin, Irving N. Attachment Theory: Its Use in Milieu Therapy and in Psychotherapy with Children in Residential Treatment. Residential Treatment for Children & Youth, Vol. 15(2), 29-37.
I intend to present first a brief history of attachment theory, then a concise review of transference and countertransference as it applies to child care workers. Out of my experiences as the Medical Director of Namaste Family & Child Development Treatment Program, I would like to discuss the effectiveness of using attachment theory in milieu treatment and psychotherapy with severely neglected, physically and sexually abused young children.

Boris, N. and C. Zeanah (1999). “Disturbances and disorders of attachment in infancy: An overview.” Infant Mental Health Journal 20(1): 1-9.

Bowlby, J. (1969). Attachment and loss: Vol 1: Attachment. New York, Basic Books.

Bowlby, J. (1973). Attachment and loss: Vol. 2: Separation. New York, Basic Books.

Bowlby, J. (1979). The making and breaking of affectionate bonds. London, Tavistock Publications.

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, Basic Books.

Campbell, S. (1990). Behavior problems in preschool children: Clinical and developmental issues. New York, The Guilford Press.

Cicchetti, D. and D. Barnett (1991). “Attachment organization in maltreated preschoolers.” Development and Psychopathology 7: 283-294.

DeAngelis, T. (1997). When children don't bond with parents, APA.

Fonagy, P. (2000). Attachment in infancy and the problem of conduct disorders in adolescence: The role of reflective function. International Association of Adolescent Psychiatry, San Francisco, CA.

Gordon, Christine. (Winter 1999). A parenting programme for parents of children with disturbed attachment patterns . Adoption and Fostering, 23/4. pp. 49-56 .
It is widely accepted that early experiences colour the way in which children view the world and in particular their relationships with other people. In this article, the author describes a programme of intervention with children who have attachment difficulties as a result of living in trauma during infancy. The article looks at developing a theoretical framework for understanding the ways in which early trauma affects a child at psychological, emotional and physiological levels. It describes an approach to parenting which is more effective than the traditional methods which tend to work better with children who have had healthy and relatively trauma-free early childhoods. The author briefly examines how this approach can be used with other forms of intervention which work more directly with children in helping them to untangle early experiences and make sense of their history.

Hanson, R. F. and E. G. Spratt (2000). “Reactive attachment disorder: What we know about the disorder and implications for treatment.” Child Maltreatment 5(2): 137-145.

Howe, David. ( Winter 1995). Adoption and attachment. Adoption and fostering, 19/4. pp.7-15.
Children's early attachment experiences can have a dramatic effect on their day-to-day behaviour, as well as on their social development in later life. Drawing from extensive interviews with adoptive parents, all of whose children were in late adolescence or young adulthood at the time of the research, the author asserts the value of understanding the influence of past care on present placements.

Karen, R. (1994). Becoming attached. New York, Warner Books.

Lanyado, Monica. (Spring 2001). Daring to try again: The hope and pain of forming new attachments. Therapeutic communities, 22/1. pp.5-18.
The difficulties and fears about forming new attachment relationships for children suffering from multiple traumatic losses are explored in this paper. Clinical illustrations are given fmm the psychotherapy of children who moved from long-term fostering to adoption, and parallels drawn with processes taking place within therapeutic communities. There is also discussion of the way in which these children 's fears that the newly acquired roots of a secure emotional base will be damaged or uprooted altogether, can be expressed within the organisational dynamics of the therapeutic community.

Magid, K. and C. A. McKelvey (1987). High Risk: Children without a conscience. Golden, CO, M. & M.

Moore, Ken; Moretti, Marlene M.; Holland, Roy. (1998). A New Perspective on Youth Care Programs: Using Attachment Theory to Guide Interventions for Troubled Youth. Residential Treatment For Children & Youth, 15/3. pp.1-24.
Traditional models of residential care for troubled youth are based on the assumption that their difficult and threatening behaviour needs to be contained and controlled. These models typically adhere to a behavioral or social learning perspective. Treatment is geared toward changing reinforcement schedules to reduce undesired behaviour as well as toward teaching social skills to increase the likelihood that youth will use socially appropriate strategies to have their needs met. In this paper we argue that, despite the usefulness of some traditional treatment strategies when employed within certain contexts, these interventions are often of limited value in working with youth who have developed internal working models of adults as rejecting, punitive and untrustworthy. The reliance of traditional treatment programs on behavioral strategies that emphasize control and containment of behaviour can, in effect, undermine already fragile attachments of troubled youth to adults and instigate power struggles that inevitably fall in helping youth to develop a sense of personal responsibility for and control of their actions. We propose that attachment theory offers a framework for a fundamentally different approach to working with troubled youth; an approach that begins with an appreciation of the youth's internal working models of self and other. This article reviews the process of transformation of a "traditional" control-focused program into a program that is guided by attachment theory. 

Munroe, Catherine. (1993); The Child Within; The Children’s Society, London

Owusu-Bempah, J; Howitt, Dennis. (1997). Socio-genealogical connectedness, attachment theory, and childcare practice. Child and family social work, 2/4. pp.199-207.
At the heart of child welfare policy and practice are issues of loss and separation, issues of loss and discontinuity of parent-child or carer-child ties. Consequently, John Bowlby's ideas concerning attachment have been influential in this field over the past 50 years. This paper argues that the society in which Bowlby, originally developed his ideas has altered greatly; in Western societies, family dynamics have changed remarkably, and continue to change. The present paper therefore argues that these ideas may not adequately address the developmental needs of today's children. Hence, it puts forward the notion of socio-genealogical connectedness to complement our existing knowledge and understanding of the psycho-social developmental needs of modern-day children. The notion's implications for policy and practice are also highlighted.

Reber, K. (1996). Children at risk for reactive attachment disorder: Assessment, diagnosis, and treatment. Progress: Family Systems R


Please use the INPUT facility to suggest any other material which you feel is useful to this subject area.