Toddler hugging his motherAttachment refers to the ability to form emotional bonds and empathic, enjoyable relationships with other people, especially close family members. Insecure attachment early in life may lead to attachment issues and difficulty forming relationships throughout life. Because early intervention often proves most effective, children who shows signs of attachment issues may benefit from speaking to a therapist.

Attachment Theory and Research

Developmental psychologist John Bowlby originally described the concept of attachment, focusing on the bond between mother and infant. Attachment, according to Bowlby, is not a one-time event, but a process that begins with birth and extends into the early years of life. A child's relationship with the primary caregiver, who is often the mother, can affect the child's attachment style throughout life, and insecure attachments can often interfere with future romantic relationships.

Children generally develop healthy, secure attachments to mothers who competently and regularly respond to the child's needs by, for example, feeding the child when the child cries. There has been significantly less research investigating the process of attachment between father and child, but preliminary studies indicate that the process is similar, with perhaps more emphasis on play.

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Researchers often measure attachment with the Strange Situation Test, developed by developmental psychologist Mary Ainsworth. In this test, a mother leaves her child with researchers, who observe the child's reactions. Children with secure attachments demonstrated a strong attachment to the mother, while children with insecure attachments exhibited a variety of unusual and unhealthy reactions, including becoming angry with the mother upon her return.

The test results determined four types of attachment:

  • Secure: The child will interact with others in the presence of the mother and will become upset when she leaves and avoid contact with strangers. This demonstrates a healthy attachment.
  • Anxious-Resistant Insecure: The child will become anxious at the presence of strangers and will not interact with them. When the mother leaves, the child will become very upset and will be unreceptive to her attempts to interact when she returns. This may demonstrate that the parent does not consistently meet the child's needs.
  • Anxious-Avoidant Insecure: The child shows ambivalence toward the mother and toward strangers, does not want to be held, and shows no preference toward caregivers. This attachment style typically means that a child has learned that efforts to have needs met will be ignored.
  • Disorganized/Disoriented: Though a child with this attachment issue may become upset when the mother leaves and appear relieved when she returns, the child may refuse to be held, hit or rock repeatedly, and show anger toward the mother. Over half of the mothers of children with a disorganized or disoriented attachment were shown to have experienced trauma-induced depression shortly before giving birth.

Understanding Attachment Issues

The attachment bond, or an infant's first bond with the primary caregiver, generally the mother, is essential to later attachment. A weak attachment bond can result in both social and emotional developmental disruptions. Attachment issues typically result from an early separation from parents, lengthy hospitalization, incidents of trauma, instances of neglect, or an otherwise troubled childhood. These issues may have an affect on a child's ability to form healthy, secure attachments later in life. Attachment is related to trust and empathy, and when attachments are not developed early in life, a child may not learn to trust and may not develop a conscience.

Studies show that between 35% and 45% of all children in the US experience some kind of attachment issue, while approximately 35% of adopted children in the United States have been diagnosed with an attachment disorder. Many of those who develop attachment issues are never diagnosed or treated, so the actual number of children affected is unknown. Attachment issues are more likely to develop in maltreated infants, primarily due to neglect or the child's being moved from one caregiver to another. Prolonged institutional care, long-term hospitalization, or other separation from parents might also lead to the development of attachment issues, as can inconsistent behavior from caregivers.

Signs of insecure attachment may include:

  • Avoidance of eye contact.
  • Avoidance of physical contact.
  • Rejection of touch or attempts at emotional connection.
  • Frequent, inconsolable crying.
  • A tendency to self-comfort.
  • A lack of interest in toys or interactive play.

Reactive Attachment Disorder (RAD)

Reactive Attachment Disorder (RAD) is a serious, diagnosable condition that develops in childhood, typically between 9 months and 5 years of age. Diagnostic criteria from the Diagnostic and Statistical Manual (DSM) indicate that children with RAD do not often seek out or respond to comfort from caregivers in the face of distress, establishing a pattern of consistently withdrawn behavior. A child might also fail to respond emotionally and socially to other people and be irritable, sad, or fearful, with no apparent reason. Children with this condition may dislike physical affection, have anger and control issues, and experience difficulty showing affection.

According to the DSM, this condition is rare: In the general population, it probably occurs in less than 1% of children. In populations of maltreated children, RAD occurs at a rate of about 10%. The only known risk factor for the condition is severe social neglect, but in the majority of cases of neglect, RAD does not develop. If care improves following the neglect, this condition is less likely to develop.

How Psychotherapy Can Help with Attachment Issues

Attachment issues that are left unresolved can interfere with the ability to maintain relationships of any kind later in life. Children who have attachment issues can often benefit from therapy, as in therapy they may be able to learn what healthy relationships look like, explore ways to form constructive bonds with caregivers, and develop ways to cope with the symptoms that resulted from their early attachment issues.

Play therapy is often effective for children experiencing RAD. A child with this condition might attend therapy with the caregiver, and treatment generally focuses on strengthening their relationship and working to develop a healthy attachment.

Adults who have never addressed problems with attachment and who see the result of attachment issues in their lives might, in treatment, identify and explore early losses, grieve for the childhood bonds that were not experienced, and gain closure while learning how to develop healthy attachments and accept love, if they have difficulty doing so. Through therapy, adults who have experienced attachment issues may become able to build stronger bonds with friends, children, and partners.

Case Examples

  • Attachment issues in adopted son: Shawn, 6, is brought in for therapy by his newly adoptive parents, who adopted him from the foster care system last year. Though he had been loving and sweet in the beginning, he had also been impulsive, prone to sudden bursts of aggression, and displayed sexualized behavior, but they overlooked this, assuming the behaviors would improve as he grew accustomed to a stable life. Instead, things deteriorated rapidly. Shawn's parents tell the therapist he is aggressive with his older siblings, is impossible to discipline, is frequently in trouble at school, and wets the bed nightly. He seems angry for no reason and does not allow anyone to comfort him. His parents worry they may have to send him to a group home for children with behavior problems. The therapist recognizes the signs of attachment issues, and instead of trying to change Shawn’s behavior with reinforcement and punishment, as Shawn's caregivers have, the therapist works on creating positive attachment experiences in therapy between the parents and Shawn. In addition, the therapist helps the parents understand the motivation behind Shawn's behaviors, and they explore ways to provide attachment-facilitating parenting experiences at home. After several months, results begin to appear. Shawn accepts hugs and is less easily triggered. Instead of hitting his siblings when upset, he cries and asks for help. Because his behavior was a symptom of intense emotional ambivalence, when positive parenting addressed the issue, the symptoms began to fade.
  • Intimacy issues in marriage: Mei, 32, is married and having problems with intimacy. Her sex life with her husband began to worsen almost immediately after their honeymoon, and she admits the problem is hers; she is repulsed by sexual invitations from her husband, and she is afraid of touching him in bed in any way. She feels angry at him for no reason she can identify and feels that she would like to live “separate lives.” However, the thought of divorce terrifies her, and she does not want that. Mei cannot explain her feelings, but an examination of her childhood reveals instances of severe neglect Mei had thought she had gotten over. Therapy reveals Mei has intense fears of both rejection and of being enveloped or dominated by others. Through work on communication skills and by experiencing catharsis (emotional release) in the presence of, at first, the therapist and, later, her husband, Mei is able to develop a bond that feels safe with her husband, and she can begin to repair her marriage.

References:

  1. Adoption USA: Social and emotional well-being. (2007). Retrieved from http://www.aspe.hhs.gov/hsp/09/NSAP/chartbook/chartbook.cfm?id=20.
  2. Adult Attachment Disorder and Treatment. (n.d.). Retrieved from http://attachmenttherapy.com/adult.htm.
  3. Brotherson, S. (2005). Understanding Attachment in Young Children. Bright Beginnings, (6). Retrieved from http://www.ag.ndsu.edu/pubs/yf/famsci/fs617.pdf.
  4. Cassidy, J., & Shaver, P. R. (1999). Handbook of attachment: Theory, research, and clinical applications. New York, NY: Guilford Press.
  5. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  6. Reactive attachment disorder. (2014, July 10). Retrieved from http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/definition/con-20032126
  7. Reactive attachment disorder of infancy or early childhood. (2014, May 14). http://www.nlm.nih.gov/medlineplus/ency/article/001547.htm
  8. Surcinelli, P., Rossi, N., Montebarocci, O., & Baldaro, B. (2010). Adult attachment styles and psychological disease: Examining the mediating role of personality traits. The Journal of Psychology, 144(6), 523-34. Retrieved from http://search.proquest.com/docview/758657166?accountid=1229