Bonding and Attachment in Maltreated Children
Lesson 3: Factors Affecting Bonding and Attachment

In this lesson, learn more about:

  • How attachment and bonding can be defined

  • Some of the physiological processes at work during attachment and bonding experiences

  • Experiences that facilitate bonding

  • The role of attunement in bonding and attachment.


When are the windows of opportunity for bonding and attachment?

Timing is everything.  Bonding experiences lead to healthy attachments and healthy attachment capabilities when they are provided in the earliest years of life.  During the first three years of life, the human brain develops to 90 percent of adult size and puts in place the majority of systems and structures that will be responsible for all future emotional, behavioral, social and physiological functioning during the rest of life.  There are critical periods during which bonding experiences must be present for the brain systems responsible for attachment to develop normally.  These critical periods appear to be in the first year of life and are related to the capacity of the infant and caregiver to develop a positive interactive relationship.

What happens if this window of opportunity is missed?

The impact of impaired bonding in early childhood varies.  Severe emotional neglect in early childhood can be devastating. Without touch, stimulation and nurturing, children can literally lose the capacity to form any meaningful relationships for the rest of their lives.  Fortunately, most children do not suffer this degree of severe neglect.  There are, however, many millions of children who have some degree of impaired bonding and attachment during early childhood.  The problems that result from this can range from mild interpersonal discomfort to profound social and emotional problems.  In general, the severity of problems is related to how early in life, how prolonged, and how severe the emotional neglect has been.

This does not mean that children with these experiences have no hope to develop normal relationships.  Very little is known about the ability of “replacement” experiences later in life to replace or repair the undeveloped or poorly organized bonding and attachment capabilities. 

Clinical experiences and a number of studies suggest that improvement can take place, but it is a long, difficult and frustrating process for families and children.  It may take many years of hard work to help repair the damage from only a few months of neglect in infancy.


Did you know?

Infants with facial disfigurement
(i.e., severe cleft palate) have a greater degree of difficulty maintaining sustained attention and engagement from their caregivers and later in life demonstrate more attachment problems.

Are there ways to classify attachment?

Like human traits such as height or weight, individual attachment capabilities are also continuous.  In an attempt to study this range of attachments, however, researchers have clustered the continuum into four categories of attachment: secure, insecure-resistant, insecure-avoidant, and insecure-disorganized/disoriented.  Securely attached children feel a consistent, responsive, and supportive connection to their mothers, even during times of significant stress.  Insecurely attached children feel inconsistent, punishing, unresponsive emotions from their caregivers and feel threatened during times of stress.  The table below illustrates these classifications.


Strange Situation Procedure:

Classification of Attachment

Percentage at One-Year

Response in Strange Situation

Securely attached

60-70 %

Explores with M in room; upset with separation; warm greeting upon return; seeks physical touch and comfort upon reunion

Insecure: avoidant

15-20 %

Ignores M when present; little distress on separation; actively turns away from M upon reunion

Insecure: resistant

10-15 %

Little exploration with M in room, stays close to M; very distressed upon separation; ambivalent or angry and resists physical contact upon reunion with M

Insecure:  disorganized disoriented

5-10 %

Confusion about approaching or avoiding M; most distressed by separation; upon reunion acts confused and dazed – similar to approach-avoidance confusion in animal models

Dr. Mary Ainsworth developed a simple process to examine the nature of a child’s attachment.  This is called the Strange Situation Procedure.  Simply stated, the mother and infant are observed in a sequence of “situations:” parent-child alone in a playroom; stranger entering room; parent leaving while the stranger stays and tries to comfort the baby; parent returns and comforts infant; stranger leaves; mother leaves infant all alone; stranger enters to comfort infant; parent returns and tries to comfort and engage the infant.  The behaviors during each of these situations is observed and “rated.”  The behaviors of children in this testing paradigm are scored and used to categorize attachment styles.

What other factors hinder bonding and attachment?

Any factors that interfere with bonding experiences can interfere with the development of attachment capabilities.  When the interactive, reciprocal "dance" between the caregiver and infant is difficult or disrupted, bonding experiences are a  challenge to maintain.  Disruptions can occur because of primary problems with the infant, the caregiver, the environment or the "fit" between the infant and caregiver.

Infant: The child’s “personality” or temperament influences bonding.  If an infant is difficult to soothe, irritable, or unresponsive--compared to a calm, self-soothing child--he or she will have more difficulty developing a secure attachment.  The infant's ability to participate in the maternal-infant interaction may be compromised due to a medical condition such as prematurity, birth defect, or illness.

Caregiver: The caregiver's behaviors can impair bonding.  Critical, rejecting, or interfering parents tend to have children that avoid emotional intimacy.  Abusive parents tend to have children that become uncomfortable with intimacy and withdraw.  The child’s mother may be unresponsive to the child due to maternal depression, substance abuse, overwhelming personal problems, or other factors that interfere with her ability to be consistent and nurturing with the child.

Environment:  A major impediment to healthy attachment is fear.  If an infant is distressed due to pain, pervasive threat, or a chaotic environment, they will have a difficult time participating in even a supportive caregiving relationship.  Children in violent, dangerous circumstances are vulnerable to developing attachment problems: be it a war zone, community violence, domestic violence, or refugee infants and children. 

 Fit: The "fit" between the temperament and capabilities of the infant and the mother is crucial.  Some caregivers can be just fine with a calm infant but are overwhelmed by an irritable infant.  The process of paying attention to another, reading each other's non-verbal cues, and responding appropriately is essential to maintain the bonding experiences that build in healthy attachments.  Sometimes, a style of communication and response style used by a mother with one of her other children may not fit her newborn infant.  The mutual frustration of being "out of sync" can impair bonding.


How does abuse and neglect influence attachment?

There are three primary themes that have been observed in abusive and neglectful families. 

The most common effect is that maltreated children are, essentially, rejected.  Children that are rejected by their parents will have a host of problems (see below) including difficulty developing emotional intimacy. 

Another theme is "parentification" of the child.  This takes many forms.  One common form is when a young immature girl becomes a single parent.  The infant is treated like a playmate and very early in life like a friend.  It is common to hear these young mothers talk about their four-year-old as "my best friend" or "my little man."  In other cases, the adults are so immature and uninformed about children that they treat their children like adults-- or even like another parent.  As a result, their children may participate in fewer activities with other children who are “immature.”  This false sense of maturity in children often interferes with the development of same-aged friendships.


The third common theme is the transgenerational nature of attachment problems --they pass from generation to generation.  In abusive families, it is common for rejection and abuse to be transgenerational; the neglectful parent was neglected as a child.  They pass on the way they were parented. 

It is important to note that previously secure attachments can change suddenly following abuse and neglect.  For example, a child’s positive views of adults may change following physical abuse by a baby-sitter.  The child’s perception of a consistent and nurturing world may no longer “fit” with her reality. 

Are attachment problems always from abuse?

No, in fact the majority of attachment problems are likely due to parental ignorance about development rather than abuse.  Many parents have not been educated about the critical nature of the experiences of the first three years of life.  Currently, this ignorance is so widespread that it is estimated that 1 in 3 people has an avoidant, ambivalent, or resistant attachment with their caregiver.  Despite this insecure attachment, these individuals can form and maintain relationships--yet not with the ease that others can.  With more public education and policy support for these areas, these statistics can improve. 



What specific problems can I expect to see in maltreated children with attachment problems?

The specific problems that you may see will vary depending upon the nature, intensity, duration and timing of the neglect and abuse.  They may also differ from child to child.  Some children will have profound and obvious problems, while some will have very subtle problems that you may not realize are related to early life neglect.  Sometimes, these children do not appear affected by their experiences.  However, it is important to remember the reason you are working with the children and that they have been exposed to terrible things.  There are some clues that experienced clinicians consider when working with these children. 

Developmental delays: Children experiencing emotional neglect in early childhood often have developmental delays in other domains as well.  The bond between the young child and caregivers provides the major vehicle for a child’s development.  It is in this primary context that children learn language, social behaviors, and many other key behaviors and skills required for healthy maturation.  Lack of consistent and enriched experiences in early childhood can result in lags in physical, motor, language, emotional, social, and cognitive development.

Eating:  Atypical eating behaviors are common, especially in children with severe neglect and attachment problems.  They will hoard food, hide food in their rooms, eat as if there will be no more meals--even if they have had years of consistent available foods.  They may have failure to thrive, rumination (throwing up food), swallowing problems and, later in life, unusual eating behaviors that are often misdiagnosed as anorexia nervosa.

Soothing behavior: These children will use very primitive, immature, and seemingly bizarre soothing behaviors.  For example, they may scratch or cut themselves, bite themselves, head bang, rock, or chant.  These symptoms will increase during times of distress or threat.

Emotional functioning: A range of emotional problems is common among these children, including symptoms of depression and anxiety.  One common behavior is “indiscriminant” attachment.  All children seek safety.  Keeping in mind that attachment is important for survival; children may seek attachments-- any attachments--for their safety.  Non-clinicians may notice abused and neglected children are “loving” and hug virtual strangers.  Children do not develop a deep emotional bond with relatively unknown people; rather, these "affectionate" behaviors are actually safety-seeking behaviors.  Clinicians become concerned because these behaviors contribute to the abused child’s confusion about intimacy and are not consistent with normal social interactions.  Furthermore, although the child seeks safety, these inappropriately affectionate behaviors can, ironically, put the child in very dangerous situations.

Inappropriate modeling:  Children model adult behavior--even if it is abusive.  They learn abusive behavior is the “right” way to interact with others.  As you can see, this potentially causes problems in their social interactions with adults and other children.  For children that have been sexually abused, they may become more at-risk for future victimization.  Males that have been sexually abused may become sexual offenders.

Aggression:  One of the major problems with neglected, poorly attached children is aggression and cruelty.  This is related to two primary problems in neglected children: (1) lack of empathy and (2) poor impulse control.  Empathy, or the ability to emotionally "understand" the impact of your behavior on others, is impaired in these children.  They really do not understand or feel what it is like for others when they do or say something hurtful.  Indeed, these children often feel compelled to lash out and hurt others-- most typically something less powerful than they are.  They will hurt animals, smaller children, peers, and siblings.  One of the most disturbing elements of this aggression is that it is often accompanied by a detached, cold lack of empathy.  They may show regret (an intellectual response) but not remorse (an emotional response) when confronted about their aggressive or cruel behaviors.


Remember that, while these difficulties are often associated with early maltreatment, they can also occur under other circumstances and should not be seen as conclusive evidence of child maltreatment. 


Assignment #3

Read though this case scenario and then consider the questions below.

Case Scenario:  Ben

Gail and Charles were expecting their first child.  The pregnancy had been a difficult one.  Gail had experienced gestational diabetes and her migraine headaches had become worse during the pregnancy.  Finally, bleeding required that Gail be placed on “full bed rest” for three weeks.  These three weeks consumed most of Gail’s remaining sick time, leaving her only 6 weeks of maternity leave.  Fortunately, Gail’s parents lived in town and were able to help in many ways.  Gail, a very quiet and subdued individual, was able to use the time to read the many baby books she had found.  To improve the couple’s financial situation, Charles began working double shifts.   

Baby Ben was born 6 weeks early, weighing 4lbs, 3oz.  Ben remained in the hospital for 3 weeks after his birth.  By the time he went home, he had regained his birth weight, but not much more.   He was struggling with nursing.  In addition, he was having difficulty with his sleep cycle due to the necessity of nursing every three hours.  Ben appeared to fall asleep, to sleep more soundly, and sleep longer when held.  Physically, Gail was exhausted and was still recovering from injuries she sustained during labor.  Her migraines continued, but were less frequent and less severe.  Despite her weakened physical condition, Gail enjoyed the time she spent holding Ben and often found it restful and soothing for them both.   

However, there were times when Ben could be very difficult to soothe and the frequency and intensity of his distress often surprised her.  She often worried that there was a serious problem and made frequent calls to her mother and Ben’s pediatrician.  Charles continued to be very loving and supportive, but continued to work a great deal to meet the family’s financial obligations.


 Consider and list the stressors in the above case scenario, whether case-specific or typical.

 What are some of the circumstances and personal characteristics that could interfere with “optimal” parent-child bonding?

 What are some of the situational and personal characteristics that can off-set these risks?

to Case Scenario


1.       1st pregnancy

2.       Prematurity

3.       Low birth weight; difficulty gaining weight and nursing

4.       Financial concerns (father’s long hours, mother’s limited maternity leave)

5.       Hospitalization after the birth

6.       Possible mismatch between parent’s temperament (i.e., quiet, subdued) and baby’s level of distress

7.       Mother’s physical condition

8.       Exhaustion of parents

9.       Baby’s sleep difficulties



1.       Supportive marital partners

2.       Supportive extended family

3.       Parent motivated to seek information

4.       Mother enjoys contact with baby


Lesson 3 Section Quiz

1. Problems resulting from early childhood neglect can include:
a. Poor physical growth
 b. Shyness
 c. Difficulty interacting appropriately
 d. All of the above

2.  What are some of the factors that can interfere with bonding and attachment
a. Using a midwife for the baby's birth
 b. Living in a home with domestic violence
 c. A lack of siblings
 d. All of the above

3. The majority of attachment problems are likely the result of:
a. Parental ignorance about child development
 b. Intentional cruelty toward newborns
 c. "Spoiling" children
 d. None of the above

4. Primitive, immature self-soothing strategies can include all of the following except:
a. Head banging
 b. Scratching oneself
 c. Writing in a journal
 d. Rocking

5. Aggression in poorly attached children in most often the result of:
 a. Poor ability to empathize with others
 b. Overly-controlled emotions
 c. Violence on television
 d. All of the above

6. The securely attached infant in Ainsworth's Strange Situation 
 a.  is able to explore the new environment, albeit cautiously
 b.  resists physical comfort from his mother upon her return
 c.  greets his mother warmly upon her return
 d. a & c

7.  Indiscriminately attached children are often overly affectionate with people they barely know because they are
a. confused about who their primary caregivers are
 b. lonely
 c. seeking safety
 d. practicing their social skills

Identify the following statements as either True or False.

1. T or F - Critical periods for bonding experiences appear to occur in the first year of life.

2. T or F - Once the window of opportunity for attachment and bonding experiences passes, the child has lost the capacity to attach to others.

3. T or F - "Parentification" means teaching a child the parents' views and beliefs.

4. T or F - Developmental delays are highly atypical in children with attachment problems.

5. T or F - Hording food is common among children with early deprivation experiences.

6. T or F - It is common for neglect to occur in multiple generations in a single family. 


Lesson 3 Section Quiz Answers

1. Problems resulting from early childhood neglect can include:

The correct answer: d. All of the above

2.  What are among the factors that can interfere with bonding and attachment

The correct answer:  b. Living in a home with domestic violence

3. The majority of attachment problems are likely the result of:

The correct answer:  a. Parental ignorance about child development

4. Primitive, immature self-soothing strategies can include all of the following except:

The correct answer:  c. Writing in a journal

5. Aggression in poorly attached children in most often the result of:

The correct answer:  a. Poor ability to empathize with others

6. The securely attached infant in Ainsworth's Strange Situation 

The correct answer: d. a & c

7.  Indiscriminately attached children are often overly affectionate with people they barely know because they are

The correct answer: c. seeking safety

Identify the following statements as either True or False.

1. The correct answer:  True - Critical periods for bonding experiences appear to occur in the first year of life.

2. The correct answer:   False - Once the window of opportunity for attachment and bonding experiences passes, the child has lost the capacity to attach to others.

3. The correct answer:  False - "Parentification" means teaching a child the parents' views and beliefs.

4. The correct answer:  False - Developmental delays are highly atypical in children with attachment problems.

5. The correct answer:  True - Hording food is common among children with early deprivation experiences.

6. True - It is common for neglect to occur in multiple generations in a single family. 

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