Bonding and Attachment in Maltreated Children
Lesson 4: What can I do to help?
In this lesson, learn more about:
  • How different problems can manifest themselves in daily life

  • Approaches to helping maltreated children

Ways to help!

Parents and caregivers make all the difference in the lives of maltreated children. This section suggests some different ways to help.

Nurture these children:
These children need to be held and rocked and cuddled.  Be appropriately physical, caring, and loving to children with attachment problems.  Be aware that for many of these children, touch in the past has been associated with pain, torture, or sexual abuse.  In these cases, make sure you carefully monitor how they react--be “attuned” to their responses to your nurturing and act accordingly.  In many ways, you are providing replacement experiences that should have taken place during their infancy--but you are doing this when their brains are harder to modify and change.  Therefore, they will need even more bonding experiences to help develop attachments.


Try to understand behavior before dispensing punishment or consequences:
The more you can learn about attachment problems, bonding, normal development, and abnormal development, the better you will be able to develop useful behavioral and social interventions.  Information about these problems can prevent you from misunderstanding a child’s behaviors.  When these children hoard food, for example, it should not be viewed as "stealing" but as a common and predictable result of being deprived during early childhood.  A punitive approach to this problem (and many others) will not help the child mature.  Indeed, punishment may actually increase the child's sense of insecurity, distress, and need to hoard food.  Many of these children's behaviors are confusing and disturbing to caregivers.   You can get help from professionals if you find yourself confused by a child’s behavior or struggling to create and implement a practical and useful approach to these problems.


Parent these children based on emotional age: 
Abused and neglected children will often be emotionally and socially delayed.  When they are frustrated or fearful, they will regress further.  For example, this means that, at any given moment, a ten-year-old child may, emotionally, be a two-year-old.  Despite our wishes that they would “act their age” and our insistence to do so, they are not capable of that.  These are the times that we must interact with them at their emotional level.  If they are tearful, frustrated, overwhelmed (emotionally age two), parent them as if they were that age.  Use soothing non-verbal interactions.  Hold them.  Rock them.  Sing quietly.  Breathe deeply.  This is not the time to use complex verbal explanations about the consequences of inappropriate behavior.  It is also important to note that, while a child may show a delay in one area, they may be “on target” in others.  As stated above, stay “in tune” with the child—meet her where she is.


Be consistent, predictable and repetitive:
Maltreated children with attachment problems are very sensitive to transitions, surprises, chaotic social situations, changes in schedule, and, in general, any new situation.  Busy and unique social situations will overwhelm them, even when they are pleasant!  Birthday parties, sleepovers, holidays, family trips, the start and end of the school year--all can be disorganizing for these children.  Because of this, any efforts that can be made to be consistent, predictable, and repetitive will be very important in making these children feel "safe" and secure.  When they feel safe and secure, they can benefit from the nurturing, enriching emotional and social experiences you provide them.  If they are anxious and fearful, they cannot benefit from your nurturing in the same ways.


Model and teach appropriate social behaviors:
Many abused and neglected children do not know how to interact with other people.  One of the best ways to teach them is to model this in your own behaviors and then narrate for the child what you are doing and why.  Become a play-by-play announcer: "I am going to the sink to wash my hands before dinner because…” or “I take the soap and get soapy here and…"  Children see, hear, and imitate.

In addition to modeling, you can "coach" maltreated children as they play with other children.  Use a similar play-by-play approach: "Well, when you take that from someone they probably feel pretty upset.  If you want them to have fun when you play this game…"  Positive play with other children can help increase self-esteem and confidence.  Over time, success with other children will make the child less socially awkward and aggressive.  Maltreated children are often "a mess" because of their delayed socialization.  If a child is teased because of her clothes or grooming, it can help to have “cool” clothes and improved hygiene.  

One area that these children have problems in is modulating appropriate physical contact.  Some of these behaviors are noticeable, while some are almost imperceptible.  They don't know when to hug, when to pick their nose or touch their genitals, how close to stand, or when to establish or break eye contact.  In these cases, it is important to gently guide without shaming or embarrassing the child.  

As discussed earlier, children with attachment problems will often initiate physical contact (e.g., hugs, holding hands, crawling into laps) with strangers.  Adults often misinterpret this as affectionate behavior.  It is not.  It is best understood as "supplication" behavior and it is socially inappropriate.  How adults handle this inappropriate physical contact is very important.  We should not refuse to hug the child and lecture them about "appropriate behavior."  We can gently guide the child toward ways to interact differently with grown-ups and other children (e.g., “Why don’t you sit over here?”).  It is important to make these lessons clear, using as few words as possible.  They do not have to be directive--rely on nonverbal cues.  It is equally important to guide in a way that does not make the child feel bad or guilty.


Ironically enough, children with attachment problems frequently are overly affectionate and attentive to strangers. 

This is often misinterpreted as a form of healthy attachment bonding but in fact is reflecting profound attachment problems and makes them more vulnerable to exploitation.


Listen to and play with these children:

One of the most enjoyable ways to help is just stop, sit, listen, and play with these children.  When you are quiet and interactive with them, you find that they will begin to show you and tell you about what is really inside them.  Yet, as simple as this sounds, it is one of the most difficult things for adults to do--to stop, quit worrying about the time, your next task, the “right words,” and really relax into the moment with a child.  Practice this.  You will be amazed at the results.  These children will sense that you are there just for them--they will feel how you care.

 It is during these quiet moments that you can best reach and coach these children.  This is a great time to begin teaching children about their different "feelings."  Regardless of the activity, the following principles are important to include:

 1. All feelings are okay to feel: sad, glad, or mad (more emotions for older children).

2. Teach the child healthy ways to act when sad, glad, or mad.

3. Begin to explore how other people may feel and how they show their feeling -- e.g.., “How do you think Bobby feels when you push him?”

4. When you sense that the child is clearly happy, sad, or mad, ask him how he is feeling-- let him tell you.

 Help them begin to put words and labels to feelings; help them prepare alternate, healthy ways to respond to these feelings.

Have realistic expectations of these children: 

Abused and neglected children have so much to overcome.  And, for some, they will not overcome all of their problems.  For a Romanian orphan adopted at age five, after spending her early years without any emotional nurturing, the expectations should be limited.  She was robbed of some, but not all, of her potential.  We do not know how to predict potential in a vacuum, but we do know how to measure the emotional, behavioral, social and physical strengths and weaknesses of a child.  A comprehensive evaluation by skilled clinicians can be very helpful in beginning to define the skill areas of a child and the areas where progress will be slower.

Be patient with the child's progress and with yourself: 

Progress will be slow. The slow progress can be frustrating. Many adoptive parents will feel inadequate because all of the love, time, and effort they offer their child may not seem to be having any effect.  But it does.  Don't be hard on yourself.  Many loving, skilled, and competent parents have been swamped by the needs of a neglected and abused child that they have taken in. 

Take care of yourself:  

Caring for maltreated children can be exhausting and demoralizing.  You cannot provide the consistent, predictable, enriching, and nurturing care these children need if you are depleted.  Make sure you get rest and support.  Respite care can be crucial.  Enlist help from friends, family and community resources.  You will not be able to help your child if you are exhausted, depressed, angry, overwhelmed, and resentful.

Take advantage of other resources:

Many communities have support groups for adoptive or foster families.  Professionals with experience in attachment problems or maltreated children can be very helpful.  You will need help.  Remember, the earlier and more aggressive the interventions, the better.  Children are most malleable early in life and as they get older change is more difficult.

Remember that what you are doing is enormously important.  You may not feel as though you have made a difference.  However, it is critical to remember that every positive experience a child has with a kind, attentive, respectful, adult--even when brief--can help refute what they have known in the past.



Lesson 4 Section Quiz

1.  Consistency and predictability are particularly important for maltreated children because:

a.  Children need an extremely full schedule to learn and develop                  

b.  They instill the child with a sense of safety, allowing them to better learn and develop

c.  A caregiver needs to know what a child is doing at every minute to help the child learn and develop

d.  None of the above

2. True or False:  Punishment typically helps a maltreated child feel secure, because they know where they stand.


3.  True or False: Abused and neglected children always experience physical touch as positive.


4.  Maltreated children often have difficulty coping with all the but following:

a.  Consistency and predictability

b.  Transitions

c.  Chaotic social situations

d.  Novel circumstances


5.  True or False:  Offering a running commentary on a child’s behavior during play can help teach a child appropriate social skills.

6.  If a child runs to hug you when you first meet her:

a.  Turn and walk the other way

b.  Stop and give her an explanation about appropriate behavior

c.  Gently guide her toward a more appropriate greeting

d.  None of the above

7. True or False:  Listening and playing with maltreated children can allow the child to open up and talk freely.

8. When working with or caring for maltreated children, it is important to:

a.  Maintain fixed expectations

b.  Improvement should happen fast if it is going to happen at all

c.  Talking a lot helps a child feel comfortable

d.  The earlier and more aggressive the intervention, the better.

9.  True or False:  A comprehensive, professional evaluation can help identify a child’s strengths and problematic areas.

10. Which of the following is a self-care strategy?

a.  Getting adequate rest

b.  Setting aside time for yourself

c.  Enlisting occasional respite care

d.  All of the above.


Lesson 4 Quiz Answers

1. Consistency and predictability are particularly important for maltreated children:

The correct answer:  b

Comment: Consistency and predictability instill children with a sense of safety, allowing them to better learn and develop.

2. Punishment typically helps a maltreated child feel secure, because they know where they stand.

The correct answer:  False

Comment: Maltreated children, as do all children, respond best to encouragement, gentle redirection, clear limits and expectations.

3.  Abused and neglected children always experience physical touch as positive.

The correct answer:  False

Comment: Many maltreated children find physical touch threatening and must learn, over time, what both  appropriate touch and physical boundaries are.

4.  Maltreated children often have difficulty coping with all the but following:

The correct answer:  a

Comment: Consistency and predictability help all children feel safe and secure.

5.  True or False:  Offering a running commentary on a child’s behavior during play can help teach a child appropriate social skills.

The correct answer:  False

Comment: Your insightful comments can help a child understand cause and effect.  When you say to your child "I see you've offered Rachel your toy truck.  Sharing is a great way to make a friend," it helps your child understand the value of his interaction.

6.  If a child runs to hug you when you first meet her:

The correct answer:  c

Comment: Many children with attachment problems are indiscriminant with their physical affection.  Do not reject these children.  Rather gently guide their intended embrace into a more slightly distant interaction - such as a warm pat on the arm or rub on the back along with a big smile and warm hello!

7. Listening and playing with maltreated children can allow the child to open up and talk freely.

The correct answer:  True

Comment: The safer a child feels, the more he will reveal.

8. When working with or caring for maltreated children, it is important to:

The correct answer:  d

Comment:  Intervene as early and as aggressively as possible.

9.  A comprehensive, professional evaluation can help identify a child’s strengths and problematic areas.

The correct answer:  a

Comment:  Focus your efforts.

8. Which of the following is a self-care strategy?

The correct answer:  d

Comment:  Don't underestimate the energy it requires to care for at-risk children (and children in general)!  Get rest, time for yourself and help with the children in your care so that you can return to them refreshed and more able to meet their needs.


There are many other places to learn more about attachment and bonding in maltreated children.  A few starting places are listed below. 


Zero to Three is a national, nonprofit organization located in Washington, D.C., dedicated solely to advancing the healthy development of babies and young children.  Founded in l977 by top developmental experts, ZERO TO THREE disseminates key developmental information, trains providers, promotes model approaches and standards of practice and works to increase public awareness about the significance of the first three years of life.

734 15th Street, NW, Suite 1000
Washington, DC 20005
(202) 638-1144.

PACT: A nonprofit 501(c)(3) organization begun by two adoptive parents in 1991, Pact has developed a national reputation for excellence in serving all members of the adoption triad. Each year, Pact offers educational events attended by more than 1500 individuals, provides - free of charge - over 1000 crisis consultations to birth parents, and consults with hundreds of potential adoptive parents. Top priority is given to programs especially designed to support and inform adopted children and adopted adults of color.

Pact, An Adoption Alliance
3450 Sacramento Street Suite 239
San Francisco, CA 94118
(415) 221-6957
(510) 482-2089 FAX

Attachment Parenting International is a coalition of concerned individuals, professionals, and grassroots organizations. They advocate special “attachment parenting” methods to develop and fulfill a child's need for trust, empathy, and affection in order to create secure and enduring relationships. This organization feels that attachment parenting, in conjunction with support groups can not only strengthen families but provide a simple and cost-effective model to aid in the prevention of child abuse, behavioral disorders, criminal acts, and other serious social problems. 

Attachment Parenting International
1508 Clairmont Place
Nashville, Tennessee 37215
(615) 298 4334



Attachment:  A special form of emotional relationship.  Attachment involves mutuality, comfort, safety and pleasure for both individuals in the relationship.

Attunement:  The ability to read and respond to the communicated needs of another.  This involves synchronous and responsive attention to the verbal and non-verbal cues of another.

Bond:  A bond is a relationship.  Bonds may be of special mutual emotional nature such as an attachment or they may be based upon other emotions (e.g., fear – such as seen in the bond between captor and captive). 

Bonding:  Any activity, action or behavior that helps establish or maintain a relationship.  

Strange-Situation procedure:  A specialized clinical-research procedure involving eight separations and reunions with an infant and their caregiver designed to determine the nature of the attachments.

Getting Involved

Our society has been ineffective in preventing, identifying, and responding to the maltreatment of children. The impotence of our social systems to help children does not mean that you, as an individual, are powerless. Your actions can have dramatic impact on children in your community and, by supporting the efforts of effective organizations, your actions can impact thousands of children in this generation and in generations to follow.

There are many ways that you can choose to fight the maltreatment and trauma of children. Whatever method you choose, know that however small your effort seems, your participation is critical. In the end, unless we all participate in some fashion, we will always fall short of our true potential as individuals and as a society. Choose to help in a way that works for you. You may want to work directly with maltreated children, or you may choose to contribute in any variety of important ways. Please remember, you don't need to work directly with the child to be able to make a dramatic difference in their life.

Give Your Time

In your community, there are children that need the gift of attention, respect, instruction, comfort, and hope. So many children from abusive settings have lost hope. Even brief interactions with respectful, honest, and nurturing adults can be helpful to the abused or traumatized child, allowing them to know that adults can be kind.

There are many ways to find children who need your time. Volunteer to be a foster parent, to rock the crack-addicted infant in the hospital, to teach a child to read, to be an aide in the local public school, to answer phones at a battered women's shelter. In all of these settings, you can enrich the life of a child. You can give a child hope.

Give Your Skills

You may not realize how your skills can benefit maltreated children. Desperately underfunded child protection, child welfare, and child mental health systems can always benefit from the innovative use of your skills. A residential treatment center may need help with accounting or computer programming. A local children's shelter may not have a library.

A dancer can teach some foster children how to dance. A computer programmer can teach these children computer skills. A writer can write editorials/articles/books about these issues or help an agency create a newsletter. Your skills, whatever they are, can be used to fight abuse.

Give Your Money

In the United States, we spend more money on studying and treating abusers than we do on their child victims. Research, clinical services, and specialized professional training in child abuse are dramatically underfunded. You can help support these critical activities by financially supporting effective and innovative programs such as the ChildTrauma Academy.

Please direct donations to:

The ChildTrauma Academy
5161 San Felipe, Suite 320
Houston, Texas 77056

Checks should be made payable to "The ChildTrauma Academy."

As you give time, skills, or money to help these broken children, you may find that your life will be enriched and that hope has a new meaning for you. You can make a difference in the life of a child with your time, and in the lives of many children with your financial support. Choose to act.

Give Your Voice

Play a role in helping change the policies and practices that have allowed our society to ignore children. Remember, children don't vote. And far too many traumatized children have no effective adult advocacy. We allocate research and service-delivery dollars in the United States in a way that reflects political power. Maltreated children have no political power in this country, nor any other country.

Whenever you can, talk to the media. Talk with your local, state, and federal representatives to inform them and urge them to think about the future of our children. Write letters or send e-mails to make them aware of your concern. They all say that children are our future. Make them walk the walk and not just talk the talk.


Assignment #4

Identify 3 resources (i.e., professionals, agencies, organizations) in your community that can assist families and children.  Examples of these types of resources can include:

          Social workers

          “Child Find” programs


          Head Start/Early Head Start programs


          Child advocacy attorneys/agencies


          Parent education programs


          In-home family services

          Early Childhood Intervention programs

          Children’s enrichment programs


Congratulations! You have completed Lesson 4 and the Course.

A Final Word From Your Instructor

I have really enjoyed the opportunity to teach all of you about Bonding and Attachment. This course is intended as an introduction.  The subject is such an important one.  So much of healthy development is dependant upon the early relationships we each experience in our lives.  I encourage you all to continue learning. Read, question your colleagues, network in your community, and find ways to help children.

It is my sincerest hope that you will be able to apply the information you have learned in your daily life. Each positive interaction you have with a child will undoubtedly make the world a better place for children and ultimately us all.

I wish you the best of luck in your endeavors and thank you for your time and commitment to children.

Bruce D. Perry, MD, Ph.D.

If you have just completed this course for CEU credit, please remember that you need to complete the questionnaire and mail your payment to us.  Return to questionnaire & payment instructions.


Bonding and Attachment in the Maltreated Child (3 credit hours)


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