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What Is Attachment Theory?

The Importance of Early Emotional Bonds

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

• Attachment Theory
• Stages of Attachment

Attachment Styles

Attachment theory focuses on relationships and bonds (particularly long-term) between people, including those between a parent and child and between romantic partners. It is a psychological explanation for the emotional bonds and relationships between people.

This theory suggests that people are born with a need to forge bonds with caregivers as children. These early bonds may continue to have an influence on attachments throughout life.

History of the Attachment Theory

British psychologist John Bowlby was the first attachment theorist. He described attachment as a "lasting psychological connectedness between human beings." Bowlby was interested in understanding the anxiety and distress that children experience when separated from their primary caregivers.

Thinkers like Freud suggested that infants become attached to the source of pleasure. Infants, who are in the oral stage of development, become attached to their mothers because she fulfills their oral needs.

Some of the earliest behavioral theories suggested that attachment was simply a learned behavior. These theories proposed that attachment was merely the result of the feeding relationship between the child and the caregiver. Because the caregiver feeds the child and provides nourishment, the child becomes attached.

Bowlby observed that feedings did not diminish separation anxiety. Instead, he found that attachment was characterized by clear behavioral and motivation patterns. When children are frightened, they seek proximity from their primary caregiver in order to receive both comfort and care.

Understanding Attachment

Attachment is an emotional bond with another person. Bowlby believed that the earliest bonds formed by children with their caregivers have a tremendous impact that continues throughout life. He suggested that attachment also serves to keep the infant close to the mother, thus improving the child's chances of survival.

Bowlby viewed attachment as a product of evolutionary processes. While the behavioral theories of attachment suggested that attachment was a learned process, Bowlby and others proposed that children are born with an innate drive to form attachments with caregivers.

Throughout history, children who maintained proximity to an attachment figure were more likely to receive comfort and protection, and therefore more likely to survive to adulthood. Through the process of natural selection, a motivational system designed to regulate attachment emerged.

The central theme of attachment theory is that primary caregivers who are available and responsive to an infant's needs allow the child to develop a sense of security. The infant learns that the caregiver is dependable, which creates a secure base for the child to then explore the world.

So what determines successful attachment? Behaviorists suggest that it was food that led to forming this attachment behavior, but Bowlby and others demonstrated that nurturance and responsiveness were the primary determinants of attachment.

Ainsworth's "Strange Situation"

In her research in the 1970s, psychologist Mary Ainsworth expanded greatly upon Bowlby's original work. Her groundbreaking "strange situation" study  revealed the profound effects of attachment on behavior. In the study, researchers observed children between the ages of 12 and 18 months as they responded to a situation in which they were briefly left alone and then reunited with their mothers.

Based on the responses the researchers observed, Ainsworth described three major styles of attachment: secure attachment, ambivalent-insecure attachment, and avoidant-insecure attachment. Later, researchers Main and Solomon (1986) added a fourth attachment style called disorganized-insecure attachment based on their own research.

A number of studies since that time have supported Ainsworth's attachment styles and have indicated that attachment styles also have an impact on behaviors later in life.

Maternal Deprivation Studies

Harry Harlow's infamous studies on maternal deprivation and social isolation during the 1950s and 1960s also explored early bonds. In a series of experiments, Harlow demonstrated how such bonds emerge and the powerful impact they have on behavior and functioning.  

In one version of his experiment, newborn rhesus monkeys were separated from their birth mothers and reared by surrogate mothers. The infant monkeys were placed in cages with two wire-monkey mothers. One of the wire monkeys held a bottle from which the infant monkey could obtain nourishment, while the other wire monkey was covered with a soft terry cloth.

While the infant monkeys would go to the wire mother to obtain food, they spent most of their days with the soft cloth mother. When frightened, the baby monkeys would turn to their cloth-covered mother for comfort and security.

Harlow's work also demonstrated that early attachments were the result of receiving comfort and care from a caregiver rather than simply the result of being fed.

The Stages of Attachment

Researchers Rudolph Schaffer and Peggy Emerson analyzed the number of attachment relationships that infants form in a longitudinal study with 60 infants. The infants were observed every four weeks during the first year of life, and then once again at 18 months.

Based on their observations, Schaffer and Emerson outlined four distinct phases of attachment, including:

Pre-Attachment Stage

From birth to 3 months, infants do not show any particular attachment to a specific caregiver. The infant's signals, such as crying and fussing, naturally attract the attention of the caregiver and the baby's positive responses encourage the caregiver to remain close.

Indiscriminate Attachment

Between 6 weeks of age to 7 months, infants begin to show preferences for primary and secondary caregivers. Infants develop trust that the caregiver will respond to their needs. While they still accept care from others, infants start distinguishing between familiar and unfamiliar people, responding more positively to the primary caregiver.

Discriminate Attachment

At this point, from about 7 to 11 months of age, infants show a strong attachment and preference for one specific individual. They will protest when separated from the primary attachment figure (separation anxiety), and begin to display anxiety around strangers (stranger anxiety).

Multiple Attachments

After approximately 9 months of age, children begin to form strong emotional bonds with other caregivers beyond the primary attachment figure. This often includes a second parent, older siblings, and grandparents.

Factors That Influence Attachment

While this process may seem straightforward, there are some factors that can influence how and when attachments develop, including:

• Opportunity for attachment : Children who do not have a primary care figure, such as those raised in orphanages, may fail to develop the sense of trust needed to form an attachment.
• Quality caregiving : When caregivers respond quickly and consistently, children learn that they can depend on the people who are responsible for their care, which is the essential foundation for attachment. This is a vital factor.

There are four patterns of attachment, including:

• Ambivalent attachment : These children become very distressed when a parent leaves. Ambivalent attachment style is considered uncommon, affecting an estimated 7% to 15% of U.S. children. As a result of poor parental availability, these children cannot depend on their primary caregiver to be there when they need them.
• Avoidant attachment :   Children with an avoidant attachment tend to avoid parents or caregivers, showing no preference between a caregiver and a complete stranger. This attachment style might be a result of abusive or neglectful caregivers. Children who are punished for relying on a caregiver will learn to avoid seeking help in the future.
• Disorganized attachment : These children display a confusing mix of behavior, seeming disoriented, dazed, or confused. They may avoid or resist the parent. Lack of a clear attachment pattern is likely linked to inconsistent caregiver behavior. In such cases, parents may serve as both a source of comfort and fear, leading to disorganized behavior.
• Secure attachment : Children who can depend on their caregivers show distress when separated and joy when reunited. Although the child may be upset, they feel assured that the caregiver will return. When frightened, securely attached children are comfortable seeking reassurance from caregivers. This is the most common attachment style.

The Lasting Impact of Early Attachment

Children who are securely attached as infants tend to develop stronger self-esteem and better self-reliance as they grow older. These children also tend to be more independent, perform better in school, have successful social relationships, and experience less depression and anxiety.

Research suggests that failure to form secure attachments early in life can have a negative impact on behavior in later childhood and throughout life.

Children diagnosed with oppositional defiant disorder (ODD), conduct disorder (CD), or post-traumatic stress disorder (PTSD) frequently display attachment problems, possibly due to early abuse, neglect, or trauma. Children adopted after the age of 6 months may have a higher risk of attachment problems.

Attachment Disorders

In some cases, children may also develop attachment disorders. There are two attachment disorders that may occur: reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED).

• Reactive attachment disorder occurs when children do not form healthy bonds with caregivers. This is often the result of early childhood neglect or abuse and results in problems with emotional management and patterns of withdrawal from caregivers.
• Disinhibited social engagement disorder affects a child's ability to form bonds with others and often results from trauma, abandonment, abuse, or neglect. It is characterized by a lack of inhibition around strangers, often leading to excessively familiar behaviors around people they don't know and a lack of social boundaries.

Adult Attachments

Although attachment styles displayed in adulthood are not necessarily the same as those seen in infancy, early attachments can have a serious impact on later relationships. Adults who were securely attached in childhood tend to have good self-esteem, strong romantic relationships, and the ability to self-disclose to others.

A Word From Verywell

Our understanding of attachment theory is heavily influenced by the early work of researchers such as John Bowlby and Mary Ainsworth. Today, researchers recognize that the early relationships children have with their caregivers play a critical role in healthy development. 

Such bonds can also have an influence on romantic relationships in adulthood. Understanding your attachment style may help you look for ways to become more secure in your relationships.

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Ainsworth MD, Bell SM. Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation . Child Dev . 1970;41(1):49-67. doi:10.2307/1127388

Main M, Solomon J. Discovery of a new, insecure-disorganized/disoriented attachment pattern. In: Brazelton TB, Yogman M, eds., Affective Development in Infancy. Ablex.

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Ainsworth MDS, Blehar MC, Waters E, Wall S.  Patterns of Attachment: A Psychological Study of the Strange Situation . Erlbaum.

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

What is Attachment Theory? Bowlby’s 4 Stages Explained

No matter what the “it” refers to, Sigmund Freud would have probably said yes to that question.

However, we now know a lot more about psychology, parenting, and human relationships than Freud did.

It’s clear now that not every issue can be traced back to one’s mother. After all, there is another person involved in the raising (or at least the creation) of a child.

In addition, there are many other important people in a child’s life who influence him or her. There are siblings, grandparents, aunts and uncles, godparents, close family friends, nannies, daycare workers, teachers, peers, and others who interact with a child on a regular basis.

The question posed above is tongue-in-cheek, but it touches upon an important discussion in psychology—what influences children to turn out the way they do? What affects their ability to form meaningful, satisfying relationships with those around them?

What factors contribute to their experiences of anxiety, avoidance, and fulfillment when it comes to relationships?

Although psychologists can pretty conclusively say that it’s not entirely the mother’s fault or even the fault of both parents, we know that a child’s early experiences with their parents have a profound impact on their relationship skills as adults.

Much of the knowledge we have on this subject today comes from a concept developed in the 1950s called attachment theory . This theory will be the focus of this article: We’ll explore what it is, how it describes and explains behavior, and what its applications are in the real world.

Before you continue, we thought you might like to download our three Positive Relationships Exercises for free . These detailed, science-based exercises will help you or your clients build healthy, life-enriching relationships.

This Article Contains:

What is attachment theory a definition, research and studies, erik erikson, attachment theory in babies, infants, and early childhood development, attachment theory in adults: close relationships, parenting, love, and divorce, attachment theory in grief and trauma, the attachment theory test, using attachment theory in the classroom (worksheet and pdf), attachment theory in social work, criticisms of attachment theory, recommended books, articles, and essays, a take-home message.

The psychological theory of attachment was first described by John Bowlby, a psychoanalyst who researched the effects of separation between infants and their parents (Fraley, 2010).

Bowlby hypothesized that the extreme behaviors infants engage in to avoid separation from a parent or when reconnecting with a physically separated parent—like crying, screaming, and clinging—were evolutionary mechanisms. Bowlby thought these behaviors had possibly been reinforced through natural selection and enhanced the child’s chances of survival.

These attachment behaviors are instinctive responses to the perceived threat of losing the survival advantages that accompany being cared for and attended to by the primary caregiver(s). Since the infants who engaged in these behaviors were more likely to survive, the instincts were naturally selected and reinforced over generations.

These behaviors make up what Bowlby termed an “attachment behavioral system,” the system that guides us in our patterns and habits of forming and maintaining relationships (Fraley, 2010).

Research on Bowlby’s theory of attachment showed that infants placed in an unfamiliar situation and separated from their parents will generally react in one of these ways upon reunion with the parents:

• Secure attachment: These infants showed distress upon separation but sought comfort and were easily comforted when the parents returned;
• Anxious-resistant attachment: A smaller portion of infants experienced greater levels of distress and, upon reuniting with the parents, seemed both to seek comfort and to attempt to “punish” the parents for leaving.
• Avoidant attachment: Infants in the third category showed no stress or minimal stress upon separation from the parents and either ignored the parents upon reuniting or actively avoided the parents (Fraley, 2010).
• In later years, researchers added a fourth attachment style to this list: the disorganized-disoriented attachment style, which refers to children who have no predictable pattern of attachment behaviors (Kennedy & Kennedy, 2004).

It makes intuitive sense that a child’s attachment style is largely a function of the caregiving the child receives in his or her early years. Those who received support and love from their caregivers are likely to be secure, while those who experienced inconsistency or negligence from their caregivers are likely to feel more anxiety surrounding their relationship with their parents.

However, attachment theory takes it one step further, applying what we know about attachment in children to relationships we engage in as adults. These relationships (particularly intimate and/or romantic relationships) are also directly related to our attachment styles as children and the care we received from our primary caregivers (Firestone, 2013).

The development of this theory gives us an interesting look into the study of child development.

Bowlby and Ainsworth: The History and Psychology of Attachment Theory

Bowlby’s interest in child development traces back to his first experiences out of college, in which he volunteered at a school for maladjusted children. According to Bowlby, two children sparked his curiosity and drive that laid the foundations of attachment theory.

There was an isolated and distant teenager who had no stable mother figure in his life and had recently been expelled from his school for stealing, and an anxious 7- or 8-year-old boy who followed Bowlby wherever he went, earning himself a reputation as Bowlby’s “shadow” (Bretherton, 1992).

Through his work with children, Bowlby developed a strong belief in the impact of family experiences on children’s emotional and behavioral wellbeing .

Early on in his career, Bowlby proposed that psychoanalysts working with children should take a holistic perspective, considering children’s living environments, families, and other experiences in addition to any behaviors exhibited by the children themselves.

This idea grew into a strategy of helping children by helping their parents, a generally effective strategy given the importance of the child’s relationships with their parents (or other caregivers).

At roughly the same time Bowlby was creating the foundations for his theory on attachment, Mary Ainsworth was finishing her graduate degree and studying security theory, which proposed that children need to develop a secure dependence on their parents before venturing out into unfamiliar situations.

In 1950, the two crossed paths when Ainsworth took a position in Bowlby’s research unit at the Tavistock Clinic in London. Her initial responsibilities included analyzing records of children’s behavior, which inspired her to conduct her own studies on children in their natural settings.

Through several papers, numerous research studies, and theories that were discarded, altered, or combined, Bowlby and Ainsworth developed and provided evidence for attachment theory.

Theirs was a more rigorous explanation and description of attachment behavior than any others on the topic at the time, including those that had grown out of Freud’s work and those that were developed in direct opposition to Freud’s ideas (Bretherton, 1992).

There were several groundbreaking studies that contributed to the development of attachment theory or provided evidence for its validity, including the study described earlier in which infants were separated from their primary caregivers and their behavior was observed to fall into a “style” of attachment.

Further findings on emotional attachment came from a surprising place: rhesus monkeys.

The Harlow Experiments

His work showed that motherly love was emotional rather than physiological, that the capacity for attachment is heavily dependent upon experiences in early childhood, and that this capacity was unlikely to change much after it was “set” (Herman, 2012).

Harlow discovered these interesting findings by conducting two groundbreaking experiments.

In the first experiment, Harlow separated infant monkeys from their mothers a few hours after birth. Each monkey was instead raised by two inanimate surrogate “mothers.” Both provided the infant monkeys with the milk they needed to survive, but one was made out of wire mesh while the other was wire mesh covered with soft terry cloth.

The monkeys who were given the freedom to choose which mother to associate with almost always chose to take milk from the terry cloth “mother.” This finding showed that infant attachment is not simply a matter of where they get their milk—other factors are at play.

For his second experiment, Harlow modified his original setup. The monkeys were given either the bare wire mesh surrogate mother or the terry cloth mother, both of which provided the milk the monkeys needed to grow.

Both groups of monkeys survived and thrived physically, but they displayed extremely different behavioral tendencies. Those with a terry cloth mother returned to the surrogate when presented with strange, loud objects, while those with a wire mesh mother would throw themselves to the floor, clutch themselves, rock back and forth, or even “scream in terror.”

This provided a clear indication that emotional attachment in infancy, gained through cuddling, affected the monkey’s later responses to stress and emotion regulation (Herman, 2012).

These two experiments laid the foundations for further work on attachment in children and the impacts of attachment experiences in later life.

Erikson’s work was based on Freud’s original personality theories and drew from his idea of the ego. However, Erikson placed more importance on context from culture and society than on Freud’s focus on the conflict between the id and the superego.

In addition, his stages of development are based on how children socialize and how it affects their sense of self rather than on sexual development.

The eight stages of psychosocial development according to Erikson are:

• Infancy—Trust vs. Mistrust : In this stage, infants require a great deal of attention and comfort from their parents, leading them to develop their first sense of trust (or, in some cases, mistrust);
• Early Childhood—Autonomy vs. Shame and Doubt : Toddlers and very young children are beginning to assert their independence and develop their unique personality, making tantrums and defiance common;
• Preschool Years—Initiative vs. Guilt : Children at this stage begin learning about social roles and norms. Their imagination will take off at this point, and the defiance and tantrums of the previous stage will likely continue. The way trusted adults interact with the child will encourage him or her to act independently or to develop a sense of guilt about any inappropriate actions;
• School Age—Industry (Competence) vs. Inferiority : At this stage, the child is building important relationships with peers and is likely beginning to feel the pressure of academic performance. Mental health issues may begin at this stage, including depression, anxiety, ADHD, and other problems.
• Adolescence—Identity vs. Role Confusion : The adolescent is reaching new heights of independence and is beginning to experiment and put together his or her identity. Problems with communication and sudden emotional and physical changes are common at this stage (Wells, Sueskind, & Alcamo, 2017).
• Young Adulthood—Intimacy vs. Isolation : At this stage (ages 18-40, approximately), the individual will begin sharing with others more, including people outside o the family. If the individual is successful in this stage of development, he or she will build satisfying relationships that have a sense of commitment, safety, and care; if not, they may fear commitment and experience isolation, loneliness, and depression (McLeod, 2017).
• Middle Adulthood—Generativity vs. Stagnation : In the penultimate stage (ages 40-65, approximately), the individual is likely established in his or her career, relationship, and family. If the individual is not established and contributing to society, he or she may feel stagnant and unproductive.
• Late Adulthood—Ego Integrity vs. Despair : Finally, late adulthood (ages 65 and above) usually brings reduced productivity, which can either be embraced as a reward for one’s contributions or be met with guilt or dissatisfaction. Successfully navigating this stage will protect the individual from feeling depressed or hopeless, and help the individual cultivate wisdom (McLeod, 2017).

Although it does not map completely onto attachment theory, Erikson’s findings are clearly related to the attachment styles and behaviors Bowlby, Ainsworth, and Harlow identified.

John Bowlby – Attachment Theory – Diana Simon Psihoterapeut

According to Bowlby and Ainsworth, attachments with the primary caregiver develop during the first 18 months or so of the child’s life, starting with instinctual behaviors like crying and clinging (Kennedy & Kennedy, 2004). These behaviors are quickly directed at one or a few caregivers in particular, and by 7 or 8 months old, children usually start protesting against the caregiver(s) leaving and grieve for their absence.

Once children reach the toddler stage, they begin forming an internal working model of their attachment relationships. This internal working model provides the framework for the child’s beliefs about their own self-worth and how much they can depend on others to meet their needs.

In Bowlby and Ainsworth’s view, the attachment styles that children form based on their early interactions with caregivers form a continuum of emotion regulation, with anxious-avoidant attachment at one end and anxious-resistant at the other.

Secure attachment falls at the midpoint of this spectrum, between overly organized strategies for controlling and minimizing emotions and the uncontrolled, disorganized, and ineffectively managed emotions.

The most recently added classification, disorganized-disoriented, may display strategies and behaviors from all across the spectrum, but generally, they are not effective in controlling their emotions and may have outbursts of anger or aggression (Kennedy & Kennedy, 2004).

Research has shown that there are many behaviors in addition to emotion regulation that relates to a child’s attachment style. Among other findings, there is evidence of the following connections:

• Secure Attachment: These children are generally more likely to see others as supportive and helpful and themselves as competent and worthy of respect. They relate positively to others and display resilience, engage in complex play and are more successful in the classroom and in interactions with other children. They are better at taking the perspectives of others and have more trust in others;
• Anxious-Avoidant Attachment : Children with an anxious-avoidant attachment style are generally less effective in managing stressful situations. They are likely to withdraw and resist seeking help, which inhibits them from forming satisfying relationships with others . They show more aggression and antisocial behavior, like lying and bullying, and they tend to distance themselves from others to reduce emotional stress;
• Anxious-Resistant Attachment : These children are on the opposite end of the spectrum from anxious-avoidant children. They likely lack self-confidence and stick close to their primary caregivers. They may display exaggerated emotional reactions and keep their distance from their peers, leading to social isolation.
• Disorganized Attachment : Children with a disorganized attachment style usually fail to develop an organized strategy for coping with separation distress, and tend to display aggression, disruptive behaviors, and social isolation. They are more likely to see others as threats than sources of support, and thus may switch between social withdrawal and defensively aggressive behavior (Kennedy & Kennedy, 2004).

It is easy to see from these descriptions of behaviors and emotion regulation how attachment style in childhood can lead to relationship problems in adulthood.

Attachment styles are primarily discussed in the context of our childhood and upbringing.

In the early stages of development, children develop different attachment patterns to their parents or caregiver. These attachment styles can be predictive of how children grow up. For example, anxious or avoidant attachment styles are often powerful predictors for psychopathology or maladjustment development in the later stages of life (Benoit, 2004).

On the contrary, children with secure attachment styles to their parents are also more likely to have secure attachments to their romantic partners. This being said, attachment styles from childhood play a significant role in all the relationships you will encounter.

From this image, you may notice that the secure attachment style is the only one with a “positive” connotation, whereas the other attachment styles seem to have more unfavorable consequences.

If you recognize yourself as displaying one of the more maladaptive attachment styles, don’t fret because this is 1. very common and 2. not set in stone. For example, if you identify with the fearful-avoidant attachment style, you may see that trust seems to be the biggest issue.

The purpose of this image is not to make you feel ashamed about having a particular attachment style, but the opposite. By accepting and embracing your weaknesses, you allow yourself to grow.

Indeed, it is clear how these attachment styles in childhood lead to attachment types in adulthood. Below is an explanation of the four attachment types in adult relationships.

Examples: The Types, Styles, and Stages (Secure, Avoidant, Ambivalent, and Disorganized)

The adult attachment styles follow the same general pattern described above (Firestone, 2013):

Secure Attachment

These adults are more likely to be satisfied with their relationships, feeling secure and connected to their partners without feeling the need to be together all the time. Their relationships are likely to feature honesty , support, independence, and deep emotional connections.

Dismissive-Avoidant (or Anxious-Avoidant) Attachment

One of the two types of adult avoidant attachments, people with this attachment style generally keep their distance from others. They may feel that they don’t need human connection to survive or thrive, and insist on maintaining their independence and isolation from others.

These individuals are often able to “shut down” emotionally when a potentially hurtful scenario arises, such as a serious argument with their partner or a threat to the continuance of their relationship.

Anxious-Preoccupied (or Anxious-Resistant) Attachment

Those who form less secure bonds with their partners may feel desperate for love or affection and feel that their partner must “complete” them or fix their problems.

While they long for safety and security in their romantic relationships, they may also be acting in ways that push their partner away rather than invite them in. The behavioral manifestations of their fears can include being clingy, demanding, jealous, or easily upset by small issues.

Fearful-Avoidant (or Disorganized) Attachment:

The second type of adult avoidant attachment manifests as ambivalence rather than isolation. People with this attachment style generally try to avoid their feelings because it is easy to get overwhelmed by them. They may suffer from unpredictable or abrupt mood swings and fear getting hurt by a romantic partner.

These individuals are simultaneously drawn to a partner or potential partner and fearful of getting to close. Unsurprisingly, this style makes it difficult to form and maintain meaningful, healthy relationships with others.

Each of these styles should be thought of as a continuum of attachment behaviors, rather than a specific “type” of person. Someone with a generally secure attachment style may on occasion display behaviors more suited to the other types, or someone with a dismissive-avoidant style may form a secure bond with a particular person.

Therefore, these “types” should be considered a way to describe and understand an individual’s behavior rather than an exact description of someone’s personality.

Based on a person’s attachment style, the way he or she approaches intimate relationships, marriage, and parenting can vary widely.

The number of ways in which this theory can be applied or used to explain behavior is compounded and expanded by the fact that relationships require two (or more) people; any attachment behaviors that an individual displays will impact and be influenced by the attachment behaviors of other people.

Given the huge variety of individuals, behaviors, and relationships, it is not surprising that there is so much conflict and confusion.

It is also not surprising, although no less unfortunate, that many relationships end up in divorce or dissolution, an event that may continue an unhealthy cycle of attachment in the children of these unions.

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Speaking of unfortunate situations, attachment theory also has applications in the understanding of the  grief and trauma associated with loss.

Although you may be most familiar with Kübler-Ross’s Five Stages of Grief, they were preceded by Bowlby’s Four Stages. During Bowlby’s work on attachment, he and his colleague Colin Murray Parkes noticed four stages of grief:

• Shock and Numbness: In this initial phase, the bereaved may feel that the loss is not real, or that it is simply impossible to accept. He or she may experience physical distress and will be unable to understand and communicate his or her emotions.
• Yearning and Searching: In this phase, the bereaved is very aware of the void in his or her life and may try to fill that void with something or someone else. He or she still identifies strongly and may be preoccupied with the deceased.
• Despair and Disorganization: The bereaved now accepts that things have changed and cannot go back to the way they were before. He or she may also experience despair, hopelessness, and anger, as well as questioning and an intense focus on making sense of the situation. He or she might withdraw from others in this phase.
• Reorganization and Recovery: In the final phase, the bereaved person’s faith in life may start to come back. He or she will start to rebuild and establish new goals, new patterns, and new habits in life. The bereaved will begin to trust again, and grief will recede to the back of his or her mind instead of staying front and center (Williams & Haley, 2017).

Of course, one’s attachment style will influence how grief is experienced as well. For example, someone who is secure may move through the stages fairly quickly or skip some altogether, while someone who is anxious or avoidant may get stuck on one of the stages.

We all experience grief differently, but viewing these experiences through the lens of attachment theory can bring new perspective and insight into our unique grieving processes and why some of us get “stuck” after a loss.

If you’re interested in learning about your attachment style, there are many tests, scales, and questionnaires out available for you to take.

Feeny, Noller, and Hanrahan developed the Original Attachment Three-Category Measure in 1987 to test respondents’ adult attachment style. It contains only three items and is very simple, but it can still give you a good idea of which category you fall into: avoidant, anxious/ambivalent, or secure. You can complete the measure yourself or read more about it on page 3 of  this PDF .

Bartholomew and Horowitz’s Relationships Questionnaire added to The Three-Category Measure by expanding it to include the dismissive-avoidant category. You can find it on the same PDF as the Three-Category Measure, starting on page 3.

Fraley, Waller, and Brennan’s Experiences in Close Relationships Questionnaire-Revised (ECR-R) is a 32-item questionnaire that gives results measured by two subscales related to attachment: avoidance and anxiety (Fraley, Waller, & Brennan, 2000). Items are rated on a scale from 1 (strongly disagree) to 7 (strongly agree). You can find this questionnaire on the final three pages of the PDF mentioned above.

In addition to these scales, there are several less rigorous attachment style tests that can help you learn about your own style of connecting with others. These aren’t instruments often used in empirical research, but they can be helpful tools for learning more about yourself and your attachment style.

Diane Poole Heller developed an Attachment Styles Test, which contains 45 items rated on a three-point scale from “Rarely/Never” to “Usually/Often.” You can find it here , although after completing it you must enter an email to receive your results.

The Relationship Attachment Style Test is a 50-item test hosted on Psychology Today’s website. It covers the four attachment types noted earlier (Secure, Anxious-Ambivalent, Dismissive-Avoidant, Fearful-Avoidant) as well as Dependent and Codependent attachment styles .

If you are interested in taking this test, you can find it at this link . However, be aware that while you receive a free “snapshot report” at the end, you will need to pay to see your full results.

One of the ways in which the principles and concepts of attachment theory have been effectively applied to teaching is the practice of emotion coaching.

Emotion coaching is about helping children to become aware of their emotions and to manage their own feelings particularly during instances of ‘misbehavior.’ It enables practitioners to create an ethos of positive learning behavior and to have the confidence to de-escalate situations when behavior is challenging” (National College for Teaching and Leadership, 2014).

Emotion coaching is more about supporting children in learning about and regulating their own emotions and behavior than it is about “coaching” in the traditional sense. In emotion coaching, teachers are not required—or even encouraged—to promote proper behavior through rewards or punishments.

Instead, emotion coaching involves:

• Teaching students about the world of “in the moment” emotion;
• Showing students strategies for dealing with emotional ups and downs;
• Empathizing with and accepting negative or unpleasant emotions as normal, but not accepting negative behavior;
• Using moments of challenging behavior as opportunities for teaching;
• Building trusting and respectful relationships with the students (National College for Teaching and Leadership, 2014).

According to attachment theory expert Dr. John Gottman, there are five steps to emotion coaching, and they can be practiced by parents, teachers, or any significant adult in a child’s life:

• Tune in: Notice or become aware of your own and the child’s emotions. Make sure you are calm enough to practice emotion coaching, otherwise, you might want to give both of you a quick breather;
• Connect: Use this situation as an opportunity for you to practice and for the child to learn. State objectively (This is important!) what emotions you think the child is experiencing to help them connect their emotions to their behavior;
• Accept and Listen: Practice empathy. Put yourself in the child’s shoes, think about a situation when you felt a similar emotion, and try to remember what it felt like;
• Reflect: Once everyone is calm, go back over what the child said or did, mentioning only what you saw, heard, or understand of the situation. Reflect on what happened and why it happened;
• End with Problem Solving/Choices/Setting Limits: Whenever possible, try to end the situation by guiding or involving the child in problem-solving (Somerset Children & Young People, n.d.).

To learn more about emotion coaching and improve your skills as a parent or teacher, try the following activity.

What Would an Emotion Coach Do?

This short, two-page activity from the Somerset Emotion Coaching Project can help you enhance your understanding of what emotion coaching is—and what it is not.

There are five scenarios presented along with six potential responses. Your task is to read the scenario and decide which response(s) is/are the appropriate emotion coaching response(s).

The first scenario is: “Angry pupil over not wanting to attend a compulsory revision session.”

Your options include:

• Get cross with the pupil for the bad behavior;
• Tell the pupil they will have to complete an extra session due to the bad behavior;
• Help the pupil to think about what they can do about the problem;
• Tell the pupil not to make a big deal about staying after school;
• Validate the pupil’s expression of anger and frustration;
• Soothe the pupil.

This is an excellent activity to do in groups, as you can discuss each option with others and hear different perspectives from your own. In addition to identifying the emotion coaching response(s), you can also discuss which options are dismissive, avoidant, etc.

You can see the rest of the scenarios and try your hand at this activity by clicking here (an automatic download will start when you click on the link).

Emotion Coaching Scripts

Another great resource from the Somerset Emotion Coaching Project, this activity gives you a chance to practice brainstorming emotion coaching-appropriate responses.

As an added bonus, you can use the scripts you develop to guide you the next time you encounter a situation like those described.

There are six scenarios which you are instructed to create a script for:

• A pupil arrives late to class. She refuses to communicate with you and says “Don’t even start, just leave me alone”;
• A young person refuses to sit by her usual friends at a youth center and says that they have been saying unkind comments about her size;
• A boy regularly fails to complete work independently and will often sit passively and contribute little. He rarely presents with disruptive behavior but simply completes very little work. He appears isolated from his peers;
• A nursery child is crying at drop-off time and is clinging to her parent who has to go to work;
• An aggressive, confrontational parent is annoyed because she’s been asked to come in and talk about her son’s behavior. She approaches you and starts the conversation by saying, “You’re always having a go at us”;
• During recess, a group of young boys was fighting and one of them was hurt (not seriously). You approach them and they all look at you with worried expressions.

For each scenario, the instructions encourage you to:

• Recognize the emotion the child is displaying;
• Validate that emotion;
• Label the emotion the child is feeling;
• Empathize with the child;
• Set limits, if appropriate, and problem-solve.

Completing this worksheet provides you with an excellent opportunity to think, plan, and prepare for effective emotion coaching. You can download this activity for your own use here (an automatic download will start when you click on the link).

If you’re interested in learning more about applying attachment theory to teaching, check out Louis Cozolino’s book Attachment-Based Teaching: Creating a Tribal Classroom . He puts forth a simple but potentially game-changing idea: Relationships are the key to better performance rather than rigidly structured curricula.

In addition, our article Attachment Styles in Therapy: Worksheets & Handouts provides useful worksheets pertaining attachment styles.

Emotion coaching can also be used by social workers, to some extent. However, the application of attachment theory to social work is more significant in the three key messages that it espouses:

• It is vital for social workers to offer children and families a safe haven and secure base. This does not mean families should be forever comfortable and come to depend on the social worker, but families should know a social worker can provide a safe place when they are struggling as well as support for moving forward and outward;
• Social workers must be aware of children’s (and their families’) inner experiences and practice mentalization , or “bringing the inside out.” One of the most important factors in finding healing and improving family relations is to ensure that parents have an idea of what is going on in their children’s heads, including how they feel and think about their parents;
• Among the most effective tools in a social worker’s toolbox is the practice of recording parents as they interact with their child and using the videos to coach the parent. Valuable insights can be found in watching oneself parenting, and the social worker can provide in the moment coaching, offering praise for the parents’ strengths alongside suggestions for improvement (Shemmings, 2015).

Of course, there are many ways to apply attachment theory to working with children, especially those who are in the midst of family crises. However, if these three points are attended to, you’ll have the most important bases covered.

For social workers who work with adults, there are some different strategies and key points to keep in mind, specifically:

• Remember that attachment theory applies throughout the entire range of life, and many behaviors and processes are shaped by early attachment, including staying safe, seeking comfort, regulating proximity to the attachment figure, and seeking predictability;
• Keep in mind that attachment patterns are not based on a few key moments, but on thousands of moments throughout early life, and how an attachment figure responds (or does not respond) sets a template for the child’s attachment style in the future. This template affects how the child recognizes and responds to their own emotions and how they interact with attachment figures;
• This early template becomes deeply embedded in the brain and therefore has a significant impact on our ability to regulate our emotions and connect and relate to others in adulthood. This can lead an adult who was abused in childhood to fail to recognize that they are being abused in their intimate relationship, or even cause them to find comfort and stability in the predictability of their situation;
• Remember that attachment behaviors are adaptive to the context in which they were formed. Habits and behaviors that are adaptive in childhood, in an evolutionary sense at least, may become maladaptive and harmful in adulthood;
• Finally, social workers should never think that they are “treating” a set of behaviors and must recognize that the individual’s strategies were formed for a reason and likely helped him or her survive a difficult situation in childhood. The role of a social worker is to help clients avoid overapplying those strategies and to guide them in adding effective, new strategies to their toolboxes (Hardy, 2016).

As with any popular theory in psychology, there are several criticisms that have been raised against it.

Chief among them are the following criticisms:

• Overemphasis on Nurture: This criticism stems from psychologist J. R. Harris, who believes that parents do not have as much of an influence over their child’s personality or character as most people believe. She notes that much of one’s personality is determined by genetics rather than environment (Harris, 1998; Lee, 2003).
• The stressful situation criticism of attachment theory’s limitations notes that the model was based on a child’s reactions in momentary, stressful situations (being separated from one’s parent), and does not provide any insight into how children and parents interact in non-stressful situations;
• Further, the early model did not take into consideration the fact that children can have different kinds of attachments to different people; the attachment with the mother may not represent the attachments formed with others;
• Finally, the mother was viewed as the automatic primary attachment figure in the early model, when the father, stepparent, sibling, grandparent, aunt, or uncle may be the person that the child connects most strongly with (Field, 1996; Lee, 2003).

Although some of these criticisms have faded over time as the theory is injected with new evidence and updated concepts, it is useful to look at any theory with a critical eye.

17 Exercises for Positive, Fulfilling Relationships

Empower others with the skills to cultivate fulfilling, rewarding relationships and enhance their social wellbeing with these 17 Positive Relationships Exercises [PDF].

Created by experts. 100% Science-based.

A few of the most popular books on attachment theory can be found below:

• Attached: The New Science of Adult Attachment and How It Can Help You Find—and Keep—Love by Amir Levine and Rachel Heller ( Amazon );
• Attachment in Psychotherapy by David J. Wallin ( Amazon );
• Handbook of Attachment: Theory, Research, and Clinical Applications (3rd Edition) by Jude Cassidy and Phillip R. Shaver ( Amazon );
• Theories of Attachment: An Introduction to Bowlby, Ainsworth, Gerber, Brazelton, Kennell, & Klaus by Carol Garhart Mooney ( Amazon );
• Insecure in Love: How Anxious Attachment Can Make You Feel Jealous, Needy, and Worried and What You Can Do About It by Leslie Becker-Phelps ( Amazon );
• Wired for Love: How Understanding Your Partner’s Brain and Attachment Style Can Help You Defuse Conflict and Build a Secure Relationship by Dr. Stan Tatkin ( Amazon ).

There are also several great websites that host insightful essays and informative articles about attachment theory and its applications, including:

• www.communitycare.co.uk : The Community Care website calls itself “The heart of your social care career” and offers many interesting pieces on social work, attachment theory, and working with children and families who are struggling.
• “Attachment Theory” by Saul McLeod:  This article provides an excellent, brief introduction to attachment theory, as well as information on the Harlow experiments, the stages of attachment, and Lorenz’s imprinting theory.
• “A Brief Overview of Adult Attachment Theory and Research” by R. Chris Fraley:  This piece from attachment theory expert R. Chris Fraley also gives readers a thorough and academic introduction to familiarize them with the theory.
• “Attachment Styles at Work: Measurement, Collegial Relationships, and Burnout” by Michael P. Leiter, Arla Day, and Lisa Price:  This article , published in the journal Burnout Research in 2015, dives into the applications of attachment theory in the workplace, a subject we didn’t explore in this piece. The authors share some interesting insights about how one’s attachment style affects their relationships and performance in the workplace.

This piece tackled attachment theory, a theory developed by John Bowlby in the 1950s and expanded upon by Mary Ainsworth and countless other researchers in later years. The theory helps explain how our childhood relationships with our caregivers can have a profound impact on our relationships with others as adults.

Although attachment theory may not be able to explain every peculiarity of personality, it lays the foundations for a solid understanding of yourself and those around you when it comes to connecting and interacting with others.

What do you think about attachment theory? Do you think there are attachment styles not covered by the four categories? Are there any other criticisms of attachment theory you think are valid and worthy of discussion? We’d love to hear your thoughts in the comment section.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free .

• Benoit, D. (2004). Infant-parent attachment: Definition, types, antecedents, measurement and outcome. Paediatrics & Child Health, 9(8) , 541-545.
• Bretherton, I. (1992). The origins of Attachment Theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28, 759-775.
• Cherry, K. (2018). The story of Bowlby, Ainsworth, and Attachment Theory: The importance of early emotional bonds. Retrieved from https://www.verywellmind.com/what-is-attachment-theory-2795337
• Field, T. (1996). Attachment and separation in young children. Annual Review of Psychology, 47 , 541-561.
• Firestone, L. (2013). How your attachment style impacts your relationship.  Retrieved from https://www.psychologytoday.com/blog/compassion-matters/201307/how-your-attachment-style-impacts-your-relationship
• Fraley, R. C. (2010). A brief overview of adult attachment theory and research. Retrieved from https://internal.psychology.illinois.edu/~rcfraley/attachment.htm
• Hardy, R. (2016). Tips on applying attachment theory in social work with adults. Retrieved from http://www.communitycare.co.uk/2016/12/06/attachment-theory-social-work-adults/
• Harris, J. R. (1998). The nurture assumption: Why our children turn out the way they do. Free Press.
• Herman, E. (2012). Harry F. Harlow, monkey love experiments. Retrieved from http://pages.uoregon.edu/adoption/studies/HarlowMLE.htm
• Kennedy, J. H., & Kennedy, C. E. (2004). Attachment theory: Implications for school psychology. Psychology in the Schools, 41 , 247-259.
• Lee, E. J. (2003). The attachment system throughout the life course: Review and criticisms of attachment theory . Retrieved from http://www.personalityresearch.org/papers/lee.html
• McLeod, S. (2017). Erik Erikson. Retrieved from https://www.simplypsychology.org/Erik-Erikson.html
• National College for Teaching and Leadership (2014). An introduction to attachment and the implications for learning and behaviour [PDF Slide Presentation] . Retrieved from https://www.bathspa.ac.uk/media/bathspaacuk/education-/research/digital-literacy/education-resource-introduction-to-attatchment.pdf
• Shemmings, D. (2015). How social workers can use attachment theory in direct work. Retrieved from http://www.communitycare.co.uk/2015/09/02/using-attachment-theory-research-help-families-just-assess/
• Somerset Children & Young People Health & Wellbeing. (n.d.). Emotion coaching and self-regulation. Retrieved from http://www.cypsomersethealth.org/?ks=1&page=mhtk_secp_5
• Wells, J., Sueskind, B., & Alcamo, K. (2017). Child and adolescent issues. Retrieved from https://www.goodtherapy.org/learn-about-therapy/issues/child-and-adolescent-issues
• Williams, L., & Haley, E. (2017). Before the five stages were the FOUR stages of grief. Retrieved from https://whatsyourgrief.com/bowlby-four-stages-of-grief/

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What our readers think.

muchas gracias por la información

The linked surveys are problematic, when they refer to intimate or close relationships, particularly for persons who’ve only had one close adult relationship. Or none.

Article is defective (‘to’ instead of ‘too’ aside). Cannot – for the life of me – find the four stages of attachment declared at the outset; only four styles. For what’s it’s worth I experienced paternal absence and maternal rejection – prostitute mother and pimp father – which is to say, no parenting or attachment at all – leading to a hotch-potch of all three non-secure ‘styles’.

how does attachment influences personality development in adulthood.

Good question! We answer this question by linking the different attachment styles to adult behaviors traits in this article: https://positivepsychology.com/attachment-style-worksheets/ (see the subsection ‘Attachment Theory in Psychology: 4 Types & Characteristics’)

Hope this helps!

– Nicole | Community Manager

How do I reference this article

You can reference this article in APA 7th as follows: Ackerman, C. A. (2018, April 27). What is Attachment Theory? Bowlby’s 4 stages explained. PositivePsychology.com. https://positivepsychology.com/attachment-theory/

I think that a big limitation when discussing Attachment Theory, that I haven’t seen addressed, is the effect of trauma on a older child past the early defining stage, or an adult. Bullying, accidents and injury, severe illness, family upheaval, or other significant life events can significantly affect a person’s psychological state, and thus alter a Securely Attached style to one of the other types.

Thank you for an informative article! Do you happen to know of any non-profit organizations that focus on stopping the cycle of maladaptive attachment in families? I’m a student with some ideas for a program that I’d like to pitch to some organizations that serve at risk individuals.

Glad you found the article helpful — that sounds like an interesting idea! Your question’s a little tricky. It’s hard to know how explicitly existing services draw on Bowlby’s principles. However, I suspect that the messages of the framework are likely embedded in various parent support groups and educational opportunities. If you’re interested in the U.S. specifically, maybe check out some of the services listed here and inquire about any curriculums.

Thank you, Nicole!

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Attachment theory and research.

• Pehr Granqvist Pehr Granqvist Stockholm University
•  and  Robbie Duschinsky Robbie Duschinsky Sidney Sussex College Cambridge
• https://doi.org/10.1093/acrefore/9780190236557.013.51
• Published online: 31 August 2021

Attachment theory was founded by John Bowlby (1907–1990), a British child psychiatrist and psychoanalyst. The theory builds on an integration of evolutionary theory and ethology, cybernetics and cognitive science, as well as psychoanalytic object relations theory. The theory postulates that an attachment behavioral system evolved via natural selection processes. Bowlby conceived of the attachment system as a behavioral control system that continuously monitors the offspring’s proximity to caregivers, which has in turn been associated with protection from dangers and thus increased chances of survival and reproduction in humans’ and many other mammals’ ancestral environments. Attachment is a species-wide phenomenon denoting the strong bonds that children form to their caregiver(s), seeking to maintain proximity and communication, protesting separations, and using the caregiver(s) as a safe haven to return to for comfort and protection and as a secure base to explore the environment from. Attachments take time, maturation, and repeated sequences of interaction to form and are typically observed from the second half of children’s first year of life onward. According to the theory, attachment-related experiences with the caregiver(s) become internalized in the form of cognitive-affective representations of self and others (internal working models [IWMs]) that organize the child’s behavior and displays of affect in relation to the caregiver(s). Although malleable, such IWMs display a certain measure of continuity across time and situations and may generalize to affect the individual’s expectancies and behavioral inclinations in other and later interpersonal relationships. As pioneered by Mary Ainsworth and colleagues, attachments vary in quality, largely depending on the caregiver’s behaviors (e.g., responsivity and sensitivity to the child’s signals), whereas evidence for a direct influence of genetic heritability is limited. Variations in attachment are typically described using two dimensions (secure–insecure, organized–disorganized) subsuming four categories (secure, insecure–avoidant, insecure-resistant–ambivalent, disorganized–disoriented). Much of the empirical research regarding attachment has focused on these variations and their measurement. Ainsworth and colleagues’ Strange Situation Procedure (SSP), applicable for children aged 10–18 months, is often heralded as the “gold standard” attachment measurement tool. The concerted body of research indicates that secure attachment (or associated factors), marked by confidence in the caregiver’s availability, is generally a protective factor in socioemotional development. In contrast, insecure (avoidant and resistant) attachment, characterized by lack of confidence in the caregiver’s availability, is generally a vulnerability factor in development. Disorganized attachment, reflecting confused, conflicted, or apprehensive child behaviors in the presence of the caregiver (in the SSP), is a risk factor in development, most notably for externalizing behavior problems. Notably, the effect sizes observed have typically been small to moderate, and much is unknown about linking mechanisms and moderating influences. Although most readily observed in early childhood, humans form attachments throughout the lifespan. Accordingly, much research has also focused on adult (e.g., spousal) attachment and the intergenerational transmission of attachment from caregivers to their children.

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John Bowlby’s Attachment Theory

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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John Bowlby (1907 – 1990) was a psychoanalyst (like Freud) and believed that mental health and behavioral problems could be attributed to early childhood.

Key Takeaways

• Bowlby’s evolutionary theory of attachment suggests that children come into the world biologically pre-programmed to form attachments with others, because this will help them to survive.
• Bowlby argued that a child forms many attachments, but one of these is qualitatively different. This is what he called primary attachment, monotropy.
• Bowlby suggests that there is a critical period for developing attachment (2.5 years). If an attachment has not developed during this time period, then it may well not happen at all. Bowlby later proposed a sensitive period of up to 5 years.
• Bowlby’s maternal deprivation hypothesis suggests that continual attachment disruption between the infant and primary caregiver could result in long-term cognitive, social, and emotional difficulties for that infant.
• According to Bowlby, an internal working model is a cognitive framework comprising mental representations for understanding the world, self, and others, and is based on the relationship with a primary caregiver.
• It becomes a prototype for all future social relationships and allows individuals to predict, control, and manipulate interactions with others.

Evolutionary Theory of Attachment

Bowlby (1969, 1988) was greatly influenced by ethological theory, but especially by Lorenz’s (1935) study of imprinting .  Lorenz showed that attachment was innate (in young ducklings) and therefore had a survival value.

During the evolution of the human species, it would have been the babies who stayed close to their mothers that would have survived to have children of their own.  Bowlby hypothesized that both infants and mothers had evolved a biological need to stay in contact with each other.

Bowlby (1969) believed that attachment behaviors (such as proximity seeking) are instinctive and will be activated by any conditions that seem to threaten the achievement of proximity, such as separation, insecurity, and fear.

Bowlby also postulated that the fear of strangers represents an important survival mechanism, built-in by nature.

Babies are born with the tendency to display certain innate behaviors (called social releases), which help ensure proximity and contact with the mother or attachment figure (e.g., crying, smiling, crawling, etc.) – these are species-specific behaviors.

These attachment behaviors initially function like fixed action patterns and share the same function. The infant produces innate ‘social releaser’ behaviors such as crying and smiling that stimulate caregiving from adults.

The determinant of attachment is not food but care and responsiveness.

Bowlby’s monotropic theory

A child has an innate (i.e., inborn) need to attach to one main attachment figure (i.e., monotropy).

Bowlby’s monotropic theory of attachment suggests attachment is important for a child’s survival.

Attachment behaviors in both babies and their caregivers have evolved through natural selection. This means infants are biologically programmed with innate behaviors that ensure that attachment occurs.

Although Bowlby did not rule out the possibility of other attachment figures for a child, he did believe that there should be a primary bond which was much more important than any other (usually the mother).

Other attachments may develop in a hierarchy below this. An infant may therefore have a primary monotropy attachment to its mother, and below her, the hierarchy of attachments may include its father, siblings, grandparents, etc.

Bowlby believes that this attachment is qualitatively different from any subsequent attachments.  Bowlby argues that the relationship with the mother is somehow different altogether from other relationships.

The child behaves in ways that elicit contact or proximity to the caregiver.  When a child experiences heightened arousal, he/she signals to their caregiver.

Crying, smiling, and locomotion are examples of these signaling behaviors.  Instinctively, caregivers respond to their children’s behavior, creating a reciprocal pattern of interaction.

Critical Period

A child should receive the continuous care of this single most important attachment figure for approximately the first two years of life.

Bowlby (1951) claimed that mothering is almost useless if delayed until after two and a half to three years and, for most children, if delayed till after 12 months, i.e., there is a critical period.

If the attachment figure is broken or disrupted during the critical two-year period, the child will suffer irreversible long-term consequences of this maternal deprivation.  This risk continues until the age of five.

Bowlby used the term maternal deprivation to refer to the separation or loss of the mother as well as the failure to develop an attachment.

The underlying assumption of Bowlby’s Maternal Deprivation Hypothesis is that continual disruption of the attachment between infant and primary caregiver (i.e., mother) could result in long-term cognitive, social, and emotional difficulties for that infant.

The implications of this are vast – if this is true, should the primary caregiver leave their child in daycare, while they continue to work?

Maternal Deprivation

Bowlby’s maternal deprivation hypothesis suggests that continual attachment disruption between the infant and primary caregiver (i.e., mother) could result in long-term cognitive, social, and emotional difficulties for that infant.

Bowlby (1988) suggested that the nature of monotropy (attachment conceptualized as being a vital and close bond with just one attachment figure) meant that a failure to initiate or a breakdown of the maternal attachment would lead to serious negative consequences, possibly including affectionless psychopathy.

Bowlby’s theory of monotropy led to the formulation of his maternal deprivation hypothesis.

John Bowlby (1944) believed that the infant’s and mother’s relationship during the first five years of life was crucial to socialization.

According to Bowlby, if separation from the primary caregiver occurs during the critical period and there is no adequate substitute emotional care, the child will suffer from deprivation.

This will lead to irreversible long-term consequences in the child’s intellectual, social, and emotional development.

Bowlby initially believed the effects to be permanent and irreversible:

• delinquency,
• reduced intelligence,
• increased aggression,
• depression,
• affectionless psychopathy

Bowlby also argued that the lack of emotional care could lead to affectionless psychopathy,

Affectionless psychopathy is characterized by a lack of concern for others, a lack of guilt, and the inability to form meaningful relationships.

Such individuals act on impulse with little regard for the consequences of their actions.  For example, showing no guilt for antisocial behavior.

The prolonged deprivation of the young child of maternal care may have grave and far-reaching effects on his character and so on the whole of his future life (Bowlby, 1952, p. 46).

Bowlby believed that disrupting this primary relationship could lead to a higher incidence of juvenile delinquency, emotional difficulties, and antisocial behavior. To test his hypothesis, he studied 44 adolescent juvenile delinquents in a child guidance clinic.

Bowlby 44 Thieves

To investigate the long-term effects of maternal deprivation on people to see whether delinquents have suffered deprivation.

According to the Maternal Deprivation Hypothesis, breaking the maternal bond with the child during their early life stages is likely to affect intellectual, social, and emotional development seriously.

Between 1936 and 1939, an opportunity sample of 88 children was selected from the clinic where Bowlby worked. Of these, 44 were juvenile thieves (31 boys and 13 girls) who had been referred to him because of their stealing.

Bowlby selected another group of 44 children (34 boys and 10 girls) to act as ‘controls (individuals referred to the clinic because of emotional problems but not yet committed any crimes).

On arrival at the clinic, each child had their IQ tested by a psychologist who assessed their emotional attitudes toward the tests. The two groups were matched for age and IQ.

The children and their parents were interviewed to record details of the child’s early life (e.g., periods of separation, diagnosing affectionless psychopathy) by a psychiatrist (Bowlby), a psychologist, and a social worker.  The psychiatrist, psychologist, and social worker made separate reports.

Bowlby found that 14 children from the thief group were identified as affectionless psychopaths (they were unable to care about or feel affection for others); 12 had experienced prolonged separation of more than six months from their mothers in their first two years of life.

In contrast, only 5 of the 30 children not classified as affectionless psychopaths had experienced separations.

Out of the 44 children in the control group, only two experienced prolonged separations, and none were affectionless psychopaths.

The results support the maternal deprivation hypothesis as they show that most of the children diagnosed as affectionless psychopaths (12 out of 14) had experienced prolonged separation from their primary caregivers during the critical period, as the hypothesis predicts

Bowlby concluded that maternal deprivation in the child’s early life caused permanent emotional damage.

He diagnosed this as a condition and called it Affectionless Psychopathy. According to Bowlby, this condition involves a lack of emotional development, characterized by a lack of concern for others, a lack of guilt, and an inability to form meaningful and lasting relationships.

Bowlby directly observed parental separation’s harm in evacuating children from bombing during WWII, strengthening his hospital research indicating it profoundly impacts children’s emotional and behavioral development.

Limitations

The supporting evidence that Bowlby (1944) provided was in the form of clinical interviews of, and retrospective data on, those who had and had not been separated from their primary caregiver.

This meant that Bowlby asked the participants to look back and recall separations.  These memories may not be accurate.

A criticism of the 44 thieves study was that it concluded affectionless psychopathy was caused by maternal deprivation.  This is correlational data and only shows a relationship between these two variables. It cannot show a cause-and-effect relationship between separation from the mother and the development of affectionless psychopathy.

Other factors could have been involved, such as the reason for the separation, the role of the father, and the child’s temperament. Thus, as Rutter (1972) pointed out, Bowlby’s conclusions were flawed, mixing up cause and effect with correlation.

Many of the 44 thieves in Bowlby’s study had been moved around a lot during childhood, and had probably never formed an attachment.  This suggested that they were suffering from privation, rather than deprivation, which Rutter (1972) suggested was far more deleterious to the children. This led to a very important study on the long-term effects of privation, carried out by Hodges and Tizard (1989).

The study was vulnerable to researcher bias. Bowlby conducted the psychiatric assessments himself and made the diagnosis of Affectionless Psychopathy. He knew whether the children were in the ‘theft group’ or the control group. Consequently, his findings may have been unconsciously influenced by his own expectations. This potentially undermines their validity.

Bowlby struggled to apply his new maladaptation model to retrospective research on adolescents with conduct problems, as such studies prejudice outcomes by selecting for problems and then looking backward.

Cautious of this, in 1950, Bowlby, Robertson, and new researcher Mary Ainsworth (1956) began a forward-looking “follow-up study” on whether preschoolers who were hospitalized long-term subsequently developed conduct issues.

Assessing 60 such children aged 6-13 and controls, contrary to maternal deprivation hypotheses, they found more emotional apathy, withdrawal, and poor control than criminality.

So, while early prolonged separation impacted some children’s later adjustment, outcomes proved far more varied than Bowlby’s theory initially predicted. The improved prospective methodology highlighted limitations in Bowlby’s previous retrospective approaches.

In the conclusions of the paper Bowlby admitted that his theory regarding the development of conduct problems may be wrong:

It is clear that some of the workers, including the present senior author, in their desire to call attention to dangers which can often be avoided have on occasion overstated their case. In particular, statements implying that children who are brought up in institutions or who suffer other forms of serious privation and deprivation in early life commonly develop psychopathic or affectionless characters (e.g., Bowlby, 1944) are seen to be mistaken. (Bowlby et al., 1956, p. 240)

Short-Term Separation

When WWII ended in 1945, Bowlby had to choose between completing child psychoanalysis training or researching parental separation’s impact on children. He chose the latter, joining colleagues at London’s Tavistock Clinic.

Robertson and Bowlby (1952) believe that short-term separation from an attachment figure leads to distress.

John Bowlby spent two years working alongside a social worker, James Robertson (1952), who observed that children experienced intense distress when separated from their mothers. Even when other caregivers fed such children, this did not diminish the child’s anxiety.

They found three progressive stages of distress:

• Protest : The child cries, screams, and protests angrily when the parent leaves. They will try to cling to their parents to stop them from leaving. Protest could last from a few hours to several days.
• Despair : The child’s protesting gradually stops, and they appear calmer, although still upset. The child refuses others’ attempts for comfort and often seems withdrawn and uninterested in anything. In the despair stage, children become increasingly withdrawn and hopeless.
• Detachment : If separation continues, the child will engage with other people again. All emotions are suppressed, and children live moment-to-moment by repressing feelings for their mother. On the surface, children were seen to be happy and content, but when the mother visited, they frequently ignored her and hardly cried when she left. If this state continues, children become so withdrawn as to seek no mothering at all – a sign of major psychological trauma.

Controversy arose between Bowlby and Robertson regarding the stages of separation, particularly the third stage, which Robertson termed denial, but Bowlby called detachment.

However, both powerfully influenced attitudes and practices around keeping mothers and children together. This led to advocacy for allowing parental presence and major reforms in hospital policies.

A Two-Year-Old Goes to Hospital

Though doctors saw the despair phase as adjustment, Bowlby felt it showed distress’s harm.

To demonstrate this, Robertson filmed two-year-old Laura’s distress when hospitalized for eight days for minor surgery in “ A Two-Year-Old Goes to Hospital ” (1952).

Time series photography showed the stages through which a small child, Laura, passed during her 8-day admission for umbilical hernia repair. The film graphically depicted Laura’s behavior while separated from her mother for a period of time in strange circumstances” (Alsop-Shields & Mohay, 2001).

Laura cries out for her mother from admission onward, pleading in anguish to go home when visited the second day. As the week progresses, her initial constant distress gives way to listlessness and detachment during the parents’ increasingly ambivalent visits.

However, when approached by hospital staff, Laura startles out of her trance to suddenly burst into tears and fruitlessly call for her mother once more.

The raw behaviors captured on film revealed the three-phase separation response of protest, despair, and detachment observed in Bowlby and Robertson’s prior research.

Laura’s suffering starkly contradicts expectations of childrens’ ready hospital adjustment, instead demonstrating their deep distress from both physical separation and the hospital environment itself.

These findings contradicted the dominant behavioral theory of attachment (Dollard and Miller, 1950), which was shown to underestimate the child’s bond with their mother.  The behavioral theory of attachment states that the child becomes attached to the mother because she feeds the infant.

Implications for nursing include the development of family-centered care models keeping parents integral to a child’s hospital care in order to minimize trauma, principles now widely implemented as a result of this pioneering work on attachment.

Internal Working Model

The child’s attachment relationship with their primary caregiver leads to the development of an internal working model (Bowlby, 1969).

This internal working model is a cognitive framework comprising mental representations for understanding the world, self, and others.

The social and emotional responses of the primary caregiver provide the infant with information about the world and other people, and also how they view themselves as individuals.

For example, the extent to which an individual perceives himself/herself as worthy of love and care, and information regarding the availability and reliability of others (Bowlby, 1969).

Bowlby referred to this knowledge as an internal working model (IWM), which begins as a mental and emotional representation of the infant’s first attachment relationship and forms the basis of an individual’s attachment style.

A person’s interaction with others is guided by memories and expectations from their internal model which influence and help evaluate their contact with others (Bretherton & Munholland, 1999).

Working models also comprise cognitions of how to behave and regulate affect when a person’s attachment behavioral system is activated, and notions regarding the availability of attachment figures when called upon.

Bowlby (1969) suggested that the first five years of life were crucial to developing the IWM, although he viewed this as more of a sensitive period rather than a critical one.

Around the age of three, these seem to become part of a child’s personality and thus affect their understanding of the world and future interactions with others (Schore, 2000).

According to Bowlby (1969), the primary caregiver acts as a prototype for future relationships via the internal working model.

There are three main features of the internal working model: (1) a model of others as being trustworthy, (2) a model of the self as valuable, and (3) a model of the self as effective when interacting with others.

It is this mental representation that guides future social and emotional behavior as the child’s internal working model guides their responsiveness to others in general.

The concept of an internal model can be used to show how prior experience is retained over time and to guide perceptions of the social world and future interactions with others.

Early models are typically reinforced via interactions with others over time, and become strengthened and resistant to change, operating mostly at an unconscious level of awareness.

Although working models are generally stable over time they are not impervious to change and as such remain open to modification and revision.  This change could occur due to new experiences with attachment figures or through a reconceptualization of past experiences.

Although Bowlby (1969, 1988) believed attachment to be monotropic, he did acknowledge that rather than being a bond with one person, multiple attachments can occur arranged in the form of a hierarchy.

A person can have many internal models, each tied to different relationships and different memory systems, such as semantic and episodic (Bowlby, 1980).

Collins and Read (1994) suggest a hierarchical model of attachment representations whereby general attachment styles and working models appear on the highest level, while relationship-specific models appear on the lowest level.

General models of attachment are thought to originate from early relationships during childhood, and are carried forward to adulthood where they shape perception and behavior in close relationships.

Attachment & Loss Trilogy

The attachment books trilogy developed key concepts regarding attachment, separation distress, loss responses, and clinical implications over the course of the three volumes.

Attachment (1969/1982)

• Provided evidence for the importance of early parent-child relationships.
• Analyzed the systemic and “goal-corrected” nature of behavior.
• Introduced the concept of an “environment of adaptedness” that organisms inherit a potential to develop systems suited for.
• Discussed how attachment behaviors in infants are components of an attachment system designed to achieve security.
• Explained how attachment behaviors change via feedback from caregivers, becoming oriented toward discriminated figures.
• Posited attachment as a foundational system for survival that interacts with other systems like exploration.

Separation (1973)

• Focused on the negative impacts of separation from attachment figures.
• Outlined phases of separation responses in infants and children.
• Analyzed short- and long-term pathological effects of loss or deprivation.
• Studied how mourning progresses in relation to attachment bonds.
• Linked separation distress and avoidance to later issues of delinquency.

Loss (1980)

• Explored the concept of “loss” in relation to attachment theory.
• Proposed stages of the mourning process.
• Studied outcomes following the loss of an attachment figure.
• Examined detachment and defense processes resulting from loss.
• Applied attachment theory understanding to treatment approaches.

Critical Evaluation

Implications for children’s nursing.

• During Robertson and Bowlby’s research, the British government established a parliamentary committee investigating children’s hospital conditions. This resulted in the 1959 Platt Report, containing 55 recommendations, including allowing parental presence and provisions for their accommodation and children’s education/recreation (Alsop-Shields & Mohay, 2001).
• Robertson also specifically critiqued task-oriented nursing and childcare institutions (Robertson, 1955, 1968, 1970) as emotionally neglectful. He and Bowlby suggested dysfunctional families be kept together but supported (Robertson & Bowlby, 1952) – principles now accepted but decades ahead of their time.
• Robertson and Bowlby’s work has greatly influenced the development of family-centered pediatric nursing models like partnership-in-care and family-centered care in the 1990s. By planning care around the whole family unit rather than just the hospitalized child, and involving parents closely in care, these models aim to reduce emotional trauma for children.

Bifulco et al. (1992) support the maternal deprivation hypothesis. They studied 250 women who had lost mothers, through separation or death, before they were 17.

They found that the loss of their mother through separation or death doubles the risk of depressive and anxiety disorders in adult women. The rate of depression was the highest in women whose mothers had died before the child reached 6 years.

Mary Ainsworth’s (1971, 1978) Strange Situation study provides evidence for the existence of the internal working model. A secure child will develop a positive internal working model because it has received sensitive, emotional care from its primary attachment figure.

An insecure-avoidant child will develop an internal working model in which it sees itself as unworthy because its primary attachment figure has reacted negatively to it during the sensitive period for attachment formation.

Bowlby’s Maternal Deprivation is supported by Harlow’s (1958) research with monkeys .  Harlow showed that monkeys reared in isolation from their mother suffered emotional and social problems in older age.  The monkey’s never formed an attachment (privation) and, as such grew up to be aggressive and had problems interacting with other monkeys.

Konrad Lorenz (1935) supports Bowlby’s maternal deprivation hypothesis as the attachment process of imprinting is an innate process.

Bowlby’s (1944, 1956) ideas had a significant influence on the way researchers thought about attachment, and much of the discussion of his theory has focused on his belief in monotropy.

Although Bowlby may not dispute that young children form multiple attachments, he still contends that the attachment to the mother is unique in that it is the first to appear and remains the strongest.  However, the evidence seems to suggest otherwise on both of these counts.

• Schaffer & Emerson (1964) noted that specific attachments started at about eight months, and very shortly thereafter, the infants became attached to other people. By 18 months, very few (13%) were attached to only one person; some had five or more attachments.
• Rutter (1972) points out that several indicators of attachment (such as protest or distress when an attached person leaves) have been shown for various attachment figures – fathers, siblings, peers, and even inanimate objects.

Critics such as Rutter have also accused Bowlby of not distinguishing between deprivation and privation – the complete lack of an attachment bond, rather than its loss.  Rutter stresses that the quality of the attachment bond is the most important factor, rather than just deprivation in the critical period.

Bowlby used the term maternal deprivation to refer to the separation or loss of the mother as well as the failure to develop an attachment.  Are the effects of maternal deprivation as dire as Bowlby suggested?

Michael Rutter (1972) wrote a book called Maternal Deprivation Re-assessed .  In the book, he suggested that Bowlby may have oversimplified the concept of maternal deprivation.

Bowlby used the term “maternal deprivation” to refer to separation from an attached figure, loss of an attached figure and failure to develop an attachment to any figure.  These each have different effects, argued Rutter.  In particular, Rutter distinguished between privation and deprivation.

Michael Rutter (1981) argued that if a child fails to develop an emotional bond , this is privation, whereas deprivation refers to the loss of or damage to an attachment.

Deprivation might be defined as losing something that a person once had, whereas privation might be defined as never having something in the first place.

From his survey of research on privation, Rutter proposed that it is likely to lead initially to clinging, dependent behavior, attention-seeking, and indiscriminate friendliness, then as the child matures, an inability to keep rules, form lasting relationships, or feel guilt.

He also found evidence of anti-social behavior, affectionless psychopathy, and disorders of language, intellectual development and physical growth.

Rutter argues that these problems are not due solely to the lack of attachment to a mother figure, as Bowlby claimed, but to factors such as the lack of intellectual stimulation and social experiences that attachments normally provide.  In addition, such problems can be overcome later in the child’s development, with the right kind of care.

Bowlby assumed that physical separation on its own could lead to deprivation, but Rutter (1972) argues that it is the disruption of the attachment rather than the physical separation.

This is supported by Radke-Yarrow (1985), who found that 52% of children whose mothers suffered from depression were insecurely attached. This figure raised to 80% when this occurred in a context of poverty (Lyons-Ruth,1988). This shows the influence of social factors. Bowlby did not take into account the quality of the substitute care. Deprivation can be avoided if there is good emotional care after separation.

Is attachment theory sexist?

Feminist critics argue Bowlby’s attachment theory is sexist for overly emphasizing mothers as ideal caregivers while neglecting other influences like fathers (e.g., Vicedo, 2017).

His popular 1950s parenting articles reinforced gender roles by proclaiming mothers uniquely important and always available. Critics also attacked his concept “monotropy” – instincts focused on one caregiver, presumably the mother.

However, Bowlby’s academic writings use phrases like “mothers or foster-mothers,” adoptive mothers, and “mother substitutes,” acknowledging many can serve as primary caregiver.

He never scientifically stated only biological mothers suffice. While “monotropy” poorly implies a singular caregiver, Bowlby meant children form one main attachment, not only to mothers. So academically, Bowlby did not limit caregivers to mothers, though his public emphasis on maternal deprivation and parenting did reinforce gender biases.

There are implications arising from Bowlby’s work.  He reinforced the idea that a mother should be the most central caregiver and that this care should be given continuously. An obvious implication is that mothers should not go out to work.  There have been many attacks on this claim:

• Mothers are the exclusive carers in only a very small percentage of human societies; often there are a number of people involved in the care of children, such as relations and friends (Weisner, & Gallimore, 1977).
• Van Ijzendoorn, & Tavecchio (1987) argue that a stable network of adults can provide adequate care and that this care may even have advantages over a system where a mother has to meet all a child’s needs.
• There is evidence that children develop better with a mother who is happy in her work, than a mother who is frustrated by staying at home (Schaffer, 1990).

Ainsworth, M. D. S., Bell, S. M., & Stayton, D. J. (1971) Individual differences in strange- situation behavior of one-year-olds. In H. R. Schaffer (Ed.)  The origins of human social relations . London and New York: Academic Press. Pp. 17-58.

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978).  Patterns of attachment: A psychological study of the strange situation . Hillsdale, NJ: Erlbaum.

Alsop‐Shields, L., & Mohay, H. (2001). John Bowlby and James Robertson: theorists, scientists and crusaders for improvements in the care of children in hospital.  Journal of advanced nursing ,  35 (1), 50-58.

Bifulco, A., Harris, T., & Brown, G. W. (1992). Mourning or early inadequate care? Reexamining the relationship of maternal loss in childhood with adult depression and anxiety. Development and Psychopathology, 4(03) , 433-449.

Bowlby, J. (1944). Forty-four juvenile thieves: Their characters and home life. International Journal of Psychoanalysis, 25(19-52) , 107-127.

Bowlby, J. (1951). Maternal care and mental health . World Health Organization Monograph.

Bowlby, J. (1952). Maternal care and mental health. Journal of Consulting Psychology, 16(3) , 232.

Bowlby, J. (1953). Child care and the growth of love . London: Penguin Books.

Bowlby, J. (1956). Mother-child separation. Mental Health and Infant Development, 1, 117-122.

Bowlby, J. (1957). Symposium on the contribution of current theories to an understanding of child development. British Journal of Medical Psychology, 30(4) , 230-240.

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

Bowlby, J. (1980). Loss: Sadness & depression. Attachment and loss (vol. 3); (International psycho-analytical library no.109). London: Hogarth Press.

Bowlby, J. (1988). Attachment, communication, and the therapeutic process. A secure base: Parent-child attachment and healthy human development , 137-157.

Bowlby, J., Ainsworth, M., Boston, M., & Rosenbluth, D. (1956). The effects of mother‐child separation: a follow‐up study .  British Journal of Medical Psychology ,  29 (3‐4), 211-247.

Bowlby, J., and Robertson, J. (1952). A two-year-old goes to hospital. Proceedings of the Royal Society of Medicine, 46, 425–427.

Bretherton, I., & Munholland, K.A. (1999). Internal working models revisited. In J. Cassidy & P.R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 89– 111) . New York: Guilford Press.

Collins, N. L., & Read, S. J. (1994). Cognitive representations of adult attachment: The structure and function of working models. In K. Bartholomew & D. Perlman (Eds.) Advances in personal relationships, Vol. 5: Attachment processes in adulthood  (pp. 53-90). London: Jessica Kingsley.

Harlow, H. F., & Zimmermann, R. R. (1958). The development of affective responsiveness in infant monkeys. Proceedings of the American Philosophical Society, 102 ,501 -509.

Hodges, J., & Tizard, B. (1989). Social and family relationships of ex‐institutional adolescents. Journal of Child Psychology and Psychiatry, 30(1) , 77-97.

Lorenz, K. (1935). Der Kumpan in der Umwelt des Vogels. Der Artgenosse als auslösendes Moment sozialer Verhaltensweisen. Journal für Ornithologie 83, 137–215.

Lyons-Ruth, K., Zoll, D., Connell, D., & Grunebaum, H. E. (1986). The depressed mother and her one-year-old infant: Environment, interaction, attachment, and infant development. In E. Tronick & T. Field (Eds.), Maternal depression and infant disturbance (pp. 61-82). San Francisco: Jossey-Bass.

Ministry of Health (1959). The Welfare of Children in Hospital, Platt Report . London: Her Majesty’s Stationery Office.

Radke-Yarrow, M., Cummings, E. M., Kuczynski, L., & Chapman, M. (1985). Patterns of attachment in two-and three-year-olds in normal families and families with parental depression. Child development , 884-893.

Robertson J. (1953). A Two-Year-Old Goes to Hospital: A Scientific Film Record (Film) . Concord Film Council, Nacton.

Robertson, J. (1955). Young children in long-term hospitals.  Nursing Times ,  23 (9).

Robertson, J. (1958).  Going to Hospital with Mother: A Guide to the Documentary Film . Tavistock Child Development Research Unit.

Robertson, J. (1968). The long-stay child in hospital.  Maternal Child Care ,  4 (40), 161-6.

Robertson, J., & Robertson, J. (1968). Jane 17 months; in fostercare for 10 days.  London: Tavistock Institute of Human Relations. Film .

Robertson, J., & Robertson, J. (1971). Young children in brief separation: A fresh look.  The psychoanalytic study of the child ,  26 (1), 264-315.

Rutter, M. (1972). Maternal deprivation reassessed. Harmondsworth: Penguin.

Rutter, M. (1979). Maternal deprivation, 1972-1978: New findings, new concepts, new approaches. Child Development , 283-305.

Rutter, M. (1981). Stress, coping and development: Some issues and some questions. Journal of Child Psychology and Psychiatry, 22(4) , 323-356.

Schaffer, H. R. & Emerson, P. E. (1964). The development of social attachments in infancy. Monographs of the Society for Research in Child Development , 29 (3), serial number 94.

Schore, A. N. (2000). Attachment and the regulation of the right brain. Attachment & Human Development, 2(1) , 23-47.

Tavecchio, L. W., & Van Ijzendoorn, M. H. (Eds.). (1987). Attachment in social networks: Contributions to the Bowlby-Ainsworth attachment theory . Elsevier.

Vicedo, M. (2020). Attachment Theory from Ethology to the Strange Situation. In  Oxford Research Encyclopedia of Psychology .

Weisner, T. S., & Gallimore, R. (1977). My brother’s keeper: Child and sibling caretaking. Current Anthropology, 18(2) , 169.

Further Reading

• The Internal Working Models Concept: What Do We Really Know About the Self in Relation to Others?
• The Effects of Maternal Deprivation
• Davies, R. (2010). Marking the 50th anniversary of the Platt Report: from exclusion, to toleration and parental participation in the care of the hospitalized child .  Journal of Child Health Care ,  14 (1), 6-23.
• Bowlby, J. (1963). Pathological mourning and childhood mourning .  Journal of the American Psychoanalytic Association ,  11 (3), 500-541.

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Stages of Attachment Identified by John Bowlby And Schaffer & Emerson (1964)

Attachment Theory In Psychology

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• Introduction

Normative features of attachment theory

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attachment theory , in developmental psychology , the theory that humans are born with a need to form a close emotional bond with a caregiver and that such a bond will develop during the first six months of a child’s life if the caregiver is appropriately responsive. Developed by the British psychologist John Bowlby , the theory focused on the experience, expression, and regulation of emotions at both species (normative) and individual (person-specific) levels of analysis.

Bowlby believed that the attachment system, as he and others called it, served two primary functions: to protect vulnerable individuals from potential threats or harm and to regulate negative emotions following threatening or harmful events. The normative component of attachment theory identifies the stimuli and contexts that normally evoke and terminate different kinds of emotions, as well as the sequence of emotions usually experienced following certain relational events. The individual-difference component addresses how people’s personal histories of receiving care and support from attachment figures shape their goals, working models (i.e., interpersonal attitudes, expectations, and cognitive schemas), and coping strategies when emotion-eliciting events in relationships occur.

Bowlby’s fascination with the emotional ties that bind humans to each other began with an astute observation. In all human cultures and indeed in primate species, young and vulnerable infants display a specific sequence of reactions following separation from their stronger, older, and wiser caregivers. Immediately following separation, infants protest vehemently, typically crying, screaming, or throwing temper tantrums as they search for their caregivers. Bowlby believed that vigorous protest during the early phases of caregiver absence is a good initial strategy to promote survival, especially in species born in a developmentally immature and very dependent state. Intense protests often draw the attention of caregivers to their infants, who would have been vulnerable to injury or predation during evolutionary history if left unattended.

If loud and persistent protests fail to get the caregiver’s attention, infants enter a second stage, known as despair, during which they usually stop moving and become silent. Bowlby believed that from an evolutionary standpoint, despondency is a good second strategy to promote survival. Excessive movement could result in accident or injury, and loud protests combined with movement might draw predators. According to this logic, if protests fail to retrieve the caregiver quickly, the next best survival strategy would be to avoid actions that might increase the risk of self-inflicted harm or predation.

After a period of despair, infants who are not reunited with their caregivers enter a third and final stage: detachment. During this phase, the infant begins to resume normal activity without the caregiver, gradually learning to behave in an independent and self-reliant manner. Bowlby believed that the function of emotional detachment is to allow the formation of new emotional bonds with new caregivers. He reasoned that emotional ties with previous caregivers must be relinquished before new bonds can fully be formed. In terms of evolution , detachment allows infants to cast off old ties and begin forming new ones with caregivers who might be able to provide the attention and resources needed for survival. Bowlby also conjectured that these normative stages and processes characterize reactions to prolonged or irrevocable separations in adult relationships, which might also have evolutionary adaptive value in terms of maintaining, casting aside, or forming new romantic pairings.

In addition to identifying the course and function of these three distinct stages, Bowlby also identified several normative behaviours that infants commonly display in attachment relationships. Such hallmark behaviours include sucking, clinging, crying, smiling, and following the caregiver, all of which serve to keep the infant or child in close physical proximity to the caregiver. Bowlby also documented unique features of caregivers and their interactions with the infant that are likely to promote attachment bonds. The features include the competence with which the caregiver alleviates the infant’s distress, the speed with which the caregiver responds to the infant, and the familiarity of the caregiver to the infant. These behaviours and features are also believed to be critical to the development of adult attachment relationships.

What Is Attachment Theory? Definition and Stages

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Attachment describes the deep, long-term bonds that form between two people. John Bowlby originated attachment theory to explain how these bonds form between an infant and a caregiver, and Mary Ainsworth later expanded on his ideas. Since it was initially introduced, attachment theory has become one of the most well-known and influential theories in the field of psychology.

Key Takeaways: Attachment Theory

• Attachment is a deep, emotional bond that forms between two people.
• According to psychologist John Bowlby, in the context of evolution, children’s attachment behaviors evolved to make sure they could successfully remain under the protection of their caregivers in order to survive.
• Bowlby specified four phases of child-caregiver attachment development: 0-3 months, 3-6 months, 6 months to 3 years, and 3 years through the end of childhood.
• Expanding on Bowlby's ideas, Mary Ainsworth pointed to three attachment patterns: secure attachment, avoidant attachment, and resistant attachment. A fourth attachment style, disorganized attachment, was later added.

Origins of Attachment Theory

While working with maladjusted and delinquent children in the 1930s, psychologist John Bowlby noticed that these children had trouble forming close relationships with others. He looked into the children’s family histories and noticed that many of them had endured disruptions in their home lives at an early age. Bowlby came to the conclusion that the early emotional bond established between a parent and their child is key to healthy development. As a result, challenges to that bond could have consequences that impact a child throughout their lifetime. Bowlby delved into a number of perspectives to develop his ideas, including psychodynamic theory , cognitive and developmental psychology, and ethology (the science of human and animal behavior within the context of evolution). The result of his work was attachment theory.

At the time, it was believed that babies become attached to their caregivers because they fed the baby. This behaviorist perspective , saw attachment as a learned behavior.

Bowlby offered a different perspective. He said that human development should be understood in the context of evolution . Infants survived throughout much of human history by ensuring they stayed in close proximity to adult caregivers. Children’s attachment behaviors evolved to make sure the child could successfully remain under the protection of their caregivers. Consequently, the gestures, sounds, and other signals infants give off to attract the attention of and maintain contact with adults are adaptive.

Phases of Attachment

Bowlby specified four phases during which children develop attachment to their caretakers.

Phase 1: Birth to 3 Months

From the time they’re born, infants show a preference for looking at human faces and listening to human voices. During the first two to three months of life, infants respond to people but they don’t distinguish between them. At around 6 weeks, the sight of human faces will elicit social smiles, in which babies will happily smile and make eye contact. While the baby will smile at any face that appears in their line of sight, Bowlby suggested that social smiling increases the chances that the caretaker will respond with loving attention, promoting attachment. The baby also encourages attachment with caregivers through behaviors like babbling, crying, grasping, and sucking. Each behavior brings the infant in closer contact with the caregiver and further promotes bonding and emotional investment.

Phase 2: From 3 to 6 Months

When infants are about 3 months old, they start to differentiate between people and they begin to reserve their attachment behaviors for the people they prefer. While they’ll smile and babble at the people they recognize, they won’t do more than stare at a stranger. If they cry, their favorite people are better able to comfort them. Babies’ preferences are restricted to two to three individuals and they usually favor one person in particular. Bowlby and other attachment researchers often assumed this individual would be the infant’s mother, but it could be anyone who most successfully responded to and had the most positive interactions with the baby.

Phase 3: From 6 Months to 3 Years

At about 6 months, babies’ preference for a specific individual becomes more intense, and when that individual leaves the room, the infants will have separation anxiety. Once babies learn to crawl, they will also attempt to actively follow their favorite person. When this individual returns after a period of absence, babies will enthusiastically greet them. Starting at about 7 or 8 months old, babies will also start to fear strangers. This can manifest itself as anything from a bit of extra caution in the presence of a stranger to crying at the sight of someone new, especially in an unfamiliar situation. By the time babies are a year old, they have developed a working model of their favored individual, including how well they respond to the child.

Phase 4: From 3 Years Until Childhood Ends

Bowlby didn’t have as much to say about the fourth stage of attachment or the way attachments continued to impact people after childhood. He did observe, however, that at around 3 years old, children start to comprehend that their caretakers have goals and plans of their own. As a result, the child is less concerned when the caretaker leaves for a period of time.

The Strange Situation and Patterns of Infant Attachment

After moving to England in the 1950s, Mary Ainsworth became John Bowlby’s research assistant and long-term collaborator. While Bowlby had observed that children exhibited individual differences in attachment , it was Ainsworth who undertook the research on infant-parent separations that established a better understanding of these individual differences. The method Ainsworth and her colleagues developed for assessing these differences in one-year-old children was called the “Strange Situation.”

The Strange Situation consists of two brief scenarios in a lab in which a caregiver leaves the infant. In the first scenario, the infant is left with a stranger. In the second scenario the infant is briefly left alone and then joined by the stranger. Each separation between caregiver and child lasted about three minutes.

Ainsworth and her colleagues’ observations of the Strange Situation led them to identify three different patterns of attachment. A fourth attachment style was later added based on the findings from further research.

The four attachment patterns are:

• Secure Attachment: Infants who are securely attached use their caregiver as a secure base from which to explore the world. They will venture out to explore away from the caregiver, but if they're frightened or in need of reassurance, they will return. If the caregiver leaves they will get upset just as all babies will. Yet, these children are confident that their caregiver will return. When that happens they will greet the caregiver with joy.
• Avoidant Attachment : Children who exhibit avoidant attachment are insecure in their attachment to the caregiver. Avoidantly attached children will not become overly distressed when their caregiver leaves, and upon their return, the child will deliberately avoid the caregiver.
• Resistant Attachment : Resistant attachment is another form of insecure attachment. These children become extremely upset when the parent leaves. However, when the caregiver returns their behavior will be inconsistent. They may initially seem happy to see the caregiver only to become resistant if the caregiver attempts to pick them up. These children often respond angrily to the caregiver; however, they also display moments of avoidance as well.
• Disorganized Attachment: The final attachment pattern is most often displayed by children who have been subject to abuse, neglect, or other inconsistent parenting practices. Children with a disorganized attachment style seem to be disoriented or confused when their caregiver is present. They seem to view the caregiver as a source of both comfort and fear, leading to disorganized and conflicting behaviors.

Research has demonstrated that early attachment styles have consequences that reverberate for the rest of an individual’s life. For instance, someone with a secure attachment style in childhood will have better self-esteem as they grow up and will be able to form strong, healthy relationships as adults. On the other hand, those with an avoidant attachment style as children may be unable to become emotionally invested in their relationships and have difficulty sharing their thoughts and feelings with others. Similarly those who had a resistant attachment style as one-year-olds have difficulty forming relationships with others as adults, and when they do, often question whether their partners truly love them.

Institutionalization and Separation

The necessity of forming attachments early in life has serious implications for children who grow up in institutions or are separated from their parents when they're young. Bowlby observed that children who grow up in institutions often don’t form an attachment to any adult. While their physical needs are attended to, because their emotional needs aren’t fulfilled, they don’t bond with anyone as infants and then seem incapable of forming loving relationships when they get older. Some research has suggested that therapeutic interventions might help make up for the deficits these children experienced. However, other events have demonstrated that children that haven’t developed attachments as infants continue to suffer from emotional issues. Further research is still required on this topic, however, one way or another, it seems clear that development proceeds best if children are able to bond with a caretaker in their first years of life.

Separation from attachment figures in childhood can also lead to emotional problems. In the 1950s, Bowlby and James Robertson found that when children were separated from their parents during extended hospital stays—a common practice at the time—it led to a great deal of suffering for the child. If children were kept from their parents for too long, they seemed to stop trusting people, and like the institutionalized children, were no longer able to form close relationships. Fortunately, Bowlby’s work resulted in more hospitals allowing parents to stay with their young children.

Implications for Child-Rearing

Bowlby and Ainsworth’s work on attachment suggests that parents should see their babies as fully equipped to signal what they need. So when babies cry, smile, or babble, parents should follow their instincts and respond. Children with parents who promptly respond to their signals with care tend to be securely attached by the time they are a year old. This doesn’t mean that parents should take the initiative to go to the child when the child hasn't signaled. If the parent insists on attending to the child whether the infant is signaling their desire for attention or not, Bowlby said the child can become spoiled. Bowlby and Ainsworth felt, instead, caretakers should simply be available while letting their child pursue their own independent interests and explorations.

• Cherry, Kendra. “Bowlby & Ainsworth: What is Attachment Theory?” Verywell Mind , 21 September 2019. https://www.verywellmind.com/what-is-attachment-theory-2795337
• Cherry, Kendra. “The Different Types of Attachment Styles” Verywell Mind , 24 June 2019. https://www.verywellmind.com/attachment-styles-2795344
• Crain, William. Theories of Development: Concepts and Applications. 5th ed., Pearson Prentice Hall. 2005.
• Fraley, R. Chris and Phillip R. Shaver. “Attachment Theory and Its Place in Contemporary Personality Theory and Research.” Handbook of Personality: Theory and Research, 3rd ed., edited by Oliver P. John, Richard W. Robins, and Lawrence A. Pervin, The Guilford Press, 2008, pp. 518-541.
• McAdams, Dan. The Person: An Introduction to the Science of Personality Psychology . 5th ed., Wiley, 2008.
• McLeod, Saul. “Attachment Theory.” Simply Psychology , 5 February 2017. https://www.simplypsychology.org/attachment.html
• Adult Attachment Styles: Definitions and Impact on Relationships
• Understanding Fearful Avoidant Attachment Style
• Surviving Infancy in the Middle Ages
• Definition and Examples of Baby Talk or Caregiver Speech
• Dr. Spock's "The Common Book of Baby and Child Care"
• The 6 Best Magazines for Toddlers
• An Introduction to Erikson’s Stages of Psychosocial Development
• Understanding Shakespeare's "Seven Ages of Man" in Today's World
• What Is Object Permanence?
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• What Is the Premack Principle? Definition and Examples
• Make His Father's Day Special With These Quotes About Dads
• Cingulate Gyrus and the Limbic System
• Roman Exposure of Infants
• Holophrase in Language Acquisition
• Crime Profile: The Debra Evans Case

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Contributions of Attachment Theory and Research: A Framework for Future Research, Translation, and Policy

Jude cassidy.

University of Maryland

Jason D. Jones

Phillip r. shaver.

University of California, Davis

Attachment theory has been generating creative and impactful research for almost half a century. In this article we focus on the documented antecedents and consequences of individual differences in infant attachment patterns, suggesting topics for further theoretical clarification, research, clinical interventions, and policy applications. We pay particular attention to the concept of cognitive “working models” and to neural and physiological mechanisms through which early attachment experiences contribute to later functioning. We consider adult caregiving behavior that predicts infant attachment patterns, and the still-mysterious “transmission gap” between parental AAI classifications and infant Strange Situation classifications. We also review connections between attachment and (a) child psychopathology, (b) neurobiology, (c) health and immune function, (d) empathy, compassion, and altruism, (e) school readiness, and (f) culture. We conclude with clinical-translational and public policy applications of attachment research that could reduce the occurrence and maintenance of insecure attachment during infancy and beyond. Our goal is to inspire researchers to continue advancing the field by finding new ways to tackle long-standing questions and by generating and testing novel hypotheses.

One gets a glimpse of the germ of attachment theory in John Bowlby's 1944 article, “Forty-Four Juvenile Thieves: Their Character and Home-Life,” published in the International Journal of Psychoanalysis . Using a combination of case studies and statistical methods (novel at the time for psychoanalysts) to examine the precursors of delinquency, Bowlby arrived at his initial empirical insight: The precursors of emotional disorders and delinquency could be found in early attachment-related experiences, specifically separations from, or inconsistent or harsh treatment by, mothers (and often fathers or other men who were involved with the mothers). Over the subsequent decades, as readers of this journal know, he built a complex and highly generative theory of attachment.

Unlike other psychoanalytic writers of his generation, Bowlby formed a working relationship with a very talented empirically oriented researcher, Mary Ainsworth. Her careful observations, first in Uganda ( Ainsworth, 1967 ) and later in Baltimore, led to a detailed specification of aspects of maternal behavior that preceded individual differences in infant attachment. Her creation of the Strange Situation ( Ainsworth, Blehar, Waters, & Wall, 1978 ) provided a gold standard for identifying and classifying individual differences in infant attachment security (and insecurity) and ushered in decades of research examining the precursors and outcomes of individual differences in infant attachment. (A PsycInfo literature search using the keyword “attachment” yields more than 15,000 titles).

By the beginning of the 21 st century, the National Research Council and the Institute of Medicine's Committee on Integrating the Science of Early Childhood Development based its policy and practice conclusions and recommendations on four themes, one of which was that “early environments matter and nurturing relationships are essential ( Shonkoff & Phillips, 2000 , p. 4) … Children grow and thrive in the context of close and dependable relationships that provide love and nurturance, security, responsive interaction, and encouragement for exploration. Without at least one such relationship, development is disrupted, and the consequences can be severe and long-lasting” (p. 7). This clear and strong statement could be made in large part because of the research inspired by Bowlby's theory and Ainsworth's creative research methods.

Years after Ainsworth's Strange Situation was proposed, Mary Main and colleagues (e.g., George, Kaplan, & Main, 1984 ; Main, Kaplan, & Cassidy, 1985 ) provided a way to study the intergenerational transmission of attachment patterns. They and other researchers found that a parent's “state of mind with respect to attachment” predicted his or her infant's pattern of attachment. Moreover, since the 1980's there has been an explosion of research examining attachment processes beyond the parent-child dyad (e.g., in adult romantic relationships), which has supported Bowlby's (1979) belief that attachment is a process that characterizes humans “from the cradle to the grave” (p. 129). In the present article, space limitations lead us to focus principally on attachment processes early in life and consider the adult attachment literature largely in relation to parental predictors of infant attachment.

A Simple Model of Infant-Mother Attachment

During the 70 years since Bowlby's initial consideration of the developmental precursors of adolescent delinquency and psychopathology, researchers have provided a complex picture of the parental and experiential precursors of infant attachment, the links between early attachment-related experiences and later child functioning, the mechanisms involved in explaining these links, and moderators of these linking mechanisms. Much has been learned at each of several analytic levels, including behavior, cognition, emotion, physiology, and genetics. Figure 1 summarizes this literature in a simple model. We have selected several of the components in Figure 1 for further discussion. For each component, following a brief background and review of the current state of knowledge, we offer suggestions for future research, based largely on identification of gaps in theory or methodological innovations that make new lines of discovery possible. We begin by considering one of the central concepts of attachment theory, the internal working model, followed by a consideration of physiological mechanisms that also help to explain the influence of early attachments. Next, we consider the caregiving behavior that predicts infant attachment and the perplexing issue of the transmission gap between parental Adult Attachment Interview (AAI) classifications and infant Strange Situation classifications. We then examine connections between attachment and (a) child psychopathology, (b) neurobiology, (c) health and immune function, (d) empathy, compassion, and altruism, (e) school readiness, and (f) culture. Finally, we discuss the translational application of attachment research to reducing the risk of developing or maintaining insecure attachments and the policy implications of attachment research.

Note . A complete depiction of attachment processes would require several pages. For instance, here we note the parent's own attachment representations as a contributor to parental attachment-related behavior. There are many other important contributors to parental behavior, including culture, SES, parental age, parental personality, child temperament, and presence or absence of a partner, to name a few. Each of the constructs and arrows in Figure 1 could be surrounded by numerous others.

Internal Working Models

One of the key concepts in attachment theory is the “attachment behavioral system,” which refers to an organized system of behaviors that has a predictable outcome (i.e., proximity) and serves an identifiable biological function (i.e., protection). According to Bowlby (1969/1982 ), such a system is organized by experience-based “internal working models” (IWMs) of self and environment, including especially the caregiving environment.

It is by postulating the existence of these cognitive components and their utilization by the attachment system that the theory is enabled to provide explanations of how a child's experiences with attachment figures come to influence in particular ways the pattern of attachment he develops. (pp. 373-374)

Much of the research on these models is based on the notion that, beginning in the first year of life, mentally healthy individuals develop a “secure base script” that provides a causal-temporal prototype of the ways in which attachment-related events typically unfold (e.g., “When I am hurt, I go to my mother and receive comfort”). According to Bretherton (1991 ; Bretherton & Munholland, 2008 ), secure base scripts are the “building blocks” of IWMs. Theoretically, secure children's and adults' scripts should allow them to create attachment-related “stories” in which one person successfully uses another as a secure base from which to explore and as a safe haven in times of need or distress. Insecure individuals should exhibit gaps in, or distortion or even absence of, such a script. H. Waters and colleagues ( H. Waters & Rodrigues-Doolabh, 2001 ; H. Waters & Waters, 2006 ) tested this hypothesis by having children complete story stems that began with a character's attachment behavioral system presumably being activated (e.g., a child rock-climbing with parents hurts his knee). Secure attachment at 2 years of age was positively correlated with the creation of stories involving knowledge of and access to the secure base script at ages 3 and 4. (A similar methodology has been used in studies of young adults; see Mikulincer, Shaver, Sapir-Lavid, & Avihou-Kanza, 2009 .)

New Directions in the Examination of IWM Formation during Infancy

Despite Bowlby's hypothesis that infants develop IWMs during the first year of life (see also Main et al., 1985 ), almost no empirical work has focused on attachment representations during infancy (instead, most research on IWMs has involved children, adolescents, and adults). We believe, as do others ( Johnson et al., 2010 ; Sherman & Cassidy, 2013 ; Thompson, 2008 ), that IWMs can be studied in infancy. Such work is made possible by recent efforts to bridge social-emotional and cognitive developmental research (e.g., Calkins & Bell, 2010 ; Olson & Dweck, 2008 ), along with methodological advances and accumulating research on an array of previously unexplored infant mental capacities.

Attachment researchers have assumed that infants recall the emotional nature of their attachment-related social experiences with specific individuals (e.g., experiences of comfort with vs. rejection by mother), and that they use these memories to create IWMs that guide their attachment behavior in subsequent interactions with these individuals. This claim has been supported with correlational research findings; for example observations indicating that infants' daily interactions with attachment figures are linked to their IWMs reflected in behavior in the Strange Situation ( Ainsworth et al., 1978 ). These findings can now be supplemented with results from experimental studies.

There is a compelling body of experimental work showing that infants extract complex social-emotional information from the social interactions they observe. For example, they notice helpful and hindering behaviors of one “person” (usually represented by a puppet or a geometric figure) toward another, they personally prefer individuals who have helped others, they form expectations about how two characters should behave toward each other in subsequent interactions, and they behave positively or negatively toward individuals based on what they have observed (e.g., Hamlin & Wynn, 2011 ; Hamlin, Wynn, Bloom, & Mahajan, 2011 ). This work could and should be extended to include attachment relationships, revealing in detail how infants form “models” of particular adults and then modify their emotional reactions and social behaviors toward those adults accordingly ( Johnson et al., 2010 ). At present, there is no experimental research showing that infants form expectations about the later social behavior of another person toward them based on the infants' own past interactions with that person – a capacity that is assumed to underlie infants' development of working models of their caregivers.

As explained in detail in another paper ( Sherman & Cassidy, 2013 ), we urge infancy researchers to consider the specific cognitive and emotional capacities required to form IWMs and then to examine these capacities experimentally. Methods used by researchers who study infant cognition, but rarely used by attachment researchers (e.g., eye-tracking, habituation paradigms), will prove useful. For example, habituation paradigms could allow attachment researchers to study infant IWMs of likely mother and infant responses to infant distress (see Johnson et al., 2010 ). Another research area relevant to attachment researchers' conception of IWMs concerns infants' understanding of statistical probabilities. When considering individual differences in how mothering contributes to attachment quality, Bowlby (1969/1982) adopted Winnicott's (1953) conception of “good enough” mothering; that is, mothering which assures a child that probabilistically, and often enough, the mother will prove responsive to the child's signals. Implicit in such a perspective is the assumption that an infant can make probabilistic inferences. Only recently has there been a surge in interest in the methods available to evaluate this assumption of attachment theory (e.g., Krogh, Vlach, & Johnson, 2013 ; Pelucchi, Hay, & Saffran, 2009 ; Romberg & Saffran, 2013 ; Xu & Kushnir, 2013 ).

One useful conceptual perspective, called rational constructivism, is based on the idea that infants use probabilistic reasoning when integrating existing knowledge with new data to test hypotheses about the world. Xu and Kushnir (2013) reviewed evidence that by 18 months of age, infants use probabilistic reasoning to evaluate alternative hypotheses ( Gerken, 2006 ; Gweon, Tenenbaum, & Schulz, 2010 ), revise hypotheses in light of new data ( Gerken, 2010 ), make predictions ( Denison & Xu, 2010 ), and guide their actions ( Denison & Xu, 2010 ). Moreover, infants are capable of integrating prior knowledge and multiple contextual factors into their statistical computations ( Denison & Xu, 2010 ; Teglas, Girotto, Gonzales, & Bonatti, 2007 ; Xu & Denison, 2009 ). Xu and Kushnir (2013) have further proposed that these capacities appear to be domain-general, being evident in a variety of areas: language, physical reasoning, psychological reasoning, object understanding, and understanding of individual preferences. Notably absent from this list is the domain of social relationships, including attachment relationships.

Several questions about probabilistic inferences can be raised: Do infants make such inferences about the likely behavior of particular attachment figures, and could this ability account for qualitatively different attachments to different individuals (e.g., mother as distinct from father)? Do infants use probabilistic reasoning when drawing inferences related to the outcomes of their own attachment behaviors? (This is related to if-then contingencies: “If I cry, what is the probability that χ will occur?”) How complex can this infant reasoning become, and across what developmental trajectory? “If I do χ, the likelihood of outcome y is 80%, but if I do w , the likelihood of y is only 30%.” Do infants consider context? “If I do χ, the likelihood of y is 90% in context q , but only 20% in context r .” How do infants calculate variability in these probabilities across attachment figures?

In sum, it seems likely that infants use statistical inference to understand their social worlds. This ability would seem to be evolutionarily adaptive in relation to attachment figures, because infants could incorporate probabilistic inferences into their IWMs and use them to guide their attachment behavior. Important advances in our understanding of attachment behavior might occur with respect to how and when this incorporation happens, and also with respect to the role of statistical inference in infants' openness to change in response to changing environmental input (e.g., in response to interventions designed to change parental behavior).

Child-Parent Attachment, Response to Threat, and Physiological Mechanisms of Influence

Bowlby's emphasis on cognitive IWMs as the mechanism through which early experiences influence later functioning is understandable given the emerging cognitive emphasis in psychology when he was writing. But scientists are becoming increasingly aware that the effects of attachment-related experiences are carried in the body and brain in ways not easily reducible to cognition. As a way to touch briefly on the physiological processes involved in attachment, we focus here on a central issue in attachment theory: infants' responses to threat as these are shaped by attachment relationships. One of the core propositions of attachment theory is that proximity to an attachment figure reduces fear in the presence of a possible or actual threat. As explained in the previous section, Bowlby thought the mechanism that explained this link is children's experience-based cognitive representation of the availability of an attachment figure. Specifically, it is because securely attached infants are more likely than insecurely attached infants to have mental representations of caregiver availability and responsiveness that they are able to interpret a threat as manageable and respond to it with less fear and anxiety. Yet in species that do not possess human representational capacities, the link between attachment and response to threat clearly exists, suggesting that in humans there is likely to be more to attachment orientations than cognitive IWMs. (For the initial and more extensive discussion of ideas presented in this section, see Cassidy, Ehrlich, and Sherman [2013] .)

Another Level of “Representation” or Internal Structure: Physiology

Since the time of Bowlby's original writings, one important advance that has extended our understanding of the link between attachment and response to threat has roots in Myron Hofer's laboratory in the 1970s. Hofer, a developmental psychobiologist, noticed defensive vocal protest responses to maternal separation in infant rat pups and asked what non-representational process could account for them. He and his colleagues conducted a series of tightly controlled experiments to identify what physiological subsystems, which he called hidden regulators, are disrupted when mothers are removed from their pups (for reviews, see Hofer, 2006 ; Polan & Hofer, 2008 ). The pups exhibit changes in multiple physiological and behavioral systems, such as those controlling heart rate, body temperature, food intake, and exploration. Hofer concluded that mother-infant interactions have embedded within them a number of vital physiological regulatory functions that are disrupted by separation from mother and do not require cognitive mediators. These regulators can be disentangled by experimentally manipulating parts of a “mother”: the food she provides, her warmth, her licking and grooming, etc. Later, Meaney and colleagues (e.g., Liu et al., 1997 ; reviewed in Meaney, 2001 ) found that rat pups that received high levels of maternal licking and grooming and arched-back nursing positions had milder responses to threat and increased exploratory behavior – effects that lasted into adulthood (and in fact, into subsequent generations as a function of maternal affection in each successive generation). This research group further found that individual differences in maternal behavior were mediated by differences in offsprings' gene expression ( Weaver et al., 2004 ), a finding that has opened up a new research domain for researchers studying both animals and humans ( Sharp, Pickles, Meaney, Marshall, Tibu, & Hill, 2012 ; Suomi, 2011 ).

Early Attachment-Related Experiences and Human Infant Biological Response to Stress

In humans, a fully developed stress response system, the HPA axis, is present at birth ( Adam, Klimes-Dougan, & Gunnar, 2007 ). A growing body of research indicates that differences in the quality of early care contribute to variations in the initial calibration and continued regulation of this system. This regulation in turn plays an important role in shaping behavioral responses to threat ( Jessop & Turner-Cobb, 2008 ).

Researchers have examined connections between caregiving experiences and infant stress physiology by comparing infants' cortisol levels before and after a stressful task (e.g., the Strange Situation). For example, Nachmias, Gunnar, Mangelsdorf, Parritz, and Buss (1996) found that inhibited toddlers who were insecurely attached to their caregivers exhibited elevated cortisol levels following exposure to novel stimuli. There is also experimental evidence that mothers' touch buffers infants' cortisol stress response (in this case, during the still-face laboratory procedure in which mothers are asked to cease interacting emotionally with their infants; Feldman, Singer, & Zagoory, 2010 ). Children living in violent families endure particularly stressful caregiving environments, which are extremely dysregulating for them ( Taylor, Repetti, & Seeman, 1997 ). A number of studies have documented the disrupted stress response of maltreated children (e.g., De Bellis et al., 1999 ; Hart, Gunnar, & Cicchetti, 1995 ). Even living in a family in which the violence does not involve them directly has negative consequences for children, and studies suggest that the quality of caregiving in these harsh environments plays an important role in modifying the stress response (e.g., Hibel, Granger, Blair, Cox, & The FLP Investigators, 2011 ).

Attachment as a Regulator of Infant Stress Reactivity: Further Questions

Just as infants are thought to have evolved a capacity to use experience-based information about the availability of a protective caregiver to calibrate their attachment behavioral system ( Main, 1990 ), and given the close intertwining of the attachment and fear systems, it is likely that infants also evolved a capacity to use information about the availability of an attachment figure to calibrate their threat response system at both the behavioral and physiological levels ( Cassidy, 2009 ). And this capacity is probably not solely “cognitive,” which raises important questions for research: How are representational and physiological processes linked and how do they influence each other and affect child functioning? Does the nature of their interaction vary across particular aspects of child functioning and across developmental periods? How can we understand these interactions in relation to both normative development and individual differences?

In humans, representations and physiological (e.g., stress) reactions are thought to affect each other in ways unlikely to occur in other species. Sapolsky (2004) noted that, in humans, representational processes – the anticipation of threat when none currently exists – can launch a stress response. Relatedly, Bowlby (1973) , focusing on the link between attachment and fear, specified representational “forecasts of availability or unavailability” of an attachment figure as “a major variable that determines whether a person is or is not alarmed by any potentially alarming situation” (p. 204). Thus, the representations that others will be unavailable or rejecting when needed – that is, representations that characterize insecure attachment – could contribute to chronic activation of physiological stress response systems, as could the associated representations of others as having hostile intentions ( Dykas & Cassidy, 2011 ). Conversely, in times of both anticipated and actual threat, the capacity to represent a responsive attachment figure can diminish physiological responses associated with threatening or painful experiences (see Eisenberger et al., 2011 ; Coan, Schaefer, & Davidson, 2006 ). Moreover, consideration of linkages between representational and non-representational processes must include the possibility that causality flows in both directions: Physiological stress responses can presumably prompt a person to engage in higher-level cognitive processes to understand, justify, or eliminate the stressor.

When and how do young children use attachment-related representations as regulators of stress? Neither normative trajectories nor individual differences in the use of representations to influence stress reactivity have been examined extensively. Evidence that stress dysregulation can lead to the conscious engagement of representational processes comes from children as young as 4 who are able to describe strategies for alleviating distress (e.g., changing thoughts, reappraising the situation, mental distraction; Sayfan & Lagattuta, 2009 ). Less studied but of great interest are possible “automatic emotion regulation” processes ( Mauss, Bunge, & Gross, 2007 ) that do not involve conscious or deliberate self-regulation. Recent studies of adults show that there are such processes, that there are individual differences in them that might relate to attachment orientations, that they are associated with particular brain regions that are not the same as those associated with conscious, deliberate emotion regulation, and that they can be influenced experimentally with priming procedures.

Many researchable questions remain: Given the extent to which many forms of psychopathology reflect problems of self-regulation in the face of stress (e.g., Kring & Sloan, 2010 ), can “hidden regulators” stemming from infant-mother interactions tell us about the precursors of psychopathology? What about hidden regulators embedded within a relationship with a therapist (who, according to Bowlby [1988] , serves as an attachment figure in the context of long-term psychotherapy)? When change occurs following long-term therapy, does this change emerge through cognitive representations, changes at the physiological level, or both? See Cassidy et al., (2013) for additional suggestions for future research.

Maternal Caregiving and Infant Attachment: Intergenerational Transmission of Attachment and the “Transmission Gap”

In 1985, Main and colleagues published the first evidence of the intergenerational transmission of attachment: a link between a mother's attachment representations (coded from responses to the AAI; George et al., 1984 ) and her infant's attachment to her ( Figure 1 , Path c). Based on findings from Ainsworth's initial study of the precursors of individual differences in infant attachment ( Ainsworth et al., 1978 ), researchers expected this link to be explained by maternal sensitivity: That is, they believed that a mother's state of mind with respect to attachment guides her sensitive behavior toward her infant ( Figure 1 , Path a), which in turn influences infant attachment quality ( Figure 1 , Path b). However, at the end of a decade of research, van IJzendoorn (1995) published a meta-analysis indicating that the strong and well-replicated link between maternal and infant attachment was not fully mediated by maternal sensitivity (see also Madigan et al., 2006 ). van IJzendoorn labeled what he had found as the “ transmission gap .” Moreover, meta-analytic findings revealed that the link between maternal sensitivity and infant attachment, although nearly universally present across scores of studies, was typically considerably weaker than that reported in Ainsworth's original study ( De Wolff & van IJzendoorn, 1997 ).

The transmission gap has been one of the most perplexing issues facing attachment researchers during the past 15-20 years. Immediate attempts to understand it focused largely on measurement of maternal behavior. Many studies have been aimed at understanding why the strength of the association between maternal sensitivity and infant attachment, while not negligible, is lower than the particularly strong effect found in Ainsworth's original study, and lower than attachment researchers expected. These studies have provided important insights, but no consensus has emerged about how to understand maternal behavior as a predictor of infant attachment. Continued efforts in this area are essential, and they will inform both researchers' understanding of the workings of the attachment behavioral system and clinicians' attempts to reduce the risk of infant insecure attachments.

Further consideration of Bowlby's concept of the secure base may help researchers better understand maternal contributors to infant attachment. First, we should note that any consideration of caregiving influences necessitates consideration of differential child susceptibility to rearing influence. According to the differential susceptibility hypothesis ( Belsky, 2005 ; see also Boyce & Ellis, 2005 , on the theory of biological sensitivity to context, and Ellis, Boyce, Belsky, Bakermans-Kranenberg, & van IJzendoorn, 2011 , for an integration of the differential susceptibility hypothesis and the theory of biological sensitivity to context), children vary genetically in the extent to which they are influenced by environmental factors, and for some children the influence of caregiving behavior on attachment may be minimal. Moreover, we underscore that the thinking presented in the present paper relates to the initial development of infant attachment during the first year of life; contributors to security are likely to differ at different developmental periods.

A focus on secure base provision

For Bowlby (1988) , the secure base concept was the heart of attachment theory: “No concept within the attachment framework is more central to developmental psychiatry than that of the secure base” (pp. 163–164). When parents provide a secure base, their children's confidence in the parents' availability and sensitive responsiveness when needed allows the children to explore the environment freely. The secure base phenomenon contains two intertwined components: a secure base from which a child can explore and a haven of safety to which the child can return in times of distress. In fact, as noted earlier, the central cognitive components of secure attachment are thought to reside in a secure base script (i.e., a script according to which, following a distressing event, the child seeks and receives care from an available attachment figure, experiences comfort, and returns to exploration).

If the goal of research is to understand what components of a parent's behavior allow a child to use the parent as a secure base, researchers should focus as precisely as possible on the parent's secure base provision rather than on his or her parental behavior more broadly. Through experience-based understanding of parental intentions and behavior, an infant gathers information to answer a central secure base question: What is my attachment figure likely to do when activation of my attachment system leads me to seek contact? If experiences lead the infant to believe that the parent will be responsive (most of the time) to behaviors related to activation of his/her attachment system, then the infant will use the parent as a secure base, and behavioral manifestations of the secure base script will appear (i.e., the secure base script will be evident in the Strange Situation attachment assessment, and the infant will be classified as secure). In 2000, E. Waters and Cummings, when proposing an agenda for the field in the millennium of the 2000s, urged that the secure-base concept be kept “at center stage in attachment theory and research” (p. 164). We share this opinion, and believe that additional consideration of the secure base notion will provide a useful framework within which to consider parental behavior as a predictor of infant attachment.

Bowlby (1988) emphasized that an infant's sense of having a secure base resides in the infant's confidence that parental sensitive responsiveness will be provided when needed (e.g., specifying “especially should he [the infant] become tired or frightened” [p. 132]). As such, it may be useful for attachment researchers to frame their question as: Which contexts provide the infant with information about the parent's likely behavior when needed – not in all contexts, but specifically in response to activation of the infant's attachment system ? Bowlby (1969/1982) described the relevant contexts as “fall[ing] into two classes: those which indicate the presence of potential danger or stress (internal or external), and those concerning the whereabouts and accessibility of the attachment figure” (p. 373).

Especially during the early years of life, both of these circumstances are likely to be associated with infant distress. This association has led some writers to wonder whether maternal response to infant distress is particularly predictive of infant attachment quality (e.g., Thompson, 1997 ), and there is compelling evidence that this is the case (e.g., Del Carmen, Pedersen, Huffman, & Bryan, 1993 ; Leerkes, 2011 ; Leerkes, Parade, & Gudmundson, 2011 ; McElwain & Booth-LaForce, 2006 ). When infants experience comfort from parental sensitive responses to their distress, they develop mental representations that contribute to security (“When I am distressed, I seek care, and I am comforted”). These representations are then thought to guide secure attachment behavior, and the physiological regulation that comes from regaining calmness in contact with the parent is thought to calibrate the child's stress reactivity systems and feed back into further secure mental representations (e.g., Cassidy et al., 2013 ; Suomi, 2008 ). The greater predictive power of the maternal response to distress, compared to maternal response to non-distress, may emerge from the considerable intertwining of infant distress and the infant's attachment system during the first year of life.

Future studies attempting to predict infant attachment might benefit from a framework that considers two components of parental behavior: (a) parental behavior related specifically to the secure base function of the infant's attachment system as Bowlby described it (see above), and (b) parental response to infant distress. Table 1 presents a 2 (attachment-related or not) × 2 (infant distressed or not) matrix that gives rise to a number of research questions. One key question is the following: Is parental behavior in response to an infant's attachment behavioral system most predictive of infant attachment, regardless of whether or not the infant is distressed (i.e., parental behavior in both cells 1 and 2)? Another set of questions relates to distress: Is parental response to any form of infant distress the most central predictor of infant attachment (i.e., parental behavior in both cells 1 and 3)? Does the termination of the physiological and emotional dysregulation of distress – no matter what the cause – that occurs through parental care solidify a tendency to use the parent as a secure base? Or do the cognitive models that derive from experiences of distress in different contexts (e.g., distress during play versus distress when seeking comfort) contribute differentially to secure base use? Most previous research has not drawn distinctions concerning the context of infant distress; future work that considers this distinction is needed.

Note . The following examples describe 5- to 12-month old infants participating in studies with their mothers in Cassidy's lab. Cell 1 . The context is attachment-related, and the infant is distressed: After having been left alone in an unfamiliar laboratory playroom, a crying 12-month-old crossed the room to her returning mother and reached to be picked up. Cell 2 . The context is attachment-related, and the infant is not distressed: An 8-month-old infant had been playing contentedly for 20 minutes near her mother at home. The mother had been sitting on the floor holding a toddler whose hair she was braiding. When the mother finished and the toddler moved away, the infant crawled to the mother, clambered up on her lap, and snuggled in for a hug; after exchanging tender pats with her mother, the infant returned to play on the floor. The lack of accessibility to the mother may have led to the infant's seeking contact in a manner that did not involve other activities (e.g., play or feeding). Cell 3 . The context is not attachment-related, and the infant is distressed: A 12-month-old infant became distressed when a toy was removed. Cell 4 . The context is not attachment-related, and the infant is not distressed: An infant, with her mother nearby, played happily with toys.

Additional questions raised by Table 1 include: Is it the combination of maternal behavior when the infant's attachment system is central, along with any behavioral response to infant distress, that best predicts infant attachment (i.e., maternal behavior in cells 1, 2, and 3)? Finally, is it the case (as some have suggested; e.g., Pedersen & Moran, 1999) that maternal behavior in all four cells is predictive of infant attachment? Attempts to increase understanding of the precursors of infant attachment will require the development of detailed coding systems.

Finally, it will be crucial for future research conducted within a secure base framework to identify the specific maternal behaviors in response to activation of the infant's attachment system that predict infant security (for one approach, see Cassidy et al., 2005 , and Woodhouse & Cassidy, 2009 , who note that providing physical contact until the infant is fully calmed may be a more powerful predictor of later security than the general sensitivity of the parent's response). Basic research examining the extent to which infant distress occurs in relation to the attachment behavioral system will provide an important foundation for further work.

Additional mediational pathways: Genetics, cognitions, and emotions

Following the discovery of the transmission gap, several studies examined the possibility of a genetic mediating mechanism. However, neither behavior-genetic nor molecular-genetic research so far indicates a genetic component to individual differences in secure vs. insecure attachment, although mixed findings have emerged concerning a genetic vulnerability for infant disorganized attachment ( Bakermans-Kranenburg & van IJzendoorn, 2004 , 2007 ; Bokhorst et al. 2003 ; Fearon et al., 2006 ; Roisman & Fraley, 2008 ). (For evidence that variability in infants' serotonin-transporter-linked polymorphic region 5-HTTLPR predicts not whether infants are secure or insecure, but their subtype of security or subtype of insecurity, see Raby et al., 2012 ). Future research should examine other genes and gene X environment interactions (see Suomi, 2011 , for examples from primate research).

Despite a conceptual model of intergenerational transmission in which maternal behavior is central, examination of additional linking mechanisms purported to underlie maternal behavior, such as maternal cognitions and emotions, will continue to be important. Perhaps such factors may be more reliably measured than maternal behavior, and if they are, mediating relations may emerge to shed light on mechanisms of transmission (e.g., Bernier & Dozier, 2003 ). Moreover, from a clinical standpoint, factors thought to underlie maternal behavior may be more amenable targets of intervention than her behavior itself. For example, continued examination of maternal cognition through the study of constructs such as reflective functioning and maternal insightfulness may shed light on the link between mother and child attachment ( Oppenheim & Koren-Karie, 2009 ; Slade, Sadler, & Mayes, 2005 ). These constructs refer to the extent to which a mother can see the world from her infant's point of view while also considering her own mental state. There is evidence that these and other components of maternal cognition (e.g., perceptions of the baby, attributions about infant behavior and emotions, maternal mindmindedness) are linked to maternal and/or child attachment, and additional research is needed to clarify the extent to which these components mediate the link between the two (e.g., Leerkes & Siepak, 2006 ; Zeanah, Benoit, Hirshberg, Barton, & Regan, 1994 ).

Another aspect of maternal functioning that should prove fruitful for researchers examining the transmission gap is maternal emotion regulation. As Cassidy (2006) has proposed, much maternal insensitivity can be recast as a failure of maternal emotion regulation. That is, when mothers themselves become dysregulated in the face of child behavior or child emotions that they find distressing (particularly child distress), their maternal behavior is more likely to be driven by their own dysregulation rather than the needs of the child (see also Slade, in press ). Evidence that maternal emotion-regulation capacities contribute to problematic parenting and insecure attachment has been reported ( Leerkes et al., 2011 ; Lorber & O'Leary, 2005 ), as have data indicating that maternal state of mind with respect to attachment (i.e., maternal secure base script knowledge) is uniquely related to maternal physiological regulation in response to infant cries (but not in response to infant laughter; Groh & Roisman, 2009 ). Unfortunately, although there is a sound conceptual and empirical basis for maternal emotion regulation as a mediator of the link between maternal and child attachment, there has been no empirical examination of this possibility.

In sum, the direction of future work depends on researchers' goals. If the goal is to understand the maternal behavior that mediates the link between maternal state of mind and child attachment, then the focus, obviously, must be on maternal behavior. If, however, the goal is to understand what factors may guide maternal behavior, and as such may themselves be successful targets of intervention, then examination of factors such as maternal cognitions and emotions should prove useful as well.

Caregiving as a Function of Adult Attachment Style

Although most researchers using self-report measures of adult attachment have not focused on links with parenting, there is a substantial and growing body of literature (more than 50 published studies) that addresses this link (see Jones, Cassidy, & Shaver, 2013 , for a review). Whereas researchers using the AAI have focused mainly on links between adults' AAI classifications and their observed parenting behaviors , attachment style researchers have focused mainly on links between adult attachment style and self-reported parenting cognitions and emotions (reviewed by Mikulincer & Shaver, 2007 ). But the few studies in which self-report attachment measures were used to predict parenting behavior have found support for predicted associations (e.g., Edelstein et al., 2004 ; Mills-Koonce et al., 2011 ; Rholes, Simpson, & Blakely, 1995 , Study 1; Selcuk et al., 2010 ). This is especially the case for maternal self-reported attachment-related avoidance (note that each of these studies was conducted with mothers only [Edelstein et al. included 4 fathers], so caution is warranted in generalizing these findings to fathers).

It would be useful to have more studies of adult attachment styles and observed parenting behavior. It would also be important to conduct longitudinal and intergenerational research using self-report measures. Prospective research is needed examining the extent to which adult attachment styles predict both parenting behaviors and infant attachment (see Mayseless, Sharabany, & Sagi, 1997 , and Volling, Notaro, & Larsen, 1998 , for mixed evidence concerning parents' adult attachment style as a predictor of infant attachment). Of related interest to researchers examining attachment styles and parenting will be longitudinal research examining the developmental precursors of adult attachment as measured with self-report measures (see Fraley, Roisman, Booth-LaForce, Tresch Owen, & Holland, 2013 , and Zayas, Mischel, Shoda, & Aber, 2011 , for evidence that self-reported attachment style in adolescence and early adulthood is predictable from participants' mothers' behavior during the participants' infancy and early childhood).

In general, we need more merging of social and developmental research traditions. It would be useful to include both the AAI and self-report attachment style measures in studies of parenting behaviors and cognitions. It would also be useful to know how the two kinds of measures relate similarly and differently to parenting variables. Scharf and Mayseless (2011) included both kinds of measures and found that both of them prospectively predicted parenting cognitions (e.g., perceived ability to take care of children), and in some cases, the self-report measure yielded significant predictions when the AAI did not (e.g., desire to have children). From the viewpoint of making predictions for practical or applied purposes, it is beneficial that both interview and self-report measures predict important outcomes but sometimes do so in non-redundant ways, thus increasing the amount of explained variance.

Mothers and Fathers

It is unclear whether it is best to think of a single kind of parental caregiving system in humans or of separate maternal and paternal caregiving systems. Harlow proposed separate maternal and paternal systems in primates (e.g., Harlow, Harlow, & Hansen, 1963 ). Within a modern evolutionary perspective, the existence of separate maternal and paternal caregiving systems is readily understood. Because mothers and fathers may differ substantially in the extent to which the survival of any one child enhances their overall fitness, their parenting behavior may differ. In addition, the inclusion of fathers in future attachment research is crucial. We contend that the field's continued focus on mothers is more likely to reflect the difficulty of recruiting fathers as research participants than a lack of interest in fathers. Bowlby, after all, was careful to use the term “attachment figure” rather than “mother,” because of his belief that although biological mothers typically serve as principal attachment figures, other figures such as fathers, adoptive mothers, grandparents, and child-care providers can also serve as attachment figures. Presumably, it is the nature of the interaction rather than the category of the individual that is important to the child. Also, addition of fathers will permit examination of attachment within a family systems perspective ( Byng-Hall, 1999 ; Johnson, 2008 ). Future research should examine (a) whether the precursors of infant-father attachment are similar to or different from the precursors of infant-mother attachment; (b) whether the Strange Situation best captures the quality of infant-father attachments (some have suggested that it does not; Grossmann Grossman, Kindler, & Zimmermann, 2008 ); (c) the influence of infants' relationships with fathers and father figures on their subsequent security and mental health; (d) possible differences in the working models children have of mothers and fathers; and (e) possible influences of parents' relationship with each other on the child's sense of having, or not having, a secure base ( Bretherton, 2010 ; Davies & Cummings, 1994 ).

Attachment and Psychopathology

As mentioned at the outset of this article, Bowlby was a clinician interested in the influence of early experiences with caregivers on children's later mental health and delinquency ( Bowlby, 1944 , 1951 ). Yet following a line of thinking that later came to characterize the developmental psychopathology approach (e.g., Cicchetti, 1984 ), Bowlby developed attachment theory as a framework for investigating and understanding both normal and abnormal development ( Sroufe, Carlson, Levy, & Egeland, 1999 ). Given space limitations and the focus of this journal, we will concentrate on relations between attachment and child psychopathology ( Figure 1 , Path d; see Cassidy & Shaver, 2008 , and Sroufe, Egeland, Carlson, & Collins, 2005a , for reviews of attachment and psychosocial functioning more broadly). The vast majority of existing studies have, however, not focused on clinically diagnosed psychopathology, but have been concerned with relations between attachment and continuous measures of internalizing and externalizing symptoms (e.g., assessed with the Child Behavior Checklist [CBCL]; Achenbach, 1991 ).

Bowlby's Theory of Attachment and Psychopathology

Bowlby used Waddington's (1957) developmental pathways model to explain how early attachment relates to later developmental outcomes, including psychopathology. According to this model, developmental outcomes are a product of the interaction of early childhood experiences and current context (at any later age). Early attachment is not expected to be perfectly predictive of later outcomes. Moreover, attachment insecurity per se is not psychopathology nor does it guarantee pathological outcomes. Instead, insecurity in infancy and early childhood is thought to be a risk factor for later psychopathology if subsequent development occurs in the context of other risk factors (e.g., poverty, parental psychopathology, abuse). Security is a protective factor that may buffer against emotional problems when later risks are present (see Sroufe et al., 1999 , for a review).

Attachment and Internalizing/Externalizing Behavior Problems: State of the Field

Over the past few decades, there have been many studies of early attachment and child mental health. The findings are complicated and difficult to summarize, as explained by Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, and Roisman (2010 , p. 437): “With the sheer volume, range, and diversity of studies…it has become virtually impossible to provide a clear narrative account of the status of the evidence concerning this critical issue in developmental science” (italics added). Studies contributing to this body of work have used diverse samples and different methods and measures, and have yielded inconsistent and, at times, contradictory results. Fortunately, two recent meta-analyses ( Fearon et al., 2010 ; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012 ) provide quantitative estimates of the degree of association between child attachment and internalizing/externalizing symptoms.

The meta-analyses revealed that insecurity (avoidant, ambivalent, and disorganized combined) was related to higher rates of internalizing and externalizing symptoms (though the link appears to be stronger for externalizing symptoms). When the subtypes of insecurity were examined individually, avoidance and disorganization were each significantly related to higher rates of externalizing problems, but only avoidance was significantly related to internalizing problems. Ambivalence was not significantly related to internalizing or externalizing. Contrary to expectations, neither meta-analysis yielded much support for an interaction of child attachment and contextual risk in predicting behavior problems. For example, neither meta-analysis found support for the predicted child attachment by SES interaction. However, given that high versus low SES is a rather imprecise measure of the numerous psychosocial risk factors that could contribute (individually and additively) to behavior problems, along with evidence from large sample studies supporting an attachment by risk interaction (e.g., Fearon & Belsky, 2011 ), these results should be interpreted cautiously. In sum, the answer to the question “Is early attachment status related to later mental health difficulties?” is a resounding yes, but the precise nature of the connections remains unclear.

Attachment and Psychopathology: Gaps in the Research and Future Directions

More research is needed on mechanisms, or mediators, that help to explain how insecurity, or a particular form of insecure attachment, leads in some cases to psychopathology. These mechanisms should be considered at different levels of analysis: neurological, hormonal, cognitive, behavioral, and social-interactional. Mediators may include difficulties in emotion regulation and deficits in social skills, for example. Given the documented links between early attachment and emotion regulation and physiological stress responses ( Cassidy, 1994 ; Spangler & Grossmann, 1993 ), as well as the role of emotion dysregulation and HPA axis irregularities in psychopathology ( Gunnar & Vazquez, 2006 ; Kring & Sloan, 2010 ), emotion regulation seems to be a promising target for mechanism research. More research is also needed on potential moderators and risk factors, such as age, gender, personality, traumas and losses, SES, exposure to family and neighborhood violence. Researchers should consider the cumulative effects of multiple risk factors as well as interactions among risk factors ( Belsky & Fearon, 2002 ; Fearon & Belsky, 2011 ; Kazdin & Kagan, 1994 ).

Given that most research on the mental health sequelae of early attachment has focused on internalizing and externalizing symptoms in non-clinical samples, future research should focus more on clinically significant problems and consider specific clinical disorders. The CBCL is not a measure of psychopathology, although it does indicate risk for eventual psychopathology ( Koot & Verhulst, 1992 ; Verhulst, Koot, & Van der Ende, 1994 ). Future research should address why the link between attachment and problematic behaviors is stronger for externalizing than for internalizing problems, and whether this difference holds for diagnosable pathology (e.g., conduct disorder or major depression). This may be partially a measurement issue. The CBCL is often completed, with reference to a child, by a parent, a teacher, or both. It may be easier to see and remember externalizing behaviors than it is to notice whether a child is experiencing anxiety, sadness, or internal conflicts. Another important diagnostic issue is comorbidity. It is very common for clinicians to assign a person to multiple diagnostic categories. Perhaps attachment theory and related measures could help to identify common processes underlying comorbid conditions and suggest where their roots lie ( Mineka, Watson, & Clark, 1998 ). One likely possibility is emotion regulation and dysregulation influenced by early experiences with parents.

Moreover, additional research is needed on the precise nature of the early childhood predictive factors and issues of causation. Is the issue really attachment status at age 1, for example, or is it continual insecure attachment across years of development? Also, we need to know whether attachment status per se is the issue or whether, for example, poor parenting predicts both attachment classification and psychopathology. Answering these questions will require studies using repeated assessments of attachment, parenting, context, and psychopathology. Further, there is increasing recognition of the importance of genetics and gene-by-environment interactions in understanding the development of psychopathology (e.g., Moffitt, 2005 ). Given preliminary evidence for genetic influences on disorganized attachment ( Lakatos et al., 2000 ) as well as evidence for a gene-by-early-maternal-sensitivity interaction in predicting mental health outcomes ( Bakermans-Kranenburg & van IJzendoorn, 2006 ), this area of inquiry is a very promising avenue for further research. There is also growing evidence concerning environmental effects on gene expression (i.e., epigenetics; Meaney, 2010 ). Especially interesting is the possibility that secure attachment may protect a child from the expression of risky genotypes (see Kochanska, Philibert, & Barry, 2009 , for preliminary evidence).

The Neuroscience of Attachment

Recent methodological advances (e.g., fMRI) have enabled researchers to investigate the neural correlates of attachment in humans. Initial theoretical formulations and empirical findings from the nascent subfield of “attachment neuroscience” ( Coan, 2008 ) have begun to provide answers to important questions about the neurobiology of attachment. Recent advances in this area include: (a) identifying key brain structures, neural circuits, neurotransmitter systems, and neuropeptides involved in attachment system functioning (see Coan, 2008 , 2010 , and Vrtička & Vuilleumier, 2012 , for reviews); (b) providing preliminary evidence that individual differences in attachment can be seen at the neural level in the form of differential brain responses to social and emotional stimuli ( Vrtička & Vuilleumier, 2012 ); (c) demonstrating the ability of attachment figures to regulate their spouses' neural threat response (i.e., hidden regulators; Coan et al., 2006 ); and (d) advancing our understanding of the neurobiology of parenting (see Parsons, Young, Murray, Stein, & Kringelbach, 2010 , for a review).

These early findings suggest important directions for attachment research. First, the vast majority of research on the neurobiology of attachment has been conducted with adults (yet see Dawson et al., 2001 ; White et al., 2012 ). However, researchers have the tools to examine the neural bases of attachment in younger participants. It is feasible to have children as young as 4 or 5 years old perform tasks in a functional magnetic resonance imaging scanner ( Byars et al., 2002 ; Yerys et al., 2009 ), and less invasive measures such as EEG are commonly used with infants and even newborns. Additional investigations with younger participants could move the field of attachment neuroscience forward in important ways. For example, researchers could find ethically acceptable ways to extend the work of Coan and colleagues (2006) to parents and children: Just as holding the hand of a spouse attenuates the neural threat response in members of adult couples, holding the hand of a caregiver may have a similar effect on children. Researchers should also extend the sparse literature on how individual differences in attachment in children relate to differential neural responses to social and emotional stimuli.

Second, there is a need for longitudinal investigations that address several important unanswered questions: (a) What does child-parent attachment formation look like at the neural level in terms of the circuits involved and changes in neurobiology over time? (b) What is the role of developmental timing (i.e., sensitive and critical periods in brain development) in the formation of neural circuits associated with attachment? (c) Is the neural circuitry associated with attachment the same for children, adolescents, and adults? Some researchers have suggested that the neural circuitry associated with attachment may be different at different ages ( Coan, 2008 ).

Third, future research should examine the ability of experience to change neural activity in brain regions related to attachment, and should explore potential clinical implications of these findings. For example, Johnson et al. (2013) compared the ability of spousal hand-holding to buffer neural responses to threat before and after couples underwent Emotion-Focused Therapy (EFT). They found that EFT increased the ability of hand-holding to attenuate threat responses; similar examination of both parent and child neural activity in response to attachment-related interventions would be informative.

Fourth, it is important for future research to identify which, if any, brain regions are specific to attachment and which are shared with other related social constructs such as caregiving or affiliation more broadly. There is initial evidence that caregiving and attachment involve both unique and overlapping brain regions ( Bartels & Zeki, 2004 ).

Finally, given the inherent interpersonal nature of attachment, future research should attempt to study attachment-related neural processes in situations that approximate as closely as possible “real” social interactions ( Vrtička & Vuilleumier, 2012 ). To date, all studies of the neuroscience of attachment have focused on the neural activity of only one partner in a relationship. By capitalizing on further methodological advances in neuroimaging (e.g., hyperscanning; Montague et al., 2002 ) researchers may be able to examine simultaneously the neural activity of a parent and child while they are interacting.

Attachment, Inflammation, and Health

Evidence is accumulating that attachment insecurity in adulthood is concurrently associated with negative health behaviors (e.g., poor diet, tobacco use; Ahrens, Ciechanowski, & Katon, 2012 ; Huntsinger & Luecken, 2004 ; Scharfe & Eldredge, 2001 ) and problematic health conditions (e.g., chronic pain, hypertension, stroke, heart attack; McWilliams & Bailey, 2010 ). Despite these intriguing cross-sectional findings in adult samples, much less is known about how early attachment relates to long-term health outcomes. One longitudinal study ( Puig, Englund, Collins, & Simpson, 2012 ) reported that individuals classified as insecurely attached to mother at 18 months were more likely to report physical illnesses 30 years later. Two other studies found that early insecure attachment was associated with higher rates of obesity at age 4.5 ( Anderson & Whitaker, 2011 ) and 15 ( Anderson, Gooze, Lemeshow, & Whitaker, 2012 ). Additional longitudinal investigations of the links between early attachment and health outcomes are needed to replicate these findings in different samples using a wider variety of health measures (e.g., medical records, biomarkers, onset and course of specific health problems).

Another goal for future research is to advance our understanding of the processes or mechanisms by which early attachment is related to later health outcomes. Recent proposals that early psychosocial experiences become “biologically embedded” at the molecular level and influence later immune system functioning (e.g., inflammation) provide a promising model with which to pursue this kind of research (see Miller, Chen, & Parker, 2011 , for a review of the conceptual model and its empirical support). In brief, the model proposes that early adverse experiences result in immune system cells with a “proinflammatory phenotype” and neuroendocrine dysregulation leading to chronic inflammation. Inflammation, in turn, is involved in a variety of aging-related illnesses including cardiovascular disease, autoimmune diseases, and certain types of cancer ( Chung et al., 2009 ).

As mentioned earlier, there is mounting evidence that early experiences with caregivers (including their influence on attachment) contribute to the calibration and ongoing regulation of the HPA axis (e.g., cortisol reactivity, diurnal cortisol rhythms), a system that is central to the body's stress response ( Adam et al., 2007 ; Gunnar & Quevedo, 2007 ; Luijk et al., 2010 ; Spangler & Grossmann, 1993 ). The HPA axis also plays an integral role in inflammatory responses and immune system functioning. In addition, there is evidence that early maternal warmth (retrospectively reported) can buffer the deleterious effects of early adversity on pro-inflammatory signaling in adulthood ( Chen, Miller, Kobor, & Cole, 2011 ; see also Pietromonaco, DeBuse, & Powers, 2013 , for a review of the links between adult attachment and HPA axis functioning). Finally, studies show that attachment in adulthood is concurrently related to biomarkers of immunity: attachment-related avoidance is related to heightened levels of the proinflammatory cytokine interleukin-6 (IL-6) in response to an interpersonal stressor ( Gouin et al., 2009 ) and to lower levels of natural killer cell (NK) cytotoxicity (NK cells are involved in immune defense; Picardi et al., 2007 ); attachment-related anxiety is related to elevated cortisol production and lower numbers of T cells ( Jaremka et al., 2013 ).

These initial findings provide an empirical basis for researchers to pursue further the connections between attachment and health. Future research should prospectively examine the relation between early attachment security and biomarkers of inflammation in adulthood. Further, researchers should attempt to elucidate the relations among attachment, HPA axis functioning, inflammation, and the immune system to better understand the biological processes underlying the link between early experience and later health outcomes.

Attachment and Empathy, Compassion, and Altruism

Shortly after the development of the Strange Situation, which allowed researchers to validly assess infants' attachment orientations, there was strong interest in the potential links between attachment security and prosocial motives and behaviors (e.g., empathy, compassion). From a theoretical standpoint, there are reasons to expect that secure children – whose own needs have been responded to in a sensitive and responsive way – will develop the capacity to respond to the needs of others empathically. Several early investigations confirmed the association between child attachment security and empathic responding ( Kestenbaum, Farber, & Sroufe, 1989 ; Sroufe, 1983 ; Teti & Ablard, 1989 ). Over the past 24 years, however, the link between child attachment status and prosocial processes (e.g., empathy, helping, altruism) has received surprisingly little research attention (though see Panfile & Laible, 2012 ; Radke-Yarrow, Zahn-Waxler, Richardson, Susman, & Martinez, 1994 ; van der Mark, van IJzendoorn, & Bakermans-Kranenburg, 2002 ). In contrast, social/personality psychologists have generated substantial and compelling empirical support for a connection between adult attachment and prosocial motives and behaviors.

Mikulincer, Shaver, and colleagues ( Mikulincer & Shaver, 2001 ; Mikulincer, Shaver, Gillath, & Nitzberg, 2005 ; Mikulincer, Shaver, Sahdra, & Bar-On, in press ) have demonstrated that both dispositional and experimentally augmented attachment security (accomplished through various forms of “security priming”) are associated with several prosocial constructs, including reduced outgroup prejudice, increased compassion for a suffering stranger and willingness to suffer in her place, and the ability and willingness of one partner in a couple to listen sensitively and respond helpfully to the other partner's description of a personal problem. In addition, surveys completed in three different countries (United States, Israel, the Netherlands) revealed that more secure adults (measured by self-reports) were more likely to volunteer in their communities (e.g., by donating blood or helping the elderly). Avoidant respondents were much less likely to volunteer, and although anxious respondents volunteered, their reasons for doing so (e.g., to receive thanks, to feel included) were less generous than those of their more secure peers ( Gillath et al., 2005 ).

Further study of how early attachment relates to various forms of prosocial behavior is needed. Developmental attachment researchers would benefit from using the experimental techniques that Mikulincer, Shaver, and colleagues used. Are young children who were classified as secure in the Strange Situation (especially in comparison to children classified as avoidant) more willing to help a suffering individual or more willing to interact with a child from a different ethnic group? Can experimental security “boosts” increase tolerance, empathy, compassion, and altruism in children? There is already robust experimental evidence that infants as young as 14 to 18 months readily engage in altruistic behavior (e.g., retrieving an out-of-reach object for a stranger; see Warneken & Tomasello, 2009 , for a review). To the best of our knowledge, however, no study has examined whether variations in infant attachment predict individual differences in this kind of instrumental helping behavior (although the potential for attachment-related differences has been proposed by Dweck; see Tomasello, Dweck, Silk, Skyrms, & Spelke, 2009 ). Warneken and Tomasello (2009) have proposed that these early helping behaviors reflect a biological predisposition for altruism in infants that begins to be influenced by social and cultural experiences only “a year or two after [the infants] have started behaving altruistically” (p. 400). However, given the innumerable social experiences that infants encounter in the first year of life and the pioneering work by Johnson and colleagues ( Johnson, Dweck, & Chen, 2007 ; Johnson et al., 2010 ) showing that 12- to 16-month-old infants with different attachment patterns have different expectations about others' helpfulness, it may be possible to observe attachment-related individual differences in early helping behaviors earlier than Warneken and Tomasello suggest.

Attachment and School Readiness

In recent years researchers, educators, and policy makers have been increasingly interested in understanding factors that predict children's school readiness and in developing and testing programs that may better prepare children (particularly at-risk children) for school entry. In his 2013 State of the Union Address at the beginning of his second term, President Obama proposed implementing universal, high-quality preschool for all American children with the idea that these early preparatory experiences will enhance school readiness and future academic performance. The focus of much of the initial research on school readiness has been on children's basic cognitive skills such as early literacy and numeracy abilities (e.g., Duncan et al., 2007 ). More recently, researchers have recognized the importance of other competencies such as emotion regulation and social skills (e.g., High and the Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health, 2008 ). Further, High et al. listed “strong nurturing relationships” as one of the universal needs of children that must be met to promote school readiness and positive educational outcomes (p. e1009).

The conclusions reached by High et al. suggest that child attachment security is an important factor to consider when studying school readiness and developing programs designed to improve school readiness (for initial empirical evidence, see Belsky & Fearon, 2002 , and Stacks & Oshio, 2009 ). Decades of research have provided substantial evidence that early attachment security is associated with better emotion regulation capacities and greater social competence (e.g., Cassidy, 1994 ; Sroufe et al., 2005a ; Thompson, 2008 ). In addition, research has demonstrated that secure attachment is associated with better academic performance ( Granot & Mayseless, 2001 ) as well as enhanced cognitive skills and executive functions ( Bernier, Carlson, Deschênes, & Matte-Gagné, 2012 ; Jacobsen, Edelstein, & Hofmann, 1994 ). Thus, as research on school readiness continues to advance, greater consideration of the direct and indirect influences of early attachment security on school readiness is warranted. For example, researchers should test mediational models in which attachment security predicts greater emotion regulation or social competence, which in turn predicts greater school readiness. In addition, both parenting and school readiness interventions could consider whether increasing parental secure base provision fosters a child's school readiness. Moreover, consideration of the extent to which preschool teachers perform secure base and safe haven functions for their young students, and whether these components of the student-teacher relationship relate to young children's classroom functioning will be important (see Commodari, 2013 ).

Attachment and Culture

Bowlby (1969/1982 ) viewed the attachment behavioral system as a product of human evolutionary history, making it cross-culturally universal. Ainsworth's (1967 ; Ainsworth et al., 1978 ) early studies in Uganda and the US provided empirical support for similar attachment processes in very different cultures. Although some researchers have disputed the cross-cultural validity of core tenets of attachment theory (e.g., Rothbaum, Weisz, Pott, Miyake, & Morelli, 2000 ), decades of research strongly suggest that the basic phenomenon and the major kinds of individual differences are universal (see van IJzendoorn & Sagi-Schwartz, 2008 , for a review). Three hypotheses rooted in attachment theory have been examined and supported in cross-cultural research: that secure attachment is the most prevalent pattern in all cultures and is viewed as the most desirable pattern; that maternal sensitivity influences infant attachment patterns; and that secure infant attachment predicts later social and cognitive competence.

Yet much more research is needed. As psychological knowledge, research, and applications become increasingly global, it will become more feasible to map the detailed effects of cross-cultural and contextual differences in parenting, co-parenting, community care, environmental harshness and instability, and conflicts and war on attachment patterns and attachment-related mental health problems. It will be increasingly important to define “culture” and “context” more specifically. Within any large and diverse society, and in every large urban area (in a world increasingly urbanized), there are many cultures and subcultures. Moreover, within any modern society there are large differences in ethnicity, religion, diet, education, income, economic security, and threats to health and the availability of medical care. It is therefore important not to think of differences only between nation states but also within different groups and contexts within each nation.

Translating Attachment Research to Clinical Practice Interventions with Infants and Young Children at Risk for Insecure Attachment

Just as the study of individual differences in attachment began with the study of infants, so the systematic study of how to create attachment-related change focused initially on attempts to alter the developmental trajectory of infants who are at risk of developing or maintaining insecure attachments. Given the substantial and converging longitudinal research underscoring the risks associated with insecure attachment (e.g., poorer mental and physical health and lower social competence), the need to intervene to reduce the risk of insecure attachment is clear. In the past 20 years, researchers and clinicians have developed numerous therapeutic programs to prevent or reduce insecure attachment ( Bakermans-Kranenburg, van IJzendoorn, & Juffer, 2003 ; Egeland, Weinfield, Bosquet, & Cheng, 2000 ; see Berlin, Zeanah, & Lieberman, 2008 , for a review). Despite the fact that a handful of attachment interventions have shown initial success (e.g., Bernard et al., 2012 ; Cassidy et al., 2011 ; Cicchetti, Rogosch, & Toth, 2006 ; Hoffman, Marvin, Cooper, & Powell, 2006 ; Klein Velderman, Bakermans-Kranenburg, Juffer, & van IJzendoorn, 2006 ; Lieberman, Weston, & Pawl, 1991 ; Lyons-Ruth & Easterbrooks, 2006 ; Sadler et al., 2013 ; Toth, Rogosch, Manly, & Cicchetti, 2006 ; van den Boom, 1994 , 1995 ), we have as yet a collection of individual initiatives with little replication. More research is needed to identify the critical targets of attachment interventions and to understand the process of change.

Targets of early intervention

What should an intervention target? Until recently, this question was framed largely as: Should interventions target parental behavior, parental representations, or both? Greater specificity is required. When an intervention targets parental behavior, what specific components of behavior should be targeted? We discussed potential aspects of parental behavior earlier. When an intervention targets parental representations, what specific components should be targeted? Should interventions target representations of the parent her- or himself, of the infant, of the relationship; of the baby as an entity with a mind (e.g., mentalizing approaches; Slade et al., 2005 ); or maternal attributions about the infant's behavior ( Bugental et al., 2002 )?

Several studies (described earlier) suggest additional intervention targets. For example, the evidence that maternal emotion regulation capacities influence parenting ( Dix, 1991 ; Leerkes, Crockenberg, & Burrous, 2004 ; Lorber & Slep, 2005 ; Smith & O'Leary, 1995 ) suggests that targeting maternal emotion regulation capacities might be useful in bringing about change (e.g., the Circle of Security intervention; Hoffman et al., 2006 ). Another target of intervention is suggested by research with non-human primates and other mammals that demonstrates the soothing and regulatory functions that physical contact with an attachment figure can provide ( Hofer, 1994 , 2006 ; Meaney, 2001 ; Suomi, 2008 ; see Feldman, Singer, & Zagoory, 2010 , for such evidence in humans; see also Field, 2011 ). Interventions focused on infant-mother contact may prove useful (see Anisfeld, Casper, Nozyce, & Cunningham, 1990 , for a randomized trial in which mothers assigned to carry their infants in soft baby carriers were more likely to have infants who were securely attached at age 1). Of course, consideration of intervention targets necessarily requires considering moderators of intervention effectiveness. Targeting certain components may be more effective for some mothers than others.

The desire to intervene to reduce the risk of insecure attachment rests on the assumption that doing so in turn reduces the risk of poor child functioning, including a reduction in behavior problems and psychopathology. Remarkably, although there are a number of studies, described above, that show a link between insecure attachment and behavior problems and psychopathology, much less research has focused on whether intervening to reduce the risk of insecure attachment actually leads to a reduction in later problems (yet see Dozier et al., 2006 ; Moss et al., 2011 ; Klein Velderman et al., 2006 ; van den Boom, 1995 ; Van Zeijl et al., 2006 ). Future intervention research should test the change model according to which improving parenting reduces the risk of insecure attachment, which in turn reduces child behavior problems and psychopathology. Given that behavior problems associated with early insecure attachment may not emerge until later in development, and the evidence that the link between insecure attachment and behavior problems grows stronger over time ( Fearon & Belsky, 2011 ), longitudinal studies with long-term outcome assessments will be an important component of future intervention research.

Intervention development and issues of implementation

No attachment intervention has yet achieved widespread implementation. When following the typical efficacy-to-effectiveness clinical model, researchers initially design an intervention with a highly specified protocol, and only once it has proven to be efficacious in a tightly controlled setting do they begin to consider the adaptations needed for effectiveness in real-world settings. With attachment-based infant interventions, the problem has been that initial interventions are typically very expensive, and real-world social agencies attempting to meet the needs of at-risk infants cannot afford them. This is an unfortunate situation, especially because, over the past decade, there has been a call for researchers to attend to issues of implementation during the early stages of intervention planning. For instance, an argument that “the focus on feasibility in the prevention research cycle should not be restricted to the effectiveness stage” has been put forward by Ialongo and colleagues (2006) .

Several components of early attachment-based interventions make implementation at a broad public health level impractical. Many such interventions involve videotaping individual parent-infant interactions and providing individualized parental feedback (e.g., Dozier et al., 2006 ; Klein Velderman et al., 2006 ). This requires considerable resources: extensive training and supervision of staff; expertise and time to create individual diagnostic and treatment plans; and time, space, equipment, skills, and parental assent for individual videotaping. From an attachment perspective, the problem is how to provide an individualized approach that does not require expensive highly skilled staff. This problem has not been easy to solve (e.g., Berlin, Ziv, Amaya-Jackson, & Greenberg, 2005 ). Continued attempts to develop interventions that are widely and affordably implementable are important.

We urgently need evaluations of comprehensive theory- and research-based intervention protocols that can be widely implemented among families whose infants and children are at elevated risk for developing or maintaining insecure attachments . Addressing this need is in keeping with the NIMH (2008) strategic plan's objective of moving interventions to “common practice” more quickly and of examining interventions in “the care setting in which they are delivered” (p. 35). Continued testing of attachment-based interventions should occur further down the efficacy-to-effectiveness stream – with affordable protocols that can be provided through existing service delivery mechanisms. Expensive interventions are not implementable on a broad scale within the current American health care and educational structures.

Intervention development and testing are enormously expensive, yet replication of existing interventions is crucial. We propose that the dedication of resources to development of new interventions occur only when theory, clinical perspectives, or research indicate that existing interventions lack an important component that could reasonably contribute to change.

Interventions during Adolescence

Adolescence is a period of increased risk-taking behavior and mental health disorders ( Centers for Disease Control and Prevention [CDC], 2012 ; Roberts, Attkisson, & Rosenblatt, 1998 ), and attempts to reduce these problematic symptoms and behaviors are important. The dramatic biological and cognitive changes that occur during adolescence have led some researchers to consider this period as a second sensitive period (e.g., Andersen & Teicher, 2008 ; Guttmannova et al., 2011 ), and as such, adolescents may be particularly open to environmental interventions that can lead to improved functioning.

Interventions designed to help adolescents are typically targeted at the reduction of specific problems (e.g., depression or delinquency), and there are many effective interventions for helping troubled adolescents (e.g., Dishion & Kavanagh, 2003 ; Stein, Zitner, & Jensen, 2006 ). Yet given evidence that the link between attachment security and healthy functioning continues to exist in adolescence ( Dykas, Ziv, & Cassidy, 2008 ; Kobak & Sceery, 1988 ; see Allen, 2008 , for a review), increasing adolescent attachment security may also be an effective means of reducing adolescent problems. In other words, does an intervention focused on the adolescent-parent attachment relationship increase the likelihood of reduced problematic adolescent behavior? There has been remarkably little research on this important question. Moreover, the associations among intervention, attachment, and psychopathology may be more complex in adolescence than they are in infancy and early childhood. Another important way to examine the connections among these factors is to design studies to determine whether reducing adolescent psychopathology contributes to secure adolescent attachment.

In an intervention designed to enhance adolescent-parent attachment security – with the idea being that increased security will reduce the prevalence of adolescent problems – questions about intervention approaches arise. For instance, should an intervention include the parent, the adolescent, or both? Bretherton (1992) described Bowlby as the first family therapist because of his proposition that change in a child's attachment to a parent is possible only when there is change within the interaction between the child and the parent (see also Byng-Hall, 1999 ). There has been almost no examination of this proposition in adolescence. One randomized controlled trial ( Diamond et al., 2010 ) showed that Attachment-Based Family Therapy (ABFT) was more efficacious than Enhanced Usual Care in reducing adolescents' depressive symptoms and suicidal ideation.

Policy Implications

Throughout this article we have suggested topics for future research. At least as important are the needs for application of the findings already obtained and increased collaborations among researchers, policy makers, educators, and child service workers. Here we list a few important areas for such efforts.

Attachment research has clearly established the importance of early experiences with parents for child development. Yet far too many parents enter parenthood with insufficient knowledge about child development and the importance of the early parent-child relationship, and without the knowledge and skills needed to parent in a sensitive, responsive manner. Unfortunately, there is almost no future-parent education at any grade level in public schools. In American schools, there seems to be a greater focus on education about sex than about successful parenting. (And most sex education classes do not deal with other aspects of couple relationships, even though there is a considerable body of attachment-related research relevant to establishing and maintaining healthy couple relationships – a foundation for healthy parent-child relationships.) Even at the college level, there are few courses aimed at preparing young adults for healthy marriages and parenting. Researchers and educators should work together to develop future-parent curricula that could be implemented as part of high school and university education. There are several empirically supported parent training programs based on attachment research (described earlier; see Berlin et al., 2008 , for a review), but these have yet to be made a part of general education.

In the context of dramatic social and economic changes, many parents are struggling to strike a balance between work and family responsibilities and to find quality care for their children while the parents are at work or school. There is a need for more flexible work arrangements that recognize child care as a prime societal concern. This includes re-examination of parental leave policies that require parents to return to work too soon after childbirth, either because of company policy or because of financial necessity. In addition, greater attention to the training and screening of childcare workers and prospective foster parents is warranted. In a review of attachment theory and its implications for society, Sweeney (2007) suggested, among several policy implications, “legislative initiatives reflecting higher standards for credentialing and licensing childcare workers, requiring education in child development and attachment theory, and at least a two-year associate's degree course as well as salary increases and increased stature for childcare positions” (p. 342). The massive NICHD childcare study showed that high quality daycare is compatible with secure attachment of young children to their parents, and also that when home conditions make secure attachment unlikely, high quality daycare can increase children's chances of achieving attachment-related security ( NICHD Early Child Care Research Network, 1997 ).

Policies directed at helping families in which one or both parents serve in the military could also be informed by attachment theory and research. Military service often entails frequent moves within the United States and separation of at least one parent from the family during periods of service overseas. In thousands of cases, the separation ends with a soldier's death, and his or her family is left to cope with the tragedy. Attention to helping spouses and children cope effectively with attachment-related stresses that have the potential to damage their lives for years to come has increased in recent years (e.g., Maholmes, 2012 ; see also Riggs & Riggs, 2011 , for consideration of military families within an attachment theory framework), but there continues to be a need for research-informed interventions that consider the particular challenges faced by military families (for discussion, see Miller, Miller, & Bjorklund, 2010 ; Paris et al., 2010 ).

We end with a brief mention of policy implications related to parental incarceration. Elsewhere ( Cassidy, Poehlmann, & Shaver, 2010 ) we have provided reviews and studies related to this issue. Often, incarcerated parents are unable to see their children, and pressures are placed on the rest of extended families, and in many cases on the foster care system. For each adult placed in prison, there are likely to be, on average, more than one or two people outside of prison who suffer from the incarceration. Policy makers could consider the separations and losses that accompany parental incarceration within an attachment framework. Research is needed to assess the value of greater contact between incarcerated individuals and their children, and of parenting interventions that can take place as part of rehabilitation.

Brief Conclusions

Our goal in this article has been to provide a current “state of the art” description of what is known in many important areas of attachment research, discuss gaps in current knowledge, and suggest important avenues for future research and for creating and evaluating practical interventions. Although we have, by design, focused on issues within attachment research specifically, an important enterprise for the future is to consider how attachment is differentiated from, and integrated with, other features of development. As our colleague Alan Sroufe responded when asked his views on the future of attachment research (personal communication, 2012; see also Sroufe, Egeland, Carlson, & Collins, 2005b ), “There is a lot more to personal development than attachment, and there is a lot more even to parenting than attachment. The task is to describe how all of this fits and works together.” That task arises with respect to every phase of development – infancy, childhood, adolescence, and adulthood. And the range of issues and factors to be considered is somewhat different at every stage or phase of development.

Certain large goals of any worthy society – the mental and physical health of its members, the optimal development of each individual's interests and capacities, and a safe environment free of violence and hatred – are likely to be achieved only to the extent that infants and children receive the benefits of what Bowlby and Ainsworth called a safe haven and a secure base, which as far as we can see imaginatively into the future are likely to depend on responsive attachment figures. Partly through the efforts of Bowlby, Ainsworth, and their intellectual offspring, it has been possible to improve hospital procedures, reduce child abuse, contribute to better parenting, increase understanding of the development of psychopathology, and to provide a much better understanding of our social nature as mammals, primates, and human beings. With the goal of a mentally and physically healthy human race in mind, we can simultaneously be proud of the accomplishments of attachment researchers and look forward to participating in addressing the many intellectual, clinical, and educational challenges remaining.

Acknowledgments

Author Note: The writing of this article was supported by awards to Jude Cassidy from NIDA (R21 DA025550), to Jason Jones from NIDA (F31 DA033848), and to Phillip Shaver from the Fetzer Institute. The authors are grateful to Susan S. Woodhouse for engaging in extensive conversations about maternal response to distress, and to Kenneth N. Levy for helpful suggestions about links between attachment and psychopathology.

Invited contribution to the 25 th anniversary edition of Development and Psychopathology .

Contributor Information

Jude Cassidy, University of Maryland.

Jason D. Jones, University of Maryland.

Phillip R. Shaver, University of California, Davis.

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Reviewed by Psychology Today Staff

Attachment is the emotional bond that forms between infant and caregiver , and it is how the helpless infant gets primary needs met. It then becomes an engine of subsequent social, emotional, and cognitive development. An infant's early social experience stimulates the growth of the brain and can influence the formation of stable relationships with others.

Attachment provides the infant's first coping system; it sets up a mental representation of the caregiver in an infant's mind, which can be summoned as a comforting mental presence in difficult moments. Attachment allows an infant to separate from the caregiver without distress and explore the world around her.

Neuroscientists believe that attachment is such a primal need that there are networks of neurons in the brain dedicated to setting it in motion in the first place and a hormone — oxytocin —that fosters the process.

Attachment styles are not immutable, they can change substantially over time , research suggests, and may differ from relationship to relationship. Enduring a terrible relationship might lead to a less secure attachment orientation; a history of supportive relationships may lead to increased security. Therapy —providing a safe connection and an opportunity to learn relational skills— may also be helpful .

• Early Attachment
• Attachment Styles

Attachment develops through everyday interactions as a caregiver attends to an infant's needs. The bond between infant and caregiver is usually so well established before the end of the first year of life that it is possible to test the nature and quality of the bond at that time.

As a result of their work with many child-caregiver pairs, researchers have described several basic patterns of attachment. In their studies, researchers briefly separate young children from their caregiver and observe their behavior before and after they are reunited with the caregiver.

• Children with a secure attachment may be distressed upon separation but warmly welcome the caregiver back through eye contact and hug-seeking.
• Anxious-resistant attachment describes a child who is frightened by separation and continues to display anxious behavior once the caregiver returns.
• Avoidant attachment denotes a child who reacts fairly calmly to a parent’s separation and does not embrace their return.
• Disorganized attachment is manifest in odd or ambivalent behavior toward a caregiver upon return—approaching then turning away from or even hitting the caregiver—and may be the result of childhood trauma .

A majority of children tend to show “secure” attachment behavior in studies, while others seem “insecure,” showing one of the other patterns.

Secure attachment in children has been theorized to result from sensitive, responsive caregiving , and insecurity from its lack. While there is evidence that parenting can influence attachment security , it’s also clear that other factors—including genetics—play a formative role .

British psychoanalyst John Bowlby proposed that children’s attachment behaviors (such as showing distress at a parent’s absence) are part of an evolved behavioral system that helps ensure they are cared for. Psychologist Mary Ainsworth later began to experimentally study variations in how children respond to separation from parents. Others have expanded attachment theory to adult relationships .

Abuse and trauma in childhood may hinder the development of secure attachment and may be predictive of attachment insecurity later in life . In cases of severe neglect or mistreatment, a child may develop reactive attachment disorder (RAD) , characterized by difficulty forming a bond with caregivers.

Attachment security and behaviors have been studied in adult relationships, and attachment-related patterns that differ between individuals are commonly called "attachment styles." There seems to be an association between a person’s attachment characteristics early in life and in adulthood, but the correlations are far from perfect.

Many adults feel secure in their relationships and comfortable depending on others (echoing “secure” attachment in children). Others tend to feel anxious about their connection with close others—or prefer to avoid getting close to them in the first place. Studies of persons with borderline personality disorder , characterized by a longing for intimacy and a hypersensitivity to rejection, have shown a high prevalence and severity of insecure attachment.

Attachment styles in adulthood have labels similar to those used to describe attachment patterns in children:

• Anxious-preoccupied (high anxiety , low avoidance)
• Dismissing-avoidant (low anxiety, high avoidance)
• Fearful-avoidant (high anxiety, high avoidance)

However, attachment styles may be better thought of as dimensional, where a person rates as relatively high, low, or somewhere in the middle in their levels of attachment-related anxiety and attachment-related avoidance. Also, a person may not exhibit the same kind of attachment pattern in every close relationship.

A person may have high attachment anxiety if she worries a lot about being abandoned or uncared for. This is  measurable by one’s agreement with statements such as “I worry about being alone” and “I often worry that romantic partners don’t really love me." Someone high in attachment avoidance likely worries about other people getting “too close.”

People with a secure attachment style tend to fare better on outcomes such as relationship stability and sexual satisfaction , research suggests, and may be less likely to engage in disruptive acts such as partner surveillance or harmful sexual behavior .

Recovery from Borderline Personality Disorder is possible, but two factors may make it especially difficult.

Wondering whether you are overfunctioning in your relationship? Consider these 7 signs and some tips for shifting the pattern.

Deciding whether to do therapy in person or virtually is an important one. Be sure to consider the richness of the interpersonal interactions as you decide.

Controlling behaviors do not need to ruin relationships. Learn to address the real issues and avoid the unpleasant process of compensating and becoming controlling yourself.

Do you feel overwhelmed and cluttered with material possessions? How can we better understand our struggles with hoarding behavior in relation to Bowlby's attachment styles?

In the rush to find lasting love and security, many people idolize a new partner. But the false story they tell themselves often leads to heartache.

Sociopolitical losses can shatter our assumptions and worldviews.

Should therapy be used to hasten contact between children and an abusive parent?

About 40 percent of people believe their partner is keeping secrets. Understanding why your partner might be hiding something can help you figure out how to cope.

Much conflict in relationships is due to women not understanding that men are afraid of them and men not understanding that women are trying to connect.

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