Attachment Theory by John Bowlby and
Mary Ainsworth
Attachment is the deep and enduring connection established between a child and caregiver in the first several years of life. It profoundly influences every
component of the human condition - mind, body, emotions, relationships and values. Attachment is not something that parents do to their children;
rather, it is something that children and parents create together, in an ongoing reciprocal relationship. Attachment to a protective and loving caregiver
who provides guidance and support is a basic human need, rooted in millions of years of evolution. There is an instinct to attach: babies instinctively
reach out for the safety and security of the "secure base" with caregivers; parents instinctively protect and nurture their offspring. Attachment is a
physiological, emotional, cognitive and social phenomenon. Instinctual attachment behaviors in the baby are activated by cues or signals from the
caregiver. Thus, the attachment process is defined as the baby and the caregiver influencing one another over time.
SECURE attachment: (Approximately 65% of babies
assessed showed this type of attachment). The baby prefers the
parent as a safe base for exploring the room. Baby prefers
parent over stranger. Baby may show distress when separated
from parent. Baby seeks proximity and contact with parent on
INSECURE-AVOIDANT attachment: (approximately 20% of
assessed babies showed this type of attachment). This kind of
attachment is unhealthy and associated with tense or irritable
parenting; shows little interest in child, handling in a mechanical
fashion, failing to adjust feedings to the baby's pace, less
responsive to their cries and calls, resentful, negative. Baby in
assessment does not show preference for parent over stranger.
Avoids contact with parent by looking away or turning away.
This baby doesn't usually cry on separation with parent; little or
no proximity seeking when parent returns. Baby seems
unemotional; focuses on toys or environment throughout
(approximately 15% of assessed babies).
Description of parenting similar to insecure-avoidant; parent
may also be intrusive, overstimulating, or hostile. Baby shows
ambivalent approach-resist behavior; seeks proximity with
parent, but then resists contact; baby does not avoid parent;
shows anger or overly passive; little or no exploration with toys.
(a very small percentage of babies). This type of attachment was
added later for babies who were unable to easily be categorized
into another category. Associated with parents who were
abusive and/or have themselves suffered childhood traumas,
have unresolved difficulties with their own parents, or are still
mourning the death of their own attachment figure. Babies in
this category have been frightened by their caregiver and are
confused about how to respond when they are stressed. Baby
is assessment acts confused, dazed, and may show
contradictory behaviors; or baby may be calm and then angry;
baby may be motionless or show apprehension; their behaviors
are not consistently avoidant or resistant as in other categories.
The baby may cling to the parent while crying hard and leaning
away with gaze averted.
generally for 1 year old children, designed by MARY AINSWORTH; baby's
behavior described is "secure."

EPISODE                                       Behavior of infant
1. Introduction
Assistant introduces parent and                         Baby held by parent.
baby to the room. The episode lasts
30 seconds; the other episodes last
approximately 3 minutes each.
2. Unfamiliar room
Parent places the baby on the floor                
with toys and sits in chair. Parent             
is told not to direct baby's actions,            
but otherwise to respond normally.           
3. Stranger enters
Unfamiliar female adult knocks on              
door, then enters. Stranger speaks              
with parent, then approaches the                 
baby to play.   
4. Parent leaves
_________________________________________________________________________________________________Parent quietly leaves
the room,                   
leaving baby with the stranger.                   
Stranger returns to sit in the chair.            

5. Parent returns, stranger leaves
Parent returns and stranger leaves.          
Parent comforts baby, if baby wishes,        
and returns baby to play with the toys.     
6. Parent leaves again
Parent says "bye bye" and leaves                       Baby shows separation anxiety,
the infant alone in the room.                             distress.
7. Stranger enters again
While baby is still alone, the same                    Baby may show stranger anxiety,
stranger enters again. Stranger sits                 clearly prefers that parent return.
on chair,  then calls or approaches
the baby to play.
8. Reunion, stranger leaves
Parent returns and stranger leaves.                 Joy on reunion. Baby seeks
Parent picks up baby for a reunion                   proximity and contact with
that ends the procedure.                                    parent.
Diagnostic criteria for 313.89 Reactive Attachment Disorder of Infancy or Early Childhood

A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):
    (1) persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited,
hypervigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and
resistance to comforting, or may exhibit frozen watchfulness)
    (2) diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity
with relative strangers or lack of selectivity in choice of attachment figures)

B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation) and does not meet criteria for a Pervasive
Developmental Disorder.

C. Pathogenic care as evidenced by at least one of the following:
          (1) persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection
          (2) persistent disregard of the child's basic physical needs
          (3) repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care)

D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began
following the pathogenic care in Criterion C).

Specify type:

Inhibited Type: if Criterion A1 predominates in the clinical presentation.
Disinhibited Type: if Criterion A2 predominates in the clinical presentation.

Reprinted  from the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association
Baby may be wary of room at first
but uses parent as a safe secure
base. Baby plays with toys while
parent is present. Usually
maintains visual contact with
parent during play.
Baby may show stranger anxiety
and clearly prefer parent over
stranger. While parent is in the
room, the baby may allow the
stranger to approach and play.
Baby shows separation anxiety and
renewed stranger anxiety. May be
somewhat comforted by the
stranger, but clearly wants the
Baby seeks contact with parent for
joyful reunion. Seeks proximity
and clings. May continue playing
while the parent is present.