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This Padlet was updated on 26/06/2025. It has sources from the course learning materials and additional sources to enhance your professional development. 

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This Padlet was updated on 26/06/2025. It has sources from the course learning materials and additional sources to enhance your professional development. 

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How children's secure attachment sets the stage for positive well-being

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Parents or caregivers who a child can return to in times of distress to receive comfort or protection provide a secure base for the child from which they feel safe to explore the world.

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Attachment Issues and Attachment Disorders in Children

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Attachment problems can affect your child’s development, relationships, and overall well-being. Here’s how to overcome insecure attachment.

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What's a key person's role?

While going to a childminder or to nursery can be an exciting and enriching experience for a child, it can also be a stressful experience. This is partly because it is something new and unfamiliar, but also because it involves the child separating from the main person who looks after them. To help young children manage this, they need to be able to depend on a known and reliable caregiver at the setting, namely a 'key person'. (Previously the term 'key worker' was commonly used to describe this role, but many nurseries now use the term, 'key person' to emphasise the central importance of the relationship between the child and the 'person' responsible for their care.)

Key people are usually allocated a small group of children to look after. They will be the main carer for each of these particular children while they are in the care of the nursery or childminder. If a child is able to form a close relationship with a 'key' person who is consistently available to them this will help them to feel more secure. This key person will become an additional 'attachment figure', in the absence of their parents or carers.

Just like with the attachment relationships that the child has formed with their parents or carers, this new relationship is a secure foundation on which the child can build their capacity to explore, play and learn.

Depending on the age of the children they care for, key people have a range of responsibilities, such as feeding, changing, activity planning and monitoring each child's developmental progress. Through these activities, the key person's most important task is to get to know the child as an individual and to develop a warm and empathic relationship with them. A key part of this is responding sensitively to their verbal and non-verbal cues.

Like parents, key people can't always be perfectly attuned to their key children, and like parents, they can't, and won't, get it right all the time. But what is most important for the baby, toddler or young child is that they have a consistent and reliable adult who keeps trying to understand them and what they need.

Also see: Separation anxiety

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Relationship with the key person in a childcare setting

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Advice on key workers or childminders on supporting babies, infants and young children with ensuring nursery and school remains an exciting and enriching experience.

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Research suggests autistic people may have different communication styles and preferences to non-autistic people. Communication differences must be present for an autism diagnosis, but these can vary widely between autistic people.

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Attachment can be defined as a deep and enduring emotional bond between two people in which each seeks closeness and feels more secure when in the presence of the attachment figure.

The initial and perhaps most crucial emotional bond forms between infants and their primary caregivers.

Distinct behaviors characterize attachment in children and adults, such as seeking closeness with the attachment figure when distressed or threatened (Bowlby, 1969).

John Bowlby

Attachment theory in psychology finds its roots in the pioneering work of John Bowlby (1958). During the 1930s, Bowlby was a psychiatrist at a Child Guidance Clinic in London, treating numerous emotionally troubled children.

His experiences there underscored the significance of a child's relationship with their mother in shaping their social, emotional, and cognitive development.

It molded his understanding of the connection between early separations from the mother and subsequent maladjustment, leading him to develop his attachment theory.

The attachment bond isn't coincidental. Its primary purpose is to ensure the survival of the vulnerable infant, requiring the constant presence of a caregiver (Bowlby, 1973, 1980).

Viewed from this lens, attachment emerges as an evolutionary concept. The behavior of seeking proximity is universally observed across cultures (Van Ijzendoorn & Sagi-Schwartz, 2008).

Bowlby (1988) contended that the drive for proximity arises from an interconnected set of behavioral systems that collectively shape behavior. These include the attachment, caregiving, and exploratory behavioral systems.

Attachment Behavioral System

The attachment behavioral system concerns the tendency of an individual to seek security during times of stress (Mikulincer & Shaver, 2003), which can be internal (i.e., hunger, fatigue, illness) or from external features of the environment, such as threatening stimuli (Bowlby, 1988).

The more extreme the stress, the more intense the attachment system activation. The attachment system is most readily activated during the first five years of life, a period characterized by high levels of vulnerability and dependence.

Once the attachment system is activated, the infant is motivated to seek proximity to significant others (attachment figures) to protect themselves from physical or emotional harm (Bowlby, 1969).

If this goal is achieved, the infant develops feelings of safety and security, and their attachment system becomes deactivated. The infant will call upon a range of attachment behaviors with the goal of attaining proximity to the attachment figure.

Bowlby (1988) suggests the attachment behavioral system remains important throughout life and will also motivate adults to seek proximity in times of stress during adulthood.

Caregiving System

The attachment figure is viewed as a 'safe haven', and their role is to correspondingly alter their level of responsiveness to deactivate the infant's attachment system by promoting feelings of security.

George and Solomon (1996) call this reciprocal response of the attachment figure to the infant's attachment system the 'caregiving' system.

Bowlby (1969) posits that the caregiving system exists to provide protection and support to others in need of assistance, through providing sensitive and responsive care.

The caregiving system is activated when an individual expresses a need for support or their attachment system is activated, and is deactivated when the care recipient appears to be in a secure state (Shaver & Mikulincer, 2006).

Once activated, the caregiver may utilize a variety of behavioral strategies intended to improve the other person's well-being, re-establishing their felt security, and facilitating their coping efforts.

Caregiving strategies include validating a person's worries, providing physical closeness and affection, and communicating that a person is loved and valued (Mikulincer & Shaver, 2007).

In addition to attachment behaviors, the caregiving system can support exploratory behaviors (Feeney, 2004).

The Importance of Early Emotional Bonds

Attachment behavior in adults toward the child includes responding sensitively and appropriately to the child's needs. Such behavior appears universal across cultures.

Attachments are most likely to form with those who responded accurately to the baby's signals, not the person they spent more time with. Schaffer and Emerson called this sensitive responsiveness.

Reciprocity is the mutual, two-way interaction between an infant and caregiver, where both respond to each other's signals, such as when a baby's smile evokes a smile in return. This interaction is vital for a child's development, establishing their foundational trust and shaping future relationships and learning.

Exploratory Behavioral System

When infants feel safe and secure, and their attachment system is deactivated, their energy can be devoted to what Bowlby (1969) refers to as the exploratory behavioral system.

The exploratory behavioral system refers to behaviors that drive the organism to interact with the environment in a bid to inspect it, manipulate it, and master it (Mikulincer & Shaver, 2007).

According to Bowlby (1969), the exploratory system is activated by novelty and is terminated when a person exhibits a sense of competence and familiarity with their environment. From this perspective, attachment figures can also be seen as a 'secure base' which infants use to explore their social world (Ainsworth, Blehar, Waters, & Wall, 1978).

The more assured the infant is in the availability of their attachment figure in times of stress, the more likely they will interact with others and their environment. Thus attachment, far from interfering with exploration, is viewed as nurturing exploration.

Caregivers who provide a secure base allow infants to become autonomous, inquisitive, and experimental. Children who lack a secure base find their attachment system keeps overriding their attempts to be autonomous and to competently interact with their social environment.

This, in turn, can impair and harm a child's social, emotional, and cognitive development (Bowlby, 1980). Of course, not all attachment figures become a secure base, and this function is based on the responsiveness of their caregiver towards the infant (Ainsworth & Wittig, 1969).

Ainsworth et al. proposed the interconnecting between attachment and exploratory systems are adaptive as they ensure a balance between protection and exploration of the social and physical environment.

Ainsworth's Strange Situation

Mary Ainsworth and her colleagues discovered three major patterns that infants attach to their primary caregivers ("mother figures") from their Strange Situation Procedure (Ainsworth et al., 1978).

The study recruited four different samples of infants at around one year of age, and engaged them in the Strange Situation procedure, roughly described below:

An infant was put into an unfamiliar environment with his or her mother and was free to explore the environment; a stranger entered the room and gradually approached the infant; the mother then left the room, returning after the infant spent some time alone with the stranger.

Ainsworth and colleagues observed how comfortable each infant was physically farther away from the mother in an unfamiliar environment, how each infant interacted with the stranger, and how each infant greeted the mother upon her return.

Based on the observations, they sorted the infants into three groups: secure, anxious, and avoidant.

Attachment Styles

Attachment styles refer to the particular way in which an individual relates to other people. The style of attachment is formed at the very beginning of life, and once established, it is a style that stays with you and plays out today in how you relate in intimate relationships and in how you parent your children.

The concept involves one's confidence in the availability of the attachment figure for use as a secure base from which one can freely explore the world when not in distress and a safe haven from which one can seek support, protection, and comfort in times of distress.

Secure Attachment

Bowlby (1988) described secure attachment as the capacity to connect well and securely in relationships with others while also having the capacity for autonomous action as situationally appropriate.

Secure attachment is characterized by trust, an adaptive response to being abandoned, and the belief that one is worthy of love.

An infant with a secure attachment is characterized as actively seeking and maintaining proximity with the mother, especially during the reunion episode. The infant may or may not be friendly with the stranger, but always shows more interest in interacting with the mother.

Additionally, during the same situation the infant tended to be slightly distressed during separation from the mother, but the infant rarely cried.

Ainsworth and colleagues interpreted infants who were securely attached to their mothers, showed less anxiousness and more positive attitudes toward the relationship, and were likely because they believed in their mothers' responsiveness towards their needs.

Anxious (Ambivalent) Attachment

Anxious attachment (also called ambivalent) relationships are characterized by a concern that others will not reciprocate one's desire for intimacy. This is

caused when an infant learns that their caregiver or parent is unreliable and does not consistently provide responsive care towards their needs.

An anxiously attached infant is characterized as being somewhat ambivalent (and resistant) to the mother. The infant often demonstrated signs of resisting interactions with the mother, especially during the strange situation reunion episode.

However, once contact with the mother was gained, the infant also showed strong intentions to maintain such contact. Overall, ambivalent infants often displayed maladaptive behaviors throughout the Strange Situation.

Ainsworth and colleagues found ambivalent infants to be anxious and unconfident about their mothers' responsiveness, and their mothers were observed to lack "the fine sense of timing" in responding to the infants' needs.

As adults, those with an anxious preoccupied attachment style are overly concerned with the uncertainty of a relationship. They hold a negative working model of self and a positive working model of others.

Avoidant Attachment

Children with avoidant attachment styles tend to avoid interaction with the caregiver, and show no distress during separation. This may be because the parent has ignored attempts to be intimate, and the child may internalize the belief that they cannot depend on this or any other relationship.

An infant with an avoidant attachment was characterized as displaying little to no tendency to seek proximity with the mother.

The infant often showed no distress during separation from the mother, interacted with the stranger similarly to how he or she would interact with the mother, and showed slight signs of avoidance (turning away, avoiding eye contact, etc.) when reunited with the mother.

Ainsworth and colleagues interpreted infants' avoidance behaviors as a defensive mechanism against the mothers' own rejecting behaviors, such as being uncomfortable with physical contact or being more easily angered by the infants.

Disorganized (Fearful) Attachment

Main and Solomon (1986) discovered that a sizable proportion of infants did not fit into secure, anxious, or avoidant, based on their behaviors in the Strange Situation experiment. They categorized these infants as having a disorganized attachment type.

Disorganized attachment is classified by children who display sequences of behaviors that lack readily observable goals or intentions, including obviously contradictory behaviors or stilling/freezing of movements.

Main and Solomon found that the parents of disorganized infants often had unresolved attachment-related traumas, which caused the parents to display either frightened or frightening behaviors, resulting in the disorganized infants being confused or forcing them to rely on someone they were afraid of at the same time.

Stages of Attachment

Rudolph Schaffer and Peggy Emerson (1964) investigated if attachment develops through a series of stages by studying 60 babies at monthly intervals for the first 18 months of life (this is known as a longitudinal study).

The children were all studied in their own homes, and a regular pattern was identified in the development of attachment.

The babies were visited monthly for approximately one year, their interactions with their carers were observed, and carers were interviewed.

A diary was kept by the mother to examine the evidence for the development of attachment. Three measures were recorded:

* Stranger Anxiety - response to arrival of a stranger.

* Separation Anxiety - distress level when separated from carer, degree of comfort needed on return.

* Social Referencing - degree that child looks at carer to check how they should respond to something new (secure base).

They discovered that baby's attachments develop in the following sequence:

Very young infants are asocial in that many kinds of stimuli, both social and non-social, produce a favorable reaction, such as a smile.

Indiscriminate Attachments (6 weeks to 7 months)

Infants indiscriminately enjoy human company; most babies respond equally to any caregiver. They get upset when an individual ceases to interact with them.

From 3 months, infants smile more at familiar faces and can be easily comfortable by a regular caregiver.

Specific Attachment (7 - 9 months)

Special preference for a single attachment figure. The baby looks to particular people for security, comfort, and protection. It shows fear of strangers (stranger fear) and unhappiness when separated from a special person ( separation anxiety).

Some babies show stranger fear and separation anxiety much more frequently and intensely than others; nevertheless, they are seen as evidence that the baby has formed an attachment. This has usually developed by one year of age.

Multiple Attachment (10 months and onwards)

Many of the babies from the Schaffer and Emerson study had multiple attachments by 10 months old, including attachments to mothers, fathers, grandparents, siblings, and neighbors.

The baby becomes increasingly independent and forms several attachments. By 18 months, the majority of infants have formed multiple attachments.

The multiple attachments formed by most infants vary in their strength and importance to the infant. Attachments are often structured in a hierarchy, whereby an infant may have formed three attachments, but one may be stronger than the other two, and one may be the weakest.

The results of the study indicated that attachments were most likely to form with those who responded accurately to the baby's signals, not the person they spent more time with. Schaffer and Emerson called this sensitive responsiveness.

Intensely attached infants had mothers who responded quickly to their demands and, interacted with their child. Infants who were weakly attached had mothers who failed to interact.

The Lasting Impact of Early Attachment

According to Bowlby's theory (1988), when we form our primary attachment, we also make a mental representation of what a relationship is (internal working model), which we then use for all other relationships in the future i.e., friendships, working, and romantic relationships.

The different attachment styles may be viewed as internal working models of "relationships" that evolved from event experiences (Main, Kaplan, & Cassidy, 1985).

This would suggest that early interactions with caregivers could not only shape how an infant understood and behaved in relationships (as exemplified by infant attachment styles), but that such impact could be carried forward into adult attachment.

According to Bowlby (1969) later relationships are likely to be a continuation of early attachment styles (secure and insecure) because the behavior of the infant's primary attachment figure promotes an internal working model of relationships which leads the infant to expect the same in later relationships.

In other words, there will be continuity between early attachment experiences and later relationships. This is known as the continuity hypothesis.

In humans, attachment does not conclude in infancy, or even childhood, but instead is active throughout the lifespan, with individuals gaining comfort from both physical and mental representations of significant others (Bowlby, 1969).

It is through an individual's internal working model that childhood patterns of attachment are carried forward across the life cycle into adolescence and adulthood.

The notion of security is still an important one; however, the growing emergence of autonomy is also significant as the attachment system in adults is less likely to be activated due to them being able to tolerate higher levels of distress compared to children.

During adulthood, new attachment bonds are formed which may become a significant source of support during periods of distress, or during periods of goal achievement and exploration.

Researchers have proposed that working models are interconnected within a complex hierarchical structure (Bowlby, 1980; Bretherton, 1985, 1990; Collins & Read, 1994; Main, Kaplan, & Cassidy, 1985).

For example, the highest level model comprises beliefs and expectations across all types of relationship, and lower level models hold general rules about specific relations, such as romantic or parental, underpinned by models specific to events within a relationship with a single person.

The existence of multiple mental models is supported by evidence which demonstrates considerable within-person variability in the expectations and beliefs that people hold about the self and others (Baldwin & Fehr, 1995).

Furthermore, although specific models of attachment relationships are positively associated with more overarching general working models, the correlations are small to moderate (less than .40), indicating that they comprised distinct beliefs regarding the self and significant others (Cozzarelli, Hoekstra, & Bylsma, 2000).

Likely, general mental models indicate a typical appraisal of the self and others across relationships, and relationship-specific beliefs about the self and one's partner would plausibly represent only a part of these generalized beliefs.

Key Takeaways

Attachment is defined as a "lasting psychological connectedness between human beings" (Bowlby, 1969, p. 194), and may be considered interchangeable with concepts such as "affectional bond" and "emotional bond."

Attachment is characterized by specific behaviors in children, such as seeking proximity to the attachment figure when upset or threatened (Bowlby, 1969).

Attachment theory explains how the parent-child relationship emerges and influences subsequent development.

A person's first attachment is often established with the primary caregiver during infancy. However, it must be noted that attachment is not unique to infant-caregiver relationships but may also be present in other social relationships.

Attachments of various kinds are formed through the repeated act of "attachment behaviors" or "attachment transactions," a continuing process of seeking and maintaining a certain level of proximity to another specified individual (Bowlby, 1969).

Because caregivers vary in sensitivity and responsiveness, not all infants attach to caregivers in the same way.

References

Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49-67.

Ainsworth, M. D. S. (1973). The development of infant-mother attachment. In B. Cardwell & H. Ricciuti (Eds.), Review of child development research (Vol. 3, pp. 1-94) Chicago: University of Chicago Press.

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

Ainsworth, M. D. S. (1991). Attachments and other affectional bonds across the life cycle. In C . M. Parkes, J. Stevenson-Hinde, & P. Marris (Eds.), Attachment across the life cycle (pp. 33-51). London: Routledge.

Ainsworth. M. D. S., & Wittig, B. A. (1969) Attachment and exploratory behaviour of one-year-olds in a strange situation. In: B. M. Foss (Ed.) Determinants of infant behaviour, IV. London: Methuen, p. 111-136.

Bowlby, J. (1958). The nature of the childs tie to his mother. International Journal of Psychoanalysis, 39, 350-371.

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

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

Bowlby, J. (1973). Attachment and loss, Vol. 2: Separation. New York: Basic Books.

Bowlby, J. (1980). Attachment and loss, Vol. 3: Loss, sadness and depression. New York: Basic Books.

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.

Dollard, J. & Miller, N.E. (1950). Personality and psychotherapy. New York: McGraw-Hill.

Feeney, B. C. (2004). A secure base: responsive support of goal strivings and exploration in adult intimate relationships. Journal of Personality and Social Psychology, 87(5), 631.

George, C., & Solomon, J. (1996). Representational models of relationships: Links between caregiving and attachment. Infant Mental Health Journal, 17(3), 198-216.

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

Mikulincer, M., & Shaver, P. R. (2003). The attachment behavioral system in adulthood: Activation, psychodynamics, and interpersonal processes. Advances in Experimental Social Psychology, 35, 53-152.

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford Press.

Prior, V., & Glaser, D. (2006). Understanding attachment and attachment disorders: Theory, evidence and practice. Jessica Kingsley Publishers.

Schaffer, H. R., & Emerson, P. E. (1964). The development of social attachments in infancy. Monographs of the Society for Research in Child Development, 1-77.

Shaver, P. R., & Mikulincer, M. (2006). Attachment theory, individual psychodynamics, and relationship functioning. The Cambridge handbook of personal relationships, 251-271.

Van Ijzendoorn, M. H., & Sagi-Schwartz, A. (2008). Cross-cultural patterns of attachment: Universal and contextual dimensions. In J. Cassidy & P. Shaver (Eds) Handbook of Attachment: Theory, Research and Clinical Applications (pp. 880-905). New York: Guildford Press.

FAQs

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Attachment Theory In Psychology Explained

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Attachment can be defined as a deep and enduring emotional bond between two people in which each seeks closeness and feels more secure when in the presence of the attachment figure.

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Introduction

What is attachment theory and why is it important?

Attachment is a clinical term used to describe "a lasting psychological connectedness between human beings" (Bowlby, 1997). In particular, attachment theory highlights the importance of a child's emotional bond with their primary caregivers. Disruption to or loss of this bond can affect a child emotionally and psychologically into adulthood, and have an impact on their future relationships.

Only specially trained and qualified professionals should assess a child's attachment style. However, it's important for all adults working with children to understand what attachment is and know how to help parents and carers become attuned to their child's needs. You might do this by working with them directly, or by signposting families to other appropriate services. In the long term, this can help improve wellbeing and provide positive outcomes for both the child and their caregivers.

Understanding attachment in the early years

Children can form attachments with more than one caregiver, but the bond with the people who have provided close care from early infancy is the most important and enduring (Bowlby, 1997).

It's important that parents and carers are attuned and responsive to their baby's needs and are able to provide appropriate care. This includes recognising if their baby is hungry, feeling unwell or in need of closeness and affection (Howe, 2011).

Forming an attachment is something that develops over time for a child, but parents and carers can start to form an emotional bond with their child before they are born. Sometimes a parent or carer may have difficulty forming this bond, for example if they are experiencing mental health issues or don't have an effective support network.

On this page, you'll find information on:

why attachment is important

how children develop attachment

attachment issues, insecure and secure attachment and behaviours to look out for

how trauma can affect attachment

how you can support parents and carers to develop a bond with their child.

Need specific information?

Our information specialists are here to help you find research, guidance and best practice.

References

Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Howe, David (2011) Attachment across the lifecourse: a brief introduction. Basingstoke: Palgrave Macmillan.

Stages of attachment

Stages of attachment

The first two years of a child's life are the most critical for forming attachments (Prior and Glaser, 2006).

During this period, children develop an 'internal working model' that shapes the way they view relationships and operate socially. This can affect their sense of trust in others, self-worth and their confidence interacting with others (Bowlby, 1997).

When are attachments formed?

Attachments are formed in different ways during the phases of a child's development.

Antenatal (before birth)

During the antenatal period, parents and carers can form a bond with their child. Any bonds formed before birth can have a positive impact on the relationship between babies and their caregivers once the child is born (Condon and Corkindale, 1997).

Birth until 6 weeks

This is sometimes referred to as the pre-attachment phase because the baby doesn't appear to show an attachment to any specific caregiver. However, parents and carers who provide a nurturing environment and are responsive to their babies needs can lay the foundation for secure attachments to form (Bowlby, 1997).

6 weeks until 6-8 months

During this stage of their development, a baby might start to show a preference for their primary and secondary caregivers (often the mother and father).

6-8 months until 18 months-2 years

During this period a child begins to show a strong attachment to their primary caregivers. Babies start to develop separation anxiety during this phase and can become upset when their caregiver leaves, even for short periods (Bowlby, 1997).

18 months - 2 years onwards

At this point children are likely to become less dependent on their primary caregiver, particularly if they feel secure and confident the caregiver will return and be responsive in times of need (Bowlby, 1997).

References

Prior, V. and Glaser, D. (2006) Understanding attachment and attachment disorders: theory, evidence and practice. London: Jessica Kingsley. Condon, J. T. and Corkindale, C. (1997)
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.

The correlates of antenatal attachment in pregnant women. British Journal of Medical Psychology. Cambridge University Press, 70 (4): 359-372. Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.

Types of attachment

Types of attachment

A child's need for attachment is part of the process of seeking safety and security from their caregiver.

What does secure attachment look like?

In secure caregiver-child relationships, the caregiver is usually sensitive and tuned in to the child's needs. They are able to provide care that is predictably loving, responsive and consistent.

Young children who have formed a secure attachment to their caregiver may display the following patterns of behaviour during times of stress or exploration:

proximity maintenance - wanting to be near their primary caregiver

safe haven - returning to their primary caregiver for comfort and safety if they feel afraid or threatened

secure base - treating their primary caregiver as a base of security from which they can explore the surrounding environment. The child feels safe in the knowledge that they can return to their secure base when needed

separation distress - experiencing anxiety in the absence of their primary caregiver. They are upset when their caregiver leaves, but happy to see them and easily comforted when they return

Benefits of secure attachment

When caregivers react sensitively to ease their child's distress and help them regulate their emotions, it has a positive impact on the child's neurological, physiological and psychosocial development (Howe, 2011).

Children with secure attachments are more likely to develop emotional intelligence, good social skills and robust mental health (Howe, 2011).

Effects of insecure attachment

Not receiving comfort and security in the early years can have a negative effect on children's neurological, psychological, emotional and physical development and functioning (Newman, 2015).

Babies and young children who have attachment issues may be more likely to develop behavioural problems such as attention deficit hyperactivity disorder (ADHD) or conduct disorder (Fearon et al, 2010).

Children who have attachment issues can have difficulty forming healthy relationships when they grow up. This may be because their experiences have taught them to believe that other people are unreliable or untrustworthy (Bowlby, 1997).

Adults with attachment issues are at a higher risk of entering into volatile relationships and having poor parenting skills, behavioural difficulties and mental health problems (Howe, 2011).
> Find out more about how trauma affects child brain development
Further reading

Take a look at our reading list on child attachment.
> View the reading list on the NSPCC Library catalogue

Attachment issues

Attachment issues

Factors affecting attachment

Some circumstances can make it more challenging for a child and their caregivers to form a pattern of secure attachment. These may include:

abuse, maltreatment and trauma experienced by the parent or child

parental mental health difficulties

parental substance misuse

the child having multiple care placements

parents being separated from their baby just after birth, for example if the baby is receiving neonatal care

stress such as having a low income, being a single parent, or being a young parent

bereavement or loss of another caregiver that a child had an attachment with

Signs that a child may have attachment issues

Children's behaviour can be influenced by a wide range of circumstances and emotions.

Indicators that a baby or toddler might not have a secure attachment with their caregiver will emerge as a pattern of behaviour over time, particularly during moments of stress or exploration. This pattern might include:

being fearful or avoidant of a parent or carer

becoming extremely distressed when their carer leaves them, even for a short amount of time

rejecting their caregiver's efforts to calm, soothe, and connect with them

not seeming to notice or care when their caregiver leaves the room or when they return

being passive or non-responsive to their carer

seeming to be depressed or angry

not being interested in playing with toys or exploring their environment

As children with attachment issues get older, these behaviour patterns might evolve. As well as being evident during times of stress, some behaviours may start to become obvious at other times. These may include the child:

finding it difficult to ask for help

struggling to form positive relationships with adults and peers

struggling to concentrate

struggling to calm themselves down

both demanding and rejecting attention or support at the same time

becoming quickly or disproportionately angry or upset, at times with no clear triggers

appearing withdrawn or disengaged from activities

daydreaming, being hyperactive or constantly fidgeting or moving

(Mentally Healthy Schools, 2020).

If you think a child may have attachment issues, you should refer them to a suitably trained health and social care professional for a full assessment. You should follow your organisation's procedures to make a health and social care referral, or contact your local authority children's social care services.

References

Bowlby, John (1989) The making and breaking of affectional bonds. London: Routledge. Mentally Healthy Schools (2020)
Howe, David (2011) Attachment across the lifecourse: a brief introduction. Basingstoke: Palgrave Macmillan.
Attachment and child development. [Accessed 09/11/2020].

Trauma and attachment

Trauma and attachment

The signs of attachment issues can be similar to indicators that a child is experiencing other challenges, such as:

This means it's important to consider everything that's going on in a child's life and make sure they and their family are provided with appropriate support.

Think about all your previous experiences with the child and their caregivers, to help you build a clear picture of their relationships and recognise any concerning patterns of behaviour.

The impact of trauma and attachment

Children who have experienced abuse, neglect and trauma might develop coping strategies that can make it more complicated to recognise attachment issues.

For example, one sign of secure attachment is that children see their caregiver as a secure base to explore from. But children who have experienced neglect, for example, might display independent behaviour in order to protect themselves from the emotional pain of not having their needs met (Marvin et al, 2002).

It is also possible for a child to develop an attachment to someone who is maltreating them (Blizard & Bluhm, 1994).

As well as affecting attachment, experiencing trauma can have an impact on a child's brain development. Children might need extra support to help strengthen the architecture of their brain.
> Find out more about how trauma affects child brain development
What to do if you're worried that a child is experiencing or at risk of abuse or neglect
If a child is in immediate danger, call the police on 999.
If you're worried about a child but they are not in immediate danger, you should share your concerns.

Follow your organisation's child protection procedures without delay. These should provide clear guidelines on the steps you need to take if a child discloses abuse. They will state who in your organisation has responsibility for safeguarding or child protection and who you should report your concerns to.

Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.

Contact the police. They will assess the situation and take the appropriate action to protect the child.

Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our child protection specialists will talk through your concerns with you, give you expert advice and take action to protect the child as appropriate. This may include making a referral to the local authority.

> Find out more about recognising and responding to abuse
If your organisation doesn't have a clear safeguarding procedure or you're concerned about how child protection issues are being handled in your own, or another, organisation, contact the Whistleblowing Advice Line to discuss your concerns.
> Find out about the Whistleblowing Advice Line on the NSPCC website
When you're not sure

The NSPCC Helpline can help when you're not sure if a situation needs a safeguarding response. Our child protection specialists are here to support you whether you're seeking advice, sharing concerns about a child, or looking for reassurance.

Whatever the need, reason or feeling, you can contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk

Our trained professionals will talk through your concerns with you. Depending on what you share, our experts will talk you through which local services can help, advise you on next steps, or make referrals to children's services and the police.
> Find out more about how the NSPCC Helpline can support you

Supporting children and families

Supporting children and families

Building positive relationships

It's important for anyone who works with children and families to support parents and carers in building positive relationships with their child. Having positive interaction and play with caregivers can help a child's brain to develop healthily.
> See our early years resources which you can share with parents and caregivers
Video feedback programmes can also be used by specially trained social care professionals to help caregivers improve their interactions with their child. This involves caregivers being filmed when they are interacting with their child and then watching the recording with a trained practitioner, who gives them feedback and helps them build on their strengths.

Support for parents and carers

If parents are struggling with their own issues, it may make it harder for them to bond with their child and provide consistant and responsive care. They may have:

experienced abuse of trauma themselves

drug and/or alcohol dependencies

mental health issues.

> Find out more about parental mental health > Learn more about parental substance misuse
Services for children and families

The NSPCC has many services that children and families can be referred to, from supporting parents and carers in taking care of their children to preventing sexual abuse and overcoming abuse.

Our services might be suitable for children and families you are working with:

Pregnancy in Mind helps parents who are at risk of or experiencing mild to moderate anxiety and depression during pregnancy. The service helps build parents' capacity to provide sensitive, responsive care to their babies and keep these skills developed postnatally and as their children develop
Browse for more services
Further reading

Take a look at our reading list about child attachment interventions, support and treatment.
> View the list on the NSPCC Library catalogue
Supporting children's mental health

Children with attachment issues may have problems expressing or controlling their emotions and forming positive relationships, which might affect their mental health.

It's important to make sure children and young people have access to mental health support.
> Find out more about child mental health > See the NSPCC's advice for parents and carers on how to support their child's mental health
Childline

If a child or young person needs confidential help and advice you can always direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online. Children under the age of 12 can be directed to the Childline Kids website.

We also have a series of posters and wallet cards you can download for free. These can be printed and displayed in your setting to encourage children to contact Childline if they need to talk.

Introduction

What is attachment theory and why is it important?

Attachment is a clinical term used to describe "a lasting psychological connectedness between human beings" (Bowlby, 1997). In particular, attachment theory highlights the importance of a child's emotional bond with their primary caregivers. Disruption to or loss of this bond can affect a child emotionally and psychologically into adulthood, and have an impact on their future relationships.

Only specially trained and qualified professionals should assess a child's attachment style. However, it's important for all adults working with children to understand what attachment is and know how to help parents and carers become attuned to their child's needs. You might do this by working with them directly, or by signposting families to other appropriate services. In the long term, this can help improve wellbeing and provide positive outcomes for both the child and their caregivers.

Understanding attachment in the early years

Children can form attachments with more than one caregiver, but the bond with the people who have provided close care from early infancy is the most important and enduring (Bowlby, 1997).

It's important that parents and carers are attuned and responsive to their baby's needs and are able to provide appropriate care. This includes recognising if their baby is hungry, feeling unwell or in need of closeness and affection (Howe, 2011).

Forming an attachment is something that develops over time for a child, but parents and carers can start to form an emotional bond with their child before they are born. Sometimes a parent or carer may have difficulty forming this bond, for example if they are experiencing mental health issues or don't have an effective support network.

On this page, you'll find information on:

why attachment is important

how children develop attachment

attachment issues, insecure and secure attachment and behaviours to look out for

how trauma can affect attachment

how you can support parents and carers to develop a bond with their child.

Need specific information?

Our information specialists are here to help you find research, guidance and best practice.

References

Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Howe, David (2011) Attachment across the lifecourse: a brief introduction. Basingstoke: Palgrave Macmillan.

Stages of attachment

Stages of attachment

The first two years of a child's life are the most critical for forming attachments (Prior and Glaser, 2006).

During this period, children develop an 'internal working model' that shapes the way they view relationships and operate socially. This can affect their sense of trust in others, self-worth and their confidence interacting with others (Bowlby, 1997).

When are attachments formed?

Attachments are formed in different ways during the phases of a child's development.

Antenatal (before birth)

During the antenatal period, parents and carers can form a bond with their child. Any bonds formed before birth can have a positive impact on the relationship between babies and their caregivers once the child is born (Condon and Corkindale, 1997).

Birth until 6 weeks

This is sometimes referred to as the pre-attachment phase because the baby doesn't appear to show an attachment to any specific caregiver. However, parents and carers who provide a nurturing environment and are responsive to their babies needs can lay the foundation for secure attachments to form (Bowlby, 1997).

6 weeks until 6-8 months

During this stage of their development, a baby might start to show a preference for their primary and secondary caregivers (often the mother and father).

6-8 months until 18 months-2 years

During this period a child begins to show a strong attachment to their primary caregivers. Babies start to develop separation anxiety during this phase and can become upset when their caregiver leaves, even for short periods (Bowlby, 1997).

18 months - 2 years onwards

At this point children are likely to become less dependent on their primary caregiver, particularly if they feel secure and confident the caregiver will return and be responsive in times of need (Bowlby, 1997).

References

Prior, V. and Glaser, D. (2006) Understanding attachment and attachment disorders: theory, evidence and practice. London: Jessica Kingsley. Condon, J. T. and Corkindale, C. (1997)
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.

The correlates of antenatal attachment in pregnant women. British Journal of Medical Psychology. Cambridge University Press, 70 (4): 359-372. Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.

Types of attachment

Types of attachment

A child's need for attachment is part of the process of seeking safety and security from their caregiver.

What does secure attachment look like?

In secure caregiver-child relationships, the caregiver is usually sensitive and tuned in to the child's needs. They are able to provide care that is predictably loving, responsive and consistent.

Young children who have formed a secure attachment to their caregiver may display the following patterns of behaviour during times of stress or exploration:

proximity maintenance - wanting to be near their primary caregiver

safe haven - returning to their primary caregiver for comfort and safety if they feel afraid or threatened

secure base - treating their primary caregiver as a base of security from which they can explore the surrounding environment. The child feels safe in the knowledge that they can return to their secure base when needed

separation distress - experiencing anxiety in the absence of their primary caregiver. They are upset when their caregiver leaves, but happy to see them and easily comforted when they return

Benefits of secure attachment

When caregivers react sensitively to ease their child's distress and help them regulate their emotions, it has a positive impact on the child's neurological, physiological and psychosocial development (Howe, 2011).

Children with secure attachments are more likely to develop emotional intelligence, good social skills and robust mental health (Howe, 2011).

Effects of insecure attachment

Not receiving comfort and security in the early years can have a negative effect on children's neurological, psychological, emotional and physical development and functioning (Newman, 2015).

Babies and young children who have attachment issues may be more likely to develop behavioural problems such as attention deficit hyperactivity disorder (ADHD) or conduct disorder (Fearon et al, 2010).

Children who have attachment issues can have difficulty forming healthy relationships when they grow up. This may be because their experiences have taught them to believe that other people are unreliable or untrustworthy (Bowlby, 1997).

Adults with attachment issues are at a higher risk of entering into volatile relationships and having poor parenting skills, behavioural difficulties and mental health problems (Howe, 2011).
> Find out more about how trauma affects child brain development
Further reading

Take a look at our reading list on child attachment.
> View the reading list on the NSPCC Library catalogue

Attachment issues

Attachment issues

Factors affecting attachment

Some circumstances can make it more challenging for a child and their caregivers to form a pattern of secure attachment. These may include:

abuse, maltreatment and trauma experienced by the parent or child

parental mental health difficulties

parental substance misuse

the child having multiple care placements

parents being separated from their baby just after birth, for example if the baby is receiving neonatal care

stress such as having a low income, being a single parent, or being a young parent

bereavement or loss of another caregiver that a child had an attachment with

Signs that a child may have attachment issues

Children's behaviour can be influenced by a wide range of circumstances and emotions.

Indicators that a baby or toddler might not have a secure attachment with their caregiver will emerge as a pattern of behaviour over time, particularly during moments of stress or exploration. This pattern might include:

being fearful or avoidant of a parent or carer

becoming extremely distressed when their carer leaves them, even for a short amount of time

rejecting their caregiver's efforts to calm, soothe, and connect with them

not seeming to notice or care when their caregiver leaves the room or when they return

being passive or non-responsive to their carer

seeming to be depressed or angry

not being interested in playing with toys or exploring their environment

As children with attachment issues get older, these behaviour patterns might evolve. As well as being evident during times of stress, some behaviours may start to become obvious at other times. These may include the child:

finding it difficult to ask for help

struggling to form positive relationships with adults and peers

struggling to concentrate

struggling to calm themselves down

both demanding and rejecting attention or support at the same time

becoming quickly or disproportionately angry or upset, at times with no clear triggers

appearing withdrawn or disengaged from activities

daydreaming, being hyperactive or constantly fidgeting or moving

(Mentally Healthy Schools, 2020).

If you think a child may have attachment issues, you should refer them to a suitably trained health and social care professional for a full assessment. You should follow your organisation's procedures to make a health and social care referral, or contact your local authority children's social care services.

References

Bowlby, John (1989) The making and breaking of affectional bonds. London: Routledge. Mentally Healthy Schools (2020)
Howe, David (2011) Attachment across the lifecourse: a brief introduction. Basingstoke: Palgrave Macmillan.
Attachment and child development. [Accessed 09/11/2020].

Trauma and attachment

Trauma and attachment

The signs of attachment issues can be similar to indicators that a child is experiencing other challenges, such as:

This means it's important to consider everything that's going on in a child's life and make sure they and their family are provided with appropriate support.

Think about all your previous experiences with the child and their caregivers, to help you build a clear picture of their relationships and recognise any concerning patterns of behaviour.

The impact of trauma and attachment

Children who have experienced abuse, neglect and trauma might develop coping strategies that can make it more complicated to recognise attachment issues.

For example, one sign of secure attachment is that children see their caregiver as a secure base to explore from. But children who have experienced neglect, for example, might display independent behaviour in order to protect themselves from the emotional pain of not having their needs met (Marvin et al, 2002).

It is also possible for a child to develop an attachment to someone who is maltreating them (Blizard & Bluhm, 1994).

As well as affecting attachment, experiencing trauma can have an impact on a child's brain development. Children might need extra support to help strengthen the architecture of their brain.
> Find out more about how trauma affects child brain development
What to do if you're worried that a child is experiencing or at risk of abuse or neglect
If a child is in immediate danger, call the police on 999.
If you're worried about a child but they are not in immediate danger, you should share your concerns.

Follow your organisation's child protection procedures without delay. These should provide clear guidelines on the steps you need to take if a child discloses abuse. They will state who in your organisation has responsibility for safeguarding or child protection and who you should report your concerns to.

Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.

Contact the police. They will assess the situation and take the appropriate action to protect the child.

Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our child protection specialists will talk through your concerns with you, give you expert advice and take action to protect the child as appropriate. This may include making a referral to the local authority.

> Find out more about recognising and responding to abuse
If your organisation doesn't have a clear safeguarding procedure or you're concerned about how child protection issues are being handled in your own, or another, organisation, contact the Whistleblowing Advice Line to discuss your concerns.
> Find out about the Whistleblowing Advice Line on the NSPCC website
When you're not sure

The NSPCC Helpline can help when you're not sure if a situation needs a safeguarding response. Our child protection specialists are here to support you whether you're seeking advice, sharing concerns about a child, or looking for reassurance.

Whatever the need, reason or feeling, you can contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk

Our trained professionals will talk through your concerns with you. Depending on what you share, our experts will talk you through which local services can help, advise you on next steps, or make referrals to children's services and the police.
> Find out more about how the NSPCC Helpline can support you

Supporting children and families

Supporting children and families

Building positive relationships

It's important for anyone who works with children and families to support parents and carers in building positive relationships with their child. Having positive interaction and play with caregivers can help a child's brain to develop healthily.
> See our early years resources which you can share with parents and caregivers
Video feedback programmes can also be used by specially trained social care professionals to help caregivers improve their interactions with their child. This involves caregivers being filmed when they are interacting with their child and then watching the recording with a trained practitioner, who gives them feedback and helps them build on their strengths.

Support for parents and carers

If parents are struggling with their own issues, it may make it harder for them to bond with their child and provide consistant and responsive care. They may have:

experienced abuse of trauma themselves

drug and/or alcohol dependencies

mental health issues.

> Find out more about parental mental health > Learn more about parental substance misuse
Services for children and families

The NSPCC has many services that children and families can be referred to, from supporting parents and carers in taking care of their children to preventing sexual abuse and overcoming abuse.

Our services might be suitable for children and families you are working with:

Pregnancy in Mind helps parents who are at risk of or experiencing mild to moderate anxiety and depression during pregnancy. The service helps build parents' capacity to provide sensitive, responsive care to their babies and keep these skills developed postnatally and as their children develop
Browse for more services
Further reading

Take a look at our reading list about child attachment interventions, support and treatment.
> View the list on the NSPCC Library catalogue
Supporting children's mental health

Children with attachment issues may have problems expressing or controlling their emotions and forming positive relationships, which might affect their mental health.

It's important to make sure children and young people have access to mental health support.
> Find out more about child mental health > See the NSPCC's advice for parents and carers on how to support their child's mental health
Childline

If a child or young person needs confidential help and advice you can always direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online. Children under the age of 12 can be directed to the Childline Kids website.

We also have a series of posters and wallet cards you can download for free. These can be printed and displayed in your setting to encourage children to contact Childline if they need to talk.

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Attachment and child development | NSPCC Learning

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Explains why attachment is important as well as the different stages. Includes information on types of attachment, attachment issues and the effect of trauma.

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What is stress and our natural reaction to it?

Dr. Damour: We all come equipped with a stress response that helps us react to threats (this is known as our 'fight or flight' response). The natural stress response helps to keep us safe - but it shouldn't be activated all the time.

Most of us, in our day-to-day lives, are in a state of reasonable calm. But when faced with a threatening situation, we enter a state of biological and psychological alarm: Our heart races, breathing quickens, blood rushes to our extremities, we focus our attention on the perceived threat and we are oriented toward finding safety. These reactions are useful, protective and automatic. They serve to shield us from the impact of dangerous situations.

Once the threat has passed, we typically move from a state of alarm back to a state of calm. The length of time it takes us to return to feeling calm will depend on the quality of our support systems, whether we have experienced serious adversity before and other vulnerabilities such as disabilities or mental health concerns.
>>Read What is stress?

What is toxic stress?

Children can be exposed to danger or even intense stress without that stress becoming damaging or toxic, so long as a caring adult buffers the impact of the threatening or stressful event. For example, being in the presence of an adult who remains calm or receiving comfort once the stress has passed -perhaps with verbal reassurance and a warm embrace-can help return a child's emotional reaction to a natural state of calm.

Toxic stress can occur when a child is in a chronically stressful situation that causes a prolonged stress response. For example, we see toxic stress in children who are in circumstances where they feel unsafe over a long period of time and do not have the buffering effect of being cared for by supportive adults.

Examples of when toxic stress can occur include when children experience chronic neglect, family violence, physical abuse, parental mental illness, sexual abuse and ongoing emotional abuse.

It is possible for children to be in ongoing, stressful situations and not experience toxic stress. Children can be shielded from toxic stress by the steady support of a loving adult who helps them to feel safe and who keeps them from becoming emotionally overwhelmed.

What effects can toxic stress have on a child?

Being on constant high alert can impact our brain and our body and can lead to lasting neurological and physical changes. Children who experience toxic stress may go on to have a very powerful stress response in reaction to even minor stressors, may have difficulty controlling their anger and anxiety, and may struggle to feel safe in their relationships with others. Toxic stress can also impact the functioning of the immune system and can lead to persistent inflammation in the body. Over time, toxic stress can contribute to heart disease and chronic high blood pressure.

What are some signs of a child experiencing toxic stress?

There can be outward signs, such as circumstances that would require a child to be on high alert all the time. Perhaps there's someone in the home who is frightening, or the child is being neglected or abused. These factors would cause a child to become constantly vigilant.

Younger children who are experiencing toxic stress may become withdrawn, have tantrums, complain of having headaches or stomach aches, have difficulty sleeping, or experience frequent nightmares. Older children and teenagers who have been exposed to toxic stress may become withdrawn or defiant, engage in risky behavior, be aggressive with others, or be harmful to themselves. In children of all ages, toxic stress can lead to constant anxiety and difficulty feeling calm or focused.
>>Read How to support your teen during stressful times

What is the best way for an adult to support a child going through toxic stress situations?

Adults are most helpful to highly stressed children when we try to feel with them, when we put ourselves in the child's shoes and imagine what they are going through. Empathizing deeply with their experience often provides a strong instinctive sense of what needs to happen next, whether it's offering physical comfort, emotional comfort, or serving in some other soothing or protective role.

Of course, if it's possible to remove the child from the situation causing toxic stress, that would be ideal. But when that is not an option, we should try to imagine the situation from the child's perspective so that we can use the resources uniquely available to adults to minimize the impact of chronic stressors. Physical and emotional comfort from a loving adult can play a powerful role in reducing the impact of toxic stress.

If you as an adult are also struggling, what is the best way to make sure that you're taking care of yourself and taking care of your child?

It can be incredibly hard for an adult to shield a child from toxic stress when the adult feels overwhelmed too. One thing that can help is to put the situation into words by saying to oneself, "I am in a chronically stressful situation. My child is in this situation with me. There are things I can do to protect my child from the impact of what is happening." Finding the language to describe a situation, even a very difficult one, can help to focus us on what we need to do and think about putting the child's needs at the centre, even as we work to protect ourselves.

How can you go about seeking help from family, friends or support groups?

Anyone experiencing toxic stress should make the most of every available support. Do not feel ashamed about what you are going through. Everyone deserves to feel safe. Let people you trust know about what you - and your child - are experiencing so that you do not feel isolated. Accept help from others when they offer it. Remember, taking good care of yourself is one of the most important things you can do to take care of your child.

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Learn what to look for and when to seek help

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Toxic stress increases a child's risk of developing emotional, behavioral, and cognitive problems. It can also trigger serious disease. How? Recent research reveals how severe, chronic stress "gets under the skin" - disregulating hormones, turning genes "on" and "off," and altering a child's brain.
You encounter a stressor, and your body reacts. You feel the rush of adrenaline, increasing your heart rate and blood pressure. Cortisol levels spike, triggering a surge of glucose to power your muscles. Neurotransmitters switch you into a mode that favors rapid, automatic, responses. You're hyper-focused on sensory cues from the environment, and ready to fight, flee, or otherwise cope with the challenge at hand.

If you've been startled by a velociraptor, you might experience all these physiological changes as terror. But this doesn't change the fact that the stress response is beneficial. It enhances your ability escape. And what if the stressor is something you enjoy? Maybe you're playing a fast-paced video game, or riding a roller coaster, or coasting down a hill on your bike. Maybe you're feeling happily "pumped" about performing in front of an audience, or competing in a sports event. You might interpret the stress response as pleasantly exciting or invigorating.

In itself, there isn't anything bad about the stress response. Yet we know that stress can harmful. During early life, it can even change the course of development.

So where do we draw the line between adaptive and maladaptive stress responses? When does stress become "toxic," and what does that really mean for a child's long-term health and well-being?

What is toxic stress?

Like most things in life, the stress response is costly, and the body pays for it by diverting energy away from normal biological functions. At the same time, the direct effects of stress hormones - like surging blood pressure, and spiked blood sugar levels - can cause harm if they continue over time. They can also disrupt normal immune function, and lead to chronic inflammation.

So while you might not suffer negative consequences from a short-lived stress response, the situation changes if you feel stressed-out every day, for weeks or months or longer. Now your body is subject to a lot of extra wear and tear, and you're experiencing a "toxic stress response," which experts define as:

"Prolonged activation of the stress response systems that can disrupt the development of brain architecture and other organ systems and increase the risk for stress related disease and cognitive impairment, well into the adult years" (National Academy of Sciences, Engineering, and Medicine 2019).

But how do we know about these developmental disruptions, and what do they look like? Let's take a closer look at the evidence.

What do we know about the effects of toxic stress on children?

It makes sense that toxic stress could cause lasting damage. Chronically high blood pressure, elevated blood glucose levels, persistent inflammation - that's a recipe for developing cardiovascular disease and metabolic disorders, like diabetes. And there are sound theoretical reasons for believing that early life stress could pose special risks. The brain is developing, so it will be more vulnerable to adverse conditions.

But of course proving causation is tricky. It's clear, for example, that growing up in poverty exposes kids to all sorts of stressors, and these children are at higher risk for poor outcomes. But how much is attributable to toxic stress, and how much to other factors? Kids may have worse outcomes because they are malnourished, or because they receive inferior medical care.

The best way to determine causation is by performing experiments. Raise a bunch of kids under similar conditions, with one difference: Some are randomly assigned to experience toxic stress. But we can't treat human children this way. So researchers piece together other lines of evidence - experiments conducted on nonhuman creatures, and studies that track the real-world outcomes of kids who happen to experience early life stress.

What have researchers learned? As you might expect, early life stress increases a child's chances of developing symptoms of anxiety and depression. It's also correlated with sleep problems in later life, and the tendency to sleep fewer hours total (Kajeepeta et al 2015). In addition, some of the most intense, adverse childhood experiences - abuse, neglect, exposure to violence, seriously ill family members, death of a parent - are major risk factors for disease, drug use, and shorter life spans (Merrick et al 2019; Grummit et al 2021).

And there's more. In the last decade, researchers have learned about the physiological changes that accompany toxic, chronic stress. These help us understand how stress gets "under the skin" and causes lasting developmental problems.

How toxic stress alters the body's stress response system: Two different paths

When you imagine a child experiencing toxic stress - day after day, week after week - you might assume the kid is swimming in stress hormones. In many cases, you would be correct. But the full story is more complex.

For example, it's been confirmed in experiments on nonhuman animals, and in observational studies of human beings: Young creatures, subjected to chronic stress, tend to experience chronically high levels of cortisol. They may also become especially reactive to specific stressors, and develop symptoms of anxiety.

It's a pattern that might persist for years. But not always.

In some cases, the body eventually adapts to a high-stress environment. Instead of pumping out stress hormones, it pulls back. It shifts down cortisol production, and becomes less reactive to daily stressors, so that an individual no longer experiences the normal spike in cortisol we'd expect when something alarming or exciting happens.

This is called a "blunted" stress response. Does it help protect kids under strain from developing certain stress-related diseases? Maybe. But it comes with its own set of problems. Kids with lower levels or cortisol and blunted stress reactivity are at higher risk for developing a variety of externalizing behavior problems, including poor emotional regulation, impulsiveness, aggression, and antisocial conduct disorders (Koss and Gunnar 2018).

So chronic, toxic stress in children can lead to two different kinds of disruptions of the stress response system, and both are associated with worse outcomes.

Early life stress and shortened telomeres

What is a telomere? Telomeres are molecules that form protective caps, or bumpers, at the ends of our chromosomes, keeping our DNA safe from damage. The longer the telomere, the better it can prevent our DNA from degrading over time. But unfortunately, the telomeres themselves tend to wear away. As we age, telomeres become progressively shorter.

When telomeres shorten at a faster pace, we experience the physiological signs of aging earlier in life. So it's very disturbing to learn that chronically, psychologically-stressed children tend to have shorter telomeres. In particular, kids show signs of accelerated telomere erosion if they have experienced major stressors like abuse, neglect, family violence, bullying, neighborhood disorder, loss of a parent, or maternal depression (Coimbra et al 2017; Ridout et al 2018; Rentscher et al 2020). And the timing of toxic stress appears to be important. The younger the child, the more powerful the effect (Ridout et al 2018).

Toxic childhood stress can turn certain genes "on" or "off"

Our DNA is tightly coiled to fit inside the nucleus of a cell. It's also, in places, attached to small chemical groups called methyl groups. These methyl groups have the effect of silencing nearby genes, and sometimes that's a good thing, because it's a gene that is better left "turned off."

Of course there are lots of genes that we want to keep turned "on" for good health. But sometimes these genes get "methylated," leading to trouble - including disregulated stress responses, disease, structural brain changes, and psychopathologies (like depression).

As it turns out, early life stress can cause changes in both directions - turning off "good" genes, and turning on "bad" ones. These so-called epigenetic alterations have been firmly established in controlled experiments on non-human animals. And studies of humans has documented strong correlations between early life stress and epigenetic change.

Much of this research focuses on cases where children were the victims of caregiver abuse, neglect, or bullying. But studies have also reported epigenetic changes in the wake of other stressors, like growing up in a high-crime neighborhood; living with a parent who is mentally ill or suffering from a serious physical illness; experiencing parental divorce; or experiencing the death of a parent (Houtepen et al 2018; Reuben et al 2020; Soares et al 2021).

How does toxic stress affect brain development?

Once again, we have converging evidence from both experiments and correlational studies. Early life stress affects the brain.

For example, consider children who've grown up with severe stressors, like maltreatment, poverty, or institutionalized care. When these kids are asked to look at emotionally-charged cues (like fearful faces), they show distinctive patterns of brain activity. The amygdala - a brain region associated with the processing emotion - becomes especially busy (Herzberg and Gunnar 2020).

There is also evidence that toxic stress influences the way the brain processes information about rewards, and the effects depend - in part - on a child's age. When kids experience toxic stress very early in life, it may bias them in the direction of risk avoidance. By contrast, toxic stress experienced during adolescence is linked with a pattern of risk taking.

And there is striking - and disturbing - evidence that toxic stress alters the very structure of a child's brain.

Personal and social stressors in early life have been linked with reductions in grey matter volume in the prefrontal cortex, amygdala and other subcortical regions (Tyborowska et al 2018).

In addition, numerous studies have reported links between early life stress and reduced growth of the hippocampus, a brain region associated with learning and memory. Children with hippocampal volume are at higher risk for cognitive deficits and symptoms of psychopathology (Smith and Pollack 2020).

This is all very alarming. Are children's lives irreversibly damaged by early life stress?

It can feel overwhelming, especially when you consider how many children face serious adversity. In a recent study of more than 200,000 adults living in the United States, researchers asked how many people had experienced one or more of the following adversities during childhood:

physical, emotional, or sexual abuse;

household mental illness;

household substance use;

household domestic violence;

an incarcerated household member; and

parental separation or divorce.

Approximately 58% had experienced at least one of these adverse child experiences. More than 21% had experienced three or more (Giano et al 2020). And that translates into a large portion of the population that's at heightened risk for the physiological, psychological, and cognitive problems we've discussed here. Even if your own kids aren't affected, many of your children's peers are.

That should inspire us to change the economic and social conditions that give rise to childhood adversity. In addition to alleviating suffering, it would be a major economic boon to society. In the United States alone, experts estimate that childhood exposure to crime and violence is costing society more than $450 billon per year (Gilad and Gutman 2019).

But even if we reduced childhood poverty and crime rates, stressors would still exist. Kids would still need our help.
And here's what crucial to remember: Adults can do a great deal to buffer kids from the effects of stress. They can also do a lot to help children recover from distressing experiences.
As I explain in this article, caregivers can have a big impact on children's coping skills, especially when times are tough. When parents are warm and supportive, at-risk children are less likely to suffer the medical problems and altered brain development associated with stress.

Moreover, as I note elsewhere, there's evidence that parents can boost a child's levels of oxytocin (a hormone that promotes feelings of closeness and calm), and reverse the harmful, epigenetic changes associated with toxic stress. It's also clear that kids benefit from healthy social bonds. When we forge secure attachment relationships with our children, we help them develop the ability self-soothe. Read more about that here.

So while toxic stress is damaging, we can help kids recover. It's a question of being sensitive to their needs, and creating an environment where they feel secure and supported.

More information about coping with stress, and raising healthy kids

Family members stress each other. It's the way of things. So one of the most important ways to help kids is by attending to our own stress levels. In this article, I discuss the many factors that contribute to parental stress, and what we should do to help ourselves. In addition, I've prepared these parenting stress management tips. They include many evidence-based practices for coping with, and recovering from, stressors.

And check out these Parenting Science articles for promoting mental health, social harmony, and resilience:

References: How toxic stress affects child development

Barnett Burns S, Almeida D, Turecki G.2018. The Epigenetics of Early Life Adversity: Current Limitations and Possible Solutions. Prog Mol Biol Transl Sci. 2018;157:343-425.

Burns SB, Szyszkowicz JK, Luheshi GN, Lutz PE, Turecki G. 2018. Plasticity of the epigenome during early-life stress. Semin Cell Dev Biol. 2018 May;77:115-132.

Catale C, Gironda S, Lo Iacono L, Carola V. 2020. Microglial Function in the Effects of Early-Life Stress on Brain and Behavioral Development. J Clin Med. 9(2):468.

Coimbra BM, Carvalho CM, Moretti PN, Mello MF, Belangero SI. 2017. Stress-related telomere length in children: A systematic review. J Psychiatr Res. 92:47-54.

Gilad M and Gutman A. The Tragedy of Wasted Funds and Broken Dreams: An Economic Analysis of Childhood Exposure to Crime and Violence (September 23, 2019). University of Illinois Law Review , Available at SSRN: https://ssrn.com/abstract=3458626 or http://dx.doi.org/10.2139/ssrn.3458626

Grummitt LR, Kreski NT, Kim SG, Platt J, Keyes KM, McLaughlin KA. 2021. Association of Childhood Adversity With Morbidity and Mortality in US Adults: A Systematic Review. JAMA Pediatr. 2021 Dec 1;175(12):1269-1278.

Herzberg MP and Gunnar MR. 2020. Early life stress and brain function: Activity and connectivity associated with processing emotion and reward. Neuroimage. 2020 Apr 1;209:116493

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Marini S, Davis KA, Soare TW, Zhu Y, Suderman MJ, Simpkin AJ, Smith ADAC, Wolf EJ, Relton CL, Dunn EC. 2020. Adversity exposure during sensitive periods predicts accelerated epigenetic aging in children. Psychoneuroendocrinology. 113:104484.

Merrick MT, Ford DC, Ports KA, et al. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention - 25 States, 2015-2017. MMWR Morb Mortal Wkly Rep 2019;68:999-1005.

Monaghan P. 2014. Organismal stress, telomeres and life histories. J Exp Biol. 217(Pt 1):57-66.

National Academies of Sciences, Engineering, and Medicine. 2019. Vibrant and healthy kids: Aligning science, practice, and policy to advance health equity. Washington, DC: National Academies Press.

Nelson CA, Bhutta ZA, Burke Harris N, Danese A, Samara M. Adversity in childhood is linked to mental and physical health throughout life. BMJ. (2020) 371:m3048. doi: 10.1136/bmj.m3048

Patterson SK, Strum SC, Silk JB. 2022. Early life adversity has long-term effects on sociality and interaction style in female baboons. Proc Biol Sci. 289(1968):20212244.

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Content last modified 2/9/2022

image of child peering out of slat by Doidam 10 / shutterstock

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How toxic stress affects child development - PARENTING SCIENCE

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Recent studies reveal how toxic stress "gets under the skin" -- disregulating hormones, turning genes "on" and "off," and altering a child's brain.

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Have you ever noticed that some people seem to handle a crisis with ease, or adapt well to change and wonder how they do it? Resilience.

What do we mean by resilience?

The American Psychological Association defines resilience as "the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress-such as family and relationship problems, serious health problems, or workplace and financial stressors."

Everyone will experience ups and downs throughout their lives. We cannot possibly prepare for or control every stressor, tragedy, loss or crisis that may come our way. What we can do is control how we respond to those events.

Why is resilience important and how does it help us?

That is where resilience comes in. It is not a personality trait, or something you are born with. Resilience is about thoughts, feelings and behaviors that can be learned, and can help you bounce back after facing adversity. For parents, building resilience in children is key to helping your child prepare for what the future may hold.

Podcast: The 7 C's of Resiliency

Kim LaFountain, LMHC, talks about why building resilience in kids is important to help them in all aspects and areas of life in a recent episode of Bradley Hospital's Mindcast.
Listen to The 7 C's of Resiliency podcast

The seven Cs of resilience and how to build it in children

There are seven qualities that can help build resilience. By helping your child focus on those seven qualities, you can help your child become more flexible and more easily recover from life's challenges.

Competence.

The ability to effectively handle various situations; acquired through experience. Children cannot become competent without developing skills that allow them to trust their own judgments, make responsible choices, and face difficult situations.

To build competence:

Confidence.

Solid belief in one's own abilities; the ability to face and cope with life's challenges.

To build confidence:

Connection.

Close ties to family, friends, school, and community give children a solid sense of security that produces strong values; sense of connection prevents kids from seeking destructive alternatives to attention.

To build their sense of connection:

Character.

A fundamental sense of right and wrong that allows children to stick to their own values and demonstrate a caring attitude toward others; encourages sense of self-worth and confidence.

To build positive character:

Contribution.

Understand that the child can make the world a better place. Gives children a sense of purpose and motivates them to take actions and make choices that will improve the world.

To help your child understand the importance of contributing to society:

Coping.

Capacity to enact a wide array of positive, adaptive coping strategies protects against unsafe behaviors; children who learn to cope with stress are better prepared to overcome challenges.

To improve your child's ability to cope:

learn positive coping strategies and model those behaviors to help your child adopt effective strategies

create a family environment in which talking, listening, and sharing are safe, comfortable, and productive

Control.

Children who realize that they can control the outcomes of their decisions have more trust in their ability to handle adverse situations. Children who see control as an external force become passive and pessimistic.

To help your child understand the importance of control:

By learning these behaviors and modeling them for your child, parents can instill resilience in children that will help them cope with all the curves that life may throw their way.

For more tips on children's health and well-being, visit the Grow section of our Be Well health and wellness blog.

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The Seven Cs of Resilience and How Parents Can Build Resilient Children

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Have you ever noticed that some people seem to handle a crisis with ease, or adapt well to change and wonder how they do it? Resilience. The American Psychological Association defines resilience as "the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress-such as family and relationship problems, serious health problems, or workplace and financial stressors."

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Welcome to the Mindfulness Hub

With the pandemic still creating lots of anxiety and stress, it's more important than ever to look after your children's wellbeing. This year we've got Dr Ranj an NHS doctor, and Cbeebies presenter onboard to help us all to wind down and relax with a special exercise, and resources from Twinkl below.

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Welcome to the Mindfulness Hub With the pandemic still creating lots of anxiety and stress, it's more important than ever to look after your children's wellbeing. This year we've got Dr Ranj an NHS doctor, and Cbeebies presenter onboard to help us all to wind down and relax with a special exercise, and resources from Twinkl below.

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Key points:

Self-regulation involves children’s developing ability to regulate their emotions, thoughts and behaviour to enable them to act in positive ways toward a goal.

Self-regulation grows out of co-regulation, where adults and children work together toward a common purpose, including finding ways to resolve upsets from stress in any domain and return to balance.

The foundations of emotional and cognitive self-regulation in the early years are integrally tied together, and both are necessary for behavioural self-regulation.

A pedagogy which includes co-regulation strategies will help children develop self-regulatory skills.

Developing self-regulation, like many elements of development and learning, is not something children do by themselves.  It is a process that grows out of attuned relationships where the caregiver and baby or child are closely attentive to each other and engage in sensitive, responsive exchanges.

There is no single definition of self-regulation, with aspects of it being referred to in many different ways – including impulse control, behavioural control, emotional competence, self-direction, and executive function.  While there are other domains such as biological self-regulation (e.g. babies building their ability to regulate body temperature and recognising body sensations such as hunger), it can be most helpful to focus on the interlinked aspects of emotional self-regulation and cognitive self-regulation, and how these work together to enable children to manage thoughts, feelings and behaviour.

Self-regulation involves children’s developing ability to regulate their emotions, thoughts and behaviour to enable them to act in positive ways toward a goal. The rapid brain development which takes place in early childhood paves the way for the growth of self-regulation, which develops both through the maturing of the brain’s neural systems and through opportunities to practice.  It continually develops through to adulthood, with further development of self-regulation taking place in adolescence. Self-regulation is now recognised as crucially important in young children’s development, strongly predicting children’s later success in relating to others and in their learning, while supporting lifelong mental and physical health.

Self-regulation depends on and grows out of co-regulation, where adults and children work together toward a common purpose, including finding ways to resolve upsets from stress in any domain, and return to balance.  Over time and with consistent practice, the process shifts from co-regulation between adult and child to the child’s self-regulation.  The flexibility of brain cells and pathways in the early years means that the brain’s architecture is altered in response to the quality and consistency of co-regulation experiences, building the capacity for self-regulation.

In its earliest stages, co-regulation involves a carer helping a baby who is overwhelmed by feelings – perhaps from being hungry, uncomfortable, or unhappy for any reason – to return to a state of calm.  Through voice, sensitive handling, and tuning in to respond promptly to a baby’s signals, the adult helps the baby experience returning to balance after being in a state of emotional arousal.  Each experience of co-regulation helps to build the neural pathways that regulate emotion.

Cognition interacts with emotions, as the baby learns to recognise and interpret situations which then results in a different emotional response.  For instance, a fretful baby who needs attention and can wait when hearing the carer’s voice, rather than wailing in deep distress, has learned from the adult’s prompt responses to their cues that help will be provided and it is possible to wait. Gradually an adult’s soothing a baby toward sleep at bedtime can be transferred to the baby who learns to self-soothe when waking in the night.

For young children, co-regulation also has both emotional and cognitive aspects.  It includes the adult modelling calming strategies and naming and talking about feelings and ways to manage.  This helps children learn to recognise their feelings and builds their cognitive awareness of strategies to reduce or manage extremes of emotion. At the same time, adults scaffold cognitive self-regulation by talking with children about thinking and learning.

The foundations of emotional and cognitive self-regulation in the early years are integrally tied together, and both are necessary for behavioural self-regulation.  Emotions running very high get in the way of cognitive aspects of self-regulation, as a child who is experiencing very strong emotions will have difficulty in holding back impulses, focusing attention, or thinking in flexible ways to solve problems.  Over-arousal of the emotional part of the brain constrains the thinking part, so a child who is very upset will first need help through emotional co-regulation before they can begin to think about the situation.

Cognitive self-regulation includes focusing attention, executive function (usually defined as including mental flexibility, inhibitory control, and working memory), goal-setting, self-monitoring, problem-solving, taking different perspectives (such as being aware of others’ thinking and picturing the future), and decision-making. When feelings are in balance, a child is able to use developing cognitive skills to make decisions about their goals and what behaviour is needed, such as choosing to apply the executive function of resisting impulses or concentrating.  At the same time, children can begin to use cognitive self-regulation to support emotional self-regulation, by monitoring their emotional state and deciding on strategies to calm themselves if necessary. A child managing their behaviour, then, depends on emotional and cognitive self-regulation working together with both aspects in balance.

Self-regulation is not the same thing as compliance, such as sitting still and listening when expected to.  A child who is stressed and struggling to resist the impulse to move or speak is very different from a child who is calm and alert, in a balanced state of feeling, thinking, and behaviour.  Children can fluctuate in their capacity to self-regulate just as adults can. It is not a fixed state. However, noticeably large regressions may indicate high levels of distress or be in response to a traumatic experience.

A pedagogy which includes co-regulation strategies will help children develop self-regulatory skills. Researchers have identified three basic strategies for co-regulation:

Positive Relationships – Provide a warm, responsive relationship where children feel respected, comforted and supported in times of stress, and confident that they are cared for at all times.

Enabling Environments – Create an environment that makes self-regulation manageable, structured in a predictable way that is physically and emotionally safe for children to explore and take risks without unnecessary stressors.

Learning and Development – Teach self-regulation skills through modelling, suggesting strategies, providing frequent opportunities to practice, and scaffolding to support children to use self-regulation skills.

Resources

Bibliography

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