This article was written with contributions from Hannah Larson LPC. She is a Pediatric Therapist and LPC.
What is Attachment in Childhood?
Attachment in childhood is the relationship formed between a very young child and primary caregiver. This relationship is the foundation a child uses in approaching relationships across the lifespan.
Secure attachment in childhood is the relationship a young child forms in early life with a reliable, predictable, consistent, and dependable caregiver. A healthy bond is important, and the absence of this bond can cause harm to a child.
Children who don’t have secure attachments, for whatever reason, can develop insecure or disordered attachment. This disordered attachment is characterized by a failure to trust caregivers and a Push/Pull interaction style that is needy one moment and sometimes violent and out of control the next moment.
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Symptoms of Attachment Concerns in Children
Insecure attachment in childhood is formed when a caregiver is inconsistent, constantly changing, and unpredictable. This insufficient care or pathogenic care is a risk factor for disordered attachment. When a child’s basic needs are not met, they are less likely to form secure attachments.
Children with attachment disorders have challenges interacting with others. For example, children can be less likely to seek or respond to comfort because they are less trusting of adults. Other children can be overly attention-seeking and clingy to adult strangers or acquaintances.
Although there are many types of attachment symptoms, here are some of the common signs.
- Lack of warm and affectionate interactions: your child is slow to warm up to you or not at all. When you go to hug, it feels robotic. Social interactions may be impaired across the board.
- Overly friendly with adults: your child will talk to or hug a stranger as if they were someone well known and close
- Lack of comfort-seeking when scared or ill: your child does not go to you for support when hurting
- Overly dependent: your child never wants to leave you and is not able to even do the most minor task without you
- Ignoring caregiver: your child is unaware of your presence, ignoring requests, or coming to you for comfort.
- Caregiving others: your child is the parent; instead of caring for their own needs, your child is overly concerned about you or another child or sibling
- Bossy and violent: your child can become violent when you are gently but firmly enforcing rules
Different Forms of Attachment in Children
Children with secure attachment can be comforted by their caregivers when distressed. They trust that their caregivers will take care of them and show up for them. Children with secure attachment feel comfortable exploring the world and knowing that they will be comforted when distressed.
Securely attached children have learned that they will be loved and cared for in their lives. They have a stable world free of excessive pain and trauma, and they have parents upon whom they can rely. This child’s needs are met. These parents set clear limits and realistic expectations, remain patient, and stay positive. These parenting skills become even more important when a child has a history of attachment challenges.
Insecure avoidant attachment
Children with insecure and avoidant attachment become very angry and distressed when their caregiver leaves. They are resistant to their caregiver when they return. Children with insecure-avoidant attachment are not quickly calmed when comfort is offered. These children are less confident in exploring their environment and may be unsure of strangers.
Children with anxious attachment resist or are ambivalent about closeness and trust. They are moderately controlling and insecure and have a somewhat negative inner working model. As a result, they will either cling to you or reject you.
Children with disorganized attachment are not able to find comfort from their caregiver by signaling anxiety to their caregiver or by directing attention away from their caregiver. A child may demonstrate inappropriate caregiving to others for their age and controlling behaviors towards their primary caregivers. Children with disorganized attachment tend to be unable to trust and be close to others. They may lack remorse, can be aggressive and punitive, and have no organized strategy to connect.
Sometimes, children on the autism spectrum can show disorganized attachment in the absence of maltreatment. It can also show up in children if a parent is terminally ill or their caregiver is subjected to violence.
Reactive attachment disorder
Children with reactive attachment disorder often show a lack of positive emotions with caregivers and present negative emotions of fear, sadness, and irritability, even during pleasant interactions. Children with RAD show avoidant behavior socially, aggression, unpredictable interactions with others that may quickly shift from familiar and comfortable to angry and rigid. These children can be uncooperative. Their challenges are based on mistrust of adults resulting from the early, even prenatal experience of stressful exposures and lack of consistent and predictable caregiving.
Disinhibited social engagement disorder
Disinhibited social engagement disorder is marked by overly familiar behavior with adults. For example, a child may have a push/pull interaction with their caregivers and then cling to the friendly parent at the pool, walk up to the neighbor’s door and ask to come inside. They may meet a substitute teacher and ask to come over to their house on the weekend. DSED is marked by overly familiar behavior and a tendency to attach to anyone quickly.
Causes of Disrupted Attachment in Childhood
A significant loss
Symptoms of attachment concerns may surface if your family has gone through the great loss of a caregiver like a parent or close grandparent. This issue is particularly common when the lost family member was a primary caregiver. However, some children may feel particularly attached to a family member like an aunt or uncle, or grandparent, who is not a caregiver and this loss can impact attachment as well.
A lengthy hospital stay
If a primary caregiver had a lengthy hospitalization or medical issue that impacted bonding with an infant or young child, you might notice symptoms. Some children with attachment challenges had to be in the hospital a lot in infancy or early childhood. These frequent separations can cause attachment issues. Further, in a hospital setting, there are adults frequently hurting the child. Even though these medical professionals intend no harm, the infant or toddler does not understand this positive intent. As a result, the child may feel afraid to trust adults.
Even in loving families and stable homes, children can experience what is called ‘developmental trauma.’ This is trauma that results from relational interaction patterns. For example, if a child has a very anxious mother, the child may pull away, detach, and ‘dissociate’ from their own emotions in order to not stress their mother out. Children rely on primary caregivers for survival so they may go to extreme lengths to protect the relationship, even by way of sacrificing their own authentic feelings. In this case, the child will likely have difficulty attaching to others and may avoid closeness and intimacy. 
Frequent changes in a young child’s life can also cause developmental trauma. For example, a move across town, divorce, death of a pet, or change of schools can cause some level of what psychologists call ‘small t trauma.’
Committed and loving parents may have a child who struggles with attachment. Examples include very loving parents who are in the midst of a violent and contentious separation and divorce, a single parent with little support and an unpredictable work schedule who must pass the young child from relative to relative, and parents who suffer from depression or addiction.
If your child was adopted following infancy or if your child was adopted at birth from a birth mother who had high stress and trauma in her pregnancy, you may notice symptoms.
Children may suffer from issues related to attachment if they are abused or mistreated, spend time in the foster system, have parents in jail, or otherwise cannot form a stable, trusting, predictable relationship with caregivers. International adoptions that take months or years to finalize or children who go from having minimal care and support to joining a loving family may have attachment challenges because the first months or years of life were challenging and unpredictable.
Environmental factors that can cause attachment issues in childhood
According to the book Attachment, Trauma, and Healing (p. 133), causes of disrupted attachment include the following factors. 
Parent and caregiver factors
- Abuse or neglect
- Ineffective or insensitive care
- Depression, bipolar, postpartum
- Substance abuse
- Adolescent parenting
- Prolonged absence due to being in prison or hospitalized
- Family history of maltreatment and compromised attachment
- Difficult temperament
- Premature birth
- Medical conditions; unrelieved pain, colicky
- Failure to thrive
- Hospitalization: separation and loss
- Violence- victim or witness
- Out-home-placements- foster care, foreign orphanages
- Lack of support- absent parent or extended kin, isolation, lack of adequate medical care
- Lack of Stimulation
How to Help Your Child Form Secure Attachments
Create a loving, supportive and safe environment: your child needs to know their physical needs are met and that you will keep them safe and free from harm. For children who have had their attachment disrupted, harsh discipline, time out, and punitive punishments hurt the relationship between the caregiver and child and should not be used under any circumstances.
Start first by creating a loving and safe environment. If your child needs redirection or correction for behavior, allow them to calm down first, stay near and wait to provide lessons and learning until after your child has calmed down.
Learn emotional regulation skills for yourself and teach them to your child: emotional regulation is the ability to self-soothe and calm yourself down in a healthy way.
- As the adult, calm down first: When you or your child is upset, it is important to not respond from this place. Instead, state that you are going to take a break from your child and return.
If your child is upset, and if you can remain calm, stay with your child, so they know they are safe and allow them to calm down on their own. Always teach lessons from a place where both of you are calm.
When they are activated and upset, do not try to reason with your child. Wait for calm behavior to have a discussion and problem solve.
- Teach your child to recognize emotions in their body: help them recognize where they experience different emotions. For example, do they feel tightness and an uncomfortableness in their heart, signaling sadness?
When they are angry, does their face turn red? Does your child tense certain muscles? Help your child develop a feeling vocabulary and understand what the felt sensation of those emotions feels like in their body.
RECOGNIZING EMOTIONS TAKES A LOT OF PRACTICE. KEEP AT IT.
- Help your child link an emotion, an uncomfortable feeling, and a healthy coping strategy: For example, when your child is experiencing a painful emotion, help them recognize the emotion instead of having an outburst. They can ride the wave of the emotion and choose a healthy strategy for coping.
Healthy strategies include riding a bike, walking, progressive muscle relaxation, visualizing a favorite place, drawing a picture, texting a cheerful friend, having a cold glass of water, drinking tea, and taking a bath.
- Get help for yourself: the key to teaching your child emotional regulation is the ability to regulate your own emotions in a healthy way. Many of us were not taught healthy ways to cope, and it may be hard to stay calm yourself. Get the support you need!
- Make time for positive connections every day: Help your child know they are loved and cared for by providing quality time for connection. It looks like 15 minutes of positive, uninterrupted attention, maybe at bedtime where your child can share anything with you; you play a game. This time is special and is not taken away from them. It helps your child know they are cared for and important. You can also schedule a once-a-month activity with your child where you do something special together. The importance here is consistency and that it happens no matter the circumstance.
When to Seek Help for Attachment Concerns in Childhood
If you have concerns that your child may not have a secure attachment, it would be best to work with a mental health professional that can help guide you and your child.
Children with severe attachment concerns, such as demonstrating violence, hurting animals, or refusing to talk, need special behavioral support and care. It is best to work with a professional trained in treating attachment and trauma so they can guide you on best practices.
Professional Resources for Attachment Concerns in Childhood
If your child is struggling with this symptom to the point that it is getting in the way of their learning, relationships, or happiness, the following professionals could help. They may offer diagnosis, treatment, or both.
- Psychotherapist or play therapist: to treat symptoms of attachment, trauma, anxiety, or depression. Make sure to find a specific attachment or trauma therapist as not all therapists are trained in these skills
- Family therapy: to help with the family system. In addition to having a therapist to work with your child, you are likely to need a family therapist to help with the family system as it is such a crucial part of secure attachment
- Psychologist or neuropsychologist: to consider a full assessment to look at attachment versus other factors like autism
- Pediatrician: to prescribe medicines and to treat health conditions; this approach is often an effective treatment when combined with psychotherapy for emotional aspects
- Psychiatrist: to provide and manage medication.
- Parenting consultation with a psychologist: to help parents, as some children may be more challenging to raise. Behaviorally challenging kids may need extra support from parents. Again this professional should be trained in working with trauma and attachment issues
Similar Conditions to Attachment Concerns in Childhood
If your child is struggling with a similar problem not directly addressed in this section, see the list below for information about other related symptom areas.
- Emotional regulation: some children can be particularly intense. They may have temper tantrums and might be more emotionally labile. Temperament refers to personality characteristics that we are born with, early indicators of who we will be. According to researchers Thomas and Chess, intensity is one of 9 temperament characteristics obvious early in life that could influence emotion regulation. This intensity could also relate to mood.
- Mood swings: some children are more intense and moody, which can be evidence of later mood regulation challenges. It will be important to watch for signs of anxiety or depression. Significant mood swings are consistent with attachment disorders, but attachment is not the only probable cause of these challenges.
- Perseverating: some children have the tendency to obsess over objects or interests. Children may have an insatiable need to do something calm and predictable repeatedly, which gives a sense of security and stability. Repetitive and perseverative behavior can also be a sign of an Autism Spectrum Disorder. Often, clinicians have difficulty distinguishing some symptoms of autism from attachment. Early history is very important, and consideration of the emotional nature of the perseveration should be observed, rather than a need for sameness and routine that is more likely to be Autism.
- Sad memories or cognitive distortions/unstable early life/family problems: some children may have experienced abuse, neglect, poor early care, or may have been exposed to something traumatic like the death of a family member. These memories may not be accessible by your child but may have a significant impact even if the experiences happened before they could form words. Having had these experiences could be a sign of Trauma or an attachment disorder.
References on Attachment in Childhood
Levy and Orlans (2014). Attachment, Trauma, and Healing. Jessica Kingsley Publishers, Philadelphia.
Resources on Attachment in Childhood
National Institute for Health and Care Excellence (NICE); 2015 Nov. Children’s Attachment: Attachment in Children and Young People Who Are Adopted from Care, in Care or at High Risk of Going into Care.
Huebner, Dawn (2007). What to Do When Your Temper Flares: A Kid’s Guide to Overcoming Problems With Anger (What to Do Guides for Kids).
Purvis, Karyn B., & Cross, David R., & Sunshine, Wendy Lyons (2007). The connected child: Bring hope and healing to your adoptive family.
Dewdney, A (2007). Llama Llama Mad at Mama. Viking Books for Young Readers.
Ross Greene: The Explosive Child: A parent’s guide for parenting chronically inflexible children.
Levine and Kline (2007). Trauma Through A Child’s Eyes.
Winfrey, Oprah & Perry, Bruce (2021). What Happened to You?: Conversations on Trauma, Resilience, and Healing.