Focus on the Family

Attachment and Bonding

by Debi Grebenik

Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. . . .It always protects, always trusts, always hopes, always perseveres.
—1 Corinthians 13:4–5, 7

One family with whom I worked wanted to expand their family by adopting a child from another country. Their family consisted of the parents and two sweet-natured little girls. The parents wanted to adopt a younger male child. The little boy they adopted came into their lives through much perseverance in the adoptive process. They were thrilled to have him join their family.

Then, a few months after the adoption, he began to act out. His behaviors were targeted on the primary caregiver, his mother. He would yell at and hit her; defecate and urinate on the floor; cry and scream instead of sleep at night; and he wouldn't allow anyone to touch or attempt to calm him. As a result of his escalating behaviors, the mother began to react to him and became angry with herself for her negative thoughts toward him.

When I met them, she felt as though her son was in the process of ruining her family. She expressed how much she despised how he changed their family. She found herself yelling at him in response. The father became the only one who could soothe the child. Without his presence, the boy's behaviors continued to escalate.

The emotionally drained family needed answers. Why was this happening? What could they do? (You can read more about this family in the next article.)

First, I explained the issue of attachment and bonding. As parents interact with and relate to their children, children reflect what they see. They model facial expressions, voice intonations, and physical gestures, and these elements contribute to the child's developing attachment capabilities. For some of us, this process is second nature; for others, it is unknown territory.

Attachment can be a complex concept. To understand, let's look for it in everyday life. The face of attachment is evident in children who, while playing with other children, go to their parent(s) and touch them or stand near them to "touch base" and then return to playing with their friends. Attachment is also seen when children run to their parent(s) when hurt, sad, afraid, or overwhelmed. When attachment is present, the parent(s) can soothe this child. A child who is not attached may be hypervigilant; always on guard out of fear; or they may not respond to the parent's words, sounds, or gestures.

All different degrees of attachment exist. A child may have experienced an intermittent attachment process such as when parents are deployed, divorced, or depressed. If there is even one significant adult in a child's life who will provide consistency and unconditional love and support, that child can attach. Attachment is based on the needs of the child.

Bruce Perry, M.D., a specialist in child development and trauma, defines attachment as "a special enduring form of 'emotional' relationship with a specific person which involves soothing, comfort and pleasure."1 An attached child finds security and safety in context of this special relationship. It is within this secure and safe relationship that a child is able to develop emotionally, physically, socially, culturally, intellectually, and spiritually. This connectedness provides the context for a child to learn, love, survive, work, create and grow.

Attachment is also demonstrated when the loss or threat of loss of the specific person evokes distress. Distress is manifested through behaviors: bouts of crying, throwing tantrums, periods of hoarding, moments of withdrawing, actions of self-mutilating, and other significant behaviors.

1Bruce Perry, M.D., Bonding and Attachment in Maltreated Children (, 2001.

A New Definition of Attachment/Regulation

Attachment is the affectional tie between two people.

by Debi Grebenik

Psychoanalyst John Bowlby, drawing on concepts from ethology, cybernetics, information processing, developmental psychology, and psychoanalysis, formulated the basic tenets of attachment theory. He defined attachment as the affectional tie between two people. It begins with the bond between the infant and mother. This bond then represents how the child's life relationships will be formed.

Bowlby stated, "The initial relationship between self and others serves as a blueprint for all future relationships."1 In other words, it is at this beginning stage that a baby learns how to relate to others. Initially, his or her world is very small and focused only on the parents or primary caretakers. Their response to the baby will determine the baby's ability to attach.

In attachment interactions between baby and mother, the secure mother regulates (calms) the baby's shifting arousal levels, which affects the baby's emotional states.2 If, during stressful events, a sustained calm stage can be reached due to parental soothing, the child develops self-regulation skills. The child begins to learn how to self-soothe, and these skills form the building blocks of healthy and significant future relationships. The ability to self-regulate and be regulated is a prerequisite to the ability to form healthy attachments.3

This process is easy to observe when a mother rocks, holds or bounces her child; perhaps coupled with a shushing sound while the baby calms. Some babies settle down just at the touch, smell or sound of their mothers.

Babies, children and youth who did not experience this soothing process find it difficult to calm down in moments of stress. These are the individuals who may react with only a minor provocation. An adolescent who begins yelling, cursing or crying when asked to complete a task or chore provides an example of someone who is not able to self-soothe. Attachment can thus be defined as the dyadic regulation of emotion.4

Bonding involves a set of behaviors that leads to an emotional connection, (which is also known as attachment).5 Understanding this process is key to helping a child with attachment disorder.

The positive interaction (needs-arousal) cycle

As we've mentioned, attachment occurs when the caregivers, primarily parents, provide stable and consistent responses to the child's distress. Distress occurs when a baby or child experiences hunger, fatigue, illness or any other type of discomfort.

An emotionally healthy adult delights in taking care of his or her baby or child. The mother and father respond to their child with eye contact, cooing sounds, physical snuggling, and rocking movements. In turn, the child responds with smiling, gurgling, clinging, sucking, and playing. This reciprocal interaction creates the basis for attachment. See the diagram below.

Healthy Attachment Cycle6

The safety and security that a strong attachment builds creates healthy cognitive, social, emotional and spiritual development for the child as he matures.

Children (biological or adopted) who do not get their needs met as babies and small children typically do not form a strong attachment with their parents. Even when adopting a baby, it is important to consider that the removal of a child from his or her biological mother creates a traumatic event in the life of the child.

One experienced mother, Amber Bartell, discovered this when she took little Amy into her home. As an infant, Amy had been passed from friend to friend by her mother. So when Amy was placed with Amber's family, bonding was anything but natural. In fact, Amy constantly pulled away from Amber. Whenever Amber tried to lay Amy on her shoulder, for instance, Amy held her body rigidly away from Amber. This continued until Amy was 11 months old.

So keep in mind that attachment with the new parents may not be automatic. Knowing this, parents need to understand not only the truth that establishing an attached, loving, and committed relationship with their child is key, but also the fact that this may take some considerable time and effort. The adoptive parents' investment in fostering attachment can mitigate the trauma experienced by the child in the removal from her biological mother.

It is also important to note that adopted children (who suffer from attachment problems) may experience difficulties during certain developmental phases such as adolescence. These difficulties occur because of the youth's inability to meet her own needs. Out of her frustration, she might express her anger by yelling, hitting, vandalizing, threatening or withdrawing.

As well, the parent of an adopted child may have missed out on some significant aspects of attachment in his or her own upbringing. The adoption process thus may trigger unresolved emotions for the parents. It is important for parents to be self-aware, understanding the challenges and blessings of their own childhoods. When beginning the process to adopt a child, parents often prepare financially, physically and spiritually, without considering what effect the adoption will have emotionally.

Remember the family mentioned at the beginning of this article series? By the time I saw them in family therapy, the situation had escalated and they were almost ready to dissolve the adoption. As we plowed through what was going on in their lives, we were able to discover the real issues. Throughout the mother's life, people at every stage had given up on her and cast her aside. That's all she knew in relationships — rejection.

Instead of responding as the parent when things became difficult with her son, she became that little girl and felt rejected once again. As the mother understood and expressed her pain and hurts, her heart began to mend, and her ability to feel and express love to her son began to swell. She experienced her son for who he was — a little child who needed her calm presence, realistic expectations, unconditional love, and unlimited patience. She could now respond to his broken and wounded soul as his mother instead of as another broken child.

Through the power of prayer, processing pain with another person, and the presence of the Holy Spirit, healing can occur — both for the parent and the child. That is the quiet beauty of parenting hand in hand with God. This is also what gives hope; you can make a difference in the life of a child and, at the same time, you can become more of the parent God intends for you to be.

1John Bowlby, Attachment and Loss. Vol. 1: Attachment (New York: Basic Books, 1969).
2Allan Schore, "The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health," Infant Journal of Mental Health, 2001, 22: 7–66.
3B. Bryan Post, The Great Behavior Breakdown, audio CD Recording (Oklahoma City, OK: Post Institute for Family Centered Therapy, 2004).
4L. Alan Sroufe, Emotional Development (New York: Cambridge University Press, 1995).
5Bruce Perry, M.D., Bonding and Attachment in Maltreated Children (, 2001.
6Adapted from a simpler diagram by Foster W. Cline, M.D., Understanding and Treating the Severely Disturbed Child (Evergreen, CO: Evergreen Consultants in Behavior, 1979), 28.

Dealing With Trust and Control Issues

The sensitive parent is attuned to his or her child's natural rhythms and responds to those appropriately and timely.

by Debi Grebenik

One family had a 12-year-old son they adopted at age six. He was adopted previously at age three when the rights of his birthparents were terminated; but unfortunately, the adoption dissolved and he lived in a residential treatment center until he was adopted by his new family. Obviously, this young boy had experienced multiple traumas in his brief life.

As a result, he exhibited significant behavioral issues. Most notably, he acted as though he were a 2- or 3-year-old. He was not able to interact socially with children his own age. In addition, he could not identify or express feelings and his cognitive delays were evident. Even his motor skills were compromised.

To their credit, the parents did not focus on some of his challenging behaviors. Instead, they provided him with unconditional love and acceptance, much like God does for us every day. Part of what these parents did was rock and cuddle with this boy to provide him with some of the connections he missed as a baby. They also told him how sad they were that they did not get to take care of him as a baby, protect him, and nurture him. They created new bonds with him as they talked constantly about how special he was to them — and they saw enormous progress in his behaviors.

The sensitive parent is attuned to his or her child's natural rhythms and responds to those appropriately and timely.1 This attunement, which is primarily nonverbal communication, is paramount to secure attachment. A parent's ability to be attuned is contingent on his or her own experiences of trust, attachment and bonding. When children have parents who respond sensitively to their signals and provide comforting bodily contact, the children can then respond readily and appropriately to the distress of others, thus demonstrating the ability to empathize.2 As a result, positive patterns of interaction are deposited in the brain's limbic system, providing a repertoire of experiences for the child to build upon. The child begins to trust and relate to his parents emotionally. This is where the healing begins.

Each child needs to make a connection with a significant adult with whom he or she can feel safe and process his or her hurts, fears, and hopes.

The three A's of attachment

Let's take a look at the three A's of Attachment as offered by Dr. B. Bryan Post:

Take a moment, read those, take a deep breath, and read them again. Certainly, you are providing most, if not all, of these key components. But if there is a lack in any of these areas, become proactive in emphasizing this in your relationship with your child. For most of us, this process comes naturally; for some, however, this process is difficult.

While it would be easy to be judgmental toward parents unable to provide this secure base, we must remember that some parents enter into the parenting chapter of their lives without the experience of having been adequately parented themselves.

They bring their crippling pasts to the parenting role. Some come with histories of physical abuse, sexual exploitation, extreme neglect, domestic violence, drug exposure, economic deprivation, medical trauma or parental absence. Due to the significance of these backgrounds, some will be crippled in their ability to respond sensitively to their child's needs. They may not understand the potential harm that their actions or inactions may have on a child in their care.

Attachment disorder can be transmitted intergenerationally. Children lacking secure attachments with caregivers commonly grow up to be parents who are incapable of establishing this crucial foundation with their own children. Instead of acknowledging, understanding, and following the instinct to protect, nurture, and love their children, they abuse, neglect, and abandon. But with self-awareness and help, parents can and do break these cycles. It is vital that we work together to break such cycles.

1John Bowlby, A Secure Base: Clinical Applications of Attachment Theory (Padstow, Cornwall: TJ International Ltd, 1988), 9.
2Ibid., 15.
3Heather T. Forbes and B. Bryan Post, Beyond Consequences, Logic, and Control (Orlando, FL: Beyond Consequences Institute, LLC, 2006).

Reactive Attachment Disorder

Understanding, recognizing and treating a lack of attachment

by Debi Grebenik

When attachment is interrupted or incomplete, resulting in behavioral responses that meet specified criteria, the diagnosis of Reactive Attachment Disorder may be given. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, Fourth Edition, Text Revision), Reactive Attachment Disorder is a disorder caused by a lack of attachment to any specific caregiver at an early age, and it results in the inability of the child to form normal, loving relationships with others. Because Reactive Attachment Disorder results from an interruption in the bonding cycle, the interruptions may be caused by various factors such as in utero substance abuse, parental neglect, and physical abuse. Additional factors include maternal ambivalence, depression or illness, which all alter the baby's growth and development.

Adopted children are more likely to exhibit emotional, behavioral, and educational problems than children who are raised by their biological parents.1 This is due to the fact that, on average, they have experienced an interruption in attachment. For example, having a greater number of caregivers may have prevented them from having that crucial experience of forming a strong, secure attachment in infancy.

But whether adopted or not, any child may experience stressors such as abuse, neglect or trauma, prenatally or during the first years of their lives. The most damage or benefit is realized during the first 36 months of a child's life, during which time the human brain develops to 90 percent of its adult size. This is also the time when the brain builds the systems and structures that will lay down future tracts for social, emotional, behavioral, and intellectual responses.2

It is during this crucial period of brain development that a child can be scarred significantly. When the primary needs for survival are not met consistently and appropriately, the effects are significant, even if those effects may take some time to become apparent. As the behaviors surface, a therapist should assess if the child meets the threshold for a diagnosis of Reactive Attachment Disorder. The child must meet the criteria as identified by the Diagnostic and Statistical Manual of Mental Disorders. Children may experience attachment challenges, but it is only when the attachment challenges begin to affect the child's life negatively that it is considered a disorder.

It is important to note that when a child experiences significant neglect, holes are created in the brain, interfering with a child's ability to think consequentially.(For more information, see The beauty is that these holes can be healed (over time) through restorative and regulated relationships with parents who are calm, peaceful, and committed. This peace comes from more than just an emotionally healthy life. Ultimately, it comes through Jesus Christ our Lord. As He promises in John 14:27, "Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled, and do not be afraid." Typically (but not always), healing takes about 15 to 18 months to occur.

While most families want their attachment-challenged child to be in therapy — and it's true that therapy is beneficial — keep in mind that the child's most effective therapists are the parents, guided by God, the loving Father. This healing can be a slow, evolving process; however, be encouraged that some progress can be seen early on. Parents need to remember that parenting an attachment-challenged child is a marathon, not a sprint. Parents, with the support of a specially trained Christian therapist, can give the child the loving, calm, and consistent environment needed to bring about the child's emotional and spiritual healing.

It is also important to remember that parenting will bring up our own fears: Am I doing the right thing? How can I keep my child safe? What if my child acts out in church? In public? What will others think? How will this affect my other children? My marriage? Do I have what it takes? Once again Scripture points us down the right path in 1 John 4:18, "There is no fear in love. But perfect love drives out fear, because fear has to do with punishment. The one who fears is not made perfect in love." Those fears can be mitigated within the context of relationship. These relationships include friends, family, and church. Within these relationships fears can be expressed, processed and understood.

Armed with understanding, parents will not be crippled by their own fears. Most of us know the value of "venting" our emotions to a good friend, spouse, pastor or therapist. This venting provides a therapeutic opportunity to express our emotions that prevents us from becoming emotionally frozen or handicapped.

The key here is to bask in the perfect love of the Father, while realizing that His love will fill the spaces where fear formerly resided. When we live this way, we can parent our children from a place of love, not of fear; responding to their needs before they even know they have a need, rather than reacting from a place of fear.

1S. E. Kay Hall and G. Geher, "Behavioral and Personality Characteristics of Children with Reactive Attachment Disorder," Journal of Psychology: Interdisciplinary and Applied, 2003.
2Perry, 2001.

Promoting Healthy Attachment

Suggestions for an effective bonding experience

by Debi Grebenik

Knowing the prenatal and early history of any child that you adopt is important; this information helps guide the parents' responses to the hurting child. Many interventions mitigate the effects of early trauma.

When a baby is placed in your arms for adoption, it is important that the parents give their baby the time needed to bond with them. If the child is older, some modification of these suggestions can be implemented. For babies, suggestions for an effective bonding experience include:

Parenting children of all ages is dependent on the developmental age of the child. If you adopt an older child, the preceding principles are still relevant. Remember that your child may be at a much younger age emotionally.

For toddlers, it is imperative to remember that toddlers' verbal skills can be limited, inhibiting their ability to express their feelings. With this limitation, parents need to allow toddlers to vent their emotions while continually being present in the moment. For example, if a toddler begins to cry, scream or act out, the parent can sit down next to the child and calmly say that she is right there and she's not leaving. This statement needs to be repeated in a quiet voice until the child calms down.

For older children, it is important to work toward building a strong relationship with them. In addition, when working with youth, it is imperative to focus on their stressors, not their behaviors, and to respond in love, not react out of our own fears and emotions. Older children also need a contained, stress-free environment with calm, loving parents. One family that I worked with adopted an adolescent girl. I encouraged both parents to spend one-on-one time with her daily, particularly during times of transition such as waking up in the morning, coming home after school, and at bedtime. These times were to calm her fears and build her trust in their presence and care for her.

Other soothing options include quiet music, soft lights and calming scents. Touch also provides a venue for soothing. Touch, rocking and massage are tools that parents use to provide relaxing and comforting opportunities for children. It is within the loving relationship between parents and their child that a child is healed.

You may want to seek therapy if you are overwhelmed and stressed and feel as though your child is struggling. If possible, seek out a Christian therapist with experience in working with adoptions or attachment. Ask other parents which therapist they used. Call the adoption agency and seek referrals. You might consider joining a support group — online or near your home. Don't walk this road alone. Remember to seek a therapist who will work with the family, not just the child; one who will not shame or blame your child and who will see God's plan for you and your family.

Hope for parents

As Christian parents, we have a significant, life-changing resource in the presence of the Holy Spirit. As promised by the Lord Jesus Christ, the Holy Spirit brings peace — He is the one who provides a defense against the current stressors of life and the power of past trauma events. As parents, you can learn and invest all that you can for your child to be healthy and whole. But the Lord alone can reach into the depths of your child's heart and psyche where no one else can reach and bring healing.

Remember the wise words of James 1:4, "Perseverance must finish its work so that you may be mature and complete, not lacking anything." That verse encapsulates the parenting process: Endure. Trust. Relate. Grow. Enjoy.

Sow the seeds of attachment and you will reap the harvest of a meaningful and peaceful relationship with your child.

Next Steps and Related Information

Additional resources on attachment and bonding in adoptive families

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