Implications of attachment theory and research for developmental-behavioral pediatrics

This article presents a basic overview of attachment theory, concepts, and research. The review includes a discussion of the nature of the attachment relationship, its origins in human evolutionary history, and common misconceptions about attachment. We describe phases in the development of attachment relationships and review research on factors that influence attachment variations. We discuss the implications of variations in early attachment relationships for later development (adaptation and maladaptation). And finally, we review briefly the implications of attachment theory and research for pediatric practice. Some key points are that (1) virtually all infants become attached to caregivers regardless of quality of care; (2) attachment relationships evolve in phases over time; (3) children with disabilities form attachment relationships in ways comparable to nondisabled children but manifest attachment somewhat differently; (4) the consequences for attachment of out-of-home care, separations, and significant disruptions (e.g., adoption) depend on timing and circumstances; (5) many infant regulatory difficulties, as well as child behavior problems, originate in the caregiving relationship; and finally, (6) change in parent-child relationship disturbances is complex and requires time and effort.