Characteristics and Treatment of Childhood Attachment Disorders: Four Key Points for Nurturing Attachment

 

In recent years, understanding of attachment disorders has advanced. However, obtaining information on how to prevent attachment disorders or how to interact with children who already have unstable attachment remains difficult at present.

 

　In this article, a licensed psychologist, under the supervision of a physician, has compiled key points based on professional knowledge regarding how to treat and interact with children with attachment disorders. We invite you to read it.

 

<Created: 2025.9.26 / Last Updated: 2025.9.26>

※When using content from this site, such as through reprinting, please kindly cite our site name as the source or provide a link.

		Author of this Article Ichitaro Miki — Certified Public Psychologist Osaka University (BA); Osaka University Graduate School (MA) Over 20 years in psychological clinical practice. Specializes in trauma and attachment difficulties that underlie a wide range of problems and “ikizurasa” (chronic distress). Author of Developmental Trauma: The Real Cause of “Ikizurasa” and other books (approx. 40,000 copies in total), appearances on TV programs, clinical supervision for dramas, and numerous features in web media and magazines. Click here for full profile

		Medical Supervision for This Article Dr. Keiro Iijima (Psychosomatic Medicine, etc.) Not only a psychosomatic medicine specialist, but also a clinical psychologist, Kampo physician, and general practitioner, with expertise across these fields. Specializes particularly in treating somatic symptom disorders and autonomic nervous system dysfunction. View full profile here

＜Article Writing Policy＞

・Licensed psychologists write, explain, and present key points based on years of clinical experience and client experiences (particularly from the perspective of attachment and trauma therapy).

・We reference specialized books and objective data to the best of our knowledge.

・We strive to incorporate the latest research findings whenever possible.

・This article has been translated from the original Japanese using AI. Therefore, it may contain unnatural translations, particularly for specialized terms.

 

Table of Contents

・Point 1: Caregivers (Parents) Understand the Characteristics of Attachment Formation

・Point 2: Understand Key Parenting Principles Crucial for Attachment Formation

・Point 3: Parenting Won't Always Go Smoothly. Caregivers should not blame themselves

・Point 4. Know that attachment can be rebuilt through future nurturing

 

　→Related articles here

　　・What is Attachment Disorder? Its Characteristics and Symptoms

　　・Attachment Styles / Types and Characteristics of Attachment Disorders: Diagnosis and Self-Check

　　・How to Heal Adult Attachment Disorder: 5 Essential Points

 

 

　

Point 1: Caregivers (Parents) Understand the Characteristics (Mechanism) of Attachment Formation

First, caregivers need to understand the mechanisms of attachment formation. For example, understanding that the period from six months to one and a half years is the attachment formation stage fundamentally changes how you approach creating a nurturing environment. When families and communities understand the mechanisms of attachment formation, they grasp the underlying principles of the issues, enabling them to apply this knowledge effectively. This leads to better advice and mutual support for parenting.

 

　Related articles are here

　▶What is Attachment Disorder? Its Characteristics and Symptoms

 

 

・The Four Stages of Attachment Formation

Bowlby, who established attachment theory, posits that attachment forms through four distinct stages.

 

＜Stage 1＞ From Birth to Around 12 Weeks

This stage involves no recognition of specific people, and no attachment to particular individuals is observed. The infant communicates with people by sending signals like smiling or crying to elicit a response.

※Recent research suggests attachment formation actually begins around this time. The experience of this interaction—signaling behavior and receiving a response—appears to form the foundation for attachment development.

 

＜Stage 2＞ From around 12 weeks to 6 months old

This is the stage immediately preceding the formation of attachment. The infant begins to recognize people and shows an increasing number of intimate reactions toward them. They start to select specific individuals and display attachment behaviors. These behaviors are directed not only toward the mother but also toward a few specific family members. By mirroring the infant's emotional behaviors, parents provide the infant with confirmation of their own emotions and a sense of continuity in their experiences. This interaction helps the infant understand that their emotional expressions are acknowledged and responded to. This process is crucial for the infant's emotional development and the formation of secure attachment.

＜Stage 3＞ From around 6 months to 1 year old

These behaviors are directed not only toward the mother but also toward a few specific individuals, such as other family members. When parents mirror the infant's emotional behaviors, the infant confirms their own emotions and gains continuity of experience. This forms the foundation for a sense of self-identity—who they are.

 

 

＜Stage Three＞ From 6 Months to 2-3 Years Old: Peak of Attachment Formation

This is the period when attachment formation and attachment behaviors are most active. The peak is considered to be around 18 months. Increased mobility through crawling also encourages attachment behaviors.
The child begins approaching attachment figures and seeking contact. They dislike separation from caregivers, become anxious, and feel reassured upon reunion.

They begin using caregivers as a secure base for exploratory behavior. Research shows they don't seek attachment indiscriminately, but rather set the goal of gaining safety and security. They adjust their behavior based on the caregiver's actions and responses to achieve this goal.

They also begin showing empathy towards others and engaging in altruistic behaviors. This forms the foundation for theory of mind. Parallel to the organization of attachment, this is also a period where anxiety towards strangers increases (stranger anxiety).

Prolonged separation from the primary caregiver, who is the attachment figure, can be considered a psychological trauma with significant physical and mental effects. This period continues until around age 2 or 3.

 

＜Stage Four＞ Age 3 and Beyond: From the Actual Attachment Figure to the “Internal Working Model”

By this stage, children begin to understand that others besides themselves have their own intentions and purposes, and act accordingly.
Even when caregivers are not constantly present, children can stabilize their emotions by predicting others' actions.

Even when the attachment figure is not physically present, the child can hold an image of themselves and the caregiver within their mind. They develop the conviction that they are worthy of love and are loved by their parents. This is called the “internal working model”.

 

From this stage onward, the presence of the “internal working model” allows the child to interact with society confidently and achieve independence while maintaining emotional stability.

When the relationship with caregivers is unstable, the “internal working model” also becomes distorted and unstable, significantly impacting subsequent interactions with society.

 

 

　

 

Point 2: Understanding Key Caregiving Elements Crucial for Attachment Formation

According to attachment researcher Mary Ainsworth, what is crucial for attachment formation is the responsiveness and effectiveness (functioning as a secure base) of a specific caregiver.

　
1. Responsiveness and Sensitivity

The degree and consistency of the following four points are crucial.

 

・Sensitivity – Responsiveness

　　This refers to sensitivity to and appropriate interpretation of the infant's subtle cues, and responding appropriately.

 

・Acceptance – Rejection

Refers to the ability to accept the various positive and negative reactions shown by the child.

 

・Cooperation - Intervention/Interference

Refers to the ability to respect the child as an independent being. Rather than direct, excessive interference, it involves indirectly creating the right mood and guiding the child towards what they wish to do.

 

・Approachability – Ignoring

　　This refers to the parent being readily available to the child, allowing immediate attention to be given when needed.

 

 

2. Length of Time Spent with the Caregiver

　　Particularly from six months to one and a half years of age, specific caregivers literally need to be constantly attentive. Separation during this period, bereavement, or being placed in daycare for long hours without consideration for consistency in care are factors that can destabilize attachment. It is crucial for caregivers to spend sufficient time with the child.

 

　　
３．Parenting Methods

The intensity and style of parenting are crucial. Neglect and abuse obviously have detrimental effects. While abuse may bring to mind physical violence, it is also understood that environmental changes during early childhood, such as moving, attitudes that negate the child's personality, and parental discord significantly impact attachment. It is necessary to ensure an environment with minimal stress and maximum safety and security.

 

4. The Caregiver's Attachment Style

Just as attachment patterns can be passed down across generations, the caregiver's attachment style influences how the child forms attachments. Parents should understand their own attachment style and consciously work to compensate for any deficiencies. Alternatively, it's necessary to seek help from family members without overburdening themselves.

 

If you want to know your attachment style, you can take a simple assessment on the page below.

(Reference)→“Attachment Style Assessment Test”

 

 

 

Point 3: Parenting won't always go smoothly. Caregivers shouldn't blame themselves

・Feeling irritated is a natural reaction

Recent research shows that postpartum hormonal changes and the process of fostering independence can cause mothers and infants to experience depression, aversion, and irritability alongside affection. Furthermore, when support is scarce and stress mounts, anyone can feel overwhelmed and tempted to give up on parenting.

It's also true that some children are harder to raise due to developmental characteristics. Ease of raising varies greatly from child to child. There's no need to feel pressured thinking, “Other families seem to manage just fine.”

 

・Objectively Assess Your Situation

Even when you struggle to interact well with your child, understanding whether it stems from internal (physical) or external environmental factors makes it easier to adjust your behavior. Caregivers should not blame themselves; it is simply important to objectively understand their situation.

※ If a parent has tendencies toward developmental disorders like Asperger's syndrome, interactions with the child may become detached, or they may compulsively impose their own values due to a lack of self-other differentiation. It is also important for caregivers to recognize these characteristics in themselves.

 

・The Importance of Balancing Harmony and Resistance

　Parenting involves a fluctuating progression between harmony and resistance—or, in other words, the conflicting forces of attachment formation and independence. It means connecting while simultaneously distancing. Distancing creates the need for connection, and appropriate connection requires a degree of separation. One could say that from the moment the umbilical cord is cut, parent and child are continually moving apart.

 

Even in the most harmonious mother-child relationship, the proportion of synchrony is only about 30%. It is understood that for the majority of the time, there is a gap between what is desired and the response received. It is known that excessive synchrony or interference beyond this point can actually be counterproductive. To put it extremely, considering that even mother and child can only synchronize about 30% of the time, empathy with others is not built on complete synchronization but rather on a moderate sense of restraint that respects the other person's world.

Over-involvement becomes the imposition of the caregiver's own feelings and does not foster appropriate empathy. Children may become unable to recognize their own feelings or communicate them appropriately to others, or they may become overly sensitive to others' reactions, viewing relationships through a lens of dominance and submission.

 

Reference) Two Hormones Supporting Attachment

　It is known that oxytocin and vasopressin, secreted from the posterior pituitary gland in the brain, are involved in attachment formation. Both reduce stress levels and enhance basic trust and a sense of security. Oxytocin is particularly strengthened by female hormones, while vasopressin is enhanced by male hormones. Both are known to be influenced by the nurturing environment. In cases of insecure attachment, the oxytocin-vasopressin system ceases to function properly.

 

 

・Focus on Key Points and Cut Corners Wisely

It is unprecedented in human history for families and mothers to become so deeply involved in children's education, discipline, meals, and more. The reality is that parental (especially maternal) responsibility is being emphasized to an abnormal degree. This could even be said to negatively impact attachment formation.

Placing further demands on families has reached its limit. Paradoxically, stabilizing attachment requires not “more intensive parenting,” but rather acquiring appropriate knowledge and then “focusing on key points and cutting corners wisely.” We need to adjust societal structures to reduce family involvement and responsibility toward children.

 

　Related Articles Here

　▶What is a Dysfunctional Family? Causes and Characteristics of Family Troubles

 

 

 

 

Point 4: Know that attachment can be rebuilt through future nurturing

・Attachment Improves Based on Environment

Even in cases where the nurturing environment up to age 18 months was insufficient, leading to an insecure attachment style, it is known that the child can develop a secure attachment style depending on the subsequent nurturing environment. In fact, comparing cases where a secure attachment was present until around 18 months but the nurturing environment later deteriorated, with cases where an insecure attachment was present but the nurturing environment later improved, the latter group showed better outcomes (Takashi Okada, ”Attachment Breakdown" (Kadokawa Sensho)).

 

 

・Whether inappropriate experiences are subsequently processed is the decisive factor

Attachment researchers like Main et al. state: “The issue isn't whether traumatic attachment experiences actually occurred in the past. Rather, how the mother currently interprets and integrates past attachment experiences profoundly influences the child's attachment pattern.”

While the mother is the primary subject here, for the child, it is not the presence or absence of past inappropriate care or emotional wounds that matters, but how those experiences were resolved that determines whether an insecure or secure attachment pattern develops.

In reality, even parents with secure attachment styles often have a history of traumatic experiences, grew up in inadequate caregiving environments, or have less-than-warm relationships with their own parents. The difference in whether a child develops an insecure attachment style lies in whether those unresolved issues have been resolved.

 

 

・Creating an Environment that Supports Caregivers ~ Raising Children as a Family and Society, Not Just the Mother's Responsibility

　Particularly in Japan, it has been pointed out that an excessive burden of childcare falls on mothers. Raising children is not solely the responsibility of mothers (women). Men must be equally involved, and society must provide support. We need to create an environment where both mothers and fathers can work while forming sufficient bonds with their children. Childcare must be manageable, with ample consideration given to the stress experienced by caregivers.

 

Reference: Caregiver Stress and Balance

Stress from the burden of childcare responsibility being placed solely on mothers is a significant issue. Research shows that mothers feel more positive about childcare when fathers participate, even more so than when the mother is a full-time homemaker. ・Creating an Environment to Support Caregivers ~ Avoid placing the entire responsibility on mothers; instead, the entire family and society should participate in childcare. In Japan, it has been pointed out that the burden of childcare is disproportionately placed on mothers. Childcare is not solely the responsibility of mothers (women). Men must be equally involved, Research shows mothers feel more positive about childcare when fathers participate, and even more so when they work compared to being stay-at-home mothers.

The stressful environment of a stay-at-home mother being one-on-one with the child all the time can also risk damaging healthy attachment formation (the paradox that using attachment theory as a shield to force mothers into one-on-one childcare can actually harm attachment). It is unrealistic for mothers alone to be with their children constantly. Fathers and other family members should share the burden. While support systems like childcare remain underdeveloped, utilizing societal assistance can reduce stress. Engaging the entire family and society in childcare ultimately contributes to balanced, stable attachment formation.

 

 

・Utilize family support and childcare services appropriately

In today's society where women are increasingly entering the workforce, it is unrealistic to idealize mothers providing constant, one-on-one childcare. Research shows that one-on-one childcare can cause excessive stress, destabilizing caregivers and fostering negative feelings toward parenting. These negative emotions negatively impact attachment formation. Utilize social support services like childcare appropriately when needed.

 

Reference: If you have concerns about your child, consult a public agency

　　→ “Childcare Consultation Services in Each Region (e.g., Tokyo, Osaka, etc.)”

　　→「Mental Health and Welfare Centers Nationwide」

 

 

　→Related articles here

　　・What is Attachment Disorder? Its Characteristics and Symptoms

　　・Attachment Styles / Types and Characteristics of Attachment Disorders: Diagnosis and Self-Check

　　・How to Heal Adult Attachment Disorder: 5 Essential Points

 

 

※ When using content from this site (e.g., through reprinting), please kindly cite this site as the source or provide a link.

(References & Sources)

Junichi Shoji, Makiko Okuyama, Mari Kubota, “Attachment” (Akashi Shobo)
Mari Kubota, “Research on Attachment” (Kawashima Shoten)
Miyuki Kazui, Toshihiko Endo “Attachment: Bonds Across the Lifespan” (Minerva Shobo)
Miyuki Kazui, Toshihiko Endo “Attachment and Clinical Practice” (Minerva Shobo)
Takashi Okada, “Attachment Breakdown” (Kadokawa Sensho)
Takashi Okada Attachment Disorder (Kobunsha)

Takashi Okada, Overcoming Attachment Disorder (Kobunsha)
Kazuhiro Takigawa, Ryuji Kobayashi, Toshiro Sugiyama, Shozo Aoki “The Science of Child Development: Attachment and Bonds”
“Childcare Support and Clinical Psychology vol.9 September 2014: Attachment Theory and Clinical Psychology”

Keiko Takahashi “The Psychology of Human Relationships: The Lifespan Development of the Affection Network” (University of Tokyo Press)

Keiko Takahashi “The Structure of Bonds” (Kodansha Gendai Shinsho)

Shuko Aiko, “Can Attachment Disorders Be Cured?” (Kafu-sha)

Joji Kandabashi, “Notes on Psychoanalysis for Treatment” (Sogensha)