When a baby acts upset because a caregiver is leaving the baby is exhibiting?

As we move through our daily lives, we experience a variety of emotions. An emotion is a subjective state of being that we often describe as our feelings. Emotions result from the combination of subjective experience, expression, cognitive appraisal, and physiological responses (Levenson, Carstensen, Friesen, & Ekman, 1991).  An emotion often begins with a subjective (individual) experience, which is a stimulus. Often the stimulus is external, but it can also be an internal one. For example, if a child thinks about losing a treasured toy, he or she may become sad even though they still have possession of the toy.  Emotional expression refers to the way one displays an emotion and includes nonverbal and verbal behaviors (Gross, 1999).

Emotional Development in Infancy

Emotions are often divided into two general categories: Basic emotions (primary emotions), such as interest, happiness, anger, fear, surprise, sadness, and disgust, which appear first, and self-conscious emotions (secondary emotions), such as envy, pride, shame, guilt, doubt, and embarrassment. Unlike primary emotions, secondary emotions appear as children start to develop a self-concept, and require social instruction on when to feel such emotions. The situations in which children learn self-conscious emotions vary from culture to culture. Individualistic cultures teach us to feel pride in personal accomplishments, while in more collective cultures children are taught to not call attention to themselves unless they wish to feel embarrassed for doing so (Akimoto & Sanbinmatsu, 1999).

At birth, infants exhibit two emotional responses: attraction and withdrawal. They show attraction to pleasant situations that bring comfort, stimulation, and pleasure, and they withdraw from unpleasant stimulation such as bitter flavors or physical discomfort. At around two months, infants exhibit social engagement in the form of social smiling as they respond with smiles to those who engage their positive attention (Lavelli & Fogel, 2005).

Social Smiling is a form of communication.

Social smiling becomes more stable and organized as infants learn to use their smiles to engage their parents in interactions. Pleasure is expressed as laughter at 3 to 5 months of age, and displeasure becomes more specific as fear, sadness, or anger between ages 6 and 8 months.  Anger is often the reaction to being prevented from obtaining a goal, such as a toy being removed (Braungart-Rieker, Hill-Soderlund, & Karrass, 2010). In contrast, sadness is typically the response when infants are deprived of a caregiver (Papousek, 2007). Fear is often associated with the presence of a stranger, known as stranger wariness or stranger anxiety, or the departure of significant others known as separation anxiety. Both appear sometime between 6 and 15 months after object permanence has been acquired. Further, there is some indication that infants may experience jealousy as young as 6 months of age (Hart & Carrington, 2002).

Social influences and the development of emotions

Facial expressions of emotion are important regulators of social interaction. In the developmental literature, this concept has been investigated under the concept of social referencing; that is, the process whereby infants seek out information from others to clarify a situation and then use that information to act (Klinnert, Campos, & Sorce, 1983). To date, the strongest demonstration of social referencing comes from work on the visual cliff. In the first study to investigate this concept, Campos and colleagues (Sorce, Emde, Campos, & Klinnert, 1985) placed mothers on the far end of the “cliff” from the infant. Mothers first smiled to the infants and placed a toy on top of the safety glass to attract them; infants invariably began crawling toward their mothers. When the infants were in the center of the table, however, the mother then posed an expression of fear, sadness, anger, interest, or joy. The results were clearly different for the different faces; no infant crossed the table when the mother showed fear; only 6% did when the mother posed anger, 33% crossed when the mother posed sadness, and approximately 75% of the infants crossed when the mother posed joy or interest.

This mother is encouraging her child to crawl across the visual cliff. The child hesitates to move forward as they see the transparent surface. 

Other studies provide similar support for facial expressions as regulators of social interaction. Researchers posed facial expressions of neutral, anger, or disgust toward babies as they moved toward an object and measured the amount of inhibition the babies showed in touching the object (Bradshaw, 1986). The results for 10- and 15-month-olds were the same: Anger produced the greatest inhibition, followed by disgust, with neutral the least. This study was later replicated using joy and disgust expressions, altering the method so that the infants were not allowed to touch the toy (compared with a distractor object) until one hour after exposure to the expression (Hertenstein & Campos, 2004). At 14 months of age, significantly more infants touched the toy when they saw joyful expressions, but fewer touched the toy when the infants saw disgust.

As infants and toddlers interact with other people, their social and emotional skills continue to develop throughout childhood.

Empathy

A person can acquire emotions, such as anger and happiness, from people around him or her. This process is called emotional contagion, whereby emotional expression of a person leads another person to experience a similar emotional state (Bruder et al., 2012; Peters and Kashima, 2015). A component of emotional contagion, emotional mimicry, is defined as the imitation of the facial, verbal, or postural expressions of others (Hatfield et al., 1993; Hess and Fischer, 2013). For example, newborn babies will cry when they hear others crying.

During childhood, the development of empathyis a crucial part of emotional and social development in childhood. The ability to identify with the feelings of another person helps in the development of prosocial (socially positive) and altruistic (helpful, beneficent, or unselfish) behavior. Altruistic behavior occurs when a person does something in order to benefit another person without expecting anything in return. Empathy helps a child develop positive peer relationships; it is affected by a child’s temperament, as well as by parenting style. Children raised in loving homes with affectionate parents are more likely to develop a sense of empathy and altruism, whereas those raised in harsh or neglectful homes tend to be more aggressive and less kind to others.

Empathy begins to increase in adolescence and is an important component of social problem-solving and conflict avoidance. According to one longitudinal study, levels of cognitive empathy begin rising in girls around 13 years old, and around 15 years old in boys (Van der Graaff et al., 2013). Teens who reported having supportive fathers with whom they could discuss their worries were found to be better able to take the perspective of others (Miklikowska, Duriez, & Soenens, 2011).

Temperament

Perhaps you have spent time with a number of infants. How were they alike? How did they differ? How do you compare with your siblings or other children you have known well? You may have noticed that some seemed to be in a better mood than others and that some were more sensitive to noise or more easily distracted than others. These differences may be attributed to temperament. Temperament is the innate characteristics of the infant, including mood, activity level, and emotional reactivity, noticeable soon after birth.

In a 1956 landmark study, Chess and Thomas (1996) evaluated 141 children’s temperaments based on parental interviews. Referred to as the New York Longitudinal Study, infants were assessed on 9 dimensions of temperament including:

• Activity level, rhythmicity (regularity of biological functions),
• approach/withdrawal (how children deal with new things),
• adaptability to situations
• intensity of reactions
• threshold of responsiveness (how intense a stimulus has to be for the child to react)
• quality of mood
• distractibility
• attention span
• persistence.

Based on the infants’ behavioral profiles, they were categorized into three general types of temperament:

• Easy Child (40%) who is able to quickly adapt to a routine and new situations, remains calm, is easy to soothe, and usually is in a positive mood.
• Difficult Child (10%) who reacts negatively to new situations, has trouble adapting to routine, is usually negative in mood, and cries frequently.
• Slow-to-Warm-Up Child (15%) has a low activity level, adjusts slowly to new situations, and is often negative in mood.

As can be seen, the percentages do not equal 100% as some children were not able to be placed neatly into one of the categories. Think about how you might approach each type of child in order to improve your interactions with them. An easy child will not need much extra attention, while a slow-to-warm-up child may need to be given advance warning if new people or situations are going to be introduced. A difficult child may need to be given extra time to burn off their energy. A caregiver’s ability to work well and accurately read the child will enjoy a goodness-of-fit, meaning their styles match and communication and interaction can flow. Parents who recognize each child’s temperament and accept it will nurture more effective interactions with the child and encourage more adaptive functioning. For example, an adventurous child whose parents regularly take her outside on hikes would provide a good “fit” for her temperament.

Parenting is bidirectional: Not only do parents affect their children, but children also influence their parents. Child characteristics, such as temperament, affect parenting behaviors and roles. For example, an infant with an easy temperament may enable parents to feel more effective, as they are easily able to soothe the child and elicit smiling and cooing. On the other hand, a cranky or fussy infant elicits fewer positive reactions from his or her parents and may result in parents feeling less effective in the parenting role (Eisenberg et al., 2008). Over time, parents of more difficult children may become more punitive and less patient with their children (Clark, Kochanska, & Ready, 2000; Eisenberg et al., 1999; Kiff, Lengua, & Zalewski, 2011). Parents who have a fussy, difficult child are less satisfied with their marriages and have greater challenges in balancing work and family roles (Hyde, Else-Quest, & Goldsmith, 2004). Thus, child temperament is one of the child characteristics that influence how parents behave with their children.

Temperament does not change dramatically as we grow up, but we may learn how to work around and manage our temperamental qualities. Temperament may be one of the things about us that stays the same throughout development. In contrast, personality is the result of the continuous interplay between biological disposition and experience.

Personality also develops from temperament in other ways (Thompson, Winer, & Goodvin, 2010). As children mature biologically, temperamental characteristics emerge and change over time. A newborn is not capable of much self-control, but as brain-based capacities for self-control advance, temperamental changes in self-regulation become more apparent. For example, a newborn who cries frequently does not necessarily have a grumpy personality; over time, with sufficient parental support and an increased sense of security, the child might be less likely to cry.

In addition, personality is made up of many other features besides temperament. Children’s developing self-concept, their motivations to achieve or to socialize, their values and goals, their coping styles, their sense of responsibility and conscientiousness, and many other qualities are encompassed in personality. These qualities are influenced by biological dispositions, but even more by the child’s experiences with others, particularly in close relationships, that guide the growth of individual characteristics. Indeed, personality development begins with the biological foundations of temperament but becomes increasingly elaborated, extended, and refined over time. The newborn that parents gazed upon becomes an adult with a personality of depth and nuance.

Emotional Regulation and Self Control

A final emotional change is in self-regulation. Emotional self-regulation refers to strategies we use to control our emotional states so that we can attain goals (Thompson & Goodvin, 2007). This requires effortful control of emotions and initially requires assistance from caregivers (Rothbart, Posner, & Kieras, 2006). Young infants have very limited capacity to adjust their emotional states and depend on their caregivers to help soothe themselves. Caregivers can offer distractions to redirect the infant’s attention and provide comfort to reduce emotional distress. As areas of the infant’s prefrontal cortex continue to develop, infants can tolerate more stimulation. By 4 to 6 months, babies can begin to shift their attention away from upsetting stimuli (Rothbart et al, 2006). Older infants and toddlers can more effectively communicate their need for help and can crawl or walk toward or away from various situations (Cole, Armstrong, & Pemberton, 2010). This aids in their ability to self-regulate. Temperament also plays a role in children’s ability to control their emotional states, and individual differences have been noted in the emotional self-regulation of infants and toddlers (Rothbart & Bates, 2006).

It is in early childhood that we see the start of self-control, a process that takes many years to fully develop. According to Lecci & Magnavita (2013), “Self-regulation is the process of identifying a goal or set of goals and, in pursuing these goals, using both internal (e.g., thoughts and affect) and external (e.g., responses of anything or anyone in the environment) feedback to maximize goal attainment” (p. 6.3). Self-regulation is also known as willpower. When we talk about willpower, we tend to think of it as the ability to delay gratification. For example, Bettina’s teenage daughter made strawberry cupcakes, and they looked delicious. However, Bettina forfeited the pleasure of eating one, because she is training for a 5K race and wants to be fit and do well in the race. Would you be able to resist getting a small reward now in order to get a larger reward later? This is the question Walter Mischel investigated in his now-classic “marshmallow test.”

Can this child delay gratification for a larger reward? 

Mischel designed a study to assess self-regulation in young children. In the marshmallow study, Mischel and his colleagues placed a preschool child in a room with one marshmallow on the table. The child was told that he could either eat the marshmallow now or wait until the researcher returned to the room and then he could have two marshmallows (Mischel, Ebbesen & Raskoff, 1972). This was repeated with hundreds of preschoolers. What Mischel and his team found was that young children differ in their degree of self-control. Mischel and his colleagues continued to follow this group of preschoolers through high school, and what do you think they discovered? The children who had more self-control in preschool (the ones who waited for the bigger reward) were more successful in high school. They had higher SAT scores, had positive peer relationships, and were less likely to have substance abuse issues; as adults, they also had more stable marriages (Mischel, Shoda, & Rodriguez, 1989; Mischel et al., 2010). On the other hand, those children who had poor self-control in preschool (the ones who grabbed the one marshmallow) were not as successful in high school, and they were found to have academic and behavioral problems.

Emotional intelligence

The concept of emotional intelligence was introduced in the 60s and rose in popularity with the release of Daniel Goleman’s 1995 book Emotional Intelligence – Why it can matter more than IQ.

Emotional Intelligence (EI) can be generally defined as how we perceive, communicate, regulate, and understand our own emotions, as well as the emotions of others. According to Lane (2000a), the most pivotal aspect of EI is probably related to the awareness of emotional experiences in oneself and others.  Investigations of EI in children have suggested that a higher EI level appears to be an important predictive factor of health-related outcomes, such as improved well-being and social interactions during development (Andrei et al., 2014), as well as fewer somatic complaints (e.g., Jellesma et al., 2011). EI appears to have a positive impact on children’s adaptive capacities (Mavroveli et al., 2008; Davis and Humphrey, 2012).  A number of studies on EI through childhood have been conducted within educational settings; showing that EI can be important for positive adaptation within the classroom, with particular implications for social-emotional competencies and for consequent adaptive behaviors with peers (Frederickson et al., 2012). For instance, Petrides et al. (2004) showed that pupils with high EI scores were less likely to be expelled from their schools and had a lower frequency of unauthorized absences. Additional studies revealed that high EI scores were positively associated with multiple peer ratings for prosocial behavior (Mavroveli et al., 2009). Moreover, data from self-report surveys revealed that a high EI is negatively related to bullying (Mavroveli and Sánchez-Ruiz, 2011), and victimization attitude (Kokkinos and Kipritsi, 2012), and behavioral problems in general (Poulou, 2014). Although the literature still lacks clear and direct results regarding this relationship (Mavroveli et al., 2009; Hansenne and Legrand, 2012), it seems that EI may moderate the relationship between intelligence and scholastic performance (Agnoli et al., 2012).  Overall, high EI (especially in the ability to regulate emotions) is associated with several positive outcomes for children. 

Emotional Disorders

Many children have fears and worries and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although some fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression.

Mental health disorders are diagnosed by a qualified professional using the Diagnostic and Statistical Manual of Mental Disorders (DSM). This is a manual that is used as a standard across the profession for diagnosing and treating mental disorders.

Persistent or extreme forms of fear and sadness could be due to anxiety or depression.

Depression

Occasionally being sad or feeling hopeless is a part of every child’s life. However, some children feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations where they could do something to address the situations. When children feel persistent sadness and hopelessness, they may be diagnosed with Major Depressive Disorder (MDD).

We now know that youth who have depression may show signs that are slightly different from the typical adult symptoms of depression. Children who are depressed may complain of feeling sick, refuse to go to school, cling to a parent or caregiver, feel unloved, hopeless about the future, or worry excessively that a parent may die. Older children and teens may sulk, get into trouble at school, be negative or grouchy, are irritable, indecisive, have trouble concentrating, or feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child who shows changes in behavior is just going through a temporary “phase” or is suffering from depression.

Younger children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.  Although MDD can be diagnosed in younger children, it is not very common

Older children and teens with depression may get into trouble at school, sulk, and be irritable. Teens with depression may have symptoms of other disorders, such as anxiety, eating disorders, or substance abuse.  However, it is the first cause of disability among adolescents aged 10 to 19 years (WHO 2014). Suicide is the third cause of death in this age group, and adolescent depression is a major risk factor for suicide. Depressed adolescents experienced significantly more stressors during the year before onset when compared with a comparable 12-month period in normal controls. 

Anxiety

Many children have fears and worries and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are called internalizing disorders.

Internalizing disorders involve thoughts and feelings.

When a child does not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include:

• Being very afraid when away from parents (separation anxiety)
• Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobia)
• Being very afraid of school and other places where there are people (social anxiety)
• Being very worried about the future and about bad things happening (general anxiety)
• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.

Treatment for anxiety and depression

The first step to treatment is to have the child evaluated by a healthcare provider or a mental health specialist. The American Academy of Child and Adolescent Psychiatry (AACAP) recommends that healthcare providers routinely screen children for behavioral and mental health concerns.  Some of the signs and symptoms of anxiety or depression in children could be caused by other conditions, such as trauma. It is important to get a careful evaluation to get the best diagnosis and treatment.

Consultation with a health provider can help determine if medication should be part of the treatment. It is important to note that although antidepressants can be effective for many people, they may present serious risks to some, especially children, teens, and young adults. Antidepressants may cause some people, to have suicidal thoughts or make suicide attempts. 

A mental health professional can develop a therapy plan that works best for the child and family. Behavior therapy includes child therapy, family therapy, or a combination of both. The school can also be included in the treatment plan. For very young children, involving parents in treatment is key. Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. Behavior therapy for anxiety may involve helping children cope with and manage anxiety symptoms while gradually exposing them to their fears so as to help them learn that bad things do not occur.

Disruptive, Impulse-Control, and Conduct Disorders

In 2013, the 5th revision to the DSM (DSM-5) added a chapter on disruptive, impulse-control, and conduct disorders. It brings together several disorders that were previously included in other chapters (such as oppositional defiant disorder, conduct disorder, intermittent explosive disorder, pyromania, and kleptomania) into one single category. These disorders are marked by behavioral and emotional disturbances specifically related to self-control.

Conduct Disorder

Conduct disorder (CD) is a psychological disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others, or major age-appropriate norms, are violated. These behaviors are often referred to as “antisocial behaviors.” It is often seen as the precursor to antisocial personality disorder, which is not diagnosed until the individual is 18 years old. The child diagnosed with CD often presents with a lack of empathy, or the ability to recognize the feelings of others.

CD is diagnosed in the DSM-5 based on a prolonged pattern of antisocial behavior such as serious violation of laws and social norms and rules. According to DSM-5 criteria, there are four categories that could be present in the child’s behavior: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules. Almost all adolescents who have a substance use disorder also have conduct disorder-like traits; therefore it is important to exclude a substance-induced cause before diagnosing CD.

The most effective treatment for an individual with conduct disorder is one that seeks to integrate individual, school, and family settings. Additionally, treatment should also seek to address familial conflicts such as marital discord or maternal depression. In this manner, a treatment would serve to address many of the possible triggers of conduct problems. Several treatments currently exist, the most effective of which is multi-systemic treatment (MST), an intensive, integrative treatment that emphasizes how an individual’s conduct problems fit within a broader context.

Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) involves patterns of anger, irritability, argumentative or defiant behavior, and/or vindictiveness. Unlike children with conduct disorder (CD), children with oppositional defiant disorder are not aggressive toward people or animals, do not destroy property, and do not show a pattern of theft or deceit.

Symptoms of ODD are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. For a child or adolescent to qualify for a diagnosis of ODD, behaviors must cause considerable distress for the family or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by the presence of other disorders such as ADHD, depression, or substance use disorders.

Many pregnancies and birth problems are related to the development of conduct problems; however, strong evidence for causation is lacking. Malnutrition, specifically protein deficiency, lead poisoning, and a mother’s use of nicotine, marijuana, alcohol, or other substances during pregnancy may increase the risk of developing ODD. Deficits and injuries to certain areas of the brain can also lead to serious behavioral problems in children. Brain imaging studies have suggested that children with ODD may have subtle differences in the part of the brain responsible for reasoning, judgment, and impulse control.

Approaches to the treatment of ODD include parent management training, individual psychotherapy, family therapy, cognitive-behavioral therapy, and social skills training. According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents. Several preventative programs have had a positive effect on those at high risk for ODD. Both home visitation and programs such as Head Start have shown some effectiveness in preschool children. Social skills training, parent management training, and anger management programs have been used as prevention programs for school-age children at risk for ODD. For adolescents at risk for ODD, cognitive interventions, vocational training, and academic tutoring have shown preventative effectiveness.

Prolonged defiance and argumentative behaviors are some signs of ODD. 

Intermittent Explosive Disorder

Intermittent explosive disorder (IED) is a behavioral disorder characterized by explosive outbursts of anger, often to the point of rage, that are disproportionate to the situation at hand (e.g., impulsive screaming triggered by relatively inconsequential events). Impulsive aggression is unpremeditated and is defined by a disproportionate reaction to any provocation, real or perceived. The disorder itself is not easily characterized and often exhibits comorbidity with other mood disorders, particularly bipolar disorder. Individuals diagnosed with IED report their outbursts as being brief (lasting less than an hour), with a variety of bodily symptoms (sweating, stuttering, chest tightness, twitching, palpitations) reported by a third of one sample. Aggressive acts are frequently reported as accompanied by a sensation of relief and in some cases pleasure but often followed by later remorse.

The current DSM-5 criteria for a diagnosis of IED include recurrent outbursts that demonstrate an inability to control impulses. These can either include verbal aggression (tantrums, verbal arguments, or fights) or physical aggression that occurs twice in a week-long period for at least three months and does not lead to the destruction of property or physical injury; or three outbursts that involve injury or destruction within a year-long period.

In addition, the person must experience aggressive behavior that is grossly disproportionate to the magnitude of the psychosocial stressors. The outbursts cannot be premeditated and must cause distress or impairment of functioning, or lead to financial or legal consequences. The diagnosis can only be given to individuals 6 years of age or older, and the recurrent outbursts cannot be explained by another mental disorder and are not the result of another medical disorder or substance use.

Impulsive behavior, and especially impulsive violence predisposition, has been correlated to differences in levels of serotonin in the brain. IED may also be associated with lesions in the prefrontal cortex, with damage to these areas, including the amygdala, increasing the incidence of impulsive and aggressive behavior and the inability to predict the outcomes of an individual’s own actions. Lesions in these areas are also associated with improper blood sugar control, leading to decreased brain function in these areas, which are associated with planning and decision-making.

Treatments are often attempted through both cognitive behavioral therapy and psychotropic medication regimens, though the pharmaceutical options have shown limited success. Therapy aids in helping the patient recognize the impulses in hopes of achieving a level of awareness and control of the outbursts, along with treating the emotional stress that accompanies these episodes.

Other Impulse-Control Disorders

In addition to those listed above, the DSM-5 lists several other impulse-control disorders under this chapter. Pyromania is characterized by impulsive and repetitive urges to deliberately start fires. Studies done on children and adolescents suffering from pyromania have reported its prevalence to be between 2.4%-3.5% in the United States. Kleptomania is characterized by an impulsive urge to steal purely for the sake of gratification. In the U.S. the presence of kleptomania is unknown but has been estimated at around 6 per 1,000 individuals.

Attachment is a deep and enduring emotional bond that connects one person to another across time and space (Ainsworth, 1973; Bowlby, 1969).  Attachment does not have to be reciprocal.  One person may have an attachment to an individual which is not shared.  Attachment is characterized by specific behaviors in children, such as seeking proximity to the attachment figure when upset or threatened (Bowlby, 1969).

Attachment behavior in adults towards the child includes responding sensitively and appropriately to the child’s needs.  Such behavior appears universal across cultures. Attachment theory explains how the parent-child relationship emerges and influences subsequent development.

Attachment theory in psychology originates from the seminal work of John Bowlby (1958).  In the 1930s John Bowlby worked as a psychiatrist in a Child Guidance Clinic in London, where he treated many emotionally disturbed children. This experience led Bowlby to consider the importance of the child’s relationship with their mother in terms of their social, emotional, and cognitive development.  Specifically, it shaped his belief about the link between early infant separations from the mother and later maladjustment and led Bowlby to formulate his attachment theory.

John Bowlby, working alongside James Robertson (1952) observed that children experienced intense distress when separated from their mothers.  Even when such children were fed by other caregivers, this did not diminish the child’s anxiety. These findings contradicted the dominant behavioral theory of attachment (Dollard and Miller, 1950) which was shown to underestimate the child’s bond with their mother.  The behavioral theory of attachment stated that the child becomes attached to the mother because she fed the infant.

Bowlby defined attachment as a ‘lasting psychological connectedness between human beings (1969, p. 194).  He proposed that attachment can be understood within an evolutionary context in that the caregiver provides safety and security for the infant. Attachment is adaptive as it enhances the infant’s chance of survival. This is illustrated in the work of Lorenz (1935) and Harlow (1958).  According to Bowlby infants have a universal need to seek close proximity with their caregiver when under stress or threatened (Prior & Glaser, 2006).  Most researchers believe that attachment develops through a series of stages.

Stages of Attachment

Rudolph Schaffer and Peggy Emerson (1964) studied 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 the arrival of a stranger.
• Separation Anxiety – distress level when separated from a carer, the degree of comfort needed on return.
• Social Referencing – the degree a child looks at their carer to check how they should respond to something new (secure base).

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

Asocial (0 – 6 weeks) – 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, and 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 with a regular caregiver.

Specific Attachment (7 – 9 months) – Special preference for a single attachment figure emerges.  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) – The baby becomes increasingly independent and forms several attachments. By 18 months, the majority of infants have formed multiple attachments. 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 children. Infants who were weakly attached had mothers who failed to interact.  Many of the babies had several attachments by ten months old, including attachments to mothers, fathers, grandparents, siblings, and neighbors.  The mother was the main attachment figure for about half of the children at 18 months old and the father for most of the others.  The most important fact in forming attachments is not who feeds and changes the child but who plays and communicates with him or her. Therefore, responsiveness appeared to be the key to attachment.

Attachment Theories

Psychologists have proposed two main theories that are believed to be important in forming attachments.   The learning/behaviorist theory of attachment (e.g., Dollard & Miller, 1950) suggests that attachment is a set of learned behaviors.  The basis for the learning of attachments is the provision of food.  An infant will initially form an attachment to whoever feeds it.  They learn to associate the feeder (usually the mother) with the comfort of being fed and through the process of classical conditioning, come to find contact with the mother comforting.

They also find that certain behaviors (e.g., crying, smiling) bring desirable responses from others (e.g., attention, comfort), and through the process of operant conditioning learn to repeat these behaviors to get the things they want.

The evolutionary theory of attachment (e.g., Bowlby, Harlow, Lorenz) suggests that children come into the world biologically pre-programmed to form attachments with others because this will help them to survive. The infant produces innate ‘social releaser’ behaviors such as crying and smiling that stimulate innate caregiving responses from adults.  The determinant of attachment is not food, but care and responsiveness.

Bowlby suggested that a child would initially form only one primary attachment (monotropy) and that the attachment figure acted as a secure base for exploring the world.  The attachment relationship acts as a prototype for all future social relationships so disrupting it can have severe consequences.

This theory also suggests that there is a critical period for developing an attachment (about 0 -5 years).  If an attachment has not developed during this period, then the child will suffer from irreversible developmental consequences, such as reduced intelligence and increased aggression.

Harry Harlow

Harry Harlow (1958) wanted to study the mechanisms by which newborn rhesus monkeys bond with their mothers. These infants were highly dependent on their mothers for nutrition, protection, comfort, and socialization.  What, exactly, though, was the basis of the bond?

The behavioral theory of attachment would suggest that an infant would form an attachment with a caregiver that provides food.  In contrast, Harlow’s explanation was that attachment develops as a result of the mother providing “tactile comfort,” suggesting that infants have an innate (biological) need to touch and cling to something for emotional comfort.  Harry Harlow did a number of studies on attachment in rhesus monkeys during the 1950s and 1960s.  His experiments took several forms:

1. Infant monkeys reared in isolation– He took babies and isolated them from birth. They had no contact with each other or anybody else.  He kept some this way for three months, some for six, some for nine, and some for the first year of their lives. He then put them back with other monkeys to see what effect their failure to form attachment had on behavior.  As a result, the monkeys engaged in bizarre behavior such as clutching their own bodies and rocking compulsively. They were then placed back in the company of other monkeys.  To start with the babies were scared of the other monkeys, and then became very aggressive towards them. They were also unable to communicate or socialize with other monkeys. The other monkeys bullied them. They indulged in self-mutilation, tearing hair out, scratching, and biting their own arms and legs.  Harlow concluded that privation (i.e., never forming an attachment bond) is permanently damaging (to monkeys). The extent of the abnormal behavior reflected the length of the isolation. Those kept in isolation for three months were the least affected, but those in isolation for a year never recovered the effects of privation.

Wire and cloth surrogates  

1. Infant monkeys reared with surrogate mothers– 8 monkeys were separated from their mothers immediately after birth and placed in cages with access to two surrogate mothers, one made of wire and one covered in soft terry toweling cloth.  Four of the monkeys could get milk from the wire mother and four from the cloth mother.  The animals were studied for 165 days.  Both groups of monkeys spent more time with the cloth mother (even if she had no milk).  The infant would only go to the wire mother when hungry.  Once fed it would return to the cloth mother for most of the day.  If a frightening object was placed in the cage the infant took refuge with the cloth mother (its safe base). This surrogate was more effective in decreasing the youngster’s fear.  The infant would explore more when the cloth mother was present.  This supports the evolutionary theory of attachment, in that it is the sensitive response and security of the caregiver that is important (as opposed to the provision of food).

The behavioral differences that Harlow observed between the monkeys who had grown up with surrogate mothers and those with normal mothers were;

1. They were much more timid.
2. They didn’t know how to act with other monkeys.
3. They were easily bullied and wouldn’t stand up for themselves.
4. They had difficulty with mating.
5. The females were inadequate mothers.

These behaviors were observed only in the monkeys who were left with the surrogate mothers for more than 90 days. For those left less than 90 days the effects could be reversed if placed in a normal environment where they could form attachments.

Harlow concluded that for a monkey to develop normally s/he must have some interaction with an object to which they can cling during the first months of life (critical period). Clinging is a natural response – in times of stress, the monkey runs to the object to which it normally clings as if the clinging decreases the stress.  He also concluded that early maternal deprivation leads to emotional damage but that its impact could be reversed in monkeys if an attachment was made before the end of the critical period.  However, if maternal deprivation lasted after the end of the critical period, then no amount of exposure to mothers or peers could alter the emotional damage that had already occurred.  Harlow found therefore that it was social deprivation rather than maternal deprivation that the young monkeys were suffering from.  When he brought some other infant monkeys up on their own, but with 20 minutes a day in a playroom with three other monkeys, he found they grew up to be quite normal emotionally and socially.

Ethics of Harlow’s Study

Harlow’s work has been criticized.  His experiments have been seen as unnecessarily cruel (unethical) and of limited value in attempting to understand the effects of deprivation on human infants.  It was clear that the monkeys in this study suffered from emotional harm from being reared in isolation.  This was evident when the monkeys were placed with a normal monkey (reared by a mother), they sat huddled in a corner in a state of persistent fear and depression.  Also, Harlow created a state of anxiety in female monkeys which had implications once they became parents.  Such monkeys became so neurotic that they smashed their infant’s face into the floor and rubbed it back and forth.

Harlow’s experiment is sometimes justified as providing a valuable insight into the development of attachment and social behavior. At the time of the research, there was a dominant belief that attachment was related to physical (i.e., food) rather than emotional care.  It could be argued that the benefits of the research outweigh the costs (the suffering of the animals).  For example, the research influenced the theoretical work of John Bowlby, the most important psychologist in attachment theory.  It could also be seen a vital in convincing people about the importance of emotional care in hospitals, children’s homes, and daycare.

Mary Ainsworth and the Strange Situation

Developmental psychologist Mary Ainsworth, a student of John Bowlby, continued studying the development of attachment in infants. Ainsworth and her colleagues created a laboratory test that measured an infant’s attachment to his or her parent. The test is called The Strange Situationbecause it is conducted in a context that is unfamiliar to the child and therefore likely to heighten the child’s need for his or her parent (Ainsworth, 1979).

During the procedure, which lasts about 20 minutes, the parent and the infant are first left alone, while the infant explores the room full of toys. Then a strange adult enters the room and talks for a minute to the parent, after which the parent leaves the room. The stranger stays with the infant for a few minutes, and then the parent again enters and the stranger leaves the room. During the entire session, a video camera records the child’s behaviors, which are later coded by the research team. The investigators were especially interested in how the child responded to the caregiver leaving and returning to the room, referred to as the “reunion.” On the basis of their behaviors, the children are categorized into one of four groups where each group reflects a different kind of attachment relationship with the caregiver. One style is secure and the other three styles are referred to as insecure.

• A child with a secure attachment style usually explores freely while the caregiver is present and may engage with the stranger. The child will typically play with the toys and bring one to the caregiver to show and describe from time to time. The child may be upset when the caregiver departs but is also happy to see the caregiver return.
• A child with an ambivalent (resistant) attachment style is wary about the situation in general, particularly the stranger, and stays close or even clings to the caregiver rather than exploring the toys. When the caregiver leaves, the child is extremely distressed and is ambivalent when the caregiver returns. The child may rush to the caregiver but then fails to be comforted when picked up. The child may still be angry and even resist attempts to be soothed.
• A child with an avoidant attachmentstyle will avoid or ignore the mother, showing little emotion when the mother departs or returns. The child may run away from the mother when she approaches. The child will not explore very much, regardless of who is there, and the stranger will not be treated much differently from the mother.
• A child with a disorganized (disoriented) attachment style seems to have an inconsistent way of coping with the stress of the strange situation. The child may cry during the separation, but avoid the mother when she returns, or the child may approach the mother but then freeze or fall to the floor.

How common are the attachment styles among children in the United States? It is estimated that about 65 percent of children in the United States are securely attached. Twenty percent exhibit avoidant styles and 10 to 15 percent are ambivalent. Another 5 to 10 percent may be characterized as disorganized.

Some cultural differences in attachment styles have been found (Rothbaum, Weisz, Pott, Miyake, & Morelli, 2010). For example, German parents value independence and Japanese mothers are typically by their children’s sides. As a result, the rate of insecure-avoidant attachments is higher in Germany and insecure-resistant attachments are higher in Japan. These differences reflect cultural variation rather than true insecurity, however (van Ijzendoorn and Sagi, 1999).

Keep in mind that methods for measuring attachment styles have been based on a model that reflects middle-class, U. S. values and interpretation. Newer methods for assessment of attachment styles involve using a Q-sort technique in which a large number of behaviors are recorded on cards and the observer sorts the cards in a way that reflects the type of behavior that occurs within the situation (Waters, 1987). There are 90 items in the third version of the Q-sort technique, and examples of the behaviors assessed include:

• When the child returns to the mother after playing, the child is sometimes fussy for no clear reason.
• When the child is upset or injured, the child will accept comfort from adults other than the mother.
• The child often hugs or cuddles against the mother, without her asking or inviting the child to do so.
• When the child is upset by their mother’s leaving, the child continues to cry or even gets angry after she is gone.

At least two researchers observe the child and parent in the home for 1.5-2 hours per visit. Usually, two visits are sufficient to gather adequate information. The parent is asked if the behaviors observed are typical for the child. This information is used to test the validity of the Strange Situation classifications across age, cultures, and clinical populations. .

In the years that have followed Ainsworth’s ground-breaking research, researchers have investigated a variety of factors that may help determine whether children develop secure or insecure relationships with their primary attachment figures. As mentioned above, one of the key determinants of attachment patterns is the history of sensitive and responsive interactions between the caregiver and the child. In short, when the child is uncertain or stressed, the ability of the caregiver to provide support to the child is critical for his or her psychological development. It is assumed that such supportive interactions help the child learn to regulate his or her emotions, give the child the confidence to explore the environment and provide the child with a safe haven during stressful circumstances.

Evidence for the role of sensitive caregiving in shaping attachment patterns comes from longitudinal and experimental studies. For example, Grossmann, Grossmann, Spangler, Suess, and Unzner (1985) studied parent-child interactions in the homes of 54 families, up to three times during the first year of the child’s life. At 12 months of age, infants and their mothers participated in the strange situation. Grossmann and her colleagues found that children who were classified as secure in the strange situation at 12 months of age were more likely than children classified as insecure to have mothers who provided responsive care to their children in the home environment.

Van den Boom (1994) developed an intervention that was designed to enhance maternal sensitive responsiveness. When the infants were 9 months of age, the mothers in the intervention group were rated as more responsive and attentive in their interaction with their infants compared to mothers in the control group. In addition, their infants were rated as more sociable, self-soothing, and more likely to explore the environment. At 12 months of age, children in the intervention group were more likely to be classified as secure than insecure in the strange situation.

Attachment Patterns and Child Outcomes

Attachment researchers have studied the association between children’s attachment patterns and their adaptation over time. Researchers have learned, for example, that children who are classified as secure in the strange situation are more likely to have high-functioning relationships with peers, to be evaluated favorably by teachers, and to persist with more diligence in challenging tasks. In contrast, insecure-avoidant children are more likely to be construed as “bullies” or to have a difficult time building and maintaining friendships (Weinfield, Sroufe, Egeland, & Carlson, 2008).

Research on attachment in adolescence finds that teens who are still securely attached to their parents have fewer emotional problems (Rawatlal, Kliewer & Pillay, 2015), are less likely to engage in drug abuse and other criminal behaviors (Meeus, Branje & Overbeek, 2004), and have more positive peer relationships (Shomaker & Furman, 2009).

Attachment Disorder

The Diagnostic and Statistical Manual 5th Edition (DSM-5) classifies reactive attachment disorder (RAD) as a trauma- and -stressor-related condition of early childhood caused by social neglect and maltreatment. Affected children have difficulty forming emotional attachments to others, show a decreased ability to experience positive emotion, cannot seek or accept physical or emotional closeness and may react violently when held, cuddled, or comforted. Behaviorally, affected children are unpredictable, difficult to console, and difficult to discipline. Moods fluctuate erratically, and children may seem to live in a “flight, fight, or freeze” mode. Most have a strong desire to control their environment and make their own decisions. Changes in routine, attempts to control, or unsolicited invitations to comfort may elicit rage, violence, or self-injurious behavior. In the classroom, these challenges inhibit the acquisition of core academic skills and lead to rejection from teachers and peers alike.

As they approach adolescence and adulthood, socially neglected children are more likely than their neuro-typical peers to engage in high-risk sexual behavior, substance abuse, have an involvement with the legal system, and experience incarceration

The genesis of reactive attachment disorder is always trauma; specifically, the severe emotional neglect commonly found in institutional settings, such as overcrowded orphanages, foster care, or in homes with mentally or physically ill parents. Over time, infants who do not develop a predictable, nurturing bond with a trusted caregiver, do not receive adequate emotional interaction and mental stimulation halt their attempts to engage others and turn inward, ceasing to seek comfort when hurt, avoiding physical and emotional closeness, and eventually become emotionally bereft. The absence of adequate nurturing results in poor language acquisition, and impaired cognitive development and contributes to behavioral dysfunction.

Since WWII, physicians, psychologists, and attachment theorists have documented the impact of social neglect on physical and emotional development. Experiments completed in the 1940s and 1950s found that maternal deprivation had a profound effect on infant growth, motor development, social interaction, and behavior. In the film Psychogenic Diseases in Infancy (Spitz, 1952), infants deviated from the normal, expected course of development and became “unapproachable, weepy and screaming” within the first 2 months of maternal deprivation. As the deprivation continued, facial expressions became rigid and then flat; motor development regressed, and by the fifth month, infants were “lethargic,” unable to “sit, stand, walk, or talk,” suffered from growth abnormalities, developed “atypical, bizarre finger movements,” and no longer sought or responded to social interaction; 37.3% of the infants died within 2 years. These early experiments became the foundation for Attachment Theory and outlined the constellation of symptoms of what the DSM, Third Edition (DSM–III) would later call reactive attachment disorder.

The DSM-5 gives the following criteria for reactive attachment disorder:

• “A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
  • The child rarely or minimally seeks comfort when distressed.
  • The child rarely or minimally responds to comfort when distressed.
• A persistent social or emotional disturbance characterized by at least two of the following:
  • Minimal social and emotional responsiveness to others
  • Limited positive affect
  • Episodes of unexplained irritability, sadness, or fearfulness are evident even during nonthreatening interactions with adult caregivers.
• The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
  • Social neglect or deprivation in the form of persistent lack of basic emotional needs for comfort, stimulation, and affection met by caring adults
  • Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care)
  • Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios)
• The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion
• The criteria are not met for autism spectrum disorder.
• The disturbance is evident before age 5 years.
• The child has a developmental age of at least nine months.”

These diagnostic criteria provide an outline of symptoms; however, providers must also recognize the global impact on cognition, behavior, and affective functioning.  Abuse in childhood has been correlated with difficulties in working memory and executive functioning, while severe neglect is associated with underdevelopment of the left cerebral hemisphere and the hippocampus.  Social skills are below what would be expected of either their chronological age or developmental level. Children with RAD may respond to ordinary interactions with aggression, fear, defiance, or rage.  Affected children are more likely to face rejection by adults and peers, develop a negative self-schema, and experience somatic symptoms of distress. Psychomotor restlessness is common, as is hyperactivity and stereotypic movements, such as hand flapping or rocking. RAD increases the risk of anxiety, depression, and hyperactivity, and reduces frustration tolerance. Ailing children are likely to be highly reactive, even in non-threatening situations.

Evaluation

Clinicians should have a low threshold for referring children with a known history of adoption, abuse, foster, or institutional care to a child psychologist or psychiatrist for a comprehensive biopsychosocial assessment detailing the child’s history, a description of the symptoms over time, and direct observation of the parent-child interaction.  Attachment behaviors and signs of secure attachment (e.g., comfort-seeking, good eye contact, child-initiated interaction) should be assessed at every visit. Clinicians should maintain a low threshold for referral to a child development specialist, a child psychiatrist, or a child psychologist.

Treatment / Management

Treatment of RAD requires a multi-pronged approach incorporating parent education and trauma-focused therapy. Parent education focused on developing positive, non-punitive behavior management strategies,  ways of responding to nonverbal communication, anticipation and coping strategies for when triggers arise and parent-child psychotherapy can facilitate bonding and healthy attachment. Empathy and compassion are key elements to building trust. Developing a nurturing parent-child relationship is the cornerstone to overcoming the damage caused by severe neglect and abuse.

Prognosis

Even with intervention, injured children encounter difficulties in every aspect of their lives; from classroom learning to develop a secure sense of self.  The traumatic situations which lead to the attachment disorder create a persistent state of stress that diminishes their capacity for resilience.  Early identification and treatment have been shown to improve outcomes; however, parent education and support are key. Parents adopting children from state custody or from overseas orphanages should receive education on the impact of social deprivation and connect them with service agencies or providers specializing in attachment disorders.

a complex reaction pattern, involving experiential, behavioral, and physiological elements, by which an individual attempts to deal with a personally significant matter or event.

an outward manifestation of an emotion

any one of a limited set of emotions that typically are manifested and recognized universally across cultures.

emotions generated when events reflect on the worth or value of oneself.

Stranger anxiety is manifested by crying when an unfamiliar person approaches. It is normal when it starts at about 8 to 9 months and usually abates by age 2 years. Stranger anxiety is linked with the infant’s developmental task of distinguishing the familiar from the unfamiliar

the normal apprehension experienced by a young child when away (or facing the prospect of being away) from the person or people to whom he or she is attached (particularly parents). Separation anxiety is most active between 6 and 10 months of age.

seeking out information from other people in order to understand how to react and act in a particular situation.

an apparent, but not actual drop from one surface to another, originally created to test babies' depth perception.

the rapid spread of an emotion from one or a few individuals to others

the imitation of the emotional expressions of others

understanding a person from his or her frame of reference rather than one’s own,

the basic foundation of personality, usually assumed to be inborn and present early in life

how well the child's temperament matches the parent's temperament

the enduring characteristics and behavior that make up an individual’s unique adjustment to life, including major traits, interests, drives, values, self-concept, abilities, and emotional patterns

the ability to manage emotions and behavior in accordance with the demands of the situation

the ability to be in command of one’s behavior (overt, covert, emotional, or physical) and to restrain or inhibit one’s impulses

a research design that measures a child’s ability to delay gratification. The child is given the option of either waiting to get their favorite treat, or if not waiting for it. If the child choses not to wait, they receive a less-desired treat. The minutes or seconds a child waits measures their ability to delay gratification.

in DSM–5, a mood disorder characterized by persistent sadness and other symptoms of a major depressive episode but without accompanying episodes of mania or hypomania or mixed episodes of depressive and manic or hypomanic symptoms

in DSM V, any of a group of disorders that have as their central organizing theme the emotional state of fear, worry, or excessive apprehension.

fear of social situations in which embarrassment may occur (e.g., making conversation, meeting strangers) or there is a risk of being negatively evaluated by others (e.g., seen as stupid, weak, or anxious)

being constantly worried about a variety of everyday things, like doing well in school or in sports.

an anxiety disorder characterized by recurrent, unexpected panic attacks that are associated with (a) persistent concern about having another attack, (b) worry about the possible consequences of the attacks, (c) significant change in behavior related to the attacks (e.g., avoiding situations, engaging in safety behavior, not going out alone), or (d) a combination of any or all of these.

a form of psychotherapy that applies the principles of learning, operant conditioning, and classical conditioning to eliminate symptoms and modify ineffective or maladaptive patterns of behavior

a form of psychotherapy that focuses on modifying negative emotions, behaviors, and thoughts by replacing them with positive ones.

refers to a group of repetitive and persistent behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules, respecting the rights of others, showing empathy, and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill

a childhood behavior disorder defined by a persistent pattern of hostile, vindictive, and defiant behavior toward authority figures. Children with ODD are frequently irritable, argumentative, and disobedient

is a mental health disorder in which kids have short periods of intense, unexpected anger and violent behavior. These feelings seem to come out of nowhere. They feel they have no control over their anger

an impulse-control disorder characterized by (a) repeated failure to resist impulses to set fires and watch them burn, without monetary, social, political, or other motivations; (b) an extreme interest in fire and things associated with fire; and (c) a sense of increased tension before starting the fire and intense pleasure, gratification, or release while committing the act.

an impulse-control disorder characterized by a repeated failure to resist impulses to steal objects that have no immediate use or intrinsic value to the individual, accompanied by feelings of increased tension before committing the theft and either pleasure or relief during the act

refers to family interactions in which parents are aware of their children’s emotional and physical needs and respond appropriately and consistently

the idea that infants are born with the innate need to create one main and special bond with their attachment figure.

pleasant positive feelings, a state of relaxation, an optimistic approach to life, where a person feels happy and their mood is high in spirits. For example, picking up a baby who is crying and providing comfort.

is a standardized procedure devised by Mary Ainsworth in the 1970s to observe attachment security in children within the context of caregiver relationships. It applies to infants between the age of nine and 18 months. The procedure involves series of eight episodes lasting approximately 3 minutes each, whereby a mother, child and stranger are introduced, separated and reunited.

the positive parent–child relationship, in which the child displays confidence when the parent is present, shows mild distress when the parent leaves, and quickly reestablishes contact when the parent returns.

a form of insecure attachment in which infants show a combination of positive and negative responses toward a parent. After separation, for example, infants may simultaneously seek and resist close contact with the returning parent.

a form of insecure attachment in which infants do not seek proximity to their parent after separation. Instead, the infant does not appear distressed by the separation and avoids the returning parent

a form of insecure attachment in which infants show no coherent or consistent behavior during separation from and reunion with their parents.

a data-collection procedure, often used in personality measurement, in which a participant or independent rater sorts a broad set of stimuli into categories using a specific instruction set. The stimuli are often short descriptive statements (e.g., of personal traits) printed on cards

is a rare but serious condition in which an infant or young child doesn't establish healthy attachments with parents or caregivers; usually when basic needs for comfort, affection and nurturing aren't met and loving, caring, stable attachments with others are not established

When a baby is upset because a caregiver is leaving the baby is exhibiting what?

What is an infant's distressed reaction when the caregiver leaves called?

Is the distress reaction shown by babies when they are separated from their primary caregiver?

What is a lasting bond between an infant and a caregiver called?