Attachment
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Attachment in Children with Autism Spectrum Disorder
John Doe
Department of Psychology, Liberty University
Authors Note
Correspondence concerning this article should be addressed to John Doe, 00 street, city,
State Zipcode, United States. Email: johndoe@school.edu
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Abstract
It is generally accepted that early attachment is a pivotal aspect of child development however,
autism spectrum disorder (ASD) symptomology may pose challenges for parent-child
interactions. This is likely due to the social communication impairment and atypical social
reciprocity that characterizes ASD. Despite these deficits’ children with ASD are capable of
forming secure attachments. Empirical research indicates that severe levels of functioning, a lack
of parental sensitivity, and parental psychopathology could negatively affect attachment security
in children with ASD. Severe levels of functioning in ASD have been shown to have a negative
effect on attachment security. Additionally, parental sensitivity appears to have a positive
correlation with secure attachment in ASD. Furthermore, parental psychopathology has been
associated with lower attachment levels exhibited in children with ASD. While there are multiple
factors that could influence attachment formation in children diagnosed with ASD, empirical
evidence suggests that mild levels of ASD, parental sensitivity, and parental psychological
wellbeing can all contribute to the development of secure attachment in children diagnosed with
ASD.
Keywords: Attachment, autism Spectrum Disorder, parental sensitivity
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Attachment in Children with Autism Spectrum Disorder
Attachment is an important factor that influences a child’s social and psychological
development (Kahane & El-Tahir, 2015). Children with autism spectrum disorder (ASD) are
particularly vulnerable to the negative effects of inadequate attachment due to their social
deficits (Kahane & El-Tahir, 2015). Additionally, research evidence suggests that children with
autism are at a higher risk of developing insecure attachment patterns. There also appears to be a
poor understanding of attachment formation in ASD. Therefore, the purpose of this research
paper is to discuss and examine the empirical research surrounding attachment formation in
children diagnosed with ASD.
It is generally accepted that early attachment is a pivotal aspect of child development
however, ASD symptomology may pose challenges for parent-child interactions (Baker et al.,
2015). This is likely due to the social communication impairment and atypical social reciprocity
that characterizes ASD. Despite these deficits’ children with ASD are capable of forming secure
attachments (Teague et al., 2017). To gain a comprehensive understanding of secure attachment
formation in children with ASD, this discussion will examine three factors that significantly
impact attachment formation in ASD. Severe levels of functioning in ASD have been shown to
have a negative effect on attachment security. Additionally, parental sensitivity appears to have a
positive correlation with secure attachment in ASD. Furthermore, parental psychopathology has
been associated with lower attachment levels exhibited in children with ASD. While there are
multiple factors that can influence attachment formation in children diagnosed with ASD,
empirical evidence suggests that ASD severity, parental sensitivity, and parental psychological
wellbeing are significant to the development of secure attachment in ASD.
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Empirical Research
ASD Severity Levels and Attachment
Severe levels of functioning could have a negative effect on attachment security in
children diagnosed with autism. It is possible that social deficits that characterize an ASD
diagnosis may present difficulties for parent-child interactions. Therefore, severe levels of
impairment in domains such as social communication and social reciprocity could have
implications for attachment outcome in children with autism. Thus, hindering the development of
secure attachment in children diagnosed with ASD.
Bond et al. (2020) sought to investigate the link between parenting experiences and
attachment in children diagnosed with ASD. The research focused on parenting experiences
related to parenting scripts and intentions. Participants in the study included five parents with
biological children diagnosed with ASD. The study used parent interviews, parenting intention
scales, and an attachment measure to gather data. The results of the study demonstrated an
interaction between parent’s early attachment experiences and autistic features in parent-child
attachments patterns among participant families. Based on the significant interaction found
between autistic diagnostic features and parent-child attachment patterns it could be deduced that
ASD diagnostic features (i.e., social communication impairment, social interaction deficits) are
relevant to attachment formation in ASD.
Levy et al. (2020) also examined the effects of ASD symptomology on attachment
formation. Their research was aimed at investigating the effects of maternal communication on
attachment in autism spectrum disorder (ASD). Participants in the study included 45 boys with
ASD between the ages of 2-5 years old. Strange situation procedures were used to assess the role
of disrupted maternal communication in disorganized attachment related behaviors in children
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with ASD. Additionally, multiple measures were utilized to assess the participants level of
functioning and maternal disrupted behavior. The results of the study demonstrate a link between
the children’s level of functioning and attachment classification, lower levels of functioning were
associated with higher levels of disrupted maternal communication. These findings highlight the
link between ASD levels of functioning and attachment in ASD. Thus, suggesting that lower
levels of functioning in children with ASD could pose challenges for maternal communication
thus inhibiting secure attachment formation.
Martin et al. (2020) conducted an experiment to examine attachment in autism spectrum
disorder. The study recruited a sample comprised of 95 at-risk of autism infants. The study
assessed attachment in children prior to their ASD diagnosis. A strange situation procedure was
utilized to assess attachment behaviors among the infants. The results of the study demonstrated
a link between the high risk/ASD infant group and an insecure attachment classification. A
strength of the study was the use of non-ASD comparison groups. However, the study was
weakened by the small sample size of ASD infants. The study was useful in highlighting the
potential overlap in ASD symptomology and insecure attachment behaviors. Martin et al. found
a link between high risk/ASD infant group and an insecure attachment classification denoting the
overlap in ASD symptomology and attachment insecurity.
Van IJzendoorn et al. (2007) conducted a study to examine the effects of parental
sensitivity on attachment in children with autism spectrum disorder. The study included a sample
of 55 parent-child dyads. The study included toddlers (35 boys, 20 girls) diagnosed with ASD,
intellectual disability, language delays, and typically developing. A strange situation paradigm
was implemented to assess attachment and the emotional availability scale was utilized to
measure parental sensitivity. The results of the study showed a negative correlation between
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autistic symptom severity in the social domain and attachment security. The experimental groups
did not significantly differ in parental sensitivity however, the ASD group exhibited insecure and
disorganized attachment behaviors. This experiment highlights the impact of ASD symptom
severity on secure attachment in autism.
Grzadzinski et al. (2014) conducted an experiment to examine attachment in autism. The
study recruited a sample comprised of 95 at-risk of ASD infants. The study measured attachment
levels in participant children prior to their ASD diagnosis. A strange situation procedure was
used to evaluate attachment behaviors among the infants. The results of the study demonstrated a
link between the high risk/ASD infant group and an insecure attachment classification.
Additionally, a link between developmental levels and reunion behaviors (used to classify
attachment styles) was found indicating the importance of cognitive functioning in emotional
attachment. Thus, suggesting that lower levels of cognitive functioning could hinder parent-child
attachment. This study highlights the probable connection between low levels of functioning and
insecure attachment behaviors.
It appears that the severity levels of an ASD diagnosis can have significant effects for
attachment security in children with ASD. Lower functioning in domains relevant to
interpersonal relationships could affect attachment behaviors exhibited in children with autism.
Thus, making it difficult for parents to identify and respond to their child’s needs. It is also
possible that severe deficits in social communication, social reciprocity, and intellectual
functioning can impeded the development of secure attachment in children with ASD due to the
constraints it may place on parent-child interactions. Based on research evidence it appears that a
child’s level of functioning can have significant implications for attachment formation however,
parent variables also play a significant role in attachment security in children with ASD.
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Parental Sensitivity and Attachment in ASD
Based on the research surrounding attachment theory, parental sensitivity is a wellestablished factor that has been known to impact the attachment outcome of typically developing
children. However, parental sensitivity also appears to play a significant role in the development
of secure attachment in children with autism. Thus, highlighting the importance of parental
factors in the development of secure attachment in ASD.
Koren-Karie et al. (2009) conducted an experiment to investigate the association between
maternal sensitivity and secure attachment in autism. The research sample was comprised of 45
boys diagnosed with ASD. Child attachment and maternal sensitivity were assessed utilizing a
strange situation procedure and the emotional availability scale (respectively). While controlling
for ASD severity, level of functioning, and child responsiveness the results demonstrated a link
between maternal sensitivity and secure attachment in ASD. The research evidence supports the
formative role of parental sensitivity in attachment formation in ASD. Koren-Karie et al. found
that higher levels of maternal sensitivity were indeed associated with secure attachment in ASD.
Oppenheim et al. (2012) also conducted an experiment aimed at investigating the role of
maternal sensitivity on attachment in children with autism spectrum disorder. The study sample
included 45 mother-son dyads with children between the ages of 2-5 years old. Maternal
insightfulness, maternal sensitivity, children’s level of functioning, and attachment were all
assessed using distinct measurement tools. The findings revealed that maternal sensitivity
mediates maternal insightfulness and attachment in ASD. This study emphasizes the relevance of
maternal sensitivity in attachment formation in ASD.
Siller et al. (2014) conducted research aimed at examining the effects of parenting
interventions on attachment outcomes in children with ASD. Seventy children (64 boys, 6 girls)
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diagnosed with autism were included in a randomized clinical trial. As part of the study, the
participant’s parents received parent advocacy coaching and focused playtime interventions.
Following the parenting interventions, maternal perception of child attachment questionnaire,
cognitive and language ability scale, communication ability scale, and a separation-reunion
episode were used to examine attachment. Research findings indicated a significant effect of
treatment for children’s avoidant attachment related behaviors but not for contact seeking
behaviors. These findings highlight the importance of parenting factors such as parental
sensitivity in improving parent-child attachment outcomes.
Dolev et al. (2016) conducted an experiment aimed at examining the link between
maternal resolution of child’s diagnosis and maternal sensitivity in ASD. The research sample
was comprised of 46 mother-son (with autism) dyads. The children in this study ranged from
ages 2-8 years old. Parent interviews and questionnaires were used to gather data pertaining to
maternal resolution, parenting stress, and social support. Furthermore, maternal sensitivity was
evaluated through observation of parent-child interactions during social play. The research
finding revealed that resolved mothers exhibited higher maternal sensitivity during a social play
context. Conversely, Dolev et al. also found that un-resolved mothers of children diagnosed with
autism displayed less maternal sensitivity during social play thus impacting the child’s
attachment security.
Comparable to attachment formation in typically developing children, parental sensitivity
can also increase attachment security among children with ASD. This notion appears to be
corroborated by the research evidence surrounding parental sensitivity and attachment in autism.
Given the social impairment of ASD, parental sensitivity could be particularly important for
children diagnosed with autism. Conversely, unresponsive parenting could further exacerbate
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ASD symptomology considering the implications of attachment on the psychological
development of children. Moreover, there is an additional prominent parent variable that can
further inhibit security attachment in ASD.
Parental psychopathology and Attachment in ASD
Parent factors are particularly salient during early child development (McCartney &
Phillips, 2006). Therefore, it does not seem ludicrous to imply that a parent’s psychological
wellbeing could alter their child’s developmental outcome. Furthermore, parental
psychopathology has also been linked to a wide range of internalizing and externalizing
problems (McCartney & Phillips, 2006). Therefore, much like typically developing children,
parental psychopathology could also be linked to lower levels of attachment in children with
autism.
Keenan et al. (2016) designed an experiment to examine the effects of caregiver
wellbeing on attachment in autism. Participants recruited for the study included 24 children with
ASD and 24 typically developing children. Child attachment, caregiver attachment, and
attachment style were all assessed utilizing various measurement tools. The findings indicated
that the ASD group reported higher caregiver stress and attachment related anxiety. Keenan et al.
found that caregivers of children with ASD reported higher levels of stress and attachment
related anxiety thus affecting the development of attachment in ASD.
Rutgers et al. (2007) designed a study aimed at examining the connection between
parenting styles and attachment in ASD. The study sample was comprised of 89 families with
young children. Participants were divided into an ASD group, clinical group, and non-clinical
group. Parent factors such as parenting style, social support, and psychological problems were
assessed along with attachment security using various measures. The results of the study
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indicated that children with ASD displayed lower attachment while ASD parents showed less
authoritative parenting styles. Additionally, Rutgers et al. also found an inverse correlation
between secure attachment and fewer psychological problems.
Teague et al. (2018) also designed a study to investigate the effects of caregiver mental
health on attachment in autism. The study sample included 49 parent-child dyads. Participants in
the study included 29 children with ASD and 20 children with other disabilities. Various
measures were utilized to assess for ASD symptomology, parent quality, and caregiver mental
health. The results showed that caregiver mental health problems were significantly higher for
the ASD group. Additionally, the ASD group also reported higher problematic parenting
strategies and lower closeness suggesting less secure attachment. Thus, underscoring the
relevance of parental psychopathology in attachment formation outcomes in ASD.
Parental psychopathology is a prominent factor with extensive implications for
attachment formation. This variable could potentially have negative effects on parental
sensitivity thus inhibiting a parent’s ability to respond appropriately to their child’s behavior.
Consequently, parental stress and anxiety could further exacerbate ASD symptomology. It is
evident that exposure to parental psychopathology could be a risk factor for the development of
attachment insecurity in children with autism.
Conclusion
Even though there are multiple factors that can influence attachment security in ASD, the
research evidence presented above lends support for the significant effects of ASD levels of
functioning, parental sensitivity, and parental psychological wellbeing. The research evidence
presented above not only highlights the impact of ASD diagnostic features but also that of parent
factors that can also hinder parent-child interactions. These studies have shown that severe levels
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of functioning, inadequate parental sensitivity, and parental psychopathology can all hinder the
development of secure attachment in children diagnosed with ASD. It appears that severe levels
of functioning can have negative outcome for attachment security in children with ASD (Van
IJzendoorn et al., 2007). Furthermore, as evidenced by attachment theory parental sensitivity
plays a significant role in attachment development, this also appears to apply to attachment
formation in children with autism (Oppenheim et al., 2012). Lastly, parents of children with ASD
tend to experience more distress and attachment anxiety which can negatively impact their
psychological wellbeing among other variables involved in the development of attachment
security (Teague et al., 2018). However, the research composite presented in this discussion also
lends favorable indications corroborating the notion that children diagnosed with autism can
develop attachment security despite their diagnosis.
A Biblical Integration of Attachment
Attachment in childhood is connected to spiritual development because it sets a precedent
for future attachment formation (McCartney & Phillips, 2006). Thus, early attachment patterns
can have enduring effects that can be transferred onto future relationships to include those of a
spiritual nature. The view that parent-child interactions can influence behavior in adulthood is
also supported by Scripture, “train up a child in the way he should go even when he is old, he
will not depart from it” (Proverbs 22:6 ESV). This notion is also argued by John Bowlby’s
attachment theory proposing that early parent-child interactions can have enduring effects for the
developmental trajectory of interpersonal functioning (McCartney & Phillips, 2006).
Early parents-child interactions can influence subsequent spiritual development in the
sense that early experiences of attachment carry over onto future relationships thus influencing
spiritual interactions. For Christians, an important aspect of spiritual development is developing
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a personal/intimate relationship with God. This belief is transmitted in Luke 10:27 “you shall
love the Lord your God with all your heart and with all your soul and with all your strength and
with all your mind, and your neighbor as yourself.” Biblical teachings and attachment theory
both highlight the pivotal influence of early attachment on the development of future
relationships to include spiritual bond between God and His children.
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