Relationship styles in children with a disability


Relationship Styles in Children with a Disability

Based on John Bowlby’s Attachment Theory

By: Tara Hearne (Psychology Intern at Secure Start®) and Colby Pearce

Relational styles in children can be broken down into four main categories:


A child with a secure relational style has an established sense of trust in their primary caregivers and the world. They feel safe in being able to interact with others and explore their environment with their caregiver acting as a secure base. Children with a secure relational style may show distress at being left by their caregiver but on their caregivers return, are easily comforted and return quickly back to play and exploration. Secure children feel comfortable expressing their emotions and seek and accept comfort from their caregivers when feeling distressed. These children have a positive view of themselves and others.


A child with an insecure-avoidant relational style typically does not show overt signs of distress when left by their caregivers and will avoid contact on their return. They usually show no preference between their caregivers and strangers. Children with an insecure-avoidant relational style appear to be self-reliant and often prefer solitary play. Insecure-avoidant children typically do not seek out comfort when distressed and will usually resist comfort (avert their gaze or fail to return a hug) when it is offered. These children tend to have a positive view of themselves and a negative view of others.


A child with an insecure-ambivalent relational style has a low threshold for distress while also anticipating that comfort will not be forthcoming. They are excessively clingy to their caregivers and upon separation show obvious distress. When their caregiver returns they are not easily comforted and become obsessed with them, oscillating between wanting closeness and feeling angry with their caregiver. Insecure-ambivalent children are often seen as demanding, clingy, immature, angry and easily overwhelmed by their emotions. These children tend to have a negative view of themselves and a positive view of others.


A child with a disorganised relational style often displays inconsistent, contradictory and varied behaviour in response to their caregivers. When reunited with their caregiver, they may greet them but with their gaze averted or by turning away straight after greeting them. They may seek out their caregiver to engage with or be comforted by them but disengage from them immediately after – in a push-pull (“I want you but I don’t want you”) method of interaction. Disorganised children allow their caregiver to hold them but with their limbs stiff or eyes averted. Externalising, disruptive and aggressive behaviours tend to be the predominately seen behaviour problems in children with a disorganised relational style. These children tend to have a negative view of themselves and others.

Relationship style prevalence and contributing factors for children with a disability

Studies have found that prevalence of secure relationship styles seen in children with a disability tend to be somewhat lower (50%) than for typically developing children (60%). It was also found that if children with a disability did not have a secure relationship style, it was most likely to be disorganised. This is seen at a rate about the same as that of typically developing children who have experiences early relational trauma or adverse childhood experiences (ACEs).

The higher rate of disorganised relational style seen in children with a disability is thought to be, in part, a function of stress. Due to physical and cognitive constraints, they have difficulties with everyday tasks and difficulties with judging and dealing with everyday situations. Given these difficulties, it is often the case that children with a disability experience themselves to have limited control over their life and individual circumstances, which can lead to feelings of incompetence and helplessness. In turn, this can cause the child to have a near constant feeling of stress.

Frequent and sustained stress can lead to an almost permanent state of activation of the biological stress response. Prolonged activation of the stress response leads to a depleted ability to cope with even low levels of irritation. This stress response reaction may contribute to the higher prevalence of disorganised relational styles seen in children with a disability. Furthermore, it helps to explain why the rates of disorganised relationships are similar to that of children who have experienced relational trauma – owing, in part, to over-activation of the stress response and sustained feelings of helplessness in both cases.

As well as a heightened stress response, children with a disability may have difficulties early in life with relational/social behaviours. They may be delayed in their ability to exhibit attachment-related behaviours such as smiling, approaching and vocalising, making it more difficult for caregivers to interpret the needs of the child. This can lead to less responsiveness from caregivers in a negative feedback loop – the less the child shows attachment related behaviours, the less the parent responds, then the less the child responds and so on it goes.

The increased level of care children with a disability need, coupled with the inability of the child to respond to interactions in a meaningful way, intensifies the stress felt by both child and caregiver. This, in turn, can negatively impact secure caregiver-child relationship development. In short, children with a disability behave differently to typically developing children; therefore, more is required of caregivers in regards to relationship development and maintenance. Therapeutic relationship enrichment can assist in promoting and enhancing the caregiver-child relationship. The Triple-A Model of Therapeutic Care and the CARE Therapeutic Framework offer simple, practical, back-to-basics care strategies intended to promote secure relational styles between all children and those who care for them.

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Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social and Personal Relationships, 7, 147-178.

Brennan, K.A., Clark, C.L., & Shaver, P.R. (1998). Self  report measurement of adult attachment.. In J. A. Simpson & W. S. Rholes (Eds.), Attachment Theory and Close Relationships (pp. 46-76). New York: Guilford Press. Janssen, C. G. C., Schuengel, C., & Stolk, J. (2002). Understanding challenging behaviour in people with severe and profound intellectual disability: A stress-attachment model. Journal of Intellectual Disability, 46(6), 445-453.

Malekpour, M. (2007). Effects of attachment on early and later development.  The British Journal of Developmental Disabilities, 53(105), 81-95.

Pearce, C. (2016). A Short Introduction to Attachment and Attachment Disorder (Second Edition). London: Jessica Kingsley Publishers.

Schuengel, C., Schipper, J. C., Sterkenburg, P. S., & Kef, S. (2013). Attachment, intellectual disabilities and mental health: Research, assessment and intervention. Journal of Applied Research in Intellectual Disabilities, 26, 34-46.

About colbypearce

I am a practising Clinical Psychologist with twenty-seven years’ experience working with children and young people recovering from abuse and neglect. I am also an author and educator in trauma-informed, therapeutic caregiving. My programs are implemented in Australia and Ireland, and I am well-known for my practical and accessible guidance for caregivers and professionals alike.
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1 Response to Relationship styles in children with a disability

  1. Reblogged this on africandream01 and commented:
    Great post written by Colby Pearce worth reading

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