Table 1

 Attributes acquired through normal parental attachment and affected by disordered attachment

Understanding of the “inner world” Recognition and correct attribution of body signals—pain, hunger, satiety, toilet needs, temperature Understanding and expression of emotions appropriate to circumstances; language for feelings Rationalising, remembering, planning, problem solvingP, age 3, was adopted because of neglect. He did not react to minor injuries. He showed no awareness of the need for the toilet. He ate without limit if allowed, to the point of vomiting. K, age 4, was neglected before adoption. In her adoptive home, she showed no sense of fun or enjoyment, did not cry and showed little temper. She seemed unaware of the feelings of others.
Stress regulation Parental attunement regulating the child’s stress Stress regulatory system permanently set Routine, predictability, cognition, trust–reducing anxietyM, age 17, was adopted age 18 months after initial neglect. Although well attached and socially integrated, his temper has always been a problem, despite CAMHS help. It “flares 0 to 100 with no in between” and he feels out of control. He “turns grey” and his “eyes change”.
Understanding of relationships J, age 4, was neglected. At 2 y 9 mth, after 9 mth in care, he appeared autistic with no speech or eye contact, and ritualistic play. These problems settled. P, age 5, learned to gain closeness by sexually provocative behaviour, and H, age 6, by excessive compliance. A, age 11, was neglected. Her early speech development was delayed. Since adoption at age 5 her speech remains unsophisticated, missing nuance and humour. She is affectionate and caring, but misjudges social situations. L, age 7, learned to take control in the face of inadequate parenting. While very engaging, her adopters experience her as sly and manipulative, and unfamiliar with the concept of parental authority. Discipline is problematic. She is similarly controlling of peers and friendships are short-lived.
Benefits of relationships
    Strategies to achieve attention
    Verbal and non-verbal communication; nuance, humour, gesture, facial expression, touch, behaviour
    Experience of mood and emotion as communicable
Social rules, authority, hierarchy, types of relationship
Understanding of the outside world Cause and effect Socially acceptable norms of routine and behaviour Awareness of dangerT, age 4, was neglected and exposed to violence at home. He shows no awareness of danger and will climb to or jump from excessive heights if unsupervised, such that he needs to be watched constantly. In shops he is liable to run off without turning to look for his foster mother.
Ability to explore the world Inquisitiveness Motivation Cognitive and motor skills for exploration Opportunity Safety to explore Routine and safety allowing concentrationO, age 3, previously neglected, shows no spontaneous curiosity and, if allowed, “just sits”. She shows no imaginative play. She walks “through”, not round obstacles. Her adoptive parents have had to teach her to want to play as well as how to do so. J, age 10, experienced domestic violence until age 2. He formed significant but insecure attachment to his adoptive parents. He has prominent features of ADHD. Disruptive behaviour and tempers have led to school exclusion.