Child & Adolescent Psychopathology - Attachment and Self-Regulation

Bowlby’s Attachment Theory

• Evolutionary basis: proximity to caregivers ensures survival

• Internal working models: how children learn to view self, others, relationships

• Secure vs. insecure patterns

• Sensitive caregiving as central to regulation and resilience 

Evolutionary Basis of Attachment

• Attachment as a biologically based survival mechanism

• Ensures proximity to caregiver in times of threat

• Shaped by natural selection for protection and care

Attachment Styles

• Secure attachment

• Anxious-Preoccupied attachment

• Avoidant-Dismissive attachment

• Fearful-Avoidant (Disorganized) attachment

Secure Attachment

• Confident in caregiver’s availability; uses caregiver as a secure base.

• Childhood: Caregivers are responsive → child feels safe exploring.

• Adulthood: Comfortable with intimacy and autonomy, trusts others

Anxious-Preoccupied Attachment

• Heightened distress; inconsistent reassurance-seeking

• Childhood: Inconsistent caregiver response → child becomes clingy.

• Adulthood: Worries about rejection, seeks constant reassurance

Avoidant-Dismissive Attachment

• Minimized attachment needs; avoids closeness

• Childhood: Caregivers are emotionally unavailable → child learns to self-soothe.

• Adulthood: Values independence over closeness, downplays emotions

Fearful-Avoidant (Disorganized) Attachment

• Contradictory, fearful behaviors; often linked to maltreatment or trauma. 

• Childhood: Caregiver is both source of comfort and fear →

confusion.

• Adulthood: Desires closeness but fears rejection, volatile

relationships.

Reactive Attachment Disorder (RAD)

• Associated with severe neglect or inconsistent caregiving

• Emotionally withdrawn, inhibited; rarely seeks comfort.

• Limited positive affect, unexplained irritability/sadness.

Self-Regulation

The ability to manage emotions, behaviors, and thoughts in ways that are flexible, adaptive, and responsive to the environment

• Includes physiological (e.g., sleep-wake cycles), emotional, attentional, and behavioral regulation

Self-Regulation - Core Actions

• Modulating emotional arousal (e.g., calming oneself when upset)

• Controlling impulses and delaying gratification

• Sustaining attention and shifting focus as needed. 

Self-Regulation - Characteristics

• Multidimensional and develops over time

• Common thread across diagnostic spectrum

• Begins in infancy

Self-Regulation in Infancy

• Infants rely on co-regulation from caregivers (soothing, routines, rhythmic interaction).

• Early attachment plays a crucial role.

• Babies learn to regulate by being regulated — they borrow nervous systems.

Examples of Self-Regulation Difficulties

• Headaches

• Difficulty sleeping

• Disproportionate perfectionism

• Crying spells

• Avoidance caused low distress tolerance

• Conflicts with peers

• Zoning out

• Feeling “on edge”

• Skipping school

• Lack of co-regulation from caregivers

• Aggression

• Anxiety

Self-Regulation in Middle Childhood

Use learned coping skills strategies independently

Self-Regulation in Adolescence

Balance emotional needs with long-term goals, navigate complex social emotions.

Stress and Dysregulation

• Chronic stress, trauma, neglect, or disorganized caregiving can dysregulate the developing nervous system.

• This impacts emotion, learning, and behavior — sometimes mimicking or leading to psychopathology.

Self-Regulation and Resilience

• Stable, nurturing relationships can buffer stress and support regulation.

• Children learn emotional intelligence through modeled regulation.

• "Serve and return" interactions scaffold developing self-regulation

• Interventions must focus on relationships, not just

individual behavior.