





































Graduate Students Journal of Psychology                                                                                  Copyr


Graduate Students Journal of Psychology                                                                               Copyright 2004 by the Department of Counseling and Clinical Psychology 
2004, Vol. 6                                                                                                                              Teachers College, Columbia University                    ISSN 1088-4661 
 
 
 

Attachment relationships between Children with Physical Disabilities and Their 
Caregivers 

 
Anna Nedelisky 

The New School University 
 

Past research has empirically linked the experience of raising a disabled child to high levels of pa-
rental stress, depression, social isolation, psychological maladjustment, and child maltreatment.  
Findings from this research indicate that the cumulative influence of these factors may significantly 
affect the child-caregiver attachment relationship. Likewise, exposure to medical intervention, re-
peated hospitalizations, onerous care-giving responsibilities, and extensive financial outlays has 
also been found to constitute a source of stress for the caregivers of a child with a physical disabil-
ity.  A consequence of this stress is that attachment relations may, in some instances, be adversely 
affected.  The effects of childhood physical disability on the child-caregiver attachment relationship 
will be further explored in this review of the literature.   
 
 

designed to explore child-caregiver attachment relations in 
families in which there is a child with a physical disability.    

A series of behaviors used to achieve and maintain 
proximity to a caregiver in infancy signifies the formation 
of an attachment relationship (Bowlby, 1969).  Yet, the 
implications of this early relationship experience appear to 
extend far beyond these first years of life, in that the at-
tachment relationship may also serve to teach the child how 
to interpret and interact with the world in general (Bowlby, 
1969).   

 
The Effects of Childhood Physical Disability on 

the Family & the Disabled Child 
 

Roughly 41 million people in the U.S. have been esti-
mated to have a disability (Kaye, 1998).  Ten point seven 
percent of these disabled individuals are 18 years of age or 
younger and are considered “limited in their activity” (i.e. 
functional limitations in adults and limitations in play in 
children; Kaye, 1998).  Children below the age of five ac-
count for two to three percent of this number (Wenger et 
al., 1996).   A chronic physical disorder is defined as any 
disorder which interferes with the daily functioning of the 
individual for more than three months in a year, causes 
hospitalization lasting for more than one month in a year, or 
is predicted to do either at the time of diagnosis (Pless & 
Pinkerton, 1975).  Factors, such as the severity of the 
physical impairment, the potential for developmental delay, 
and the financial and social support of the family, play a 
crucial role in determining how the child and his/her family 
adjust to the physical disability (Hendricks et al., 2000; 
Wiegner & Donders, 2000).   

The attachment relationship established between a 
child with a physical disability and his or her caregiver may 
be impacted by the presence of a disability in a number of 
meaningful ways.  Childhood physical disability has been 
associated with an increased vulnerability to psychological 
as well as social maladjustment in both the caregiver(s) and 
the disabled child (Lavigne et al., 1992; Miller et al., 1992; 
Patterson et al., 1992, Wallander et al., 1988).  This phe-
nomenon appears to have an interactive effect in that the 
burden of caring for a child with a physical disability seems 
to be correlated with the increased risk of psychological 
and/or social maladjustment in the caregiver (Breslau, Sta-
ruch & Mortimer, 1982; Wallander & Varni, 1998; Weigner 
& Donders, 2000), and the experience of being provided for 
by a caregiver who has a psychological or social malad-
justment seems to increase the pre-existing risk that the 
physically disabled child may develop such a maladjust-
ment as well (Emery & O’Leary, 1984; Orvaschel & 
Walsh-Allis, 1988; Turner, Beidel, & Costello, 1987).  As a 
result, it appears evident that the presence of a child with a 
physical disability may have a significant effect on the well 
being of the individual caregiver and the child, as well as 
the  child-caregiver  attachment  relationship.  This  paper is    

Providing the care needed by a child with a physical 
disability can be a burden on the family (Leonard et al., 
1993; Patterson et al., 1992).  For some families, providing 
for a disabled child may consist of care that is needed up to 
24 hours a day, seven days a week, for years on end.  The 
chronic burden of caring for a child with a physical disabil-
ity can lead to a depletion of caregiver time and energy, 
disruptions to family life due to multiple visits to medical 
facilities, constant anxiety in relation to financial problems 
and the future of the disabled child, as well as feelings of 
guilt and isolation (Breslau, Staruch, & Mortimer, 1982).  
Studies investigating the relationship between family ad-

 
 

Correspondence concerning this article should be addressed to 
Anna Nedelisky. E-mail: anedelis@aol.com. 
 

5 



NEDELISKY 
 
justment and the presence of a child with a physical disabil-
ity have also reported elevated levels of depression in par-
ents of disabled children (Breslau, Staruch, & Mortimer, 
1982; Canning, Harris, & Kelleher, 1996; Jessop, Riess-
man, & Stein, 1988).  Likewise, parents of a child with a 
physical disability experience higher levels of stress than 
parents of a non-disabled child (Hendricks et al., 2000; Pat-
terson et al., 1992; Leonard et al., 1993).  The impact of this 
stress may be mediated by the methods the family develops 
for allocating responsibility for care within the home, the 
parent’s pre-morbid psychological adjustment, or current 
degree of social support (Wiegner & Donders, 2000).   

Reviews investigating the adverse effects of childhood 
physical disability have confirmed that children who have a 
chronic physical disability are twice as likely to develop a 
secondary emotional disorder than physically healthy chil-
dren (Eiser, 1990; Pless & Nolan, 1991).  A predictive as-
sociation between parental depression, anxiety, and marital 
discord on child maladjustment has been demonstrated in 
research on physically healthy children (Emery & O’Leary, 
1984; Orvaschel & Walsh-Allis, 1988; Turner & Beidel, & 
Costello, 1987; Varni & Setoguchi, 1993).  When the estab-
lished risk of psychological maladjustment in parents of 
physically disabled children is taken into account (Breslau, 
Staruch & Mortimer, 1982; Wallander & Varni, 1998; 
Weigner & Donders, 2000), it is reasonable to suggest that 
children with a physical disability may have an even greater 
risk of becoming maladjusted. 

Varni and Setoguchi (1993) found that social support 
appears to mediate the relationship between psychological 
maladjustment and healthy adjustment in physically dis-
abled children.  Family support and perceived social sup-
port (as in the cognitive appraisal that one is cared for and 
valued and that significant others are available to them if 
they are needed [Heller, Swindle, Dusenburg, 1986]) from 
parents, classmates, teachers, and friends were all found to 
be significant factors in the positive adaptation of children 
with physical disabilities (Varni & Setoguchi, 1993).  Fur-
thermore, Varni and colleagues (1991) recommend that 
teaching social skills (such as conversation and friendship-
making skills, as well as teaching how to handle teasing and 
name-calling) may serve as an intervention against the de-
velopment of maladjustment in children who are disabled. 
 

Attachment Theory 
 

Attachment behavior, according to Bowlby (1969, p. 
371), “refers to any of the various forms of behavior that a 
child commonly engages in to attain and/or maintain a de-
sired proximity.”  These behaviors can include smiling, 
looking, vocalizing, following, or clinging.  Ainsworth 
(1967) suggested that greeting behaviors, gazing, and ex-
ploration are also attachment behaviors.  Bowlby (1969) 
viewed the attachment between the child and the caregiver 
as a reciprocal phenomenon in which both parties must emit 
and accurately respond to the other’s signals and cues.  The 
way in which parents respond to their infant’s signals de-

termines to a large degree the quality of the child-caregiver 
attachment relationship (Isabella & Belsky, 1991).   The 
influence of the attachment relationship is thought to extend 
beyond infancy and, in essence, acts as a foundation upon 
which the individual learns to relate to others as well as to 
the world in general (Bowlby, 1969).   

 
Implications of a Physical Disability in Child-

hood on the Child-Caregiver Attachment  
Relationship 

 
Attachment and the 
Communication/Interpretation of Cues  
 

Disabled children, in many instances, are unable to 
send unambiguous cues or to respond to the caregiver in a 
clear manner (Osofsky, 1976).  A sense of constant fear or 
distress, depression and emotional numbing are common 
reactions to persistent illness and disability (Cox & Lam-
brenos, 1992).  The communication of fear and distress are 
infant attachment behaviors that precede the emergence of 
the attachment relationship (Cox & Lambrenos, 1992).  In a 
review of the literature on childhood physical disability and 
child-caregiver attachment, Cox and Lambrenos (1992) 
found that social and emotional communication may de-
velop in such a way that the caregiver has a great deal of 
difficulty in understanding the child’s meaning and, there-
fore, in alleviating the child’s distress.   As a result of the 
physical disability, the child’s emotions may be expressed 
in such a way that the caregiver has difficulty registering or 
interpreting them.  “It may be presumed,” suggest Cox and 
Lambrenos (1992, p. 1040), “that the quality of an attach-
ment relationship may be impaired if physical disabilities 
interfere with child attachment behaviors or with relevant 
parent-child interactions that precede their appearance.”     

Just as the caregiver may have difficulty interpreting a 
disabled child’s cues and signals, a child with a physical 
disability may also have difficulty interpreting the care-
giver’s actions (Cox & Lambrenos, 1992).   The child may 
subsequently fail or be delayed in learning to associate feel-
ings with certain expressions and may, therefore, be less 
capable of either regulating or expressing his/her own affec-
tive state.   The disabled child may also be less physically 
able to orient him/herself in close proximity to the care-
giver, which traditionally facilitates a greater sense of secu-
rity in the child (Cox & Lambrenos, 1992).   A child who 
feels distant from the caregiver may in turn come to feel 
abandoned by the caregiver, which could further serve to 
complicate the attachment process.   
 
Attachment and Hospitalization 
 

Young children, regardless of physical disability, re-
quire continuous and sensitive care-taking experiences in 
order to develop a sense of trust in the people around them 
(Minde, 2000).  In a hospital, however, a young child’s 

 6



CHILD-CAREGIVER ATTACHMENT RELATIONSHIPS 
 

need to be assured of continual and sensitive care is repeat-
edly violated.  A study by Minde and colleagues (1980) 
reported that infants who were hospitalized for an average 
of 49 days were cared for by an average of 72 different 
nurses.   The over-stimulation and consistent change evi-
dent in the lives of these young, hospitalized children 
clearly illustrates the difficulty they face in securing any 
sense of solidarity or trust in their surroundings.  The ex-
perience of prolonged hospitalization in childhood may 
subsequently be found to affect a child’s capacity to form 
healthy attachments. 

Similar to Bowlby (1959), Douglas (1975) and Quinton 
and Rutter (1976) found that repeated hospitalizations may 
be associated with an indefinite separation from the child’s 
caregivers and may be very traumatic and stressful experi-
ences.  Unfortunately, some children seem to be given rea-
son to fear that the separation represented by their stay in 
the hospital may be more extensive than it first appears.  
Thompson (1985) found that mothers of young infants ap-
peared much more committed to their infants if their infants 
were allowed to go home for two or more weeks during the 
first three months of life.  These findings support earlier 
research by Lampe, Trause and Kennell (1977) who 
matched 30 hospitalized infants by social class and illness 
and then compared the degrees to which they were visited 
by their parents.  Lampe and colleagues (1977) found that 
only 16% of infants who had never been home were visited 
daily by their parents or caretakers, whereas 70% of those 
who had been home received daily visits.  These findings 
appear to indicate that the attachment relationship is at-
tained, to some degree, through the experience of providing 
complete care for the infant in the home and that this level 
of attachment must be achieved before the parents or care-
givers can truly commit themselves to the infant (Lampe, 
Trause, & Kennell, 1977).   
 
Attachment & Stress 
 

Parents of disabled children experience a number of 
stressors (Breslau, Staruch, & Mortimer, 1982; Hendricks et 
al., 2000; Miller et al., 1992; Patterson et al., 1992; Leonard 
et al., 1993; Wiegner & Donders, 2000).  The infant-mother 
attachment relationship and the experience of stress were 
assessed in a sample of 100 economically disadvantaged 
infants and mothers (Vaughn et al., 1979).  Higher stressful-
event scores were found to be associated with a change 
from secure to anxious attachment at 12 and 18-month as-
sessments (Vaughn et al., 1979).   In a study of attachment 
and life circumstances, Thompson, Lamb, and Estes (1982) 
found that attachment classifications are prone to modifica-
tion as conditions change in the family.  The studies by 
Thompson and colleagues (1982) and Vaughn and col-
leagues (1979) were completed with non-disabled middle 
and lower class populations.  However, given the well es-
tablished association between stress and the experience of 
caring for a physically disabled child (Breslau et al., 1982; 

Henricks et al., 2000; Leonard et al., 1993; Miller et al., 
1992; Patterson et al., 1992), it seems reasonable to general-
ize from these findings that stress in the context of caring 
for a physically disabled child may result in a diminished 
child-caregiver attachment relationship.   

This generalization seems to be supported by Crisis 
Theory, which posits that people who experience a great 
deal of stress tend to become inner focused and become less 
capable of attending to cues in their environment (Capuzzi, 
1989).  When applied to a discussion of the formation of 
child-caregiver attachment in the context of a childhood 
disability, it seems likely that the stress involved in having 
a disabled child may result in a decrease of caregiver sensi-
tivity to the child’s cues, which would in turn affect the 
caregiver’s responsiveness to the child.   
 

The Disabled Child-Caregiver Attachment 
Relationship 

 
For children with physical disabilities and non-disabled 

children alike, ratings of maternal sensitivity, accessibility, 
emotional expressivity, and acceptance during the fourth 
quarter of the infant’s first year of life are all factors that 
appear to predict whether an infant will subsequently be 
classified as forming a secure or insecure attachment 
(Ainsworth et al., 1978).   Though a moderate level of at-
tentiveness and stimulation during the last few months of a 
child’s infancy sounds like a reasonable feat to accomplish, 
research has shown that mothers of disabled children have a 
great deal more with which to contend.  Rogers (1988) 
found that mothers of children with disabilities tend to be 
more active and express less positive affect than mothers of 
non-disabled children.  Other researchers have consistently 
reported that, in comparison with controls, mothers of 
physically disabled children are more active, controlling 
and stimulating, and less responsive in their interactions 
(Tyler & Kogan, 1972; Wasserman et al., 1985).  In light of 
the fact that maternal sensitivity and emotional responsivity 
have been found to be positively correlated with the forma-
tion of secure attachment in normal samples (Ainsworth et 
al., 1978) and that mothers of disabled children have been 
found to be less likely to interact with their children in this 
manner (Rogers, 1988; Tyler & Kogan, 1972; Wasserman 
et al., 1985), the apparent lack of a difference in attachment 
security reported by some researchers among disabled in-
fant groups versus non-disabled infants is interesting (Cox 
& Lambrenos, 1992). 

In a study by Wasserman, Lennon, Allen, and Shi-
lansky (1987), the apparent lack of attachment differences 
between a disabled and non-disabled child population was 
further explored.  Attachment was assessed in 46 non-
disabled infants and 36 disabled infants (who were diag-
nosed with mostly congenital facial or orthopedic malfor-
mations).   This study reported no difference in attachment 
security between the non-disabled and the physically dis-
abled samples.  Consistent with Ainsworth’s findings 

 7



NEDELISKY 
 

Other research investigating the attachment phenome-
non in disabled populations has indicated that childhood 
disability does not defeat attachment between young dis-
abled children and their caregiver(s), although the extent to 
which the disability may impair the attachment relationship 
is still unclear (Blacher & Meyer, 1983; Cox & Lambrenos, 
1992; Capuzzi, 1989).  Having previously found an appar-
ent association between the physical manifestation of the 
disability, the performance of the child on intelligence 
measures, and maternal detachment, Wasserman, Allen and 
Solomon (1985) next sought to understand if there is a rela-
tionship between patterns of mothering and the maladjust-
ments or deficits in children with physical disabilities.  
Fourteen disabled infants (facial and orthopedic disabilities) 
and their mothers, 14 premature infants (who share the de-
viant early experience of extended hospitalization with 
physically disabled infants, but have no current disabilities) 
and their mothers, and 14 healthy infants and their mothers 
were videotaped in free-play, separation, and reunion sce-
narios at nine, 12, 18, and 24 months.  Infants with physical 
disabilities were found to have consistently less focused 
elaborated play and scored 24 months behind healthy in-
fants in standardized measures of cognitive-linguistic func-
tioning (Wasserman et al., 1985).  Infants with physical 
disabilities were also found to be less likely to employ so-
cial initiatives (such as requesting interaction with his/her 
mother or the experimenter) and were more passive in re-
spect to separation and exploration at the age of two years.  
Whereas healthy infants tended to develop increasingly 
positive affective expression with age (i.e. smiles, laughter, 
affectionate contact, and positive physical expression), in-
fants with physical disabilities tended to decrease in posi-
tive affective expression (Wasserman et al., 1985). 

(1978), early maternal responsivity (i.e. matching or re-
sponding to the infant’s bids or cues) and availability (i.e. 
attention directed towards the infant) were found to be as-
sociated with infant attachment security for both groups.  
Specifically, in both disabled and non-disabled groups, 
higher levels of maternal responsivity, availability, and age-
related increments of positive maternal affect (i.e. exhibit-
ing warmth or happiness) at nine months were associated 
with secure infant attachment.  Mothers of disabled infants 
were found to be lower in responsivity at nine months, 
higher in positive affect at 12 months, and were not found 
to differ in nine-month availability from the control moth-
ers.  In sum, the results of this study’s comparison of at-
tachment in disabled versus non-disabled infants found that 
mothers of disabled infants are no more or less likely to 
foster secure attachment in their infants than control moth-
ers; they simply seem to use a different strategy for its pro-
motion (Wasserman et al., 1987). 

Building on this finding, the results of a study by 
Capuzzi (1989) showed that there was a significant increase 
in attachment in a disabled population and their mothers 
between one and six months and also between one and 12 
months.  This finding led Capuzzi (1989) to propose that 
the attachment relationship between the disabled infant and 
his/her mother is dynamic in that it adapts and develops 
over time.  “Like any other affectional relationship,” notes 
Vaughn and colleagues (1979, p. 975), “infant-mother at-
tachments arise from interaction; they continue to develop 
even after an affective bond has formed, and they are re-
sponsive to changes in the behavior of either partner.”  This 
study by Capuzzi (1989) indicated that social support ap-
pears to buffer the negative effects of having a disabled 
infant on the infant-mother attachment relationship.   In 
particular, Capuzzi (1989) found that affirmative support 
appeared to be most important in predicting maternal at-
tachment, though she stressed that more research into this 
topic is needed. 

Wasserman and her colleagues (1985) found that 
mothers of children with physical disabilities generally ex-
erted a greater attempt to respond to the differences in their 
child’s competence by stimulating, focusing, and using 
other compensatory methods than mothers of either prema-
ture or healthy children.  A developmental increase in the 
use of encouragement, one component of which is positive 
reinforcement, was particularly noted in mothers of children 
with physical disabilities.  The findings of Wasserman and 
colleagues (1985) suggested, however, that the sustained 
effort of such compensatory labors might lead to maternal 
burn out or even the maternal distancing effects observed in 
the study by Wasserman & Allen (1985). 

In a review of the attachment literature pertaining to 
children with a series of physical as well as mental and de-
velopmental disabilities, Blacher & Meyer (1983) reported 
that the attachment relationship between disabled children 
and their caregivers may be delayed or even absent.  The 
presence of a disability in childhood, therefore, may have 
an adverse or detrimental effect on the quality or formation 
of the child-caregiver attachment relationship.  Past re-
search by Holt (1968) appears to stand in support of these 
findings.  In collecting follow up data on a study of 30 eight 
to 12 year old children who had been hospitalized between 
two to five years of age for a variety of different illnesses, 
Holt (1968) found that some children failed to include their 
mothers in drawings of their families.  The exclusion of the 
mother suggested to Holt (1968) that the children might 
have felt abandoned by their mothers during their respective 
hospitalizations.  The fact that these drawings were made in 
later youth appears to indicate that the perceived maternal 
abandonment in early childhood may have a lasting effect 
on the child’s attachment to his/her mother.   

Another factor, which may act as a potential challenge 
to the disabled infant-caregiver attachment relationship, is 
the developmental milestone marked by the age of two.  As 
Wasserman and her colleagues have discussed in the previ-
ously reviewed studies (Wasserman & Allen, 1985; 
Wasserman et al., 1985), the age of two marks a pivotal 
time in a young child’s life when increases in cognitive 
skill, independence, and exploration occur.  Just as this age 
can be exciting, it can also be an extraordinarily difficult 
time for caregivers who have yet to recognize the full extent 
of their child’s disability.  Wasserman and Allen (1985) 

 8



CHILD-CAREGIVER ATTACHMENT RELATIONSHIPS 
 

noted that children born with physical disabilities might be 
different behaviorally from developmentally normal chil-
dren as early as their second year.  These differences may 
not be due to their general risk status so much as mediated 
by the experience of early child-caregiver separation, re-
peated hospitalizations, or thwarted caregiver hopes 
(Wasserman & Allen, 1985).  Whereas children with physi-
cal disabilities may not appear to differ from healthy chil-
dren in attachment, play, and affective expression at one 
year, divergences in behavior may become evident by the 
age of two (Wasserman et al., 1985).  Likewise, an increase 
in maternal ignoring may become apparent as the physically 
disabled child reaches the age of two (Wasserman et al., 
1985).   Noting that physically disabled infants, who were 
not especially delayed or ignored at one year, appear to 
experience maternal ignoring by the age of two, researchers 
suggested that mothers of physically disabled children may 
get their first sense that the child is not as lively or as active 
as was expected and may subsequently withdraw from the 
child at this age (Wasserman et al., 1985).  The emergence 
of the physically disabled child’s second year, therefore, 
may have profound implications for the quality of the 
physically disabled child-caregiver attachment relationship, 
as well as mark a crucial time for meaningful intervention. 
 

Rejection versus Attachment 
 

In contrast to the act of forming an attachment, re-
searchers have found that parental rejection and/or a reluc-
tance to attach to the disabled infant may be common (Cox 
& Lambrenos, 1992).  Attachment appears to not only play 
a significant role in the nurturing and growth of a child, but 
it may also play a role in the stability of the home and the 
safety of the disabled child (Blacher & Meyers, 1983).  
Believing that the existence as well as the quality of the 
attachment relationship is particularly pertinent to how par-
ents of disabled children mediate the varied crises and ago-
nies they experience, Blacher and Meyers (1983) suggested 
that attachment plays a significant role in the care of this 
vulnerable population:   

… the quality of attachment could well relate to the 
early burnout of parents as care-providers, to the 
early inclination to place children out of the natural 
home, to abuse or neglect, to family accord or dis-
cord, and even to the quality of parent collabora-
tion with service providers and school personnel. 
(p. 359) 
Brooks-Gunn and Lewis (1982) also studied the effects 

of childhood physical disability on the child-caregiver at-
tachment relationship.  They found that the age-related de-
crease in maternal responsivity to infants’ fretting and cry-
ing was much more rapid for disabled infants and their 
mothers than in the comparison group.  Based on these 
findings, Brooks-Gunn and Lewis (1982) suggested that 
there is a correlation between decreased maternal respon-
sivity and the description of the disabled child as “diffi-

cult.”  These researchers stressed that disabled infants 
dubbed “difficult” were not necessarily found to be any less 
responsive in their behavior than a comparison group, de-
spite the fact that they were perceived as such by their 
mothers.  Brooks-Gunn and Lewis (1982) found that by the 
end of the first year, mothers of disabled infants vocalized 
less in response to interaction sequences initiated by their 
infants’ behavior than mothers of non-disabled children.  
This difference in maternal responsivity to interactions ini-
tiated by the behavior of the “difficult” disabled infant was 
found to persist to the end of the infants’ second year 
(Brooks-Gunn & Lewis, 1982).  In a study of ten children 
with cerebral palsy, Kogan and colleagues (1974) also 
noted a marked decline in maternal responsivity to their 
disabled children.   Data collected at three one-year inter-
vals (between the ages of one to four) showed a gradual 
decrease in maternal warmth and acceptance as the disabled 
child aged in comparison with an age-matched non-disabled 
group.  Kogan and colleagues (1974) noted that a decline in 
maternal warmth and acceptance in the mothers of disabled 
children appeared to be related to the child’s increasing 
deficit in gross motor development.  

Likewise, preliminary research by Cox and Lambrenos 
(1992) suggests that many parents seem to “turn off” their 
responses to their disabled children as they discover that 
their children are not making the developmental progress 
that might be reasonably expected of them as they enter 
their second year of life.  Major developmental markers 
such as a failure or a delay in the child’s ability to stand, 
walk, or talk at certain expected ages are events which par-
ents, who may have previously operated in denial, are now 
perhaps forced to read and interpret as an indicator of the 
child’s disability (Cox & Lambrenos, 1992).  Cox and 
Lambrenos (1992) warn that parents, who choose to “turn 
off” their responses to their disabled children and subse-
quently withdraw from them during their second year of 
life, could experience a serious impact on the existing child-
caregiver attachment relationship (Cox & Lambrenos, 
1992). 

 
The Disabled Child-Caregiver Attachment 

Relationship: 
A Risk Factor for Maltreatment 

 
Research by past theorists, such as Helfer (1975), has 

been in accord with recent reports suggesting that a disrup-
tion in the attachment relationship does indeed appear to be 
a risk factor for maltreatment in a disabled child population 
(Brooks-Gunn & Lewis, 1982; Cox & Lambrenos, 1992).  
The Child Abuse Prevention and Maltreatment Act 
(CAPTA) defines “Maltreatment” as: 

at minimum, any recent act or failure to act on the 
part of a parent or caretaker, which results in death, 
serious physical or emotional harm, sexual abuse 
or exploitation, or an  

 9



NEDELISKY 
 

act or failure to act which presents an imminent 
risk of serious harm. (42 U.S.C.A. §510g(2), 1998) 

Blacher, J., & Meyers, C.E. (1983).  A review of attach-
ment formation and disorder of disabled children.  
American Journal of Mental Deficiency, 87, 359-371. Helfer (1975) proposed that parental maltreatment of 

disabled children might be due to a disability-related inter-
ference affecting the bonding process between the child and 
the caregiver(s).  Schwartz and Schwartz (1977) concurred, 
suggesting that poor maternal attachment may be a factor in 
the maltreatment of disabled children.  Ainsworth (1980) 
proposed that influential disruptions in the formation of the 
infant-caregiver attachment relationship frequently occur 
when the infant is separated from the caregiver at or imme-
diately after birth.  Despite the fact that recent attempts to 
demonstrate these findings have been contradictory (Rode 
et al., 1981), it remains plausible that disabled children ap-
pear to run a greater risk of such separations and, as a re-
sult, attachment relationship disruptions may be more likely 
in this population (Holt, 1968; Lampe, Trause, & Kennell, 
1977; Minde, 2000; Thompson, 1985). Recommendations 

Bowlby, J. (1969).  Attachment and loss: Attachment (Vol. 
1).  London: Hogarth.  

Breslau, N., Staruch, K., & Mortimer, E. (1982).  Psycho-
logical distress in mothers of disabled children.  Ameri-
can Journal of the Disabled Child, 136, 682-686. 

Brooks-Gunn, J., & Lewis, M. (1982).  Affective exchanges 
between normal and handicapped  

 infants and their mothers.  In T. Field, & A. Fogel (Eds.), 
Emotion and interaction:  

 Normal and high risk infants.   Hillsdale, NJ: Erlbaum. 
Canning, R.D., Harris E.S., & Kelleher, K.J. (1996). Fac-

tors predicting distress among caregivers to children with 
chronic medical conditions.  Journal of Pediatric Psy-
chology, 21, 735-749. 

Capuzzi, C. (1989).  Maternal attachment to disabled in-
fants and the relationship to social support.  Research in 
Nursing & Health, 12, 161-167.Child Abuse Prevention 
and Maltreatment Act of 1998, 42 U.S.C.A. § 510g(2) 
(West Suppl.1998). 

Through an extensive review of the literature, this au-
thor concludes that a unidirectional causal relationship be-
tween childhood physical disability and the quality of the 
child-caregiver attachment relationship is not possible to 
establish at this time, though it is apparent that the presence 
of a physical disability may constitute a risk factor to the 
well-being of the child-caregiver attachment relationship 
(Capuzzi, 1989; Cox & Lambrenos, 1992).  Like any other 
relationship, however, the child-caregiver attachment rela-
tionship is a dynamic entity that develops over time 
(Capuzzi, 1989; Vaughn et al., 1979).  Initiating appropriate 
interventions to promote the healthy development of this 
attachment relationship, as well as greater emphasis in the 
research community on the longitudinal study of the effect 
of physical disability on the child-caregiver attachment re-
lationship, represent the next steps in further clarifying our 
understanding of the attachment phenomenon in a physi-
cally disabled child population (Cox & Lambrenos, 1992).  
By educating caregivers regarding issues, such as the sig-
nificance of the attachment relationship to the development 
of the child or the beneficial attributes of social support and 
improved communication skills, intervention programs 
could make a significant contribution to the care and well 
being of the disabled child (Minde, 2000).   

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