Relationship styles in children with a disability

Colby Pearce Attachment National Psychology ExamRelationship 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 rates and contributing factors for children with a disability

Studies have found that prevalence rates 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 been traumatised.

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 see their life as one of low controllability, which can lead to general feelings of incompetence and helplessness. This can cause the child to have a near constant feeling of stress.

Frequent and sustained stress leads 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 stress. 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 traumatised children – 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 offers simple, practical, back-to-basics care strategies intended to promote secure relational styles between all children and those who care for them.



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. (2009). A short introduction to attachment and attachment disorder. 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.

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Lessons about Learning: Some Truths about Behaviour Management

ConsistencyConventional behaviour management, as it is widely used in the care and management of children, incorporates three main techniques:

  • Reinforcement of wanted or desired behaviours;
  • Punishment of unwanted or undesirable behaviours; and
  • Extinction of unwanted or undesirable behaviours by ignoring or otherwise removing the intended outcome (reward/reinforcer) for such behaviours.

The psychological science behind these techniques comes from the Operant Conditioning Paradigm. Developed by academic psychologist B. F. Skinner in the 1930’s, the Operant Conditioning Paradigm asserts that a behaviour becomes part of an individual’s repertoire if in its operation the individual receives some form of desired or desirable reward or achieves a desired outcome.

Think of a conventional school classroom. Children learn that in order to gain the attention and assistance of the teacher they must raise their hand. When they raise their hand they are rewarded with the teacher’s attention and assistance. Of course, during their early schooling children are told that this is the behaviour they must perform in order to gain the teacher’s attention and assistance. They are reminded to do so when they call out or seek the teacher’s attention and assistance by other, less desirable means. Children also see other children raise their hand and gain attention and assistance from the teacher (a.k.a. social learning). But what if the teacher did not respond to hands being raised or only responded sometimes? Would raising one’s hand become part of a child’s behavioural repertoire to gain the teacher’s attention and assistance?

The answer to this questions lies in the three main conditions under which an action is reinforced (or not) in operant conditioning experiments. In the original experiments in the 1930’s rats and pigeons were placed in an experimental apparatus called a Skinner Box. The Skinner Box was a plain box with a lever or button and a chute. The chute was connected to a feed bottle located above the Skinner Box. The apparatus was set up to release a food reward (or not) via the chute in response to presses of the button or lever. The basic experiment involved seeing how well the animals learnt to press the button or lever under different reinforcement conditions. The reinforcement conditions were as follows:

  1. Consistent (or Continuous) Reinforcement, whereby the animal received a food reward for every press of the button or lever;
  2. Inconsistent Reinforcement, whereby the animal received a food reward sometimes but not others when they pressed the button or lever; and
  3. No Reinforcement, whereby the animal never received a food reward for presses of the button or lever.

Animals in condition 1 soon learnt to press the button or lever in order to access a food reward. Once they had learnt this, these animals appeared to only press the button or lever when food was required.

Animals in condition 2 were slow to learn to press the button or lever to access a food reward. Once learnt, these animals pressed the bar or lever at a higher rate and with greater persistence than the animals in condition 1.

Animals in condition 3 soon lost interest in the button or lever and never learnt to access food by pressing the button or lever.

What has all this got to do with human children? Apart from remembering that we too are animals, think of the infant’s acquisition of spoken language. The infant babbles and occasionally makes a noise that approximates a word. Perhaps, in imitation of what they hear from their mother-figure, that noise is “mu” or “ma”. The response of the mother-figure is typically delight and the bestowing of attention on the infant. The infant is rewarded for uttering “mu” or “ma” and, repeated consistently enough, the infant learns to secure their mother-figure’s attention and delight by saying “mu” or “ma”. Such is the beginning of language acquisition.

So, in terms of behaviour management, children learn new, wanted and desired behaviours most quickly, and only perform such behaviours when required or it is desirable to do so, when the behaviour is consistently reinforced/rewarded. Where the behaviour is reinforced inconsistently, the children are slow to learn and, when they do, they are prone to engaging in the behaviour with high rate and great persistence, which can be a problem. If it is never rewarded/reinforced, they never learn.

Punishment works differently. Punishment involves substituting the desirable reinforcer/reward for something undesirable for a behaviour that has already gone through an operant conditioning process. In further research Skinner delivered an electric shock to rats instead of the food reward. Referred to as aversive conditioning, the rats in these experiments soon stopped pressing the lever. However, in subsequent research Skinner was also able to demonstrate that the rats experienced a significant fear response as a result of being shocked for presses of the lever. In humans, fear impairs learning and can precipitate undesirable behaviours associated with the fight-flight-freeze response, thereby negating the benefits of punishment. In addition, punishment is less effective at stopping an unwanted or undesired behaviour when it is delivered inconsistently.

Ignoring the unwanted or undesirable behaviour that has already gone through a conditioning process, also called extinction, is the third behaviour management technique referred to above. In operant conditioning terms, it involves taking away the reward/reinforcer. In further research involving rats and pigeons that had learnt to press the button or lever under conditions of either consistent or inconsistent reinforcement, the food reward was taken away. What happened next is, from my perspective, one of the most interesting and least widely known aspects of the operant conditioning paradigm. As you might expect, the rats and pigeon’s who originally received a food reward for each and every press of the button or lever were quick to learn that conditions had changed and soon stopped pressing the button or lever when the behaviour was no longer reinforced. In contrast, the rats and pigeons whose behaviour developed under inconsistent reinforcement conditions were slow to learn that conditions had changed and continued to press the button or lever with a high rate and great persistence.

In behaviour management terms, extinction works best when the unwanted or undesirable behaviour was originally rewarded/reinforced on a consistent basis and when the reward/reinforcer is taken away completely. Extinction is less successful when the unwanted or undesirable behaviour was rewarded/reinforced on an inconsistent basis. The child is slow to learn that conditions have changed and will continue to display the unwanted or undesirable behaviour at a high rate and great persistence, giving the impression that extinction is not working.

What is worse, if you cannot ignore (or remove the reinforcer) or punish the unwanted or undesirable behaviour consistently, the child and their behaviour is on an inconsistent reinforcement paradigm; meaning that they will continue to perform the unwanted or undesirable behaviour in anticipation of it being rewarded/reinforced at least some of the time.

Behaviour management is further complicated by the fact that, for many children, their unwanted/undesirable behaviours developed under conditions of inconsistent reinforcement; as is the case in children raised in chaotic households or where abuse and neglect are a feature. These latter children might view punishment and extinction as desired outcomes of their behaviour, though abused and neglected children are also more likely to exhibit undesirable behaviours associated with activation of the fight-flight-freeze response when they are punished or denied access to a desired outcome.

Adults in a caregiving role with children cannot rely solely on conventional behaviour management to address all unwanted or undesirable behaviours. Fortunately, there are other, effective ways to promote positive behaviour in children.

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Teen Suicide Prevention: Connection Matters

A great deal of scientific and social endeavour is expended on preventing suicide. Few losses evoke emotions in others as much as a person’s death by their own hand.

A person’s suicide evokes predictable questions: Why did they not confide in someone? Why did they not ask for help? Why did their feel so alone?

The suicide of a young person is especially poignant.

Twenty-five years ago there was a spike in media attention on the purported role of music in suicide among teens. Much speculation centred on the possible contribution of heavy metal music to teen suicide.

Against this backdrop of media interest, a small group of researchers in Adelaide, South Australia, were studying the role of music preference as an indicator of vulnerability to suicide among teens. This research, which was published in 1993 in the Journal of the American Academy of Child and Adolescent Psychiatry, could not and did not allocate a causative role to certain music preferences in teen suicidal behaviour. Rather, what the research showed was that teens who acknowledged unconventional music preferences, such as teenage girls who acknowledged a preference for hard rock and heavy metal music, were more likely to also acknowledge having engaged in suicidal behaviour than those with more conventional preferences.

Certain types of music do not necessarily cause teens to resort to suicide. Rather, music preference may be seen to reflect how connected an individual feels to mainstream interests, ideals and values. Connection to the mainstream plays an important role in regulating emotions and behaviours. When a teen feels disconnected from the mainstream they are at-risk of feeling isolated and alone and of resorting to unconventional behaviours that are not socially-sanctioned to resolve personal difficulties. They may even form new groups or subcultures with other lonely, isolated and disenfranchised individuals, where the behaviour of the new group is not regulated by conventional ideals and standards of behaviour.

Such is what occurs with suicide.

Suicide among teens can be prevented.

Suicide among teens can be prevented by all of us taking active steps to connect with those who are lonely and isolated; by taking the time to engage with them and see the world through their eyes; to communicate understanding of their experiences – their thoughts, their feelings, their interests.

Only then will they feel understood.

Only then will they feel like a valid person.

Only then will they feel connected to something bigger than themselves.

Only then will they confide in others.

Only then will they ask for help.

Only then will they no longer feel alone.

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Therapeutic Foster Care

AAA-Model-of-Therapeutic-CareThe Triple-A Model of Therapeutic Care© is a tripartite model that accounts for the impact of complex developmental trauma in three key areas of psychological functioning:

  • Attachment (science of relationships and social-emotional development)
  • Arousal (psychophysiology of emotion and behaviour activations systems – a.k.a. “Neurobiology of Trauma”)
  • Accessibility to needs provision (science of human behaviour).

The Triple-A Model of Therapeutic Care represents an integration of twenty-five years of endeavour as an applied researcher, clinician, teacher and writer by author and Clinical Psychologist, Colby Pearce.

The Triple-A Model of Therapeutic Care is a step-by-step approach that:

  • Offers children experiences that support the promotion of secure attachment, thereby restoring the foundations for a happy and successful life after experienced abuse and neglect.
  • Offers children experiences that promote feelings of safety in relationships to reduce anxiety proneness and promote new learning and the development of brain structures responsible for thoughtful consideration, planning and effective action.
  • Offers children experiences that facilitate new learning that their needs are understood and important and will be met reliably and predictably through conventional care.

The Triple-A Model of Therapeutic Care is concerned with carer wellbeing and incorporates information and strategies for preventing vicarious trauma (a.k.a. compassion fatigue) among carers of children recovering from abuse and neglect.

The Triple-A Model of Therapeutic Care incorporates a built-in evaluation methodology. Ongoing evaluation shows that implementation of the Triple-A Model of Therapeutic Care results in targeted changes in caregiving behaviour. Children to whom the Triple-A Model of Therapeutic Care is delivered show evidence of:

  • Improved attachment security (they increase their independent play, reflecting an emergent secure base);
  • Reduced arousal (they sleep better, they waken happier, they have fewer emotional outbursts and their outbursts are of shorter duration); and
  • Reduced preoccupation with their needs (they are less demanding/coercive/ preoccupied with needs/wishes).

The Triple-A Model of Therapeutic Care© can be delivered to alternate care programs internationally:

UK/Ireland Consultants:

John Gibson:

Craig Wilkinson:

Tina Hendry:

Robin Barker:

A limited international release of the caregiver handbook for the Triple-A Model of Therapeutic Care is available now for download to your PC or laptop. The Limited Release Handbook for the Triple-A Model of Therapeutic Care is reasonably priced at $30:00 (AUD) and can be accessed internationally (please check exchange rates in your own currency). Upon payment you will receive via download to your PC or laptop a personalised PDF of the handbook.

Buy Now

For more information about Triple-A, contact the author, Colby Pearce, at

For more about Colby’s contribution to international thinking about attachment, resilience, mental health and recovery from child abuse and neglect, please refer to the publication list below.

Pearce, C.M (2012). Repairing Attachments. BACP Children and Young People, 28-32

Pearce, C.M. (2011). A Short Introduction to Promoting Resilience in Children. London:          JKP

Pearce, C.M. (2011). The Comeback Kid. Junior Magazine

Pearce, C.M. (2011) Attached to the Unattached. SEN Magazine

Pearce, C.M. (2010). An Integration of Theory, Science and Reflective Clinical Practice in        the Care and Management of Attachment-Disordered Children – A Triple A Approach.        Educational and Child Psychology (Special Issue on Attachment), 27 (3): 73-86 

Pearce, C.M. (2009) A Short Introduction to Attachment and Attachment Disorder.                   London: JKP

Pearce, C.M., Martin., G., & Wood, K. (1995). Significance of Touch for Perceptions of              Parenting andPsychological Adjustment Among Adolescents. Journal of the Academy          of Child and Adolescent Psychiatry, 34 : 160-167.

Pearce, C.M., & Martin, G. (1994). Predicting Suicide Attempts Among Adolescents. Acta        Psychiatrica Scandinavica, 90 : 324-328.[1]

Pearce, C.M., & Martin, G. (1993). Locus of Control as an Indicator of Risk for Suicidal               Behaviour Among Adolescents. Acta Psychiatrica Scandinavica, 88 : 409-414.

Allison, S., Pearce, C., Martin, G., Miller, K., & Long, R. (1995). Parental Influence,                     Pessimism, and Adolescent Suicide. Archives of Suicide Research, 1 : 229-242.

Allison, S., Powrie, R., Pearce, C., & Martin, G. (1995). Continuing Medical Education in          Marital and Family Therapy: A Survey of South Australian Psychiatrists. Australian              and New Zealand Journal of Psychiatry, 29 : 638-644

Martin, G., Rozanes, P., Pearce, C.M., & Allison, S. (1995). Adolescent Suicide, Depression      and Family Dysfunction. Acta Psychiatrica Scandinavica, 92 : 336-344.

Martin, G., Clarke, M., & Pearce, C.M.. (1993). Adolescent Suicide: Music Preference as an      Indicator of Vulnerability. Journal of the American Academy of Child and Adolescent         Psychiatry, 32 : 530-535.

[1] The findings of this article formed the basis of the assessment process in the video Youth Suicide: Recognising the Signs, produced by the Child Health Foundation as part of a nation-wide education program for GP’s.

Attachment Colby Pearce   Resilience Colby Pearce

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Upcoming presentations in Port Pirie


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What did the man do?


I am fascinated by videos such as these, of otherwise untamed species of animal developing a special bond with humans. I am particularly interested when, as in the case of the video below, the member of the otherwise untamed species could be very dangerous to the human.

I ask that you watch this video and ask yourself the following questions:

  • What kind of care would the man have given to the lion to inspire such affection?
  • Would he have loved and nurtured her or would he have punished her by taking away food and play time and locking her in a smaller enclosure or cage when she did the ‘wrong’ thing?
  • What would this lion do for the man that was in her power to do?

I believe that it is the relationship you have with children that is the most powerful source of influence you have over their behaviour, as well as their wellbeing and adjustment.

Punishment is problematic.

Children respond best when they feel safe and loved.

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Punishment is Problematic

People do not act for no reason.

They may act in response to an idea.

They may act in response to an emotion.

They may act in response to a need that requires satisfaction.

They may act because the way their brain developed impairs their capacity to think before they act in the presence of a trigger (stimulus).

If we accept the truth that people do not act for no reason, then we must similarly accept that when we punish a child for their actions without making any effort to try to understand why they did what they did, we are essentially communicating to them that their thoughts, feelings, needs and biological characteristics are unimportant or invalid. Repeated often enough, the child develops the belief that they are unimportant and invalid.

The consequences of invalidation include behavioural problems, emotional problems, preoccupations with needs and a lack of regard for the impact of one’s behaviour on others.

We can avoid perpetuating maladaptive behaviour in children by responding with understanding and gently teaching them a different way.

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Parental Trust Post Trauma

Parental “trust” post-trauma

What follows is an allegory that forms part of how I help young people understand parental care and protection and reframe “they no longer trust me” narratives following a traumatic event.

This is a story about a little dog who lived with a family much like yours and mine.

The family of the little dog lived in a conventional house on a conventional block in a conventional street.

The family was devoted to the little dog and it to them.

The little dog enjoyed freedom of movement inside and outside of the family home and never strayed from the property. Such was the trust of the owners of the little dog, the gate to the property was typically left open.

One day a neighbour’s dog strayed into the property where the little dog lived, cornering it in the front yard. The neighbour’s dog was large and aggressive. Frightened, for the first time in its life the little dog ran from the property of its owners. It was some hours before the little dog was found by a kindly stranger and returned to its family.

Thereafter, for a time, the owners of the little dog kept the gate to their property closed; not because they did not trust the little dog, but because they wanted to ensure that the neighbour’s dog did not enter their yard again.

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An Ode to Recovery from Developmental Trauma

An Ode to Recovery from Developmental Trauma

By Colby Pearce

What happened to me, I cannot tell,

To make me think that life is hell.

That drugs and alcohol must stay,

To take the fear and pain away.

And artifice, my friend inside,

to help my needs be satisfied.

On you I know I can’t depend,

You make me vulnerable again.


What happened to you, I can say this,

You were a babe when needs were missed.

When world was filled with fear and pain,

When parents left, rare seen again.

When those who took upon your care,

Were one by one led to despair.

And ignorance it sealed your fate,

Admonition, rejection, no abate.


But I know you, I’ve trod your path,

By no means has my life been harsh.

But fate has led to many like you,

And hardship lent understanding too.

And walked with them, so have I done,

And been of aid to more than some.

Through sensitivity, understanding and with fun,

We’ll disperse the clouds to reveal the sun.

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Child Protection Reflections

Some reflections on child protection . . .

The requirement that children be protected from abuse, neglect and interpersonal trauma is conceptually simple and beyond reproach.

Child protection in practice is not-so-simple.

Child protection in practice requires the community to be informed about the ill-effects of child maltreatment on the development and psychological wellbeing of maltreated children. Child protection in practice requires the community to stand against the abuse and neglect of children.

Strong and effective child protection in practice requires a statutory workforce that is well-trained and well-supported. Child protection workers require the knowledge and the tools to properly assess and address matters referred to them on an individual, case-by-case basis. There should be no universal adherence to dogma, such as “family preservation”, “permanency planning” or “solution-based-casework”. These all detract from individualised, informed and thoughtful decision-making.

Strong and effective child protection in practice requires a strong and informed leadership that supports their professional workforce, to the benefit of children who require protection and assistance with recovery from trauma.

Strong and effective child protection in practice requires well-trained and well-supported foster parents. Foster parents are vital to all endeavours to protect children.

Strong and effective child protection in practice requires a professional workforce that is appropriately trained and equipped with strategies to help children recover from abuse and neglect.

Strong and effective child protection in practice requires that we care more about the future of our community than our own contemporary self-interest and strive assiduously for a more sensitive and caring society for our children and grandchildren.

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