(Highest risk if these occur in first two years of life)

  • Sudden or traumatic separation from primary caretaker (through death, illness hospitalization of caretaker, or removal of child)

  • Physical, emotional, or sexual abuse

  • Neglect (of physical or emotional needs)

  • Illness or pain which cannot be alleviated by caretaker

  • Frequent moves and/or placements

  • Inconsistent or inadequate care at home or in day care (care must include holding, talking, nurturing, as well as meeting basic physical needs)

  • Chronic depression of primary caretaker

  • Neurological problem in child which interferes with perception of or ability to receive nurturing.  (i.e. babies exposed to crack cocaine in utero) 


  • A.    Unable to engage in satisfying reciprocal relationship:
            1.    Superficially engaging, charming (not genuine)
            2.    Lack of eye contact
            3.    Indiscriminately affectionate with strangers
            4.    Lack of ability to give and receive affection on parents' terms (not cuddly)
            5.    Inappropriately demanding and clingy
            6.    Persistent nonsense questions and incessant chatter
            7.    Poor peer relationships
            8.    Low self esteem
            9.    Extreme control problems - may attempt to control overtly, or in sneaky ways

  • B.    Poor cause and effect thinking:
            10.    Difficulty learning from mistakes
            11.    Learning problems - disabilities, delays
            12.    Poor impulse control

  • C.    Emotional development disturbed:  child shows traits of young child in "oral stage"
            13.    Abnormal speech patterns
            14.    Abnormal eating patterns

  • D.    Infantile fear and rage.  Poor conscience development.
            15.    Chronic "crazy" lying
            16.    Stealing  
            17.    Destructive to self, others, property
            18.    Cruel to animals    
            19.    Preoccupied with fire, blood, and gore

  • E.    "Negative attachment cycle" in family
            1.    Child engages in negative behaviors which can't be ignored
            2.    Parent reacts with strong emotion, creating intense but unsatisfying connection
            3.    Both parent and child distance and connection is severed