Robbie Duschinsky (University of Cambridge) reflects on parenting a profoundly unwell and disabled child whilst undertaking research and writing about attachment.
01 August 2025
Ibegan conducting research addressing child-caregiver attachment relationships in 2012. A few years later, things settled down for my wife Sophie and I in our jobs, and we felt it was time to start a family. I felt positive about becoming a dad, and reassured by what I had learnt from attachment theory and research. I understood about the importance of being available to offer support for a child when they wanted to explore (a 'secure base'); and to offer them help and comfort when they were distressed (a 'safe haven'). This is what attachment researchers called a 'secure attachment'. I doubted I'd be anything like a perfect parent, but that did not seem to be especially the point. Someone my child could trust – I thought that sounded possible.
The next few years were hard. Sophie and I celebrated the start of three pregnancies, only for each to end in miscarriage. Miscarriage is not so uncommon, and I remained hopeful, though these losses weighed on both of us.
In 2019, following a fourth pregnancy, our daughter A was born. However, it soon became clear that she was seriously unwell. We received news of our daughter's diagnosis of a very rare and serious genetic condition over the phone the day that lockdown began. The severity of the condition can vary. For A it has meant profound intellectual disability, long-term struggles with nutrition, and impairments in communication and mobility. Most immediately, she was in pain 16-20 hours a day for her first few years. Coinciding with the pandemic, lockdowns and huge healthcare backlogs, Sophie and I were largely on our own with our sick daughter, with limited access to help.
In 2021, A began having seizures, which did not respond well to medication, and since that time she has needed continuous monitoring day and night. At that time, she lost the ability to vocalise, eat, drink, walk, play with toys, smile, or even routinely recognise us. Now, heading towards her sixth birthday, some of these skills have returned, such as her smile and increasingly her ability to recognise us. Many skills remain partially or wholly lost.
Through A's early years, and still today to an extent, I faced a daily battle with feelings of hopelessness and heartbreak. In this context, something that made a profound difference was my work on attachment theory and research. Thinking about, researching and writing about attachment helped me retain a sense that whilst the situation could feel impossible, it did not mean that it actually was impossible. Sophie and I couldn't stop A being ill. But attachment research gave some indications of where we could start in trying to parent our daughter.
A lot of well-meaning nonsense and hazy generalities are circulated about attachment. Inaccurate information is so much easier to come by than accurate information – it's wild. But attachment theory and research has also generated some recommendations for parents, supported by researcher consensus as well as experimental evidence from attachment-based interventions. My experiences have given me an urgent sense of the value of some of these key messages. I have tried to make these accessible in my books, and especially in one for students and general readers called The Psychology of Attachment, written with my friends and colleagues Pehr Granqvist and Tommie Forslund.
The challenges A faced were extreme and rare. But the recommendations of attachment theory and research still had bearing for Sophie and I, maybe even more so given our daughter's suffering and need for comfort. The focus of this article is on the ideas I found helpful in giving some sense of how to proceed with A's care. I close by bringing the reader up to the present, thinking about what I have learnt from these experiences, and how these lessons have shaped me as a parent to A's little sister, as a co-parent with my wife Sophie, and also as a researcher.
Providing a safe haven
An early and important source of help for Sophie and I as parents was the idea of the caregiver as a 'safe haven'. By this attachment researchers mean that when a child is distressed, they are disposed to seek a familiar caregiver with the expectation of help and protection. Touch and comfort from a familiar adult, these basic things, help an infant to re-find equilibrium. Older children can get the same reassurance by other indications of the caregiver's availability. Even as adults we are still disposed to look for comfort when we are distressed, unless we have learnt that this will backfire.
In being available when a child is distressed, a caregiver gradually helps the child learn to trust, and to cope with difficult feelings (Ainsworth, 1985). The extent of security of each close relationship makes an additional contribution to a child's development in these regards, highlighting the importance of caregivers supporting one another in their provision of safe haven availability to a child (Dagan et al., 2021).
Sophie and I could not protect our daughter from pain. However, we could remain with her through it, holding her, and walking her up and down our little flat for unending hours. We could reassure her that she was not alone. We could try to teach her the expectation that when she was distressed, her mum or I would be completely there with her, even if, to our sorrow, we didn't know how to make things better. We could try to support one another with the grief we were feeling.
Attachment theory suggests that caregivers are most readily able to offer a safe haven to their child when they feel themselves supported by their family, community and society (Supkoff et al., 2013). Due to the pandemic and the severity of A's illness, at times we have felt quite abandoned by community and society, with exceptions. We have found it tremendously difficult to access support from health and social care services, who have often been hell-bent on reducing costs or trying to pass responsibility to other services regardless of what this means for A's safety or our family's ability to cope. Some professionals have gone above and beyond to help us. There's been almost no middle ground. Likewise many friends from before we became parents ran in horror at A's suffering and what our lives looked like. But some friends really stepped up to try to look after us, acting towards A like extended family. And since 2024 A has started attending a specialist primary school, which she absolutely loves, and which has reduced pressure on us too.
Attending to our child's signals
Attachment research has a premise that a lot goes on at the level of behaviour that mostly does not get noticed. On this basis, a second recommendation made by the attachment literature was the idea that caregivers can consider their child's actions as having 'signal value' for their experiences and needs (Ainsworth, 1977). The caregiver can be on the look-out for behaviours and vocalisations that might give relevant clues. This will allow the caregiver to accurately identify the child's motivations, and respond to them appropriately and in a timely way. For instance, being able to distinguish signals of tiredness from hunger or pain can be helpful in ensuring that the caregiver is available as a safe haven when needed.
It was very hard to discern A's experiences and needs. For her first years, other signals were often drowned out by pain. Then, with the seizures, she lost much of what capacity she had to communicate her experiences and needs. At times it felt that A was inaccessible to us, for all that she was physically present and required care.
Yet the idea of the child's actions as having 'signal value' suggested that signal might still be found, even if most of A's means of communicating her experiences and needs had been overloaded, blocked or damaged. We began keeping a moment-to-moment diary of everything we thought might have signal value, day and night: what A seemed to pay attention to, when she was capable of attention; bowel movements; coughs; when she fell asleep and woke up; changes in her breathing. Sophie and I worked together to try to interpret these signals.
This level of attention was, and remains, costly. It is exhausting, and comes at the expense of other things. But over time it has helped build our understanding of A's experiences and needs, allowing us to respond to them. We searched for A in these small signals, and in this way, over time, began to identify critical factors for her care, including triggers for pain and for seizures, and other indicators associated with better days for her. We discovered, for instance, that she loved cheesy '90s pop music (e.g. Spice Girls, Aqua), and given the lack of access to medical care, this was what we had available as pain relief for A for her early years.
Sophie and I feel that A acts like someone who believes that we are trying to interpret her signals and to help. On her better days she reaches out for contact, she smiles, and she rarely resists her medical care; she readily forms new relationships with people who are responsive to her cues. A knows we are listening out for her signals; and Sophie and I know that A's signals can be found and trusted. Despite all that we have to bridge in order to achieve this understanding, this sense of mutual trust makes a huge practical and emotional difference to every day of interaction and care.
Avoidance and Emotional Defence
A third point raised by attachment theory and research is that a child's signals of their experiences and needs can be obstructed by the caregiver's own defences (Main & Hesse, 1992), or when a caregiver feels chronically overwhelmed (Cyr et al., 2010). So when a child signals to us, our defences or feelings of overwhelm can hinder us from recognising or responding to these signals.
Attachment theory is sometimes perceived as about categories, putting people into boxes. That's a stereotype and simplification. In reality, we all have tendencies towards particular kinds of defence or dysregulation, tendencies that will be elicited particularly when we are under stress, and shaped and reshaped by the training our life continues to give us in how to cope. Parents, including those of children with additional needs, have our own histories. For me, A's additional needs have confronted me with the limits of my defences, not least from watching them buckle at times from the pressure placed on them.
A's quality of life is frequently not good. But with the passing years it has been generally getting better, and when she is not in pain or dazed by seizures she is a remarkably happy and resilient little person. Even so, perhaps the hardest challenge for me as a parent, my most pervasive defence, has been to bear to try to see things from A's point of view. Whilst able to cognitively attend minutely to signals of her experience and needs, I nonetheless find it aversive to imagine what A's life might be like for her. To go beyond A's signals and what they mean for what I need to do, and try to fully imagine her mind behind those signals.
Attachment theory and research teaches that avoidance is a strategy, one that can be protective when the alternative would be getting overwhelmed and dysregulated. It isn't bad. But avoidant behaviour by carers is penalised by the contemporary health and social care system: our experience has been that unless you are telling professionals repeatedly that you are not coping, help gets stripped away, even when this is manifestly unsafe. Additionally, attachment research regards avoidance as emotionally impoverishing when it is stuck in place. When we barricade ourselves off from the experience of others, this can help us cope, but also risks leaving us feeling empty (Slade et al., 2023).
Over the years I've given this challenge a lot of thought; I've talked about it with Sophie; I've had counselling through our local children's hospice. Though it is hard, I am learning how to use avoidance more flexibly, and try, where I can, to feel out what A's experience might be. The more I do, the more pleasure and pain I receive in being A's parent. As I do, the more A seems to respond to me and engage, even if her forms of engagement remain limited. This would be in line with the idea from attachment theory that exploration is facilitated when a child feels their caregiver's engagement with their experiences (Fonagy & Target, 1997).
The present
In 2022, Sophie and I had another little girl, L, who has been healthy and hilarious. The weight of past experience and day-to-day pressures of A's care has certainly affected me as a parent. As someone who generally thought of himself as quite silly, I can at times barely recognise myself in my parenting behaviour, which can sometimes be flat and exhausted, lacking playfulness.
I struggle especially with the rough play L enjoys, and requests most days: even faced with our firework of a toddler, my hands expect A's vulnerability, and it requires intense concentration to adjust. But Sophie and I also have an intensified sense of the preciousness of L's communications, and confidence in our capacity for teamwork as parents.
I continue to try to learn from attachment theory and research to inform me as a parent. Indeed, I sometimes talk in my head to the attachment researchers I have read or know about my caregiving responsibilities for A; I find this can help with making sense of it all.
In turn, my experiences as a parent have shaped how I have interpreted and undertaken attachment theory and research, and informed my writing about the topic. This has included a sense of wonder at the power of some of the levers available to caregivers: touch, noticing signals, provision of a secure base. I've also gained greater tenderness in considering the challenges caregivers may face in thinking about the mind of their child.
Experiences as A's parent have also given me additional questions. For instance, whereas attachment researchers generally treat 'safe haven availability' as a single thing, I've been brought to think about its different aspects, such as a caregiver's response to indications of pain, distress, fear and incomprehension. I have also become more critical of the limited way that attachment theory and research have addressed the wider context of family life, even when the data was available to do so. I cannot unlearn what I have learnt as a parent about the power of social isolation and failures of health and social care systems, and this has left a decisive mark on me as a researcher.
In Cornerstones of Attachment Research, written before A was born, I wrote of a sense of affection for attachment theory and its 'genuine insights into the strange, drunk-dialling human heart'. For all that I am more critical of attachment theory and research now, I couldn't have possibly known then how precious some of those insights would prove to me when I became a parent.Dr Robbie Duschinsky is Professor of Social Science and Health and Head of the Applied Social Science Group within the Primary Care Unit.
See also our 'parenting' collection.
Key sources and further reading
Ainsworth, M.D.S. (1977) Social development in the first year of life: Maternal influences on infant-mother attachment. In: J. M. Tanner (Ed.) Developments in Psychiatric Research (pp.1-20). London: Hodder & Stoughton
Ainsworth, M. D. (1985). Attachments across the life span. Bulletin of the New York Academy of Medicine, 61(9), 792-812; Goldberg, S. (2000) Attachment and Development, London: Routledge.
Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2025). Attachment in pediatrics: No such thing as a child. In M. H. Bornstein & P. E. Shah (Eds.), APA Handbook of Pediatric Psychology, Developmental-Behavioral Pediatrics, and Developmental Science (pp. 205–226). American Psychological Association.
Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development & Psychopathology, 22(1), 87-108.
Dagan, O., Schuengel, C., Verhage, M. L., et al. (2021). Configurations of mother‐child and father‐child attachment as predictors of internalizing and externalizing behavioral problems: An individual participant data (IPD) meta‐analysis. New Directions for Child and Adolescent Development, 2021(180), 67-94.
Doodeman, T. W., Schuengel, C., & Sterkenburg, P. S. (2023). Effects of the Attune & Stimulate‐checklist for caregivers of people with severe and profound intellectual disabilities: A randomised controlled trial. Journal of Applied Research in Intellectual Disabilities, 36(5), 1136-1149
Dozier, M., & Bernard, K. (2019). Coaching Parents of Vulnerable Infants: The attachment and biobehavioral catch-up approach. New York: Guilford Publications
Duschinsky, R. (2020) Cornerstones of Attachment Research, Oxford: Oxford University Press – free to download from the Oxford University Press website
Duschinsky, R., Granqvist, P., & Forslund, T. (2023). The Psychology of Attachment. London: Routledge.
Duschinsky, R. (2025) Developments in Attachment Research, Oxford: Oxford University Press – free to download from the Oxford University Press website
Fonagy, P. & Target, M. (1997). Attachment and reflective function: Their role in self-organization. Development and psychopathology, 9(4), 679-700
Foster, S.L., Schofield, G., Geoghegan, L., Hood, R., Sagi-Schwartz, A … Duschinsky, R. (2025) Attachment theory and research: What should be on the core curriculum for child and family social workers?. Social Work Education, forthcoming.
Main, M. & Hesse, E. ([1992] 2021). Disorganized/disoriented infant behaviour in the Strange Situation, lapses in the monitoring of reasoning and discourse during the parent's Adult Attachment Interview, and dissociative states. In Tommie Forslund & Robbie Duschinsky (Eds.) Attachment Theory and Research: A Reader (pp.108-132), NY: Wiley.
Mucha, L. (2025). Please Find Attached: How Attachment Theory Explains Our Relationships, London: Bloomsbury
Schuengel, C., & Oosterman, M. (2019). Parenting self-efficacy. In Bornstein M. H. (Ed.), Handbook of parenting: Being and becoming a parent (654–680). London: Routledge
Slade, A (2009). Mentalizing the unmentalizable: Parenting children on the spectrum. Journal of Infant, Child, and Adolescent Psychotherapy, 8(1), 7-21.
Slade, A, Sadler, L. S., Eaves, T., & Webb, D. L. (2023). Enhancing attachment and reflective parenting in clinical practice. Guilford Publications.
Supkoff, L., Puig, J., & Sroufe, L.A (2013). Situating resilience in developmental context. In M. Ungar, The Social Ecology of Resilience. (pp. 127-142). New York: Springer
Berástegui, A, & Pitillas, C. (2024). The family keyworker as a critical element for attachment resilience in the face of adversity. Journal of Family Theory & Review, 16(1), 106-123.
Vandesande, S., Bosmans, G., & Maes, B. (2019). Can I be your safe haven and secure base? A parental perspective on parent-child attachment in young children with a severe or profound intellectual disability. Research in developmental disabilities, 93, 103452.
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