Can Autistic Children Be Securely Attached?

When my son was an infant, I was fascinated by his every expression. He would drift into heavy trance states, seemingly deep in thought and not quite accessible. He didn’t like to be put down, but when I would come and go, he didn't appear to care or notice. When I gradually returned to work, I was often overwhelmed imagining his sadness at our separations. The projections were agonizing reactivations of my own childhood attachment wounds.

It is in our essential human nature to create intimate emotional bonds and seek proximity to a caregiver when stressed or in danger. All babies attach to their caregivers. The attachment we form in the first year of life to our primary caregivers lays a blueprint for how we approach relationships throughout our lives. It can change over time and can vary in different relationships. As we grow up, we count on our secure attachment figures to be there for us when we explore the world, and we reach for them when we feel threatened, hurt, or in need of comfort.

Securely attached neurotypical children are able to regulate their arousal and self-soothe. In research settings, they display more looking, pointing, and showing objects to their mothers than less securely attached peers (Capps et al., 1994). They show distress when the mother leaves the room, and they can be comforted by her and return to play upon reunion.

It used to be thought that autistic children could not form attachment relationships. This is not true. A systematic review of attachment research with autistic children showed that 47% of the children were classified as securely attached. However, autistic children are less likely to be securely attached than their typically developing counterparts (Teague et al., 2017). Why is this?

Many studies conclude that either 1) autistic “symptoms” and “deficits” impede secure attachment, or 2) the high levels of stress in parenting an autistic child inhibit parental responsiveness. It is important to recognize that both of these views are arrived at by viewing the situation through a neurotypical lens that pathologizes the autistic child or sees them as a burden. It is time to reframe autistic children's attachment behaviors as a unique expression of their different wiring and not a deficit in their neurobiology.

While it may be true that parents have difficulty understanding their autistic children’s attachment behaviors and responding appropriately, if we employ the lens of the double empathy problem, the autistic child may be just as confused by their parent’s behavior. As a reminder, the double empathy problem, developed by social psychologist Damian Milton, posits that communication is a two-way street; ruptures in communication are due not to autistic cognition but to a breakdown in reciprocity and mutual understanding of people who experience the world differently.

Due to different neurotypes, parents and children may have difficulty giving meaning and predicting one another’s behavior, leading to misattunement. However, if parents are educated on how attachment can look different in autistic children, they will be better able to read their baby’s cues and respond more sensitively in turn.

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The work of psychologist Peter Fonagy and his colleagues (1991) shows that parental reflective functioning—the awareness of mental states underlying behavior—is the key to sensitive and attuned parenting and paves the way for secure attachment. The question, however, is whether this holds true for autistic children who have neurobiological differences that make it difficult for synchronicity in the parent-child dyad.

Past research seemed to blame autistic “symptoms” for undermining reflective functioning. Autistic traits such as differences in joint attention or social referencing were seen as obstacles to dyadic synchrony. Autistic children may not make eye contact, may position their bodies differently, or may not seek proximity to their caregiver.

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I want to reposition these “symptoms” as a mutual challenge for the parent and child in understanding one another’s behavior and shared experiences. Since reflective functioning is bidirectional, the challenges in communication between the pair may cause dysregulation. Unfortunately, parents of autistic children often see themselves as incompetent and lose confidence in their parenting abilities.

A better understanding of autistic communication patterns will increase caregivers' sensitivity to their children, creating a positive feedback loop. Knowing, for example, that differences in eye contact or body positioning are just neuro-differences and not signifiers of rejection of maternal affection can help mothers be more responsive, interrupting the negative feedback loop of parents becoming angry, depressed, or distant by reacting to feeling rejected by their children. When autism is identified early, it can help parents learn to understand their children’s behavior, enhance reflective functioning, and respond more sensitively to their baby’s cues.

A study of autistic children by Oppenheim and Koren-Karie (2008) found that the key to securely attached children is maternal insightfulness. This was defined as "the capacity to think about the motives that underlie their child's behavior, to be open to new and unexpected behaviors of the child, to show acceptance of the child's challenging behaviors, and to see the child in a multidimensional way." Insightfulness was unrelated to the severity of the child’s diagnosis or level of support needs. Thus, the objective traits of the child were less important than the mother’s empathy and capacity to enter the child’s point of view.

The study showed that how the child used the adult as a secure base differed from neurotypical dyads. For example, some children showed distress when the mother left and became regulated again when she returned, even though they may not have sought proximity or interaction and may have seemed oblivious on the outside to the mother’s presence. This is a great reminder that while a child may not seem excited to see you, your presence helps the child feel safe and connected. There is no one way to be attached.

As my son got older, when I came home from work, I was never met with “Hi, Mom,” but with the much more predictable “I’m hungry.” In conjunction with his milk obsession, it made me feel like some kind of Pavlovian cow. Stimulus: See mom. Response: Get food/milk. Is it reasonable to see this stimulus/response as a secure reunion where my nurturing presence has made everything in my son’s world right again? I hope so.