Attachment theory provides an intriguing perspective on possible mechanisms for the development and maintenance of childhood anxiety disorders. Moreover, it is one of the better researched paradigms of parent–child relations, providing the opportunity to test these mechanisms empirically. Evidence linking attachment and childhood anxiety is reviewed to illustrate how attachment and other environmental factors can interact with temperament in the development of anxiety disorders. Such interactions may also contribute to the maintenance of anxiety over time, and to the considerable morbidity associated with childhood anxiety disorders. Informed by an understanding of these interactions, clinical suggestions for working with anxious children and their families are provided.

Attachment theory and anxiety

A brief review of attachment theory is presented below, and theoretical links to anxiety are described for behavioural, cognitive and emotional aspects of the theory.

Attachment theory postulates that to promote survival infants tend to behave in ways that enhance proximity to their caregivers, and caregivers tend to behave reciprocally (Bowlby, 1973). As a result of these tendencies, an interactive system focused on a specific caregiver, usually the mother, develops during the first year of life. When the infant has adequate proximity or contact with the caregiver for a given situation, attachment behaviours subside. When proximity or contact is inadequate, attachment behaviours escalate and compete with other behavioural systems, for example the exploratory system (Bowlby, 1973).

Using an experimental procedure involving two brief separations and reunions between parents and their 1-year-old infants (termed the ‘strange situation procedure’), Ainsworth et al. (1978) were able to classify infant attachments as ‘secure’ (B classification) or ‘insecure’.