attachment in adoption

Since my daughter, my brother and I are all adopted I was very interested in researching the topic of attachment.I foolishly thought adopting would be easier for me as I was adopted. After my daughter came home  I struggled for  years to attach with her as she was angry and grieved her many losses. We also have opposite personalities.  I took the struggles as a personal failure and did not find much understanding or sympathy in my family or friends. I tried many specialists and counselors - who did not help,and found little information or assistance on adoption websites. I bought and read many books.  It took a great toll on my marriage as well. I know that there must be others who are going through the same struggles and I wish to say it was through prayer, hope and time that I finally realized that this biggest challenge of my life was  just meant to be, is getting better over time and is not  due to my personal failure as a mother and a person. The research and writing of this paper for school was also very helpful. I hope that my story can inspire and help others who are going through similar difficulties that my daughter and I faced.

attachment in adoption 


Attachment and Bonding

The term attachment describes the process or end result of a connection between two people. Attachment has two meanings: the first is the reciprocal love and emotion that binds two individuals, and the second is the process that individuals experience in order to reach this connection (Murphy, 2009). Attachment has also been studied in animals. Attachment is seen in romantic love and other relationships, such as those with friends and family members. The terms attachment and bonding are often used interchangeably to define this process and to describe interaction between mothers and their infants.

John Bowlby, a British child psychiatrist, first formally introduced the term attachment in 1958 (Karen, 1998, p. 90). Bowlby described bonding as instantaneous, whereas he felt attachment was better reserved for the description of feelings closer to the complexities found in love (Karen, 1998). Some modern-day theorists refer to the baby’s tie to its mother as bonding and the mother’s tie to her infant as attachment (Lothian, 1999).

There are many theories that attempt to explain how and why people become attached based upon conjecture, science, historical reference, and human and animal studies. Theories on attachment range from neurological, genetic, and biological to psychological (Barry, Kochanska, & Philibert, 2008; Insel, 2000), physiological (Lothian, 1999), social (Barry et al., 2008; Murphy, 2009), and reciprocal (Wolf, 2003). The study of attachment is important because researchers believe that a strong attachment to one’s parent as an infant affects the individual’s self-concept, social skills, and coping mechanisms later in life (Willinger, Diendorfer-Radner, Willnauer, Jörgl, & Hager, 2005). Thus, the study of attachment and bonding between biological mothers and their infants and the study of attachment in general can be helpful in facilitating attachment and bonding between adopted children and their parents. 


According to Walker and Avant (2005), the purpose of the concept analysis is to narrow the focus and concentrate on the reason the concept analysis is valuable. In a broad sense, attachment is a valuable concept to study because it affects quality of life (Karen, 1998; Lothian, 1999; Murphy, 2009; Willinger et al., 2005). The purpose of this analysis is to understand more clearly and completely how attachment is formed. This knowledge can be used to create and sustain a stronger, more lasting bond between the adopted child and parent. A strong attachment between parent and child will be beneficial both now and later as the child matures into an adult. 

Uses of the Concept

Walker and Avant (2005) suggest that both implicit and explicit uses of the term be identified. (n.d.) dates the term to the 1590s and defines attachment as “something that attaches” (para. 3). It further describes the word in relationship terms as a “feeling that binds one to a person, thing, cause, ideal, or the like; devotion; regard” (para. 2). (n.d.) states synonyms for attachment as “fond regard, bond, adherence, adhesion, affixation” (para. 5) and also suggests the words “obligation” or “union.”

There are many theories about attachment as well. Scientifically, it has been seen as neurological or biological (Insel, 2000). It has also been described as deriving from physical proximity, togetherness, and interaction (Lothian, 1999). There has also been a theory that attachment is formed when an individual encounters helplessness or weakness, which would be altruistic in nature (Wolf, 2003). A final theory is that attachment is seen as reciprocal and rooted in mutual affection, irreplaceability, and the need individuals have for social support (Wolf, 2003).

Review of Literature

Attachment Theory

Early theory accepted attachment as something that was preprogrammed genetically. In 1898, Herbert Spencer stated that the instinct to parent begins when an individual encounters helplessness or weakness, which in turn further promotes human and species survival (Wolf, 2003). This theory would be conducive to adoption parenting and bonding to non-genetic offspring. Similar to this is the idea that we are genetically preprogrammed to be attracted to the appearance of an infant, which in turn becomes a type of trigger to a mothering instinct (Van IJzendoorn & Juffer, 2006). This, however, would not be useful to help us understand and explain bonding to non-infant children or attachment between adults.

Further studies in the 1930s focused on what Anna Freud describes as “cupboard-love” (Karen, 1998, p. 89). This was the accepted theory that children and offspring love their parents because they feed them and thus ensure their survival. This theory was not completely accepted, and a number of studies on hospitalized and institutionalized children appeared to prove the opposite. It was not until 1958 that a psychologist at the University of Wisconsin, in a disturbing and now famous study, accidentally found a way to disprove this theory while researching rhesus monkeys (Karen, 1998). Harry Harlow found that when newborn monkeys were taken from their mothers, the monkeys bonded with and attached to a piece of cloth or soft object over the hard utilitarian milk-producing “surrogate.” It was found that if a newborn monkey was unfortunate enough to not have any soft object available in its cage and only milk from a dispenser available, it would wither and die. The monkeys raised with soft terrycloth mothers over real mothers also had difficulty socializing and were unable to parent in adulthood (Karen, 1998).

Another more modern-day theorist, Sarah Hrdy, pointed out that human mothers calculate the risk and the chance for their infants’ survival and make a conscious choice to commit only if they believe the child is a worthy risk that they can afford. This theory was an attempt to explain the position of mothers in some cultures where it is an expected societal norm to give up their infants or children for some sort of family or future gain. She goes on to admit that a mother’s choice can be affected by hormonal changes and close proximity as well as together time immediately after birth (Wolf, 2003).

The theory that attachment is wired into our neurobiology is often supported by studies of other mammals and the anthropological theory that survival of offspring is vital to survival of the species (Insel, 2000; Wolf, 2003). In a scientific study, Thomas Insel (2000) found quantifiable evidence that the hormone oxytocin, which is found only in mammalian brain cells, influenced the actions of mammals to pair-bond and parent offspring. This, however, does not give us as much insight into the reasons and construction behind non-biological parent-child attachment bonds.

More recently, there have been studies on how environment and genetics interact to influence attachment. Barry et al. (2008) found that environment can measurably influence certain individuals with specific genotypes. For example, a person with a specific genetic code has been seen to be more at risk for a number of behavioral and emotional problems, including increased impulsivity, aggressiveness, and risk-taking behavior. In this theory, both nature and nurture work in combination to influence the individual and in turn his or her relationships.

A final theory by anthropologists John Tooby and Leda Cosmides states that love or attachment, including friendship, maternal, family, or romantic bonding, is influenced by the “mutuality of affection rather than unidirectional investment” (Wolf, 2003, p. 545). They view these relationships as psychological and long-term with insurance that social support will most often be vital, reciprocal, and available to individuals throughout their lifetime (Wolf, 2003). It is also believed that desire for companionship and the solace it brings is rooted in human nature (Karen, 1998).

This review of literature found some theories that are widely accepted today and others that may seem antiquated. There may be an aspect of truth found in each theory of attachment; the true meaning of attachment may be found in a combination of them all.  

Defining Attributes

Attachment in Adoption

Walker and Avant (2005) state that the very heart of concept analysis is found in the defining attributes. They point out the characteristics that recur within the analysis help individualize and separate the concept from anything else. All attachment in adoption requires time and effort from both parties involved. Thinking through what is necessary for attachment to take place in adoption, a number of attributes can be listed, such as interaction, shared experiences, and exposure, both physical and inter-relational. There is some sort of pleasure or reward involved (Lothian, 1999). Often, the meeting of basic needs such as food, water, clothing, and shelter is involved (Wolf, 2003). Additional attributes include consistency and the ability to focus on each other or the relationship without having to spend a lot of time or effort on the basic needs of survival.  

Model Case

A Mother-Son Bond

            A book written by Michael Lewis based on a true story about a mother and her adopted son was recently made into a movie, The Blind Side. This story is a model case for attachment in adoption. Walker and Avant (2005) write that the model case is a true example that contains all the defining attributes of the concept; in this case, Leigh Anne Tuohy, a white suburban mother, first emotionally and then legally adopted Michael Oher, a struggling black ninth-grade boy attending her daughter’s school. The mother and son formed a strong attachment in spite of the challenge of dealing with racial and social hostility from society and others in their environment (Holmes, 2009). This model case included all of the defining attributes listed above, with the most crucial being interaction, shared experience, reward, and the meeting of basic needs as well as consistency and focus. One attribute found in this case that was not listed was challenge against adversity. This type of stress and adversity could bring the individuals closer or pull them farther apart, depending upon the stability of the bond and the strength of the individuals. 

Contrary Cases

Adoption Termination

Walker and Avant (2005) describe the contrary case as an example of a case that is definitely not the concept. A contrary case that recently made headlines involved a seven-year-old boy renamed Justin who was adopted in the U.S. as a child and returned to Russia not long after. His adoptive mother placed him unaccompanied onto a plane with a note stating, “After giving my best to this child, I am sorry to say that for the safety of my family, friends and myself, I no longer wish to parent this child” (Belkin, 2010, para. 7).

A second contrary case was reported in 2009 when a different adoptive mother relinquished her son, two and a half years old, to another family. This biological mother of five girls made the difficult decision to share her personal story in an article on the New York Times website. She explained that with this adopted son, she was not the parent she knew she could be. She also wrote that even though it was terribly painful, deciding to give her son to a better family and a better mother was the right thing to do (Tedaldi, 2009). There were over 400 comments on the online article in response to her story. A commenter named Barbara stated, “Good lord what really bothers me here is that natural parents who have challenging kids don’t give their kids away, its 24/7 parenting until we die. Why should it be any different with adoption?” (Tedaldi, 2009, comment 17). In response to this comment, another reader named Rin wrote:

I’d like to point out that natural parents DO give their kids away all the time... Furthermore, it’s worth noting that many post-institutionalized children have issues that children raised by parents since birth almost never have (such as coprophagia or attachment disorders), which can make parenting very, very challenging. Parenting securely attached children is a very different ballgame from parenting children who have been institutionalized and have multiple delays. I don’t think this can or should be boiled down to an ‘adopted versus birth’ child issue, but rather an ‘attached versus unattached’ issue… (Tedaldi, 2009, comment 39)

Both of these cases, although very sad, are perfect examples of failure to attach in adoption.


Walker and Avant (2005) state that antecedents are what is necessary prior to and for the concept to take place. For attachment in adoption to take place, it is an obvious deduction that both the parent and the child must be open to the relationship. There must be some sort of desire from each individual to become attached (Belkin, 2009). The individuals must be able to spend the time to be with each other, to focus on each other over and above anything else (Lothian, 1999). It may also be important that the relationship be viewed by both as permanent, without any other alternatives (Belkin, 2010; Tedaldi, 2009).


Walker and Avant’s (2005) definition of consequences is what the concept produces. The consequences of attachment in adoption are a commitment to each other and the relationship that is formed. There is a positive relationship of give and take with a feeling of contentment and reward from the connection (Karen, 1998; Lothian, 1999). Basic physical, social, psychological, and emotional needs are met, which ensures a positive outlook for the child’s future development and future relationships (Lothian, 1999). There will also be separation anxiety seen in the child (Karen, 1998) and feelings of deeper responsibility seen from the parent. The child will be less preoccupied with the birth mother, and the parent will have less grieving for a lost biological child (Murphy, 2009).

One adoptive mother reflecting on her son’s victory in the battle to overcome attachment disorder states:

When my son says I love you, mommy, reaches for me and gives me hugs and kisses, it means more to me than a simple gesture of love. It means life. My son has been given an immense gift; for the rest of his life, he will be able to give and receive love. What greater miracle could anyone ever wish for? (Murphy, 2009, p. 215)

Empirical Referents

Walker and Avant (2005) define empirical referents as actual observable phenomena that display to us that a concept exists. With attachment in adoption, these observable phenomena would include actions and reactions on the part of the parent and child that display happiness, warmth, affection, and empathy toward one another. These would be similar to what is seen between two individuals that care for and love one another. The child would display an automatic response of searching for the parent to share specific experiences—either ones that excite them or make them happy, or ones that upset them and create anxiety (Karen, 1998). Frequent eye contact and the desire to spend time together would also be important. Spontaneous displays of affection like hugs, kisses, and cuddling and positive facial expressions such as smiling and laughing would also fall into the same category (Lothian, 1999). 

Implications for Practice

Theory Significance

According to Chinn and Kramer (2008), to determine the significance of a theory we must question its practical and clinical value. Also, the theory needs to produce a sense of understanding that is valuable in nursing. Natalie Murphy (2009), a master’s-prepared nurse and doctoral student, writes that families who are struggling with attachment issues are in need of professional assistance. She states that between the years 1996 and 2006, 18 unfortunate children perished at the hands of their adoptive parents (Murphy, 2009, p. 213). This is not the only unfortunate and startling statistic: she also writes that 81 children were relinquished by their adoptive parents during the same time frame (Murphy, 2009, p. 213). This is clear proof of the theory’s clinical importance and practicality. Murphy points out that nurses are invaluable in providing assistance to adopting families, and suggests that nurses follow Swanson’s middle range theory of caring as a guide when helping families who are struggling with attachment issues. 

Implications for Research

Attachment does not always take place between biological infants and their parents. Anthropologist Sarah Hrdy notes that throughout human history, mothers have been known to abandon their children, sell or give them away, mutilate them, and even kill them (Wolf, 2003). Fortunately, most would agree that the majority of maternal infant bonds are successful (Wolf, 2003). Biological children, and infants in particular, connect with their mothers through a long pregnancy and subsequent birth, aided by the release of oxytocin, and often by breastfeeding (Lothian, 1999). There are shared, familiar physical features, and the relationship usually grows along with the infant.

This relationship begins quite a distance ahead of the adopted child-parent relationship. Murphy (2009) points out that the adopted family’s very existence develops within the context of loss: the adopted parents’ loss of a biological child and the child’s loss of a birth mother, previous caretakers, and in international adoption, culture and language. This all takes place under the scrutiny of many in society who view adoption as “second best” (Murphy, 2009, p. 211). There has been extensive research on attachment and bonding between biological mothers and their infants, but more research focused on facilitating attachment in adopted families would be extremely beneficial. This research would also help us assist children in alternative situations to bond with their caretakers, such as those being raised by extended family or friends due to a parent’s military absence, illness, or death.  


Handle with Care

Adoption has been seen throughout human history. Similar to altruism, it is a behavior that lacks any easy explanation. The Bible and other religious and historical works contain stories of children abandoned by their parents who were taken in by kind strangers (Van IJzendoorn & Juffer, 2006). Adoption has also been seen in animals. Van IJzendoorn and Juffer (2006) cite that the rearing of another’s young has been observed in more than 120 bird species and over 120 species of mammals (p. 1232). In our modern society, as in our past history, many children are being raised by adults other than their biological parents. Nurses will encounter these non-biological families as well as children and families with bonding and attachment issues. More research on attachment with non-biological children and children other than infants is warranted. This would serve to improve the lives and futures of everyone involved.

Lisa Belkin (2009), a New York Times author, exposes the gravity and complexity that lie before us when dealing with or treating attachment issues:

I think all bonds of love are fragile. They only exist because humans create them from nothing and declare them sacred. They can be bruised and battered and, yes, broken. No relationship exists but for the desire of two people to keep it whole. I think its better to understand that this bond—any bond—needs work and sustenance, rather than to believe that it springs fully formed and invulnerable. (Comment 50)

In conclusion, further research into the concept would only serve to assist families and children, now and in the future. To ignore the value and necessity of further research and education into the topic would be detrimental to individuals, families, and society. As previously noted, adoptive families would not be the only ones to benefit from further research into bonding and attachment. If even one child or family is helped, to paraphrase the adoptive mother previously mentioned, it would be an immense gift for all (Murphy, 2009, p. 215).


Attachment. (n.d.). In unabridged. Retrieved from

Attachment. (n.d.). In Retrieved from

Barry, R. A., Kochanska, G., & Philibert, R. A. (2008). G x E interaction in the organization of attachment: Mother’s responsiveness as a moderator of children’s genotypes. Journal of Child Psychology and Psychiatry, 49(12), 1313-1320. doi:10.1111/j.1469-610.2008.01935.x

Belkin, L. (2009, August 26). Terminating an adoption. New York Times. Retrieved from

Belkin, L. (2010, April 9). Shipping an adopted son back to Russia. New York Times. Retrieved from

Chinn, P. L., & Kramer, M. K. (2008). Theory and nursing: integrated knowledge development in nursing (7th ed.). St. Louis, MO: Mosby.

Holmes, L. (2009). ‘The Blind Side’: When a true story is hard to tell. National Public Radio. Retrieved from

Insel, T. R. (2000). Toward a neurobiology of attachment. Review of General Psychology, 4(2), 176-185. doi10.1037//1089-2680.4.2.176

Karen, R. (1998). Becoming attached: First relationships and how they shape our capacity to love. New York, NY: Oxford.

Lothian, J. A. (1999). Questions from our readers: Maternal infant attachment, naturally. Journal of Perinatal Education, 8(4), 8-11. Retrieved from CINAHL database.

Murphy, N. L. (2009). Facilitating attachment after international adoption. The American Journal of Maternal Child Nursing, 34(4), 210-215. Retrieved from CINAHL database.

Tedaldi, A. (2009, August 26). My adopted son. New York Times. Retrieved from

Van IJzendoorn, M. H., & Juffer, F. (2006). Adoption as intervention: Meta-analytic evidence for massive catch-up and plasticity in physical, socio-emotional, and cognitive development. Journal of Child Psychology and Psychiatry, 47(12), 1228-1245. doi:10.1111/j.1469-7610.2006.01675.x

Walker, L. O., & Avant, K. C. (2005). Strategies for theory construction in nursing (4th ed.). Upper Saddle River, NJ: Prentice-Hall.

Willinger, U., Diendorfer-Radner, G., Willnauer, R., Jörgl, G., & Hager, V. (2005). Parenting stress and parental bonding. Behavioral Medicine, 31, 63-69. Retrieved from CINAHL database.

Wolf, A. P. (2003). Maternal sentiments: How strong are they? Current Anthropology, 44, 31-48. Retrieved from CINAHL database

Make a free website with Yola