The authors used a longitudinal design to investigate the relationship between extreme parental neglect and quality of attachment in infants.

The sample consisted of 267 participants who were categorised into three groups: a neglect group, consisting of 31 mothers who were characterised as neglectful or abusive towards their infants (violence, poor physical care, unsanitary conditions, exposure to hazards); an excellent care group, containing 33 mothers who offered their infants a high standard of care; and the remaining sample, which consisted of 145 mother-infant pairs at time 1 and 130 at time 2. Quality of maternal caregiving was assessed using the Child Care Rating Scale, and Attachment was measured using the Strange Situation Procedure at 12 and 18 months. Changes in family circumstances between the two periods were also examined.

At both times of testing, the excellent care group contained the largest and the neglectful group the smallest number of securely attached infants. Of the 34 mothers in the overall sample who returned to work by the time their infant was 11 months or age, 17 (50%) had infants who were classified as anxious/avoidant at 12 months.

Different patterns of care were associated with infants classified as avoidant or resistant, and who had neglectful or abusive mothers. The mothers of infants classified as anxious/avoidant tended to be more abusive than neglectful. Many of them lacked the basic skills to care for their infants. In contrast to this, mothers of infants classified as anxious/resistant tended to be more neglectful than directly abusive. Levels of care for these children were dependent on the prevailing mood of the mother, some of whom were heavy drug users, and they tended to only interact with their infants when it was necessary. Generally, these mothers had the skills to care for their children but, for a variety of reasons, showed a tendency to withdraw from them. Of all the mothers in the sample, these had the most chaotic lives and the least support from their families.

A substantial change in distribution of attachment was observed for infants of neglectful mothers between 12 and 18 months, with a shift in emphasis from avoidance to resistance. While this may be due to a maturational lag in this group, it is also consistent with the hypothesis that infants receiving inconsistent care will succeed in their efforts to obtain attachment security from the mother or give up and become avoidant.

Some anecdotal evidence was reported that indicated that increased provision of support by family members, or an increasingly stable life for the mother, were associated with changes towards secure attachment for their infants.