There is increasing evidence that “sensitive and responsive care” is the critical dimension of care in ELS models. Multiple studies have demonstrated that it is difficult to elevate cortisol in young children when a parent with whom they have a secure attachment relationship is present. In contrast, infants in insecure relationships appear to have difficulty using their parent’s presence to prevent cortisol increases to emotionally distressing events (Ahnert et al., 2004; Nachmias et al., 1996; Spangler and Schieche, 1998). Notably, infants with disordered/ disorganized (i.e. atypical) attachment relationships are both most at risk for behavioral and emotional problems (Van Ijzendoorn et al., 1999), and are most likely to exhibit more prolonged cortisol elevations to threat (Hertsgaard et al., 1995; Spangler, 1997, but see also Spangler and Grossmann, 1999). Parental sensitivity and responsiveness reduces the probability of disorganized/disordered attachment in high risk infants (Bakermans-Kranenburg et al., 2003; Lyons-Ruth et al., 1987), and months later predicts the capacity of the parent’s presence to buffer toddler cortisol responses to a pain stimulus (Gunnar et al., 1996).
