Evidence Based Dyadic Therapies for 0- to 5-Year-Old Children With Emotional and Behavioral Difficulties

Abstract

As many as one in four preschool-aged children are estimated to struggle with psychosocial stress and social-emotional issues; yet, interventions are often postponed until older ages when change is actually more difficult. Reasons for this include limited interventions, paucity of FDA approved medications for young children, as well as the dearth of clinicians adequately trained in psychotherapeutic approaches for young children. This commentary outlines indications of the four most commonly used evidence-based dyadic psychotherapies for young children: Child-Parent Psychotherapy (CPP) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), used primarily for young children with trauma, and Parent-Child Interaction Therapy (PCIT) and Child Parent Relationship Therapy (CPRT), used mostly for children with behavioral issues. Rooted in attachment theory and further supported by the premise that the quality of the child–caregiver dyad is paramount to psychological wellbeing, these therapies focus on strengthening this relationship. Literature indicates that insecure or disorganized early attachments adversely affect an individual’s lifelong trajectory. These therapies have demonstrated efficacy leading to positive behavioral changes and improved parent–child interactions. The major challenges of clinical practice focused on young children and their families include proper diagnosis and determining the best therapeutic strategy, especially for families who have not benefited from prior interventions. At this time, it is still unclear which therapy is best indicated for which type of patients and it mostly has been driven by convenience and provider preference or training. Further research is required to tailor treatments more successfully to the child’s needs.

Current approaches and future directions for addressing ethics in infant and early childhood mental health

“…The evolution of Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood (ZERO TO THREE, 1994, 2005, 2021) strengthened IECMH diagnostic approaches, generated wide interest among professionals, consumers, and health care and policy systems, and is recognized internationally as the essential nosology of infant and early childhood disorders (Zeanah et al., 2021). Additionally, there are a wide range of evidence‐based universal, indicated, selective, and treatment interventions (McLuckie et al., 2019; National Child Traumatic Stress Network [NCTSN], n.d.; Shafi et al., 2019) and a number of approaches aimed at a variety of systems including pediatric primary care (e.g., Gleason, 2019), the child welfare (e.g., Lewis et al., 2022; Youth Law Center, 2020) and juvenile court systems (e.g., Fischer et al., 2020; Osofsky & Lieberman, 2011; Oxford et al., 2016), and child care and early education (Conners‐Burrow et al., 2013; Trigg & Keyes, 2019).…”

Cognitive-Behavioral Play Therapy and COVID-19 Pandemic Trauma in Preschool Children

“…Other programs in children and adolescents include client-centered play therapy, eye movement desensitization and reprocessing (EMDR) [ 23 ], kid narrative exposure therapy (KIDNET) [ 38 ], Support for Students Exposed to Trauma (SSET) [ 39 ], and Trauma Grief Component Treatment (TGCT) [ 40 ]; however, these programs are still experimental. It is clear that evidence-based approaches for preschoolers and evidence-based psychotherapy for coping with trauma in preschool children are not too broad (child-parent psychotherapy (CPP) [ 41 ], TF-CBT [ 4 , 36 , 42 ], and play therapy). Meta-analyzes and systematic reviews, RCTs, quantitative and experimental surveys, and qualitative studies support the use of play therapy in children aged 3-12 years [ 43 ].…”

“…Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy for coping with trauma in adults, adolescents, and young children [35][36][37]. Other programs in children and adolescents include client-centered play therapy, eye movement desensitization and reprocessing (EMDR) [23], kid narrative exposure therapy (KIDNET) [38], Support for Students Exposed to Trauma (SSET) [39], and Trauma Grief Component Treatment (TGCT) [40]; however, these programs are still experimental.…”

Postpartum Depression—Identifying Risk and Access to Intervention

“…Evidence-based interventions such as dyadic psychotherapies focusing on the caregiver-child relationship (e.g., Circle of Security, Parent-Child Interaction Therapy, Child-Parent Psychotherapy, and Trauma-Focused CBT) and home visiting programs such as Attachment and Biobehavioral Catch-Up, have been shown to have positive impacts to attachment and parent-child outcomes [51,60,61]. In the identification of peripartum depression, identifying high-risk dyadic relationships and offering targeted approaches to psychotherapy can help to abort intergenerational cycles related to depression, anxiety, and trauma.…”