Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population

Abstract

Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.

Distilling Common History and Practice Elements to Inform Dissemination: Hanf-Model BPT Programs as an Example

“…Such work is consistent with the broader movement toward “developmentally lateral extensions” (Carpenter, Puliafico, Kurtz, Pincus, & Comer, 2014 p. 341) of established treatments to children with other presenting issues in the same age range (e.g., Cartwright-Hatton et al, 2011; Waters, Ford, Wharton, & Cobham, 2009). Of relevance to lateral extensions of Hanf-Model BPT programs in particular, ecological systems theory (see Cummings, Davies, & Campbell, 2000 for a review) highlights that the primary context in which normal and abnormal development occurs among young children is the family.…”

“…Whereas treatments for behavior disorders have focused on the critical importance of intervention in early childhood, interventions for childhood internalizing problems have generally targeted older children who have the cognitive and emotional capacity to participate in interventions that target how their thoughts, feelings, and behaviors are interrelated (e.g., Pulifico, Comer, Pincus, 2012). Yet, anxiety and depression do affect young children and the early onset of internalizing symptoms, in turn, tends to be associated with more protracted illnesses in adolescence and adulthood (e.g., Carpenter et al, 2014; Hammen, Brennan, & Kennan-Miller, 2008; Luby, Belden, Pautsch, Si, & Spitznagel, 2009). Moreover, internalizing problems tend to co-occur with behavior disorders in young children (Angold & Costello, 1993; Birmaher et.…”

“…al., 1996; Fanti & Henrich, 2010), suggesting that the potential for treatment to target multiple symptom clusters would be more cost-effective for families. As such, Hanf-Model BPT researchers have considered the relevance of using the theory and practice elements that characterize BPT to reshape the parent-child context in which internalizing problems may develop among young children as well (see Carpenter et al, 2014, for a review). For example, there is preliminary data to suggest that Hanf-Model Programs have the capacity to alleviate comorbid symptoms of separation anxiety disorder in children with problem behavior (PCIT; Choate, Pincus, Eyberg, Barlow, 2005; Pincus, Santucci, Ehrenreich, 2008; Herman, Borden, Reinke, & Webster-Stratton, 2011).…”

The Role of BIS Sensitivity in the Relationship Between Family Enmeshment and Child Anxiety

“…Additionally, the robust relationship between BIS sensitivity and anxiety resulting from our study, in combination with our finding that family enmeshment was no longer significantly related to child anxiety when BIS sensitivity was included as a mediator, suggests that interventions designed to decrease BIS activity are important when focusing on the reduction of anxiety in youth. Interventions like the ''Turtle Program'' (a program that assists parents in developing behaviors that support decreased BI in children), may work toward effectively attenuating youth BIS sensitivity (Carpenter et al 2014).…”

The development and evaluation of a natural helpers' training program to increase the engagement of urban, Latina/o families in parent-child interaction therapy

“…PCIT is a parent training program with strong evidence of efficacy in treating young children with conduct problems along with a wide range of other emotional and familial concerns (Carpenter, Puliafico, Kurtz, Pincus, & Comer, 2014;Chaffin et al, 2004;McCabe & Yeh, 2009). The program is conducted in two phases, the Child-Directed Interaction (CDI) phase is focused on enhancing the parent-child relationship, and the Parent-Directed Interaction (PDI) phase is focused on effective discipline practices (Eyberg & Funderburk, 2011).…”