Skip to main content

Advertisement

Log in

Treatments for Early Childhood Trauma: Decision Considerations for Clinicians

  • Evidence based intervention
  • Published:
Journal of Child & Adolescent Trauma Aims and scope Submit manuscript

Abstract

The period from birth to age six represents a time of significant risk for exposure to trauma. Following trauma exposure, children may experience significant negative and lasting psychological, cognitive, and physical effects. Over the last two decades, the demand for and availability of evidence-based treatments (EBTs) for children under the age of six who have experienced trauma has dramatically increased. Three of the most well-supported and widely disseminated EBTs for early childhood trauma are Trauma-Focused Cognitive Behavioral Therapy, Parent-Child Interaction Therapy, and Child-Parent Psychotherapy. Increasingly, clinicians are receiving training in more than one EBT. This paper provides an overview of each intervention; presents clinicians with various child, caregiver, and environmental factors to consider when deciding amongst these three EBTs; and applies these considerations to three composite cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Bjorseth, A., & Wichstrom, L. (2016). Parent-child interaction therapy (PCIT) in the treatment of young children’s behavior problems: A randomized controlled study. PLoS One, 11, e0159845. https://doi.org/10.1371/journal.pone.0159845.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brestan, E. V., Eyberg, S. M., Boggs, S. R., & Algina, J. (1997). Parent-child interaction therapy: Parents’ perception of untreated siblings. Child & Family Behavior Therapy, 19, 13–28.

    Article  Google Scholar 

  • Campbell, C., Chaffin, M., & Funderburk, B. (2014). Parent-child interaction therapy (PCIT) in child maltreatment cases. In R. Reece, J. Sargent, & R. Hanson (Eds.), Handbook of child abuse treatment (2nd ed.). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Carpenter, A. L., Puliafico, A. C., Kurtz, S. M., Pincus, D. B., & Comer, J. S. (2014). Extending parent-child interaction therapy for early childhood internalizing problems: New advances for and overlooked population. Clinical Child and Family Psychology Review, 17, 340–356. https://doi.org/10.1007/s10567-014-0172-4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chadwick Center for Children and Families. (2004). Closing the quality chasm in child abuse treatment: Identifying and disseminating BEST practices. San Diego: Author.

    Google Scholar 

  • Chadwick Center for Children and Families & Child and Adolescent Services Research Center. (2018). The California Evidence-Based Clearinghouse for Child Welfare. Retrieved May 12, 2018 from http://www.cebc4cw.org/

  • Chaffin, M., Silovsky, J. F., Funderburk, J. F., Valle, L. A., Breston, E. V., Balachova, T., et al. (2004). Parent-child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72, 500–510. https://doi.org/10.1037/0022-006X.72.3.500.

    Article  PubMed  Google Scholar 

  • Chase, R. M., & Eyberg, S. M. (2008). Clinical presentation and treatment outcome for children with comorbid externalizing and internalizing symptoms. Journal of Anxiety Disorders, 22, 273–282. https://doi.org/10.1016/j.janxdis.2007.03.006.

    Article  PubMed  Google Scholar 

  • Chinitz, S., Guzman, H., Amstutz, E., Kohchi, J., & Alkon, M. (2017). Improving outcomes for babies and toddlers in child welfare: A model for infant mental health intervention and collaboration. Child Abuse & Neglect, 70, 190–198. https://doi.org/10.1016/j.chiabu.2017.05.015.

    Article  Google Scholar 

  • Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2000). The efficacy of toddler-parent psychotherapy for fostering cognitive development in offspring. Journal of Abnormal Psychology, 28, 135–148. https://doi.org/10.1023/A:1005118713814.

    Article  Google Scholar 

  • Cicchetti, D., Rogosch, F. A., Toth, S. L., & Sturge-Apple, M. L. (2011). Normalizing the development of cortisol regulation in maltreated infants through preventative interventions. Development and Psychopathology, 23, 789–800. https://doi.org/10.1017/S0954579411000307.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 35(1), 42–50. https://doi.org/10.1097/00004583-199601000-00011.

    Article  PubMed  Google Scholar 

  • Cohen, J. A., & Mannarino, A. P. (1997). A treatment study of sexually abused preschool children: Outcome during one year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1228–1235. https://doi.org/10.1097/00004583-199709000-00015.

    Article  PubMed  Google Scholar 

  • Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004a). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43(4), 393–402. https://doi.org/10.1097/00004583-200404000-00005.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2004b). Treating childhood traumatic grief: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 43(10), 1225–1233. https://doi.org/10.1097/01.chi.0000135620.15522.3.

    Article  PubMed  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Staron, V. R. (2006). A pilot study of modified cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG). Journal of the American Academy of Child and Adolescent Psychiatry, 45(12), 1465–1473. https://doi.org/10.1097/01.chi.0000237705.43260.2c.

    Article  PubMed  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Murray, L. K. (2011). Trauma-focused CBT for youth who experience ongoing traumas. Child Abuse & Neglect, 35, 637–646. https://doi.org/10.1016/j.chiabu.2011.05.002.

    Article  Google Scholar 

  • Cohen, J., Oser, C., Quigley, K., & Stark, D. R. (2013). Nurturing change: State strategies for improving infant and early childhood mental health. Washington D.C.: Zero To Three.

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed.). New York: Guilford.

    Google Scholar 

  • Danko, C. M., Garbacz, L. L., & Budd, K. S. (2016). Outcomes of parent-child interaction therapy in an urban community clinic: A comparison of treatment completers and dropouts. Children & Youth Services Review, 60, 42–51. https://doi.org/10.1016/j.childyouth.2015.11.007.

    Article  Google Scholar 

  • Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1, 310–321. https://doi.org/10.1177/1077559596001004003.

    Article  Google Scholar 

  • Deblinger, E., Steer, R., & Lippmann, J. (1999). Maternal factors associated with sexually abused children’s psychosocial adjustment. Child Maltreatment, 4, 13–20. https://doi.org/10.1177/1077559599004001002.

    Article  Google Scholar 

  • Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). A follow-up study of a multisite, randomized, controlled trial for children with abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1474–1484. https://doi.org/10.1097/01.chi.0000240839.56114.bb.

    Article  PubMed  Google Scholar 

  • Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-focused cognitive behavioral therapy for children: Impact of the trauma narrative and treatment length. Depression and Anxiety, 28, 67–75. https://doi.org/10.1002/da.20744.

    Article  PubMed  Google Scholar 

  • Deblinger, E., Mannarino, A.P., Runyon, M. K., Pollio, E., & Cohen, J.A. (2017). Trauma-focused cognitive behavioral therapy for children in Foster Care: An implementation manual.

    Google Scholar 

  • Dozier, M., Meade, E. B., & Bernard, K. (2014). Attachment and biobehavioral catch-up: an intervention for parents at risk of maltreating their infants and toddlers. In S. Timmer, & A. Urquiza (Eds.), Evidence-based approaches for the treatment of child maltreatment (pp. 43–60). New York, NY: Springer.

  • Enlow, M. B., Blood, E., & Egeland, B. (2013). Sociodemographic risk, developmental competence, and PTSD symptoms in young children exposed to interpersonal trauma in early life. Journal of Traumatic Stress, 26, 686–694. https://doi.org/10.1002/jts.21866.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eyberg, S. M., & Funderburk, B. (2011). Parent-Child Interaction Therapy protocol. Gainesville, FL: PCIT International, Inc.

  • Fantuzzo, J. W., & Fusco, R. A. (2007). Children’s direct exposure to types of domestic violence crime: A population-based investigation. Journal of Family Violence, 22, 158–171. https://doi.org/10.1007/s10896-007-9105-z.

    Article  Google Scholar 

  • Funderburk, B. W., & Eyberg, S. (2011). Parent-child interaction therapy. In J. C. Norcross & G. R. Vanden Bos (Eds.), History of psychotherapy: Continuity and change (2nd ed.). Washington, DC: APA.

    Google Scholar 

  • Gershater-Molko, R. M., Lutzker, J. R., & Welsh, D. (2002). Using recidivism to evaluate project SafeCare: Teaching bonding, safety, and health care skills to parents. Child Maltreatment, 7, 277–285. https://doi.org/10.1177/1077559502007003009.

    Article  PubMed  Google Scholar 

  • Ghosh Ippen, C., Harris, W. W., Van Horn, P., & Lieberman, A. F. (2011). Traumatic and stressful events in early childhood: Can treatment help those at highest risk? Child Abuse and Neglect, 35, 504–513. https://doi.org/10.1016/j.chiabu.2011.03.009.

    Article  PubMed  Google Scholar 

  • Grossman, D. C. (2000). The history of injury control and the epidemiology of child and adolescent injuries. The Future of Children, 10, 23–52.

    Article  Google Scholar 

  • Gurwitch, R. H., Messer, E. P., & Funderburk, B. W. (2017). Parent-child interaction therapy. In M. A. Landolt, M. Cloitre, & U. Schnyder (Eds.), Evidence-based treatments for trauma related disorders in children and adolescents (pp. 341–361). Cham: Springer International Publishing.

    Chapter  Google Scholar 

  • Herschell, A., Calzada, E., Eyberg, S. M., & McNeil, C. B. (2002). Parent-child interaction therapy: New directions in research. Cognitive and Behavioral Practice, 9, 9–16. https://doi.org/10.1016/S1077-7229(02)80034-7.

    Article  Google Scholar 

  • Iwaoka-Scott, A., & Lieberman, A. (2015). Moving from dyads to triads: Implementation of child-parent psychotherapy with fathers. Zero To Three, 35, 18–24.

    Google Scholar 

  • Keiley, M. K., Howe, T. R., Dodge, K. A., Bates, J. E., & Pettit, G. S. (2001). The timing of child physical maltreatment: A cross-domain growth analysis of impact on adolescent externalizing and internalizing problems. Development and Psychopathology, 13, 891–912.

    Article  Google Scholar 

  • Kennedy, S. C., Kim, J. S., Tripodi, S. J., Brown, S. M., & Gowdy, G. (2016). Does parent–child interaction therapy reduce future physical abuse? A meta-analysis. Research on Social Work Practice, 26, 147–156. https://doi.org/10.1177/1049731514543024.

    Article  Google Scholar 

  • Kohlhoff, J., & Morgan, S. (2014). Parent-child interaction therapy for toddlers: A pilot study. Child & Family Behavior Therapy, 36, 121–139. https://doi.org/10.1080/07317107.2014.910733.

    Article  Google Scholar 

  • Kolko, D. J. (1996). Individual cognitive-behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment, 1, 322–342. https://doi.org/10.1177/1077559596001004004.

    Article  Google Scholar 

  • Lieberman, A. F. (1991). Attachment theory and infant-parent psychotherapy: Some conceptual, clinical and research considerations. In D. Cicchetti & S. L. Toth (Eds.), Rochester Symposium on Developmental Psychopathology, Vol. 3. Models and integrations (pp. 261–287). Rochester: University of Rochester Press.

    Google Scholar 

  • Lieberman, A. F., Van Horn, P., & Ghosh Ippen, C. (2005). Toward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44(12), 1241–1248. https://doi.org/10.1097/01.chi.0000181047.59702.58.

    Article  PubMed  Google Scholar 

  • Lieberman, A. F., Gosh Ippen, C., & Van Horn, P. (2015). Don’t hit my mommy: A manual for child-parent psychotherapy with young children exposed to violence and other trauma (2nd ed.). Washington, D. C.: Zero To Three.

  • Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon, M. K., & Steer, R. A. (2012). Trauma-focused cognitive-behavioral therapy for children: Sustained impact of treatment 6 and 12 months later. Child Maltreatment, 17(3), 231–241. https://doi.org/10.1177/1077559512451787.

    Article  PubMed  Google Scholar 

  • McNeil, C. M., & Hembree-Kigin, T. L. (2010). Parent-child interaction therapy (2nd ed.). New York: Springer.

    Book  Google Scholar 

  • Mongillo, E. A., Briggs-Gowan, M., Ford, J. D., & Carter, A. S. (2009). Impact of traumatic life events in a community sample of toddlers. Journal of Abnormal Child Psychology, 37, 455–468. https://doi.org/10.1007/s10802-008-9283-z.

    Article  PubMed  Google Scholar 

  • Murray, L. K., Cohen, J. A., & Mannarino, A. P. (2013). Trauma-focused cognitive behavioral therapy for youth who experience continuous traumatic exposure. Peace and Conflict: Journal of Peace Psychology, 19(2), 180–195. https://doi.org/10.1037/a0032533.

    Article  PubMed  Google Scholar 

  • National Registry of Evidence-Based Programs and Practices (2010). Intervention summary: Child-parent Psychotherapy. Retrieved June 6, 2018 from http://legacy.nreppadmin.net/ViewIntervention.aspx?id=194

  • Osofsky, J. D., & Lieberman, A. F. (2011). A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children. American Psychologist, 66, 120–128. https://doi.org/10.1037/a0021630.

    Article  PubMed  Google Scholar 

  • Osofsky, J. D., Stepka, P. T., King, L. S. (2017). Treating infants and young children impacted by trauma: interventions that promote healthy development. Washington D.C.: American Psychological Association.

    Book  Google Scholar 

  • Pearl, E., Thieken, L., Olafson, E., Boat, B., Connelly, L., Barnes, J., & Putnam, F. (2012). Effectiveness of community dissemination of parent-child interaction therapy. Psychological Trauma: Theory, Research, Practice, & Policy, 4, 204–213. https://doi.org/10.1037/a0022948.

    Article  Google Scholar 

  • Pears, K., & Fisher, P. A. (2005). Developmental, cognitive, and neuropsychological functioning in preschool-aged foster children: Associations with prior maltreatment and placement history. Developmental and Behavioral Pediatrics, 26, 112–122. https://doi.org/10.1097/00004703-200504000-00006.

    Article  Google Scholar 

  • Runyon, M. K., & Deblinger, E. (2014). Combined parent-child cognitive behavioral therapy (CPC-CBT): An approach to empower families at-risk for child physical abuse. New York: Oxford University Press.

    Google Scholar 

  • Saunders, B.E., Berliner, L., & Hanson, R.F. (Eds.). (2004). Child Physical and Sexual Abuse: Guidelines for Treatment (Revised Report: April 26, 2004). Charleston, SC: National Crime Victims Research and Treatment Center.

  • Scarborough, A. A., & McCrae, J. S. (2010). School-age special education outcomes of infants and toddlers investigated for maltreatment. Children and Youth Services Review, 32, 80–88. https://doi.org/10.1016/j.childyouth.2009.07.015.

    Article  Google Scholar 

  • Scheeringa, M. S., Zeanah, C. H., Myers, L., & Putnam, F. W. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 561–570. https://doi.org/10.1097/01.CHI.0000046822.95464.14.

    Article  Google Scholar 

  • Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853–860. https://doi.org/10.1111/j.1469-7610.2010.02354.x.

    Article  PubMed  Google Scholar 

  • Scudder, A. T., Taber-Thomas, S. M., Schaffner, K., Pemberton, J. R., Hunter, L., & Herschell. (2017). A mixed-methods study of system-level sustainability of evidence-based practices in 12 large-scale implementation initiatives. Health Research Policy and Systems, 15, 102–114. https://doi.org/10.1186/s12961-017-0230-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sigel, B. A., Benton, A. H., Lynch, C. E., & Kramer, T. L. (2013). Characteristics of 17 statewide initiatives to disseminate trauma-focused cognitive-behavioral therapy (TF-CBT). Psychological Trauma: Theory, Research, Practice, & Policy., 5, 323–333. https://doi.org/10.1037/a0029095.

    Article  Google Scholar 

  • Silverman, W., Ortiz, C., Viswesvaran, C., Burns, B., Kolko, D., Putnam, F., & Amaya-Jackson, L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child and Adolescent Psychology, 37, 156–183. https://doi.org/10.1080/15374410701818293.

    Article  PubMed  Google Scholar 

  • Stern, D. N. (1995). The motherhood constellation: a unified view of parent-infant psychotherapy. New York: Basic Books.

  • Timmer, S. G., Urquiza, A. J., Zebell, N. M., & McGrath, J. M. (2005). Parent-child interaction therapy: Application to maltreating parent-child dyads. Child Abuse and Neglect, 29, 825–842. https://doi.org/10.1016/j.chiabu.2005.01.003.

    Article  PubMed  Google Scholar 

  • Timmer, S. G., Ware, L. M., Urquiza, A. J., & Zebell, N. M. (2010). The effectiveness of parent-child interaction therapy for victims of interparental violence. Violence and Victims, 25, 486–503. https://doi.org/10.1891/0886-6708.25.4.486.

    Article  PubMed  Google Scholar 

  • Toth, S. L., Rogosch, F. A., Manly, J. T., & Cicchetti, D. (2006). The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: A randomized preventive trial. Journal of Consulting and Clinical Psychology, 74(6), 1006–1016. https://doi.org/10.1037/0022-006X.74.6.1006.

    Article  PubMed  Google Scholar 

  • U.S. Department of Health and Human Services (2018). Child maltreatment 2016. Washington, DC: U.S. Government Printing Office.

  • Ward, M. A., Theule, J., & Cheung, K. (2016). Parent–child interaction therapy for child disruptive behaviour disorders: A meta-analysis. Child & Youth Care Forum, 45, 675–690. https://doi.org/10.1007/s10566-016-9350-5.

    Article  Google Scholar 

  • Ware, L. M., & Herschell, A. D. (2010). Child physical abuse. In C. McNeil & T. Hembree-Kigin (Eds.), Parent-child interaction therapy (2nd ed., pp. 255–284). New York: Springer.

    Google Scholar 

  • Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Mirand, J., Bearman, S. K., et al. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth. Archives of General Psychiatry, 69, 274–282. https://doi.org/10.1001/archgenpsychiatry.2011.147.

    Article  PubMed  Google Scholar 

  • Zero To Three (2016). Michigan’s Pioneer Spirit offers professional opportunities for its early childhood mental health system. Retrieved November 4, 2018 from https://www.zerotothree.org/resources/839-michigan-s-pioneer-spirit-offers-professional-opportunities-for-its-early-childhood-mental-health-system

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karin L. Vanderzee.

Ethics declarations

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vanderzee, K.L., Sigel, B.A., Pemberton, J.R. et al. Treatments for Early Childhood Trauma: Decision Considerations for Clinicians. Journ Child Adol Trauma 12, 515–528 (2019). https://doi.org/10.1007/s40653-018-0244-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40653-018-0244-6

Keywords

Navigation