Abstract
Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions—Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
Briggs-Gowan, M. J., Carter, A. S., Clark, R., Augustyn, M., McCarthy, K. J., & Ford, J. D. (2010). Exposure to potentially traumatic events in early childhood: Differential links to emergent psychopathology. Journal of Child Psychology and Psychiatry and Allied Disciplines, 51(10), 1132–1140. https://doi.org/10.1111/j.1469-7610.2010.02256.x.
Carpenter, G. L., & Stacks, A. M. (2009). Developmental effects of exposure to intimate Partner violence in early childhood: A review of the literature. Children and Youth Services Review, 31(8), 831–839. https://doi.org/10.1016/j.childyouth.2009.03.005.
Cary, C. E., & McMillen, J. C. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34(4), 748–757. https://doi.org/10.1016/j.childyouth.2012.01.003.
Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2006). Fostering secure attachment in infant in maltreating families through preventive interventions. Development and Psychopathology, 18(3), 623–650. https://doi.org/10.1017/S0954579406060329.
Cohen, J. A. , Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed.). Guilford.
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.
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(9), 1228–1235. https://doi.org/10.1097/00004583-199709000-00015.
Cohen, J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma-focused CBT for youth with complex trauma. Child Abuse & Neglect, 36(6), 528–541.
Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577–584. https://doi.org/10.1001/archpsyc.64.5.577.
De Bellis, M. D., & Van Dillen, T. (2005). Childhood post-traumatic stress disorder: An overview. Child and Adolescent Psychiatric Clinics of North America, 14(4), 745–772. https://doi.org/10.1016/j.chc.2005.05.006.
De Young, A. C., Kenardy, J. A., & Cobham, V. E. (2011). Trauma in early childhood: A neglected population. Clinical Child and Family Psychology Review, 14(3), 231–250. https://doi.org/10.1007/s10567-011-0094-3.
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(1), 67–75. https://doi.org/10.1002/da.20744.
U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2022). Child maltreatment 2020. https://www.acf.hhs.gov/cb/data-research/child-maltreatment.
Dunn, E. C., Nishimi, K., Powers, A., & Bradley, B. (2017). Is developmental timing of trauma exposure associated with depressive and post-traumatic stress disorder symptoms in adulthood? Journal of Psychiatric Research, 84, 119–127. https://doi.org/10.1016/j.jpsychires.2016.09.004.
Eyberg, S., & Funderburk, B. (2011). Parent-child interaction therapy protocol. PCIT International.
Eyberg, S. M., Funderburk, B. W., Hembree-Kigin, T. L., McNeil, C. B., Querido, J. G., & Hood, K. K. (2001). Parent-child interaction therapy with behavior problem children: One and two year maintenance of treatment effects in the family. Child and Family Behavior Therapy, 23(4), 1–20. https://doi.org/10.1300/J019v23n04_01.
Eyberg, S., Boggs, S., & Jaccard, J. (2014). Does maintenance treatment matter? Journal of Abnormal Child Psychology, 42(3), 355–366. https://doi.org/10.1007/s10802-013-9842-9.
Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. L. (2009). Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 124(5), 1411–1423. https://doi.org/10.1542/peds.2009-0467.
Gurwitch, R. H., & Warner-Metzger, C. M. (2022). Trauma-directed interaction (TDI): An adaptation to parent-child interaction therapy for families with a history of trauma. International Journal of Environmental Research and Public Health, 19, 6089. https://doi.org/10.3390/ijerph19106089.
Hankerson, S. H., Moise, N., Wilson, D., Waller, B. Y., Arnold, K. T., Duarte, C., Lugo-Candelas, C., Weissman, M. M., Wainberg, M., Yehuda, R., & Shim, R. (2022). The intergenerational impact of structural racism and cumulative trauma on depression. American Journal of Psychiatry, 179(6), 434–440. https://doi.org/10.1176/appi.ajp.21101000.
Hood, K. K., & Eyberg, S. M. (2003). Outcomes of parent-child interaction therapy: Mothers’ reports of maintenance three to six years after treatment. Journal of Clinical Child and Adolescent Psychology, 32(3), 419–429. https://doi.org/10.1207/S15374424JCCP3203_10.
Jimenez, M. E., Wade, R., Lin, Y., Morrow, L. M., & Reichman, N. E. (2016). Adverse experiences in early childhood and kindergarten outcomes. Pediatrics, 137, e20151839. https://doi.org/10.1542/peds.2015-1839.
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(2), 147–156. https://doi.org/10.1177/1049731514543024.
Lawson, D. M., & Quinn, J. (2013). Complex trauma in children and adolescents: Evidence-based practice in clinical settings. Journal of Clinical Psychology, 69(5), 497–509.
Lieberman, A. F., & Van Horn, P. (2009). Giving voice to the unsayable: Repairing the effects of trauma in infancy and early childhood. Child and Adolescent Psychiatric Clinics of North America, 18(3), 707–720. https://doi.org/10.1016/j.chc.2009.02.007.
Lieberman, A. F., Van Horn, P. J., & 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.
Lieberman, A. F., Ippen, G., 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.). Zero To Three.
Liming, K. W., & Grube, W. A. (2018). Wellbeing outcomes for children exposed to multiple adverse experiences in early childhood: A systematic review. Child & Adolescent Social Work Journal, 35(4), 317–335. https://doi.org/10.1007/s10560-018-0532-x.
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.
McGuire, A., Steele, R. G., & Singh, M. N. (2021). Systematic review on the application of trauma-focused cognitive behavioral therapy (TF-CBT) for preschool-aged children. Clinical Child and Family Psychology Review, 24(1), 20–37. https://doi.org/10.1007/s10567-020-00334-0.
McNeil, C. B., & Hembree-Kigin, T. L. (2010). Parent-child Interaction Therapy (2nd ed.). Springer.
Mersky, J. P., Topitzes, J., Grant-Savela, S. D., Brondino, M. J., & McNeil, C. B. (2016). Adapting parent–child interaction therapy to foster care: Outcomes from a randomized trial. Research on Social Work Practice, 26(2), 157–167. https://doi.org/10.1177/1049731514543023.
Mesman, G. R., John, S. G., Dougherty, E. H., Edge, N. A., Pemberton, J. L., Vanderzee, K. L., & McKelvey, L. M. (2021). Sleep as a moderator of young children’s traumatic stress and behavior problems: A treatment-referred sample. Journal of Child & Adolescent Trauma, 14(3), 311–319. https://doi.org/10.1007/s40653-020-00318-w.
Milot, T., Ethier, L. S., St-Laurent, D., & Provost, M. A. (2010). The role of trauma symptoms in the development of behavioral problems in maltreated preschoolers. Child Abuse & Neglect, 34(4), 225–234. https://doi.org/10.1016/j.chiabu.2009.07.006.
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(4), 455–468. https://doi.org/10.1007/s10802-008-9283-z.
National Child Traumatic Stress Network (2012). Child-parent psychotherapyhttps://www.nctsn.org/sites/default/files/interventions/cpp_fact_sheet.pdf.
Patterson, G. R., Capaldi, D., & Bank, L. (1991). An early starter model for predicting delinquency. In D. Pepler & R. K. Rubin (Eds.), The development and treatment of childhood aggression (pp. 139–168). Erlbaum.
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 and Policy, 4(2), 204–213. https://doi.org/10.1037/a0022948.
Rae, T., & Zimmer-Gembeck, M. (2007). Behavioral outcomes of parent-child interaction therapy and triple p – positive parenting program: A review and meta-analysis. Journal of Abnormal Child Psychology, 35(3), 475–495. https://doi.org/10.1007/s10802-007-9104-9.
Scheeringa, M. S., & Zeanah, C. H. (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of disorders in preschool children and their caregivers following hurricane Katrina. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 508–518. https://doi.org/10.1080/15374410802148178.
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.
Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., & Amaya-Jackson, L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 37(1), 156–183. https://doi.org/10.1080/15374410701818293.
Sprang, G., Craig, C. D., Clark, J. J., Vergon, K., Tindall, M. S., Cohen, J., & Gurwitch, R. (2013). Factors affecting the completion of trauma-focused treatments: What can make a difference? Traumatology, 19(1), 28–40. https://doi.org/10.1177/1534765612445931.
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(4), 486–503. https://doi.org/10.1891/0886-6708.25.4.486.
van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35, 401–408. https://doi.org/10.3928/00485713-20050501-06.
Vanderzee, K. L., Sigel, B. A., Pemberton, J. R., & John, S. G. (2019). Treatments for early childhood trauma: Decision considerations for clinicians. Journal of Child & Adolescent Trauma, 12(4), 515–528. https://doi.org/10.1007/s40653-018-0244-6.
Wamser-Nanney, R., & Steinzor, C. E. (2016). Characteristics of attrition among children receiving trauma-focused treatment. Psychological Trauma: Theory Research Practice and Policy, 8(6), 745. https://doi.org/10.1037/tra0000143.
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(5), 675–690. https://doi.org/10.1007/s10566-016-9350-5.
Warren, J. M., Halpin, S. A., Hanstock, T. L., Hood, C., & Hunt, S. A. (2022). Outcomes of parent-child Interaction Therapy (PCIT) for families presenting with child maltreatment: A systematic review. Child Abuse & Neglect, 134, 105942.
Weiner, D. A., Schneider, A., & Lyons, J. S. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31(11), 1199–1205. https://doi.org/10.1016/j.childyouth.2009.08.013.
Werba, B. E., Eyberg, S. M., Boggs, S. R., & Algina, J. (2006). Predicting outcome in parent-child interaction therapy: Success and attrition. Behavior Modification, 30(5), 618–646. https://doi.org/10.1177/0145445504272977.
Woolgar, F., Garfield, H., Dalgleish, T., & Meiser-Stedman, R. (2022). Systematic review and Meta-analysis: Prevalence of posttraumatic stress disorder in trauma-exposed preschool-aged children. Journal of the American Academy of Child and Adolescent Psychiatry, 61(3), 366–377. https://doi.org/10.1016/j.jaac.2021.05.026.
Yehuda, R., Halligan, S. L., & Grossman, R. (2001). Childhood trauma and risk for PTSD: Relationship to intergenerational effects of trauma, parental PTSD, and cortisol excretion. Development and Psychopathology, 13(3), 733–753. https://doi.org/10.1017/S0954579401003170.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Competing interests
The authors have no relevant financial or non-financial interests to disclose.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Smith, A.B., Cooley, D.T., Mesman, G.R. et al. Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments. Journ Child Adol Trauma 16, 839–852 (2023). https://doi.org/10.1007/s40653-023-00573-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40653-023-00573-7