Columbia University Mailman School of Public Health

Dyadic Treatment

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Introduction

Dyadic Treatment is a form of therapy in which the infant or young child and parent are treated together. A clinician is present with the parent-child dyad, or in a nearby room, and coaches the parent to encourage positive interactions that can help improve parenting, the parent-child relationship, and the child’s behavior. Both the parent and child have the chance to experience more positive ways to interact with each other. There are several evidence-based models of dyadic treatment (e.g., Parent-Child Interaction Treatment and Child-Parent Psychotherapy). Clinicians must receive rigorous training in order to deliver evidence-based dyadic treatment and achieve desired outcomes.

State Profiles that Include Dyadic Treatment

Research Support for Dyadic Treatment

Dyadic therapies involve treatment delivered to a parent and child simultaneously. Several manualized dyadic approaches have shown evidence of effectiveness in treating social-emotional and behavioral problems in young children. Three widely used models are Child-Parent Psychotherapy, Parent-Child Interaction Therapy, and Attachment and Biobehavioral Catch-up (ABC).

Child-Parent Psychotherapy (CPP) (also known as Toddler-Parent Psychotherapy and Infant-Parent Psychotherapy) is for children from birth to five years who have experienced trauma or are at risk of insecure attachment or social-emotional problems. A number of randomized controlled trials have examined the effects of CPP on outcomes. These studies have shown significant improvements in child behavior problems, traumatic stress symptoms, diagnostic status, and mothers’ avoidance symptoms for preschool children and mothers exposed to marital violence,1 particularly for those children who experienced multiple traumatic and stressful life events2; secure attachment3 and cortisol regulation4 for infants in maltreating families; and child avoidance, resistance, and anger, and maternal empathy and engagement for anxiously attached toddlers of Spanish-speaking immigrant mothers.5

Parent-Child Interaction Therapy (PCIT) involves observation and coaching of parent-child interactions and is designed to address externalizing behavior problems for children from two to seven years. A number of studies have examined PCIT effectiveness; a recent research review concluded that this dyadic treatment reduces child externalizing behavior and parent stress and improves parent-child interactions among children with externalizing behavior scores in the clinical range.6

Attachment and Biobehavioral Catch-up (ABC) is a 10-week in-home program designed to support parents to provide nurturing care to children from 6 to 24 months old who have experienced early adversity. ABC providers coach parents and other caregivers during in-person sessions to engage in practices that help children develop attachment, self-regulation, and coping skills. A systematic review of randomized control trials of ABC conducted with populations of children involved in child welfare or foster care found that the program had positive impacts across a number of child outcomes, including fewer problem behaviors, greater positive attachment, and less avoidance.7

Dyadic treatment for depressed mothers and their young children. The availability of dyadic treatment is important because the evidence is still mixed on whether treating maternal depression by itself fully addresses the harms it can cause to children’s development.8 There is evidence that dyadic treatment involving mothers with depression and their children shows positive outcomes for children’s behavior problems and cognitive development, and for parent-child relationships. A study comparing the use of PCIT in depressed and non-depressed mothers and their two- to seven-year-old children with externalizing behavior problems found that both groups showed similar, significant improvements in observed child behavior and parent-child interactions.9 A randomized controlled trial of CPP with non-low-income mothers meeting diagnostic criteria for major depression at some point since the birth of their toddler-age children found positive effects on children’s attachment security10 and cognitive development.11

Promising adaptations. In recent years, researchers have begun to test models of dyadic treatment that involve fewer sessions than traditional models or that deliver the treatment in a group format rather than to a single dyad. A six-week dyadic treatment program for children age one to 10 years, PC-CARE, was found to improve children’s externalizing behavior, improve parenting, and reduce parenting stress across all ages. Coaching and guidance in this intervention are tailored to the age of the children.12 Another study of PCIT delivered in both small groups and individually to parents and children age three to six with conduct problems found that the treatment across the two formats resulted in similar improvements in children’s behavior, parenting, and parent stress.13

References

  1. Lieberman, A. F., van Horn, P., & Ippen, C. G. (2005). Toward evidence-based treatment: Child-Parent Psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child & Adolescent Psychiatry, 44(12), 1241-1248.
  2. Ippen, C. G., 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 & Neglect, 35(7), 504-513.
  3. Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18(3), 623-649.
  4. Cicchetti, D., Rogosch, F. A., Toth, S. L., & Sturge-Apple, M. L. (2011). Normalizing the development of cortisol regulation in maltreated infants through preventive interventions. Development and Psychopathology, 23(3), 789-800.
  5. Lieberman, A. F., Weston, D. R., & Pawl, J. H. (1991). Preventive intervention and outcome with anxiously attached dyads. Child Development, 62(1), 199-209.
  6. Thomas, R., Abell, B., Webb, H. J., Avdagic, E., & Zimmer-Gembeck, M. J. (2017). Parent-Child Interaction Therapy: A meta-analysis. Pediatrics, 140(3), 1-15.
  7. Grube, W. A., & Liming, K. W. (2018). Attachment and Biobehavioral Catch-up: A systematic review. Infant Mental Health Journal, 39(6), 656-673.
  8. Cuijpers, P., Weitz, E., Karyotaki, E., Garber, J., & Andersson, G. (2015). The effects of psychological treatment of maternal depression on children and parental functioning: A meta-analysis. European Child & Adolescent Psychiatry, 24(2), 237-245.
  9. Timmer, S. G., Ho, L. K., Urquiza, A. J., Zebell, N. M., Fernandez y Garcia, E., & Boys, D. (2011). The effectiveness of Parent-Child Interaction Therapy with depressive mothers: The changing relationship as the agent of individual change. Child Psychiatry & Human Development, 42(4), 406-423.
  10. Cicchetti, D., Toth, S. L., & Rogosch, F. A. (1999). The efficacy of Toddler-Parent Psychotherapy to increase attachment security in offspring of depressed mothers. Attachment & Human Development, 1(1), 34-66.

    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.
  11. Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2000). The efficacy of Toddler-Parent Psychotherapy for fostering cognitive development in offspring of depressed mothers. Journal of Abnormal Child Psychology, 28(2), 135-148.
  12. Timmer, S. G., Hawke, B., Forte, L. A., Boys, D. K, & Uquiza, A, J. (2018) An open trial of parent-child care: A six-week dyadic parenting intervention for children with externalizing behavior problems. Journal of Psychiatry and Human Development, 1-12.
  13. Niec, L. N. Barnett, M. L., Prewett, M. S., Chathem, S., Jenelle, R. (2015) Group parent-child interaction therapy: A randomized-controlled trial for the treatment of conduct problems in young children. Journal of Consulting and Clinical Psychology. 84(8), 682-698.