This is the second of three posts looking at building resilience in children. Resilience is measured through such tests as delay discounting, where a child is able to resist a reward now in exchange for a larger reward later, and impulsivity, or the inability to restrain one’s self or a lack of self-control.

Problems with self-regulation can appear very early in life. Infants can demonstrate a lack of interest in their world as well as an inability to calm down. Efforts to improve behavior also begin early in life, and lessons about building resilience in children can start very young.

Just this week, BMC Psychology published the results of a randomized-controlled trial of interventions with 90 toddlers aged 12-24 months presenting with parent-reported “challenging behaviors,” most often “tantrums” along with aggression and non-compliance. One-third were assigned to a waitlist where they acted as a control group. One-third were given “Circle of Security-Parenting,” video-based group therapy described as “an active control condition.” One-third were given individualized Parent-Child Interactive Therapy (PCIT).

The international team of researchers conducting the study was led by psychiatrist Jane Kohlhoff at the School of Clinical Medicine, University of New South Wales, in Australia, and included researchers from West Virginia University in Morgantown and the University of Florida in Gainesville. The researchers focus on attachment theory as a source of problem behaviors, citing:

[…] a large body of evidence documenting longitudinal links between insecure and disorganised attachment in infancy/toddlerhood and a range of social-emotional, mental health and functional outcomes in middle childhood and adolescence.

Attachment theory traces many of the problems of self-regulation in children to dysfunctional attachment in infancy: “insensitive, unresponsive, or inconsistent caregiving.” The interventions developed for toddlers focus on “enhancing parenting sensitivity to the child’s emotional needs.” PCIT was developed for older children and has recently been adapted for toddlers.

PCIT involves play sessions with the toddler, the caregiver, and a therapist. The therapist is usually behind a one-way mirror communicating in real time with the caregiver over an in-ear microphone. Before and after each session, the therapist works to enhance “parental reflectiveness” and to stress positive reinforcement over negative reinforcement in helping improve toddler behavior.

Caregivers also learn how to regulate their own emotions such as frustration, anger, irritability, and impatience. They learn how to see their own emotional state, label it, and take self-calming measures such as counting, deep breathing, guided visualization, and relaxation. Toddlers play games that promote listening skills and support reasoning skills including “telling,” “showing,” and “trying again.”

Early trials of PCIT for toddlers “showed statistically and clinically significant improvements in parental verbalizations (e.g., increased praise, decreased criticism) and child behavior (e.g., decreased externalizing behaviors, increased compliance) following the intervention, reductions in parental depressive symptom severity, and high levels of consumer satisfaction.” That led to further trials which also showed improvement, plus follow-ups on earlier trials showing gains lasting over time.

The Australian study is the first randomized, controlled trial of PCIT for toddlers compared with both a waitlist and COS-P, a “facilitator-led, eight-session parent-education group program that uses archived clinical video footage of problematic parent-child interaction and healthy alternatives to illustrate attachment patterns and parenting styles and promote group discussion.” COS-P was intended to deliver 16 hours of therapy through eight weekly 90-minute sessions. However, half the COS-P group dropped out and the mean number of sessions attended for those who finished was six, resulting in less than 12 hours of therapy on average.

The PCIT for toddlers involved an introductory lesson, 6-8 play sessions with a live coach, and 2-4 live play sessions focused on toddler listening skills. The PCIT training had far fewer dropouts, with 24 of 30 completing the program. The researchers did not report any dropouts from the waitlist of 30, who were assessed at both the start and end of the eight-week period.

Outcomes for toddlers were measured in four different areas:

• Child social-emotional functioning
• Child attachment security
• Toddler emotion-regulation maturity
• Problematic child behaviors

The researchers found that the PCIT for the toddlers group was:

[…] the only group to show significant within-group improvements in sensitivity, self-reported parental reflectiveness, empathy and emotional understanding, parent-reported child social competence, child internalizing problems, and general behavior issues.

PICT also benefited the caregivers. The researchers concluded, “PCIT helps parents to develop and use positive parenting skills, increase parenting sensitivity, and enhance reflective functioning.”

Tomorrow, we’ll conclude our brief trilogy of articles on building resilience in children.

Written by Steve O’Keefe. First published November 26, 2024.

Sources:

“Optimizing parenting and child outcomes following parent-child interaction therapy — toddler: a randomized controlled trial,” BMC Psychology, November 22, 2024.

Image Copyright: anoushkatoronto.