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Each intervention focuses on enhancing parents’ ability to identify and respond to the infant’s cues and to meet the infant’s emotional needs.All interventions use infant–parent interactions in vivo or through video to demonstrate the infant’s cues and opportunities to meet them.
In infants and toddlers, the empirically supported therapy enhances parent–child relationships, attachment security, child cognitive functioning, and normalization of cortisol regulation.
For infants and toddlers who have been adopted internationally, those in foster care, or those thought to be at high risk of maltreatment because of exposure to domestic violence, homelessness, or parental substance abuse, the Attachment and Biobehavioral Catch-Up caregiver training supports caregivers in developing sensitive, nurturing, nonfrightening parenting behaviors.
One model developed specifically for the pediatric primary care setting is the Video Interaction Project, in which parents are paired with a bachelor’s-level or master’s-level developmental specialist who uses video and educational techniques to support parents’ awareness of their child’s developmental needs.
Acknowledging that early preventive interventions are an important component of a system of care, the body of this technical report focuses on treatment of identified clinical problems rather than children at risk because of family or community factors.
The evidence supporting family-focused therapeutic interventions for children with clinical-level concerns is robust, and these are the first-line approaches for young children with significant emotional and behavioral problems in most practice guidelines.
Generally, these interventions take an approach that focuses on enhancing emotional and behavioral regulation through specialized parenting tools and approaches.Effective treatments exist to address early clinical concerns, including relationship disturbances, attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorders, anxiety, and posttraumatic stress disorder.Measured outcomes include improved attachment relationships, symptom reduction, diagnostic remission, enhanced functioning, and in one study, normalization of diurnal cortisol release patterns, which are known to be related to stress regulation and mood disorders.Many family, individual, and community risk factors for adverse emotional, behavioral, and relationship health outcomes, including low-income status, exposure to toxic stressors, and parental mental health problems, can be identified early using systematic surveillance and screening.An extensive review of established prevention programs for the general population and identified children at high risk are described in the Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Report of Evidence-Based Programs and Practices ( Search.aspx).These clinical presentations can be distinguished from the emotional and behavioral patterns of typically developing children by their symptoms, family history, and level of impairment and, in some disorders, physiologic signs.Emotional, behavioral, and relationship disorders rarely are transient and often have lasting effects, including measurable differences in brain functioning in school-aged children and a high risk of later mental health problems.On the other hand, rigorous support for psychopharmacologic interventions is limited to 2 large randomized controlled trials.Access to psychotherapeutic interventions is limited. The pediatrician has a critical role as the leader of the medical home to promote well-being that includes emotional, behavioral, and relationship health.Some explicitly focus on enhancing parents’ self-reflection and increasing awareness of how their own upbringing may influence their parenting approach.Child Parent Psychotherapy and its partner Infant Parent Psychotherapy are derived from attachment theory and address the parent–child relationship through emotional support for parents, modeling protective behaviors, reflective developmental guidance, and addressing parental traumatic memories as they intrude into parent–child interactions.