Treating Externalizing Behaviors and Intergenerational Trauma Using Parent-Child Interaction Therapy for Toddlers: A Case Study

Abstract

Young children exposed to trauma often present with externalizing behaviors and attachment disruption that reflect early emerging deficits in emotion regulation and caregiver-child co-regulation abilities. Parent-Child Interaction Therapy for Toddlers (PCIT-T) is a dyadic, attachment, and behaviorally based intervention designed for children aged 12-24 months that targets these difficulties through in-vivo caregiver coaching with a focus on strengthening caregiver sensitivity, consistent limit-setting, and secure attachment within the parent-child relationship. Despite strong empirical support for PCIT with trauma-exposed populations, PCIT-T has not yet been examined in the context of complex early childhood trauma and caregiver adverse childhood experiences. This case report describes the use of PCIT-T with a 19-month-old male presenting with clinically significant tantrums, aggression, separation anxiety, and trauma reenactment behaviors following exposure to domestic violence, caregiver substance use, and caregiver instability. Treatment occurred over 27 sessions and focused on improving positive parenting skills, dyadic emotion regulation, and consistent limit-setting. The course of treatment was complicated by frequent disruptions in attendance related to caregiver occupational instability and ongoing psychosocial stressors. Despite these barriers, results indicated improvements in parenting skills, increased child compliance, improved emotional regulation, and enhanced attachment. This case supports PCIT-T as a feasible and appropriate intervention for toddlers exposed to complex trauma, with potential to disrupt intergenerational patterns of dysregulation through modification of caregiver-child interaction processes.