Dyadic attachment-based therapies for infants and young children with mental health problems: a scoping review

Early child-caregiver attachment is foundational to mental health (MH). While prevention efforts often aim to improve attachment quality, clinicians frequently encounter infants and young children already exhibiting clinical symptoms of MH disorders. A comprehensive summary of attachment-based dyadic interventions for this population is lacking. This scoping review aims to address this gap.

We conducted a scoping review of CINAHL, MEDLINE, PsycINFO, Web of Science, Cochrane CENTRAL and hand-searched articles to identify and characterize dyadic, relationship-based interventions for children aged 0-6 years with clinical symptoms of MH disorders. Studies were screened for eligibility and included if they examined therapeutic modalities used in clinical populations beyond preventive approaches.

Screening identified studies that evaluated several therapeutic modalities, e.g., Parent Child Interaction Therapy (PCIT), Early Pathways (EP), Watch, Wait, and Wonder, Parent-Infant Psychotherapy, and Video Feedback Interventions. PCIT and EP had the most published data, treated the largest number of participants, and demonstrated significant improvements in child or relational outcomes. However, most studies had small sample sizes and methodological limitations. Only a few interventions had been evaluated using rigorous designs such as randomized controlled trials.

Two interventions that had the most evidence were EP and PCIT, particularly for families affected by adverse social determinants of health. Both require further research to explore barriers for implementation (e.g., adaptability in multiple settings and cultures, lessen resources required for service delivery, etc.). Additional research is needed to strengthen the evidence base for dyadic, attachment-based treatments targeting clinical MH concerns in infants and young children.