Dyadic Therapy for Mothers and Children

Child Parent Psychotherapy (CPP) has been demonstrated to be effective in improving
mother-child attachment relationship, maternal (depression, posttraumatic stress symptoms,
global symptoms of distress) and child (behavior problems, posttraumatic stress symptoms and
diagnosis, cognitive and representational models) outcomes, in the context of risk factors
such as maternal depression and exposure to traumatic events. It is the only treatment for
preschool aged children and caregivers that seeks to affect changes at both behavioral and
schematic/ cognitive levels. The investigators aim to assess the feasibility and
acceptability of providing CPP as a dyadic preventive intervention for children who are
displaying signs of emotional and behavioral difficulties in the context of maternal
depression.

Investigators will compare the effectiveness of CPP to that of usual care (usual care defined
as: referral to therapists in the community and within Columbia University Medical Center for
psychoeducation, counseling/ therapy for maternal depressive symptoms, and child behavioral/
emotional difficulties) in improving maternal depressive symptoms and child emotional and
behavioral problems. The investigators will recruit mothers who report being mildly to
moderately depressed and their preschoolers (aged 3-5 years) who they are concerned are
exhibiting emotional and/or behavioral problems.

Mother-child patient dyads will be screened via telephone to assess study eligibility. If
eligible mothers and their children will complete an in-person pre-treatment assessment.
After the Time 1 (pre-treatment) assessment, mother-child patient dyads will be randomly
assigned to one of two treatment conditions - 1. six months of weekly CPP intervention
sessions OR 2. control condition in which mothers and their children will be referred for
usual treatment in the community. Random assignment will be done based on a pre-determined
schedule (a random number generator will be used to create a schedule for patient treatment
assignment). Following randomization mother-child patient dyads will complete the following
assessments: Time 2 (after 12 sessions or an average of three months), Time 3 (after 24
sessions or an average of six months), and Time 4 (six months after 24 treatment sessions or
an average of one year after Time 1). All assessments will be conducted by a licensed
clinician in conjunction with a research assistant.

Mothers (30 in each group) will be recruited through the Women's Program and pediatric
practices affiliated with Columbia University Medical Center, including the Columbia Center
of the New York Presbyterian Hospital, as well as its satellite center, the Allen Pavilion,
and the Children's Hospital of New York. Approximately 90 women will need to screened to
recruit 60 women for the study.

Inclusion Criteria:

- Maternal age 18-40 years

- Child age 3-5 years

- Maternal Beck Depression Inventory-II score 14-30

- Maternal report of at least two of ten child emotional/behavioral problems (excessive
shyness, fussiness, sleep pattern problems, irritability, frequent inappropriate
behavior) during phone screen administration of an adapted version of the Child
Behavior Checklist.

Exclusion Criteria:

- Maternal lack of fluency in English as assessed through phone screening

- Maternal self-report of suicidality as assessed through Beck Depression Inventory-II

- Maternal self-report of Psychotic/Bipolar/Thought disorder

- Maternal self-report of substance abuse problems in the past 6 months

- Maternal report of child's lack of fluency in English

- Maternal report of child's developmental disorders / mental retardations / significant
speech and language delays