Therapy for Toddlers and Preschoolers

Child Parent Psychotherapy (CPP) is an evidenced-based treatment modality for ages birth to five who have experienced trauma. Therapy occurs with the parent and child together, and the therapist supports the parent who in turn supports their child in building attachment and security in order to decrease anxiety and behavioral symptoms. Little ones are especially sensitive to transitions, difficult bodily experiences, and heightened emotions in the adults around them. The good news is that due to their rapidly developing brains, young children can make progress very quickly, especially when they have supportive, consistent adults in their lives.

What is considered “trauma” for ages birth to five?

  • Physical, sexual, or emotional abuse

  • Being exposed to substances or domestic violence while in utero

  • Being separated from a parent for a significant amount of time

  • Scary or painful medical procedures

  • Being in a serious accident or having a serious injury

  • Exposure to parental substance abuse (which often results in neglect)

  • Not receiving adequate food, shelter, or other physical care

  • Witnessing domestic violence or violence in the community

  • Death of a family member or friend

  • Exposure to emotional dysregulation in the home

How do toddlers and preschoolers respond to scary or confusing experiences?

Each child is unique and will respond differently depending on their personality and genetic makeup, but some examples of common responses are below:

  • Aggressive, angry behaviors

  • Expressing consistent worry or fear

  • Nightmares or fears of monsters or the dark

  • More tearful

  • Increased tantrums

  • More reactive (crying, protesting) upon separation from caregivers

  • Difficulty with transitions

  • Disrupted sleeping patterns

  • More defiant, including with adults

  • Regression in developmental stages

  • Flat or restricted affect (show less emotion — positive or negative — than before)

  • Avoiding people, places, or things that remind them of what happened

  • Hoarding food

  • Overly clingy with new people

  • Overly afraid of new people

  • Sexualized behaviors

  • Acting either significantly younger or significantly older than their age

Child Parent Psychotherapy (CPP) provides support to both the child and the parents, as caring for a little one who has experienced something scary and may now have “big behaviors” often brings up difficult feelings for parents. It is common for parents to experience guilt for the trauma the child has experienced (even when the trauma was entirely out of the parent’s control) and to even experience secondary trauma at times. CPP is mindful and supportive to the entire family system, regardless of the parent’s role in the trauma.

Does my child need therapy? 

Therapy can often help children with:

  • Learning or attention problems

  • Behavioral issues that occur at home, at school, or with peers

  • Difficulties with making friends or acting appropriately with peers

  • Processing past abuse or a difficult transition such as parents’ divorce

  • Worries or fears

  • A sudden decrease in academic performance

  • Excessively sad, tearful, or depressed

  • Aggressive behaviors

  • Being a victim of bullying or a bully to other children

  • Mood swings (rapidly switching between happy, angry, and sad)

  • Frequent physical complaints (headaches, stomaches) with no medical explanations by a doctor

  • Avoidance or refusal of school or other responsibilities

  • Transitions in primary caregivers (including transitions due to foster care/DCFS involvement)

  • Transitions due to adoption

How do children express themselves?

The most common way is through their behaviors. Infants have no other way to communicate that something is wrong or bothersome except to cry. As children grow older, they find other ways to do so. They might tantrum, become dominant or oppositional, become aggressive, attempt to please, seek affection, or act scared and avoidant. This is why it is important to view children’s behaviors as windows to more — when a child is acting out, it is almost always due to something bigger going on. We want to always be on the lookout for the underlying issues, and our goal is to help children use their words to communicate and to seek help.

Another way children express themselves is through play and art. Children naturally do this, and sensitive, observant parents likely notice that their child’s drawings or themes during play are code for what has either recently happened or what their child is currently feeling or thinking. This is why when children experience something scary or distressing, they often play about it over and over again. Sometimes this is evidence of a child fixating on the issue, but often, it is the child’s way of making sense of something difficult – they play about it enough until they have oriented around the event and then they stop playing about it.

There is incredible value to parents teaching their children feelings vocabulary. Parents can model this by using feelings words themselves; they can also play games with their children involving making different facial expressions connected to different feelings or connecting different feeling words to different scenarios. Children can only tell us about their experiences when they have the words to describe them.

What is play therapy?

Play reveals the child’s internal emotional world. Play therapy allows children to express themselves and their experiences through play with a trained therapist, who is assessing for common themes. Therapists can explore the child’s feelings and understanding of the world through the imaginary character’s experiences. Children often struggle with expressing their own experiences and feelings directly, but are more likely to do so through a fictional character. Children also learn through play. The therapist can explore alternative ways of coping, again, all through play. Most often, though, the deep, reparative work is done through the child working through difficult emotions through feeling heard and seen in play. They receive messages through play therapy that it is okay to address unspeakable fears and that adults can help children understand their feelings. They learn how to assert authority and to feel safe without using aggression. This is why play therapy is renowned for resulting in decreased anxiety and improved behavior at school. Play therapy is effective for toddlers up through elementary-school-aged children and occasionally teenagers who struggle with talk therapy but are more likely to express through projective play or art.

Next, read about Therapy for Depression.