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Early Childhood Services

The ABC Program: Anxiety and Behavioral Challenges of Early Childhood

The ABC Program at CUCARD is here to help families with young children (ages 2-8) who are struggling with anxiety, behavioral challenges, or a combination of both. Unlike learning the alphabet, helping young children to face fears and regulate their emotions is a skill that is not taught in schools. Fortunately, there are evidence-based techniques available for parents in need of support. Our team of early childhood experts offers comprehensive diagnostic assessments, consultations, and treatment programs that are tailored to meet the needs of your child. All ABC evaluation and treatment services are now also available via telehealth.

The ABC Program at CUCARD teaches parents how to respond most effectively to the day-to-day, moment-to-moment challenges of raising children with anxiety and behavioral disorders. Treatments will emphasize parenting skills training and live coaching of parent-child interactions, as informed by Parent-Child Interaction Therapy (PCIT), a gold standard, empirically-supported treatment for disruptive behavior. Learn more about PCIT. The ABC program utilizes PCIT as the foundation for several treatments for a broad range of early childhood anxiety and behavioral disorders.

The ABC Program can help your child with:

  • Separation Anxiety Disorder
  • Social Anxiety Disorder
  • Selective Mutism
  • Specific Phobia
  • Obsessive Compulsive Disorder
  • Generalized Anxiety Disorder
  • Attention-Deficit/Hyperactivity Disorder
  • Oppositional Defiant Disorder
  • Picky Eating
  • Behaviorally-Based Sleep Challenges
  • Trichotillomania (Hair Pulling)
  • Excoriation Disorder (Skin Picking)

Anxiety Challenges: PCIT-CALM

The CALM Program (Coaching Approach behavior and Leading by Modeling), developed at CUCARD by Jonathan Comer, Ph.D., Anthony Puliafico, Ph.D., and Anne Marie Albano, Ph.D., is an evidence-based cognitive-behavioral treatment used to address anxiety disorders in young children ages 2-7.

The CALM Program is a modification of Parent-Child Interaction Therapy (PCIT). PCIT-CALM is a specialized treatment that includes live, real-time coaching in which the therapist guides the parent via a bug-in-the-ear to respond most effectively to their child’s anxious behaviors. The CALM Program addresses the needs of young children presenting with separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, and/or specific phobias.

The CALM Program is delivered using a behavioral parent training approach, and the therapist meets weekly with both the child and their parents. During these sessions, the therapist teaches parents specific skills to encourage and reward their child’s “brave behavior.” The CALM Program is unique in that the therapist also provides individualized, in-the-moment parent coaching to assist parents in using these skills during interactions with their anxious child. Through this program, the parents become key agents of change in supporting their child in developing coping skills and mastery over their anxiety. Length of treatment varies, but typically families in our program participate in 12-16 weekly 60-minute treatment sessions.

Treatment goals include:

  • Providing parents with directive and specific skills for encouraging their child's brave behavior and decreasing their child's anxious behavior
  • using positive reinforcements
  • Providing opportunities for children to practice coping with anxiety-provoking situations in a gradual, supportive manner
  • Decreasing child and parent distress during anxiety-provoking situations
  • Strengthening a positive, mutually rewarding parent-child relationship

Behavioral Challenges: Parent-Child Interaction Therapy (PCIT)

Parent-Child Interaction Therapy (PCIT) is a specialized therapy program developed by Sheila Eyberg, PhD and Cheryl McNeil, PhD. It is designed to treat young children with behavior problems, such as defiance, aggression, or tantrums. PCIT involves working with parents and their young children to improve the quality and consistency of parent-child interactions, to improve child compliance, and to reduce disruptive behavior.

What distinguishes PCIT from other forms of treatment for disruptive behavior disorders is the active coaching component. While other forms of treatment involve education and instruction regarding effective parenting techniques, in PCIT parents practice these skills while receiving live, active coaching by their PCIT therapist.

PCIT is conducted in two phases. During the first phase, called Child-Directed Interaction, parents learn and then subsequently practice play therapy skills which are designed to enhance the parent-child relationship, improve children’s social skills, and encourage positive behaviors, all while decreasing attention-seeking behaviors. The second phase, Parent-Directed Interactions, involves learning and practicing structured and effective techniques for disciplining child misbehavior. During this phase, parents learn how to give commands, use time-out as an effective punishment, and enforce the rules of their home.

PCIT is often a short-term treatment, with some families requiring as few as twelve 60-minute treatment sessions. Numerous research studies have shown strong evidence supporting PCIT as an effective and efficient treatment for children with disruptive behavior, with child behavior improvement remaining long after treatment has ended.

Treatment goals include:

  • Providing parents with directive and specific skills for encouraging their child's brave, prosocial, and compliant behavior and decreasing their child's oppositional, anxious, and attention-seeking behavior
  • Providing opportunities for parents to practice setting limits in a supportive environment with real-time coaching
  • Increasing the rate of child compliance with parent commands
  • Strengthening a positive, mutually rewarding parent-child relationship

Combined Anxiety & Behavioral Challenges: Brave START

Brave START (Skills Training & Anxiety Reduction Treatment), developed by Steve Mazza, PhD, Phyllis Ohr, PhD, and Anne Marie Albano, PhD, was specifically designed to help children that exhibit a combination of anxiety and disruptive behavior. Brave START synthesizes the most important elements of Parent-Child Interaction Therapy (PCIT) and the CALM program (Coaching Approach behaviors by Leading and Modeling). It is the first transdiagnostic, modular, PCIT-informed treatment for children aged 2-7.

As with PCIT and CALM, Brave START is a behavioral parent training program in which the therapist meets weekly with the child and parents together. During these sessions, the therapist coaches parents to use specific skills to encourage and reward their child’s brave and respectful behavior, without inadvertently rewarding anxious and disruptive behavior. Brave START was designed to treat children presenting with separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, selective mutism, obsessive compulsive disorder, specific phobias, attention-deficit/hyperactivity disorder, and oppositional defiant disorder.

Whereas PCIT and CALM have two phases of treatment each, Brave START has three: a Child-Directed Interaction phase (in which basic skills are taught and the parent-child relationship is strengthened), a Bravery-Directed Interaction phase (in which anxiety is targeted), and a Parent-Directed Interaction phase (in which oppositional behavior is targeted).

Because Brave START is a modular program, the focus and sequence of treatment modules is flexible and dependent on each child’s unique presentation. This highly individualized approach teaches parents the skills necessary to help their child face their fears while also setting limits when appropriate. Optional modules can also be implemented to focus on various manifestations of anxiety, including perfectionism, excessive worrying and reassurance seeking, in-school interventions, and more.

Treatment goals include:

  • Providing parents with directive and specific skills for encouraging their child’s brave, prosocial, and compliant behavior and decreasing their child’s oppositional, anxious, and attention-seeking behavior
  • Providing opportunities for parents to practice setting limits in a supportive environment with real-time coaching
  • Providing opportunities for children to practice coping with anxiety-provoking situations in a gradual, supportive manner
  • Increasing the rate of child compliance with parent commands, including in anxiety-provoking situations
  • Educating parents in the principles of anxiety and behavior change
  • Decreasing child and parent distress during anxiety-provoking situations
  • Strengthening a positive, mutually rewarding parent-child relationship

ABC Telehealth Services
All ABC evaluation and treatment programs are available via telehealth. Internet-based treatments provide several benefits to families, including improved convenience and increased "ecological validity" (the ability to generalize clinic-based research findings to real-world settings). Telehealth services enable families to learn and apply new skills and behaviors in the setting that often matters most: the home.

Parent Skills Training with Supplemental Live Coaching
Some challenges of early childhood are best treated with parent skills training, in which parents participate in most sessions without their child present. This is particularly appropriate when the behavioral challenges are mild or difficult to reproduce within the clinic setting (e.g. hair-pulling, skin-picking, picky eating, and behaviorally-based sleep disturbances). When applicable, live coaching of parent-child interactions can occur within the clinic on an as-needed basis or from clinic-to-home via telehealth video conferences. With the rise of telehealth, ABC now offers live "homework coaching" to parents who struggle to keep their children engaged and focused during academic tasks.

Brave Parenting Group
We are currently recruiting for our Brave Parenting Group. This supportive and educational group is for parents of anxious children aged 3-12. In this group parents will learn about what maintains and exacerbates childhood anxiety, as well as the skills they can use to help their children manage anxiety on a day-to-day basis. This group is for parents only. Please call our intake coordinator at 212-342-0951 to express your interest in participating.