Journal of Childhood

Introduction
The early childhood period is a critical developmental stage. During this period, the parent-child relationships act as a primary determinant of emotional and behavioral regulation in children. Dysfunctional parent-child interactions can cause behavioral problems and deficits in family functioning. While parent-child interaction therapy (PCIT) and child-parent relationship therapy (CPRT) are both evidence-based interventions designed to ameliorate these issues through structured, play-based methodologies, their comparative studies are limited. Therefore, this study aimed to compare the effectiveness of PCIT and CPRT in reducing behavioral problems and enhancing family functioning among preschool children. We hypothesized that, while both interventions are effective, CPRT yields superior outcomes in reducing behavioral symptoms.

Research Methods
This is a quasi-experimental study with a pre-test-posttest design. The mothers of 45 preschool children (aged 4-6) from Yazd, Iran, were recruited via convenience sampling and randomly allocated to PCIT (n=15), CPRT (n=15), and control (n=15) groups. Inclusion criteria were parental consent and the presence of mild-to-moderate behavioral problems in the child.  Attending concurrent psychological treatment sessions was the exclusion criterion. Standardized instruments including Achenbach’s child behavior checklist (CBCL) and Epstein’s family assessment device (FAD), were used at baseline and post-intervention. The experimental groups received 10 weekly sessions of interventions. Data were analyzed using analysis of covariance (ANCOVA) in SPSS software, version 24, controlling for pretest scores.

Results
Data analysis using multivariate ANCOVA showed that, after controlling for pretest scores, there was a statistically significant difference between the experimental and control groups in the dependent variables (Pillai's Trace=0.759, F=31.262, P<0.001, η²=0.741). The univariate ANCOVA results indicated that both the PCIT and CPRT led to significant improvements compared to the control group in all measured outcomes. The post-hoc Bonferroni test results demonstrated that CPRT (η²=0.59) was significantly more effective than PCIT (η²=0.53) in reducing children's externalizing behavioral problems (P<0.05). However, there was no statistically significant difference between the two therapies in their impact on internalizing behavioral problems or family functioning; both interventions improved these variables equally.

Conclusion
Both PCIT and CPRT are effective interventions for improving family functioning and reducing behavioral problems in preschoolers. However, CPRT is significantly more effective than PCIT in reducing their externalizing behaviors. This superior efficacy is likely due to CPRT's core focus on empowering parents as primary therapeutic agents through child-centered play, which fosters a deeper emotional connection and more effectively alters the negative interaction cycles that sustain disruptive behaviors. The comparable improvements in family functioning underscore a shared strength of both modalities in enhancing overall family dynamics. Future research should focus on the long-term maintenance of these gains. Given these findings and the cultural acceptability of play-based approaches, CPRT is recommended as a particularly potent intervention for clinicians targeting externalizing behavioral problems in school-aged children. 

Ethical Considerations

Compliance with ethical guidelines
All ethical principles were considered. Participant information was kept confidential, and all individuals participated voluntarily and declared informed consent. Ethical approval was received from the Ethics Committee of the University of Science and Culture-Academic Center for Education, Culture and Research (Code: IR.ACECR.USC.REC.1403.146).

Funding
This article was extracted from the master’s thesis of  Bahareh Behjat at the Faculty of Humanities, the University of Science and Culture. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interpretation of the results, and drafting of the manuscript. Each author approved the final version of the manuscript for submission.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all parents and the respected officials of the counseling centers for their cooperation in conducting this research.