Child-based treatment of oppositional defiant disorder: mediating effects on parental depression, anxiety and stress

Abstract

Previous research has shown that child-oppositional defiant disorder (ODD) and conduct disorders (CD) are associated with parental symptoms of depression, anxiety and/or stress, probably in a bidirectional relationship with mutual influences. It is, therefore, reasonable to assume that in child-centered treatment, a decrease in child-oppositional behavior problems constitutes (at least in part) a mechanism of change for a subsequent reduction in parental psychopathology. The aim of the present study (Clinical trials.gov Identifier: NCT01406067) was to examine whether the reduction in ODD symptoms due to child-based cognitive behavioral treatment (CBT) led to a reduction in parental depression, anxiety and stress. Eighty-one boys (age 6-12 years) with a diagnosis of ODD/CD were randomized either to a cognitive behavioral intervention group or an educational play group (acting as control group). Mediation analyses were conducted using path analysis. The stronger reduction in child ODD symptoms in the CBT group compared to the control group led to a decrease in parental depression and stress, as indicated by significant indirect effects (ab = 0.07 and ab = 0.08, p < 0.05). The proposed model for mechanisms of change was, therefore, confirmed for two of the three outcome parameters. Parental psychopathology and stress can be modified by child-centered CBT. The preceding reduction in ODD symptoms acts as a mediator for at least some of the changes in parental depression and stress. However, due to some limitations of the study, other possible explanations for the results found cannot be completely ruled out and are, therefore, discussed.

Comparison of Depression, Anxiety and Stress in the Mothers of Children with and without Oppositional Defiant Behaviors

“…Although no direct investigation of these factors has been found, the results are consistent with the findings of various studies that looked at similar structures in similar groups [16,21,36,37]. Findings show that high levels of maladaptive behaviors in a child are associated with symptoms of depression, anxiety and stress in parents and probably this is a two-way communication [36]. In explaining these findings, it can be said that parental depression, anxiety and stress can be significantly associated with their daily exposure to hostility and behavioral problems in children.…”

Parental Stress of Preschool Children With Generalized Anxiety or Oppositional Defiant Disorder

“…Thus, early recognition by parents of their child's disorders is fundamental for a prompt and suitable therapeutic intervention. However, parental stress might alter their perception of their offspring's problems (19). To our knowledge, a direct comparison between parental stress and psychopathology between parents of preschool children without a clinical diagnosis and/or a non-comorbid diagnosis of anxiety or ODD has not been conducted so far.…”

“…The emergence of children's problems or the exacerbation of existing disorders is often associated with the exposure to stressful social environments. Early difficulties may persist and worsen throughout late childhood, adolescence, and into adulthood (11, 12), especially when the child receives inadequate psychological support from the primary caregivers (13–19). Identification of environmental factors associated with the development of GAD or ODD in children presents an important area for research.…”

Regulation-Focused Psychotherapy for Children (RFP-C): Advances in the Treatment of ADHD and ODD in Childhood and Adolescence

“…Parental stress, depression, and anxiety are elevated among parents of children with ODD as compared to those with typical developmental patterns (Katzmann et al, 2018;Lin et al, 2019;Manti et al, 2019). For many years, behavioral parent training (BPT) approaches, including Parent Management Training (PMT), have been the primary treatment option for children with ODD because of their robust evidence base for children with externalizing behaviors (Serketich and Dumas, 1996;Brestan and Eyberg, 1998;Kazdin and Weisz, 1998).…”