Child-based treatment of oppositional defiant disorder: mediating effects on parental depression, anxiety and stress
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.
KeywordsOppositional defiant disorder Conduct disorder Parental psychopathology Parental stress Cognitive behavioral treatment Mediation
The study received financial support from the School of Child and Adolescent Cognitive Behavior Therapy at the University Hospital Cologne. The authors wish to thank all families who participated in this study.
Compliance with ethical standards
Conflict of interest
Anja Görtz-Dorten and Manfred Döpfner receive royalties from publishing companies as authors of books and treatment manuals on child behavioral therapy, and of assessment manuals, including the treatment manual for THAV, which is evaluated in this trial. Josepha Katzmann declares that she has no conflict of interest.
All procedures performed in studies involving human participants were approved by the ethics committee of the University Hospital of Cologne and were therefore performed in accordance with the 1964 Declaration of Helsinki and its later amendments. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants prior to their inclusion in the study.
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