Evaluating the Reach, Usage, Human Support Needs, and Clinical Outcomes of Digital Parent Training for Child Oppositional Defiant Disorder Before and During Wartime: Longitudinal Study.

BACKGROUND

Digital parent training programs (DPTs) have emerged as a scalable solution for treating childhood oppositional defiant disorder (ODD), offering remote access and reduced barriers to care. However, there is limited data on their potential to reach untreated populations and their effectiveness during times of crisis, such as war.

OBJECTIVE

This study aimed to evaluate the reach, usage patterns, human support needs, and clinical outcomes of a fully remote guided DPT for child ODD, comparing 2 cohorts treated before and during wartime in Israel.

METHODS

Parents of children with ODD were enrolled in a human-supported DPT, with 25 families recruited before and 30 during wartime. Data included self-reported questionnaires (measured before-, postintervention, and 3 months after the end of the intervention), platform usage metrics, and clinician assessments.

RESULTS

Most families (62%, 34/55) had not previously received any intervention for their child's behavior problems. Significant self-reported improvements in child behavior (Cohen d≥0.79) and parenting practices (0.39≤Cohen d≤0.87) were found post intervention. On average, families engaged with the program for 138.6 minutes across 31.4 unique logins, supported by 38.8 minutes of human interaction, primarily via messaging. During wartime, parents completed onboarding significantly faster (15.70 days vs 31.36 days) and were more likely to complete the critical "overcoming disobedience" phase (27/30, 90% vs 17/25, 68%). However, while self-reported changes were similar, clinician-rated recovery from ODD was marginally lower during wartime (13/30, 43% vs 17/25, 68%).

CONCLUSIONS

DPTs present an acceptable avenue for care that could reach parents who have not sought treatment through traditional channels. However, this study's results suggest that their clinical effectiveness may be lower under extreme stress conditions such as wartime, underscoring the need for future studies in this area.