JMIR Publications

ABSTRACT

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 two 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, platform usage metrics, and clinician assessments.

Results:

Most families (61.8%, 34/55) had not previously received any intervention for their child's behavior problems. Significant self-reported improvements in child behavior (Cohen's ds ≥ 0.79) and parenting practices (0.39 ≤ Cohen's ds ≤ 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 (90% vs. 68%). However, while self-reported changes were similar, clinician-rated recovery from ODD was marginally lower during wartime (43.3% vs. 68%).

Conclusions:

DPTs present an acceptable avenue for care that could reach parents who have not sought treatment through traditional channels. However, this study 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.