# 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

## TL;DR

Digital parent training for child behavioral issues works well but may be less effective during wartime due to increased stress.

## Contribution

Examines the impact of wartime stress on the effectiveness of digital parent training for child ODD.

## Key findings

- Most families had not received prior treatment for their child's behavior.
- Parents reported significant improvements in child behavior and parenting practices.
- Wartime led to faster onboarding but lower clinician-rated recovery from ODD.

## Abstract

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.

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.

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.

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%).

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.