Factors associated with the effectiveness of cognitive behavioral therapy in children and adolescents with oppositional defiant disorder: a systematic review
DOI:
https://doi.org/10.51247/pdlc.v7i1.543Keywords:
Oppositional Defiant Disorder; Cognitive Behavioral Therapy; children; adolescents; associated factorsAbstract
Cognitive-behavioral therapy (CBT) is a first-line treatment for oppositional defiant disorder (ODD); however, the variability in response makes it difficult to identify the profiles that may benefit from each intervention. This study aimed to synthesize the scientific evidence on the clinical, demographic, familial, therapeutic, and contextual factors associated with the effectiveness of CBT-based interventions in children and adolescents with ODD, considering their predictive, moderating, or mediating role. A systematic review was conducted according to the PRISMA guidelines and registered in PROSPERO. Searches were performed in Scopus, Web of Science, PubMed, EBSCO, PsycINFO, and Redalyc, using JBI tools to assess the risk of bias. Twelve studies with approximately 2026 participants were included. Baseline symptom severity, comorbidity with ADHD, emotional regulation deficits, and dorsolateral prefrontal neural activity were associated with differences in therapeutic outcomes. Parenting practices, such as supervision, warmth, hostility, and inconsistent discipline, moderated the acquisition of adaptive skills. Adherence and certain therapeutic behaviors were associated with specific outcomes, although some analyses yielded null results. Relationship- and emotion-focused programs enhanced outcomes. Age and sex showed no consistent evidence of moderation. The study concludes that therapeutic response is related to clinical, familial, and implementation factors, supporting personalized models that integrate emotional regulation and parenting practices into the therapeutic design
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