Factores asociados a la efectividad de la terapia cognitivo-conductual en niños y adolescentes con trastorno oposicionista desafiante: una revisión sistemática.
DOI:
https://doi.org/10.51247/pdlc.v7i1.543Palabras clave:
Trastorno oposicionista desafiante; terapia cognitivo-conductual; niños; adolescentes; factores asociadosResumen
La terapia cognitivo-conductual (TCC) constituye un tratamiento de primera línea para el trastorno oposicionista desafiante (TOD); sin embargo, la variabilidad de la respuesta dificulta identificar los perfiles que pueden beneficiarse de cada intervención. Este estudio tuvo como objetivo sintetizar la evidencia científica sobre los factores clínicos, demográficos, familiares, terapéuticos y contextuales asociados con la efectividad de intervenciones basadas en TCC en niños y adolescentes con TOD, considerando su función predictora, moderadora o mediadora. Se realizó una revisión sistemática conforme a las directrices PRISMA y se registró en PROSPERO. Las búsquedas se efectuaron en Scopus, Web of Science, PubMed, EBSCO, PsycINFO y Redalyc, empleando herramientas JBI para evaluar el riesgo de sesgo. Se incluyeron 12 estudios con aproximadamente 2026 participantes. La gravedad sintomática basal, la comorbilidad con TDAH, los déficits de regulación emocional y la actividad neural prefrontal dorsolateral se asociaron con diferencias en los resultados terapéuticos. Las prácticas parentales, como supervisión, calidez, hostilidad y disciplina inconsistente, moderaron la adquisición de habilidades adaptativas. La adherencia y determinadas conductas terapéuticas se asociaron con desenlaces específicos, aunque algunos análisis fueron nulos. Los programas centrados en la relación y las emociones potenciaron los resultados. La edad y el sexo no mostraron evidencia consistente de moderación. Se concluye que la respuesta terapéutica se relaciona con factores clínicos, familiares y de implementación, respaldando modelos personalizados que integren la regulación emocional y las prácticas de crianza en el diseño terapéutico.
Descargas
Referencias
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5TM (5th ed.). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596
Barker, T. H., Habibi, N., Aromataris, E., Stone, J. C., Leonardi-Bee, J., Sears, K., Hasanoff, S., Klugar, M., Tufanaru, C., Moola, S., & Munn, Z. (2024). The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evidence Synthesis, 22(3), 378-388. https://doi.org/10.11124/jbies-23-00268
Barker, T. H., Stone, J. C., Sears, K., Klugar, M., Tufanaru, C., Leonardi-Bee, J., Aromataris, E., & Munn, Z. (2023). The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis, 21(3), 494-506. https://doi.org/10.11124/jbies-22-00430
Bonham, M. D., Shanley, D. C., Waters, A. M., & Elvin, O. M. (2021). Inhibitory Control Deficits in Children with Oppositional Defiant Disorder and Conduct Disorder Compared to Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. Research on Child and Adolescent Psychopathology, 49(1), 39–62. https://doi.org/10.1007/s10802-020-00713-9
Booker, J. A., Capriola-Hall, N. N., Greene, R. W., & Ollendick, T. H. (2020). The Parent–Child Relationship and Posttreatment child outcomes across two treatments for oppositional defiant disorder. Journal of Clinical Child & Adolescent Psychology, 49(3), 405–419. https://doi.org/10.1080/15374416.2018.1555761
Corporation for Digital Scholarship. (2026). Zotero (Versión 7.0.32) [Software informático]. https://www.zotero.org/
Daş, H., Kurnaz, M. F., & Koçtürk, N. (2024). The effectiveness of cognitive behavioral therapy in mental health problems of children and adolescents in child protection system: A meta-analysis. Journal of Behavioral and Cognitive Therapy, 34(4), 100509. https://doi.org/10.1016/j.jbct.2024.100509
Dedousis-Wallace, A., Drysdale, S. a. O., McAloon, J., Murrihy, R. C., Greene, R. W., & Ollendick, T. H. (2022). Predictors and Moderators Two treatments of oppositional defiant disorder in children. Journal of Clinical Child & Adolescent Psychology, 54(1), 67–82. https://doi.org/10.1080/15374416.2022.2127102
Derella, O. J., Johnston, O. G., Loeber, R., & Burke, J. D. (2019). CBT-Enhanced Emotion Regulation as a mechanism of improvement for childhood irritability. Journal of Clinical Child & Adolescent Psychology, 48(1), S146–S154. https://doi.org/10.1080/15374416.2016.1270832
Döpfner, M., Plück, J., Rosenberger, K. D., Klemp, M., Mühlenmeister, J., Wähnke, L., Hellmich, M., Schürmann, S., & Dose, C. (2025). Efficacy of guided and unguided web‐assisted self‐help for parents of children with attention‐deficit/hyperactivity disorder and oppositional defiant disorder: A three‐arm randomized controlled trial. Journal of Child Psychology and Psychiatry, 66(9), 1320–1332. https://doi.org/10.1111/jcpp.14153
Figueiredo, P., Azeredo, A., Barroso, R., & Barbosa, F. (2024). Callous–Unemotional Traits and Conduct Problems in Children: The Role of Strength and Positive Characteristics. Behavioral Sciences, 14(7), 609. https://doi.org/10.3390/bs14070609
Gardner, F., Leijten, P., Melendez-Torres, G. J., Landau, S., Harris, V., Mann, J., Beecham, J., Hutchings, J., & Scott, S. (2019). The earlier the better? Individual participant data and traditional meta-analysis of age effects of parenting interventions for pre-adolescent children. Child Development, 90(1), 7–19. https://doi.org/10.1111/cdev.13138
Gatti, U., Grattagliano, I., & Rocca, G. (2018). Evidence-based psychosocial treatments of conduct problems in children and adolescents: an overview. Psychiatry Psychology and Law, 26(2), 171–193. https://doi.org/10.1080/13218719.2018.1485523
Helander, M., Enebrink, P., Hellner, C., & Ahlen, J. (2022). Parent Management Training Combined with Group-CBT Compared to Parent Management Training Only for Oppositional Defiant Disorder Symptoms: 2-Year Follow-Up of a Randomized Controlled Trial. Child Psychiatry & Human Development, 54(4), 1112–1126. https://doi.org/10.1007/s10578-021-01306-3
Laas Sigurðardóttir, L. B., Melendez-Torres, G. J., Backhaus, S., Gardner, F., Scott, S., European Parenting Program Research Consortium, & Leijten, P. (2025). Individual participant data meta-analysis: Individual differences in mediators of parenting program effects on disruptive behavior. Journal of the American Academy of Child & Adolescent Psychiatry, 64(5), 564–576. https://doi.org/10.1016/j.jaac.2024.10.003
Lin, X., He, T., Heath, M., Chi, P., & Hinshaw, S. (2022). A Systematic Review of Multiple Family Factors Associated with Oppositional Defiant Disorder. International Journal of Environmental Research and Public Health, 19(17), 10866. https://doi.org/10.3390/ijerph191710866
López-Villalobos, J. A., Llano, J. M. A., Rodríguez-Molinero, L., Garrido-Redondo, M., Sacristán-Martín, A. M., Martínez-Rivera, M. T., Alberola-López, S., & Sánchez-Azón, M. I. (2014). Prevalencia del trastorno negativista desafiante en España. Revista de Psiquiatría y Salud Mental, 7(2), 80–87. https://doi.org/10.1016/j.rpsm.2013.07.002
Mars, J. A., Aggarwal, A., & Marwaha, R. (2024). Oppositional defiant disorder. En StatPearls. StatPearls Publishing. https://www-ncbi-nlm-nih-gov.translate.goog/books/NBK557443/?_x_tr_sl=en&_x_tr_tl=es&_x_tr_hl=es&_x_tr_pto=tc
Matthys, W., & Schutter, D. J. L. G. (2021). Increasing Effectiveness of Cognitive Behavioral Therapy for Conduct Problems in Children and Adolescents: What Can We Learn from Neuroimaging Studies? Clinical Child and Family Psychology Review, 24(3), 484–499. https://doi.org/10.1007/s10567-021-00346-4
Monsalve, A., Mora, L. F., Ramírez, L. C., Rozo, V., & Rojas, D. M. (2017). Estrategias de intervención dirigidas a niños con trastorno negativista desafiante, una revisión de la literatura. Revista Ciencias de la Salud, 15(1), 105–127. https://www.redalyc.org/articulo.oa?id=56249528009
Moreno, B., Muñoz, M., Cuellar, J., Domancic, S., & Villanueva, J. (2018). Revisiones Sistemáticas: definición y nociones básicas. Revista Clínica De Periodoncia Implantología Y Rehabilitación Oral, 11(3), 184–186. https://doi.org/10.4067/s0719-01072018000300184
Murrihy, R. C., Drysdale, S. A., Dedousis-Wallace, A., Rémond, L., McAloon, J., Ellis, D. M., Halldorsdottir, T., Greene, R. W., & Ollendick, T. H. (2023). Community-Delivered collaborative and proactive solutions and parent management training for oppositional youth: a randomized trial. Behavior Therapy, 54(2), 400–417. https://doi.org/10.1016/j.beth.2022.10.005
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—a web and mobile app for systematic reviews. https://doi.org/10.1186/s13643-016-0384-4
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Pedreira-Massa, J. L. (2011). Trastorno negativista (oposicionista)-desafiante en la infancia. Anales De Pediatría Continuada, 9(1), 1–6. https://doi.org/10.1016/s1696-2818(11)70001-4
Pisula, A., Bryńska, A., Wójtowicz, S., Srebnicki, T., & Wolańczyk, T. (2020). The change in the intensity of symptoms in children and adolescents with attention deficit hyperactivity disorder after “Workshops for Parents of Hyperactive Children.” Psychiatria Polska, 54(2), 317–332. https://doi.org/10.12740/pp/103618
Raschle, N. M., Borbás, R., Dimanova, P., Unternaehrer, E., Kohls, G., De Brito, S., Fairchild, G., Freitag, C. M., Konrad, K., & Stadler, C. (2025). Losing control: Prefrontal emotion regulation is related to symptom severity and predicts Treatment-Related symptom change in adolescent girls with conduct disorder. Biological Psychiatry Cognitive Neuroscience and Neuroimaging, 10(1), 80–93. https://doi.org/10.1016/j.bpsc.2024.08.005
Riise, E. N., Wergeland, G. J. H., Njardvik, U., & Öst, L. (2021). Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clinical Psychology Review, 83, 101954. https://doi.org/10.1016/j.cpr.2020.101954
Rizo, AB, (2014). Intervención cognitivo-conductual en un caso de trastorno negativista desafiante en un adolescente. Revista de Psicología Clínica con Niños y Adolescentes, 1 (1),89-100. https://www.redalyc.org/articulo.oa?id=477147183010
Robayo, A. M., Caro, L. F. M., López, L. C. R., Hernández, V. R., & Puerto, D. M. R. (2017). Intervention Strategies Used in the Treatment of Children with Oppositional Defiant Disorder, a Review of Literature. Revista Ciencias De La Salud, 15(1), 105–127. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.5384
Sánchez, R. G., Bravo, S. P., & Quintero, J. E. O. (2025). Revisión sistemática sobre la comorbilidad del trastorno negativista desafiante. Revista Canarias PediáTrica, 49(1), 39-57. https://doi.org/10.63663/canped.2025.49.1.7
Seleem, M. A., Amer, R. A., Hasanen, Y. A., & Shatkin, J. P. (2026). Effectiveness of parent management training in reducing oppositional and defiant behaviors in a clinical sample of Egyptian children. Middle East Current Psychiatry, 33(13), 1-10 https://doi.org/10.1186/s43045-026-00618-1
Sibley, M. H., Graziano, P. A., Coxe, S. J., Bickman, L., Martin, P., & Flores, S. (2023). A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity. Behavior Therapy, 54(5), 839–851. https://doi.org/10.1016/j.beth.2023.03.001
Torales, J., Barrios, I., Arce, A., & Viola, L. (2018). Trastorno negativista desafiante: una puesta al día para pediatras y psiquiatras infantiles. Pediatría (Asunción), 45(1), 65–73. https://doi.org/10.31698/ped.45012018009
Treier, A., Hautmann, C., Dose, C., Nordmann, L., Katzmann, J., Pinior, J., Scholz, K. K., & Döpfner, M. (2022). Process Mechanisms in Behavioral Versus Nondirective Guided Self-help for Parents of Children with Externalizing Behavior. Child Psychiatry & Human Development, 55(2), 453–466. https://doi.org/10.1007/s10578-022-01400-0
Waschbusch, D. A., Willoughby, M. T., Haas, S. M., Ridenour, T., Helseth, S., Crum, K. I., Altszuler, A. R., Ross, J. M., Coles, E. K., & Pelham, W. E. (2020). Effects of Behavioral Treatment Modified to Fit Children with Conduct Problems and Callous-Unemotional (CU) Traits. Journal of Clinical Child & Adolescent Psychology, 49(5), 639–650. https://doi.org/10.1080/15374416.2019.1614000
World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. https://apps.who.int/iris/handle/10665/37958
Zhang, W., Li, Y., Li, L., Hinshaw, S., & Lin, X. (2023). Vicious cycle of emotion regulation and ODD symptoms among Chinese school-age children with ODD: a random intercept cross-lagged panel model. Child and Adolescent Psychiatry and Mental Health, 17(1), 47. https://doi.org/10.1186/s13034-023-00579-x
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2025 Eudaldo Enrique Espinoza-Freire
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
