Comparing the Effectiveness of Play Therapy Training Based on Parent-Child Relationship and Parent Management Program Training in Reducing the Symptoms of Oppositional Defiant Disorder and Improving the Resilience of These Children in Elementary School

Some children may show internalizing and externalizing behavior problems in the family or school environment. Among the externalizing behavioral problems of children, oppositional defiant disorder is one of the most common psychological problems. Some researchers emphasize the role of environmental factors in children's psychopathology, including the occurrence of symptoms of oppositional defiant disorder. In other words, the family provides structural and internal dynamics that may result in behavioral problems in children and the behavioral functioning of families. In this research, we explored which family–oriented interventions are more effective in improving the symptoms of stubborn disobedience disorder and increasing resilience. As a result, the present study aimed to compare the effectiveness of play therapy training based on parent–child relationship and parent management program training on reducing the symptoms of oppositional defiant disorder and improving the resilience of these children in elementary school.

The current research method was quasi–experimental with a pretest–posttest design with a control group. The study's statistical population included all the mothers of first– to third–grade children with oppositional defiant disorder studying in the boys' primary school in the 18th district of Tehran City, Iran, in the academic year of 2021–2022. The research sample consisted of 36 mothers. They were selected by available sampling and assigned to three groups: play therapy based on the parent–child relationship, parent management program, and control (12 mothers in each group). The inclusion criteria were as follows: diagnosing symptoms of the oppositional defiant disorder in their children, lacking other severe psychiatric disorders such as schizophrenia and obsession or psychological disorders, not receiving medicine in students, lacking a history of physical diseases in students, providing consent of mothers to participate in the research, and participating in all sessions. The exclusion criteria were non–cooperation and the absence of more than two group training sessions. The study data in the pretest and posttest were gathered via Child Symptom Inventory–4 (Gadow & Sprafkin, 1994) and Social–Emotional Assets and Resilience Scales (SEARS) (Merrell et al., 2011). The subjects of the experimental groups (mothers) received play therapy sessions based on the parent–child relationship and parent management program, and no action was taken in the control group. The analysis of research data was done through descriptive (mean and standard deviation) and inferential statistics (multivariate and univariate analysis of covariance tests and Tukey's post hoc test) in SPSS version 24 software. P values less than 0.05 were considered statistically significant.

Findings showed that play therapy based on parent–child relationship and parent management program were effective in reducing symptoms of oppositional defiant disorder (p<0.001) and in increasing resilience components, including self–regulation (p<0.001), social competence (p<0.001), empathy (p<0.001), responsibility (p<0.001), and total resilience (p<0.001). A pairwise comparison showed no significant difference between the two intervention groups in reducing the variables of oppositional defiant disorder syndrome (p=0.510) and improving resilience components, including self–regulation (p=0.741), social competence (p=0.981), empathy (p=0.427), responsibility (p=0.974), and total resilience (p=0.887).

Play therapy based on parent–child relationships and parent management program effectively improves the children's oppositional defiant disorder symptoms and resilience. Furthermore, there were no significant differences between the effectiveness of the two interventions. Therefore, it is recommended that both interventions be conducted in schools and health centers by psychologists and counselors.