Volume 22, Issue 4 (9-2019)                   J Arak Uni Med Sci 2019, 22(4): 134-145 | Back to browse issues page

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Jamali Z, Khodabakhshi-Koolaee A. The Effectiveness of Parenting Behavior Management Training Via Cell Phone on Mothers in Reducing Oppositional and Aggression Symptoms in Their Children With Oppositional Defiant Disorder: A Single Case Study. J Arak Uni Med Sci 2019; 22 (4) :134-145
URL: http://jams.arakmu.ac.ir/article-1-6061-en.html
1- Department of Psychology and Educational Sciences, Faculty of Humanities, Khatam University, Tehran, Iran.
2- Department of Psychology and Educational Sciences, Faculty of Humanities, Khatam University, Tehran, Iran. , anna_khodabakhshi@yahoo.com
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1. Introduction
Childhood is one of the most critical periods of life in which one's personality develops. Oppositional Defiant Disorder (ODD) is one of the behavioral disorders categorized by malicious and harmful behaviors. Children with this disorder tend to destroy their belongings and behave stubbornly with the orders of parents and instructions of their school officials. The causes of this disorder are multifactorial, but the results indicate that one of its most critical contributing factors is the behavior of the parents toward the child, which in many cases can be resolved by parental education [3]. Since most parents do not have access to a therapist, this study aimed to investigate the effect of parenting behavior management training via cell phone (social media) on oppositional and aggression symptoms in children with ODD and hyperactivity. 
2. Materials and Methods
This single case study was conducted on 4 mothers whose scores were close to the diagnostic scores of ODD with hyperactivity in describing their children. Three mothers of these children were selected for educational intervention, and the content of parenting behavior management training was transferred to them in 8 virtual and 2 in-person sessions. The mother of one child was selected for control, and all educational content was transmitted to her in 2 in-person sessions. The content of the sessions was extracted from Danforth’s behavior management survey [7, 8]. 
The Child Symptom Inventory-4 (CSI-4), validated in Iran by two researchers, was used to assess the child’s behavioral disorders [16, 17]. Finally, with the percentage of improvement and the Reliable Change Index (RCI), the obtained data were analyzed by using the graph interpretation method .
To calculate the percentage of improvement, we subtracted the pretest scores from the posttest scores and divided the result by the pretest score. If the improvement rate was at least 50, the intervention would be clinically meaningful. The formula of the percentage of improvement was used to convert the scores into the percentage to consider the clinical significance analysis, and the formula of RCI was used for the statistical significance of the data.
3. Results
The study participants were 4 children and their mothers (Three mothers in the experimental group and one mother in the control group). The children were diagnosed with the oppositional defiant disorder with hyperactivity.
Figure 1 shows the comparison of changes in oppositional behavior scores (with CSI-4 questionnaire scale) of three children A, B, and C, whose mothers passed parenting behavior management training, with the scores of the child with mother in the control group. According to the chart, the oppositional behavior scores of all 3 children in the experimental group decreased, but no change was seen in the control group child’s score.

The improvement index percentage of oppositional behavior in all three children in the experimental group was more than 50. Also, the study showed that oppositional behavior scores decreased in the two children in the experimental group, and the improvement percentage in all 3 children in the experimental group was more than 50 (Figure 2). According to the improvement index percentage, this type of training was clinically useful in oppositional and aggressive behavior.

4. Discussion 
In this study, the intervention was done by teaching the mothers parenting behavior management via cell phone to reduce the oppositional and aggressive behavior of the experimental group during a one-month follow-up. The nature of the program, which follows specific guidelines, involves the mother in the process of treating and can help them with such children.
With more technical advances, the application of the software programs in health and therapeutic fields become more apparent [22-24]. The results of some research have revealed that cell phone education and prevention programs can be faster, easier, less worrying, and more cost-effective. For example, Vahidi and Mahmoodfekheh investigated two methods of lecturing and mobile education on reducing anxiety in patients with heart disease and found out that mobile learning could be more comfortable and more accessible [20]. Also in Xia et al. research, video conferencing technology and method were used to train interventions of behavior management and treatment of behavioral problems in hyperactive children. The results of this study showed that participants gained more up-to-date information through video conferencing [25]. 
In general, not many mothers can visit clinics due to reasons such as long distances, high costs of counseling, having other children at home, being employed, no insurance coverage for counseling and psychotherapy services, or simply being unaware of these clinics.  As a result, a child's behavioral problems at home and school with inadequate management can worsen the chaotic situation of family life and reduce its quality. Therefore, it is recommended that mental health professionals help educate mothers of children with behavioral disorders via mobile phone.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Research Ethics Committee of the Khatam University (Code: KH.96.p.100.3123).
The present paper was extracted from the MSc.thesis of the first author, Zahra Jamali, approved by the Department of Psychology and Educational Sciences, Faculty of Humanities, Khatam University.
Authors' contributions
All authors have met the standards of writing criteria based on the recommendations of the International Committee of Medical Journal Publishers (ICMJE).
Conflicts of interest
The authors declare no conflicts of interest.
The authors would like to thank the management of the Rooyesh-e Talaei  Institute and the mothers participated in this study for their valuable cooperation and patience.

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Type of Study: Original Atricle | Subject: General
Received: 2019/04/27 | Accepted: 2019/07/6

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