{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:09Z","timestamp":1785545049238,"version":"3.56.0"},"reference-count":81,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Pediatr Parent"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Oppositional symptoms in youth are characterized by an angry or irritable mood and excessive defiance (eg, arguing), negatively impacting the mental well-being of children, adolescents, and their caregivers. Pediatric digital mental health interventions (DMHIs) that approach care from a whole-family perspective may effectively address mental health (MH) symptoms in both pediatric participants and their caregivers, though this has not been explored in the context of oppositional symptoms.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The purpose of this study was to assess oppositional symptoms in children and adolescents (aged 6 to 17 years) participating in care within the real-world conditions of a family-centered DMHI. We aimed to (1) examine baseline oppositional severity and its associations with child demographic and clinical characteristics (eg, co-occurring MH symptoms), and caregiver symptoms; (2) evaluate demographic, clinical, and engagement factors associated with oppositional symptoms during care with the DMHI; and (3) determine whether changes in oppositional symptoms during care are associated with improvements in caregivers\u2019 stress, burnout, and sleep.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Retrospective analyses included 3781 child-caregiver pairs who participated in coaching and therapy with Bend Health Inc, a family-centered, pediatric DMHI. Assessments at baseline and monthly during care measured pediatric and caregiver symptoms. Children and adolescents were grouped by oppositional severity at baseline: not significant, subclinical, and clinical. Pediatric characteristics, care type, and caregiver symptoms were compared between groups. Linear mixed-effects models assessed oppositional symptoms over months and then tested whether oppositional severity and rate of symptom improvement were associated with caregiver outcomes over time.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Baseline oppositional symptoms were not significant for 51.55% (1949\/3781), subclinical for 26.47% (1001\/3781), and clinical for 21.98% (831\/3781). More severe oppositional symptoms were associated with younger age (\n P<\/jats:italic>\n <.001), nonfemale sex (\n P<\/jats:italic>\n <.001), White race or ethnicity (\n P<\/jats:italic>\n <.001), higher rates of MH diagnoses (all\n P<\/jats:italic>\n <.001), and higher rates of co-occurring inattention, hyperactivity, depression, and sleep problems (all\n P<\/jats:italic>\n <.001). Odds of elevated caregiver symptoms increased with more severe oppositional symptoms (all\n P<\/jats:italic>\n <.001). At the end of care (final follow-up), oppositional symptoms improved for 73.93% (740\/1001) with subclinical symptoms and 82.43% (685\/831) with clinical symptoms. Symptom trajectories followed a logarithmic curve, with the greatest improvements in the first several months (\n P<\/jats:italic>\n <.001). While more severe oppositional symptoms were associated with more severe caregiver stress, burnout, and sleep problems (all\n P<\/jats:italic>\n <.001), monthly improvements in caregiver symptoms were significantly larger for those whose child improved more quickly (all\n P<\/jats:italic>\n <.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Family-centered DMHIs may effectively address pediatric oppositional symptoms, as well as co-occurring impairments in caregiver well-being. These findings highlight the broader, system-level impact of scalable DMHIs (such as Bend) in addressing complex family MH needs. Future work should examine these effects in the long term and evaluate opposition-specific care pathways within DMHIs.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/82039","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T08:05:23Z","timestamp":1778659523000},"page":"e82039-e82039","source":"Crossref","is-referenced-by-count":0,"title":["Family-Focused Digital Mental Health Care for Pediatric Oppositional Symptoms and Caregiver Outcomes: Retrospective Analysis"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8252-2424","authenticated-orcid":false,"given":"Darian","family":"Lawrence-Sidebottom","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1548-4936","authenticated-orcid":false,"given":"Kelsey","family":"McAlister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9266-095X","authenticated-orcid":false,"given":"Donna","family":"McCutchen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6691-8353","authenticated-orcid":false,"given":"Monika","family":"Roots","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0276-4640","authenticated-orcid":false,"given":"Jennifer","family":"Huberty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1038\/s41572-023-00441-6","article-title":"Oppositional defiant disorder","volume":"9","author":"Hawes","journal-title":"Nat Rev Dis Primers"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1080\/15374410902851382","article-title":"The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds","volume":"38","author":"Lavigne","journal-title":"J Clin Child Adolesc Psychol"},{"key":"R3","doi-asserted-by":"crossref","unstructured":"Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 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