Optimizing Treatment for Depressed Parents of Children With Emotional and Behavioural Problems (OPTED)

Optimizing Treatment for Depressed Parents of Children With Emotional and Behavioural Problems (OPTED): A Randomized and Controlled Trial

Standard Behavioral Parent Training (BPT) is often less effective for parents experiencing depression. As such, the Addressing Depression and Positive Parenting Techniques (ADAPT) intervention is a novel BPT tailored to address the unique emotional and cognitive needs of depressed parents to improve treatment outcomes.

The objective of this study is to determine the efficacy of ADAPT in reducing child emotional and behavioral difficulties compared to the gold-standard Incredible Years Parenting Program (IYPP).

This study is a 4-year, individually-randomized group treatment (IRGT), parallel-group trial. We aim to recruit 180 caregivers and their children (aged 6-11 years) seeking treatment for their child's emotional and behavioral difficulties from multiple mental health centres across Toronto, including but not limited to the University of Toronto, Centre for Addiction and Mental Health (CAMH), and Women's College Hospital (WCH).

Participants will be asked to complete research measures:

• before randomization
• post-treatment
• 6 months after the end of treatment

Participants will be randomized to either the experimental ADAPT intervention - A 10-session virtual program (1 individual, 9 group) focused on emotion regulation, distress tolerance, and cognitive restructuring, or the control intervention: Incredible Years Parent Program (IYPP) - A 12-session gold-standard BPT delivered virtually.

Study Overview

• Status: Recruiting
• Conditions: Conduct Disorders in Children; Parenting Intervention; Depression / Major Depressive Disorder; Disruptive Behaviour in Children
• Intervention / Treatment: Behavioral: ADAPT Treatment; Behavioral: Incredible Years Parenting Program (IYPP)

• Study Type: Interventional
• Enrollment (Estimated): 180
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Brendan Andrade, PhD; Phone Number: 416-946-5905; Email: brendan.andrade@utoronto.ca

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada
      • Recruiting
      • Ontario Institute for Studies in Education (OISE)
      • Contact: Madison Moloney; Phone Number: 30525 416-535-8501; Email: madison.moloney@utoronto.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. 18 years of age or above
2. has a child aged 6-11 years with clinically elevated emotional and behavioural disorders (Abnormal Range, 93rd percentile) on the Total Difficulties Scale of the Strength and Difficulties Questionnaire (SDQ)
3. parent shows clinical elevations for mild-moderate depression on the Patient Health Questionnaire-8 (PHQ-8) (>4 and <15)
4. capacity to tolerate a virtual group context assessed by clinical interview

Exclusion Criteria:

1. Parent shows active suicidal ideation, substance use disorder, or psychosis
2. they cannot communicate in English
3. child previously diagnosed with autism or an intellectual disability

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ADAPT Treatment; Participants in the experimental arm will receive the novel Addressing Depression and Positiving Parenting Techniques (ADAPT) treatment. ADAPT is a targeted treatment adapted by the Co-PI based on the Parenting a Child Who Has Intense Emotions program. The treatment has modules that help parents build emotion regulation skills, distress tolerance skills, and helpful ways of thinking about their parenting. The program also contains components of standard behavioural parent training, including strategies to build family structure, routines, and predictable parenting responses to children's behavioral challenges. Additionally, ADAPT includes elements of Dialectical Behaviour Therapy (DBT), an effective intervention for the treatment of adults and youth with dysregulated emotion and behavior.	Behavioral: ADAPT Treatment; ADAPT is a 10-session virtual caregiver program (one individual engagement session and nine group sessions) that was developed with clinician and parent input. The initial engagement session is an individual meeting between the group facilitator and parent to build rapport and learn about the parent's unique challenges and parenting needs. Based on a motivational interviewing framework, this session is designed to gather information, discuss readiness for treatment and goals. The questions and tools used in this session help to build a collaborative understanding of unique child and parent needs that may be addressed through ADAPT and leave the parent with the hope that ADAPT can be helpful. The 9 virtual group treatment sessions that follow include modules to help parents understand the multiple potential contributions to their child's emotional/behavioral challenges, build their own emotion regulation skills, distress tolerance skills, and more helpful ways of thinking.
Active Comparator: Incredible Years Parenting Program (IYPP); Participants randomized to the control arm will receive the Incredible Years Parenting Program (IYPP). IYPP is a best-practice and widely used treatment for parents of children with EBD.	Behavioral: Incredible Years Parenting Program (IYPP); The 12-session manualized treatment is considered a gold-standard treatment because it has shown efficacy in large-scale randomized and controlled trials and meta-analyses. Parents are helped to shift their children's emotional and behavioral difficulties through improved parental skills and competencies with behaviour management, and a parental problem-solving approach. IYPP will be delivered virtually.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in child emotional and behavioral difficulties	Child emotional and behavioural difficulties are assessed using the Behaviour and Feelings Survey (BFS).	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in parental depression	Parental depression is assessed using the Patient Health Questionnaire (PHQ-8).	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up
Changes in parental quality of life	Quality of life is assessed using the World Health Organization Disability Assessment 2.0 (WHODAS).	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up
Changes in broad parenting practices	Parenting practices are assessed using the Multidimensional Assessment of Parenting (MAPS).	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up
Changes in parental stress	Parental stress is assessed using the self-reported scores on items of the Stress subscale of the Depression, Anxiety, and Stress Scale (DASS-21).	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in parental cognition	Parent cognition is assessed using the Parent Cognition Scale (PCS). The PCS will be examined as a predictor of initial symptom severity and potential treatment mechanism.	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up
Changes in parent emotion regulation	Parent emotion regulaiton is assessed using the Affect Regulation Checklist (ARC). The PCS will be examined as a predictor of initial symptom severity and potential treatment mechanism.	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up
Changes in real-time parent-reported child emotional and behavioral difficulties	Real-time parent-reported child emotional and behavioral difficulties will be assessed via ecological momentary assessment (EMA) at pre- and post-treatment, capturing momentary ratings of child symptoms.	Baseline (pre-randomization) and post-treatment (12-weeks post-randomization)
Changes in the implementation of parenting skills	Implementation of parenting skills is assessed using the Parenting Skill Use Diary (PSUD).	Baseline (pre-randomization) and post-treatment (12-weeks post-randomization).
Changes in child depressive symptoms	Child depressive symptoms will be assessed using the child-reported Short Mood and Feelings Questionnaire (SMFQ).	Baseline (pre-randomization) and post-treatment (12-weeks post-randomization).
Changes in child irritability	Child irritability will be assessed using the parent-reported Affective Reactivity Index (ARI).	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up
Changes in child perceptions of parenting behaviour	Child perceptions of parenting behaviour will be assessed using the Children's Report of Parenting Behavior Inventory (CRPBI).	Baseline (pre-randomization) and post-treatment (12-weeks post-randomization)
Changes in parental competence need satisfaction and frustration	Parental competence need satisfaction and frustration will be assessed using the relevant subscales of the Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS).	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up
Changes in child callous-unemotional traits	Child callous-unemotional traits will be assessed using the Inventory of Callous-Unemotional Traits (ICU).	Baseline (pre-randomization), post-treatment (12 weeks post-randomization), and 6-month follow-up
Changes in child self-reported emotion-regulation	Child self-reported emotion-regulation will be assessed using the Children's Emotion Management Scales (CEMS).	Baseline (pre-randomization) and post-treatment (12 weeks post-randomization)
Changes in parental self-efficacy	Parental self-efficacy is assessed using the Parenting Sense of Competence Scale (PSOC).	Baseline (pre-randomization), post-treatment (12-weeks post-randomization), and 6-month follow-up

Collaborators and Investigators

• Sponsor: University of Toronto
• Collaborators: Centre for Addiction and Mental Health; Women's College Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): August 1, 2030
• Study Completion (Estimated): August 1, 2030

Study Registration Dates

• First Submitted: June 8, 2026
• First Submitted That Met QC Criteria: August 4, 2026
• First Posted (Actual): August 6, 2026

Study Record Updates

• Last Update Posted (Actual): August 6, 2026
• Last Update Submitted That Met QC Criteria: August 4, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: depression; parenting skills; behavioural parent training; child disruptive behaviour
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Mood Disorders; Depressive Disorder; Behavior; Depression; Depressive Disorder, Major
• Other Study ID Numbers: 50526 (SMART IRB)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified study data may be shared with other reseachers upon request at the disrection of the PI.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No