Parental Satisfaction and Parenting Style among Iranian Parents of Children and Adolescents with Conduct Disorder: A Cross-Sectional and Descriptive-Correlational Study

doi:10.21203/rs.3.rs-4940073/v1

Background

Conduct disorder (CD) is a psychiatric disorder related to childhood or adolescence that is manifested by antisocial behaviors and lack of compliance with social laws and norms. CD related limitations, along with its consequences on affected individuals, may be associated with the detrimental parent-child relationships in the form of unfavorable Parenting Style (PST) and Parental Satisfaction (PSA).

Objectives

This study aimed to assess CD severity in affected individuals and measure PST, IPST, and PSA levels in their parents, along with exploring correlations between these variables and CD severity, alongside other sociodemographic indicators.

Methods

The total number of 60 parents of children and adolescents with CD have participated in the present cross-sectional and descriptive-correlational study according to the inclusion criteria and convenience sampling method. In order to evaluate the levels of PST, IPST and PSA among parents, along with their correlations with the severity of CD in their children and adolescents, the questionnaires of “Socio-Demographic Information Questionnaire (SDIQ)”, “Dibble and Cohen Parent Report (DCPR)”, “Kansas Parental Satisfaction Scale (KPSS)”, and “Rating Scale for Diagnosis of Conduct Disorder (RSDCD)” were utilized. Eventually, the SPSS version 26 was utilized to analyze the final data.

Results

Most of the participants had “normal” levels of PSA, PST and IPST (66.7%, 51.7% and 65.0% respectively). In addition, most of the children and adolescents demonstrated remarkable severity of CD (146.42 ± 17.14). Besides, the correlations between “severity of CD” with “PST”, “IPST” and “PSA” were significant and inverse (r= -0.44, p = 0.001, r= -0.42, p = 0.001 and r= -0.27, p = 0.03). Finally, the cross-correlation obtained between “demographic characteristics with PSA, PST, IPST and severity of CD” were different and varied. Bayesian analysis reveals strong mutual correlations and predictive power between PSA, PST, CD severity, and sociodemographic factors.

Conclusion

Conclusion: Participants showed normal levels of “PSA,” “PST,” and “IPST.” The severity of CD was considerable among children and adolescents, significantly inversely correlating with “PST,” “IPST,” and “PSA.” Cross-correlations with varying significance levels were found between participants' socio-demographic characteristics and “PSA,” “PST,” “IPST,” and CD severity.

Parental Satisfaction

Parenting Style

Parents

Children

Adolescents

Conduct Disorder

Conduct Disorder (CD) is one of the psychiatric disorders among childhood or adolescence, which is characterized by antisocial behaviors and disturbances in compliance with social laws and norms (1). According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), CD is characterized by “aggression”, “deception”, “robbery”, “destruction of property”, and “serious violations of laws”, often leading to Antisocial Personality Disorder (ASPD) in adulthood (2). Based on the epidemiological studies, CD is approximately prevalent among 2–9% of girls and 6–16% of boys worldwide. Moreover, the onset of the abovementioned disorder among girls is later compared to boys (3–5). Furthermore, the prevalence of CD in Iran, as the 18th most populous country in the world in terms of the number of children and adolescents, is 5.11% of boys and 4.87% of girls (6). In order to diagnose CD, at least 3 criteria need to be present during the 12 last months, including “bullying”, “using any type of weapon”, “assaulting”, “robbery”, “fire setting”, “destruction of property”, “rape”, “staying out past curfew”, “running away”, “lying”, “lack of remorse or empathy” and finally “school truancy” (7, 8).

Based on the studies in the field of the etiology of CD, the role of family environment and Parenting Style (PST) is significantly important (9). PST is defined as a set of behaviors, approaches and attitudes that parents utilize in the process of interacting and raising their children (10). Accordingly, inappropriate PST such as unstable parenting, irrational and extreme violence, aggression and punishment, strict rules, lack of empathy and positive parent-child relationships, and insufficient parenting skills play a significant role in the occurrence of CD among children and adolescents (11, 12). Besides, as mentioned by numerous studies, other unfavorable family related conditions such as “overcrowded family”, “inappropriate housing”, “divorce and separation”, “personality and mental disorders”, “alcohol and drug abuse”, and “poverty” are correlated with the occurrence of CD (13–15).

Due to the comprehensiveness and importance of the CD related consequences, it has always been discussed within numerous studies. Therefore, not only the aforementioned consequences are not limited to children and adolescents with CD, but may also involve parents and even community (16–18). Accordingly, many studies unanimously concluded that the process of raising children and adolescents with CD is significantly stressful and challenging for their parents (19, 20). Therefore, many researchers declared that the parents of children and adolescents with CD may be at the risk of impaired Quality of Life (QOL) (21, 22). In fact, parents of children and adolescents with CD may be exposed to mental disorders such as anxiety and depression, which may subsequently affect their Parental Satisfaction (PSA) (23). PSA is defined as the levels of satisfaction which parents experience within their parent-child relationship, encompassing aspects like activities, communication, praise and punishment, as well as the child's behavior in terms of responsibilities, compliance and actions. Moreover, it should be noted that PSA is also considered in order to describe the levels of parents' satisfaction with their parental role (24).

Heretofore, many researchers have demonstrated a positive and significant correlation between PSA and PST, meaning that parents with favorable PST have reported the acceptable levels of PSA (25, 26). Furthermore, congruent to what was mentioned earlier, parenting barriers and challenges associated with children and adolescents with CD are profoundly related to the unfavorable PST among their parents (27–29). Subsequently, as emphasized by many investigations, PSA among parents of children and adolescents with CD was also significantly affected by the mentioned CD related limitations, in the form of being remarkably far from the minimum standard levels (30–32).

Despite the consensus of opinions declared by many researchers within the separated studies in the field of the existent correlations between PSA, PST and the severity of CD among children and adolescents with CD, still, the number of studies that have comprehensively examined the mentioned correlation through an independent study is limited. A gap which has been fully addressed in the current study. In fact, during the present study, the mutual relationships between PSA, PST and severity of CD, along with other sociodemographic indicators have been investigated in the form of a network of correlations. Moreover, based on what was mentioned earlier about the consequences of CD related limitations among affected individuals, families and even society, the necessity of conducting more studies in this field is emphasized. Undoubtedly, following the detailed evaluation of the frequency and correlational network between the mentioned variables, the process of implementing the necessary measures related to different levels of prevention among both children and adolescents with CD and their parents will be facilitated.

Objectives:

According to what was mentioned about the importance of PSA and PST among parents of children and adolescents with CD and the scantiness of the comprehensive studies conducted in this field, the aim of the present study was to determine the severity of CD among Iranian children and adolescents, as well as the levels of PSA and PST among the Iranian parents of children and adolescents with CD. Besides, determining the cross-correlation between the variables of PSA, PST and severity of CD, along with other sociodemographic indicators were considered as the other complementary goals of the current study.

- The aim, design and setting of the study:

The current study was a cross-sectional and descriptive-correlational study conducted from April 2023 to January 2024, aiming to determine the PSA and PST among Iranian parents of children and adolescents with CD. The research was carried out in the psychiatric clinics of Imam Hussein Hospital in Tehran, Iran.

- The characteristics of participants:

The participants in the present study consisted of one parent of each child and adolescent aged 6 to 17 years with conduct disorder (CD) who referred to the psychiatric clinics of Imam Hossein Hospital in Tehran in order to screen their children and adolescents for the existence of CD. The diagnostic screening process for CD was implemented based on the psychiatrist's opinion, medical records and history, and the “Rating Scale for Diagnosis of Conduct Disorder (RSDCD).” Afterward, the sample size for the current study was calculated based on the study of Hasani et al. (33) using the following formula:

$$\:n=\frac{{{z}^{2}}_{1-\alpha\:/2\:}\times\:\:{\sigma\:}^{2}}{{\delta\:}^{2}}$$

Hence, from the initial 108 parents of children and adolescents with a definitive diagnosis of CD, only 79 individuals were simultaneously eligible based on the inclusion criteria of the study and provided their consent after being informed about the conditions and objectives of the study. Eventually, a final number of 60 individuals completed the entire questionnaire.

- Description of process:

In order to initiate the data collection process, approval from both the ethics committee of Shahid Beheshti University of Medical Sciences (SBMU) and the vice-chancellor of SBMU was acquired. Then, obtaining verification from the education department of Imam Hossein Hospital was considered. Afterward, the process of selecting the participants for the present study was implemented based on the inclusion criteria and a convenience sampling method by both authors of the current study. Accordingly, based on the inclusion criteria, the parents (either father or mother) must have children or adolescents aged 6 to 17 years with Conduct Disorder (CD, based on the psychiatrist's opinion, medical records, and the RSDCD) who have been diagnosed with CD for at least one year. Moreover, neither the parents nor their children or adolescents should have severe physical or psychocognitive disorders that may interfere with their participation in the present study (which has been specified according to the diagnosis of clinics’ psychiatrists, the self-report of the participants and their medical history). Furthermore, it was necessary for all participants to have sufficient skills in communicating in Persian. Ultimately, the principle of voluntary participation of the participants was mandatory.

Reciprocally, according to the exclusion criteria, participants who left more than 10% of the questionnaires unanswered were excluded from the study.

Subsequently, following the determination of the final participants, the questionnaires “Socio-Demographic Information Questionnaire (SDIQ),” “Dibble and Cohen Parent Report (DCPR),” and “Kansas Parental Satisfaction Scale (KPSS)” were presented to them along with comprehensive explanations. Additionally, as mentioned earlier, the RSDCD was also presented to the parents in order to measure the severity of CD among their children and adolescents.

Accordingly, the “SDIQ” was designed by the authors and consisted of the sociodemographic information of both parents and their children and adolescents with CD. To evaluate the validity of the SDIQ, the method of qualitative content validity was implemented.

The DCPR, as the second tool of the present study, was designed by Dibble and Cohen in 1974. The DCPR consisted of 23 items, and its purpose was to measure the Parent Satisfaction Tool (PST) in two conditions: the “current PST” and the “Ideal PST (IPST).” The scoring method of the DCPR was in the form of a 7-point Likert scale for the options of “never (score: 0),” “almost never (score: 1),” “seldom (score: 2),” “half the time (score: 3),” “frequently (score: 4),” “almost always (score: 5),” and “always (score: 6).” Accordingly, the total score of the DCPR, ranging from 0 to 46, indicated “inappropriate PST,” a score between 47 and 69 indicated “average PST,” and finally, a score higher than 69 indicated “appropriate PST.” The reliability of the DCPR has been evaluated by the method of “test-retest” between the responses of fathers and mothers, which was 87.5% for “current PST” and 81.25% for “IPST” (34). Moreover, it is essential to indicate that the validity of the DCPR has been confirmed by many studies (35–38).

The next tool of the current study was the KPSS. The KPSS was designed by Schumm and Hall in 1985 to evaluate the Parental Satisfaction Assessment (PSA). The KPSS consisted of 3 items that express the levels of PSA on a 7-point Likert scale from “extremely dissatisfied (score: 1)” to “extremely satisfied (score: 7).” Therefore, the total score ranged from 3 to 21, meaning that a score between 3 and 6 indicated “low levels of PSA,” a score between 7 and 12 indicated “average levels of PSA,” and eventually, a score higher than 12 indicated “high levels of PST.” To determine the reliability of this tool, the internal correlation was calculated using Cronbach's alpha coefficients, which ranged from 0.78 to 0.85 (39, 40). Furthermore, the KPSS had acceptable validity, as it has been utilized in many studies (41–43).

The RSDCD consisted of 35 items along with 5 factors: “aggression,” “irresponsibility,” “deception,” “vandalism,” and “insufficient interpersonal relationships.” The scoring method of the RSDCD was in the form of a 5-point Likert scale for the options of “never (score: 1),” “rarely (score: 2),” “sometimes (score: 3),” “often (score: 4),” and “always (score: 5).” The total score of the RSDCD ranged from 35 to 175, meaning that a higher score indicated a more severe CD, while a lower score indicated milder CD. To determine the reliability of the RSDCD, the internal correlation was calculated using Cronbach's alpha coefficients, which was 0.97 (44). The construct validity of this questionnaire was calculated using the correlation test between this questionnaire and the “Child Symptom Inventory-4 (CSI-4),” which was 0.87 (45).

Eventually, the validated Persian versions of the mentioned tools have been implemented in various Iranian studies (45–48).

- Statistical analysis:

In order to analyze the data obtained from the current research, descriptive statistics have been considered to calculate the “mean,” “standard deviation,” “absolute frequency,” and “percentage frequency” for sociodemographic and clinical variables. In addition, inferential statistics have been implemented to evaluate the correlation between the variables of PSA, PST, and the severity of CD using the “t-test” and the “Pearson correlation coefficient test.” Furthermore, the “Spearman's correlation coefficient test” has been employed to specify the correlation between the sociodemographic characteristics and the variables of PSA, PST, IPST, and the severity of CD. In addition, Bayesian regression analysis was used to investigate the mutual correlation and predictive power between PSA, PST, IPST, CD severity, and other demographic characteristics in the form of a comprehensive network of causation relationships and correlations among the mentioned variables. Ultimately, the obtained data were analyzed using SPSS version 26 software, with both the test error rate and significance level set to be less than 0.05.

- Ethical considerations:

The present study was approved by the SBMU Research Ethics Committee, and subsequently, the ethical code (IR.SBMU.RETECH.REC.1401.818) was received. Based on this, adherence to the ethical principles of “voluntary participation,” “withdrawal permission,” “providing information,” and “confidentiality” has been considered to the greatest extent throughout all stages of the present study. Furthermore, it should be noted that written informed consent was obtained from all participants.

Sociodemographic characteristics and descriptive indicators of both children and adolescents with CD and their parents

Among the total of 60 parents, most of them were middle-aged (41.15±7.42 and 44.31±7.85 years old), female (70.0%), and at least one of them was employed (56.7%). Moreover, more than half of them had secondary educational status and medium economic status. Eventually, most of the children and adolescents with CD were in the middle childhood stage (12.51±3.02 years old), male (68.3%), and they had poor educational status (65.0%) (Table 1).

Determining the levels and values of PSA, PST, and IPST among the parents of children and adolescents with CD

The remarkable values of “PSA” (7.88±3.11), “PST” (51.45±11.77), and “IPST” (60.43±12.78) have been observed among the parents of children and adolescents with CD. Moreover, the levels of “PSA” in most parents were “medium” (66.7%). Finally, despite the “normal” levels of both “PST” and “IPST” among most parents (51.7% and 65.0%, respectively), the values of these variables differed based on the implemented comparison (IPST/PST ratio = x̄ = 1.18, σ = .11) (Table 2).

Determining the severity of CD among children and adolescents

The considerable severity of CD (146.42±17.14) was obtained from the children and adolescents with CD. Moreover, based on the values of both lower and upper limits of the severity of CD (141.99 and 150.85, respectively), the significance of the aforementioned severity was emphasized (Table 3).

The cross-correlation between the variables of “severity of CD,” “PSA,” “PST,” and “IPST”

According to the statistical values of the “Pearson correlation coefficient test” between the mentioned variables, there were significant and inverse correlations between the “severity of CD” and “PST” (r = -0.44, p = 0.001), “IPST” (r = -0.42, p = 0.001), and “PSA” (r = -0.27, p = 0.03). Moreover, there was a positive and meaningful correlation between “PSA” and “PST” (r = 0.62, p = 0.001) and “IPST” (r = 0.65, p = 0.001) (Table 4).

The correlation between sociodemographic characteristics and descriptive indicators with PSA, PST, IPST, and the severity of CD

According to the statistical values of the “Spearman's correlation coefficient test,” various correlations have been obtained between the mentioned variables. In particular, inverse and meaningful correlations have been found between “PST” and “IPST” with “mental disorders among parents” (r = -0.331, p = 0.005 and r = -0.258, p = 0.023, respectively) and “IPST” with “father’s age” (r = -0.234, p = 0.036). Conversely, positive and significant correlations have been reported between “PSA,” “PST,” and “IPST” with “economic status of parents” (r = 0.291, p = 0.012; r = 0.374, p = 0.002; and r = 0.422, p = 0.001, respectively) and “PSA,” “PST,” and “IPST” with “educational status of parents” (r = 0.264, p = 0.021; r = 0.305, p = 0.009; and r = 0.345, p = 0.004, respectively). Moreover, various correlations have been observed between the “severity of CD” and the sociodemographic characteristics and descriptive indicators of children and adolescents with CD, but they were not significant (Table 5).

The mutual correlations and predictive power between the variables of PSA, PST, IPST, and severity of CD and other sociodemographic characteristics based on the Bayesian regression analysis

Based on Bayesian analysis, remarkable results have been obtained in the form of a network of mutual correlations and predictive power between the variables of PSA, PST, severity of CD, and other sociodemographic characteristics (Table 6).

The aim of the current cross-sectional and descriptive-correlational study was to determine the severity of CD among Iranian children and adolescents, as well as the levels of PSA and PST among their parents, along with the cross-correlations between these variables and other sociodemographic indicators.

Accordingly, the severity of CD among the children and adolescents of the participants in the current study was significant. This significant severity can affect the parenting criteria of participants in the form of CD-related parental problems, as indicated by many studies (49–51). Correspondingly, PSA is considered one of the aforementioned criteria. In the present study, the levels of PSA among most parents of children and adolescents with CD were medium. In other words, the levels of PSA were far from ideal and desirable levels. In this regard, studies by Matalon et al. (2023), Bjørknes et al. (2021), and Viefhaus et al. (2021) unanimously emphasized the existence of undesirable levels of PSA among parents of children and adolescents with CD, which was aligned with the results of the current study (52–54).

The next variables were the levels of PST and IPST, both of which were "normal" among the participants in the present study. However, the values of IPST (as an ideal form of PST based on the participants' perspectives) were statistically slightly more desirable than PST. Despite the expected statistical difference and superiority of IPST, the mentioned statistical difference and superiority were not significant compared to PST. The absence of a statistically significant difference between PST and IPST can be interpreted as "concerning," as it indicates the parents' desirable view toward their current PST and the fact that they have not felt any requirement to change their current PST. This proposed interpretation has been emphasized by various studies (55–57). In this regard, many studies have unanimously emphasized the existence of undesirable PST among the parents of children and adolescents with CD. Therefore, these findings were consistent with the results of the present study (58–60). However, the difference between the levels of PST and IPST has not been reported in a similar study.

Determining the cross-correlations between the main variables was the subsequent aim of the present study. Accordingly, significant inverse correlations were found between the severity of CD and PSA, PST, and IPST, meaning that more severe CD among children and adolescents correlated with lower levels of PSA, PST, and IPST among their parents. In this regard, many studies were consistent with the results of the present study, indicating that lower levels of PST among parents would lead to more severe CD among their children and adolescents (14, 15). Consequently, lower levels of PSA among their parents resulted from more severe CD among children and adolescents (53, 54, 61). Reciprocally, as expected, positive and significant cross-correlations were observed between PST, IPST, and PSA among parents of children and adolescents with CD. In fact, parents with higher levels of PSA demonstrated higher levels of PST and even IPST, and vice versa. Many studies have emphasized these cross-correlations (62–64).

To clarify the cross-correlation between sociodemographic characteristics and descriptive indicators with the main variables of the current study, the child and adolescent-related variables were considered in terms of their potential correlations with the severity of CD, and subsequently, the parent-related variables were examined concerning their potential correlation with the levels of PSA, PST, and IPST. Accordingly, more severe CD was more prevalent among children and adolescents who were older, boys, had lower educational status, and had a history of mental disorders. However, none of these correlations were significant. Nevertheless, the results have been confirmed by various studies indicating that more severe CD is associated with older age, being a boy (65), poor educational status (66), and the presence of other mental disorders (67).

Regarding the parent-related variables, the results were significant. Accordingly, younger parents demonstrated higher levels of PST, IPST, and PSA. These results may be attributed to their newer and more modern beliefs compared to older parents. In other words, modern beliefs lead to better PST, which, in turn, contributes to higher levels of PSA. The validity of this theory has been confirmed by many studies (26, 68, 69). Additionally, based on the study of Jadva et al. (2022), better parental relationships, PST, and PSA among younger parents compared to older parents have been emphasized (70).

In the present study, the levels of PSA, PST, and IPST among mothers and urban residents were higher than those of fathers and rural residents. It should be noted that similar studies have concluded with different results (71–74). Some studies were consistent with the present study, while others were inconsistent. The difference and heterogeneity of the results obtained from the reviewed studies may be attributed to sociodemographic and methodological dissimilarities. However, the statistical superiority of the variables involving mothers and urbanization in the present study could be related to their numerical superiority. Furthermore, higher levels of PST, IPST, and PSA were observed among participants who were employed and had higher educational and economic statuses. Undoubtedly, favorable economic status, higher educational levels, and being employed are potential underlying factors for desirable levels of PSA and PST among parents. Many studies have consolidated this theory (75–78). Additionally, similar studies have produced consistent results with the present study (53, 59, 79, 80). It should be noted that PST, IPST, and PSA among parents with a history of mental disorders were significantly lower compared to healthy parents. In fact, mental disorders among parents may cause disturbances in PST, which in turn leads to lower levels of PSA. This correlation has been emphasized by many studies (61, 79, 81, 82).

In conclusion, the results obtained from Bayesian regression have consolidated previous findings in the form of a network of mutual connections. There is significant predictive power between a higher educational status of children and adolescents with milder CD, along with more favorable PST, IPST, and PSA associated with lower severity of CD, the absence of mental disorders, and better educational and economic status. Each of the relationships proposed in the present study, framed as an integrated network of mutual relationships between variables, aligns with the findings of many other studies, each of which addressed some relationships separately and linearly (61, 66, 78, 79, 82).

Limitations:

The findings of this study may have limited applicability due to several factors. Firstly, the sample size was small and comprised exclusively of participants from Tehran, which may not represent broader demographics. Variability among parent-child relationships, stemming from different sociodemographic and diagnostic backgrounds, could influence the results as well. Additionally, the focus on government medical centers might have skewed the sample towards individuals from middle to lower socioeconomic populations. Access to the parents of children and adolescents with CD may also have been hindered by economic restrictions, negative attitudes, lack of awareness, or instances where CD remains undiagnosed. The research methodology further introduces constraints, as convenience sampling and self-reported measures can result in bias. These factors should be carefully considered when assessing the implications of the findings for other groups or contexts.

Implications:

Implications of this study include the importance of assessing and addressing parenting style and parental satisfaction in the treatment and management of conduct disorder in children and adolescents. The significant and inverse correlation between the severity of conduct disorder and parenting style and satisfaction highlights the potential impact of parental involvement on the behavior and well-being of affected individuals. Understanding the interplay between demographic characteristics and parenting factors can also aid in the development of tailored interventions for families dealing with conduct disorder. Additionally, the strong mutual correlations and predictive power identified through Bayesian analysis suggest the need for a comprehensive approach that considers both individual and environmental factors in the assessment and treatment of conduct disorder. Overall, these findings emphasize the crucial role of parental support and effective parenting strategies in addressing conduct disorder in children and adolescents.

According to the results of the current study, the severity of CD among Iranian children and adolescents was considerable. Moreover, the levels of PSA, PST, and IPST among most of the Iranian parents of children and adolescents with CD were “normal.” Furthermore, the “severity of CD” had significant and inverse correlations with “PST,” “IPST,” and “PSA.” Eventually, among the obtained mutual correlations between the “socio-demographic characteristics of both participants and their children and adolescents” and “PSA, PST, IPST, and severity of CD,” the inverse correlations between “PST and IPST with mental disorders of parents,” “IPST with age of parents,” along with the positive correlations between “PSA, PST, and IPST with economic and educational status of parents” were meaningful.

Ethics approval and consent to participate:

The Ethics Committee of the Shahid Beheshti University of Medical Sciences (SBMU) approved the study and all participants signed the informed consent form. This study followed the Declaration of Helsinki.

Consent for publication:

Not applicable.

Availability of data and materials:

The data sets used during the current study can be provided by the corresponding author [A.H.S], upon reasonable request.

Competing interests:
The authors declare that they have no competing interests.

Funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions:

S.N.M was involved in "designing the study", "collecting the data", "supervised" and "approved" the final paper.

A.H.S was involved in "collecting the data", "analyzing data" and "writing" the paper.

Acknowledgements:

Not applicable.

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Table.1 Sociodemographic characteristics and descriptive indicators of both children and adolescents with CD and their parents

Parents	Variables		N.		Frequency
	Gender	Male	18		30.0 %
		Female	42		70.0 %
		Total	60		100.0 %
	Occupation Status	Both Unemployed	16		26.7 %
		One Employed	34		56.7 %
		Both Employed	10		16.7 %
		Total	60		100.0 %
	Educational Status	Both Primary	9		15.0 %
		Both Secondary	32		53.3 %
		Both Higher	4		6.7 %
		Primary and Secondary	9		15.0 %
		Secondary and Higher	6		10.0 %
		Total	60		100.0 %
	Economic Status	Poor	29		48.3 %
		Medium	31		51.7 %
		Total	60		100.0 %
	Mental Disorders	None	18		30.0 %
		One	20		33.3 %
		Both	22		36.7 %
		Total	60		100.0 %
	Habitation	Village	9		15.0 %
		City	51		85.0 %
		Total	60		100.0 %
	Variables		Mean	SD	Min.	Max.
	Mother's Age		41.15	7.42	27	54
	Father's Age		44.31	7.85	32	62
	Variables		N.		Frequency
Children and Adolescents	Gender	Male	41		68.3 %
		Female	19		31.7 %
		Total	60		100.0 %
	Educational Status	Dropout	14		23.3 %
		Failed	3		5.0 %
		Poor	39		65.0 %
		Normal	4		6.7 %
		Total	60		100.0 %
	Mental Disorders	No	19		31.7 %
		Yes	41		68.3 %
		Total	60		100.0 %
	Variables		Mean	SD	Min.	Max.
	Age		12.51	3.02	6	17

Table.2 The levels and the values of PSA, PST and IPST among the parents of children and adolescents with CD

Variables							N.			Frequency
PSA			Low (below 6)				12			20.0 %
			Medium (6-12)				40			66.7 %
			High (above 12)				8			13.3 %
			Total				60			100.0 %
PST			Inappropriate (below 46)				21			35.0 %
			Normal (46-69)				31			51.7 %
			Appropriate (above 69)				8			13.3 %
			Total				60			100.0 %
IPST			Inappropriate (below 46)				8			13.3 %
			Normal (46-69)				39			65.0 %
			Appropriate (above 69)				13			21.7 %
			Total				60			100.0 %
Variables							Mean		SD	Min.			Max.
PSA							7.88		3.11	3			17
PST							51.45		11.77	33			83
IPST							60.43		12.78	41			97
Variables	Absolute value of the t-value			df		Statistical significance	Means difference		95% confidence interval of mean difference
									lower			upper
PSA	19.64			59		0.001	7.88		7.08			8.69
PST	33.84			59		0.001	51.45		48.41			54.49
IPST	36.61			59		0.001	60.43		57.13			63.74
Ratio Statistics for IPST/PST
Mean		Minimum			Maximum			Std. Deviation			Range
1.18		0.97			1.53			0.11			0.56

Table.3 The severity of the CD among children and adolescents with CD

Variables	Absolute value of the t-value	df	Statistical significance	Means difference	95% confidence interval of mean difference
Variables	Absolute value of the t-value	df	Statistical significance	Means difference	lower	upper
Severity of CD	66.16	59	0.001	146.42	141.99	150.85
	N	Min	Max	Mean	SD	SD Error Mean
	60	111	171	146.42	17.14	2.21

Table.4 Pearson correlation coefficient between the “severity of CD”, “PSA”, “PST” and “IPST”

Correlations
Variables		Severity of CD	PSA	PST	IPST
Severity of CD	Pearson Correlation	1	-0.27*	-0.44*	-0.42*
	Sig. (2-tailed)	-	0.03	0.001	0.001
	N	60	60	60	60
PSA	Pearson Correlation	-0.27*	1	0.62*	0.65*
	Sig. (2-tailed)	0.03	-	0.001	0.001
	N	60	60	60	60
PST	Pearson Correlation	-0.44*	0.62*	1	0.91*
	Sig. (2-tailed)	0.001	0.001	-	0.001
	N	60	60	60	60
IPST	Pearson Correlation	-0.42*	0.65*	0.91*	1
	Sig. (2-tailed)	0.001	0.001	0.001	-
	N	60	60	60	60

*. Significant at the 0.05 level

Table.5 Spearman's correlation coefficient between the sociodemographic characteristics and descriptive indicators with the variables of PSA, PST, IPST and the severity of CD

Correlations
				Severity of CD
Spearman's rho	Children and Adolescents	Age	Correlation Coefficient	0.175
			Sig.	0.181
			N	60
		Gender	Correlation Coefficient	0.019
			Sig.	0.887
			N	60
		Educational Status	Correlation Coefficient	-0.227
			Sig.	0.082
			N	60
		Mental Disorders	Correlation Coefficient	0.078
			Sig.	0.555
			N	60
				PST	IPST	PSA
	Parents	Mother's Age	Correlation Coefficient	-0.127	-0.109	-0.185
			Sig.	0.167	0.205	0.078
			N	60	60	60
		Father's Age	Correlation Coefficient	-0.181	-0.234*	-0.173
			Sig.	0.083	0.036	0.093
			N	60	60	60
		Gender	Correlation Coefficient	-0.121	-0.095	-0.111
			Sig.	0.179	0.236	0.199
			N	60	60	60
		Economic Status	Correlation Coefficient	0.374*	0.422*	0.291*
			Sig.	0.002	0.001	0.012
			N	60	60	60
		Habitation	Correlation Coefficient	0.078	0.019	0.110
			Sig.	0.278	0.442	0.201
			N	60	60	60
		Occupation Status	Correlation Coefficient	0.195	0.210	0.015
			Sig.	0.068	0.053	0.455
			N	60	60	60
		Educational Status	Correlation Coefficient	0.305*	0.345*	0.264*
			Sig.	0.009	0.004	0.021
			N	60	60	60
		Mental Disorders	Correlation Coefficient	-0.331*	-0.258*	-0.162
			Sig.	0.005	0.023	0.109
			N	60	60	60

*. Significant at the 0.05 level

Table.6 The mutual correlations and predictive power between the variables of PSA, PST, IPST and severity of CD and other sociodemographic characteristics based on the Bayesian regression analysis

Bayesian Mutual Correlations		Bayesian Factor	Statistical Significance
Children and Adolescents	CD * Educational Status	0.11	0.01*
Parents	PST * IPST	0.08	0.01*
	PST * CD	0.11	0.02*
	PST * Economic Status	0.09	0.04*
	PST * Mental Disorders	0.08	0.02*
	PSA * CD	0.13	0.04*
	PSA * Economic Status	0.06	0.02*
	PSA * Educational Status	0.13	0.01*

*p<0.05

No competing interests reported.

Parental Satisfaction and Parenting Style among Iranian Parents of Children and Adolescents with Conduct Disorder: A Cross-Sectional and Descriptive-Correlational Study

Status:

Version 1

Abstract

Background

Objectives

Methods

Results

Conclusion

Background

Objectives:

Methods

- The aim, design and setting of the study:

- The characteristics of participants:

- Description of process:

- Statistical analysis:

- Ethical considerations:

Results

Discussion

Limitations:

Implications:

Conclusion

Declarations

References

Tables

Additional Declarations

Status:

Version 1