Development and Validation of a Group Training Package of Positive Verbal Self-Instruction for Adolescents with Conduct Disorder
Keywords:
Conduct disorder, verbal self, instruction, positive thinking, validation, adolescents, social skillsAbstract
Introduction and Aim: The present study aimed to develop and validate a group training package based on positive verbal self-instruction for adolescents with conduct disorder.
Methodology: This study employed a mixed-method design. In the qualitative phase, a directed inductive–deductive content analysis was conducted using scientific literature published between 2010 and 2025 and semi-structured interviews with 10 psychology experts to extract and organize the components of the training package. In the quantitative phase, face validity was assessed qualitatively, and content validity was evaluated using the Content Validity Ratio (CVR) and Content Validity Index (CVI) based on expert judgments. The final package consisted of 10 group sessions lasting 45–60 minutes, designed with an active and practice-oriented approach.
Findings: The results indicated that CVI values ranged from 0.83 to 1.00 and CVR values ranged from 0.67 to 0.83, demonstrating acceptable to high content validity. All sessions were evaluated as relevant, clear, important, and comprehensive, and no major revisions or eliminations were required for the components of the training package.
Conclusion: The findings suggest that the positive verbal self-instruction training package has satisfactory structural and content validity and can be considered a practical intervention for improving emotional regulation, self-management, and social skills among adolescents with conduct disorder.
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Aggensteiner, P.-M., Böttinger, B., Baumeister, S., Hohmann, S., Heintz, S., Kaiser, A., Häge, A., Werhahn, J. E., Hofstetter, C. P., Walitza, S., Franke, B., Buitelaar, J. K., Banaschewski, T., Brandeis, D., & Holz, N. (2024). Randomized Controlled Trial of Individualized Arousal-Biofeedback for Children and Adolescents With Disruptive Behavior Disorders (DBD). European Child & Adolescent Psychiatry, 33(9), 3055-3066. https://doi.org/10.1007/s00787-023-02368-5
Agraharkar, S., Horwitz, S. M., Lewis, K., Goldstein, G., Havens, J., & Gerson, R. (2021). Agitation and Restraint in a Pediatric Psychiatric Emergency Program. Pediatric Emergency Care, 37(12), e836-e840. https://doi.org/10.1097/pec.0000000000002385
Ahmed, T., & Vs, P. (2023). Oppositional Defiant Disorder (ODD): An Overview. International Journal of Advanced Psychiatric Nursing, 5(1), 136-139. https://doi.org/10.33545/26641348.2023.v5.i1b.122
Bao, L., Kristen, A., Liu, H., Dys, S. P., Gao, Y., Wu, Q., Xiao, B., Xu, J.-J., Zhang, H., Zhang, W., Zhang, Z., & Moretti, M. M. (2025). A Pilot Study of an Attachment‐Based Parenting Intervention for Parents of Adolescents in China: Translation, Modifications, and Preliminary Effectiveness. Family Process, 64(2). https://doi.org/10.1111/famp.70040
Bright, M. A., Ortega, D. P., Bődi, C. B., & Walsh, K. (2024). School-Based Victimization Prevention Education Programs for Children and Youth With Intellectual and Developmental Disabilities: A Scoping Review. Child maltreatment, 30(2), 357-379. https://doi.org/10.1177/10775595241276412
Cervantes, P. E., Palinkas, L. A., Conlon, G. R., Richards-Rachlin, S., Sullivan, K., Baroni, A., & Horwitz, S. M. (2024). Improving Emergency Department Care for Suicidality in Autism: Perspectives From Autistic Youth, Caregivers, and Clinicians. Journal of Autism and Developmental Disorders, 55(8), 2820-2833. https://doi.org/10.1007/s10803-024-06364-9
Chambers, R., Patel, H., Richards, J., Begay, J., Littlepage, S., Begay, M., Sheppard, L., Nelson, D., Masten, K., Mitchell, K., Kee, C., Barlow, A., & Tingey, L. (2021). Feasibility, Acceptability, and Preliminary Impact of Asdzáán Be'eená. Family & community health, 44(4), 266-281. https://doi.org/10.1097/fch.0000000000000302
Chan, L., Simmons, C., Tillem, S., Conley, M. I., Brazil, I. A., & Baskin–Sommers, A. (2023). Classifying Conduct Disorder Using a Biopsychosocial Model and Machine Learning Method. Biological Psychiatry Cognitive Neuroscience and Neuroimaging, 8(6), 599-608. https://doi.org/10.1016/j.bpsc.2022.02.004
Derakhshan, A., Zhang, L. J., & Zhaleh, K. (2023). The Effects of Instructor Clarity and Non-Verbal Immediacy on Chinese and Iranian EFL Students’ Affective Learning: The Mediating Role of Instructor Understanding. Studies in Second Language Learning and Teaching, 13(1), 71-100. https://doi.org/10.14746/ssllt.31733
Ducharme, P., Kahn, J., Vaudreuil, C., Gusman, M., Waber, D. P., Ross, A. M., Rotenberg, A., Rober, A., Kimball, K., Peechatka, A. L., & Gonzalez‐Heydrich, J. (2021). A “Proof of Concept” Randomized Controlled Trial of a Video Game Requiring Emotional Regulation to Augment Anger Control Training. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.591906
Fongaro, E., Picot, M. C., Stringaris, A., Belloc, C., Vérissimo, A.-S., Franc, N., & Purper‐Ouakil, D. (2022). Parent Training for the Treatment of Irritability in Children and Adolescents: A Multisite Randomized Controlled, 3-Parallel-Group, Evaluator-Blinded, Superiority Trial. BMC psychology, 10(1). https://doi.org/10.1186/s40359-022-00984-5
Fredrick, J. W., Rodríguez, B. G., Lynch, J. D., Loren, R. E. A., & Tamm, L. (2022). Differential Diagnoses of Irritability and Temper Loss in a 6-Year-Old. Clinical Child Psychology and Psychiatry, 27(4), 1263-1276. https://doi.org/10.1177/13591045211070166
Froehlich, T. E., & Becker, S. P. (2025). Attention and Attention-Deficit/Hyperactivity Disorder in Childhood. 497-521. https://doi.org/10.1037/0000414-021
Gagnon, J. C., Ruiz, E., Mathur, S. R., & Mason-Williams, L. (2022). Interventions Addressing Incarcerated Youth Behavior: A Review of Literature. American Journal of Orthopsychiatry, 92(4), 405-417. https://doi.org/10.1037/ort0000621
Georgiopoulos, A. M., Christon, L., Filigno, S. S., Mueller, A., Prieur, M. G., Boat, T. F., & Smith, B. A. (2021). Promoting Emotional Wellness in Children With CF, Part II: Mental Health Assessment and Intervention. Pediatric Pulmonology, 56(S1). https://doi.org/10.1002/ppul.24977
Gerstl, B., Ahinkorah, B. O., Nguyen, T. P., John, J. R., Hawker, P., Winata, T., Brice, F., Bowden, M., & Eapen, V. (2024). Evidence-Based Long Term Interventions Targeting Acute Mental Health Presentations for Children and Adolescents: Systematic Review. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1324220
Gladstone, T. R. G., Buchholz, K. R., Fitzgibbon, M., Schiffer, L., Lee, M., & Voorhees, B. W. V. (2020). Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes. International journal of environmental research and public health, 17(21), 7736. https://doi.org/10.3390/ijerph17217736
Görtz‐Dorten, A., Frank, M., Fessel, A., Hofmann, L., & Döpfner, M. (2022). Effects of a Smartphone App-Augmented Treatment for Children With Oppositional Defiant Disorder / Conduct Disorder and Peer-Related Aggressive Behavior – A Pilot Study. Trials, 23(1). https://doi.org/10.1186/s13063-022-06325-6
Graziano, P. A., Sibley, M. H., Coxe, S., Bickman, L., Martin, P., Scheres, A., & Hernandez, M. L. (2024). Community-Delivered Evidence-Based Practice and Usual Care for Adolescent Attention-Deficit/Hyperactivity Disorder: Examining Mechanistic Outcomes. Behavior therapy, 55(2), 412-428. https://doi.org/10.1016/j.beth.2023.08.001
Grigorenko, E. L. (2020). Twice Exceptional Students: Gifts and Talents, the Performing Arts, and Juvenile Delinquency. New directions for child and adolescent development, 2020(169), 59-74. https://doi.org/10.1002/cad.20326
Groenman, A. P., Hornstra, R., Hoekstra, P. J., Steenhuis, L. A., Aghebati, A., Boyer, B., Buitelaar, J. K., Chronis‐Tuscano, A., Daley, D., Dehkordian, P., Dvorsky, M. R., Franke, N., DuPaul, G. J., Gershy, N., Harvey, E. A., Hennig, T., Herbert, S. D., Langberg, J. M., Mautone, J. A., . . . Barbara, J. v. d. H. (2022). An Individual Participant Data Meta-Analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 61(2), 144-158. https://doi.org/10.1016/j.jaac.2021.02.024
Haack, L. M., Jiménez, E. A. A., Meza, J. I., Friedman, L. M., Spiess, M., Beltrán, D. K. A., Delucchi, K., Herladez, A. M., & Pfiffner, L. J. (2020). Can School Mental Health Providers Deliver Psychosocial Treatment Improving Youth Attention and Behavior in Mexico? A Pilot Randomized Controlled Trial of CLS-FUERTE. Journal of Attention Disorders, 25(14), 2083-2097. https://doi.org/10.1177/1087054720959698
Haack, L. M., Pfiffner, L. J., Darrow, S. M., Lai, J., Alcaraz-Beltrán, D. K., Martínez-Beltrán, J. U., Moreno-Candil, E., Delgado-García, K., Arriaga-Guerrero, M. F., Ledesma-Saldaña, D. M., Urquídez-Valdez, M. E., & Jiménez, E. A. A. (2024). Implementation of a Multi-Site Digitally-Enhanced School Clinician Training and ADHD/ODD Intervention Program in Mexico: Randomized Controlled Trial of CLS-R-FUERTE. Journal of Technology in Behavioral Science, 9(3), 393-405. https://doi.org/10.1007/s41347-023-00367-6
Jabbarzadeh Chaharborod, M., Birami, M., Nokhostin Goldoust, A., & Hashemi, T. (2023). The Effectiveness of Verbal Self-Instruction Training on Executive Functions and Cognitive Control in Students with Specific Learning Disorders. Journal of Educational Psychology Studies, 4(21), 328-346. https://jeps.usb.ac.ir/article_7532.html
Johansson, M., Greenwood, L., Antunez, G. T., Link, K., & Sibley, M. H. (2023). Predictors of Engagement Barriers for Adolescent ADHD Treatment. Journal of Attention Disorders, 27(5), 499-509. https://doi.org/10.1177/10870547231153876
Kalvin, C., Zhong, J., Rutten, M. R., Ibrahim, K., & Sukhodolsky, D. G. (2025). Review: Evidence-Based Psychosocial Treatments for Childhood Irritability and Aggressive Behavior. Jaacap Open, 3(1), 14-28. https://doi.org/10.1016/j.jaacop.2024.01.009
Kaur, M. (2022). Oppositional Defiant Disorder: Evidence-Based Review of Behavioral Treatment Programs. Annals of Clinical Psychiatry, 34(1), 44-58. https://doi.org/10.12788/acp.0056
Khan, S., Shah, A., & Ahmad, S. S. (2015). The Role of Out-of-Class Communication in Instructor’s Verbal/Non-Verbal Behavior, Trust, and Student Motivation. Business & Economic Review, 7(1), 81-100. https://doi.org/10.22547/ber/7.1.5
Khankhanzadeh, H., & Bagheri, S. (2012). The effectiveness of verbal self-instruction on improving social adaptation of students with learning disabilities. Learning Disabilities, 2(1), 43-52. https://journal.uma.ac.ir/article_110.html
Lee, Y. J., Guidotti, F., Capranica, L., Pesce, C., Benzing, V., Hauck, J., & Ciaccioni, S. (2025). Olympic Combat Sports and Mental Health in Children and Adolescents With Disability: A Systematic Review of Controlled Trials. Frontiers in psychology, 16. https://doi.org/10.3389/fpsyg.2025.1567978
Matthys, W., & Schutter, D. J. (2021). Increasing Effectiveness of Cognitive Behavioral Therapy for Conduct Problems in Children and Adolescents: What Can We Learn From Neuroimaging Studies? Clinical Child and Family Psychology Review, 24(3), 484-499. https://doi.org/10.1007/s10567-021-00346-4
Mozaffari, S., Heidarian, M., & Akbari, M. (2021). The effectiveness of verbal self-instruction on social competence and self-esteem of students with specific learning disabilities in Sanandaj City. Early Childhood Health and Education Quarterly, 2(4), 79–96. http://jeche.ir/article-1-66-fa.html
Rivers, A. S., Winston‐Lindeboom, P., Ruan‐Iu, L., Atte, T., Tien, A. Y., & Diamond, G. (2023). Validation of a Parent Report on Externalizing Symptoms Scale: A Downward Extension of the Behavioral Health Screen. School Psychology, 38(4), 264-272. https://doi.org/10.1037/spq0000520
Ros‐Demarize, R., Chung, P., & Stewart, R. W. (2021). Pediatric Behavioral Telehealth in the Age of COVID-19: Brief Evidence Review and Practice Considerations. Current Problems in Pediatric and Adolescent Health Care, 51(1), 100949. https://doi.org/10.1016/j.cppeds.2021.100949
Santiago-Rodríguez, M. E., Ramer, J. D., Márquez, D. X., Frazier, S. L., Davis, C. L., & Bustamante, E. E. (2022). Device-Based Movement Behaviors, Executive Function, and Academic Skills Among African American Children With ADHD and Disruptive Behavior Disorders. International journal of environmental research and public health, 19(7), 4032. https://doi.org/10.3390/ijerph19074032
Scheeringa, M. S. (2020). The Diagnostic Infant Preschool Assessment-Likert Version: Preparation, Concurrent Construct Validation, and Test–Retest Reliability. Journal of Child and Adolescent Psychopharmacology, 30(5), 326-334. https://doi.org/10.1089/cap.2019.0168
Sibley, M. H., & Coxe, S. (2020). The ADHD Teen Integrative Data Analysis Longitudinal (TIDAL) Dataset: Background, Methodology, and Aims. BMC psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02734-6
Sibley, M. H., Rodriguez, L., Lopez, M., Brochu, E. M., Bracho, F. V., Ortiz, M., & Hashimoto, J. (2025). Operationalizing in-Session Treatment Engagement Strategies and Behaviors for Adolescents With ADHD and Their Parents. Journal of Attention Disorders, 29(5), 336-350. https://doi.org/10.1177/10870547241308632
Treier, A. K., Hautmann, C., Dose, C., Nordmann, L., Katzmann, J., Pinior, J., Scholz, K., & Döpfner, M. (2022). Process Mechanisms in Behavioral Versus Nondirective Guided Self-Help for Parents of Children With Externalizing Behavior. Child Psychiatry & Human Development, 55(2), 453-466. https://doi.org/10.1007/s10578-022-01400-0
Velez, J. J., & Cano, J. (2012). Instructor Verbal and Nonverbal Immediacy and the Relationship With Student Self–efficacy and Task Value Motivation. Journal of Agricultural Education, 53(2), 87-98. https://doi.org/10.5032/jae.2012.02087
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Copyright (c) 2026 Shabnam Jahanshad (Author); Parviz Sharifidaramadi; Saeed Rezayi, Mohammad Asgari (Author)

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