Violeta R. Manolova and Stoyan R. Vezenkov
Center for applied neuroscience Vezenkov, BG-1582, Sofia, e-mail: info@vezenkov.com
For citation: Manolova V.R. and Vezenkov S.R. (2025) Parental Models: A Profile of the Dynamics in Children Dropping Out of Therapy Programs for Screen Addiction. Nootism 1(1), 96-100, ISSN 3033-1765
*This paper was presented at the Second Science Conference "Screen Children" on November 23, 2024, in Sofia, Bulgaria.
Abstract
This study explores the factors contributing to the dropout of children from therapeutic programs for early screen addiction, emphasizing the role of parental dynamics in the treatment process. Screen addiction in children is an increasingly prevalent issue linked to cognitive, emotional, and behavioral disorders, with the success of therapy largely dependent on active parental involvement.
Analyzing 118 clinical cases, the study found that 28 children (23.7%) discontinued therapy, with an additional two cases (1.7%) considered on the threshold of dropout. Notably, in none of the dropout cases were both parents fully engaged in the treatment. The primary reasons for dropout included a lack of parental commitment, resistance to change, and specific behavioral patterns such as denial, doubt, disengagement, deception, and emotional distancing. Furthermore, many parents exhibited codependent behaviors that hindered the effective application of therapeutic strategies.
The findings suggest that a child’s successful recovery is strongly linked to the parents’ willingness to address their own psychological and emotional challenges while actively participating in the therapeutic process. The cases on the threshold of dropout indicate that, despite initial parental resistance, targeted interventions can lead to positive therapeutic outcomes.
This study underscores the urgent need for structured parental interventions to reduce dropout rates and enhance the effectiveness of early screen addiction treatment.
Keywords: Screen addiction, Therapeutic dropout, Parental involvement, Behavioral resistance, biofeedback
Introduction
In recent decades, screen addiction in children has become a growing concern in both scientific research and clinical practice. With the increasing digitalization of society and the widespread availability of screen devices from an early age, the negative effects of excessive screen use are becoming more apparent. Studies indicate that screen addiction can lead to pathophysiological, cognitive, emotional, and behavioral impairments. When it develops before the age of three, it can cause significant deficits in social skills, attention, emotional regulation, and even motor development. In more severe cases, children may exhibit symptoms resembling autism spectrum disorder, aggressive or self-harming behavior, and, in later stages, anxiety and depression.
The treatment programs analyzed in this study – conducted at the Vezhenkov Center for Applied Neuroscience – emphasize not only individualized therapy for the child but also active parental involvement. However, a major challenge arises in this process: many parents show resistance to therapy, lack engagement, or even undermine the efforts of specialists, making effective intervention more difficult. Similar issues have been reported in previous research on other therapeutic approaches (Borrego et al., 2008; Thomas et al., 2011).
Research in child development and addiction emphasizes the crucial role of parents in the therapeutic process. The therapy programs at the Center focus on assessing and optimizing parental behavior, level of engagement, understanding of the issue, and individual psychophysiological factors – all of which directly influence treatment outcomes. Therapists have observed that even when children make initial progress, family dynamics can sometimes disrupt the therapeutic process. Dropping out of screen addiction treatment programs remains a significant challenge for both professionals and families. Understanding the reasons behind therapy dropout can provide valuable insights for improving future interventions and effectively addressing parental factors that hinder the recovery process. Research had shown that youth with severe and enduring mental health problems (SEMHP) had often dropped out of treatment or had failed to fully benefit from interventions in child and adolescent psychiatry (CAP) (de Soet et al., 2024).
This study aims to explore the dynamics of parental behavior and the factors contributing to dropout from therapeutic programs for screen addiction in children. Through an analysis of clinical cases, it seeks to identify patterns and underlying mechanisms that hinder successful therapy completion, shedding light on common parental challenges. Understanding these factors is crucial, as early treatment discontinuation reduces the likelihood of lasting positive change and may exacerbate the child's initial symptoms.
This study is based on a review of clinical data and a systematic analysis of family profiles, with a focus on the psychophysiological, social, and behavioral factors that influence the therapeutic process. It examines how parents perceive their child's screen addiction, their motivation for change, and the internal and external barriers that hinder their active participation in therapy.
Additionally, the research explores key challenges such as parental resistance to change, denial of the problem, emotional unavailability, and the impact of parents' personal traumas on their ability to support their child during treatment.
By offering a detailed analysis of parental behaviors and the factors that obstruct the therapeutic process, this study aims to contribute to the existing scientific literature and improve intervention strategies for children with screen addiction.
Design
This study involved parents of children enrolled in a therapeutic program for early screen addiction. The children were between the ages of 3 and 12.
A total of 28 children and their parents participated in therapy sessions conducted in parallel. The sessions were held once a week, each lasting 50 minutes. During these sessions, one therapist conducted non-instrumental therapy with the child in a separate room, while another therapist simultaneously worked with one or both parents, depending on the specific case. The parental therapy sessions involved biofeedback using a multimodal system (GP8 Amp hardware and Alive Pioneer Plus software by Somatic Vision Inc., USA). A comprehensive psychophysiological screening of the parents was conducted, including measurements of heart rate variability (HRV), skin conductance level (SCL), temperature (T), and respiration (Resp.), in order to assess autonomic balance.
The primary goals of working with the parents were to support their psychophysiological health and to educate them about screen addiction and how to adequately respond to the specific needs their child presents during the course of therapy. Each week, the therapists assigned homework tasks and exercises to the parents, designed to reinforce the progress made during the child’s therapy sessions.
The program lasted for 20 weeks.
The study examined parental roles and family dynamics, points of dropout from therapy, and the reasons identified by therapists through analysis of parents’ psychophysiological responses to stress and strain, as well as through conversations and discussions about family dynamics and the child’s recovery process.
Results
Dropout from the program was recorded in all 28 cases, with an additional two cases considered on the threshold of dropout. In 100% of the cases, a severe autonomic imbalance was identified either in both parents (75.0%, or 21 out of 28 families), or in one parent – specifically the mother in 17.9% of cases (5 families) and the father in 10.7% of cases (3 families). All participating parents exhibited third-degree neuropsychological tension, accompanied by fear and helplessness responses consistent with a "freeze" pattern.
In 75.0% of families (21 out of 28), at least one parent showed signs of addiction – whether to alcohol, drugs, marijuana, or screens. Codependent behavioral patterns were identified in 85.7% of families (24 out of 28).
Dropout from therapy was distributed over the initial stages of the program: 60.7% of families (17 cases) discontinued during the first month, 25.0% (7 cases) dropped out during the second month, and 14.3% (4 cases) discontinued during the third month.
Therapy dropout was consistently associated with specific dysfunctional parental behavior patterns. Notably, there were no cases in which both parents were actively engaged in therapy. In 21.4% of families (6 cases), both parents attended the therapy sessions but remained passive and disengaged. In 14.3% of families (4 cases), one parent was permanently absent from the family, while the other participated actively in the therapeutic process. In 32.1% of cases (9 families), one parent was permanently absent and the other was emotionally unavailable to the child. In 17.9% of cases (5 families), one parent engaged with the therapy, while the other actively sabotaged the process. In the remaining 14.3% of families (4 cases), the child was primarily raised by non-parental caregivers such as grandparents or nannies, with little to no involvement from the parents themselves.
Discussions
This study offers a comprehensive analysis of the factors contributing to therapy dropout in children with screen addiction, emphasizing parental dynamics and family functioning patterns. The findings highlight several key issues among parents in dropout cases, including strong resistance to therapy, severe autonomic imbalance, lack of awareness of the problem, and difficulties in emotionally connecting with their child.
Impact of Family Dynamics
The analysis of family profiles among dropout cases reveals several key trends. All parents exhibited severe autonomic imbalance, which was linked to distorted perception of reality, low coping capacity (e.g., anxiety, depression), and difficulties in fulfilling the parental responsibilities required for their child’s recovery from addiction. Notably, in no case did both parents fully participate in therapy. When only one parent was engaged while the other remained passive or even sabotaged the process, the risk of therapy failure increased significantly.
Further analysis showed that in 32.1% of families, one parent was permanently absent, while the other was emotionally unavailable. These families had a disorganized structure, making the therapy process more challenging and limiting the effectiveness of interventions. Additionally, in 14.3% of cases, where the child was primarily raised by grandparents or other caregivers, the lack of direct parental responsibility was a major factor in therapy dropout.
These findings highlight that parental involvement is essential not only physically but also emotionally. Similar results had been demonstrated in other studies (Albaum et al., 2024). Even when one parent actively participates, their effectiveness is significantly reduced if they lack the emotional and psychological resources needed to support their child’s recovery.
Parental Behavioral Resistance
The analysis of behavioral resistance reveals that denial of the problem is one of the primary reasons for therapy dropout. Parents who fail to recognize the severity of screen addiction often downplay its consequences and see little value in intervention. This pattern is frequently linked to cognitive distortions and defense mechanisms that prevent them from objectively assessing their child's condition.
Another key factor is doubt about the effectiveness of therapy. Parents who have previously tried multiple treatments without success often develop deep skepticism toward new interventions. This lack of trust results in inconsistent participation and, ultimately, premature dropout from therapy.
Lack of engagement also plays a significant role. (Fernandez et al., 2015) When parents fail to complete assigned tasks or follow therapeutic recommendations, the likelihood of a successful outcome drops considerably. Many disengaged parents expect therapy alone to resolve the issue, without realizing that their active involvement is critical to their child's progress.
Additionally, in some cases, discrepancies in parental assessments of the child's condition create further challenges. This is particularly evident when one parent denies progress or intentionally misrepresents the child’s situation, leading to misguided decisions about whether to continue therapy.
Addictions and Psychological Barriers
The "Addictions" category includes parents struggling with dependencies on alcohol, medication, or screen devices. The data suggest that in families where parents exhibit addictive behaviors, children are at a heightened risk of developing screen addiction and experiencing a lack of stable emotional support.
Parents in a Codependent Role Toward Their Screen-Addicted Children
Parental codependency in families with screen-addicted children is marked by loss of objectivity, emotional exhaustion, and functional impairments resulting from prolonged stress and an inability to effectively manage the addiction. These parents often exist in a chronic state of distress, shaped by years of unsuccessful attempts to control or mitigate their child’s destructive behaviors, such as aggressive outbursts, anxiety, social isolation, and cognitive regression. (Werner et al., 2024)
Long-term exposure to this dynamic leads to significant psychological and emotional strain. Many parents develop heightened anxiety, depressive symptoms, and cognitive distortions, which compromise their ability to make sound decisions. This is further evidenced by the pronounced autonomic imbalance observed in most parents. Codependent parents frequently exhibit overprotective behaviors, unintentionally reinforcing their child’s addiction by avoiding confrontation and failing to set clear boundaries. Instead of restricting access to screen devices, they attempt to minimize their perceived harm while striving to maintain a sense of peace at home.
This dysfunctional parental approach further disrupts family dynamics. Codependent parents often struggle with emotional regulation, avoid making firm decisions, and, in some cases, unintentionally sabotage therapy due to fear of change and uncertainty. They tend to shift responsibility onto external factors, give up easily when progress is slow, and perceive therapeutic recommendations as an additional burden rather than an opportunity for improvement.
Parents Who Fear Their Screen-Addicted Child’s Behavior
One of the key factors contributing to therapy dropout in cases of screen addiction is parents’ fear of their child’s behavior. This fear often leads to difficulty setting boundaries, avoidance of confrontation, and an inability to effectively manage crises that arise when screen time is restricted. Some parents feel powerless in the face of their child’s intense emotional reactions, such as aggressive outbursts, tantrums, self-harming behavior, and severe anxiety episodes.
This fear may stem from a lack of confidence in their parenting abilities or past traumatic experiences that make it difficult for them to adopt a firm yet supportive parental role. As a result, these parents often avoid direct intervention and give in to their child’s demands to prevent conflict. However, in the long run, this pattern reinforces the child’s dependency on screens and weakens parental authority.
The lack of assertiveness in managing screen addiction highlights the need for specialized parental support. Targeted interventions should focus on building parental resilience, equipping them with effective crisis management strategies, and reinforcing their essential role in their child’s recovery process.
Cases on the Threshold of Dropout
Cases classified as on the threshold of dropout represent a distinct category, characterized by initial parental resistance that gradually gives way to constructive engagement. In these families, therapy facilitated significant transformation in family dynamics, leading to measurable improvements in both the emotional well-being of the parents and the behavioral functioning of the child. These cases illustrate that, even in the presence of pronounced initial resistance, appropriately targeted therapeutic interventions can yield meaningful and lasting progress.
Conclusion
This study provides a comprehensive analysis of the factors contributing to therapy dropout in children with screen addiction, emphasizing the critical role of parental involvement and family dynamics in the therapeutic process. The findings clearly indicate that the success of treatment is strongly linked to the level of parental engagement, while a lack of active participation significantly increases the risk of discontinuation.
The results highlight several key behavioral patterns among parents in dropout cases. Many exhibit denial of the problem, skepticism toward therapy, inconsistency in following treatment recommendations, or struggles with addiction and emotional instability. In particular, parental codependency – characterized by chronic stress, emotional exhaustion, and a chaotic family environment – emerges as a major barrier to effective intervention. These challenges not only hinder parental capacity to support their child's recovery but may also reinforce the very patterns that contribute to screen addiction.
Despite these challenges, the cases on the threshold of dropout demonstrate that meaningful change is achievable, even in families that initially exhibit resistance. When therapy successfully addresses both the child’s and the parents' needs, significant progress can be achieved. The last underscores the need for holistic, family-centered interventions that go beyond child-focused treatment and actively work to educate, support, and empower parents in managing their child’s recovery. Based on these findings, future research should focus on developing targeted therapeutic strategies for working with parents, aimed at reducing the likelihood of therapy dropout and enhancing the effectiveness of treatment for screen addiction.
Implications and Future Directions
These insights highlight the importance of rethinking intervention strategies for screen addiction treatment. Rather than solely targeting the child, therapy should incorporate structured parental support programs that focus on:
- Improving parental awareness of screen addiction and its consequences.
- Developing coping strategies to manage emotional and behavioral crises.
- Enhancing parental resilience to reduce stress and prevent therapy dropout.
- Encouraging family-based approaches that strengthen parent-child relationships.
Future research should further explore how tailored therapeutic models – including family-based therapy, biofeedback techniques, and behavioral coaching for parents – can enhance treatment retention and long-term recovery. By addressing both the psychophysiological and emotional challenges faced by parents, interventions can become more effective in breaking the cycle of screen addiction and fostering sustainable change and recovery in children.
References
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Thomas, R., & Zimmer-Gembeck, M. J. (2011). Parent–Child Interaction Therapy: An Evidence-Based Treatment for Child Maltreatment. Child Maltreatment, 16(2), 134–145.
de Soet, R., Vermeiren, R. R. J. M., Bansema, C. H., et al. (2024). Drop-out and ineffective treatment in youth with severe and enduring mental health problems: A systematic review. European Child & Adolescent Psychiatry, 33, 3305–3319. https://doi.org/10.1007/s00787-023-02182-z
Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioural therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108. https://doi.org/10.1037/ccp0000044
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