Psychological Maltreatment Among Children With Attention Deficit Hyperactivity Disorder

Objective:(1) To describe the prevalence of DSM-IV ADHD and the pattern of comorbidity in a representative sample of primary and middle school students in Hunan Province. (2) To investigate the rate of psychological maltreatment and explore the risk factors of psychological maltreatment among children with ADHD, examine clinical presentation and levels of crucial impairments when psychological maltreatment and ADHD co-occur.Methods:A Stratified random sample of 9495 Hunan urban and rural students aged 5-17 years were assessed using a two-phase design. ADHD diagnoses were assessed using the Investigation Screening Inventory for Child Mental Disorder, a semi-structured interview (the Kiddie Schedule for Affective Diseases and Schizophrenia, K-SADS-PL) by clinicians according to the DSM-IV criteria, Combined Raven's Test (CRT) was used in children with suspicious diagnoses as mental retardation or pervasive developmental disorders. CPMS(Child Psychological Maltreatment Scale), FACESII-CV(Family Adaptability and Cohesion Scale, Second Edition-Chinese Version), CSCS(Children's Self-concept Scale), SCARED(The Screen for Child Anxiety Related Emotional Disorders), DSRSC(Depression Self-rating Scale for Children), PLOC(The Parenting Locus of Control Scale) were completed by children with ADHD and controls, their parents completed CBCL(Child Behavior Checklist), general data questionnaire and the questionnaire of Mental Health Utility and Need. The data was input by Foxpro 9.0 and analyzed by SPSS 13.0.Results:(1) The prevalence of ADHD was 6.0%(95% confidence interval 5.5-6.4%), male 8.8%, female 2.6%, the sex prevalent ratio(male/female) was 3.38:1, there were significant differences between two gender groups(χ2=163.091, P<0.001) and among all groups with different age(χ2=29.518, P<0.01). The highest prevalence was in the group of 10 years old (7.8%). Inattentive type was the most prevalent subtype of ADHD (2.4%), the prevalence of Hyperactive/impulsive type was decreased with the increase of age. Combined type and Inattentive type was the major subtype of boys and girls with ADHD respectively. (2) 46% children with ADHD comorbid with another mental disorders, the most common comorbid category was Disruptive Behavior Disorders(31.5%), followed by Anxiety Disorders(20.7%), the most common comorbid specific disorder was Oppositional Defiant Disorder(24.4%) and Generalized Anxiety Disorder(9.0%), the rate of co-occurrence between ADHD and Anxiety Disorders was significantly higher in girls than boys(29.5%vs18.5%, P<0.05). (3) Only 33.6% parents with an ADHD child had realized their children got a mental problem,10.4% of the children with ADHD had been in contact with specialist. Over 50% parents would like to receive psychological education or counseling. (4) 46.2% children with ADHD reported psychological maltreatment, significantly higher than controls (28.8%), terrorizing was the most common behavior of psychological maltreatment in ADHD group (21.4%). (5) There was no significant gender, living area differences in the distribution of psychological maltreatment among ADHD patients (P>0.05). (6) Risk factors of psychological maltreatment within children diagnosed with ADHD include parental impulsive behavioral style, Anxiety Disorders and maternal education years. (7) Compared to the group of ADHD without maltreatment experience, scores of social problem, attention problem, aggression, externalizing behavior, anxious scales were significantly higher in the ADHD with maltreatment group(P<0.05), while the score of behavior self-concept was lower in the ADHD with maltreatment group(P<0.01). (8) Four types of psychological maltreatment:terrorizing, ignoring, belittling and corrupting showed a significantly independent predictive power to several psychological functioning of children with ADHD, different type of psychological maltreatment had different effect, belittling was related to the most pervasive function of ADHD patients. (9) After controlling for the co-occurrence of emotional disorders, psychological maltreatment was still independently positive to the anxious and depressive symptoms.Conclusion:(1) ADHD is a common behavior disorders among schoolchildren, it is significantly more common in boys than girls. Almost half patients had another mental disorder. (2) Psychological maltreatment is prevalent among juveniles with ADHD, when psychological maltreatment co-occurred with ADHD, juveniles'behavior, emotion problems were even greater and their levels of self-concept were much lower. (3) Clinician and educators should consider the possibility of psychological maltreatment when child with ADHD presenting obvious depressive or anxious mood, and carry out intervention as soon as possible.