Psychological Maltreatment Among Children With Oppositional Defiant Disorder

Objective:To investigate (1) the prevalence of Oppositional Defiant Disorder (ODD) in a representative sample of primary and middle school students of Hunan Province;(2) the prevalence of psychological maltreatment in ODD children and further the effects of psychological maltreatment on ODD childrenMethods:The prevalence of ODD in9495Hunan urban and rural students (5-17years old) was investigated by Stratified random sampling and two-phase epidemiological investigation. ODD was diagnosed with the DSM-IV criteria, basing on Screening Inventory for Child Mental Disorder and a semi-structured interview (the Kiddie Schedule for Affective Diseases and Schizophrenia, K-SADS-PL). CPMS (child psychological maltreatment scale), FACESII-CV (family adaptability and cohesion scale, second edition-Chinese version), CSCS (children’s self-concept ccale), 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 enrolled children. CBCL (Child Behavior Checklist), questionnaire of general data and the questionnaire of Mental Health Utility and Need were filled in by parents. Based on the above information, the children suspected with mental retardation or pervasive developmental disorders were further evaluated by Combined Raven’s Test (CRT) and Standardized achievement test. Finally, all children were divided into ODD group and control group. All data were imported into a database by Foxpro17.0. And the distribution and prevalence of ODD, the interaction between psychological maltreatment and ODD, risk factors of psychological maltreatment were analyzed by SPSS19.0. Results:(1) The prevalence of ODD among the primary and middle school st udents.The prevalence of ODD among all children was5.2%(95%confidence interval:4.7-5.7%),6.7%among male children and3.4%among female children. The prevalent ratio of male/female was1.97:1. Gender and age both affected significantly on the prevalence of ODD (for gender:χ2=51.222, P<0.001; for age:χ2=61.980, P<0.001). The highest prevalence of ODD was found among students of15-17years old (8.6%), and the lowest prevalence among students of5-6years old (1.9%).(2) The prevalence of other mental disorders among ODD students53.8%children with ODD were detected with other mental disorders. The most common two kinds that these mental disorders belonged to were disruptive behavior disorders (27.9%) and anxiety (23.9%). Among ODD students, the two mental disorders with the highest prevalence were Mixed Attention Deficit Disorder (12.1%) and generalized anxiety disorder (9.5%). the rate of co-occurrence of ODD and Mixed Attention Deficit Disorder in male students was significantly higher than that in girls (8.4%vs1.3%, P<0.05). In contrast, the rate of co-occurrence of ODD and generalized anxiety disorder in male students was significantly lower than that in girls (8.1%vs12.8%, P<0.05)(3) The effects of psychological maltreatment on ODD studentsPositive rate of psychological maltreatment among ODD students was45.1%, obviously higher than27.8%of control. Gender, age and rural-urban distribution had no significant effects on the rate of psychological maltreatment among ODD patients (P>0.05). Connive was the most common kind of psychological maltreatment in ODD group (16.4%).Compared to the group of ODD without maltreatment experience, scores of social problem, attention problem, aggression, externalizing behavior, anxious scales were significantly higher in the ODD with maltreatment group(P<0.01), while the score of behavior self-concept was lower in the ODD with maltreatment group(P<0.01). Four types of psychological maltreatments (terrorizing, ignoring, belittling and corrupting) showed a significantly independent predictive power to several psychological functioning of children with ODD. Different type of psychological maltreatment had different effects on the psychological functioning of children with ODD. Belittling had the most pervasive effects on the function of ODD students.(4) The realization of parents of ODD students to mental problem of studentsOnly36.5%parents with an ODD child had realized the mental problem of their children.9.2%of the children with ODD had been in contact with specialist. Over50%parents would like to receive psychological education or counseling.Conclusion:(1) ODD was an externalizing behavior disorder among school children, with higher prevalence in male school children than female. About half of ODD students had other mental disorders.(2) Psychological maltreatment was prevalent among ODD students. Behavior, emotion and self-consciousness of ODD students with psychological maltreatments were damaged more seriously than that without psychological maltreatments.(3) Clinician and educators should consider the possibility of psychological maltreatment when a child with ODD showed obvious depression or anxiety, and carry out intervention as soon as possible.3figures,40tables,141references.