Maltreatment and Emotional and Behavioral Problems in Chinese Children With and Without Oppositional Defiant Disorder

Abstract

Maltreatment has negative effects on the parent–child relationship and the emotional and behavioral development of children. The current study aimed to examine the associations among maltreatment, parent–child relationship, and emotional and behavioral problems in Chinese children with or without oppositional defiant disorder (ODD). Participants in the study included 259 children with ODD and their 269 non-ODD counterparts from northern, eastern, and southwestern China. We also collected data from their teachers and fathers or mothers. The results showed that ODD children suffered more maltreatment and had more emotional and behavioral problems than their non-ODD peers. For all children (both ODD and non-ODD children), emotional abuse predicted emotional problems but not behavioral problems. Physical abuse predicted behavioral problems but not emotional problems. Parent–child relationship mediated the effects of emotional abuse and physical abuse on emotional problems among ODD children but not among non-ODD children. Implications for prevention of emotional and physical abuse and ODD in the Chinese cultural context are discussed.

Keywords

oppositional defiant disorder child maltreatment emotional problem behavioral problem parent–child relationship

Introduction

Oppositional defiant disorder (ODD), one of the most prevalent mental disorders among children, is characterized by a recurrent pattern of angry/irritable, negative, defiant, disobedient, and hostile behavior toward authority figures that causes functional impairment and persists for at least 6 months (American Psychiatric Association [APA], 1994, 2013). ODD symptoms include both internalizing and externalizing problems (Althoff, Kuny-Slock, Verhulst, Hudziak, & van der Ende, 2014). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013) estimates prevalence rates for ODD ranging between 1% and 11%, with an overall average of approximately 3.3%.

Well established in previous research, multiple factors—such as endogenous (e.g., genetic underpinning) and exogenous origins (e.g., environmental influences such as child maltreatment)—influence children’s disruptive behavior (Burke, Loeber, & Birmaher, 2002). Among these factors, parenting behaviors stand out as having a critical influence on children’s behavior. In particular, extreme parenting behaviors, such as emotional and physical abuse, are uniquely related to children’s disruptive behavior and significantly increase the risk of maladaptive behaviors (Burke et al., 2002; Stormshak, Bierman, McMahon, & Lengua, 2000).

Although the majority of research studies on parenting, child maltreatment, and children’s disruptive behaviors have been conducted in the United States, the current study was conducted in China. In an effort to raise China’s awareness of the negative consequence of child abuse and to better understand Chinese children’s development of ODD, the current study examined the effect of parent-inflicted emotional and physical abuse on Chinese children’s emotional and behavioral problems, taking into account the mediating effect of the parent–child relationship.

The Predominant Symptoms of ODD

Unlike the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994), which considered the eight symptoms of ODD as a single dimensional model, a three-dimensional model—which was primarily proposed by Stringaris and Goodman (2009)—is applied in the DSM’s (5th ed.; DSM-5; APA, 2013) diagnostic criteria. These dimensions include angry/irritable mood, argumentative/defiant behavior, and vindictiveness.

However, not all researchers agree with the DSM-5’s diagnostic criteria for ODD. Working with pre-adolescent girls, Burke, Hipwell, and Loeber (2010) proposed a different, though somewhat similar, three-factor model. Their diagnostic model included negative affect, oppositional behavior, and antagonistic behavior. Recently, Lavigne, Bryant, Hopkins, and Gouze (2015) challenged the DSM-5 three-factor model by suggesting that a two-factor model—comprised of negative affect and oppositional behavior—was the best fitting model for ODD diagnostic criteria. Based on this two-factor model of ODD symptoms (Burke, Loeber, Lahey, & Rathouz, 2005; Lavigne et al., 2015), in the current study, anger management and aggressive behavior were selected as two predominant symptoms of ODD.

Stringaris and Goodman (2009) suggested that the three dimensions of ODD (currently used in the DSM-5) were related to different developmental outcomes based on the findings that only the irritable dimension predicted emotional disorders; the defiant dimension was the sole predictor of attention-deficit hyperactivity disorder (ADHD), and vindictiveness most strongly predicted aggressive conduct disorder. Other studies revealed that defiant children were prone to engage in violent behaviors, whereas irritable children were more likely to struggle with mood disorders (Althoff et al., 2014).

Association Between Maltreatment and ODD Symptoms

Based on previous study, child maltreatment perpetrated by parents or caregivers resulted in a continuum of detrimental outcomes for children, ranging from potential harm, harm (e.g., serious physical and/or emotional harm), and death (Children’s Bureau, 2012). In addition, maltreated children are typically exposed to multiple types of abuse, including emotional abuse and physical abuse (Children’s Bureau, 2012).

The majority of empirical evidence demonstrates the negative influence of maltreatment on children’s development, including subsequent emotional and behavioral problems (Maas, Herrenkohl, & Sousa, 2008; Manly, Kim, Rogosch, & Cicchetti, 2001). For example, child abuse is frequently associated with internalizing behavioral problems, including anxiety and depression (Spertus, Yehuda, Wong, Halligan, & Seremetis, 2003) and externalizing behavioral problems, including noncompliance and aggressive behavior (Caples & Barrera, 2006; Manly et al., 2001).

In particular, the strong connection between emotional abuse and emotional problems has been documented (Spertus et al., 2003; Spinazzola et al., 2014). For example, Teicher, Samson, Polcari, and McGreenery (2006) found that in comparison with physical abuse, emotional abuse was more predictive of elevated anxiety, depression, and anger/hostility in adults. Similarly, Spinazzola et al. (2014) found that a history of psychological maltreatment (emotional abuse or emotional neglect) in adolescents, as compared with physical abuse and sexual abuse, was a stronger predictor of depression, acute stress disorder, and anxiety disorders.

In regard to physical abuse and corporal punishment, prior research documents the connecting links between harsh punishment and ODD symptoms (Burke et al., 2002; Pardini, Fite, & Burke, 2008). A meta-analytic review by Gershoff (2002) suggested that not only did experiences of corporal punishment predict increased aggressive behavior in childhood and adulthood but also impeded the parent–child relationship. Corporal punishment has also been identified as a significant predictor of ODD symptoms (Tung & Lee, 2014). Furthermore, Lansford et al. (2002) found that adolescents who were physically abused in early childhood exhibited higher levels of depression and aggression. However, research by Manly et al. (2001) found that physical abuse had a negative effect on aggressive behavior but was not related to internalizing symptomatology. Across research studies, in general, corporal punishment and physical abuse are related more specifically to aggressive behavior (Stormshak et al., 2000).

In addition, it is important to note that ODD children have an increased risk of being maltreated by their parents and caregivers (Gershoff, 2002; Lin et al., 2014). Research that focused on Chinese ODD children indicated that, due to children’s defiant problems and ill temper, parents often emotionally punished (e.g., shaming, belittling, blaming, and isolating) and/or physically punished their children (e.g., kicking, beating, slapping, hitting the child’s buttocks, pulling hair, and twisting an ear; Lin et al., 2014).

Indeed, children’s aggression, noncompliance, and difficult temperament appear to increase the risk of children being emotionally and/or physically maltreated (Swenson, Saldana, Joyner, & Henggeler, 2006). However, relatively few studies have specifically investigated ODD and the potential links between parent–child relationships and children’s emotional and behavioral functioning. Therefore, it is important to investigate child maltreatment (in this study, emotional and physical abuse) inflicted by Chinese parents when considering their children’s associated maladaptive emotional and behavioral functioning, comparing differences between children identified with ODD and children not identified with ODD.

A growing body of research documents the bidirectional association between negative parenting and child behaviors (e.g., Burke, Pardini, & Loeber, 2008). In the early 1980s, Patterson (1982) articulated the well-known parent–child coercive cycle, which demonstrated the dynamic parenting process of disciplining children who exhibited challenging and demanding behaviors (Patterson, 1982; Patterson, Reid, & Dishion, 1992). Similarly, in a prospective study Hipwell et al. (2008) reported a bidirectional relationship between harsh punishment and children’s conduct problems. At the other extreme, Burke et al. (2008) found an interactive process between ineffective, overly timid discipline, and children’s ODD symptoms. Simply put, unskilled and ineffective parenting contributes to parents’ use of either increasingly harsh discipline to control children’s defiant and irritating behaviors or to parents’ withdrawal and failure to intervene with children’s problematic behaviors. At both extremes, these parenting practices further exacerbate children’s defiance and problematic conduct (Pardini et al., 2008).

In summary, it is clear that the link between parenting behavior and child emotional and behavioral problems is dynamic and reciprocal. However, less clear are the connections between the severe parenting behaviors, such as emotional and physical abuse, and their contribution to the underlying etiology of ODD (Burke et al., 2002). Thus, in the present study, we explored the impact of maltreatment on ODD symptoms. As the primary ODD symptoms consist of negative affect and oppositional behaviors (Lavigne et al., 2015), in our research we are especially interested in whether emotional abuse and physical abuse are differentially associated with emotional problems and aggressive problems among children with ODD. In addition, we attempted to examine whether these associations were significantly different between samples of ODD children and non-ODD children, while controlling for a range of child and parent factors.

Parent–Child Relationship as a Mediator

Child maltreatment is linked to poor parent–child relationships (Levendosky, Huth-Bocks, Shapiro, & Semel, 2003). A review by Morton and Browne (1998) indicated that most maltreated children (approximately 76%) had particular difficulty developing a secure attachment with their mother. In an attempt to explain poorly developed parent–child relationships, the following sequence of behaviors was proposed by Gershoff (2002): Children’s negative emotions such as anger and fear are evoked during maltreatment; these emotions may lead to children’s avoidant behavior toward their parents, and such avoidant behavior may further impair the bond between parents and children. In addition, abused children exhibit more aggressive behaviors in parent–child interactions (Bousha & Twentyman, 1984), which may further impair the parent–child relationship.

Previous studies have suggested that poor parent–child relationships are related to children’s disruptive problems (e.g., Greenberg, Speltz, & DeKlyen, 1993). Characteristics of poor parent–child relationships, such as low levels of emotional warmth and involvement, are significant predictors for children’s oppositional behavior, regardless of the child’s ethnicity or gender (Stormshak et al., 2000). Also related to parent–child relationships, in comparison with children who have developed secure attachments with their parents, preschool children who developed insecure attachments exhibited more ODD symptoms, particularly noncompliance and defiance (Greenberg et al., 1993).

In summary, we propose that a poor parent–child relationship is a crucial factor that is linked to oppositional behaviors associated with ODD. We also propose that a poor parent–child relationship is related to an increased likelihood for child maltreatment (emotional and physical abuse), and based on the findings from several previous studies (Herrenkohl, Huang, Tajima, & Whitney, 2003; Salzinger, Rosario, & Feldman, 2007), we hypothesize that maltreatment may increase the risk of ODD symptoms indirectly through the parent–child relationship.

Culture and Associated Perceptions of Maltreatment

One research study found that the relationship between maltreatment and adverse outcomes is moderated by the contextual perception of normality (Lansford et al., 2005). For example, in China’s cultural context, parenting behaviors such as spanking and scolding are widely accepted and are considered to be effective and legitimate in child rearing (Lau, Liu, Cheung, Yu, & Wong, 1999). In comparison with American children, Chinese children tend to perceive harsh discipline, even emotional and physical abuse, as more appropriate and normal (Wang, Xing, & Zhao, 2014). Thus, relatively speaking, maltreatment was related to fewer adverse outcomes in the sample of Chinese children (Lansford et al., 2005).

Historically, the ecological model of maltreatment proposed by Belsky (1980) emphasized the importance of considering culture’s impact on child development. Within a cultural context, the Chinese society lacks an awareness of the potential adverse outcomes of child maltreatment (Liao, Lee, Roberts-Lewis, Hong, & Jiao, 2011). Moreover, most people in China accept and tolerate child maltreatment and rarely consider it as a serious social problem (Liao et al., 2011). In addition, Confucian filial piety—the virtue of respecting one’s father, elders, and ancestors—has been and continues to be an essential and highly valued part of Chinese social morality. This embedded social respect is another cultural factor that contributes to increased child maltreatment and to the social acceptance of child maltreatment in China (Lau et al., 1999; Liao et al., 2011).

The prevalence of emotional and physical abuse among Chinese youth is high. In an investigation of childhood maltreatment in China, 14.4% of adolescents reported exposure to emotional abuse and 26.6% reported experiencing physical abuse during childhood (Tao et al., 2006). Unfortunately, relatively few studies have investigated the issue of child maltreatment and its adverse outcomes among the Chinese population. Specifically, it is unclear whether the socially accepted severe parenting in China contributes to children’s emotional and behavioral problems, especially among ODD children. The present study will address this knowledge gap.

The Present Study

The current study, conducted with children, teachers, and parents in Mainland China, focused on the effect of maltreatment on children’s ODD symptoms, with the parent–child relationship as a mediator variable. In addition, a comparison group was included that consisted of children who were not diagnosed with ODD.

Accordingly, the first research question was as follows:

Research Question 1: Are there differences between children with and without ODD in (a) parent-reported child maltreatment (emotional and physical abuse), (b) parent–child relationships, and (c) ODD symptoms, including anger management and aggressive behavior?

We proposed that, in comparison with their non-ODD peers, ODD children suffer more physical and emotional abuse, experienced poorer parent–child relationships, and experience more difficulty with anger management and aggressive behavior.

The second research question we addressed concerned the following:

Research Question 2: Is emotional abuse a stronger predictor of affective symptoms of ODD and physical abuse a stronger predictor of behavioral symptoms of ODD?

It was hypothesized that anger management was more influenced by emotional abuse than by physical abuse, and aggressive behavior was more influenced by physical abuse than by emotional abuse. We proposed that these relationships would be similar for both groups of children, those identified with ODD and those not identified with ODD.

For our third research question, we examined whether the parent–child relationship mediated the relationship between maltreatment and ODD symptoms. Considering that non-ODD children were less likely to be maltreated and exhibited fewer ODD symptoms, we did not expect a mediating effect among non-ODD children. However, the mediating effect of parent–child relationship was hypothesized among ODD children.

Method

Participants and Sample Procedure

The data were derived from a research project conducted on the topic of children’s ODD. Between 2013 and 2014, 14 elementary schools in northern, eastern, and southwestern China participated in this study. School psychologists sent invitation letters to the participating schools’ class teachers who worked with children attending first grade through sixth grade. In all, 187 class teachers were invited to nominate the children in their classes who exhibited ODD symptoms, as described in an assessment checklist based on the ODD symptoms described in the DSM-IV (APA, 1994).

There were a total of 360 children who were nominated from 7,966 children in the participating schools. After receiving the nominations, two clinical psychologists from Beijing Normal University confirmed the assessment of children, using a semi-structured interview based on the DSM-IV’s ODD diagnostic criteria. Interviews were conducted with children’s class teachers. Ultimately 305 children were identified as displaying the characteristics of ODD (3.8% of the children in the participating schools).

Invitation letters and informed consent were sent to 305 parents of children identified with ODD symptoms. Initially, a total of 282 pairs of parent and child informed consent and assent forms were obtained (92.5% participation rate). Ultimately, 259 completed sets of child assent forms and associated parent and class teacher consent forms were collected. Participating ODD children were selected from 156 classrooms. Parent–child dyad participants included 84 father–child dyads and 175 mother–child dyads. Each participating child’s teacher was also included. These participants constituted the final ODD sample. The participating ODD children included 188 boys (72.6%) and 71 girls (27.4%), ranging in age from 6 to 13 years (M = 9.56, SD = 1.59). Among these children, 79.5% were identified as an only child in their family.

A comparison group of non-ODD children was also recruited. This group consisted of at least one non-ODD child from each class in which a participating ODD child was identified. Children in the non-ODD group were included who (a) did not meet the diagnostic criteria for ODD and (b) did not suffer from mental or physical disabilities (i.e., developmental delay). In total, 269 non-ODD children (from 156 classrooms) were included. Similar to the ODD sets, the non-ODD child’s parent and class teacher were also included. In total, the non-ODD comparison group included 67 father–child and 202 mother–child dyads and each child’s classroom teacher.

The comparison sample (non-ODD children) included 143 boys (53.2%) and 126 girls (46.8%), ranging in age from 6 to 13 years (M = 9.12, SD = 1.55). Of the non-ODD group, 81.9% of the children were identified as an only child.

Chi-square (χ²) tests of significance and independent-samples t tests were conducted to identify demographic differences between ODD and non-ODD groups (see Table 1). ODD children were slightly older than their non-ODD peers, t(1, 526) = 3.22, p < .001. However, parents of ODD children were younger than those of non-ODD children, t(1, 526) = −3.47, p < .001; t(1, 526) = −1.72, p = .086, for paternal and maternal age, respectively. Compared with non-ODD group, fewer parents of ODD children obtained a degree of junior college or higher, χ²(1) = −6.43, p < .05; χ²(1) = −6.23, p < .05, for paternal and maternal education, respectively. Parents of ODD children also reported less monthly income, χ²(1) = −7.60, p < .01. As significant differences in demographic factors were found between the two groups (ODD and non-ODD), these factors were used as control variables in the subsequent analyses.

Table 1.

Characteristics of the Full Sample, ODD Group, and Non-ODD Group.

Variable	Full Sample	ODD Group	Non-ODD Group	Statistical Test
Variable	(n = 528)% or M (SD)	(n = 259)% or M (SD)	(n = 269)% or M (SD)	Statistical Test
Child
Male	62.69	72.59	53.16	χ² = 21.29***
Age	9.34 (1.59)	9.56 (1.59)	9.12 (1.55)	t = 3.22***
Caregiver
Paternal age	39.13 (5.00)	38.37 (5.18)	39.87 (4.70)	t = −3.47***
Maternal age	37.02 (4.09)	36.71 (4.39)	37.32 (3.77)	t = −1.72
Paternal education (junior college or more)	67.80	62.55	72.86	χ² = −6.43*
Maternal education (junior college or more)	62.50	57.14	67.66	χ² = −6.23*
Monthly income (10,000 RMB or more)	32.77	27.03	38.29	χ² = −7.60**
Observed variables
Emotional abuse	7.42 (2.95)	8.19 (3.48)	6.67 (2.07)	F = 26.86***
Physical abuse	8.26 (8.22)	10.62 (8.78)	5.99 (6.94)	F = 32.78***
Parent–child relationship	24.40 (11.28)	22.45 (11.56)	26.29 (10.7)	F = 9.11**
Anger management	22.96 (4.75)	21.24 (4.31)	24.63 (4.57)	F = 65.74***
Aggressive behavior	13.33 (7.54)	17.91 (7.73)	8.92 (3.80)	F = 289.30***

Note. Demographic variables that included children’s gender and age, parental age and education, and family monthly income are controlled in the covariance analysis (not shown). ODD = oppositional defiant disorder.

p < .05. **p < .01. ***p < .001.

Survey Procedure

Parents were asked to fill in a parent survey and to return surveys to the class teachers in 1 week. During school time, each participating child finished the student questionnaire in an unused school conference room or music room. When students were completing the questionnaires, trained researchers stayed in the room to provide assistance and explain the meaning of sentences when necessary. On their own time, teachers completed questionnaires that were designed to assess each participating student’s behavior. Teachers were asked to finish each questionnaire within 5 min. Teachers completed one questionnaire for each of their students who participated.

Psychiatrists from Anding Hospital, psychological counselors, and a family therapist from Family Study and Therapy Center at Beijing Normal University provided opportunities for treatment for the 305 ODD children, if the child and parent wanted to seek additional help. The Institutional Review Board of Beijing Normal University in China approved the research protocol, including the consent procedure.

Measures

Parental emotional abuse (parent reported)

The Emotional Abuse subscale from the Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998) was used to measure parental emotional abuse. On the five items related to emotional abuse (e.g., “People in your family called him/her things like stupid, lazy, or ugly”), participating parents responded using a 5-point scale (1 = never, 5 = very often). Scores of items in the Emotional Abuse subscale were summed to create composite scores for child emotional abuse, with higher scores indicating higher levels of emotional abuse. In the present study, CTQ’s Cronbach’s α was .84.

Parental physical abuse (parent reported)

Physical abuse was measured using seven items selected from the Conflict Tactics Scale (CTS; Straus, 1979). Each participating parent was asked to quantify how often he or she displayed certain behaviors toward their child (e.g., pushed, grabbed, or shoved child), on a 7-point scale (0 = never, 6 = almost every day). Summed scores of the seven items were used as the indicator of child physical abuse. Higher scores indicate higher levels of child physical abuse. Cronbach’s α of the seven items was .92 in the current study.

Child–parent relationship (father/mother reported)

The 26-item Child–Parent Relationship Scale (CPRS; Pianta, 1992; Zhang, Chen, Zhang, Zhou, & Wu, 2008) is a valid and reliable report on parental perception of the parent–child relationship (e.g., Zhang et al., 2008). This instrument was used to measure the child–parent relationship, from the parent’s perspective. Each parent rated various aspects of their relationship with their child, using a 5-point scale (1 = not true at all, 5 = always true). Items included aspects of closeness (e.g., “I share an affectionate, warm relationship with my child”); conflict (e.g., “My child easily becomes angry at me”); and dependency (e.g., “My child reacts strongly to separation from me”). The higher the total summed score, the better and stronger the parent–child relationship. In the current study, Cronbach’s α of CPRS was .82.

Anger management (child reported)

The Anger Management subscale from Children’s Emotion Management Scales (CEMS; Zeman, Shipman, & Penza-Clyve, 2001) assesses self-report of children’s anger management. Using a 3-point scale (1 = hardly ever, 2 = sometimes, and 3 = often), children respond to 12 items that included anger inhibition (e.g., “I get sad inside but I don’t show it”), coping with anger (e.g., “When I am feeling sad, I do something totally different until I calm down”), and dysregulated anger (e.g., “I say mean things to others when I am mad”). Relevant items were summed, with higher total scores indicating better anger management. In the current study, Cronbach’s α of CEMS was .80.

Aggressive behavior (teacher reported)

The Aggressive With Peers subscale from the Child Behavior Scale (CBS; Ladd & Profilet, 1996) was used to assess child aggression with peers at school. Teachers rated children’s aggressive behavior toward peers using a 5-point scale (1 = never, 5 = always) on seven items (e.g., “This child pushes or shoves other children”). Scores were summed to create a composite score, with a higher score indicating more aggressive behavior in school. Cronbach’s α of CPRS was found to be .96 in the current study.

Data Analyses

First, covariance analyses were conducted to explore if children with ODD were significantly different from their non-ODD peers in the following areas: (a) maltreatment (emotional and physical abuse), (b) parent–child relationship, and (c) ODD symptoms (anger management and aggressive behavior). Second, correlations among demographic factors and observed factors were conducted. Next, multivariable linear regression analyses were performed to explore the association of emotional abuse and physical abuse with anger management and aggressive behavior among ODD children and non-ODD children, respectively. Finally, the mediating model was examined using Mplus version 7.0 (Muthén & Muthén, 1998) within a Structure Equation Model (SEM) framework. Multiple group models were run to understand the mediation effect of parent–child relationship on the association between maltreatment and ODD symptoms in non-ODD and ODD children. Model fit was evaluated using global fit indices, including root mean square error of approximation (RMSEA) < 0.06, comparative fit index (CFI) > 0.95, Tucker–Lewis index (TLI) > 0.95, and standardized root mean square residual (SRMR) < 0.08 (Hu & Bentler, 1999).

Results

Descriptive Statistics

Descriptive characteristics of this study’s sample are presented in Table 1. In comparison with non-ODD children, parents of children who were diagnosed with ODD reported that their children experienced significantly higher levels of emotional abuse, F(1, 519) = 26.86, p < .001, and physical abuse, F(1, 519) = 32.78, p < .001; had worse parent–child relationships, F(1, 519) = 9.11, p < .01; had greater difficulty managing their anger, F(1, 519) = 65.74, p < .001; and exhibited more aggressive behaviors, F(1, 519) = 289.30, p < .001.

Correlations

The correlations among observed variables are presented in Table 2. For ODD children, emotional abuse, physical abuse, parent–child relationship, anger management, and aggressive behavior were significantly related to each other, except the correlations between emotional abuse and aggressive behavior and between anger management and aggressive behavior. For non-ODD children, all the observed variables significantly associated with each other, excluding the relationships between physical abuse and anger management and between parent–child relationship and anger management.

Table 2.

Correlations Among Background Factors and Observed Variables for Non-ODD Children and ODD Children.

	1	2	3	4	5	6	7	8	9	10	11	12
1. Children’s gender	—	−.08	−.06	−.09	−.02	.10	−.07	−.17**	−.15*	.10	.16*	−.24**
2. Children’s age	.001	—	.11	.24**	−.27**	−.24**	−.24**	.03	−.04	−.04	−.04	−.01
3. Paternal age	−.20**	.22**	—	.66**	.06	.11	.08	.01	.02	−.04	−.08	.08
4. Maternal age	−.17**	.27**	.79**	—	−.01	.04	.12*	.06	.03	.01	−.04	.15*
5. Paternal education	−.10	−.17**	.23**	.19**	—	.68**	.26**	−.07	−.12*	.07	−.03	−.03
6. Maternal education	.01	−.22**	.02	.01	.56**	—	.30**	−.08	−.13*	.10	−.03	−.01
7. Monthly income	−.22**	−.14*	.28**	.25**	.41**	.34**	—	−.06	−.04	.15*	−.06	.09
8. Emotional abuse	−.07	−.02	.01	−.01	−.004	−.01	−.09	—	.42**	−.54**	−.16**	.14*
9. Physical abuse	−.13*	−.02	−.004	.02	−.10	−.07	−.003	.62**	—	−.38**	−.08	.20**
10. Parent–child relationship	.16*	.02	−.003	.03	.05	.09	.03	−.60**	−.51**	—	.12	−.14*
11. Anger management	.05	.02	−.04	−.11	−.02	.01	−.07	−.33**	−.24**	.31**	—	−.14*
12. Aggressive behavior	−.32**	.06	.27**	.28**	.25**	.09	.27**	.11	.20**	−.14*	−.08	—

Note. Correlations in top of diagonal are for non-ODD children, in bottom for ODD children. ODD = oppositional defiant disorder.

p < .05. **p < .01. ***p < .001.

Mediator Models

Before examining the mediator models, the impact of emotional abuse and physical abuse on anger management and aggressive behavior was examined among ODD children, and then separately examined among the other group of non-ODD children. For ODD children, emotional abuse significantly predicted anger management (β = −.32, p < .001), and physical abuse predicted aggressive behavior (β = .19, p < .01) while controlling for children’s gender and age, parental age and education, and family income. The result obtained for non-ODD children was similar to ODD children. When controlling for demographic variables, emotional abuse only significantly predicted anger management (β = −.14, p < .05), and physical abuse only marginally predicted aggressive behavior (β = .14, p = .061).

Furthermore, the mediating role of parent–child relationship between maltreatment and ODD symptoms was separately examined among ODD children and non-ODD children. First, the model (see Figure 1) that included emotional abuse, physical abuse, parent–child relationship, anger management, and aggressive behavior and controlled for demographic factors was run among ODD children. This model failed to fit the data, χ²(12) = 3.67, p = .004; CFI = 0.856; TLI = 0.640; RMSEA = 0.101; SRMR = 0.051. Considering that children’s reported anger management was not related to teachers’ reported child aggressive behavior, and that these two variables revealed different patterns in the mediating model, we ran models separately for anger management (Model 1) and aggressive behavior (Model 2; see Table 3). Model 1 was a good fit to the data, χ²(6) = 1.60, p = .144; CFI = 0.978; TLI = 0.931; RMSEA = 0.048; SRMR = 0.019. While controlling for demographic factors, both emotional abuse and physical abuse could predict parent–child relationship. Parent–child relationship partially mediated the association between emotional abuse and anger management, and completely mediated the relationship between physical abuse and anger management. Model 2 failed to fit the data, χ²(6) = 5.78, p < .001; CFI = 0.847; TLI = 0.516; RMSEA = 0.136; SRMR = 0.052. No direct or indirect effects were found in the paths from emotional abuse or physical abuse through parent–child relationship to aggressive behavior. Thus, parent–child relationship did not appear to mediate the association between maltreatment and aggressive behavior.

Figure 1.

Parent–child relationship mediates the relationship between maltreatment and ODD symptoms among ODD children.

Table 3.

Path Analyses to Assess Parent–Child Relationship as a Mediator Between Maltreatment and Anger Management/Aggressive Behavior Among ODD Children.

Model	Path	B	SE	p	95% CI
Model 1	Parent–child relationship regressed on
	Emotional abuse	−1.54***	0.19	<.001	[−1.91, −1.17]
	Physical abuse	−0.27***	0.08	<.001	[−0.43, −0.12]
	Anger management regressed on
	Parent–child relationship	0.07*	0.03	.017	[0.01, 0.12]
	Emotional abuse	−0.26**	0.10	.009	[−0.46, −0.07]
	Physical abuse	−0.01	0.04	.892	[−0.09, 0.08]
	Indirect effects
	Emotional abuse to anger management	−0.10*	0.05	.025	[−0.20, −0.01]
	Physical abuse to anger management	−0.02*	0.01	.047	[−0.04, 0]
Model 2	Parent–child relationship regressed on
	Emotional abuse	−1.54***	0.19	<.001	[−1.91, −1.17]
	Physical abuse	−0.27***	0.08	<.001	[−0.43, −0.12]
	Aggressive behavior regressed on
	Parent–child relationship	−0.02	0.05	.719	[−0.11, 0.07]
	Emotional abuse	−0.06	0.18	.729	[−0.41, 0.29]
	Physical abuse	0.14*	0.07	.040	[0.01, 0.28]
	Indirect effects
	Emotional abuse to aggressive behavior	0.03	0.07	.724	[−0.12, 0.17]
	Physical abuse to aggressive behavior	0.01	0.01	.725	[−0.02, 0.03]

Note. Demographic variables that included children’s gender and age, parental age and education, and family monthly income are controlled in the two models (not shown). ODD = oppositional defiant disorder.

p < .05. **p < .01. ***p < .001.

For non-ODD children, the model that included all the observed variables and controlled for demographic factors was also run. Although the model was a perfect fit with the data, χ²(12) = 1.07, p = .384; CFI = 0.994; TLI = 0.985; RMSEA = 0.016; SRMR = 0.022, parent–child relationship was not the mediator between maltreatment and ODD symptoms among non-ODD children.

Discussion

The current study was one of the first studies to examine the special influences of emotional abuse and physical abuse on different dimensions of ODD symptoms, operationalized as anger management and aggressive behavior, among Chinese ODD children. In comparison with their non-ODD peers, children identified with ODD appeared to suffer more emotional abuse and physical abuse, experience poorer parent–child relationships, have greater difficulties with anger management, and display more aggressive behavior. We found that for both ODD children and non-ODD children, emotional abuse was the only predictor of anger management when controlling for demographic factors. Similarly, physical abuse significantly predicted aggressive behavior but not anger management. Indirect effects of emotional abuse and physical abuse via parent–child relationship on anger management were found among children with ODD.

The current study’s results replicated prior findings that children with ODD were at an increased risk of being maltreated within their family (Lin et al., 2014; Swenson et al., 2006), and that child maltreatment significantly predicted emotional and behavioral problems (Maas et al., 2008; Spinazzola et al., 2014). This finding provided support for the coercive cycle theory that posited a bidirectional view of negative parenting and child behavior, especially among children who were diagnosed with ODD. Although children with ODD are frequently characterized as exhibiting a negative affect and oppositional behavior (Burke et al., 2005), their experiences of maltreatment indeed play a significant role in explaining increased emotional and behavioral problems. Unfortunately, their negative emotions and behaviors may in turn increase the risk of being maltreated by their parents (Lin et al., 2014; Swenson et al., 2006).

Thus, when considering the needs of children identified with ODD, more attention should be paid to the often underestimated risk of parenting factors. This study extended on prior studies that focused on coercive parent–child interactions that amplified children’s antisocial behaviors (Patterson et al., 1992). However, our current findings should be interpreted with caution, because we did not directly examine the reciprocal parent–child interactional process across time due to the limitation of a cross-sectional design.

Data from the ODD and non-ODD samples are somewhat inconsistent with previous research suggesting the negative impact of emotional and physical abuse on both emotional and behavioral problems (Lansford et al., 2002; Teicher et al., 2006). For both ODD and non-ODD groups, after controlling for demographic variables, we only found a significant impact of emotional abuse on anger management and a significant impact of physical abuse on aggressive behavior. The specific effects of emotional and physical abuse may be attributed to several factors. First, almost all participants in previous studies were victims of childhood maltreatment. In contrast, one of the sampling criteria in the current study is being diagnosed as ODD but not being exposed to child maltreatment. The severity and range of emotional and physical abuse may not be comparable with previous studies. An alternative explanation is that emotional abuse and physical abuse have specific and unique effects on emotional and behavioral problems among Chinese children. Both these interpretations necessitate future research.

Second, a growing literature suggests that symptoms of ODD could be categorized into distinctive dimensions (Burke et al., 2010; Burke et al., 2005; Stringaris & Goodman, 2009), as reflected in the DSM-5 diagnostic criteria. The finding that emotional abuse was the only predictor of emotional problems and physical abuse was the only predictor of behavioral problems for ODD children supported the multiple dimensions of ODD symptoms. Moreover, the correlation between anger management and aggressive behavior was significant among non-ODD children but not among ODD children, indicating that emotional problems and behavioral problems may be distinctive among children with ODD. Finally, for non-ODD children, because they rarely suffered maltreatment and had little impairment in emotional and behavioral functioning (restriction of range), the association between maltreatment and adverse outcomes was relatively weak for these children.

The current study highlights the importance of positive parent–child relationship as a protective factor for child maltreatment among children with ODD. For these children, our findings showed that the effect of emotional abuse on anger management was partially mediated by the parent–child relationship among children with ODD. The exposure to emotional abuse in the family may place ODD children at a higher risk of experiencing poor parent–child relationships. This, in turn, may increase the severity of ODD children’s emotional problems. These findings are consistent with prior studies that linked emotional abuse to emotional problems (Spinazzola et al., 2014; Teicher et al., 2006); however, our study’s findings extend upon previous work in explaining the mediating mechanism of the parent–child relationship. It is important to note that among ODD children, the effect of physical abuse on anger management was completely mediated by the parent–child relationship. In other words, although physical abuse had no direct impact on ODD children’s anger management, physical abuse had an indirect impact on their anger management.

In regard to the ODD children’s group, one surprising finding was the lack of significant mediating effect of the parent–child relationship in explaining the effects of emotional and physical abuse on aggressive behaviors. This finding, which was inconsistent with prior research (Herrenkohl et al., 2003; Salzinger et al., 2007), may be because of the measures we used to quantify aggressive behaviors. In addition, in the current study, the classroom teacher quantified children’s aggression with peers at school. However, ODD symptoms are frequently more salient in the context of the home rather than the school (APA, 2013; Tseng, Kawabata, & Gau, 2011). Moreover, both child maltreatment and parent–child relationship were variables derived from the parent’s input. These aspects regarding the type of data and the source of the data may lessen the association of reported child aggressive behavior with both child maltreatment and the parent–child relationship. For these reasons, we cannot exclude the possibility that the parent–child relationship may mediate the association between maltreatment and aggressive behavior among ODD children in Mainland China.

Another point to consider, although the cultural perception of normality might buffer the adverse outcomes of harsh parenting, including emotional and physical abuse (Lansford et al., 2005), maltreatment still results in impaired anger management and aggressive behavior in China— where harsh discipline is widely accepted as an effective and common child-rearing technique. In addition, under the influence of Chinese respect for filial piety, parents in China often rely on emotional punishment and/or physical punishment to build their parental authority and to control their child. In addition, parents and caregivers may underestimate and fail to acknowledge the negative consequences of these parenting practices (Liao et al., 2011).

Even though parents in modern China are beginning to realize the serious effects of maltreatment on children, lacking appropriate parenting skills, parents often revert to the traditional style of disciplining children with emotional and/or physical abuse. Parents in China, especially parents of irritable and oppositional children, urgently need to be taught effective and healthy parenting skills which include non-abusive strategies for disciplining their children.

Limitations

When interpreting this study’s findings, one must consider the present study’s limitations. First, the non-ODD group was not demographically matched to the ODD group. This mismatch raises the possibility for other interpretations regarding our findings, in particular the finding that ODD children suffered more maltreatment than non-ODD children. We cannot rule out that the differences in maltreatment may be due to the effects of demographic variables. Future studies need to take greater care in more precisely matching demographic variables across groups.

Second, the measure used in this study primarily focused on children’s behaviors in school settings. This may constrain the generalization of findings, limiting conclusions to apply solely to school settings rather than to settings outside the school (e.g., family).

Third, child abuse was measured by parent’s self-reports. It is possible that they may have consciously or unconsciously underestimated the severity of abuse they inflicted upon their children. In future studies—to improve upon this weakness—researchers should consider measures from multiple sources, including child-reported abuse and experimental observations of abusive interactions. Even though the maltreatment in this study might be underestimated, the robustness of findings suggests the critical effects of maltreatment on ODD symptoms. In summary, for future research, we recommend using global measures of child maltreatment.

Conclusion and Implications

The current study highlights the negative impact of child maltreatment on emotional and behavioral problems among children identified with and not with ODD. While controlling for demographic variables, only emotional abuse predicted anger management and only physical abuse predicted aggressive behavior. In addition, for ODD children, both emotional abuse and physical abuse affected anger management through the parent–child relationship.

Overall, our results support the division of multiple dimensions of ODD symptoms in DSM-5 (APA, 2013). Moreover, our data support Patterson’s (1982) coercive theory, and suggest a bidirectional relationship between negative parenting and child behavior.

Researchers and practitioners who work with ODD children should pay more attention to the parent–child relationship, including harsh parental discipline and associated child maltreatment. Prevention strategies to decrease the incidence of ODD in children or to lessen the severity of ODD should be linked to children’s predominant symptoms. For example, when working with children who exhibit more negative affect, prevention could focus on two intervention strategies: (a) lessening risk factors associated with emotional problems, such as reducing the incidence of emotional abuse, and (b) reinforcing protective factors, such as improving the parent–child relationship. Prevention efforts for children who exhibit more behavioral problems could focus on reducing risk factors such as reducing the incidence of and countering the effects of physical abuse and harsh physical punishment.

In China, successful prevention of the coercive cycle of maltreatment and ODD symptoms requires proactive efforts to heighten public awareness of the adverse consequences of punitive and harsh discipline. Prevention efforts must also include parent training that encourages positive parent–child relationships and offers positive parenting strategies to manage children’s oppositional, aggressive, and problematic behavior.

Footnotes

Acknowledgements

We are grateful to all the parents, children, and teachers who participated or contributed to the current study.

Authors’ Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of National Social Science Foundation, Beijing Organization Committee, and State Key Laboratory Foundation.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study described in this report was supported by 2012 Annual National Young Scholar Grants from National Social Science Foundation (12CSH014), 2013 Annual Excellent Talent Project from Beijing Organization Committee (2013D009012000004), and Open Research Fund of the State Key Laboratory of Cognitive Neuroscience and Learning (CNLZD1503) in Mainland China.

Author Biographies

Longfeng Li is a postgraduate student at the Institute of Developmental Psychology, School of Psychology at Beijing Normal University. She is interested in the cognitive, emotional, and social development in children.

Xiuyun Lin, PhD, is an associate professor at the Institute of Developmental Psychology, School of Psychology at Beijing Normal University. Dr. Lin’s research interests include family and child development, developmental psychopathology, family interactions, and family therapy. Her research emphasis is the relationship of family interactions on psychopathology symptoms of children with oppositional defiant disorder.

Peilian Chi, PhD, is an assistant professor in Department of Psychology, at University of Macau, China. Dr. Chi’s research interests focuses on family-based intervention, resilience of children and adolescents, and interpersonal processes affecting family functioning.

Melissa Allen Heath, PhD, is an associate professor in Brigham Young University’s School Psychology Program. Her research interests include children’s grief, bibliotherapy, and school-based crisis intervention. Dr Heath’s emphasis is on making information practical and easy to implement across settings by teachers, staff, and parents. She currently serves as an Associate Editor of School Psychology International.

Xiaoyi Fang, PhD, is a Yangtze-river professor and Director of the Institute of Developmental Psychology at Beijing Normal University. His research interests include child and adolescent mental health, internet addiction, marriage and family therapy, and psychological development of vulnerable children. Up to now, he has acquried 25 research projects, and published more than 100 peer- reviewed English articles and 200 peer-reviewed Chinese articles.

Hongfei Du, PhD, is a visiting assistant professor in Department of Psychology, at University of Macau, China. His research interests include self-concept and self-esteem in close relationship, social motives and culture, well-being and mental health.

Zhonghui Wang is an associate professor at Department of Psychology, China Wemen’s University. Prof. Wang’s research interests include child development, social identity, sociocultural adaptation, and resilience of migrant children. His research emphasis is the relationship of social interactions on migrant children and developing effective social identity intervention program.

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