State and trait anxiety among parents having children with conduct disorder and parents having normal children

 

Bindu M V^1*, Sheeba Damodar², Jayadevan Sreedharan³, Vimal Rohan Kandoth⁴,

Jayasree Anada Bhavan Kumaran⁵

 

{¹Assistant Professor, ⁵Professor, Department of Community Medicine} {²Professor, Department of Pharmacology}

{⁴Assistant Professor, Department of Emergency Medicine} ACME, Pariyaram, Kerala, INDIA.

³Professor, Epidemiology, Gulf Medical University, UAE.

Email: itsbindumv@gmail.com

 

Abstract               Background: That conduct disorder is a continuous and persistent type of arrogant, and antisocial in character, aggressive type of behaviour which makes the child to indulge in fighting with others, stealing, setting fire to property and other things, running away from home and keeping away from school and it will make the child prone to do things which will break the expectations of others and rules and norms as per the societal culture. An important dimension about the relation between parent’s psycho social correlates and conduct disorder in children is that emergence and maintenance of conduct disorder which may affect parental mental health. The present study focuses on the intensity of state anxiety and trait anxiety in parents having children with conduct disorder. Materials and Methods: Sample was selected from 200 parents having children with conduct disorder reported in various psychiatric settings in Kerala, India, and also from 200 parents having normal children. Random sampling was used for selecting the sample. Mann-Whitney U test was used for statistical analysis. Result: Conduct disorder in children will affect their parents mental and social functioning and their life functioning of their parents. From this study, it was found that parents having children with conduct disorder is having higher intensity of state anxiety as well as trait anxiety compared to parents having normal children and the difference in intensity is statistically significance at level of significance (p<0.001)Problems and shame related to their child’s socially unacceptable and inappropriate behaviour disorder combined with the burden of handling a society which is intolerant to the child’s problem behaviour and the blame which is usually put on the shoulders of the parents will result in social isolation and anxiety in parents. Conclusion: The findings of this study illustrate the importance of recognizing, acknowledging, and addressing the burden experienced by parents of children with conduct disorders, in particular, their feelings of state and trait anxiety which leads to stigma, embarrassment, reduced quality of life, and poor health caused which is initiated by conduct disorder in children.

Key Words: Conduct Disorder, State Anxiety, Trait Anxiety, Behavior problem.

 

 

INTRODUCTION

Conduct disorder can cause a lot of distress to children, families, schools and local communities. Children having conduct disorder will often find it difficult to make friends and have difficulties understanding social situations. Even though they might be quite bright, they will not do well at school and are often near the bottom of the class. On the inside, these children may be feeling worthless and that they just cannot do anything right. It is common for them to show anger and blame others for their difficulties if they do not know how to change for the better. Conduct disorder is best described as a collection of behaviours that reflect a persistent and pervasive violation and disregard of the basic rights of individuals, age-appropriate societal norms, and laws set forth by the state and/or government (Frick and Dickens)¹ The criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition –TR (American Psychiatric Association) ² suggests that for the child or adolescent to receive a diagnosis of conduct disorder he/she must exhibit three or more of the listed behaviours in the past 12 months, with at least one item being present in the last 6 months, across the following dimensions: aggression to people and/or animals (e.g. using a weapon, getting into fist fights, kicking the family pet), destruction of property (smashing windows, punching holes in walls, setting fires, graffiti), deceitfulness or theft (e.g. stealing without a weapon, conning others), and serious violations of rules like truancy, running away (American Psychiatric Association, DSM-5^th edition)³ adds more to the personality styles of children. There will be a callous and unemotional interpersonal style in them across multiple settings and relationships. There will be limited display of pro-social emotions such as empathy or guilt in these children having conduct disorder.

Parents having children with conduct disorder (PCCD) will have psychological and social trauma in dealing with their day to day life compared to parents having children with normal children (PNC). Anxiety is considered as a psychological and physiological condition that includes various components (behavioral, cognitive, and somatic), which merge and result in feelings such as nervousness, panic and discomfort. Anxiety can be categorized as "state" or "trait”. State anxiety is an unpleasant emotional stimulation that occurs when a person is comes into contact with frightening stressors or dangers. Parents having children with conduct disorder will have to face various situations in their life which causes state anxiety in them, since conduct disorder in their child will create situations which are frightening and dangerous. Parents of children with conduct disorder show deficit in social, psychological, cognitive domain and are at risk of developing depression, psychiatric or emotional disorders including severe anxiety and stress. The criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition –TR suggests that for the child or adolescent to receive a diagnosis of conduct disorder he/she must exhibit three or more of the listed behaviours in the past 12 months, with at least one item being present in the last 6 months, across the following dimensions: aggression to people and/or animals (e.g. using a weapon, getting into fist fights, kicking the family pet), destruction of property (smashing windows, punching holes in walls, setting fires, graffiti), deceitfulness or theft (e.g. stealing without a weapon, conning others), and serious violations of rules like truancy, running away (American Psychiatric Association)⁴. DSM IV- TR explains anxiety as a fear of the future events, sense of insecurity or uneasiness and a feeling of nervousness. It is a physiological response of the nervous system which causes symptoms which are physical such as restlessness, sweating, and increased heart beat. (American Psychiatric Association)⁵. Anxiety is of two types; state anxiety and trait anxiety. State anxiety is considered as a temporary change in the emotional state of an individual because of an outside stimulator. It is caused by the heightened response of the autonomic nervous system which will subside eventually (Spielberger).⁶ Trait anxiety is inherited and ingrained in the personality of an individual and he may see the entire world as dangerous and threatening. These individuals will perceive several things in the environment as inappropriate and they may worry for reasons which most other people will see as silly. In this study, the difference in the intensity of state and trait anxiety among parents having children with conduct disorder (PCD) and parents having children with normal children (PNC) are included.

MATERIALS AND METHODS

An explorative study was conducted to investigate the intensity of state and trait anxiety in parents having children with conduct disorders compared to that of parents having normal children. The sample size calculated for this study was 200 parents having children with conduct disorder and 200 parents having normal children. Samples were selected from the parents of 200 diagnosed cases of children in the age group of six to twelve with conduct disorder reported in the major public and private psychiatric referral centers in Kerala and also the parents of 200 normal children were taken from all over Kerala, India. All the parents, of children diagnosed with conduct disorder in the age group of six to twelve, reported in the psychiatric settings on a random day is selected as sample. Personal data schedule is used for collecting the socio demographic details of parents and the Malayalam adaptation of spielberger’s state trait personality inventory is used for collecting the details of state and trait anxiety in parents. Coding was done for the data collected.

Statistical Analysis: Mann-Whitney U test was performed to examine the comparison of the intensity of state and trait anxiety experienced by parents having children with conduct disorder and parents having normal children.

 

RESULT

In the present study, in PNC group a total of 196 fathers and 200 mothers responded. Four fathers in PNC group were outside the district, at the time of data collection, so that details from those parents were not able to be collected. In PCCD group 200 fathers and 200 mothers participated in the study. Out of the 400 parents, 396 parents responded to the inventories. In the PCCD group, there was no male included in the age group of less than 30 years where as in PNC group there was 2.6% were in this age group. But 22.5% females who were less than 30 years of age group were included in the PCCD group and 8.5 % were included in the PNC group. More than 50% males in PCCD group and PNC group were in the age group of 35-44 years. But among females, more than 50% were in the age group of 30-39 years. 6.1 % PNC group and 6.5% PCCD group males were in the age group of below or equals to50 years and among females 0.5 % were in PCCD group and nobody in PNC group were in the age group of below or equals to 50 years. Out of the 396 parents in the PNC group only 4.3% belongs to lower primary or below education. Out of four hundred parents in the PCCD group, 7.8% belonged to this category. In PNC group, 9.1% got upper primary education and 46% were having high school education.22.2% parents were having plus 2 level qualification and 10.1% were degree level and 8.3% were having PG/Professional level education in PNC group. In the PCCD group it was 11.2%, 33.8%, 14.8%, 18.8% and 13.8% respectively in each level of education qualification. In PNC group 63.4% parents were living in Joint family, where as in PCCD group it was 36.6%. In PNC group 23.5% belonged to nuclear family and it was 76.5% in PCCD group. Occupation wise classification showed, 12.5% parents of PCCD group were daily labourers and 9.7% self employed where as in PNC group this was 25% and 6.2% respectively. All others were either salaried employees or were getting an assured minimum monthly income. In PNC group 38.4% of mothers were house wives whereas only 24.2% mothers in PCCD group belong to this category. State anxiety in parents having children with conduct disorder and those with normal children were calculated. State anxiety in parents having children with conduct disorder was high compared to parents having normal children since the median value was higher in PCCD group compared to PNC group. The difference in state anxiety score observed between the PNC group and PCCD group was statistically significant (P<0.001). The minimum score observed for state anxiety score was 8 for PNC group and 14 for PCCD group. Maximum score for observed for state anxiety score for PNC group was 28 and 31 for PCCD group. The median state anxiety score was 17 and 23 respectively for PNC and PCCD group. Regarding trait anxiety, in parents having children with conduct disorder and those with normal children, the difference observed was statistically significant (P<0.001). Trait anxiety score in the parents having children with conduct disorder was high compared to parents having normal children. The minimum score observed was 9 and 13 for PNC and PCCD groups respectively. Maximum score was 28 for PNC group and 32 for PCCD group. The median trait anxiety score was 19 and 25 respectively for PNC and PCCD groups. The median, minimum and maximum score of trait anxiety was higher in PCCD group compared to PNC group.

Table 1: State Anxiety- Results of Mann-Whitney U test

Group	Median	Minimum	Maximum	No.	Z
PNC	17	8	28	390	17.0***
PCCD	23	14	31	386

***Significant at 0.001 level

 

Table 2: Trait Anxiety- Results of Mann-Whitney U test

***Significant at 0.001 level

 

DISCUSSION

Parents having children with conduct disorder were not sure about the strategies they should accept and implement, when their children are expressing the symptoms of conduct disorder. During the time of data collection also the PCCD group of parents expressed confusion and anxiety when they were exposed to the reality of the problem situation created by their child’s conduct disorder compared to other children. This may be expressed through their response regarding questions related to state anxiety. Fendrich et al⁷ stated that parents having children with conduct disorder express higher level of state anxiety. Manor -Binyamini)⁸ examines the parental burden and sense of coherence among parents of children with conduct disorder and, parents of children without the disorder in Israel observed a statistically significant differences between the two groups; parents of children with conduct disorder reporting a higher anxiety and lower sense of coherence than the parents of children with no disorder. A study conducted by Waite and Creswell⁹ states that state anxiety in parents have got serious implication in the development and maintenance of conduct disorder in children and vice versa. A systematic review conducted to examine the association of parental anxiety and child conduct disorder (Waite et al.) ¹⁰ reported a consistent and preliminary evidence of inter relation between anxiety and parental control and anxious rearing in children with conduct disorder (Van Brakel et al,¹¹ Van Zalk and Kerr,¹² Wijsbroek et al¹³). The outcomes of studies conducted to find out the association of parental anxiety and child conduct disorder, the effect sizes were in small to medium range (Hudson and Rapee¹⁴, Schwartz et al¹⁵, Verhoeven et al¹⁶). The findings of the present study is in consistence with the above findings. Parents having children with conduct disorder would experience a higher trait anxiety. This can be again act as a precipitating factor for further conduct problems in children. The finding in the present study that trait anxiety in parents having children with conduct disorder is high compared to parents having normal children endorsees this explanation. In a longitudinal study, Lansford, Criss, Pettit, Dodge and Bates¹⁷ conducted to explore the role of positive peer relations and friendship quality like closeness and support as well as affiliation to peer groups such as sense of belongingness has got a role in mediating the link between children’s conduct disorders with parental anxiety and negative parenting like harsh discipline, low supervision and unilateral decision making by parents. The outcome of the study explains that peer group affiliation and friendship quality acquired by the children act as protective components for children who are subjected to negative parenting, and those children who are associated with peers are perceived as having lower rate of antisocial behaviour. Close association with peer group act as a buffer for the children who are subjected to lower parental monitoring or supervision and quality awareness. Higher levels of antisocial behaviour from the part of peer group and friends increased the severity of predicting serious and harsh punishment for the conduct disorder behaviour of the children. Parents may impose unilateral decision making on children’s conduct disorder behaviour if they possess relationship with low quality peer groups and those friends who are indulged in antisocial activities and behavioural problems which indicate the higher level of anxiety experienced by parents having children with conduct disorder. Mendenhall and Mount¹⁸ states that conduct disorder in children can significantly impact the parent’s mental well being and can increase the trait anxiety in them and which may decrease the quality of their life. Conduct disorder in children will create disturbances in all areas of parents’ lives, including work, mental and physical health, and social and family relationships. They may become incompetent in facing challenges in life and also has to find problems in managing financial burden, sibling rivalry, stigma, self-doubt and blame, marital stress, and difficulty accessing services, in addition to dealing with the symptoms of conduct disorder in their child. These situations in life will cause increase in trait anxiety which will have state anxiety dimensions in them. From the present study, it was found that parents having children with conduct disorder is having higher intensity of state anxiety as well as trait anxiety compared to parents having normal children and the difference in intensity is statistically significance at level of significance (p<0.001) The result of the present study also supports related study findings conducted in this area of research, that parents having children with conduct disorder is having a higher rate of anxiety in them compared to parents having normal children.

CONCLUSION

Conduct disorder in children had a significant role in increasing parental difficulties and parental anxiety. This is considered as long shadow over adulthood which is often contributing to antisocial personality disorder, substance abuse, higher rate of psychosis and even earlier death which may cause higher level of anxiety in parents. This finding is supported by various studies conducted in this area. The result of this present study shows that the state and trait anxiety in the parents having children with conduct disorder is high compared to parents having normal children. The studies which are focused on children’s conduct disorder and its role in parental anxiety explains that parental anxiety is a serious consequence which needs the attention of the health professionals working in this area. There should be a combination of different therapy and it should start with evaluation of a comprehensive nature and by following certain tools such as individual psychotherapy, parent, child and family therapy or a group therapy, parent management training, use of dyadic and social skills training programs and also proper medication

 

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