Psychopathology of Maltreated Children in a Foster Institute in Northern Taiwan

　　目的：探討安置於機構之受虐兒童青少年的精神病理特徵，並比較安置機構中主要照顧者和臨床工作者所觀察到之心理行為問題之異同，以提供我國兒童保護實務規劃及執行之參考。方法：以民國86年7月1日至87年12月31日止，以臺灣地區北部縣市政府社會局（科）轉至某育幼院執行保護安置之新進受虐兒童青少年為對象，經由一個兒童青少年精神醫療團隊，透過標準化的評估及處理流程，收集其社會背景及心理行為問題相關資料，施行精神病理評估及相關精神疾病診斷，而後進行描述性的資料分析。另配對選取30名社區國小及國中學生為對照組，以兒童行為檢核表（CBCL父母版）進行對照分析。結果：共收集3至19歲之受虐兒童青少年44名（男26人，女18人），其智力分布介於中等智能至中度智能不足；精神病理方面：95%個案有內在性情緒困擾，73%個案有外顯性行為困擾；診斷方面：95%個案有臨床精神疾病之診斷，包括憂鬱症(32%)、適應障礙症(30%)、行為規範障礙症(21%)及創傷後壓力障礙症(20%)、注意力不足過動症(18%)等；70%有多重診斷，女性出現憂鬱症及分離焦慮症的比例顯著高於男性。兒童行為檢核表對照分析顯示，受虐組在各項得分均顯著比對照組高，特別是總分及外化、非行、過動、攻擊、退縮等量尺，更達特別顯著差異。結論：接受機構安置之受虐兒童青少年有明顯不容忽視的精神病理現象及極高之精神疾病罹病率，也有高比例的特殊教育需求；主要照顧者需對其心理行為困擾有敏銳之察覺及有效協助之能力。在受虐兒童青少年的機構保護安置計畫中，應包含積極的精神醫療之評估與處置，以提供受安置個案醫療之需求。
　　Objective: This study investigated the psychopathology among maltreated children and adolescents referred from a foster institute and compared the observations of clinical professionals and their care takers In the institute. Methods: Forty-four maltreated children (aged 3 though 19 years) referred from a foster institute in northern Taiwan were assessed for behavioral/emotional problems and psychiatric morbidity by a research team through standard evaluation procedures. Data on sociodemographic characteristics and patterns of abuse were collected and assessed. A control group of thirty school children were selected from community schools by matching age, sex and SES of the parents. Child Behavior Checklist (CBCL) were completed separately by parents in control group and by caregivers In maltreated group and the results were compared between the two groups. Results: IQ scores were within the range of average to moderately retarded in all of the maltreated children. Externalizing problems were found in 73% of maltreated children and internalizing problems in 95%. Overall 95% of the maltreated children had at least one psychiatric diagnosis. Comorbid conditions were found in 70% of the maltreated children. Maltreated children had a wide range of diagnoses, with particularly high rates of depression (32%), adjustment disorders (30%), conduct disorders (21%), post-traumatic distress disorders (20%) and attention deficit hyperactivity disorders(18%). Maltreated girls had higher rates of depression and separation anxiety disorders. CBCL results in the maltreated group were significantly higher in scores for all items with particularly high total scores and scores in subscales of externalizing, aggressive behavior, delinquent behavior and withdrawn compared to the matched group. Conclusion: Children who had been placed in this foster home due to maltreatment had very high rates of psychopathology and psychiatric morbidity. Caregiver awareness of the psychological, educational and social needs of maltreated children is essential to provide effective help. Psychiatric assessment and management should be actively incorporated into foster care programs for maltreated children.