Objective: Left-behind children have a high incidence of behavioral problems in some Eastern countries, especially China. We sought to assess the combined effects of physical neglect, a major embodiment of the left-behind phenomenon, and the trauma of being left behind on subsequent behavioral problems.
Method: 776 children (including 600 left-behind children) aged 12–16 years were chosen by cluster sampling in rural China. The Childhood Trauma Questionnaire-Short Form and the Conners Teacher Rating Scale were used to evaluate physical neglect and behavioral problems.
Results: Left-behind children experienced more physical neglect (mean difference = 0.63; 95%CI 0.15–1.10; P = 0.01) and were more inattentive (mean difference=0.11; 95%CI 0.03–0.19; P = 0.009) than non-left-behind children. Physically neglected left-behind children had higher scores for conduct problems, inattention, and hyperactivity index than non-left-behind without physical neglect group (P < 0.05 for each). Among left-behind children, physical neglect group had significantly more conduct problems than those of controls (mean difference=0.14; 95%CI 0.05–0.23; P = 0.008). Physically neglected non-left-behind children had higher scores for conduct problems than those of left-behind children without physical neglect (mean difference=0.31; 95%CI 0.13–0.47; P = 0.003). Among physically neglected children, left-behind children had significantly higher scores for inattention than those of non-left-behind children (mean difference=0.13; 95%CI 0.04–0.22; P = 0.037).
Conclusion: Left-behind children have more behavioral problems than non-left-behind children. Physical neglect may result in more severe conduct problems than those associated with staying behind, and staying behind may lead to inattention. Exposure to both may lead to more obvious behavioral problems. Therefore, we should accord more attention to physically neglected and left-behind children.