Objective  To examine disparities in psychological difficulty and prosocial behavior among the children in difficult families (CDF) and in normal families and to provide empirical evidences for assessing the mental health needs of CDF and developing a moderately inclusive child welfare system.

  Methods  The data of the study were from a national survey on CDF conducted during August – September of 2018. The participants were 6 – 15 years old children (2 099 CDF and 666 age- and gender-matched control children in normal families) recruited with multistage sampling in 7 provincial regions across China. Household face-to-face interviews were carried out in the participants using the Strengths and Difficulties Questionnaire (SDQ). Independent sample t test and monotonic ordinal rank-sum test (Matel-Haenszel χ²) were adopted in analyses.

  Results  Compared to those in the control children, the score and abnormality detection rate of emotional symptoms (2.107 ± 1.977, 15.5%) and peer-communication (3.449 ± 1.497, 8.5%) were significantly higher in the 6 – 9 years old CDF (all P < 0.05); but the score of prosocial behavior (5.229 ± 2.366) was significantly lower in the 6 – 9 years old female CDF (P < 0.001). In contrast to the controls, the 10 – 15 years old CDF had significantly higher score and abnormality detection rate of hyperactivity-inattention (3.459 ± 1.691, 3.7%), emotional symptoms (2.121 ± 1.987, 7.4%), conduct problems (2.214 ± 1.563, 8.7%), and peer-communication (3.352 ± 1.445, 8.1% ) (P < 0.001 for all); however, the 10 – 15 years old CDF had significantly lower score but higher abnormality detection rate of prosocial behavior (5.570 ± 2.337, 28.3%) (both P < 0.001); the prosocial behavior score of 10 – 15 years old CDF was significantly lower in the males (5.630 ± 2.372) and the females (5.500 ± 2.295) than in the controls (both P < 0.01).

  Conclusion  The 6 – 15 years old children in difficult families are at high risk of various psychological difficulties and may perform prosocial behaviors poorly; the situation needs to be concerned, especially for the girls and the elder children.