Transcript spanking - Children's Mercy Hospital

Does spanking lead to better or
worse behavior?
© Copyright 2010
Controversial subject
• Spanking elicits strong views
• Research is contradictory
– Some studies associate spanking with long-term emotional and
behavioral problems
– Others find that spanking can be a useful disciplinary tool
Most parents spank
• Nearly 2/3 of parents of one- and two-year-olds report
using physical punishment*
• 80% of fifth-graders say they’ve been physically
punished.**
• 85% of high-school-aged children report having been
physically punished; 51% of them say they’ve been hit
with a belt or similar object.***
*Regalado et al. Pediatrics. 2004.
*Socolar et al. South Med J. 2007.
**Gershoff et al. Psychol Public Policy Law. 2007.
***Bender et al. Dev Psychopathol. 2007.
Many doctors endorse spanking
• 800 family physicians and 400 pediatricians randomly
selected from Ohio State Medical Board’s roster
• 619 (61%) physicians responded
• Main outcome measure: whether they would tell a parent
in their medical practice that spanking would be
appropriate in any one of a series of childhood
misbehaviors presented in the survey
McCormick KF. JAMA. 1992.
Results
• 70% of family physicians endorse corporal punishment
• 59% of pediatricians endorse corporal punishment
• Physicians younger than 40 were much more likely than
those older than 40 to support it
McCormick KF. JAMA. 1992.
Most supportive of spanking in
dangerous circumstances
McCormick KF. JAMA. 1992.
Spanking is decreasing over time
• The proportion of Americans in favor of physical
punishment for children was:
– 94% in the 1960s
– 84% in 1986
– 71% in 2004
• Many nations have outlawed hitting children under any
circumstances
Straus, Mather. Family violence against children: a challenge for society. 1996.
Gershoff. Unpublished analysis of General Science Surveys. 2007.
AAP concerns about CP
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Loses its impact
May lead to escalation and, ultimately, child abuse
Models aggression as a solution
Impedes other forms of discipline, like time-out
Alters the parent-child relationship
Makes discipline more difficult as the child grows into an
adolescent
• May appeal to parents as a release for their anger
Committee on Psychosocial Aspects of
Child and Family Health. Pediatrics. 1998.
AAP bottom line - 1998
• “Because of the negative consequences of spanking and
because it has been demonstrated to be no more
effective than other approaches for managing undesired
behavior in children, the American Academy of Pediatrics
recommends that parents be encouraged and assisted in
developing methods other than spanking in response to
undesired behavior.”
Committee on Psychosocial Aspects of
Child and Family Health. Pediatrics. 1998.
Does spanking work?
• Numerous studies
• Studies try to measure both efficacy and harms:
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Does spanking reduce problem behaviors?
Does spanking cause anti-social behavior?
Does antisocial behavior lead to spanking?
Are spanked children better behaved?
Or do they develop psychological problems?
• Contradictory results
Some studies find that spanking
leads to long-term problems
Does spanking improve behavior?
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807 randomly-selected mothers
Children 6-9 years old
Quantified spanking in month prior to study
Controlled for gender, maternal warmth, maternal
cognitive stimulation, SES, ethnicity
• Measured anti-social behavior two years later
Children who were
spanked more in the
month prior to the study
had more antisocial
behavior two years later,
after controlling for antisocial behavior at
baseline, and a number
of other predictors
Straus MA et al. Arch Pediatr Adolesc Med. 1997.
Risk factors for anti-social behavior
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Being male
Having a history of anti-social behavior
Having a mother of an ethnic minority
Being spanked in the week before the interview
Straus MA et al. Arch Pediatr Adolesc Med. 1997.
Conclusions
• “When parents use corporal punishment to reduce antisocial behavior, the long-term effects tend to be the
opposite.
• The findings suggest that if parents replace corporal
punishment by non-violent modes of discipline, it could
reduce the risk of anti-social behavior among children and
reduce the level of violence in American society.”
Straus MA et al. Arch Pediatr Adolesc Med. 1997.
Same data, different conclusions
• Ten years later, researchers re-analyzed the same
dataset and compared spanking with other disciplinary
techniques – including psychotherapy, time-out,
grounding and loss of privileges.
Larzelere RE et al. BMC Pediatr. 2010.
Most disciplinary tactics associated
with anti-social behavior
Larzelere RE et al. BMC Pediatr. 2010.
Conclusion
• “The strongest causal evidence against customary
spanking (Straus study) seems to be due to residual
confounding because behaviorally difficult children cause
parents to use all disciplinary corrective actions more
frequently.
• When the measure of initial child differences is improved,
the evidence against customary spanking becomes nonsignificant…”
Larzelere RE et al. BMC Pediatr. 2010.
Perhaps spanking effects are
“dose–dependent”
• 2461 children from Fragile Families and Child Well-Being
Study (1998-2005)
• Interviews with mothers when children 3 and 5 (spanking
measured at 3)
• Controlled for initial aggressive behavior and 8 other
confounding variables: maternal child physical
maltreatment, psychological maltreatment, neglect,
intimate partner aggression, stress, depression,
substance use, and consideration of abortion
• Outcome measure: child aggression at 5 years of age
Taylor CA et al. Pediatrics. 2010.
Outcome depends on frequency of
spanking
• Spanking >2 times in previous month: odds ratio 1.49 for
aggressive behavior two years later (p < 0.001)
• Spanking 1-2 times in previous month: odds ratio 1.17 for
aggressive behavior (not statistically significant)
Taylor CA et al. Pediatrics. 2010.
Two meta-analyses come to different
conclusions
• 88 studies done between 1938 and 2000
• 36,309 subjects
• 117 effect sizes
• Outcome measures: seven childhood and four adult
behaviors
Gershoff ET. Psychol Bull. 2002.
Gershoff’s outcomes
• Child behaviors
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Immediate compliance
Moral internalization
Aggression
Mental health
Delinquent, criminal,
antisocial behavior
– Quality of parent-child
relationship
– Becoming a victim of
physical abuse
• Adult behaviors
– Criminal and antisocial
behaviors
– Mental health
– Aggression
– Adult abuse of own child or
spouse
Results
• Spanking associated with “immediate compliance” – so it
works in the short run
• Associated with negative outcomes in the long run:
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Aggression
Antisocial behavior
Poor mental health
Adult abuse of own child or spouse
Gershoff ET. Psychol Bull. 2002.
Findings nearly all negative
Gershoff ET. Psychol Bull. 2002.
Limitations of meta-analysis
• The 88 studies did not consistently control for the
children’s aggression level at the outset
• Many studies measured corporal punishment and
behaviors at the same time, further confounding the
issue of cause/effect
• Corporal punishment and physical abuse are not always
clearly distinguished. Didn’t distinguish a swat on the
bottom from a punch in the face.
Gershoff ET. Psychol Bull. 2002.
Proposed solutions
• Base effect sizes on each study’s strongest data,
whenever possible
• Analyze differential effect sizes between physical
punishment and alternative disciplinary tactics
Larzelere RE et al. Clin Child Fam Psychol Rev. 2005
A different meta-analysis supports
spanking in moderation
• Review of 26 studies
– All children, on average, 13 or younger when disciplined
– Study looked at one or more alternatives to physical punishment
– At least one child outcome measured
• All children <13 at time of corporal punishment.
• Define four categories of physical punishment:
– conditional (used rarely and under specific circumstances, as when a
pre-schooler won’t stay in a time-out chair)
– customary (non-severe)
– overly severe (excessive force, hit with object, slapping in face)
– predominant (parent’s primary disciplinary method)
• Compared spanking and alternative forms of discipline
Larzelere RE et al. Clin Child Fam Psychol Rev. 2005
Findings
• If administered infrequently and not severely, spanking
does no harm, and may even be better than alternatives
• Conditional spanking reduced later noncompliance and
antisocial behavior better than 10 of 13 alternative tactics
• Customary spanking never had worse outcomes than the
alternatives
• Predominant and overly-severe spanking produced
worse results than the alternatives
Larzelere RE et al. Clin Child Fam Psychol Rev. 2005
Results
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Infrequent, non-severe spanking better than alternatives
Conditional spanking very effective
Customary spanking similar to alternatives
Predominant and overly severe spanking produced bad
outcomes
Predominant and severe spanking
are the worst. Customary,
conditional spanking not so bad.
Larzelere RE et al. Clin Child Fam Psychol Rev. 2005
Spanking looks even better when
compared to alternatives
Larzelere RE et al. Clin Child Fam Psychol Rev. 2005
Conclusions
• Spanking can effectively modify behavior if administered
rarely and not too harshly
• It is most effective in response to defiant refusal to
comply with milder disciplinary tactics, such as time-out
• Physical punishment, as well as other forms of
punishment, does not enhance positive development,
but only inhibits inappropriate behavior
Larzelere RE et al. Clin Child Fam Psychol Rev. 2005
Bottom line (no pun intended)
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Tough to study the effects of spanking
Studies give conflicting results
Best to start with mild disciplinary tactics
Spanking only effective if infrequent
Spanking can escalate to child abuse
Spanking can deter bad behavior, does
not teach good behavior
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Other disciplinary tactics no better
Resources
Straus MA, Sugarman DB, Giles-Sims J. Spanking by Parents and Subsequent AntiSocial Behavior of Children. Arch Pediatr Adolesc Med. 1997 Aug;151:761-767.
Gershoff ET. Corporal Punishment by Parents and Associated Child Behaviors and
Experiences: A Meta-Analytic and Theoretical Review. Psychol Bull. 2002;128(4):539579.
Larzelere RE, Kuhn BR. Comparing Child Outcomes of Physical Punishment and
Alternative Disciplinary Tactics: A Meta-Analysis. Clinical Child and Family Psychology
Review, 2005 March;8(1).
Committee on Psychosocial Aspects of Child and Family Health. Guidance for Effective
Discipline. Pediatrics, 1998 April;101(4):723-28.
Gershoff ET. Report on Physical Punishment in the United States: What Research Tells
Us About Its Effects on Children. Columbus, OH: Center for Effective Discipline.
Horn IB, Joseph JG, Cheng TL. Nonabusive physical punishment and child behavior
among African-American children: a systematic review. J Natl Med Assoc. 2004
Sep;96(9):1162-8.
Last updated 7/13/10