SYMPOSIUM: Safeguarding Children
Corporal punishment: a discussion of the debate
later aggression and other maladaptive behaviours.8 When used in the discipline of older children, CP is associated with drug abuse and an increased risk of violence9; and when it is used in younger children, it is actually associated with injury (presumed inadvertent injury) to the child. However, weaknesses in the methodology of many of these studies prevent complete acceptance of the link between CP and detrimental outcomes in children.10 Specifically, uncontrolled confounding in such studies leaves open the possibility of a relationship between CP and child outcomes that are not causal. Rather, critics of these studies posit that a third exposure may predispose a family unit to both CP practices and suboptimal child development outcomes, and the relationship between the two is a vestige of such confounding factors. Despite the AAP and RCPCH official stances on physical punishment, a countervailing opinion exists that some forms of physical punishment in select circumstances are acceptable and physical punishment should not be banned entirely – as it has, for example, in Norway, Finland, Sweden and Austria. Non-abusive spanking, the argument goes, has a role in effective discipline. Many parents and physicians agree: for example, in a 1994 survey of American families, more than 68% reported spanking at some time11,12; and in a 1992 survey of American paediatricians and family physicians, a majority in both specialties indicated that they support CP in certain settings.11 According to this argument, the difficulty comes in trying to determine which forms of physical discipline are permissible and which are not, and to understand how and why a possibly acceptable form of CP (like a gentle tap on a child’s buttocks) may escalate into more severe forms of punishment or even injury. Proponents of appropriately used non-abusive CP believe some discipline needs to be ‘more serious’ than others in order to make the desired lesson memorable for the child. However, debate continues over whether a caregiver is able to maintain control of the physical punishment so it does not escalate into abuse; and whether over time, punitive spankings will cease to matter in the life of the child and, therefore, increasing the severity of the spanking will be necessary to maintain the child’s perception of its import. Indeed, there is evidence that actions such as spanking can escalate into more harmful, violent disciplinary actions.13 In more than half of the instances when CP was used, it was because the ‘parents had lost it’,13 revealing that CP is more about parental frustrations and loss of control than the actions of the children. Notably absent from the debate on CP, however, is an evidence-based discussion of different child temperaments and behaviours, and how these influence – or interact with – punishment practices. For example, reports in the medical literature document maternal depression and intimate partner violence as risk factors for CP. And, as will be discussed below, it is well documented that certain cultural groups are more apt to practice CP than others. However, with respect to child-based risk factors, the literature is much thinner. Externalising behaviour,14 child age,15 and the precise type of precipitating misbehaviour (lying, talking back, being disrespectful)16 are known to be associated with CP. Additionally, children with developmental risk factors are more likely to be yelled at – and, presumably, therefore, more likely to be spanked – than typically developing children. For example, a US-based survey
Jennifer M Litzow Michael Silverstein
Abstract The use of corporal punishment (CP) is controversial. Many believe that physical punishment, when used appropriately, can be an effective form of discipline, despite the studies which show CP to be associated with unwanted behavioural outcomes. This article summarises the debate around CP, particularly focusing on two aspects of the debate often ignored; the importance of the interaction between parent and child and cultural aspects of discipline.
Keywords corporal punishment; culture; discipline; transactional model of child development
Introduction Corporal punishment (CP) as an effective form of discipline is a controversial subject. Defined as the intentional infliction of physical pain with the purpose of deterring unwanted behaviour, both the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH) have adopted formal positions unequivocally opposed to all forms of CP. The AAP has published a formal policy statement in this regard,1 and the RCPCH has, additionally, joined the ‘Children are Unbeatable’ alliance, itself opposed to all forms of CP.2 Strong countervailing opinion, however, exists that not all forms of physical discipline are abusive and that – barring frank abuse and neglect – parents should be able to discipline their children as they see fit.3 Specifically, the core of the debate around CP centres on spanking, defined as striking a child with an open hand the buttocks or extremities with the intention of modifying behaviour without causing physical injury.1 This paper will summarise elements of the debate around the use of spanking and discuss cultural aspects of discipline.
The debate around CP Multiple studies have linked CP with the subsequent development of poor behavioural outcomes. CP is associated with domestic violence4–7 and harsh physical punishment is associated with
Jennifer M Litzow MD MPH is at the Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA. Michael Silverstein MD MPH is at the Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA.
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of mothers of children with Asperger’s syndrome or other nonverbal developmental disorders indicated that nearly 60% used CP and 95% had threatened their children with CP.17 Most experts in child development, however, acknowledge that disciplinary interactions between a parent and child are the result of what both individuals bring to the scenario, and such interaction – which is captured in the widely accepted ‘transactional model’ of child development – is poorly studied. The transactional model of child development, originally proposed by Arnold Sameroff and Michael Chandler, posits that a child’s development is the result of a continuous and dynamic interaction between the child and experiences provided by her parents and social context. A child who is the subject of CP, therefore, learns from this experience (either positively or negatively); and this experience informs her subsequent behaviour. At the same time, however, the child influences her own surroundings (including her parents’ behaviour), and not all children exposed to the same set of disciplinary practices will respond similarly. Unfortunately, the practice of CP has been studied insufficiently in such a context. A recent report indicates that maternal risk factors for the practice of CP are largely unaffected by whether or not the child displays poor self-control or problematic externalising behaviour; and although this study suggests that parental factors may outweigh child factors when it comes to CP use, these results should be considered preliminary at best.
group lived in India. CP was a more acceptable form of discipline for the mothers living in India than those who had immigrated to the US.29 Similarly, CP is common in Latino families, which can cause difficulties for those who have immigrated to the US.18 In the US, much of the debate centres on whether spanking has different meanings and outcomes for Caucasian and African– American communities. While CP has been associated with longterm negative behaviours in some ethnic groups, one review of the literature suggests that the use of spanking may have beneficial or neutral outcomes in the African–American community.30 The assumption that all CP is disruptive and leads to poor developmental outcomes may be inaccurate because it does not take into account the cultural context of discipline.31,32 Many oppose this argument, claiming cultural relativism as an inexcusable reason for the acceptance of CP.33 With the growing recognition of children’s rights, CP becomes less acceptable in any circumstance, regardless of the tradition that surrounds them.33 As a global movement to ban CP gathers momentum, many continue to think of non-abusive CP as an acceptable method of discipline. Debate continues around a causal link between CP and poor behavioural outcomes. The evaluation of discipline and its effects need to be evaluated in the context of the individual relationship between parent and child and within the larger cultural context of the family. ◆
Cultural argument
References 1 Stein MT, Perrin EL. Guidance for effective discipline. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Pediatrics 1998; 101: 723–728. 2 Children Are Unbeatable Alliance. Available from: http://www. childrenareunbeatable.org.uk/ 3 Polite K. The medium/the message: corporal punishment, an empirical critique. Pediatrics 1996; 98: 849–851. 4 Straus MA. Spanking and the making of a violent society. Pediatrics 1996; 98: 837–842. 5 Nixon RD, Resick PA, Nishith P. An exploration of comorbid depression among female victims of intimate partner violence with posttraumatic stress disorder. J Affect Disord 2004; 82: 315–320. 6 Silverstein M, Augustyn M, Young R, Zuckerman B. The relationship between maternal depression, in-home violence and use of physical punishment. What is the role of child behaviour? Arch Dis Child 2008; doi:10.1136/adc.2007.128595. Available from: http://www. ncbi.nlm.nih.gov/pubmed/18786952?ordinalpos=1&itool=EntrezSy stem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_ DefaultReportPanel.Pubme d_RVDocSum. 7 Schwartz JP, Hage SM, Bush I, Burns LK. Unhealthy parenting and potential mediators as contributing factors to future intimate violence: a review of the literature. Trauma Violence Abuse 2006; 7: 206–221. 8 Weiss B, Dodge KA, Bates JE, Pettit GS. Some consequences of early harsh discipline: child aggression and a maladaptive social information processing style. Child Dev 1992; 63: 1321–1335. 9 Cohen P. How can generative theories of the effects of punishment be tested? Pediatrics 1996; 98: 834–836. 10 Larzelere RE. A review of the outcomes of parental use of nonabusive or customary physical punishment. Pediatrics 1996; 98: 824–828.
Across countries and cultures, CP is a common method of discipline and its acceptance is related to cultural values.18,19–23 CP is commonly practiced in south-west Ethiopia with poor parental knowledge of any legal framework protecting children from abuse.21 A survey of Hong Kong Chinese families revealed almost 70% of parents use CP as a form of discipline23 and a survey in Jamaica showed CP to be routine in both the home and school.24 CP is often accepted in conservative religious organisations as well; Protestant mothers are more likely to approve of CP than mothers of other backgrounds.25,26 Slight cultural differences across a country’s regions also influence discipline styles; respondents to a survey in the southern region of the US have a higher acceptance of CP than those in the northeast region.26 Despite the acceptance of CP in many parts of the world, in 1989 the United Nations convention on children’s rights called for the complete protection of children against ‘all forms of physical or mental violence’. Since then, 23 nations have completely outlawed CP as a form of accepted discipline. Despite the growing global movement to end all CP, a debate continues over whether CP has an appropriate place in some cultures. In this debate, parenting styles and discipline methods must be considered within their cultural context, not just as individual experiences and behaviours.18 From this perspective, use of CP may vary from one culture to another and even more importantly, the cultural context likely influences the long-term behavioural outcomes of CP.27 Thus, CP means different things to different children, depending on their culture.28 Meanings can change over time with exposure to cultures where CP is less accepted. A 2002 study compared attitudes towards CP of mothers from India; one group had lived in the US for more than 5 years and the other
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26 Flynn C. Regional differences in attitudes toward corporal punishment. J Marriage Fam 1994; 56: 314–324. 27 Lansford JE, Deater-Deckard K, Dodge KA, Bates JE, Pettit GS. Ethnic differences in the link between physical discipline and later adolescent externalizing behaviors. J Child Psychol Psychiatry 2004; 45: 801–812. 28 Ibanez ES, Borrego Jr. J, Pemberton JR, Terao S. Cultural factors in decision-making about child physical abuse: identifying reporter characteristics influencing reporting tendencies. Child Abuse Negl 2006; 30: 1365–1379. 29 Jambunathan SCK. Parenting attitudes of Asian Indian mothers living in the United States and in India. Early Child Dev Care 2002; 172: 657–662. 30 Horn IB, Joseph JG, Cheng TL. Nonabusive physical punishment and child behavior among African-American children: a systematic review. J Natl Med Assoc 2004; 96: 1162–1168. 31 Whaley AL. Sociocultural differences in the developmental consequences of the use of physical discipline during childhood for African Americans. Cultur Divers Ethnic Minor Psychol 2000; 6: 5–12. 32 Deater-Deckard K, Lansford JE, Dodge KA, Pettit GS, Bates JE. The development of attitudes about physical punishment: an 8-year longitudinal study. J Fam Psychol 2003; 17: 351–360. 33 Durrant JE. Physical punishment, culture, and rights: current issues for professionals. J Dev Behav Pediatr 2008; 29: 55–66.
11 McCormick KF. Attitudes of primary care physicians toward corporal punishment. JAMA 1992; 267: 3161–3165. 12 Baumrind D. The development of instrumental competence through socialization. Minn Symposium Child Psychol 1973: 3–46. 13 Graziano AM, Hamblen JL, Plante WA. Subabusive violence in child rearing in middle-class American families. Pediatrics 1996; 98: 845–848. 14 Grogan-Kaylor A. Relationship of corporal punishment and antisocial behavior by neighborhood. Arch Pediatr Adolesc Med 2005; 159: 938–942. 15 Regalado M, Sareen H, Inkelas M, Wissow LS, Halfon N. Parents’ discipline of young children: results from the National Survey of Early Childhood Health. Pediatrics 2004; 113: 1952–1958. 16 Socolar RRS, Winsor J, Hunter WM, Catellier D, Kotch JB. Maternal disciplinary practices in an at-risk population. Arch Pediatr Adolesc Med 1999; 153: 927–934. 17 Little L. Maternal discipline of children with Asperger Syndrome and nonverbal learning disorders. MCN Am J Matern Child Nurs 2002; 27: 349–354. 18 Douglas EM. Familial violence socialization in childhood and later life approval of corporal punishment: a cross-cultural perspective. Am J Orthop 2006; 76: 23–30. 19 Corporal Punishment. International Save the Children Alliance. Position on Corporal punishment; April 2003. 20 Tirosh E, Offer Shechter S, Cohen A, Jaffe M. Attitudes towards corporal punishment and reporting of abuse. Child Abuse Negl 2003; 27: 929–937. 21 Admassu F, Nida H, Belachew T, Haileamlak A. Chldren’s rights and corporal punishment in Assendabo town and the surrounding area, South West Ethiopia. Ethiop Med J 2006; 44: 9–16. 22 Chang J, Rhee S, Weaver D. Characteristics of child abuse in immigrant Korean families and correlates of placement decisions. Child Abuse Negl 2006; 30: 881–891. 23 Tang CS. Corporal punishment and physical maltreatment against children: a community study on Chinese parents in Hong Kong. Child Abuse Negl 2006; 30: 893–907. 24 Smith DE, Mosby G. Jamaican child-rearing practices: the role of corporal punishment. Adolescence 2003; 38: 369–381. 25 Gershoff Et MP, Holden GW. Parenting Influences from the pulpit: religious affiliation as a determinant of parental corporal punishment. J Fam Psychol 1999; 13: 307–320.
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Practice points • Debate continues over the use of corporal punishment as an effective form of discipline • Studies show association between CP and poor behavioural outcomes, yet methodological weaknesses prohibit drawing a causal link • The transactional model of child development may help explain how the dynamic relationship between parent and child influences discipline • CP must be evaluated within a larger cultural context
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