Analysis of the AAP 1998 Policy on Discipline

Analysis of AAP policy statement, “Guidance for Effective Discipline”

By Den A. Trumbull, MD & S. DuBose Ravenel, MD

The primary thrust of the 1998 American Academy of Pediatrics (AAP) policy statement “Guidance for Effective Discipline” is to target and condemn the use of all physical punishment by parents. Despite an excellent discussion of parental nurturance and positive reinforcement strategies, the Policy statement is ill-founded and untenable in its account of corrective strategies, especially in its critique of disciplinary spanking.

Following unsuccessful attempts to develop a policy statement about the use of disciplinary spanking that was acceptable to all its Board members, ¹ the AAP co-sponsored a Consensus conference two years ago to develop an unbiased, scientific analysis of the current research on corporal punishment. Twenty-four invited participants representing the best thinking of researchers and clinicians in this area (including one of these respondents, Dr. Trumbull) reviewed the available research data. A thirteen point consensus statement was drafted by the conference panel of experts. Concerning the use of corporal punishment by parents, the panel could not find sufficient data to proscribe the use of spanking with children between the ages of 24 months and preadolescence. A literature review presented at the conference actually found stronger evidence for beneficial than detrimental effects of spanking with 2 to 6 year old children.² The co-chairs of the conference, although coming into the conference with the preconceived notion that corporal punishment was “innately and always bad,” came to a different conclusion following the proceedings. In their personal statement they concluded that “Given a relatively ‘healthy’ family life in a supportive environment, spanking in and of itself is not detrimental to a child or predictive of later problems.”³

The new AAP discipline Policy statement largely ignores the Consensus conference findings which received consensus support and, instead, selectively plucks from the conference proceedings several allegations of the avowed spanking opponents which did not receive consensus support. Statements of neutrality or support for disciplinary spanking made by other participants are noticeably missing. For instance, eleven of the thirteen citations used in the Policy statement to support its unconditional anti-spanking position in the “supplemental information” section concern individual presentations of anti-spanking participants at the Consensus conference, not original research.

In addition to its troubling data selection and review biases, the new Policy unnecessarily handicaps parents of young children. The only corrective methods condoned in the Policy are time-out (esp. for preschoolers), verbal reprimand (infrequent), and privilege removal (older children and adolescents) , with time-out being the primary method acceptable for young children. Time-out is described as being effective only if “used consistently, . . .not excessively, and with strategies for managing escape behavior.” Its correct implementation may even require “special education with a professional.” What about the parent who for various reasons may be unable to implement time-out correctly? For the average toddler, who can require correction every 6 to 8 minutes,⁴ how can a parent avoid overusing time-out when other methods are condemned? The Consensus panel concluded that reliance on any one corrective method will diminish its effectiveness.⁵ Following the new Policy’s guidelines with young children could lead to precisely such ineffective overuse of time-out. Parents need more disciplinary options, not fewer, to deal with the many different behavioral situations and child temperaments.

A predominant theme throughout developmental research is the supreme importance of parental nurturance in determining the outcome of childhood discipline. This aspect of parenting gives meaning and efficacy to the disciplinary techniques chosen by a parent. The vast majority of research finding detrimental results from corporal punishment focuses on its use in harsh, authoritarian parenting settings. Any technique (time-out, privilege removal, etc.) studied in such settings would be associated with sub-optimal outcomes. The Policy’s references defending its condemnation of spanking rely entirely upon such studies. The studies which examine spanking used in an optimal manner and in a nurturing, moderate setting are ignored. Furthermore, the Policy relies upon studies that do not discriminate spanking, as defined by the Consensus conferees, from forms of harsh, abusive corporal punishment. This biased use of research undermines the Policy’s credibility and ultimately invalidates its conclusions.

Cited below are some of the more egregious claims included in the Policy statement, followed by brief comments of rebuttal.

Spanking is less effective than alternative strategies such as time out and privilege removal. Its effectiveness decreases with subsequent use.

No reference is cited to support this claim. The Consensus conference literature review found that no measure was more effective than spanking, except grounding with teens.² The spank backup to time-out has been repeatedly found to be one of the two most effective methods (the room-barrier method is equal to the spank).⁶^,7^,⁸ When used proactively in a nurturing setting, spanking has not been found to be inferior to other corrective measures.

Subsequent effectiveness is only achieved by systematically increasing the intensity with which spanking is delivered.

No reference is cited to support this claim. Though a common claim used by spanking opponents, this notion is incorrect in the nonabusive, nondysfunctional parenting setting.

Spanking may lead to increased aggression in children.

The best studies indicate a neutral to beneficial effect of disciplinary spanking on childhood aggression.⁹ Last year, Gunnoe published a study finding that the use of spanking with 4 to 7 year-olds was associated with reduced aggressive behavior, and noted that “For most children, claims that spanking teaches aggression seem unfounded.” ¹⁰ By contrast, the Policy relies upon sociological studies by Graziano and Straus which did not muster sufficient approval of the Consensus panel to influence the final Consensus statement. Again, the distinction must be made between abusive corporal punishment and disciplinary spanking.

Spanking models aggressive behavior.

The reference to this claim is not original research, but to Dr. Eron’s presentation at the Consensus conference. Eron’s research actually found that the parent-child relationship was the primary determinant of success with disciplinary measures. He stated, “Upon follow-up 10 years after the original data collection, we found that punishment [including physical punishment] of aggressive acts at the earlier age was no longer related to current aggression, and instead, other variables like parental nurturance and children’s identification with their parents were more important in predicting later aggression.” ¹¹ Other research supporting this claim is based upon studies of overly severe or abusive corporal punishment. Even Straus’ much-publicized 1997 study linking spanking to aggression is flawed, as outlined in Archives.¹² (see enclosed copy)

Spanking leads to altered parent-child relationships.

Again, no supporting reference is cited. Studies have shown spanking to be a part of a parenting style which yields optimal developmental results.^13,14

Spanking is no more effective as a long-term strategy than other approaches.

The cited study by Roberts & Powers does not support this claim, but actually establishes the superiority of the spank backup for time-out. This study replicated earlier data proving the effectiveness of the spank and room barrier enforcement procedures over the hold and child release procedures. They stated,“[the] Barrier and Spank procedures appeared to be the treatments of choice.”(p.267) and “Intriguingly, one of two basic procedures (Spank or Barrier) worked well for all subjects in this sample. Children who violently resisted the Spank accepted the Barrier and vice versa.”(p. 269) ² Parents must have effective enforcement procedures for time-out in order to achieve success! Furthermore, parents need more options, not fewer ones, to achieve the flexibility needed to match optimal discipline tactics with different children and different situations.

Reliance on spanking makes other discipline strategies less effective to use.

The cited article by Wilson & Lyman makes no mention of spanking or corporal punishment, and therefore does not support this claim. There is evidence that without the availability of spanking to parents, the very disciplinary strategies recommended in the Policy may be less effective (see previous comment).

Parents who spank are more likely to use other unacceptable forms of corporal punishment.

The defending citation to this claim is a survey of suburban families by avowed spanking opponent Graziano. He describes a statistical association between the use of spanking and abusive forms of corporal punishment among the parents who spank, but fails to make any statistical comparisons between spankers and non-spankers on their useage of abusive corporal punishment. Of the 83% of parents in his study who spanked, only 5% had ever raised a welt or a bruise. This biased treatment of the data provides weak conclusions and no substantive support for this claim.

The more children are spanked, the more anger they report as adults, the more likely they are to spank their children, approve of hitting a spouse, and the more marital conflicts they experience as adults.

This is entirely built upon Straus’ surveys of adults who were hit as teens, not as children.¹⁵ Furthermore, the hitting used was not limited to spanking as ordinarily practiced. Some of these teens were hit in excess of 30 times a year. Obviously, these were dysfunctional families. The statement implies a causal relationship between the spanking and subsequent adult behaviors, but represents simple statistical associations. Straus actually states in the cited reference “. . . it is a large leap of faith from the correlations described in the article to concluding that corporal punishment causes societal violence.” ¹⁶

Spanking older children and adolescents is associated with adult dysfunction.

This is from Straus’ work again which focuses on adolescents and dysfunctional families. The term “spanking” in the studies defending this claim is not restricted to the definition given in the Policy, but is nonspecific corporal punishment, including abusive, violent hitting. With respect to “older children”, how and when spanking is used determines the outcome. Simons found no detrimental effects from spanking of older children in nurturing settings.¹⁷

Spanking of preschool boys by fathers, with whom the child identified only moderately or little, resulted in increased aggressive behavior by those children.

The point of this research by Eron was that the parent-child relationship is the primary determinant of success. What is not mentioned in the Policy from this study is the finding: “For those boys who were closely identified with their fathers, the punishment [including spanking] worked the way the fathers intended—when they were punished for aggression by their fathers they tended not to be aggressive.”(p.6)¹¹

The AAP Policy statement is an unfortunate step backward in the scientific evaluation of disciplinary spanking. The advances and clarifications achieved by the Consensus conference are overridden by the careless use of research and nomenclature in the Policy statement. Where the Consensus conference took a scientific, objective look at spanking, the Policy takes a rhetorical, biased approach to reaching its conclusions. This premature condemnation of spanking will severely hamper further research on disciplinary spanking, rather than encourage it as recommended by the Consensus committee.

It is unsettling that the Academy would espouse an “all or none” blanket condemnation of spanking despite the lack of support for such a position from the literature, the AAP-sponsored conference and the majority of pediatricians. Making this the primary theme of the Policy statement cripples the effectiveness of the Policy as a whole. Such Academy positions purportedly based on science will in the long run harm the credibility of the Academy.

As pediatricians who have studied the literature and members of the Academy, we are deeply disturbed by the inadequacy of this AAP Policy on discipline. While it offers excellent guidance on encouragement of the child, it is wholly inadequate on behavioral correction. The Policy is:

A biased and incomplete presentation of the research on corporal punishment,
In opposition to clear evidence that reasoned disciplinary spanking of the preschooler is not harmful and may be beneficial,
In opposition to the consensus findings of the AAP Consensus conference,
Indirectly in opposition to future research on corporal punishment by discouraging its use in all circumstances,
In opposition to the majority opinion of the AAP membership in the recent survey, where 67% of pediatricians either supported the limited use of spanking by parents (14%), or believe that an occasional spanking by parents can be an effective form of discipline (53%).¹⁸

Given these unfortunate deficiencies, the discipline Policy statement is fatally flawed and should be revised. Furthermore, the Academy should follow the recommendation of the Consensus Conference committee to encourage quality research in this area to provide better data upon which to make reasonable conclusions.

Endnotes

1. Friedman SB, Schonberg SK, Sharkey M. Introduction. Supplement to Pediatrics. 1996:98(4):802.

2. Larzelere, Robert E. “A Review of the Outcomes of Parental Use of Nonabusive or Customary Physical Punishment.” in Friedman, Stanford B., MD, Schonberg, S. Kenneth, MD, & Sharkey, Mary (eds). “The Short and Long Term Consequences of Corporal Punishment.” supplement to Pediatrics, 1996; 98 (4):824-828.

3. Friedman, Stanford B., MD, Schonberg, S. Kenneth, MD, & Sharkey, Mary (eds). Personal statement. “The Short and Long Term Consequences of Corporal Punishment.” supplement to Pediatrics, 1996; 98 (4):857-858.

4. Hoffman ML. “Moral Internalization: Current Theory and Research” in Berkowitz L. (ed). Advances in Experimental Social Psychology. 1977; p 88. New York: Academic Press.

5. Consensus statements. “The Short and Long Term Consequences of Corporal Punishment.” in supplement to Pediatrics, 1996; 98 (4):853.

6.. Roberts MW & Powers SW. Adjusting chair timeout enforcement procedures for oppositional children. Behavioral Therapy. 1990;21:257-271.

7.. Bean AW & Roberts MW. The effect of timeout release contingencies on changes in child noncompliance. J Abn Child Psych. 1981;9:95-105

8.. Day DE & Roberts MW. An analysis of the physical punishment component of a parent training program. J Abn Child Psychol. 1983;11:141-152.

9. Trumbull, Den A. Personal statement. “The Short and Long Term Consequences of Corporal Punishment.” supplement to Pediatrics, 1996; 98 (4):860.

10. Gunnoe ML, Mariner CL. Toward a Developmental- Contextual Model of the Effects of Parental Spanking on Children’s Aggression. Archives of Pediatrics Adolesc. Med. 1997;151:768-775.

11. Eron LD. Theories of Aggression: from drives to cognitions. in Huesmann LR (ed). Aggressive Behavior, Current Perspectives. 1994;pp 3-11. New York: Plenum Press.

12. Ambati BK; Lazelere RL & Baumrind D; Miller TQ. Pediatric Forum: Corporal Punishment and Antisocial Behavior. Archives of Pediatrics Adolesc. Med. 1998;152:303-305.

13. Guarendi R. Back to the Family. 1990;215-222. New York: Simon & Schuster.

14. Baumrind, D. The development of instrumental competence through socialization. Minnesota Symp Child Psych. 1973;7:3-46.

15. Straus M. Discipline and deviance: physical punishment of children and violence and other crime in adulthood. Social Problems. 1991; 38:133-152

16. Straus M. Spanking and the making of a violent society. Pediatrics. 1996;98:840.

17. Simons RL, Johnson C, & Conger RD. Harsh corporal punishment versus quality of parental involvement as an explanation of adolescent maladjustment. J Marriage and Family. 1994; 56:591-607.

18. Executive Summary: Periodic Survey of Fellows, American Academy of Pediatrics, Division of Child Health Research. Periodic Survey #38, “Attitudes and counseling on corporal punishment in the home.” 1998.