Letter to the Pediatrics Editor
By Den A. Trumbull,MD, DuBose Ravenel, MD & David Larson, MD
The supplement to Pediatrics entitled “Role of the Pediatrician in Violence Prevention” is timely, given the increasingly serious violence problem in the United States.[i] Many of the supplement’s recommendations are well conceived and developed. However, the recommendation to “work toward the ultimate goal of ending corporal punishment in homes” (p. 580)[ii] is unwarranted and counterproductive.
Before one advises against a practice approved by 88% of American parents[iii] and supported by 67% of primary care physicians[iv], there should be sufficient scientific evidence to support the proposed change in social policy. Neither the authors nor their citations make the case for ruling out the use of mild parental spanking in the discipline of young children. Though other aspects of parenting are no less important, scientific evidence for a universal anti-spanking recommendation is lacking.
Wissow and Roter[v] have some good suggestions on how pediatricians can assist parents with their child-rearing concerns. One excellent point, for example, is that parents and pediatricians should not consider a discipline technique a failure unless it has been “used properly” and in the optimal doage (p.591). However, Wissow and Roter ignore their own principle in the case of spanking. Their cited evidence for the supposed detrimental effects of corporal punishment is based only on physical punishment of children over 10 years old[vi],[vii] or abusive levels of corporal punishment.[viii],[ix] We agree that child abuse and teenage spanking are inappropriate, but Wissow and Roter provide no evidence of any detrimental effect of spanking of preschoolers using appropriate procedure and dosages. The only cited study that actually investigated mild spanking found that it was not predictive of any negative outcomes in the study.7 One reference[x] cited as “evidence that parents can learn nonviolent means of child discipline” 5 actually supports the use of a spanking procedure to enforce compliance with time out.
With respect to published studies with the best research designs, the only randomized clinical trials of parental spanking have shown that carefully prescribed spanking is effective in improving compliance with time out in 2-to-6-year-olds. Further, those same studies have found that other disciplinary techniques were no more effective in enforcing time out.[xi],[xii],[xiii]
The Pediatrics supplement’s claims that corporal punishment increases violent behavior and is “less effective in the long-term” (p.580)2 are contradicted by the best longitudinal studies. In four prospective longitudinal studies involving young children, the average correlation between parental spanking and subsequent child aggression was insignificant (mean r=0.03).[xiv],[xv],[xvi],[xvii] The putative evidence for long-term detrimental effects of spanking primarily comes from retrospective data emphasizing abusive hitting[xviii] or being spanked, not as a preschooler, but as a teenager.[xix]
Thus, the best available evidence indicates that mild spanking by a well-defined procedure is effective both for reducing misbehavior in 2-to-6-year-olds and for increasing the effectiveness of milder discipline responses such as time out.[xx] Long term, it is a common part of the most optimal parenting style in Baumrind’s classic study.[xxi] Our research-based assessment suggests that it is inappropriate to pressure American parents and physicians to abandon spanking on the basis of current evidence. Policy statements recommending an end to corporal punishment in the home should not be issued unless research, using clear definitions of terms and addressing appropriate forms of spanking, dictates otherwise. Further, we recommend that parents be taught the proper use of disciplinary spanking and the potential harzards of harsh, inappropriate physical punishment.
Den A. Trumbull, M.D., FAAP
3054 McGehee Road
Montgomery, AL 36111
DuBose Ravenel, M.D., FAAP
High Point Infant & Child Clinic
624 Quaker Lane, Suite 200-A
High Point, NC 27262
David Larson, M.D., M.S.P.H.
Uniform Services Univ. of the Health Sciences
[i]. Spivak H, Harvey B. eds. The role of the pediatrician in violence prevention. Pediatrics. l994;94(4, Part 2).
[ii]. Conference on Violence. Findings, recommendations, and actions steps. Pediatrics. 1994;94:579-586.
[iii]. Buntain-Ricklefs JJ, Kemper KJ, Bell M, Baonis T. Punishments: What predicts adult approval? Child Abuse & Negl. 1994;18:945-956.
[iv]. McCormick K. Attitudes of primary care physicians toward corporal punishment. JAMA. 1992;267:3161-3165
[v]. Wissow LS, Roter D. Toward effective discussion of discipline and corporal punishment during primary care visits: findings from studies of doctor-patient interaction. Pediatrics. 1994;4:587-593.
[vi]. Strauss MA, Gellels JF, Steinmetz SK. Behind closed doors: violence in the American family. Garden City: Anchor Books; l98l.
[vii]. Seagull EA, Weinshank AB. Childhood depression in a selected group of low-achieving seventh-graders. J Clin Child Psychol. 1984;13:134-140.
[viii]. Holmes SJ, Robins LN. The role of parental disciplinary practices in the development of depression and alcoholism. Psychiatry. 1988;5l:24-36.
[ix]. Martinez P, Richters JE. The NIMH community violence project: II. Children’s distress symptoms associated with violence exposure. Psychiatry. 1993;56:22-35.
[x]. Forehand RL, McMahon RJ. Helping the non-compliant child: a clinician’s guide to parent training. New York: Guilford Press; 1981.
[xi]. Bean AW, Roberts MW. The effect of time out release contigencies on changes in child non-compliance. J of Abnormal Child Psychol. 1981;9:95-105.
[xii]. Day DE, Roberts MW. An analysis of the physical punishment component of a parent training program. J Abnormal Child Psychol. 1983;11:141-152,
[xiii]. Roberts MW & Powers SW. Adjusting chair timeout enforcement procedures for oppositional children. Behavior Therapy. 1990;21:257-271.
[xiv]. Chamberlin RW. Relationships between child-rearing styles and child behavior over time. AJDC 1978;132:155-160.
[xv]. Johannesson I. Aggressive behavior among school children related to maternal practices in early childhood. In: DeWit J, Hartup WW (eds.) Determinants and origins of aggressive behavior. The Hague: Mouton; 1974:413-426.
[xvi]. Lefkowitz MM, Eron LD, Walder LO, Huesmann LR. Growing up to be violent. New York: Pergamon Press; 1978.
[xvii]. Sears RR. Relations of early socialization experiences to aggression in middle childhood. J Abnormal & Soc Psychol. 1961;63:466-492.
[xviii]. Welsh RS. Severe parental punishment and delinquency: a developmental theory. J. Clin Child Psychol. 1976;5:17-21.
[xix]. Straus MA. Discipline and deviance: physical punishment of children and violence and other crime in adulthood. Soc Problems. 1991;38:133-154.
[xx]. Larzelere RE. Should the use of corporal punishment by parents be considered child abuse? No. In: Mason MA, Gambrill E ed. Debating children’s lifes: current controversies on children and adolescents. Thousand Oaks, CA; Sage; 1994:204-209.
[xxi]. Baumrind, D. The development of instrumental competence through socialization. Minnesota Symp Child Psych. 1973;7:3-46.