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Try out PMC Labs and tell us what you think. Learn More. Over the past two decades, we have seen an international shift in perspectives concerning the physical punishment of children. In , research showing an association between physical punishment and negative developmental outcomes was starting to accumulate, and the Convention on the Rights of the Child had just been adopted by the General Assembly of the United Nations; however, only four countries had prohibited physical punishment in all settings.
Today, research showing the risks associated with physical punishment is robust, the convention has been integrated into the legal and policy frameworks of many nations, and 31 countries have enacted prohibitions against the physical punishment of children. In doing so, physicians strengthen child well-being and parent—child relationships at the population level. Here, we present an analysis of the research on physical punishment spanning the past two decades to assist physicians in this important role.
As recently as 20 years ago, the physical punishment of children was generally accepted worldwide and was considered an appropriate method of eliciting behavioural compliance that was conceptually distinct from physical abuse. Some of these studies involved large representative samples from the United States; 2 some studies controlled for potential confounders, such as parental stress 3 and socioeconomic status; 4 and some studies examined the potential of parental reasoning to moderate the association between physical punishment and child aggression.
But were physical punishment and childhood aggression statistically associated because more aggressive children elicit higher levels of physical punishment? Although this was a possibility, 6 research was beginning to show that physical punishment elicits aggression.
Early experiments had shown that pain elicits reflexive aggression. By the s, it was recognized that the method by which causality is typically shown in scientific studies — the randomized control trial — had limited application for studying the physical punishment of children. Although randomized control trials can be used to study the effect of reducing physical punishment as in the Forgatch study , they cannot be used to study the effect of imposing such punishment because it would be unethical to as children to a group receiving painful treatment when research suggests that such pain poses harm not outweighed by potential benefit.
The few existing randomized control trials showed that physical punishment was no more effective than other methods in eliciting compliance. To address the causality question within ethical bounds, researchers deed prospective studies involving children who had equivalent levels of aggression or antisocial behaviour at the beginning of the study. In addition, increasingly sophisticated statistical modeling techniques were applied to correlational studies to aid understanding of the .
These studies changed the way in which physical punishment would be researched over the subsequent decade and redrew the landscape of the debate. Subsequent prospective studies yielded similar , whether they controlled for parental age, child age, race and family structure; 12 poverty, child age, emotional support, cognitive stimulation, sex, race and the interactions among these variables; 13 or other factors. A landmark meta-analysis published in 18 showed that of 27 studies on physical punishment and child aggression conducted up to that time that met the criteria of the meta-analysis , all found a ificant positive relation, regardless of the size of the sample, location of study, ages of the children or any other variable.
Almost all adequately deed studies conducted since that meta-analysis have found the same relation. Together, consistently suggest that physical punishment has a direct causal effect on externalizing behaviour, whether through a reflexive response to pain, modeling or coercive family processes.
By , research on physical punishment had expanded beyond its effect on child aggression. Studies were showing associations between physical punishment and mental health, physical injury, parent—child relationships and family violence in adulthood. One of the first such studies 25 linked slapping and spanking in childhood with psychiatric disorders in adulthood in a large Canadian sample, and its findings have since been supported by an ever-growing of studies.
Physical punishment is associated with a range of mental health problems in children, youth and adults, including depression, unhappiness, anxiety, feelings of hopelessness, use of drugs and alcohol, and general psychological maladjustment. These findings are all consistent with the growing body of literature on the impact of adverse childhood experiences on neurological, cognitive, emotional and social development, as well as physical health. Another major change in the landscape was precipitated by research that questioned the traditional punishment—abuse dichotomy.
Although research began to accumulate in the s that showed that most physical abuse is physical punishment in intent, form and effect , studies of child maltreatment have since clarified this finding. This finding was replicated in the second cycle of the study CIS In an American study, 42 infants in their first year of life who had been spanked by their parents in the month were 2.
The mounting evidence linking negative long-term outcomes to physical punishment has contributed to a global shift in perceptions of the practice. In other countries, legislative reforms have been instituted to better protect children. Most of the programs that have been evaluated are behaviourally based, with origins in the work of Patterson and colleagues. Meta-analyses of studies evaluating these programs show positive effects on the competence, efficacy and psychological health of the parents, as well as on the behaviour of the children. The consistency of research findings on physical punishment and positive discipline, along with growing support for the aims of the Convention on the Rights of the Child, has had a substantial impact on the views of health care providers.
It is now 20 years since Canada ratified the Convention on the Rights of the Child, which calls for the elimination of all forms of violence against children, including physical punishment. The debate has moved beyond discussions of outcomes and causality to those of ethics and human rights.
This new context for examining physical punishment has propelled legal, policy and attitudinal changes worldwide. Evidence is emerging that the combination of law reform and public education is more effective than either strategy alone in changing parental attitudes and behaviours.
Physicians have a primary responsibility for translating research and evidence into guidance for parents and children, and they are credible and influential voices for advancing public education and policy concerning population health. For example, physicians can educate parents on child development to reduce angry and punitive responses to normative child behaviours and provide resources on positive discipline. Furthermore, physicians can engage with other professionals to send clear, unambiguous messages on a population level. The evidence is clear and compelling — physical punishment of children and youth plays no useful role in their upbringing and poses only risks to their development.
The conclusion is equally compelling — parents should be strongly encouraged to develop alternative and positive approaches to discipline. Effective discipline rests on clear and age-appropriate expectations, effectively communicated within a trusting relationship and a safe environment. Numerous studies have found that physical punishment increases the risk of broad and enduring negative developmental outcomes.
No study has found that physical punishment enhances developmental health. Most child physical abuse occurs in the context of punishment. A professional consensus is emerging that parents should be supported in learning nonviolent, effective approaches to discipline.
See related editorial by Fletcher on and at www. No other competing interests were declared. This article has been peer reviewed. Contributors: Joan Durrant was the primary author and drafted the manuscript and its subsequent revisions. The article was conceptualized and finalized by Joan Durrant and Ron Ensom.
Both authors approved of the final version submitted for publication. National Center for Biotechnology Information , U. Author information Copyright and information Disclaimer. Correspondence to: Joan Durrant, ac.
See editorial " Positive parenting, not physical punishment " on This article has been cited by other articles in PMC. The early years: identifying patterns As recently as 20 years ago, the physical punishment of children was generally accepted worldwide and was considered an appropriate method of eliciting behavioural compliance that was conceptually distinct from physical abuse.
The t Statement on Physical Punishment of Children and Youth finds The evidence is clear and compelling — physical punishment of children and youth plays no useful role in their upbringing and poses only risks to their development.
Notes See related editorial by Fletcher on and at www. References 1. Global initiative to end all corporal punishment of children. Available: www. Straus MA. Ordinary violence, child abuse, and wife-beating: What do they have in common? The dark side of families: current family violence research. Beverly Hills CA : Sage; Travillion K, Snyder J. The role of maternal discipline and involvement in peer rejection and neglect. Discipline and deviance: physical punishment of children and violence and other crime in adulthood.
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