Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience

Effective Discipline to Raise Healthy Children

Pediatricians are a source of advice for parents and guardians concerning the management of child behavior, including discipline strategies that are used to teach appropriate behavior and protect their children and others from the adverse effects of challenging behavior. Aversive disciplinary strategies, including all forms of corporal punishment and yelling at or shaming children, are minimally effective in the short-term and not effective in the long-term. With new evidence, researchers link corporal punishment to an increased risk of negative behavioral, cognitive, psychosocial, and emotional outcomes for children. In this Policy Statement, the American Academy of Pediatrics provides guidance for pediatricians and other child health care providers on educating parents about positive and effective parenting strategies of discipline for children at each stage of development as well as references to educational materials. This statement supports the need for adults to avoid physical punishment and verbal abuse of children.

A Short-Term Evaluation of a Hospital No Hit Zone Policy to Increase Bystander Intervention in Cases of Parent-to-Child Violence

This study used a pre/post design to evaluate the implementation of a hospital-wide No Hit Zone (NHZ) bystander intervention around parent-to-child hitting. A total of 2,326 staff completed the pre-NHZ survey and received training about the NHZ policy; 623 staff completed the post-test survey 10 months later. A group of 225 parents participated in the pre-NHZ survey and a second group of 180 participated in the post-NHZ survey, also 10 months later. Compared to staff in the pre-NHZ group, staff in the post-NHZ group had more negative attitudes about spanking and more positive attitudes about intervention when parents hit children in the hospital. Few differences were found among the parent pre- and post-groups. This study demonstrated that NHZs are a feasible way to inform and train hospital staff in ways to intervene during incidents of parent-to-child hitting to promote a safe and healthy medical environment.

Adverse Childhood Experiences in Children with Intellectual Disabilities: An Exploratory Case-File Study in Dutch Residential Care

Adverse Childhood Experiences (ACEs) are negative childhood events occurring in a child’s family or social environment, that may cause harm or distress. Children with intellectual disabilities (ID) and their families are underrepresented in international ACEs research, while current insights can also contribute to the improvement of their health and well-being. Deficiencies in intellectual and adaptive functioning and living circumstances can increase their vulnerability to adversities. In the present exploratory study 69 case-files of children referred to a Dutch national center for residential youth care for children with ID were analyzed to assess the prevalence and associations of ACEs. It was found that almost half (49.3%) of the children experienced 2 ACEs from the original ACEs framework or more (M (mean) = 2.1; SD (standard deviation) = 1.8) and that the number of ACEs in children was related to the presence of ACEs in parents. Both child and parental ACEs were also related to attachment- and trauma- and stressor-related disorders. Finally, living circumstances and multiple ACEs from the expanded ACEs framework, especially related to parental characteristics, were found to be related to ACEs in children with ID. This implicates the importance of a transgenerational approach when further investigating the impact of ACEs on mental and physical health in children with ID (intellectual disabilities).

US Pediatricians' Attitudes, Beliefs, and Perceived Injunctive Norms About Spanking

OBJECTIVE

To assess United States pediatricians' attitudes, beliefs, and perceived professional injunctive norms regarding spanking.

METHOD

A self-administered questionnaire was mailed to a nationwide random sample of 1500 pediatricians in the US, drawn from a database maintained by IMS Health. Four survey mailings were conducted and cash incentives of up to $20 were provided. The response rate was 53% (N = 787).

RESULTS

Most respondents were members of the American Academy of Pediatrics (85%), had been practicing physicians for 15 years or more (66%), and were white (69%) and female (59%). All US regions were represented. About 3-quarters of pediatricians did not support the use of spanking, and most perceived that their colleagues did not support its use either. Pediatricians who were male, black, and/or sometimes spanked as children had more positive attitudes toward spanking and expected more positive outcomes from spanking than their counterparts. Nearly 80% of pediatricians never or seldom expected positive outcomes from spanking, and a majority (64%) expected negative outcomes some of the time.

CONCLUSION

The majority of pediatricians in the US do not support the use of spanking with children and are aware of the empirical evidence linking spanking with increased risk of poor health outcomes for children. Pediatricians are a key, trusted professional source in advising parents about child discipline. These findings suggest that most pediatricians will discourage the use of spanking with children, which over time could reduce its use and associated harms in the population. This is of clinical relevance because, despite strong and consistent evidence of the harms that spanking raises for children, spanking is still broadly accepted and practiced in the US.

Decreasing Caregivers' Positive Attitudes Toward Spanking

The Play Nicely program is a multimedia training program designed to teach caregivers and health care professionals how to manage early childhood aggression and to use positive parenting practices. The aim of this article is to help the practicing clinician determine whether the Play Nicely program should be incorporated into his/her practice and to evaluate whether the program is effective at decreasing positive attitudes toward spanking in a socioeconomically disadvantaged population in both a resident pediatric clinic and a community center. Thirty-three caregivers of children aged 2 to 5 years viewed the Play Nicely program and completed pre- and post-training questionnaires. Decreased positive attitudes toward spanking were reported after training. Favorable attitudes toward spanking were associated with increased use of harsher discipline and higher child externalizing behavior. This study provides support that this brief intervention is effective in a socioeconomically disadvantaged population, is portable, and can be used in a group setting. This program may serve as a prevention and population-based approach to addressing the adverse childhood experience of spanking.

The strength of the causal evidence against physical punishment of children and its implications for parents, psychologists, and policymakers

The question of whether physical punishment is helpful or harmful to the development of children has been subject to hundreds of research studies over the past several decades. Yet whether causal conclusions can be drawn from this largely nonexperimental research and whether the conclusions generalize across contexts are issues that remain unresolved. In this article, the authors summarize the extent to which the empirical research on physical punishment meets accepted criteria for causal inference. They then review research demonstrating that physical punishment is linked with the same harms to children as is physical abuse and summarize the extant research that finds links between physical punishment and detrimental outcomes for children are consistent across cultural, family, and neighborhood contexts. The strength and consistency of the links between physical punishment and detrimental child outcomes lead the authors to recommend that parents should avoid physical punishment, psychologists should advise and advocate against it, and policymakers should develop means of educating the public about the harms of and alternatives to physical punishment. (PsycINFO Database Record

Differentiating corporal punishment from physical abuse in the prediction of lifetime aggression

Corporal punishment and parental physical abuse often co-occur during upbringing, making it difficult to differentiate their selective impacts on psychological functioning. Associations between corporal punishment and a number of lifetime aggression indicators were examined in this study after efforts to control the potential influence of various forms of co-occurring maltreatment (parental physical abuse, childhood sexual abuse, sibling abuse, peer bullying, and observed parental violence). College students (N = 1,136) provided retrospective self-reports regarding their history of aggression and levels of exposure to childhood corporal punishment and maltreatment experiences. Analyses focused on three hypotheses: 1) The odds of experiencing childhood physical abuse would be higher among respondents reporting frequent corporal punishment during upbringing; 2) Corporal punishment scores would predict the criterion aggression indices after control of variance associated with childhood maltreatment; 3) Aggression scores would be higher among respondents classified in the moderate and elevated corporal punishment risk groups. Strong support was found for the first hypothesis since the odds of childhood physical abuse recollections were higher (OR = 65.3) among respondents who experienced frequent (>60 total disciplinary acts) corporal punishment during upbringing. Partial support was found for the second and third hypotheses. Dimensional and categorical corporal punishment scores were associated significantly with half of the criterion measures. These findings support efforts to dissuade reliance on corporal punishment to manage child behavior.

Associations of neighborhood disorganization and maternal spanking with children's aggression: A fixed-effects regression analysis

This study employed fixed effects regression that controls for selection bias, omitted variables bias, and all time-invariant aspects of parent and child characteristics to examine the simultaneous associations between neighborhood disorganization, maternal spanking, and aggressive behavior in early childhood using data from the Fragile Families and Child Wellbeing Study (FFCWS). Analysis was based on 2,472 children and their mothers who participated in Wave 3 (2001-2003; child age 3) and Wave 4 (2003-2006; child age 5) of the FFCWS. Results indicated that higher rates of neighborhood crime and violence predicted higher levels of child aggression. Maternal spanking in the past year, whether frequent or infrequent, was also associated with increases in aggressive behavior. This study contributes statistically rigorous evidence that exposure to violence in the neighborhood as well as the family context are predictors of child aggression. We conclude with a discussion for the need for multilevel prevention and intervention approaches that target both community and parenting factors.

Psychometric properties of the Adverse Childhood Experiences Abuse Short Form (ACE-ASF) among Romanian high school students

Child abuse is a major public health problem. In order to establish the prevalence of abuse exposure among children, measures need to be age-appropriate, sensitive, reliable and valid. This study aimed to investigate the psychometric properties of the Adverse Childhood Experiences Questionnaire Abuse Short Form (ACE-ASF). The ACE-ASF is an 8-item, retrospective self-report questionnaire measuring lifetime physical, emotional and sexual abuse. Data from a nationally representative sample of 15-year-old, school-going adolescents (n=1733, 55.5% female) from the Romanian Health Behavior in School-Based Children Study 2014 (HBSC) were analyzed. The factorial structure of the ACE-ASF was tested with Exploratory Factor Analysis (EFA) and confirmed using Confirmatory Factor Analysis (CFA). Measurement invariance was examined across sex, and internal reliability and concurrent criterion validity were established. Violence exposure was high: 39.7% physical, 32.2% emotional and 13.1% sexual abuse. EFA established a two-factor structure: physical/emotional abuse and sexual abuse. CFA confirmed this model fitted the data well [χ2(df)=60.526(19); RMSEA=0.036; CFI/TLI=0.990/0.986]. Metric invariance was supported across sexes. Internal consistency was good (0.83) for the sexual abuse scale and poor (0.57) for the physical/emotional abuse scale. Concurrent criterion validity confirmed hypothesized relationships between childhood abuse and health-related quality of life, life satisfaction, self-perceived health, bullying victimization and perpetration, externalizing and internalizing behaviors, and multiple health complaints. Results support the ACE-ASF as a valid measure of physical, emotional and sexual abuse in school-aged adolescents. However, the ACE-ASF combines spanking with other types of physical abuse when this should be assessed separately instead. Future research is needed to replicate findings in different youth populations and across age groups.

Unpacking the impact of adverse childhood experiences on adult mental health

Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts.

The relationships between harsh physical punishment and child maltreatment in childhood and intimate partner violence in adulthood

BACKGROUND

Physical punishment of children is an important public health concern. Yet, few studies have examined how physical punishment is related to other types of child maltreatment and violence across the lifespan. Therefore, the objective of the current study was to examine if harsh physical punishment (i.e., being pushed, grabbed, shoved, hit, and/or slapped without causing marks, bruises, or injury) is associated with an increased likelihood of more severe childhood maltreatment (i.e., physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, and exposure to intimate partner violence (IPV)) in childhood and perpetration or victimization of IPV in adulthood.

METHODS

Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions collected in 2004 to 2005 (n = 34,402, response rate = 86.7%), a representative United States adult sample.

RESULTS

Harsh physical punishment was associated with increased odds of childhood maltreatment, including emotional abuse, sexual abuse, physical abuse, physical neglect, emotional neglect, and exposure to IPV after adjusting for sociodemographic factors, family history of dysfunction, and other child maltreatment types (range 1.6 to 26.6). Harsh physical punishment was also related to increased odds of experiencing IPV in adulthood (range 1.4 to 1.7).

CONCLUSIONS

It is important for parents and professionals working with children to be aware that pushing, grabbing, shoving, hitting, or slapping children may increase the likelihood of emotional abuse, sexual abuse, physical abuse, physical neglect, emotional neglect, and exposure to IPV in childhood and also experiencing IPV victimization and/or perpetration in later adulthood.

Researchers Deserve a Better Critique: Response to

This commentary addresses the critique by Larzelere, Gunnoe, Roberts, and Ferguson (2017: Marriage & Family Review, 53, 24-35) ostensibly concerning the quality of research on "positive parenting" but actually critiquing physical punishment research. The critique revealed that the authors have a poor understanding of positive parenting. After explicating the different meanings of that term and describing what positive parenting is, we then address each of their four critiques of the physical punishment research. Each critique was flawed in multiple ways. After identifying their errors and correcting misinformation, we then raise broader issues about children's right not to be hit and how professional organizations are increasingly recognizing the need and calling for an end to all physical punishment of children.