Effective Discipline to Raise Healthy Children

The time sensitive and dose-responsive association between parental corporal punishment and sleep disturbances in preschoolers: A prospective cohort study

BACKGROUND

To examine whether parental corporal punishment is associated with increased risk of concurrent and later sleep disturbances among preschoolers, and whether the association is time-sensitive or dose-responsive.

METHODS

This 3-year prospective cohort study used data from the Shanghai Children's Health, Education and Lifestyle Evaluation, Preschool(SCHEDULE-P). Participants were newly enrolled preschoolers in November 2016(wave 1) and followed up in April 2018(wave 2) and April 2019(wave 3). Parents reported the children's corporal punishment experiences and sleep disturbances at each wave survey. Children's risk of sleep disturbances in relation to corporal punishment was examined using logistic regression, adjusting for children's age, gender, emotional/behavioral problems, family annual income, and maternal educational level.

RESULTS

The participants of 19,668 children included 9436(47.98 %) females, with a mean age of 3.73(SD = 0.29) years at wave 1. Exposure to corporal punishment was associated with increased odds of concurrent sleep disturbances at wave 1, 2, and 3 (aOR,1.57; 95 % CI, 1.40-1.75; P < .001; aOR,1.60; 95 % CI, 1.43-1.80; P < .001; aOR,1.74; 95 % CI, 1.54-1.95; P < .001), respectively. Exposure to corporal punishment at any wave of preschool was associated with increased odds of sleep disturbances at wave 3, and the risks were greater for proximal and accumulative corporal punishment exposure.

CONCLUSION

There is a time-sensitive and dose-responsive association between corporal punishment and sleep disturbance among preschoolers, with greater risk of sleep disturbances for proximal and accumulative exposure of corporal punishment. Promoting positive parenting strategies and avoiding corporal punishment can be a promising strategy to prevent and intervene sleep disturbances in preschoolers.

The Pediatrician's Role in Preventing Child Maltreatment: Clinical Report

Pediatricians have always seen the value of preventing health harms; this should be no less true for child maltreatment than for disease or unintentional injuries. Research continues to demonstrate that maltreatment can be prevented, underscoring the vital roles of both the family and society in healthy childhood development and the importance of strong, stable, nurturing relationships in preventing maltreatment and building the child's resilience to adversity. This clinical report elaborates the pediatrician's multitiered role in supporting relational health from infancy through adolescence, from universal interventions assessing for maltreatment risks and protective factors to targeted interventions addressing identified needs and building on strengths. When maltreatment has already occurred, interventions can prevent further victimization and mitigate long-term sequelae. Advice is provided on engaging community resources, including those that provide food, shelter, or financial support for families in need.

Genital Modifications in Prepubescent Minors: When May Clinicians Ethically Proceed?

When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors ("children"). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or "endosex" females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform any nonvoluntary genital cutting or surgery, from "cosmetic" labiaplasty to medicalized ritual "pricking" of the vulva, insofar as the procedure is not strictly necessary to protect the child's physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit-risk calculations, but on a fundamental concern to respect the child's privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter's sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians' widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity.

Humor in parenting: Does it have a role?

BACKGROUND

Despite the widespread use of humor in social interactions and the considerable literature on humor in multiple fields of study, the use of humor in parenting has received very little formal study. The purpose of this pilot study was to gather preliminary data on the use of humor in the raising of children.

MATERIALS AND METHODS

We developed and administered a 10-item survey to measure people's experiences being raised with humor and their views regarding humor as a parenting tool. Responses were aggregated into Disagree, Indeterminate, and Agree, and analyzed using standard statistical methods.

RESULTS

Respondents (n = 312) predominantly identified as male (63.6%) and white (76.6%) and were (by selection) between the ages of 18-45 years old. The majority of participants reported that they: were raised by people who used humor in their parenting (55.2%); believe humor can be an effective parenting tool (71.8%) and in that capacity has more potential benefit than harm (63.3%); either use (or plan to use) humor in parenting their own children (61.8%); and would value a course on how to utilize humor in parenting (69.7%). Significant correlations were found between the use of humor and both i) the quality of respondents' relationships with their parents and ii) assessments of how good a job their parents had done.

CONCLUSIONS

In this pilot study, respondents of childbearing/rearing age reported positive views about humor as a parenting tool.

Child maltreatment in children with medical complexity and disability

Child maltreatment is common and pediatric healthcare providers are becoming increasingly aware of risk factors and signs of abuse.1-4 Children with disabilities and those with special medical needs are recognized as a population at increased risk of child maltreatment. Understanding this risk and recognizing that not all disabilities confer the same risks can provide deeper insight for pediatric providers regarding the supports these children and their families need to prevent maltreatment.

Advancing Youth Justice: The Child and Adolescent Psychiatrist's Role

Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.

Maternal Emotional and Behavioral Regulation/Dysregulation and Parenting Practices: A Systematic Review

Emotional and behavioral regulations are crucial for the development of perceptive, responsive, and flexible parenting. Moreover, maternal emotional dysregulation constitutes a risk for maltreatment behaviors. The present study aimed to conduct a systematic review of empirical studies on the associations between mothers' emotional and behavioral regulations and parenting practices with their children or adolescents. A systematic review was conducted, including papers that addressed these variables, analyzing the direct effects, and moderation or mediation effects of maternal emotional and behavioral regulation on parenting practices, targeting child and adolescent samples. We identified 35 studies for analysis. Most of the studies (86%) showed significant associations between maternal emotional and behavioral regulation and parenting practices. Mothers' emotional dysregulation was related to a high risk of maltreatment and negative parenting, such as unsupportive reactions and harsh discipline. High maternal emotional dysregulation and negative parenting, in turn, were associated with children's aggressive behaviors. Conversely, when mothers exhibited high emotional regulation, they engaged in more positive and supportive parenting. Additionally, maternal behavioral regulation with inhibitory control and effortful control led to supportive and warm parenting. Individual and contextual factors, such as maternal victimization history and symptoms of inattention and hyperactivity, had effects on maternal emotional dysregulation, which, in turn, impacted their parenting practices. Consequently, emotional and behavioral regulation played a crucial role in mothers' parenting practices with their children and adolescents. The findings of the current review could contribute to planning parenting interventions, including maternal emotional and behavioral regulation skills, aimed at preventing maltreatment of their children.

Predictors of Corporal Punishment during the COVID-19 Pandemic

Although current policies discourage the use of corporal punishment (CP), its use is still widespread in the US. The objective of this study was to assess the proportion of parents who used CP during the pandemic and identify related risk and protective factors. We analyzed results of a nationwide cross-sectional internet panel survey of 9000 US caregivers who responded in three waves from November 2020 to July 2021. One in six respondents reported having spanked their child in the past week. Spanking was associated with intimate partner violence and the use of multiple discipline strategies and not significantly associated with region or racial self-identification. Parents who spanked sought out more kinds of support, suggesting an opportunity to reduce spanking through more effective parenting resources. Additionally, these results suggest that parents who report using CP may be at risk for concurrent domestic violence.

Multiple Perspectives on Motivating Parents in Pediatric Primary Care to Initiate Participation in Parenting Programs

OBJECTIVE

To use multiple perspectives to identify the key components of pediatric primary care conversations for motivating parents to utilize parenting programs. We aim to develop an actionable framework that primary care clinicians (PCCs) can follow for effective conversations with parents.

METHODS

We conducted focus groups and interviews with researchers (n = 6) who have experience delivering parenting interventions through primary care, clinical personnel in federally qualified health centers (FQHCs) (n = 9), parents of 3-5-year olds who receive services at a FQHC pediatric clinic (n = 6), and parent educators (n = 5). Groups and interviews were informed by nominal group technique, and researchers triangulated consolidated strategies across the groups.

RESULTS

Key strategies for PCCs to motivate parents to utilize parenting programs followed three steps: 1) learning about a parent's questions and concerns, 2) sharing resources, and 3) following up. PCCs can learn about parents' needs by empathizing, listening and responding, and asking questions that acknowledge parents' expertise. When sharing resources, PCCs can motivate participation in parenting programs by explaining each resource and its benefits, providing options that support parents' autonomy, and framing resources as strengthening rather than correcting parents' existing strategies or skills. Finally, PCCs can continue to engage parents by scheduling follow-up conversations or designating a staff member to check-in with parents. We provide examples for each strategy.

CONCLUSIONS

Findings provide guidance from multiple perspectives on strategies to motivate parents in pediatric primary care setting for utilizing parenting programs.

The Family Game to support parents with intellectual disability in managing challenging behaviours: A replication

BACKGROUND

Although many parents with intellectual disability (ID) demonstrate good parenting practices, some parents experience difficulties in managing challenging behaviours. One potential solution to this issue involves using The Family Game, a program designed to teach parents with ID how to manage challenging behaviours in their child.

AIMS

The purpose of our study was to conduct an independent replication of an investigation that had been performed by the developer of the program.

MATERIALS & METHODS

We used a multiple baseline design to examine the effects of The Family Game on the behaviour of two parents with ID who had a 3-year-old child.

RESULTS

Similarly to the original study, our results indicate that The Family Game improved the use of effective parenting strategies during role play, but that these gains failed to generalise to real-life settings.

CONCLUSION

The study further supports the necessity of adding novel strategies to the game to better promote generalisation.

A Brief Intervention in Primary Care to Improve Parents' Discipline Practices and Reach Other Caregivers

Parents (N = 599) of 6-month-old to 10-year-old children were given a handbook intervention that educates about healthy discipline in a pediatric clinic serving low-income families in Nashville, Tennessee. A research assistant spent approximately 1 minute introducing the intervention. A total of 440 parents (73.4%) responded to a follow-up survey 2 to 4 months later. Most parents (88%) who completed the follow-up survey had read at least part of the handbook. Of parents who received the handbook, 63% reported that the handbook helped them discipline their children. Half of parents reported specific changes they made because of the handbook. The most frequently reported changes were more talking/explaining/communicating (25%), more redirecting (7.8%), more patience/listening (6.0%), less anger/yelling (10.8%), and less spanking (7.5%). 42% of parents reported that they shared the handbook with other caregivers, friends, relatives, and children. A brief clinic intervention improves parents' discipline practices and reaches other caregivers.

Ethnic Differences in the Effects of Five Disciplinary Techniques on Subsequent Externalizing Behavior Problems

To identify disciplinary alternatives to replace spanking, this study investigated ethnic differences in the associations of five disciplinary techniques with subsequent externalizing behavior problems in a national sample of 7- to 11-year-olds with ANCOVAs and difference-score analyses. Most techniques led to significant reductions in externalizing problems for African-Americans or Hispanics, but only after overcoming known biases in ANCOVA and not for other European-Americans. Privilege removal had the most significantly effective results, followed by grounding. Sending children to their room and spanking significantly reduced externalizing problems only in one or two analyses for African-Americans, whereas removing children's allowance was significantly effective in one overall analysis. Parenting research needs to distinguish between more vs. less effective use of all disciplinary techniques across multiple situational and cultural contexts.

Associations between 11 parental discipline behaviours and child outcomes across 60 countries

OBJECTIVES

To test associations between 11 caregiver aggressive and non-aggressive discipline behaviours and outcomes (aggression, distraction and prosocial peer relations) of children under 5 years in low-income and middle-income countries (LMICs).

PARTICIPANTS

Data came from the fourth (2009-2013) and fifth (2012-2017) rounds of the UNICEF Multiple Indicator Cluster Surveys. Analyses were restricted to households with children under 5 years, leaving a sample of 229 465 respondents across 60 LMICs. Data were analysed using Bayesian multilevel logistic regression.

RESULTS

Verbal reasoning (80%) and shouting (66%) were the most common parental discipline behaviours towards young children. Psychological and physical aggression were associated with higher child aggression and distraction. Compared with not using verbal reasoning, verbal reasoning was associated with lower odds of aggression (OR)=0.92, 95% credible interval (CI)=0.86 to 0.99) and higher odds of prosocial peer relations (OR=1.30, 95% CI=1.20 to 1.42). Taking away privileges was associated with higher odds of distraction (OR=1.09, 95% CI=1.03 to 1.15) and lower odds of prosocial peer relations (OR=0.92, 95% CI=0.87 to 0.98). Giving the child something else to do was associated with higher odds of distraction (OR=1.06, 95% CI=1.01 to 1.12). The results indicated country-level variation in the associations between parenting behaviours and child socioemotional outcomes.

CONCLUSIONS

Psychological and physical aggression were disadvantageous for children's socioemotional development across countries. Only verbal reasoning was associated with positive child socioemotional development. No form of psychological aggression or physical aggression benefited child socioemotional development in any country. Greater emphasis should be dedicated to reducing parental use of psychological and physical aggression across cultural contexts.

Corporal Punishment in Schools

The use of corporal punishment in schools is not an effective or ethical method for management of behavior concerns and causes harm to students. The American Academy of Pediatrics recommends that corporal punishment in all school settings be abolished in all states by law and replaced by alternative forms of student behavior management. Corporal punishment remains legal in many public and private schools in the United States and is disproportionately used among Black students and children with disabilities. The aims of this policy statement are to review the incidence of school-based corporal punishment; the negative physical, psychological, and developmental impact of corporal punishment on students; and the need for continued advocacy by pediatricians, educators, and parents to abolish corporal punishment in all schools.

Heterogeneous effects of spanking on child protective services involvement in early childhood: A propensity score stratification analysis

Background

Extant literature has primarily employed linear models to estimate the average effect of spanking on children. Less is known about child and parent characteristics that may predict differential risks of children's exposure to spanking (i.e., pre-treatment heterogeneity) and the effect of spanking on child outcomes that may differ by the propensity for spanking (i.e., post-treatment heterogeneity).

Objective

The present study examines pre- and post-treatment heterogeneity in the association between maternal spanking at child age 3 and subsequent household Child Protective Services (CPS) involvement that were reported by mothers between child ages 3 to 5.

Methods

The sample consisted of 2,422 families from the Fragile Families and Child Wellbeing Study, a birth cohort study that oversampled children born to unmarried families. A propensity score stratification analysis procedure examined pre- and post-treatment heterogeneity in the association between spanking and subsequent household CPS involvement. Children were stratified into three strata depending on their propensity for experiencing spanking. Subsequently, the association between spanking and household CPS involvement was examined for each stratum.

Results

Disadvantaged socio-economic characteristics, negative psychosocial conditions of the mother, and dysregulated temperament of the child were associated with elevated risk of spanking. The odds of subsequent household CPS involvement increased by 2.4 times (β = 0.869, p <.01) for children in the stratum with the lowest propensity for experiencing spanking.

Conclusions

Results emphasize the importance of promoting alternative disciplinary strategies to families who would be considered low-risk before they may come into contact with the child welfare system.

Corporal punishment of children in Australia: The evidence-based case for legislative reform

OBJECTIVE

Across all of Australia's states and territories, it is legal for a parent or carer to hit their child. In this paper, we outline the legal context for corporal punishment in Australia and the argument for its reform.

METHODS

We review the laws that allow corporal punishment, the international agreements on children's rights, the evidence on the effects of corporal punishment, and outcomes of legislative reform in countries that have changed their laws to prohibit corporal punishment.

RESULTS

Legislative reform typically precedes attitude changes and reductions in the use of corporal punishment. Countries with the most ideal outcomes have instigated public health campaigns educating the population about law reform while also providing access to alternative non-violent discipline strategies.

CONCLUSIONS

Extensive evidence exists demonstrating the adverse effects of corporal punishment. When countries change legislation, educate the public about these effects, and provide alternative strategies for parents, rates of corporal punishment decrease.

IMPLICATIONS FOR PUBLIC HEALTH

We recommend law reform in Australia to prohibit corporal punishment, a public health campaign to increase awareness of corporal punishment and its effects, provision of access for parents to alternative evidence-based strategies to assist in parenting, and a national parenting survey to monitor outcomes.

Life-course social connectedness: Comparing data-driven and theoretical classifications as predictors of functional limitations in adulthood

A life course perspective on social relationships highlights the importance of specific relationships at specific times in life, but analyses that account for life course trajectories in social relationships are rare. This study compares theoretical and data-driven approaches to classifying life course relationships, including multiple dimensions of social connectedness at different time points across the life course. We examine each approach's ability to predict later-life functional limitations, given that functional impairment is prevalent among middle-aged and older adults. Data were from three waves of the Midlife in the United States (MIDUS) study (n = 6909). Relationship variables (parental affection, parental discipline, social support, social strain, and positive relations with others) were from wave 1 or wave 2. Functional limitations were measured at wave 3. Results showed that the data-driven approach had more predictive power than the theoretical approach. Additionally, results suggested that including only positive relationship features was nearly as robust as including both positive and negative relationship features. Overall, the data-driven approach outperformed the theoretical approach and revealed relationship trajectories consistent with life course cumulative processes.

Focusing the APA Ethics Code to Include Development: Applications to Abuse

Extant ethics codes in psychological work generally are not sufficiently developmentally oriented. Here, we examine the American Psychological Association ethics code for its developmental sensitivity, find it lacking in this regard, and make recommendations. Our approach was to place children and youth at the forefront in forming developmentally-targeted principles, meta-principles, values, and rights. To further this aim, we consulted the one ethics code in the field that is developmentally-attuned, the ethics code of the American Academy of Child and Adolescent Psychiatry. We used a revised set of ethical principles for psychological work and developed a set of meta-principles. The five APA ethics code principles are: (a) beneficence and nonmaleficence; (b) fidelity and responsibility; (c) integrity; (d) justice; and (e) respect for people's rights and dignity. The set of ethical principles taken from Young (Revising the American Psychological Association ethics code, Springer International Publishing, 2017) includes: (a) life preservation, (b) caring beneficence/nonmaleficence, (c) relational integrity, (d) respect for the dignity and rights of persons and peoples, and (e) promoting and acting from justice in society. The major meta-principles proposed here include: (a) functioning from responsibility, (b) promoting personhood, and (c) promoting participation. In addition, we added meta-principles for working from appropriate (d) theory and (e) meta-theory (Neo-Maslovian and a combined relationism-empiricism, respectively). Secondary meta-principles in the text refer to (a) systems, (b) the person as unique, (c) the vulnerabilities of people, (d) autonomy, and (e) morality.

Sensitive Periods for the Effect of Child Maltreatment on Psychopathology Symptoms in Adolescence

Introduction

Child maltreatment is among the strongest risk factors for mental disorders. However, little is known about whether there are ages when children may be especially vulnerable to its effects. We sought to identify potential sensitive periods when exposure to the 2 most common types of maltreatment (neglect and harsh physical discipline) had a particularly detrimental effect on youth mental health.

Methods

Data came from the Future of Families and Child Wellbeing Study (FFCWS), a birth cohort oversampled from "fragile families" (n = 3,474). Maltreatment was assessed at 3, 5, and 9 years of age using an adapted version of the Parent-Child Conflict Tactics Scales (CTS-PC). Using least angle regression, we examined the relationship between repeated measures of exposure to maltreatment on psychopathology symptoms at age 15 years (Child Behavior Checklist; CBCL/6-18). For comparison, we evaluated the strength of evidence to support the existence of sensitive periods in relation to an accumulation of risk model.

Results

We identified sensitive periods for harsh physical discipline, whereby psychopathology symptom scores were highest among girls exposed at age 9 years (r2 = 0.67 internalizing symptoms; r2 = 1% externalizing symptoms) and among boys exposed at age 5 years (r2 = 0.41%). However, for neglect, the accumulation of risk model explained more variability in psychopathology symptoms for both boys and girls.

Conclusion

Child maltreatment may have differential effects based on the child's sex, type of exposure, and the age at which it occurs. These findings provide additional evidence for clinicians assessing the benefits and drawbacks of screening efforts and point toward possible mechanisms driving increased vulnerability to psychopathology.

Child abuse-related homicides precipitated by caregiver use of harsh physical punishment

BACKGROUND

Physical punishment (PP), which may involve the use of physical force, has been linked to negative effects in children and can escalate to abusive or harsh PP, resulting in injury or death.

OBJECTIVE

To examine characteristics associated with fatal abuse involving caregiver use of harsh PP.

METHODS

Data were from the National Violent Death Reporting System in 40 states, the District of Columbia, and Puerto Rico for years 2012-2018. Qualitative analysis was used to code textual material into categorial data, and logistic regression was used to examine associations between various characteristics and harsh PP.

RESULTS

Approximately 4 % (n = 87) of the 2414 abuse-related homicides were known to have been precipitated by caregiver use of harsh PP. In adjusted models, homicides had greater odds of being harsh PP-related when incidents involved mothers' male companions (versus fathers), victims had a previous nonfatal injury (versus no previous nonfatal injury), and another adult participated in the fatal incident or had awareness of prior abuse/neglect (versus those without this characteristic). Two common precipitators of caregivers' use of harsh PP were: 1) child had a bathroom-related accident/soiled clothes (23.0 %; n = 20), and 2) child disobeyed a directive given by the perpetrator (17.2 %; n = 15).

CONCLUSIONS

This study highlights characteristics associated with fatal abuse precipitated by caregiver use of harsh PP. Children were physically punished for developmentally normative behaviors. Ensuring caregivers are aware of and use effective parenting practices that focus on use of nonphysical discipline and promote healthy child development, may help decrease harsh PP and physical abuse-related homicides among children.

Spanking and children's social competence: Evidence from a US kindergarten cohort study

BACKGROUND

Spanking is a risk factor for children's social competency. However, establishing causality is a challenge, given selection bias in samples and the possibility of confounding the harms of excessive spanking with the effects of infrequent spanking.

OBJECTIVE

This study addressed these causality issues to strengthen the causal estimates of the links between spanking and children's social competency.

PARTICIPANTS AND SETTING

The study used longitudinal US kindergarten cohort data from children aged 5 to 7.

METHODS

The study used matching and lagged dependent variables to mitigate selection bias associated with lifetime (Ns = 17,171-17,537) and recent (Ns = 10,393-10,724) incidence of spanking. Cases in which spanking frequency exceeded two times a week were excluded. Sample sizes are provided in ranges due to the variations across multiple imputed samples.

RESULTS

Lifetime experience of spanking by age 5 was associated with higher externalizing behaviors at ages 6 and 7, and with lower self-control and interpersonal skills at age 6. A recent incidence of spanking at age 5 was associated with higher externalizing behaviors, lower self-control, and lower interpersonal skills at ages 6 and 7. These results remain significant after cases of frequent spanking were excluded.

CONCLUSION

The results support the argument that spanking harms children's social development.

Harsh Physical Discipline: Prevalence and Associated Factors Among Primary Caregivers of Pre-school Children in Ethiopia

Harsh parental discipline is ineffective and potentially harmful to children, yet it is still common, particularly in many African countries. Culturally responsive education programs are needed to shift parenting practices in African countries, but there is limited baseline research to inform such efforts. This study’s objectives were to establish the baseline prevalence of harsh physical discipline practices among primary caregivers of pre-school children in Ethiopia and to identify associated factors to inform intervention efforts. The well-established Parent–Child Conflict Tactics Scale section on physical assault was translated and administered to primary caregivers of 1139 pre-school children aged 4–6 years sampled from four regions of Ethiopia. Trained interviewers also collected basic socio-demographic data. Based on caregiver report, 52.5% (n = 598) of the children had experienced harsh physical discipline and an additional 12.7% (n = 145) experienced moderate physical discipline in their lifetimes. After controlling for covariates, the factors significantly related to increased likelihood of harsh discipline were geographic region, female caregivers, lack of employment, at least moderate perceived social status, and non-Muslim religion. These data establish a baseline from which to evaluate the impact of future educational interventions designed to shift practices. Information about the correlates can be used to tailor such intervention efforts toward those most likely to use harsh discipline practices.

An Examination of Parents' Adverse Childhood Experiences (ACEs) History and Reported Spanking of Their Child: Informing Child Maltreatment Prevention Efforts

The current evidence indicates that spanking is harmful to children's health and development and should never be used by parents or other caregivers. However, the critical factors that inform effective spanking prevention strategies are still not well understood. The objective of the current study was to determine if a parent's own adverse childhood experiences (ACEs) history was associated with increased likelihood of reporting their child being spanked at age 10 or younger. Data were drawn from the Well-Being and Experiences Study (the WE Study), a community survey of parents and adolescents from 2017-2018 (N = 1000) from Canada. The results indicated that a parent's own history of physical abuse, emotional abuse, spanking, and household mental illness in childhood were associated with an increased likelihood that their child would have been spanked. These findings indicate that a parent's ACEs history may be related to how their own child is parented and identify families who may be more likely to rely on spanking. Preventing physical punishment is necessary for healthy child development, reducing the risk of further violence, and upholding children's rights to protection. Parent's ACEs history may be an important factor to consider when developing and implementing child maltreatment prevention efforts.

Changes in Child Discipline Strategies in Iran During the Outbreak of COVID-19

During the prolonged COVID-19 pandemic, anxiety and depression were common among caregivers and parents more prone to adopt harsh disciplinary techniques when angry or stressed. The purpose of this study was to investigate if there are any differences in parents' disciplinary strategies following social distancing efforts during the COVID-19 pandemic. An online questionnaire was completed by a convenience sample of parents (N = 605) and mothers (n = 533; 88.1%) aged 37.80 years old (SD = 5.66; range = 20-59) who lived with children aged 6-12 years in Iran during the COVID-19 pandemic. Iran's Multiple Indicator Demographic and Health Survey questionnaire was used to gauge child discipline. There was an increase in shaking (1.8%), shouting and yelling (15.5%). The findings of this study serve as a reminder to researchers and government officials that child abuse and violence are more likely to occur during stressful times and provide the scientific foundation for the development of tailored psychological treatment.

The association between spanking and physical abuse of young children in 56 low- and middle-income countries

BACKGROUND

Nearly one third of children under five in low- and middle-income countries (LMICs) experience spanking. Studies from North America suggest that spanking is associated with heightened risk of physical abuse. However, the link between spanking and physical abuse in the international context remains understudied.

OBJECTIVE

To examine the association between caregivers' spanking and physical abuse of young children in LMICs, and to estimate the extent to which physical abuse might be reduced if spanking were eliminated.

PARTICIPANTS

We used nationally representative data from 156,166 1- to 4-year-old children in 56 LMICs from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys.

METHODS

A nationally weighted multilevel logistic regression model examined the association between spanking and physical abuse. We calculated predicted probabilities of physical abuse, which we present using natural frequencies.

RESULTS

Spanking was associated with higher odds of physical abuse (OR = 5.74, p < .001). The predicted probability of physical abuse decreased by 14% comparing children who were spanked (22%) and who were not spanked (8%). When our estimates were translated to a hypothetical sample of 100 children using a natural frequency approach, 32 children were spanked; of those, seven experienced physical abuse. The elimination of spanking would result in four fewer children who were exposed to physical abuse. In relation to the population of abused children, estimates suggest that physical abuse could reduce by up to 33% if spanking were eliminated.

CONCLUSIONS

Results support the UN Sustainable Development Goals Target 16.2 that calls for eliminating all forms of violence against children. Child welfare advocates should discourage caregivers from using spanking, in order to prevent physical abuse.

Public policy and parent-child aggression: Considerations for reducing and preventing physical punishment and abuse

Parent-child physical aggression, including both physical punishment and abuse, remains a prevalent problem in the United States. In this paper, we briefly review the prevalence and harms of parent-child aggression and discuss changes in social norms and policies over the past several decades. Then, we discuss broad social policies influencing risk for parent-child physical aggression, policies relevant to reducing and preventing physical abuse, and policies relevant to reducing and preventing physical punishment. We close by considering future directions to strengthen research and evaluation and accelerate progress toward ending parent-child physical aggression.

Maternal use of corporal punishment and behavior problems in early childhood: A sibling comparison analysis

BACKGROUND

Previous research demonstrates that there are environmental and genetic factors associated with the use of corporal punishment (CP) and children's behavior problems. Thus, it is difficult to disentangle whether CP has a causal effect on children's developmental outcomes.

OBJECTIVE

This study explored the relationship between maternal use of CP at ages 3-4 years and symptoms of internalizing and externalizing behavior problems between the ages of 6 and 9 years using a sibling comparison design. In doing so, we were able to control for shared environmental factors and partially control for genetic factors that could explain the relationship between CP and behavior problems.

METHODS

This study analyzed data from 11,506 children from the United States. We used generalized linear models to assess the relationship between the use of CP and behavior problems among biological siblings raised in the same home.

RESULTS

At the population level, CP was significantly associated with the development of internalizing behavior problems (β = 0.134, SE = 0.03, p < .001). When comparing siblings, this relationship was no longer significant. In contrast, CP was significantly associated with externalizing behavior problems at both the population (β = 0.233, SE = 0.02, p < .001) and sibling comparison level (β = 0.107, SE = 0.03, p < .001).

CONCLUSION

We did not find evidence to suggest that the association between CP and externalizing behavior problems is due to environmental and genetic factors exclusively. Corroborating previous research, these results suggest that CP may increase the likelihood of externalizing behavior problems.

Patterns of caregiver aggressive and nonaggressive discipline toward young children in low- and middle-income countries: A latent class approach

BACKGROUND

Caregivers use a variety of disciplinary methods to respond to undesired child behavior. Many caregivers use nonaggressive forms of discipline, such as verbal reasoning and redirection. Some caregivers use aggressive forms of discipline, such as spanking and yelling. However, most caregivers use a combination of aggressive and nonaggressive discipline. To date, a disproportionately small number of caregiver discipline studies are conducted in low- and middle-income countries (LMICs), and few studies in low-resource contexts examine aggressive and nonaggressive behaviors simultaneously.

OBJECTIVE

This study aims to elucidate caregiver patterns of 11 disciplinary behaviors used in LMICs, and examine how these patterns relate to child outcomes and household characteristics.

PARTICIPANTS AND SETTING

Data came from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys (MICS) distributed between 2009 and 2017 (N = 218,824 respondents across 63 countries). Focal children were 3-4 years old.

METHODS

Patterns of disciplinary behaviors were estimated using a multilevel latent class analysis (LCA). Multinomial regression analyses examined associations of disciplinary patterns with caregiver-reported child outcomes and household characteristics.

RESULTS

The LCA suggested caregiver discipline fell into three overall patterns: high behavioral control, moderate behavior control, and lower behavioral control. The lower behavioral control class was associated with the most advantageous child outcomes and household socio-demographic characteristics, whereas the high behavioral control class was associated with the most disadvantageous child outcomes and household characteristics.

CONCLUSIONS

Efforts should be employed to reduce aggressive behaviors and promote positive parenting among caregivers in LMICs.

Associations between spanking beliefs and reported spanking among adolescents-parent/caregiver dyads in a Canadian sample

Background

Research consistently demonstrates that physical punishment of children including “spanking” is harmful. Interest in effective prevention is growing rapidly. The aim of the current study is to examine spanking beliefs among adolescents and parents in relation to reports of spanking that the adolescents experienced before 11 years of age.

Methods

Data were drawn from Wave 1 of a study conducted in 2017–2018 that included adolescents (14–17 years old) and one of their parents/caregivers from Manitoba, Canada (n = 1000 pairs). The study objectives were to examine: 1) spanking beliefs of adolescents and their parents; 2) the correlation between parent and adolescent spanking beliefs; 3) whether parents perceive the words “spank” vs. “hit” differently using intraclass correlation; 4) the association between parents’ beliefs about spanking and parent- and adolescent-reported use of it; and 5) the relationship between sociodemographic variables and spanking. The data were analyzed using descriptive statistics, Spearman’s correlation, intraclass correlation, and binary and multinomial logistic regression analyses.

Results

The prevalence of adolescent-reported and parents’-reported spanking were 46.0% and 39.6%, respectively. The proportions agreeing that spanking is a normal part of parenting were similar among adolescents (22.0%) and parents (18.5%), and were moderately correlated (intraclass correlation = 0.38, SE = 0.038). More than five times as many parents believed that “spanking” is necessary (19.5%) than believed that “hitting” is necessary (3.5%). Parents’ positive spanking beliefs were associated with increased likelihood of adolescent- and parent-reported spanking. Few significant associations were found between sociodemographic variables and parent-reported or adolescent-reported spanking.

Conclusions

Adolescents’ spanking beliefs are related to their parents’ spanking beliefs, suggesting that they are transmitted across generations. Public education and law reform are needed to decrease the normalization and perceived necessity of spanking in child-rearing. Efforts should include improving the understanding that spanking is a form of violence against children. With only a few significant differences noted between sociodemographic variables and parent- and adolescent- reported spanking and the prevalent use of spanking across all sociodemographic variable categories, it may be useful to develop universal approaches to awareness-raising and implementation of education strategies in Canada.

Parental Discipline and Early Childhood Development in Rural China

Children who are under the age of five in underdeveloped and developing countries, including China, exhibit developmental delays due to their exposure to risks such as impoverishment, deprived health conditions, parental punishment, neglect, and poor psychosocial stimulation. Adverse experiences during the formative years of life, such as harsh parental discipline, may put them at risk for poor physical and mental well-being. The aim of this research is to explore the pervasiveness and developmental outcomes of different forms of discipline practices in the underdeveloped rural areas of China. To do this, we used cross-sectional data on child–caregiver dyads from a large survey held in 22 poor counties in the QinBa Mountain Region. The sample included 1622 children aged 12–36 months. Partakers were requested to respond to a general survey on parenting which included basic demographic questions, the Ages and Stages Questionnaire: Social-Emotional (ASQ-SE), the Bayley Scales of Infant and Toddler Development (BSID-III), and questions on exposure of children to different discipline practices. Our findings from OLS estimates reveal that aversive discipline methods adversely affect cognitive, language, and socio-emotional development, whereas, non-aversive discipline practices have constructive effects on cognitive, language, and motor development of children.

Physical punishment, physical abuse, and child behavior problems in South Korea

BACKGROUND

Prior literature has demonstrated the associations of parental physical punishment with child behavior problems and increased risk of physical abuse. In South Korea, physical punishment is a common parenting practice. In 2021, legislative reforms eliminated legal grounds for parental physical punishment in South Korea. However, research on physical punishment, physical abuse, and child behavior problems in the Korean context is scarce.

OBJECTIVE

This study examined whether physical punishment and physical abuse have unique associations with child behavior problems and whether physical punishment is associated with increased exposure to physical abuse.

PARTICIPANTS AND SETTING

Data came from the 2010 Korean Child and Youth Panel Survey (KCYPS), a nationally representative sample of South Korean children who attended 1st grade in 2010. Our analyses were based on three waves of the KCYPS (N = 2,180).

METHODS

We employed fixed-effects regression to examine the associations of physical punishment and physical abuse with child behavior problems and the association of physical punishment with physical abuse after controlling for time-invariant characteristics.

RESULTS

Exposure to physical punishment and physical abuse was associated with higher levels of aggression, depression, and lower levels of academic behavior regulation. Physical punishment was associated with increased risk of physical abuse.

CONCLUSIONS

Our findings suggest that physical punishment is a risk for child behavior problems and physical abuse in South Korea. Child maltreatment prevention efforts should focus on shifting favorable social norms around physical punishment and promoting non-physical disciplinary practices.

Time-Out with Young Children: A Parent-Child Interaction Therapy (PCIT) Practitioner Review

Time-out is a component of many evidence-based parent training programmes for the treatment of childhood conduct problems. Existing comprehensive reviews suggest that time-out is both safe and effective when used predictably, infrequently, calmly and as one component of a collection of parenting strategies-i.e., when utilised in the manner advocated by most parent training programmes. However, this research evidence has been largely oriented towards the academic community and is often in conflict with the widespread misinformation about time-out within communities of parents, and within groups of treatment practitioners. This dissonance has the potential to undermine the dissemination and implementation of an effective suite of treatments for common and disabling childhood conditions. The parent-practitioner relationship is integral to the success of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment which involves live coaching of parent(s) with their young child(ren). Yet this relationship, and practitioner perspectives, attitudes and values as they relate to time-out, are often overlooked. This practitioner review explores the dynamics of the parent-practitioner relationship as they apply to the teaching and coaching of time-out to parents. It also acknowledges factors within the clinical setting that impact on time-out's use, such as the views of administrators and professional colleagues. The paper is oriented toward practitioners of PCIT but is of relevance to all providers of parent training interventions for young children.

Co-occurring violent discipline of children and intimate partner violence against women in Latin America and the Caribbean: a systematic search and secondary analysis of national datasets

Introduction

Intersections between violent discipline (physical punishment and/or verbal aggression) of children and intimate partner violence (IPV) against women have received growing international attention. This study aimed to determine how many Latin American and Caribbean (LAC) countries had national data on co-occurring IPV and violent discipline in the same household, how estimates compared and whether violent discipline was significantly associated with IPV.

Methods

A systematic search (following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) was used to identify which LAC countries had eligible, national co-occurrence data. The most recent eligible dataset in each country was obtained and reanalysed for comparability. Standardised national estimates were produced for prevalence of violent discipline, physical and/or sexual IPV and co-occurrence among ever partnered women of reproductive age living with a child aged 1–14. Bivariate analyses and logistic regressions produced levels and odds ratios (ORs) of physical punishment and verbal aggression in households affected by IPV (past year and before past year) compared with never, adjusted for sociodemographic characteristics.

Results

Nine countries had eligible datasets. Co-occurring physical punishment with past year IPV ranged from 1.7% (Nicaragua) to 17.5% (Bolivia); and with IPV ever from 6.0% (Nicaragua) to 21.2% (Haiti). In almost all countries, children in IPV affected households experienced significantly higher levels and ORs of physical punishment and verbal aggression, whether IPV occurred during or before the past year. Significant adjusted ORs of physical punishment ranged from 1.52 (95% CI 1.11 to 2.10) in Jamaica to 3.63 (95% CI 3.26 to 4.05) in Mexico for past year IPV; and from 1.50 (95% CI 1.23 to 1.83) in Nicaragua to 2.52 (95% CI 2.30 to 2.77) in Mexico for IPV before past year.

Conclusions

IPV is a significant risk factor for violent discipline, but few national surveys in LAC measure both. Co-occurrence merits greater attention from policymakers and researchers.

The Development, Preliminary Validation, and Clinical Application of the Quick Parenting Assessment

To prevent diseases, efforts are needed to determine how to address Adverse Childhood Experiences (ACEs), including parenting behaviors. The objective of this study, conducted in Nashville TN in 2017, was to initiate testing the psychometric properties of two new Adverse Childhood Experiences (ACEs) screening tools, the Quick Parenting Assessment (QPA) and Other Childhood Stressors (OCS). In a clinic serving low-income families, caregivers of children ages 2-10 completed assessments of parenting (QPA), other stressors (OCS), child behavior problems ((Strength and Difficulties Questionnaire (SDQ)), and Attitudes Toward Spanking (ATS). The QPA takes 1 min to complete and assesses for healthy and unhealthy parenting behaviors. Seventy-five percent of eligible participants completed the survey (N=558). A reduced 10-item QPA yielded a Cronbach's alpha of 0.79 and, in 4-10-year-olds, was associated with high SDQ conduct, hyperactivity, and total difficulties scores (r=0.44, 0.48, and 0.47; all p< 0.001). Children with QPAs of >4 were nine times more likely than those children with scores of ≤2 to have behavior problems (OR=8.93, 95% CI = 3.74-21.32). Elevated QPAs were associated with the ATS (r=0.47, p < .001). The OCS was also associated with high SDQ total difficulties scores (r=0.28, p< 0.001). Two pediatric ACEs screening tools, the QPA and the OCS, have promising psychometric properties. The findings suggest that parenting behaviors may play an outsized role in the pathogenesis of outcomes associated with ACEs. We discuss the clinical application of QPA at our institution and the theoretical potential for this instrument to reduce the rates of short- and long-term health problems.

Corporal punishment and early childhood development in 49 low- and middle-income countries

OBJECTIVE

To systematically assess the association between corporal punishment and young children's development in low- and middle-income countries (LMICs).

METHOD

Data for 69 population-based surveys from the Multiple Indicators Cluster Survey (MICS) were combined. The sample included 131,164 children aged 36-59 months living in 49 LMICs. The surveys included information about children's developmental status and exposure to corporal punishment in the prior month. Logistic models, random-effects meta-analysis, and moderation analysis were used to obtain pooled estimates and assess the extent to which the association between corporal punishment and child developmental outcomes varied across countries.

RESULTS

On average, children exposed to corporal punishment were about 24% (β = 0.76, 95% CI 0.72-0.80) less likely to be developmentally on track than children who were not exposed to corporal punishment. Challenges in social-emotional development may drive the association between child development and corporal punishment. Corporal punishment was not associated with any positive developmental outcome in any country. There was minor heterogeneity in the estimated associations, which was not explained by the extent to which corporal punishment was normative within countries.

CONCLUSIONS

All forms of corporal punishment - including spanking - are likely to be harmful to young children's development and wellbeing. Public education, legal prohibition of corporal punishment, and other efforts are needed to protect children from corporal punishment and promote their wellbeing, health, and development.

Urban, Low-Income, African American Parents' Experiences and Expectations of Well-Child Care

PURPOSE

Well-child care is the foundation of pediatric health promotion and disease prevention. Primary care quality is lower for low-income and African American children compared to white children, and social determinants have an increasingly acknowledged impact on child health. Ensuring that high-quality well-child care fulfills its potential to mitigate the negative effects of social determinants on African American children is imperative. This study provides an understanding of urban, low-income, African American well-child care experiences and expectations.

DESIGN AND METHODS

A qualitative, focus group method was used. A purposive, volunteer sample of low-income, African American parents with children birth to age five was recruited from St. Louis and Milwaukee. Focus groups were held in convenient, community sites. Data was audio-digitally recorded. Transcribed data were coded and analyzed through inductive content analysis.

RESULTS

Thirty-five caregivers, 86% females, participated in four focus groups. Categories (and sub-categories) identified include: Community factors (We want better schools, It's getting more rough where I live); Sources of parenting advice (Google it, Call your parent, Older remedies); System challenges (Cost, Frequent new faces, Politics); Challenges with providers (Couldn't help me, Missed something important, Treated differently, Are you really listening?); Anticipatory guidance (Breastfeeding, Discipline, Vaccines, Development); and What parents desire (Know them, trust).

CONCLUSIONS

This study reveals the contexts that give rise to health care disparities and provides insight into parent's healthcare behaviors.

PRACTICE IMPLICATIONS

Results offer providers guidance in providing well-child care for this population to improve pediatric care quality and child health.

Multilevel ecological analysis of the predictors of spanking across 65 countries

OBJECTIVE

Ending violence against children is critical to promote the health and socioemotional development of children across the globe. To this end, the UNICEF and the WHO have called for the abolishment of spanking, which is the most pervasive form of physical violence against children worldwide. This study used an ecological perspective to examine micro-level and macro-level predictors of parental spanking across 65 countries.

PARTICIPANTS

Data came from the fourth and fifth rounds of the UNICEF Multiple Indicator Cluster Surveys, which were administered between 2009 and 2017 (N=613 861 households). We examined the predictors of spanking using multilevel logistic regression analysis.

RESULTS

Micro-level factors (ie, those observed at the familial level) were stronger predictors of spanking in comparison to macro-level factors (ie, those observed at the community and country level). Caregiver belief that children need physical punishment in order to be raised properly was the largest risk factor for spanking (OR=2.55, p<0.001). Older child age, the child being female, the head of the household having a secondary education or higher, and higher household wealth were protective factors against spanking, while a higher number of people living in the household was a risk factor for spanking. Living in an urban community was the only macro-level factor associated with spanking.

CONCLUSIONS

Intervention at the micro-level and macro-level are important to reduce violence against children across the globe.

Adverse Childhood Experiences and Spanking Have Similar Associations with Early Behavior Problems

OBJECTIVES

To examine whether adverse childhood experiences (ACEs) and physical punishment (ie, spanking) are unique risk factors for behavior problems in early childhood, and whether ACEs moderate the associations of spanking with child behavior problems.

STUDY DESIGN

We conducted prospective, longitudinal analyses on 2380 families in the Fragile Families and Child Wellbeing Study. Mothers reported outcomes of externalizing and internalizing behavior problems at age 5 years; and the main predictors, ACEs and spanking, at age 3 years. ACEs included 9 items: physical abuse, emotional abuse, physical neglect, emotional neglect, mother's exposure to intimate partner violence, parental mental health problem, parental substance use, parental incarceration, and parental death. Multilevel models examined the associations between ACEs, spanking, and behavior problems, and the moderating effect of ACEs in the associations of spanking with behavior problems. Analyses were adjusted for preexisting behavior problems, demographics, and neighborhood conditions.

RESULTS

ACEs (β = 0.028; P < .001) and spanking (β = 0.041; P < .001) at 3 years were unique risk factors for increased externalizing behavior problems at 5 years, after controlling for covariates. The magnitude of the associations of ACEs and spanking with externalizing behavior were statistically indistinguishable. ACEs did not moderate the association between spanking and externalizing behavior.

CONCLUSIONS

ACEs and spanking have similar associations in predicting child externalizing behavior. Results support calls to consider physical punishment as a form of ACE. Our findings also underscore the importance of assessing exposure to ACEs and physical punishment among young children and providing appropriate intervention to children at risk.

Physical punishment and child outcomes: a narrative review of prospective studies

Physical punishment is increasingly viewed as a form of violence that harms children. This narrative review summarises the findings of 69 prospective longitudinal studies to inform practitioners and policy makers about physical punishment's outcomes. Our review identified seven key themes. First, physical punishment consistently predicts increases in child behaviour problems over time. Second, physical punishment is not associated with positive outcomes over time. Third, physical punishment increases the risk of involvement with child protective services. Fourth, the only evidence of children eliciting physical punishment is for externalising behaviour. Fifth, physical punishment predicts worsening behaviour over time in quasi-experimental studies. Sixth, associations between physical punishment and detrimental child outcomes are robust across child and parent characteristics. Finally, there is some evidence of a dose-response relationship. The consistency of these findings indicates that physical punishment is harmful to children and that policy remedies are warranted.

Childhood exposure to physical and emotional violence over a 57-year period in Sweden

AIMS

The aim of the present study was to examine the prevalence of childhood experiences of physical violence (CPV) and emotional violence (CEV) at the hands of parents over a 57-year period among adults born between 1937 and 1993.

METHODS

In 2012, a survey among women and men aged 18-74 years in Sweden was undertaken to examine the lifetime prevalence of physical, psychological and sexual violence and associations with current health in adulthood. Questionnaires were based on the Adverse Childhood Experiences study and a previous national survey of violence exposure. Descriptive statistics were used to analyse the frequency of exposure to CPV and CEV, and changes over time were analysed using analysis of variance and logistic regression.

RESULTS

A total of 10,337 individuals participated (response rates: 56% for women and 48% for men). CPV decreased significantly over the time period studied, particularly for those born after 1983. This decrease was more evident for male respondents. Throughout the time period studied, the proportion of women reporting CEV was higher than for men. Among both genders there was a steady rise in CEV rates from those born in the late 1930s to those born in the mid-1980s, after which there was a decline that was more marked for men.

CONCLUSIONS

A significant group of children in Sweden experience violence at the hands of parents. However, our data corroborate previous national studies that children's exposure to violence has decreased. Clear gender differences indicate that these changes have affected girls and boys differently.

Socioeconomic inequality in child mental health during the COVID-19 pandemic: First evidence from China

BACKGROUND

There are increasing concerns that the coronavirus disease (COVID-19) pandemic will disproportionately affect socioeconomically disadvantaged children. However, there lacks empirical evidence on socioeconomic inequalities in child mental health and associated factors.

METHODS

We conducted a population-based online survey in 21,526 children in China, when children were confined at home for nearly two months during the pandemic. We assessed child mental health problems with the Strengths and Difficulties Questionnaire (SDQ). Parental education level and provincial gross domestic product (GDP) per capita were treated as proxies for individual- and population-level socioeconomic status (SES), respectively. Lifestyle and family environment factors included sleep disturbances, physical activity, screen time, primary caregiver, parental mental health, and harsh parenting.

RESULTS

Of the children, 32.31% demonstrated mental health problems. Parental education from the highest (undergraduate and above) to the lowest (middle school and below) increased the adjusted odds ratio(aOR) for child mental health problems by 42% (aOR, 1.42; 95% CI, 1.29-1.57); provincial GDP per capita (RMB) from the highest (>¥100K) to the lowest (≤¥70K) increased aOR by 41% (aOR, 1.41; 95% CI%, 1.28-1.55). Sleep disturbances, physical activity <1 h/day, media exposure ≥2 h/day, non-parental care, poor parental mental health, and harsh parenting were independently associated with increased child mental health problems, regardless of SES.

LIMITATIONS

The potential sampling bias, subjective measures, and the cross-sectional design are the main limitations.

CONCLUSION

The first evidence from China suggests socioeconomic inequality in child mental health during the pandemic. As unhealthy lifestyle and unfavorable family environment are contributory factors, prioritized interventions are needed to reduce socioeconomic inequality in child mental health problems.

Maltreatment of Children With Disabilities

Over the past decade, there have been widespread efforts to raise awareness about maltreatment of children. Pediatric providers have received education about factors that make a child more vulnerable to being abused and neglected. The purpose of this clinical report is to ensure that children with disabilities are recognized as a population at increased risk for maltreatment. This report updates the 2007 American Academy of Pediatrics clinical report "Maltreatment of Children With Disabilities." Since 2007, new information has expanded our understanding of the incidence of abuse in this vulnerable population. There is now information about which children with disabilities are at greatest risk for maltreatment because not all disabling conditions confer the same risks of abuse or neglect. This updated report will serve as a resource for pediatricians and others who care for children with disabilities and offers guidance on risks for subpopulations of children with disabilities who are at particularly high risk of abuse and neglect. The report will also discuss ways in which the medical home can aid in early identification and intervene when abuse and neglect are suspected. It will also describe community resources and preventive strategies that may reduce the risk of abuse and neglect.

Child disciplinary practices, abuse, and neglect: Findings from a formative study in Chitungwiza, Zimbabwe

BACKGROUND

Zimbabwe has a high prevalence of children who have experienced abuse according to national data.

OBJECTIVE

To understand how parents/caregivers and children describe child discipline, abuse, and neglect and what factors influence each, in order to inform the adaptation of a positive parenting/caregiving intervention in Chitungwiza, Zimbabwe.

PARTICIPANTS

A total of eight focus groups were conducted, four with parents/caregivers (N = 40) and four with their children ages 10-14 (N = 40), separately, between June-July 2016.

SETTING

Chitungwiza, Zimbabwe.

METHODS

We used an inductive and deductive analytic approach to analyze focus group transcripts, using MAXQDA 12.

RESULTS

There were similar themes across focus groups of children and parents/caregivers. Findings suggest that parents/caregivers and children may be somewhat aware of the differences between discipline and abuse, but they are not completely clear about what the definitions of discipline and abuse are, and where the boundaries between discipline and abuse lie. The use of both non-physical and physical forms of discipline were described in the community, however physical discipline was a reoccurring theme in the focus groups of both parents/caregivers and their children. There were several factors that influenced discipline and/or abuse of children in the community, including the child's gender and theseverity of the child's misbehavior/actions. Parents/caregivers shared that orphan/non-biological children were particularly vulnerable to forms of abuse and neglect committed by parents/caregivers in the community, for example, withholding food and overworking a child.

CONCLUSIONS

Understanding the differences between discipline, abuse and neglect, as well as factors that influence occurrences of abuse/neglect and/or severity of abuse/neglect, need to be considered when assessing the vulnerability of children, in order to develop and refine parenting/caregiving interventions for the Zimbabwean context.

Twin Differences in Harsh Parenting Predict Youth's Antisocial Behavior

In the current study, we leveraged differences within twin pairs to examine whether harsh parenting is associated with children's antisocial behavior via environmental (vs. genetic) transmission. We examined two independent samples from the Michigan State University Twin Registry. Our primary sample contained 1,030 families (2,060 twin children; 49% female; 6-10 years old) oversampled for exposure to disadvantage. Our replication sample included 240 families (480 twin children; 50% female; 6-15 years old). Co-twin control analyses were conducted using a specification-curve framework, an exhaustive modeling approach in which all reasonable analytic specifications of the data are interrogated. Results revealed that, regardless of zygosity, the twin experiencing harsher parenting exhibited more antisocial behavior. These effects were robust across multiple operationalizations and informant reports of both harsh parenting and antisocial behavior with only a few exceptions. Results indicate that the association between harsh parenting and children's antisocial behavior is, to a large degree, environmental in origin.