“Effective Discipline to Raise Healthy Children”

November 16, 2018

The American Academy of Pediatrics (AAP) recently published its findings and recommendations on child discipline and effectiveness of corporal punishment (aka “spanking”). The results of this study prove that corporal punishment is not effective in the long-term and can lead to cognitive and mental health problems in children. 


Based on the findings, the AAP recommendations to adults caring for children include the use of healthy forms of discipline, such as positive reinforcement of appropriate behaviors, setting limits, redirecting, and setting future expectations. The AAP advises against the use of spanking, hitting, slapping, threatening, insulting, humiliating, or shaming.


Below, I highlight a few important parts of the article. (Please note that the numbers at the end of some sentences are the footnote references, the formatting of which didn’t translate well here.) You can also read the full article here:



Excerpts from the article:


Ineffectiveness of Corporal Punishment

A 2016 meta-analysis showed that current literature does not support the finding of benefit from physical punishment in the long-term.7 Several small, older studies (including meta-analyses),19–22 largely of parents who were referred for help with child behavior problems, demonstrated apparent short-term effectiveness of spanking. Only a single 1981 study of 24 children showed statistically significant short-term improvement in compliance compared with alternative strategies (time-out and a control group).23


Cycle of Corporal Punishment and Aggressive Child Behavior

Evidence obtained from a longitudinal cohort study suggested that corporal punishment of toddlers was associated with subsequent aggressive behavior. The Fragile Families and Child Wellbeing Study was based on a population-based birth cohort of approximately 5000 children from 20 large US cities between 1998 and 200024; data were collected at birth and 1, 3, 5, and 9 years of age. Young children who were spanked more than twice per month at age 3 years were more aggressive at age 5 even when the researchers controlled for the child’s aggressive behavior at age 3, maternal parenting and risk factors, and demographic factors.25 A follow-up study26 assessed these children at 9 years of age and noted correlations between spanking at age 5 years and higher levels of externalizing behavior and lower receptive vocabulary scores at age 9. A subsequent study analyzed data from all 4 waves and concluded that an increased frequency of spanking was associated with a subsequent increased frequency of externalizing behaviors, which were then associated with more spanking in response.27 This interaction between spanking and misbehavior occurs over time; each negative interaction reinforces previous negative interactions as a complex negative spiral.


Corporal Punishment As a Risk Factor for Nonoptimal Child Development

There appears to be a strong association between spanking children and subsequent adverse outcomes.35–53 Reports published since the previous 1998 AAP report have provided further evidence that has deepened the understanding of the effects of corporal punishment. The consequences associated with parental corporal punishment are summarized as follows7,19,21,27,35,54–62:

  • corporal punishment of children younger than 18 months of age increases the likelihood of physical injury;

  • repeated use of corporal punishment may lead to aggressive behavior and altercations between the parent and child and may negatively affect the parent-child relationship;

  • corporal punishment is associated with increased aggression in preschool and school-aged children;

  • experiencing corporal punishment makes it more, not less, likely that children will be defiant and aggressive in the future;

  • corporal punishment is associated with an increased risk of mental health disorders and cognition problems;

  • the risk of harsh punishment is increased when the family is experiencing stressors, such as family economic challenges, mental health problems, intimate partner violence, or substance abuse; and

  • spanking alone is associated with adverse outcomes, and these outcomes are similar to those in children who experience physical abuse.

The association between corporal punishment and adverse adult health outcomes was examined in a 2017 report that analyzed original data from the 1998 Adverse Childhood Experiences Study, which recommended that spanking be considered as an additional independent risk factor, similar in nature and effect to other adverse childhood experiences.63 In their analysis of the original 1998 Adverse Childhood Experiences study data, the investigators found that spanking was associated with increased odds of suicide attempts, moderate-to-heavy drinking, and substance use disorder in adulthood independent of the risks associated with having experienced physical and emotional abuse.


Physiologic Changes Associated With Corporal Punishment and Verbal Abuse

A history of parental corporal punishment and parental verbal abuse has been associated with changes in brain anatomy that can be visualized by using MRI. Researchers studied a group of young adults (N = 23; ages 18–25) who had prolonged and repeated exposure to harsh corporal punishment and compared the results of brain MRIs to those from a matched control group (N = 22). They reported reduced prefrontal cortical gray matter volume and performance IQ.64 A similar study from this group noted MRI results that revealed differences in white matter tracts in young adults (N = 16) who were exposed to parental verbal abuse and had no history of trauma.65 A more recent review noted relationships between physical punishment and cortisol levels.66 Elevated cortisol levels reflect stress and have been associated with toxic stress and subsequent changes in brain architecture.


Harsh Verbal Abuse Associated With Child and Adolescent Mental Health Problems

In 2009, the UN Children’s Fund defined “yelling and other harsh verbal discipline as psychologically aggressive towards children.”28 In a longitudinal study investigating the relationship between harsh verbal abuse by parents and child outcomes, researchers noted that harsh verbal abuse before age 13 years was associated with an increase in adolescent conduct problems and depressive symptoms between ages 13 and 14. Adolescent behavior affected parental behavior as well; misconduct predicted increases in parents’ use of harsh discipline between ages 13 and 14 years. Furthermore, parental warmth did not moderate the longitudinal associations between harsh discipline by parents and adolescent conduct and depressive symptoms.67


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