Physical punishment in childhood associated with later mental disorders, study says

Physicians should make parents aware of the potential consequences of discipline, such as spanking and hitting, to avoid long-term health effects, experts say.

By — Posted July 13, 2012

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The saying “spare the rod, spoil the child” may be well-ingrained in North American society, but new research shows that physically punishing children can affect their mental health.

Corporal punishments such as spanking, hitting, pushing and grabbing are associated with the development of mood and anxiety disorders, substance abuse and personality disorders, says a study published online July 2 in Pediatrics (link).

Pediatricians and family physicians should talk with parents about healthy ways of disciplining their children and recommend they avoid physical punishment, said Tracie O. Afifi, PhD, lead study author and assistant professor in the Dept. of Community Health Sciences at the University of Manitoba in Winnipeg, Manitoba.

“There are still a lot of people that believe that it is safe to hit your child,” she said. “We’re suggesting that physical punishment should not be used on children of any age. We need to focus more on positive reinforcement.”

Researchers analyzed 2004-05 national data on 34,653 adults 20 and older. They found that the 6% of adults who experienced harsh physical punishment as children were more prone to Axis I and Axis II mental disorders, such as major depression, mania and schizophrenia.

The study distinguished between physical punishment and severe child maltreatment. Any physical punishment that left a mark or a bruise was considered maltreatment and was not included in the study, Afifi said.

The research confirms concerns many physicians have had for a while, said Robert Sege, MD, PhD, a professor of pediatrics at Boston University School of Medicine. Though the link between child abuse and mental disorders is well-established, the study’s findings add another dimension.

“This adds to the scientific information that we can provide to parents to help them make decisions about how they want to raise their children,” said Dr. Sege, a member of the American Academy of Pediatrics’ Committee on Child Abuse and Neglect. “Corporal punishment can make children fear their parents rather than looking to them for support.”

Healthier forms of discipline

Though 6% is a small percentage, a large number of children are at risk when one considers there are about 75 million children in the U.S., said Benjamin Siegel, MD, professor of pediatrics at Boston University School of Medicine and chair of the AAP’s Committee on Psychosocial Aspects of Child and Family Health.

The AAP recommends against physical punishment, Dr. Siegel said. Other methods of discipline are more effective, such as giving timeouts, helping children see the natural consequences of their bad behavior and offering positive reinforcement for good behavior.

“Parents have to find ways so that children can learn life lessons in a protected way,” Dr. Sege said.

For example, after his son twice broke a window playing baseball in the yard, Dr. Sege made him miss a fun activity he was excited about to help fix the window. His son learned to avoid breaking the window after that, he said.

Physicians should foster relationships with child patients and their parents so they feel comfortable discussing topics such as discipline, Dr. Siegel said. It can start with simply asking parents or children how they are feeling to help identify if there is stress in the home.

Dr. Sege said most pediatricians discuss discipline with parents. The key is to provide information to help parents make their own decisions, he said.

“I think it is a pretty common conversation,” Dr. Sege said. “What parents don’t want us to do is to tell them they’re doing it the wrong way.”

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The prevalence of physical punishment

About 6% of 34,653 adults surveyed who received harsh physical punishment when they were children were more prone to mental disorders as adults according to a study published online July 2 in Pediatrics. Researchers distinguished physical punishments such as spanking from abuse that left bruises or marks. Physical punishment was most common among males, whites and those from families with higher income and education levels.

Group No physical punishment Physical punishment
Male 48% 59%
Female 52% 41%
White 73% 72%
Black 10% 14%
American Indian/Alaska Native 2% 2%
Asian/Native Hawaiian/Other Pacific Islander 4% 1%
Hispanic 11% 10%
Less than high school 13% 9%
High school 28% 29%
Some college 21% 23%
Postsecondary degree 38.8% 39.2%
Past year household income
$19,999 or less 17% 11%
$20,000-$39,999 24% 22%
$40,000-$69,999 27% 29%
$70,000 or more 32% 38%

Source: “Physical Punishment and Mental Disorders: Results from a Nationally Representative U.S. Sample,” Pediatrics, published online July 2 (link)

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