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20 Years of Research On Corporal Punishment Joan Durrant
20 Years of Research On Corporal Punishment Joan Durrant
O
ver the past two decades, we have seen was conceptually distinct from physical abuse. Competing interests: Ron
Ensom is part of the
an international shift in perspectives However, this perspective began to change as national knowledge transfer
concerning the physical punishment of studies found links between “normative” physi- initiative on physical
children. In 1990, research showing an associa- cal punishment and child aggression, delin- punishment at the
tion between physical punishment and negative quency and spousal assault in later life. Some of Children’s Hospital of
Eastern Ontario. No other
developmental outcomes was starting to accumu- these studies involved large representative sam- competing interests were
late, and the Convention on the Rights of the ples from the United States;2 some studies con- declared.
Child had just been adopted by the General trolled for potential confounders, such as This article has been peer
Assembly of the United Nations; however, only parental stress3 and socioeconomic status;4 and reviewed.
four countries had prohibited physical punish- some studies examined the potential of parental Correspondence to:
ment in all settings. reasoning to moderate the association between Joan Durrant,
By 2000, research was proliferating, and the physical punishment and child aggression.5 Vir- durrant@cc.umanitoba.ca
convention had been ratified by 191 of the tually without exception, these studies found CMAJ 2012. DOI:10.1503
world’s 196 countries, 11 of which had prohib- that physical punishment was associated with /cmaj.101314
ited all physical punishment. Today, research higher levels of aggression against parents, sib-
showing the risks associated with physical pun- lings, peers and spouses.
ishment is robust, the convention has been inte- But were physical punishment and childhood
grated into the legal and policy frameworks of aggression statistically associated because more
many nations, and 31 countries have enacted aggressive children elicit higher levels of physi-
prohibitions against the physical punishment of cal punishment? Although this was a possibility,6
children.1 These three forces — research, the research was beginning to show that physical
convention and law reform — have altered the punishment elicits aggression. Early experiments
landscape of physical punishment. had shown that pain elicits reflexive aggression.7
The growing weight of evidence and the re- In an early modeling study,8 boys in grade one
cognition of children’s rights have brought us to who had watched a one-minute video of a boy
a historical point. Physicians familiar with the being yelled at, shaken and spanked with a pad-
research can now confidently encourage parents dle for misbehaving showed more aggression
to adopt constructive approaches to discipline while playing with dolls than boys who had
and can comfortably use their unique influence watched a one-minute video of nonviolent re-
to guide other aspects of children’s healthy sponses to misbehaviour. In a treatment study,
development. In doing so, physicians strengthen Forgatch showed that a reduction in harsh disci-
child well-being and parent–child relationships pline used by parents of boys at risk for antiso-
at the population level. Here, we present an cial behaviour was followed by significant reduc-
analysis of the research on physical punishment tions in their children’s aggression.9 These and
spanning the past two decades to assist physi- other findings spurred researchers to identify the
cians in this important role.
Key points
The early years: identifying • Numerous studies have found that physical punishment increases the
risk of broad and enduring negative developmental outcomes.
patterns • No study has found that physical punishment enhances developmental
health.
As recently as 20 years ago, the physical pun- • Most child physical abuse occurs in the context of punishment.
ishment of children was generally accepted • A professional consensus is emerging that parents should be supported
worldwide and was considered an appropriate in learning nonviolent, effective approaches to discipline.
method of eliciting behavioural compliance that
© 2012 Canadian Medical Association or its licensors CMAJ, September 4, 2012, 184(12) 1373
Analysis
mechanisms linking physical punishment and all found a significant positive relation, re -
child aggression. gardless of the size of the sample, location of
By the 1990s, it was recognized that the study, ages of the children or any other variable.
method by which causality is typically shown in Almost all adequately designed studies con-
scientific studies — the randomized control ducted since that meta-analysis have found the
trial — had limited application for studying the same relation.19–23 In a randomized controlled
physical punishment of children. Although ran- trial of an intervention designed to reduce diffi-
domized control trials can be used to study the cult child behaviours,24 parents in more than 500
effect of reducing physical punishment (as in the families were trained to decrease their use of
Forgatch study), they cannot be used to study the physical punishment. The significant parallel
effect of imposing such punishment because it decline seen in the difficult behaviours of chil-
would be unethical to assign children to a group dren in the treatment group was largely
receiving painful treatment when research sug- explained by the parents’ reduction in their use
gests that such pain poses harm not outweighed of physical punishment. Together, results consis-
by potential benefit. The few existing randomized tently suggest that physical punishment has a
control trials showed that physical punishment direct causal effect on externalizing behaviour,
was no more effective than other methods in elic- whether through a reflexive response to pain,
iting compliance. In one such study, an average modeling or coercive family processes.
of eight spankings in a single session was needed By 2000, research on physical punishment had
to elicit compliance, and there was “no support expanded beyond its effect on child aggression.
for the necessity of the physical punishment.”10 Studies were showing associations between physi-
To address the causality question within ethi- cal punishment and mental health, physical injury,
cal bounds, researchers designed prospective parent–child relationships and family violence in
studies involving children who had equivalent adulthood. One of the first such studies25 linked
levels of aggression or antisocial behaviour at the slapping and spanking in childhood with psychi-
beginning of the study. In addition, increasingly atric disorders in adulthood in a large Canadian
sophisticated statistical modeling techniques sample, and its findings have since been supported
were applied to correlational studies to aid by an ever-growing number of studies. Physical
understanding of the results. These studies punishment is associated with a range of mental
changed the way in which physical punishment health problems in children, youth and adults,
would be researched over the subsequent decade including depression, unhappiness, anxiety, feel-
and redrew the landscape of the debate. ings of hopelessness, use of drugs and alcohol,
and general psychological maladjustment.26–29
The new millennium: addressing These relationships may be mediated by disrup-
tions in parent–child attachment resulting from
causation and broadening focus pain inflicted by a caregiver,30,31 by increased levels
of cortisol32 or by chemical disruption of the
One of the first large prospective studies (1997, brain’s mechanism for regulating stress.33 Re-
n = 807) controlled for initial levels of child anti- searchers are also finding that physical punish-
social behaviour and sex, family socioeconomic ment is linked to slower cognitive development
status and levels of emotional support and cogni- and adversely affects academic achievement.34
tive stimulation in the home.11 Even with these These findings come from large longitudinal stud-
controls, physical punishment between the ages ies that control for a wide range of potential con-
of six and nine years predicted higher levels of founders.35 Intriguing results are now emerging
antisocial behaviour two years later. Subsequent from neuroimaging studies, which suggest that
prospective studies yielded similar results, physical punishment may reduce the volume of
whether they controlled for parental age, child the brain’s grey matter in areas associated with
age, race and family structure;12 poverty, child performance on the Wechsler Adult Intelligence
age, emotional support, cognitive stimulation, Scale, third edition (WAIS-III).36 In addition,
sex, race and the interactions among these vari- physical punishment can cause alterations in the
ables;13 or other factors.14–17 These studies provide dopaminergic regions associated with vulnerabil-
the strongest evidence available that physical ity to the abuse of drugs and alcohol.37
punishment is a risk factor for child aggression These findings are all consistent with the
and antisocial behaviour. growing body of literature on the impact of ad-
A landmark meta-analysis published in 200218 verse childhood experiences on neurological,
showed that of 27 studies on physical punish- cognitive, emotional and social development, as
ment and child aggression conducted up to that well as physical health.38 Although some studies
time (that met the criteria of the meta-analysis), have found no relation between physical punish-
ment and negative outcomes,35 and others have leagues.48 In these programs, parents are taught
found the relation to be moderated by other fac- to observe their children’s behaviour, communi-
tors,12 no study has found physical punishment to cate clearly and apply contingent consequences.
have a long-term positive effect, and most stud- Meta-analyses of studies evaluating these pro-
ies have found negative effects.17 grams show positive effects on the competence,
Another major change in the landscape was efficacy and psychological health of the parents,
precipitated by research that questioned the tra- as well as on the behaviour of the children.49,50 A
ditional punishment–abuse dichotomy. Although recent implementation study of a strategy for
research began to accumulate in the 1970s that parenting and family support showed that fami-
showed that most physical abuse is physical pun- lies in the treatment group had far fewer cases of
ishment (in intent, form and effect), studies of substantiated child maltreatment, abuse injuries
child maltreatment have since clarified this find- and out-of-home placements.51
ing. For example, the first cycle of the Canadian The consistency of research findings on phys-
Incidence Study of Reported Child Abuse and ical punishment and positive discipline, along
Neglect39 (CIS 1998) showed that 75% of sub- with growing support for the aims of the Con-
stantiated physical abuse of children occurred vention on the Rights of the Child, has had a
during episodes of physical punishment. This substantial impact on the views of health care
finding was replicated in the second cycle of the providers. The Canadian Paediatric Society,
study (CIS 2003). 40 Another large Canadian “strongly discourages [original emphasis] the
study41 found that children who were spanked by use of physical punishment on children, includ-
their parents were seven times more likely to be ing spanking.”52 The American Academy of Pedi-
severely assaulted by their parents (e.g., punched atrics cautions that “corporal punishment is of
or kicked) than children who were not spanked. limited effectiveness and has potentially deleteri-
In an American study,42 infants in their first year ous side effects,” and “recommends that parents
of life who had been spanked by their parents in be encouraged and assisted in the development
the previous month were 2.3 times more likely to of methods other than spanking for managing
suffer an injury requiring medical attention than undesired behavior.”53
infants who had not been spanked. Studies of the It is now 20 years since Canada ratified the
dynamics of child physical abuse have shed light Convention on the Rights of the Child, which
on this process, which involves parents attribut- calls for the elimination of all forms of violence
ing conflict to child willfulness43 and/or rejec- against children, including physical punishment.
tion,44 as well as coercive family dynamics9 and The debate has moved beyond discussions of out-
conditioned emotional responses.45 comes and causality to those of ethics and human
The mounting evidence linking negative long- rights. This new context for examining physical
term outcomes to physical punishment has con- punishment has propelled legal, policy and attitu-
tributed to a global shift in perceptions of the dinal changes worldwide.47 An increasing number
practice. In Canada, more than 400 organizations of countries are abolishing the use of physical
have endorsed the Joint Statement on Physical punishment to better protect children and to shift
Punishment of Children and Youth.46 A subset of parents’ focus from punishment to guidance and
these organizations is listed in Appendix 1 (avail- effective discipline. Evidence is emerging that the
able at www.cmaj.ca/lookup/suppl/doi:10.1503 combination of law reform and public education
/cmaj.101314/-/DC1). In other countries, legisla- is more effective than either strategy alone in
tive reforms have been instituted to better protect changing parental attitudes and behaviours.54
children. 47 Accompanying these changes has Physicians have a primary responsibility for
been a growing emphasis on developing models translating research and evidence into guidance
of positive discipline that rely on nonviolent and for parents and children, and they are credible
effective conflict resolution. and influential voices for advancing public edu-
cation and policy concerning population health.
For example, physicians can educate parents on
The future: promoting nonviolent child development to reduce angry and punitive
parenting responses to normative child behaviours and pro-
vide resources on positive discipline.46 In addi-
There is considerable evidence that providing tion, physicians may refer parents to public
support and education to parents can reduce their health programs, resource centres, positive par-
use of physical punishment and children’s exter- enting programs and other clinical professionals
nalizing behaviours. Most of the programs that for further support. Furthermore, physicians can
have been evaluated are behaviourally based, engage with other professionals to send clear,
with origins in the work of Patterson and col- unambiguous messages on a population level.
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