New Study: Harsh Discipline is Associated with More Behavioral Problems

There was an interesting study published online this week in the journal Pediatrics:

 

The most important finding of this study was that harsh discipline tactics don’t lead to healthy, well-behaved children.

This was a longitudinal study (meaning that the same groups of kids were studied at several different time points) of Australian children in which 5107 infants (3-19 months) were monitored several times up until age 4-5 years and 4983 preschoolers (4-5-year-olds) were monitored up until age 8-9 years.  Between enrollment in the study and the final assessment, 86% and 87% of the infants and preschoolers, respectively, remained in the study.  That makes this a relatively large study with a good retention rate. 

Child mental health was assessed with the Strengths and Difficulties Questionnaire.  The SDQ, which can be downloaded in just about any language HERE, asks the parent or caregiver to mark whether statements about their children are “not true,” “somewhat true,” or “certainly true.”  For example, the SDQ asks if your child is “restless, overactive, cannot stay still for long,” or is “nervous or clingy in new situations, easily loses confidence.”

The study authors used the SDQ to determine if children had symptoms of externalizing or internalizing mental health problems.  Externalizing problems are related to aggression and oppositional defiance.  Internalizing problems include anxiety and depression.  Among the kids in this study, 20% had externalizing problems and 24% had internalizing problems at 6-7 years of age.  In the 8-9-year-old group, 17% had externalizing and 24% had internalizing problems. 

The researchers measured a wide array of potential risk factors for mental health issues, including family factors (such as mother’s age, education, single parent home, socioeconomic status), child factors (sex, race, physical health, language development, sibling), parenting practices, mother’s mental health, various family life stressors (conflicts, grief/illness, job quality), and community factors (type of childcare, rough neighborhoods).  I would say that the study was fairly comprehensive in measuring a wide range of factors that might influence a child’s mental health.  However, a major limitation of the study was that they didn’t look at the fathers at all, except for noting whether or not they were present – nothing on the fathers’ mental health or parenting practices. 

The researchers built statistical models in which they tried to explain the children’s mental health outcomes using all of those risk factors that I just listed.  They found that 20-30% (depending on the group) of mental health problems were associated with the risk factors I listed above.  The other 70-80% are associated with factors that the study didn’t examine, such as genetics, exercise, diet, or factors related to the kids’ fathers.  20-30% doesn’t seem like much, but that isn’t surprising when you consider that behavior and mental health are so complicated. 

Here are the most important findings of this study:

Of all of the potential risk factors that I listed above, harsh discipline was the strongest and most consistent predictor of externalizing problems in both age groups evaluated.  That is, as defined in this study, kids that were smacked or yelled at were more likely to be aggressive and defiant. 

Internalizing problems (anxiety and depression) were also higher in kids who were harshly disciplined, but in addition were consistently associated with kids with health problems, only children, and maternal emotional stress.  In the 4-5-year-olds, over-involved and over-protective parenting styles were also associated with internalizing problems.

A limitation of any longitudinal study like this one is that it is purely observational.  It can show that factors are associated with one another, but it can’t prove a causal relationship.  That is, this study can’t prove that harsh discipline causes more behavioral problems, it only says that kids that are disciplined harshly also have more behavioral problems.  This can lead to chicken and egg type questions.  For example, it is possible that kids that the kids are disciplined harshly because for whatever reason they have more behavioral problems, and their parents just don’t know how else to respond.  Finding out if harsh discipline makes the situation worse would require a study with an intervention – something that would compare two groups of kids, one whose parents had coaching on respectful, nonviolent discipline and another whose parents did not.  Either way, this study does show that in kids with behavioral problems, yelling and hitting are not an effective discipline strategy.  If harsh discipline worked, then the study would have shown that it was associated with kids without problems.

I wasn’t surprised by these findings, and you probably aren’t either.  Here’s why the study is important:  It gives people who work with young kids and their parents specific risk factors to watch for.  Pediatricians, educators, and social workers can use these factors to identify high-risk kids, check in with them, and talk with kids and their parents about mental health.  They might mention that hitting and yelling at kids doesn’t resolve their behavioral problems, at least not in Australia.

One surprise finding…

Mothers who had at least two alcoholic drinks per day had kids with fewer externalizing and internalizing problems.  Having been on the science side of research before, I can just imagine the authors of this study groaning when they found this result.  They tried to find another way to explain it but couldn’t.  That’s science for you.  It doesn’t always make sense.  The authors of this study guess that this particular finding is “attributable to chance.”  It is more fun to imagine that these moms put their feet up and enjoyed a couple of glasses of wine after the kids went to bed, maybe helping to offset some of that maternal emotional distress. 

Pure speculation on my part (NOT medical advice!), but on that note, I think I’m done for the night:)

Discipline for Babies?

I’ve been thinking about discipline lately.  I know the time is coming when we’ll have to set some boundaries for BabyC.  Given how quickly these last 9 months have flown by, I know that time is coming soon – or is it here already?  I want to be prepared, but just the word “discipline,” makes panic rise up in my heart. 

An infant’s needs are straight-forward enough:  feed, diaper, help to sleep (OK, that one is tough), rinse, repeat, over and over.  Luckily, it doesn’t take much thought to meet a young infant’s needs, which is good, because we were too sleep-deprived to think much during that time.  But as BabyC gets older, she is more aware of how we react to events.  She notices the expressions on our faces and the emotions in our voices.  She is observing, processing, and remembering the new things that she is learning every day.  Her little personality is starting to shine, and it is a reflection of both the way her brain is wired and of her time spent with us, her parents.  She is reaching an age at which she will need some guidance about how to behave in the world and help to understand what is appropriate and what is not, not to mention what is safe and what is not.  It is up to us to provide her with that guidance, and that scares the hell out of me.

What got me thinking about discipline was a visit a couple of weeks ago from our good friends and their 15-month-old super-cute toddler, BoyO.  They stayed with us for a week, and our house was pretty much consumed with babies during their stay.  We lived in the same town until a few months ago, and we relied heavily on these friends to give us baby-raising advice, since they had gone through everything 6 months before us.  They came to the hospital the night I was in labor, toting along their 6-month-old and a pizza to fortify my husband and mom.  At the time, I remember thinking that their little boy was HUGE – practically a teenager already compared to the tiny peanut we’d have by the next morning.  But a couple of weeks ago, as we watched BoyO and BabyC play together, they suddenly seemed more like peers, and I knew BabyC would practically be a teenager soon, too.

BabyC:  Watcha got there, BoyO?

BoyO:  Hands off, BabyC!

BoyO is no longer a baby.  He is a toddler, and an assertive one at that.  During their visit, he tested his parents again and again.  I admired how they responded, consistently, again and again.  Over the course of the week, we watched how he learned which things in our house were off limits (the fireplace, the dog, the toilet, and the stairs).  BoyO dealt with all of this pretty well, but when he was tired of being told “no,” he wore his frustrations on his sleeve.  Actually, he did seem like a teenager in a way, sometimes unable to handle his emotions and sometimes wanting more independence than he could really handle.  At times, this struggle was more than he could bear.  He did at one point wind up to hit BabyC when she pulled a toy out of his hand.  And sometimes he was just about more than his parents could bear, particularly on a gorgeous evening when we were all supposed to be enjoying a picnic and wine, but BoyO was seeking out every off-limits corner of the winery grounds.  But then there was a moment of pure sweetness when BabyC bonked her head on something and started crying, and BoyO came over to gently pat her on the back, his face as full as empathy as a toddler's can be.

My BabyC seemed oblivious to all of this, but what I saw in BoyO and his parents was our rapidly approaching future.  The time would come when we would have to set and enforce limits for BabyC.  Would we be able to handle it as well as BoyO’s parents?

BoyO’s mama told me that he turned into a hellion (her word) at 10 months, suddenly hitting and biting to show his frustration.  She said it took her by surprise, because it happened so quickly and she hadn’t imagined that she would need to discipline her baby.  And so it took about a month for her and her husband to begin to implement a game plan for handling BoyO, but once they did, it worked wonders.  Now they enforce boundaries with firm and quiet voices and use short time-outs and redirection.  A few months ago, when BoyO started throwing food from his high chair, his parents decided that was a signal that mealtime was over.  They’re pretty sure that he lost a little weight during the week that he was learning that lesson, but we never saw BoyO throw food while they were visiting. 

Initially, I watched and admired BoyO and his parents struggle to define boundaries and felt lucky that my baby hadn’t yet reached this challenging stage.  But then I started to think about what boundaries she has already tested and how many times I had responded by thinking, “She’s just a baby, she’s too young to understand right from wrong.”  BabyC started attacking the cat at around 7 months, and we laughed at how tolerant the cat was to having her ears boxed and her tail pulled.  Then, a couple weeks ago, I watched BabyC wind up for a similar attack on another baby at story time at the library.  Whoa, who taught her that behaving like that was OK?

BabyC looks maniacal here.  The cat was just happy for any attention after being upstaged by first a dog and then a baby over the last few years.  Husband and I laughed, inappropriately.

Then I remembered the one time that I have effectively defined a boundary for BabyC: when she started biting while nursing, at about 7 months old.  That behavior was not one that I could laugh about or put off dealing with.  It was painful, and it was impossible to not respond.  But again, it took me off guard and took me some time to figure out how to respond appropriately. 

The first few times it happened, I think I said “OWWW” loudly and pushed her off but then continued nursing once I had pulled myself together.  Then came the time that BabyC bit me, watched my response, and then grinned at me with glee:  “Mama, isn’t this game FUN?!”  No, BabyC, it is not.  I said my firmest “NO” (I have had a lot of practice with that voice with my dog), quietly removed BabyC from my breast, and set her on the ground.  She looked up at me inquisitively, and I ignored her.  I think I had to do that one other time before the biting stopped.  It turns out that BabyC is not too young to learn – maybe not right from wrong – but at least what games I do and don’t find fun.

So, this discipline thing is new territory for Husband and I, but we’ve decided that it is time to set and enforce some limits – no more attacking the cat, no more standing in the bathtub, and absolutely no biting.  We’ve started talking about what our discipline style will be, which is fodder for another post, because our own parents had very different styles.  I recently read this post and the resulting discussion from the “regarding baby” blog (It IS Possible To Discipline Children Effectively Without Shame- A Very Personal Post), and that solidified my intention to discipline with respect and to absolutely exclude physical punishment from our discipline strategy. 

 

When did you find that you had to start setting boundaries for your baby?  And what worked for you?  We need all the help we can get!