Teaming Up To Change Child Discipline

Most parents have had that moment when their much-beloved child sparks a rush of anger or fear. A rambunctious 3-year-old smashes a family heirloom. A frustrated grade-schooler throws a punch on the playground. A teen comes home after curfew, reeking of alcohol. In such moments, the best immediate response isn’t always obvious, and the easiest places to search for help aren’t always the most reliable. The internet, fellow parents, one’s own parents, self-help books—all offer well-meaning advice, but of sometimes dubious quality. Some of this advice, such as “spare the rod and spoil the child” or time-outs of escalating length and severity, has been thoroughly, decisively debunked. It’s no wonder many parents struggle, and that some turn to corporal punishment, which has been shown to be ineffective and potentially harmful. Though rates of spanking are on the decline in the United States, a 2014 nationally representative survey found that spanking peaks at ages 3 and 4, when just over 60 per cent of kids are spanked (Finkelhor, D., et al., Journal of Child and Family Studies, Vol. 28, No. 7, 2019).

Psychologists are helping parents and caregivers make better child discipline decisions through their work on a variety of fronts. Basic and applied researchers are unearthing the fundamentals of child development and emotional regulation and studying how physical punishment affects both. Translational scientists are developing and testing interventions that can change the way parents and children interact. And implementation experts are bringing those intervention programs to the public. Psychologists often wear many hats and collaborate closely with other professionals, such as social workers or professional counsellors, who ultimately do much of the hands-on work with families. Psychologists also work closely with those outsides of the social science professions, collaborating with lawyers, educators, clergy and other child advocates to push for changes in the policy sphere. This advocacy includes a resolution passed by APA’s Council of Representatives in February 2019 that opposes the physical discipline of children (see Protecting children). “Psychologists are professionals whom parents turn to and trust when it comes to these issues,” says Elizabeth Gershoff, PhD, a professor of Human Development and Family Sciences at the University of Texas at Austin, who researches physical discipline’s effects on children. “It’s also important because APA is seen as a voice for children in D.C. and across the country, so when we take a stand on an issue related to children, it really has weight.”

Disciplinary matters

Data collected by the United Nations Children’s Fund (UNICEF) suggest that counterproductive and damaging physical discipline is still the standard globally. According to a 2017 report based on representative samples from 30 countries, 60% of 2- to 4-year-olds around the world experience regular physical punishment. When psychologically aggressive methods such as shouting and name-calling are included with physical discipline, the number rises to 75%. In addition, more than a quarter of caregivers surveyed said that physical punishment is not only fine but in fact necessary to properly raise children (“Violent Discipline,” UNICEF, 2017). It took decades to accumulate the evidence showing that physical punishment is not effective, Gershoff says. Because researchers can’t ethically assign children to experimental conditions in which they’ll be hit, researchers have had to lean on prospective studies and longitudinal research, such as a study of 11,044 children from kindergarten through third grade by Gershoff and colleagues that found that spanking in kindergarten predicted increases in externalizing behaviour such as fighting or argumentativeness in third grade across all racial and ethnic groups (Child Development, Vol. 83, No. 3, 2012). The results of this and other studies repeatedly point to the conclusion that physical discipline leads to increased aggression and antisocial behaviour in children, a conclusion borne out by multiple meta-analyses, including a recent one by Gershoff and social work professor Andrew Grogan-­Kaylor, PhD, of the University of Michigan (Journal of Family Psychology, Vol. 30, No. 4, 2016).

Research across disciplines has also revealed the sometimes blurry lines between physical discipline and outright abuse. For example, a prospective study led by University of Michigan Social Work Professor Shawna Lee, PhD, found that children spanked at age 1 had a 33% higher likelihood of becoming involved with Child Protective Services by age 5 (Child Abuse and Neglect, Vol. 38, No. 5, 2014). Meanwhile, basic neuro­science research has found that harsh corporal punishment might change the brain in maladaptive ways. One study led by Yi-Shin Sheu, PhD, a neuroscientist at Johns Hopkins University, found changes in dopaminergic cells in young adults who had been harshly physically disciplined as children, alterations that the researchers hypothesized could be linked to greater risk for drug or alcohol abuse (Neuroimage, Vol. 53, No. 2, 2010). Another study, led by Akemi Tomoda, MD, PhD, of Harvard Medical School, found reduced prefrontal cortical grey matter volume in young adults who’d been subject to harsh corporal punishment as children, particularly in areas linked to self-knowledge and to understanding other people’s perceptions and behaviours (Neuroimage, Vol. 47, Suppl. 2, 2009).

Alternative discipline

So how can parents do better? Research suggests that positive parenting methods are the answer. These methods are informed by basic research in fields as diverse as attachment theory, social learning theory, emotional regulation and intrinsic motivation. Parents can get help in several ways. They might seek out or be referred to formal parenting programs, or they might turn to self-help or individual counselling. Relatively widespread examples of the former include The Incredible Years, a programme developed by Carolyn Webster-Stratton, PhD, now a Professor Emeritus at the University of Washington, which is delivered in group formats that encourage responsive parenting and increase support networks for families, and the Triple P–Positive Parenting Program, which delivers services at multiple levels of intensity, from brief child-rearing seminars to intensive group or individual counselling, and was developed by psychologist Matt Sanders, PhD, of the University of Queensland. ACT Raising Safe Kids, a programme developed and coordinated by the APA Violence Prevention Office, aims to help parents create nurturing, healthy environments that prevent abuse by teaching them child development, positive discipline strategies, positive communication skills and emotional regulation. Each of these programmes uses slightly different delivery approaches and strategies, but all focus on showing parents how to set age-appropriate expectations and boundaries, and how to respond calmly and clearly when a child misbehaves. In The Incredible Years Program, instructors teach non-punitive time-out strategies to parents and kids with a “Tiny Turtle” puppet, which retreats into its shell to calm down when feeling angry or frustrated. Each programme also teaches strategies for encouraging good behaviours, such as praise and positive attention. Parents also get support for their own emotions. ACT Raising Safe Kids, for example, includes anger-management strategies for caregivers.

Evaluations of positive parenting programmes have found that they work. A meta-­analysis led by Ankie Menting, PhD, a psychologist at Utrecht University in the Netherlands, found that The Incredible Years Program is effective at reducing disruptive childhood behaviour in a wide range of populations (Clinical Psychology Review, Vol. 33, No. 8, 2013). Likewise, a meta-­analysis and systematic review of 33 years of studies on the Triple P–Positive Parenting Program led by Sanders, its developer, found both short-term and long-term gains in both parenting practices and children’s behavioural and emotional outcomes (Clinical Psychology Review, Vol. 34, No. 4, 2014). ACT Raising Safe Kids has also been found effective at improving parenting practices and child behaviour in multiple socioeconomic classes and cultures (Pedro, M.E.A., et al., Psychosocial Intervention, Vol. 26, No. 2, 2017). Part of the APA Violence Prevention Office’s efforts in coordinating the ACT Raising Safe Kids Program includes recruiting researchers, especially early-­career researchers, to evaluate its efficacy, says Julia da Silva, who directs the Violence Prevention Office and is the programme developer and coordinator.

Self-help advice

Evidence-based parenting advice is also available in the do-it­-yourself form, through popular books such as “1-2-3 Magic: 3-Step Discipline for Calm, Effective, and Happy Parenting.” This book’s method, which involves providing children clear instructions and a warning count to three before delivering consequences for misbehaviour, has been shown to reduce dysfunctional parenting and problem behaviour by children for up to two years, according to research by Renata Porzig-Drummond, PhD, a clinical psychologist and lecturer at the Australian College of Applied Psychology in Sydney (Behaviour Research and Therapy, Vol. 58, 2014). Alan Kazdin, PhD, Emeritus Professor of Psychology and Child Psychiatry at Yale University, penned a self-help version of the parent management training he and his colleagues developed over years of working with children with conduct disorder, oppositional defiant disorder and other psychiatric disorders. He disseminates his work through two books (“The Kazdin Method for Parenting the Defiant Child” and “The Everyday Parenting Toolkit”) and a free online course on the website Coursera (“Everyday Parenting: The ABCs of Child Rearing”). His method involves strategies like offering children choices, which has been shown to be particularly effective at boosting intrinsic motivation in kids, according to a meta-analysis led by University of Southern California psychologist Erika Patall, PhD (Psychological Bulletin, Vol. 134, No. 2, 2008). Overall, Kazdin’s work has been shown to be effective at reducing antisocial behaviour and improving adaptive functioning in children with serious conduct problems (International Journal of Clinical and Health Psychology, Vol. 18, No. 2, 2018).

Parents, especially those with greater socioeconomic resources, may also seek out individual practitioners for help. Ilyse DiMarco, PhD, ACT, found that when she established her private practice in Summit, New Jersey, she attracted quite a few parents, particularly moms, looking to manage their anxieties and emotions around parenting. DiMarco had been trained in using cognitive-­behavioural therapy (CBT) to treat generalized anxiety disorder, obsessive-compulsive disorder and other mental disorders, but has found it to be helpful for parents without a specific diagnosis. “I’m adapting research-supported treatment to moms,” DiMarco says. As these differing approaches show, there’s no one path from basic research through programme development to dissemination. DiMarco’s clinical work has shown an unmet need, she says. She’s now working on a book on CBT for parents. Webster-Stratton, the developer of The Incredible Years, started out as a nurse practitioner working on public health outreach in Africa and ended up developing a parenting program used worldwide. Kazdin says he resisted translating his clinical work for a popular audience until he started getting requests from overwhelmed parents and surveyed the available self-help titles. Parenting-book authors “were saying things that we know from research to be completely inaccurate and false,” Kazdin says. “It was just endless: ‘If a little bit of time-out doesn’t work, make time-out four or five hours.’ What does the research show? About two minutes is enough.”

Developing an intervention, though, is often just a first step. For one thing, translational and applied work can further inform basic science, says James Gross, PhD, a clinical psychologist who runs the Psychophysiology Laboratory at Stanford University. Gross studies emotional regulation, but his team has also developed programmes to help parents of children with autism regulate their own emotions. They’ve also studied emotional regulation across development. Doing intervention work has made Gross’s basic research stronger, he says. His lab’s studies suggested that people use different strategies depending on whether they’re working to change their emotions or just hide them. Some of these strategies are more helpful than others. But in clinical work, Gross says, it has become clear that many people make regular use of emotion regulation strategies that typically aren’t helpful and fail to use strategies that typically are helpful. “Just finding out that certain emotion regulation strategies are more helpful than others in particular situations isn’t enough,” Gross says. “What is needed is a more complete understanding of why people make the emotion regulatory choices they do, and how they can be helped to make more adaptive choices.”

Reaching out and scaling up

Perhaps the most difficult challenge in supporting parents is reaching them where they are. Books are one way to do that, but rising above the competition can be difficult. “There are plenty of parenting books and maternal mental health books that are not using research-­supported principles and yet are widely consumed,” DiMarco says. Nonetheless, given the barriers to accessing mental health professionals, she says, a popular book can get evidence-based information into many people’s hands at little cost. For a programme like The Incredible Years, outreach is a major factor.  Getting it out of the university clinical setting, where it started in the 1970s, and into schools and agencies took a new skill set, says Webster-­Stratton. Teachers needed to be convinced of the benefit of partnering with parents, she says, and parents needed to see parenting support as helpful, not punitive. The researcher pitched The Incredible Years Program as a social opportunity for families and as something normative for all parents, not just those in crisis. “It was set up like, ‘You do prenatal classes, so this is just another thing that you do for your child,’” she says. The Incredible Years Program has been shown in randomized controlled trials to work better than eclectic, non-structured therapies in mental health centres (Taylor, T.K., et al., Behavior Therapy, Vol. 29, No. 2, 1998). It’s also proved effective in a variety of types of families, including those with serious stressors. Utrecht University’s Menting and colleagues found, for example, that a version of The Incredible Years enhanced with home visits by trained staff improved parental discipline practices and maternal reports of children’s behaviour in families in which the mother had just been released from incarceration (Journal of Clinical Child & Adolescent Psychology, Vol. 43, No. 3, 2014).

One major barrier to access, Webster-Stratton says, is that parenting education is often an afterthought for many organizations providing services to parents. A non-profit might have a little extra cash in its budget and decide to purchase a programme like The Incredible Years, she says—but without a long-term vision for its promulgation, the programme is likely to fizzle. Most organizations that provide services to families are local, low-budget offices with limited ability to pay and retain staff, says da Silva. APA’s Violence Prevention Office works to keep the cost of the ACT Raising Safe Kids Program low, she says, making it accessible not just in the United States but around the world.

Scalability is a persistent hurdle to many programmes’ success, says psychologist Will Aldridge II, PhD, an advanced implementation specialist and the Director of The Impact Center at the Frank Porter Graham Child Development Institute at the University of North Carolina at Chapel Hill. Aldridge and his team help organizations and governmental entities address that challenge and implement evidence-based programmes like the Triple P–Positive Parenting Program. The job, Aldridge says, involves offering very specific recommendations about staffing and organizational structure to help programmes succeed. “The biggest challenge is to get people to work together in a sustainable way,” he says. “That’s where having a background in psychology or a behaviour-change field can be very helpful.” The process of implementation can also feedback into the process of programme development. For example, Aldridge says, programme developers don’t always nail down the precise mechanism of action to explain why their programme works. The process of implementation makes figuring out the mechanisms crucial, he says, because knowing them makes it easier to determine the structures and systems needed for delivery.

This boundary-blurring, bi-directional work is common among psychologists working in a field with as much immediate impact as child discipline. And there is still much to be done. Research on how policy and legislation around corporal punishment affect its use is lacking, Gershoff says, although one study led by Nathalie DuRivage, MPH, of Columbia University and psychiatrist Viviane Kovess-Masfety, MD, PhD, of McGill University did find that parents in European countries where physical discipline is illegal used corporal punishment 1.7 times less frequently than parents in countries without bans on physical discipline (PLOS ONE, Vol. 10, No. 2, 2015). There is also work to be done in the public sphere, Gershoff says. While an outright ban on spanking seems politically unlikely in the United States, she says, the passage of bans on physical punishment in schools has more public support (corporal punishment in schools is legal in 19 states). There has also been a trend toward establishing “no-hit zones” in places such as hospitals and city government buildings, which discourages physical punishment on a local level. “There has also been collaboration across disciplines in advocacy, which is really encouraging,” Gershoff says. “That’s the only way change is going to happen.”

Credit: Stephanie Pappas for the American Psychological Association, 1 October 2019.