Should You Spank Your Child?

Physical punishment of nonabused children linked to mental health

(RxWiki News) Discipline of children is a notoriously controversial topic. The effectiveness of spanking and other forms of physical punishment have been debated for years. Is there a better form of discipline?

More and more evidence is surfacing that supports the American Academy of Pediatricians' stance against any form of physical punishment, and a recent study in the AAP's official journal adds to that evidence.

The large-scale study has found links between the risk of developing a mental disorder as an adult and a history of being spanked or otherwise physically punished as a child - even if it was just "sometimes" and the child did not grow up in an otherwise abusive home.

"Use positive reinforcement, not spanking, to discipline children."

Tracie O. Afifi, PhD, of the Departments of Community Health Sciences, of Psychiatry and of Family Social Sciences at the University of Manitoba in Canada, led a study looking at the long-term effects of physical punishment of children.

Afifi and her co-authors especially wanted to study long-term outcomes of children who received physical punishment such as spanking, smacking, grabbing, slapping or hitting - but did not experience more severe child abuse.

The children they studied therefore did not have a history of physical, sexual or emotional abuse or neglect and did not grow up in a home with domestic violence between adults in the home. Physical abuse was defined as anything that left a bruise or mark or caused an injury.

Their data came from 34,653 adults over age 20 who were involved with the US National Epidemiological Survey on Alcohol and Related Conditions, collected between 2004 and 2005 with face-to-face interviews by US Census Bureau trained interviewers.

The adults were asked whether they had experienced a range of punishments and other events before age 18 on a scale of "never, almost never, sometimes, fairly often and very often."

Adults who answered "sometimes" or more often were classified as having experienced "harsh physical punishment" for the study. Six percent of the adults had experienced harsh physical punishment without accompanying physical, sexual or emotional abuse or neglect.

The researchers looked for associations between a range of mental health disorders and physical punishment while taking into account the person's gender, age, the marital status, race/ethnicity, level of education and household income.

They also took into account whether someone had grown up in a dysfunctional household without abuse or neglect, which included growing up with an adult who had gone to jail or prison, who had an alcohol or drug problem, who had a mental illness or who had attempted or died by suicide.

They found that adults who had experienced harsh physical punishment as children were 1.3 to 2.5 times more likely to have mood and anxiety disorders, substance abuse or dependence and personality disorders, depression, alcoholism or bipolar disorder, as compared to the general population.

In fact, about 2 to 7 percent of the mental health problems occurring within the study population appeared linked to physical punishment during childhood, the authors wrote.

The children who had received physical punishment had a higher likelihood of all the disorders studied, but the associations with schizophrenia, obsessive-compulsive disorder and social phobia no longer existed once the researchers took into account other factors, such as demographics and a dysfunctional family history.

The researchers noted that this study adds to a body of additional recent literature that links poor long-term outcomes to physical punishment such as spanking. The AAP's official statement on the subject officially opposes hitting a child for any reason.

"This study is incredibly valuable. As a mental health practitioner, I see adults everyday who have mild to severe mental health problems that seemingly have no biological origin," LuAnn Pierce, a licensed clinical social worker, told dailyRx.

"As I become better acquainted with [a client's] early history, it is fairly common to see a correlation of abusive or aggressive behavior directed toward the client as child," she said. "This includes verbal and emotional abuse, a behavior that few who engage in it are able to recognize."

Pierce noted that the first step to curbing this practice is for people to recognize that they are doing it and the harm it can cause.

"The minimization of physical, verbal and emotional abuse by both victims and those who practice it is mired in denial and very difficult to address," Pierce said. "Perhaps this study and others to come will help address this defense of behavior that 32 other countries have recognized as damaging and inappropriate."

An alternative to physical punishment can be using time-outs. The rule of thumb that pediatricians recommend is one minute of observed time-out for each year of a child's age.

One limitation of the study is that it was a "cross-sectional" design, which means it only assessed adults' answers and illnesses at one point in time instead of across the adult's long-term history. There could also be errors from misremembering if the adults interviewed did not recall their childhoods accurately.

The researchers said the study could not establish that the physical punishment caused the mental illnesses the people experienced as adults, only that adults who had been physically punished even sometimes were more likely to have mental health disorders.

The study was published online July 2 in the journal Pediatrics. The research was funded by a Manitoba Medical Services Foundation Award, a Winnipeg Foundation award, a Manitoba Health Research Council establishment award, a Canadian Institutes of Health Research New Investigator award and a Manitoba Health Research Council Chair Award. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
July 2, 2012
Last Updated:
December 5, 2012