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842 SUPPLEMENT

have a warning notice to that effect. Of course,

cor-poral punishment is only one of many causes of

violence. Consequently, even if all parents stopped

hitting their children, it would not mean the end of

violence. But, it is not unreasonable to think that it

might result in at least a 10% reduction in violence

and other crime. That would be a profound change

for the 10% who are spared these problems.

How-ever, there are also indirect victims. A much larger

percentage will be spared the pain of being

victim-ized by crime. An even larger number will be spared

the trauma of having a family member victimized. A

still greater number will be spared some of the

eco-nomic costs of crime and prisons and mental health

treatment. Although it is currently impossible to

know the percentages, and to be sure that some new

evil will not replace hitting children, the research

reviewed suggests that, in addition to many other

benefits,’7 a society in which parents never spank

will be a society with less violence and other crime.

ACKNOWLEDGMENTS

This work has been supported by the National Institute of

Mental Health grant T32MH15161 and the University of New

Hampshire.

I thank Sherry L. Hamby for valuable comments and

sugges-tions.

REFERENCES

1. Durant JE. Public attitudes toward corporal punishment in Canada. In:

l,:teriiationa! Sii:;:posiu:n on Violence in Childhood and Adolescence.

Bielefeld, Cermany: University of Bielefeld; 1994

2. Montague A, ed. Learni::g No::-Aggressio::: Tb:e Experience of Non-L iterate Societies. New York: Oxford University Press; 1978

3. Mattson ME, Pollack ES, Cullen JW. What are the odds that smoking will kill you? A,:: IPublic Health:. 1987;77:425-431

4. Levinson D. Family Violence ii: Cross-Cultural Perspective. Newbury Park,

CA: Sage Publications; 1989

5. Burns NM, Straus MA. Cross-National Difft’rences in Corporal Punisb:n:ent, Infant Hon:icide, and Socioecoi:omic Factors. Durham, NH: University of

New Hampshire; 1987

6. Straus MA, Donnelly D. Violence and crime. In: Straus MA, ed. Beating the Devil Out of Them: Corporal Punishinient in America,: Families. San Francisco, CA: Lexington/Jossey-Bass; 1994:99-120

7. Edfeldt AW. Violence Too:’ards Children: An Inter,:ationa! Forinulative .3tudl/. Stockholm, Sweden: Akademilitteratur; 1979

8. Hyman IA, Wise KH. Corpora! Punishn:ent in America:: Education.

Philadelphia: Temple University Press; 1979

9. Baron L, Straus MA. Four TI:eories of Rape’ in American Society: A State-Level Analysis. New Haven, CT: Yale University Press; 1988

10. Sears RR, Maccoby EC, Leven H. Patterns ofChild Rearing. Evanston, IL:

Row, Peterson and Company; 1957

11. Strassberg Z, Dodge KA, Pettit CS, Bates JE. Spanking in the home and children’s subsequent aggression toward kindergarten peers. Develop Psvchopatl:ologi,. I 994;6:445-461

12. Kessier R, Magee WJ. Childhood family violence and adult recurrent depression. IHealth: Soc Be!:. 1994;35:13-27

13. McCord J. Questioning the value of punishment. Soc Cml:. 1991;38: 167-179

14. Straus MA. Hitting adolescents. In: Straus M, ed. Beating the Devil (.)ut of Them: Corpora! P::,iislunent in American Families. San Francisco, CA: Lexington/Jossey-Bass; 1994:35-48

15. Tsang R. Social Stress, Social Lear?:i?:g, and An5’:’r as Risk Factors for Corpora! Pu,:ishn:ent. Durham, NH: Family Research Laboratory, Uni-versity of New Hampshire; 1995

16. Straus MA, Kaufman Kantor C, Moore D. Change in cultural norms

approving marital violence from 1968 to 1992. In: Annual meeting of the American Sociological Association; 1994; Los Angeles, CA

17. Straus MA. Beating tJ:’ Devil Out Tl:enz: Corporal Pu::islune::t in Ainer-ican Families. San Francisco, CA: Jossey-Bass! Lexington Books; 1994 18. Straus MA, Yodanis CL. Corporal punishment in adolescence and

phys-ical assaults on spouses in later life: what accounts for the link?

IMarriage Fat,:. In press

19. Berkowitz L. Aggressio::: its Causes, Consequences, a;::l Control. Philadel-phia, PA: Temple University Press; 1993

20. Straus MA. The conspiracy of silence. In: Straus MA, ed. Beating the Dcii! Out of Tl:t’;,i: Corpora! Pu,:isl:,?,ent in Anzt’rican Families. San Fran-cisco, CA: Lexington/Jossey-Bass; 1994

21. American Psychological Association and the American Academy of Pediatrics. Raising Children to Resist Violence: What You Ca,, Do. Elk

Crove Village, IL: American Academy of Pediatrics Division of

Publications; 1995

22. Sugarman DB, Straus MA, Ciles-Sims J. Corporal punishment and anti-social behavior: a longitudinal analysis. Arch: Pediatr Adolesc Med. In press

RESPONSE

Assessing

the

Causal

Effect

of

Childhood

Corporal

Punishment

on

Adult

Violent

Behavior:

Methodological

Challenges

Laurie

J.

Bauman, PhD

Professor Straus’ article addresses a key scientific

question in the debate over the use of corporal

pun-ishment: whether the practice has harmful

conse-quences to society. In my discussion I have three

goals. First, I want to discuss briefly some of the

methodological challenges in testing the hypothesis

that child corporal punishment causes societal

vio-lence. Second, I would like to set Straus’ work into a

From the Department of Pediatrics, Albert Einstein College of Medicine,

Bronx, New York.

PEDIATRICS (ISSN 0031 4005). Copyright © 1996 by the American

Acad-emy of Pediatrics.

larger framework so we understand its contribution

to the debate about corporal punishment, and how

the evidence he provides could be used to help settle the question. Last, I will suggest a scientific approach

to the study of corporal punishment that would

pro-vide a set of decision rules concerning whether to

accept or reject corporal punishment of children.

METHODOLOGICAL CHALLENGES

The issue of potential short- and long-term harm

from corporal punishment is a major theme in the

literature, and many studies have been conducted to

address this issue. In his article, Straus uses two

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SUPPLEMENT 843

kinds of evidence: data from studies of societies; and

studies comparing children who were spanked and

children who were not on rates of violent behavior in

adolescence or adulthood. There are several difficul-ties in using these scientific approaches.

Societal Level Studies

Straus references societal-level data from

Mon-tague’ on eight nonviolent societies, all of which

raise children without use of corporal punishment,

and anthropological studies of over 300 societies

archived in the Human Resources Area File. He

uses these data to examine whether corporal

pun-ishment is associated with violence such as assault,

homicide, or wife-beating. Although the stated

re-search question is to examine the causal

relation-ship of childhood corporal punishment to adult

violence, the evidence available from societal-level

studies cannot be used to document causality.

Straus admits this problem, and instead uses a

noncausal interpretation of these data-the

“cul-tural spillover” principle or the “violence breeds

violence” position. That is, if we find violent

prac-tices or behaviors in one part of a society, such as

in parenting practices, then we are likely to find it

in other parts as well, such as in higher rates of

domestic violence or assault. An alternative

expla-nation for the correlation between spanking and

societal violence might be that aversive and violent

behaviors in a society are all rooted in larger

cul-tural values and norms that govern the

acceptabil-ity, appropriateness, and use of violence to coerce

behavior change. Because societal level data such

as that found in the Human Relations Area File

cannot address the issue of causal direction, Straus

turns to the second methodological strategy

scien-tists have used to examine whether there is a

causal relationship between corporal punishment

and adult violence, and that is individual-level research studies.

Individual Level Research Studies

Using data from his own impressive research as

well as data from others, Straus summarizes the

evidence on whether children who experienced

cor-poral punishment are different from children who

did not in their proclivity toward violence in

adoles-cence and adulthood. And he goes further in the

quest to document causality by suggesting possible

processes or pathways between corporal punishment

as cause and violence as effect. These include anger,

the effect of modeling violent behavior, and the role

practice effect. Although individual level research

studies can be an appropriate methodological

strat-egy for examining causal relationships, there are

se-rious methodological challenges. Straus mentions

one in particular; that aggressive children may both

be more likely to be spanked and to be violent as

adults. Two other problems include the difficulty of

relying on retrospective reports and the limitations of cross-sectional data in causal analysis. A fourth

issue is the pervasiveness of corporal punishment as

a parenting practice. Statistically, it is difficult to

examine the consequence of a risk factor such as

spanking when its distribution is so skewed. Data

suggest that about 90% of parents either use

spank-ing or agree that it is sometimes justifiable. When a

behavior is so normative it is likely that people who

do not engage in it are different in many ways from

people who do. If the children of this special small

subgroup have better or worse outcomes than the

majority of children who are spanked, how can we

possibly attribute it to spanking practices alone?

Fur-ther the extent, nature, and intensity of spanking

behavior among those who spank is likely to be

strongly associated with other behaviors and values,

such as religious beliefs, region of the country, how

parents were disciplined, kind and level of

educa-tion, socioeconomic status, and ethnicity. All these

factors also affect a child’s proclivity to violence in

adulthood. Further, we must acknowledge that one’s

location in the social structure influences exposure to all kinds of violence-as both victim and perpetrator. Under these circumstances, it is very difficult scien-tifically to determine whether corporal punishment

is a cause or a result. Finally, spanking as a form of

discipline is rarely used in isolation from other

aver-sive disciplinary strategies. It becomes impossible to

disentangle the effects of spanking from other forms

of discipline when they so regularly co-occur. To

address the many methodological problems that

emerge when studying the effects of corporal

pun-ishment on adult violent behavior, future studies

must recruit large heterogeneous samples, use

im-maculate measurement, and use sophisticated

mul-tivariate models that control for confounding factors.

For research to provide definitive answers to the

question “Does corporal punishment cause adult

vi-olence?” we need prospective longitudinal and

the-oretically-driven studies that compare various causal mechanisms.

Experimental Designs

Scientifically, in cases where causal order is in

question, the methodological gold standard for

de-termining causal relationships is the experiment, or

randomized trial. In this instance such studies would call for randomly assigning children to experimental

conditions in which they were spanked or not

spanked. Little such research has been conducted.

Most scientists do not recommend an experimental

approach that uses spanking, perhaps because

hit-ting children is aversive-by definition it causes

pain, and is noxious and potentially risky. The fact

that some studies suggest possible harm from the

practice means that many would not risk testing the

effects of spanking using an experimental model.

Under these circumstances, our most powerful

sci-entific methods would not be available to address the

issue of whether spanking causes adult violence.

However, some have suggested that a “reverse”

ex-perimental model might be feasible. Because most

parents do spank, it might be possible to randomize

families that use corporal punishment to a

“stan-dard” control group, which would impose no change

in current practices, and a nonspanking experimental

group, in which parents would be taught other

dis-ciplinary approaches and would be discouraged

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844 SUPPLEMENT

from spanking. Creative experimental research in

this field would make a major contribution to the

causal question of how spanking and other forms of

corporal punishment influence children’s violent

tendencies in childhood and later in life.

THE RESEARCH CONTEXT: WHAT EVIDENCE IS

NEEDED?

What standard of evidence is required to show

definitively that corporal punishment of children

causes adult violence? In order to know how to

formulate a future research agenda on this topic, it

would be helpful to address the nature of the

evi-dence we need. Specifically, if well-designed,

care-fully controlled research studies showed definitively

that corporal punishment caused harm by increasing

the rate of societal violence, would this evidence be

sufficient to recommend against spanking as a form

of discipline? If the scientific community agreed that scientific evidence of harm is sufficient, then Straus’

program of research is critically important-it could

provide data that would end the debate for or

against corporal punishment.

Straus’ article addresses mainly one kind of

harm-whether corporal punishment increases adult

violence. Other studies to be presented at this

con-ference address different kinds of possible harm,

such as whether corporal punishment has negative

effects on the physical, emotional, or developmental

status of children; on the parents who administer the

spanking; on other family members; or on the family

as a social institution. If any research study

defini-tively demonstrated that corporal punishment

caused harm in any of these areas, would this be

“sufficient cause” to recommend against corporal

punishment? If single studies alone are not sufficient,

how much research and replication do we need for

the weight of the evidence to be sufficient? How

large a proportion of the variance in adult

violence-how large a predictor must it be?

TOWARD A SCIENTIFIC AGENDA

I would like to make a proposal toward a future

scientific agenda that takes off from this question:

What if we never found any evidence that spanking

was harmful? What if study after study failed to

provide convincing evidence of harm? Is “do no

harm” the only standard we wish to apply to the

practice of corporal punishment? To answer this we

should seek scientific precedents for how to set the

decision rules for accepting or rejecting the use of

corporal punishment. I suggest that we consider

cor-poral punishment to be a kind of preventive or

ther-apeutic intervention, and apply the standard,

sys-tematic model of scientific inquiry to examining

whether the “intervention” of spanking should be

recommended by experts in the field. That standard

asks three sequential questions: Is it safe? Is it effec-tive? Is it safer and more effective than alternatives? This sequence of research questions is most familiar in Phases I, II, and III clinical trials of drug treat-ments, but this scientific approach has been adapted

widely and used in many intervention settings. If we

apply this model to examine the practice of corporal

punishment, then the scientific agenda would

sys-tematically address the following sequence of

ques-tions. First, Phase I would ask whether corporal

pun-ishment causes harm. If no evidence of harm is

found, then we would ask in Phase II whether it is

effective, that is, whether it has benefit and accom-plishes the goal that it is used to achieve. If it is found

to be effective, we would ask in Phase III whether it

is more effective than nonaversive alternatives.

Ac-cording to this approach, only if the practice is found to be safe, effective, and better than less aversive practices would it be recommended by professionals.

It should be noted that this scientific model works best in helping professionals make reasoned decisions

about what to recommend to families. Ultimately,

the choice individual parents make about whether or

not to use corporal punishment will be based on a

complex set of personal beliefs and values. The

find-ings of research studies concerning safety and

effec-tiveness of various disciplinary techniques will

con-tribute in only a limited way to parental choices and

behaviors. To acknowledge this implies that science

may have a small role to play in influencing family

practices, but it does have a larger influence on the

recommendations of professionals and societal

orga-nizations and institutions as they seek systematic

evidence for or against corporal punishment as a

disciplinary strategy.

REFERENCE

1. Montague A, ed. Le’,:r,:,,:’ No?:-Aggrt’s5:oI: Tlit’ Exp:’rzt’:ce of No,:-L,terat:’

Societies. New York, NY: Oxford University Press; 1978

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(4)

1996;98;842

Pediatrics

Laurie J. Bauman

Behavior: Methodological Challenges

Assessing the Causal Effect of Childhood Corporal Punishment on Adult Violent

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1996;98;842

Pediatrics

Laurie J. Bauman

Behavior: Methodological Challenges

Assessing the Causal Effect of Childhood Corporal Punishment on Adult Violent

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