PEDIATRICS Vol. 98 No. 4 October 1996, pp. 815-817
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What Clinicians Want to Know About Teaching Families New Disciplinary Tools

Lawrence S. Wissow MD1

1 Johns Hopkins University School of Medicine, Baltimore, Maryland

NOT ALL FAMILIES HAVE THE SAME EDUCATIONAL NEEDS

Dr Howard's paper points out that punishment (one way of decreasing undesired behaviors) is only part of a larger system for helping children develop adaptive interpersonal skills and culturally acceptable patterns of conduct. Parents also rely on promoting a close relationship with their child, reinforcing positive behaviors, and helping children learn a set of basic behavioral rules that are adaptable to changing situations. One of the things that we don't know about families using corporal punishment is the extent to which they lack skills in all of these areas or whether, at the risk of gross oversimplification, we would suggest that they change nothing except to replace one form of punishment (spanking) for another. In some families, corporal punishment occurs in the context of poor parent-child relationships and other forms of emotionally harsh punishment, and in other families it does not.1,2

WHAT ROLE DO PRIMARY CARE PROVIDERS HAVE IN PARENTING EDUCATION?

Dr Howard shows that a variety of behavioral interventions are available, that they have demonstrable effects, and that they work for a variety of populations. Most of the studies she described, however, would have to be classified as efficacy studies. We now know these interventions work in the hands of clinical psychologists in laboratory conditions with selected patients. What do we know about how to build these into routine pediatric practice, especially those that require several training sessions and specialized training materials?3 Research in adult mental health services suggests one direction to pursue—the development of novel collaborative arrangements between behavioral specialists and primary care providers.