- AAP —
- American Academy of Pediatrics
I served as a member of the Committee on Psychosocial Aspects of Child and Family Health of the American Academy of Pediatrics (AAP) from 1994 to 2000. It was in this period that the policy statement, Guidance for Effective Discipline, was prepared, published, and disseminated among professional and lay audiences.1 I remember intense discussions about the content of the article and then multiple revisions on the basis of detailed reviews. I received my first course in media training from the AAP shortly before its publication. Those tips proved useful during tense interviews with skeptical debaters. Eventually, the excitement wound down. Now, 18 years later, it is extremely gratifying to consider that those long hours of voluntary work may have contributed to positive change in parent discipline strategies.2
The study by Ryan et al2 in Pediatrics this month examines 4 different representative national databases from 1988 to 2011, overlapping with publication of the AAP policy statement.2 Parents were asked how they would respond to a hypothetical situation and were rated as to whether they endorsed physical or nonphysical discipline. In addition to analyzing overall secular trends, the study also evaluated associations with socioeconomic factors. Parents with lower socioeconomic status have been more likely to use physical discipline than those with higher socioeconomic status.3 Over the time span of the study, the percentage of those endorsing physical discipline declined while the percentage of those reporting nonphysical discipline increased. Trends were generally similar across all socioeconomic groups.
Although it is tempting for me to agree with the authors that the AAP policy statement deserves credit, at least in part, for changes in patterns of parent discipline, other explanations are equally likely. First, the major change in attitudes toward physical discipline occurred from 1988 to 1997, before publication of the policy statement.1 However, as the authors point out, other changes in disciplinary attitudes and practices occurred throughout the study period or from 1998 to 2011. Second, with changing attitudes, respondents to the later surveys may have been more likely to provide socially acceptable answers. However, casting the questions in a hypothetical context may have limited the tendency toward social desirability. Third, differences in the characteristics of the subjects might have led to bias. The 2011 Early Childhood Longitudinal Study- Kindergarten Cohort (ECLS-K) sample had approximately twice the percentage of respondents in the highest income bracket as the 1988 National Longitudinal Study of Youth -Child Survey (NLSY-CS) sample had. The proportion of less than high school and high school educated families declined over the 4 surveys while the rates of college-educated families increased considerably. Even though the analyses adjusted these proportions to reflect the total US population, slight differences might have contributed to the pattern of results. Nonetheless, the finding that the changes in attitudes and practices were found across all socioeconomic strata, regardless of their proportion in the total sample, is reassuring about the validity of the work.
Despite these concerns, I am pleased that this manuscript keeps this important issue in the public discourse. As the authors discuss, physical abuse reporting in the United States has declined 55% since 1990.4 If the AAP policy statement contributed even slightly toward increasing rates of compassionate and humane parental discipline, and if changes in discipline influence rates of physical maltreatment, then for me personally, the long hours of writing, debating, preparing, and presenting were totally worthwhile.
I recommend that the AAP reaffirm and reissue the policy statement on discipline.1 Though trends are favorable, many parents still report use of physical discipline. More change is necessary. In addition, the previous policy statement included several other positive recommendations for parents, such as strategies for promoting optimal parent–child relationships and for reinforcing desirable behaviors. These contributions were often overlooked in the media because of the focus on physical discipline. If attitudes and practices have changed, then pediatricians and the public may be ready for advice on alternative discipline methods. A new generation of pediatricians, allies from related fields, and parent advocates must collaborate on a new statement. This current report that links long-term trends in parent discipline to publication of an AAP policy statement can serve as a recruiting tool for volunteers and advocates to prepare a reinvigorated policy statement.
- Accepted September 6, 2016.
- Address correspondence to Heidi M. Feldman, MD, PhD, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Medical School Office Building, 1265 Welch Rd, Room 119, Stanford CA 94305. E-mail:
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.
FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.
FUNDING: Funded by grant T77MC09796 from the Leadership Education in Developmental-Behavioral Pediatrics, Maternal and Child Health Bureau, Health Resources and Services Administration.
POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds2016-0720.
- Wolraich M,
- Aceves J,
- Feldman H, et al; American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health
- Ryan R,
- Kilal A,
- Ziol-Guest K,
- Padilla C
- Finkelhor DSK,
- Jones LM
- Copyright © 2016 by the American Academy of Pediatrics