Parents’ Discipline of Young Children: Results From the National Survey of Early Childhood Health

Sample

The 2000 NSECH, conducted by the National Center for Health Statistics, used a stratified random-digit-dial sampling design to achieve a nationally representative sample of children between the ages of 4 and 35 months. Black and Hispanic subjects were oversampled to permit precise estimates for these subgroups. Child-level sampling weights were developed to adjust for nonresponse, oversampling, and the survey sampling design. Thirty-minute structured telephone interviews were conducted in English or Spanish between February 16, 2000, and July 16, 2000, with parents of a child in the target age group. Eighty-seven percent of the respondents were mothers of the sampled child. The remaining were fathers (11%), grandparents (2%), or other guardians (<1%). The Council of American Survey Research Organizations response rate for the survey was 65.6%. Data were weighted to represent US children between the ages of 4 and 35 months. Stata (Stata Corp, College Station, TX) was used for data analysis and to account for the complex survey design. A more complete description of the NSECH is presented elsewhere in this volume.²⁰

Measures

For examining the frequency of different discipline practices, parents were asked how often they currently use aversive (spanking and yelling) and nonaversive (time out, taking away a toy, and explanations) practices in the following manner: “Parents vary a lot in how they discipline, and children also vary in their response to being disciplined. I am going to read a list of methods of discipline that parents might use with children [child]’s age. For each, please tell me if you use that method often, sometimes, rarely, or never with [child].” Parents with children 19 months or older were asked to report on use of all discipline practices, whereas parents with children from 4 to 18 months of age were asked about yelling and spanking only.

Several covariates are assessed. The Parents’ Evaluation of Developmental Status (PEDS), a clinical screening tool recently adapted for telephone interview administration, is used to assess risk of developmental delay. It consists of 10 questions that elicit concerns about speech and language, motor development, behavior, social skills, self-help skills, school skills, sensory problems (vision or hearing), and global cognitive function.²¹ Using parents’ responses to the specific probes, children were categorized as being at high, moderate, low, or no developmental risk on the basis of the profile of their developmental and behavioral concerns and according to validated scoring.^22–23 The Mental Health Index-5 (MHI-5) is used as a measure of the parent’s emotional well-being. The MHI-5 is a 5-item version derived from the 38-item MHI used in the Medical Outcome Study, and consists of the following questions: How much of the time during the last month have you 1) been a very nervous person, 2) felt calm and peaceful, 3) felt down-hearted and blue, 4) felt so down in the dumps that nothing can cheer you up, and 5) been a happy person?²⁴ Items 1, 4, and 5 use a 6-point Likert scale ranging from 0 for “all of the time” to 100 for “none of the time.” Items 2 and 5 have reversed scoring so that the mean score (range: 0–100) represents overall emotional well-being. Parent frustration was measured by the following questions: In a typical day, how often would you say you feel frustrated or aggravated with your child’s behavior? Would you say always, sometimes, rarely, or never? Parents were also asked to rate their child’s health: In general, how would you describe [child]’s health? Would you say [his/her] health is excellent, very good, good, fair, or poor?

Data Analysis

Frequencies were determined for each discipline practice. χ² analyses were conducted with discipline practices dichotomized as frequent (often/sometimes) versus infrequent (rarely/never) to examine variations in parents’ use of discipline according to selected child, parent, and demographic characteristics. These included child age (4–9 months; 10–18 months, 19–35 months), child developmental risk (any vs none), child health status (excellent/very good vs good/fair/poor), frustration with parenting (frequent [always or sometimes] vs infrequent [rarely or never]), parent’s race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic English speaking [Hispanic parent who completed the interview in English], Hispanic Spanish speaking [Hispanic parent who completed the interview in Spanish]), annual household income (≤$17 500, $17 501–$35 000, $35 001–$60 000, >$60 000), maternal education (<high school vs ≥high school), and maternal marital status (married vs not married). Logistic multivariate regression was used to examine the association between the use of each discipline practice (frequent vs infrequent) and child, parent, and demographic factors. Findings from bivariate analyses guided the development of the multivariate models. Confidence intervals (CIs) for variables with >1 degree of freedom (having >2 categories) were adjusted for multiple comparisons using the Bonferroni correction method.

Univariate and Bivariate Analyses

Multivariate Analyses

Demographic Factors and Discipline Practices

Our findings of relationships between demographic factors and discipline practices are consistent with previous national studies, particularly the findings of Wissow,⁷ who used a similar method. The data reflect the importance of parent age and ethnic/racial factors in the variation of reported discipline practices. More adolescent parents relative to older parents and more black parents reported spanking, findings similar to previous national surveys.^7,8 The basis for the association with parent age is uncertain but may be attributable to teenage parents’ inexperience. The latter finding has been explained in terms of spanking’s adaptive significance to black socialization challenges.²⁵ Ethnic and racial differences, including acculturation, are possible factors in the relationship between Hispanic ethnicity and discipline practices. It is not surprising that Spanish-speaking Hispanic parents reported that they are less likely to use time out and taking away a toy given that these are largely American parenting practices. Maternal education, marital status, and income do not predict discipline practices in the multivariate model in contrast to other studies.^{8,10,14,16,17} Nevertheless, the data reflect important demographic influences, particularly of race and ethnicity, that must be considered in helping parents with child-rearing challenges.

Parent Emotions and Discipline Practices

Strong and consistent relationships were identified between parents’ emotions, (frustration with parenting and emotional well-being) and discipline practices. These findings clearly show that frustration with child rearing increases during the first 3 years of life and that this increase is associated with a greater output of reactive discipline similar to findings reported by Wissow.⁷ The data also suggest that frustration (an emotion reflecting anger) and emotional well-being reflect a propensity to react in a harsh manner by either yelling or spanking. The finding that maternal employment was associated with less frustration in multivariate analysis suggests that it may be providing respite from the demands of child rearing.

Child Factors

Child age and developmental risk are directly related to discipline practices in the multivariate model. They are also associated with frustration, along with child health, suggesting that their influence on parents’ discipline choices may occur in part through this emotional channel. These health-related factors add to the complexity in which child characteristics may influence socialization. They also underscore the important role that physicians can play in helping parents with discipline choices by addressing these health issues in the context of development and behavior.

Clinical Implications

The findings from this study have important implications for primary care practice. With increasing evidence of the harmful effects of aversive discipline,^26,27 discipline counseling takes on greater significance. Therefore, the findings by Olson et al (this volume) that more than half of parents with children between 10 and 35 months of age reported that they did not discuss discipline with their physician at a health visit in the past year suggests an important missed opportunity.²⁸ It is also of concern that parents reported spanking and yelling at their infants before 9 months, with one third of parents spanking their children before 18 months, a time when the risk of escalation to child abuse is considered to be particularly high.³ Current health supervision guidelines do not address discipline until the 9-month visit, and the current AAP statement on discipline does not address modification of recommended timetables for counseling.^3,29,30 Our findings suggest that such modifications should be considered.

The findings from this study also underscore the importance of evaluating parents’ emotions in the context of discipline counseling. Parents’ emotions are a sensitive indicator of the health of the parent–child relationship,³¹ and harsh, negative, and controlling parenting is associated with a wide range of negative developmental outcomes.³² Because there is empirical support for the efficacy of early intervention in modifying discipline practices,⁹ the appraisal of parents’ emotions relevant to child rearing becomes an important consideration for routine clinical practice. Parents who indicate that they are struggling emotionally with the demands of child rearing may be helped by a variety of community supports and services. The pediatrician can play an important role by identifying this need and facilitating access to these services. Other clinically important implications include the need for careful attention to communication and counseling techniques given the emotionally sensitive nature of this topic.³³ Finally, the consistency in which race influences discipline practices underscores the need for clinical models that elaborate these ethnic and cultural factors in counseling parents.

Limitations

There are several limitations to this study. The survey sampled only reactive practices so that the broad picture of how parents use discipline, including proactive strategies, is not represented. The context within which discipline practices are used is an important factor and was not measured; neither could different parenting styles be determined from these data. Another limitation is that the method for eliciting parents’ recall may underestimate rates reported. For example, there was no referent period established for parents, and studies that have used long referent periods (eg, the past year) have reported very high prevalence rates.²⁶ A clear definition of spanking was not provided to parents so that parents may have excluded extremes of corporal punishment. Also, severity of spanking cannot be determined beyond frequency. Therefore, inferences about the significance of the discipline practices surveyed are limited.