Childhood Discipline: Challenges for Clinicians and Parents -- American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1447 Etiology of Misbehavior Multiple factors may contribute to behavior problems, including lack of adequate discipline. Commonly, children misbehave when they are tired, bored, or hungry. Children often misbehave when they are deprived of adult attention; misbehavior may elicit attention, and parental scolding may unintentionally reinforce the undesired behavior. Children from families marred by divorce, separation, extreme poverty, substance abuse, parental depression, and other mental illness may be at greater risk for behavior disorders. Biologic factors such as certain temperaments and attention-deficit/hyperactivity disorder (ADHD) may predispose children to misbehavior. Several studies suggest that harsh discipline practices actually exacerbate misbehavior, particularly in European-American children and those with ADHD, and in children of school age. Perhaps most influential is the role of parents and other adults and children in modeling behavior. F rustrated parents may ask family physicians about discipline techniques that seem ineffective. However, physicians are often uncomfortable discussing discipline, and parents may be reluctant to introduce the subject because they are worried about criticism of their parenting skills. Parents often rely on certain discipline styles because they were disciplined in that manner when they were children. Because discipline techniques influence the social development of children, counseling about this matter is a critical part of physician-parent encounters. The term “discipline” derives from the Latin word “disciplinare,” meaning “to teach.” However, the term is most often associated with the concept of punishment, which falls short of the full meaning of the word. Discipline properly involves a multifactorial approach that makes use of models, attitudes, rewards, and punishments to teach and reinforce socially acceptable behavior. Through discipline, children become able to achieve self-control, selfdirection, and a sense of caring. Although childhood discipline is an important issue for parents, this topic is seldom emphasized by family physicians during well-child examinations. Behavior problems are relatively common but frequently under-recognized by physicians. Opportunities to counsel parents about safe, effective methods of discipline are therefore missed. Discipline should be instructive and age-appropriate and should include positive reinforcement for good behavior. Punishment is only one aspect of discipline and, in order to be effective, it must be prompt, consistent, and fair. Time-out is frequently used to correct younger children, but because it is often enforced improperly, it loses its effectiveness. Corporal punishment is a controversial but common form of discipline that is less effective than some other types of punishment. Its use is linked to child and spouse abuse, as well as to future substance use, violent crime, poor self-esteem, and depression. Despite the possible negative effects of corporal punishment, it is still widely accepted in our society. Since discipline plays an important role in the social and emotional development of children, physicians should be trained to discuss this issue with parents during routine well-child examinations. (Am Fam Physician 2002;66:144752,1463-4. Copyright© 2002 American Academy of Family Physicians.) Childhood Discipline: Challenges for Clinicians and Parents