George Davis, MD
Director of Psychiatry
NM Department of Children, Youth and Families
Many Americans agree…
“A spanking can serve as a meaningful
negative consequence in cases of
undesirable behavior, but it tends to be
most useful — and necessary — when a
child is under 3 ½ years of age…because
reasoning and taking away privileges simply
don't work with very young children.”
Dr. James Dobson





Corporal Punishment—any physically
aversive treatment from caretakers toward
children designed to modify behavior
Spanking—the alternative term
Harsh Treatment—a research term to
indicate unusually coercive and punitive
verbal, emotional or physical treatment of
children
Infancy—first two years
Early Childhood—years two to five
•
•
65% Americans support spanking, but…
94% actually spank their toddlers
•
30% parents smack babies under one
Over 50% toddlers are spanked more than
three times weekly
•
Rate of spanking toddlers has NOT declined
•
•
•
•
•
•
I was spanked and I turned out OK
Spanking and abuse are two separate
things
Spanking is okay as long as you aren’t
angry
Talking to toddlers doesn’t work
Spanking is a last resort
I.
II.
III.
IV.
V.
Review of early brain development
Review of neglect/abuse effects
Adverse Childhood Experiences
Research on corporal punishment
Discussion and argumentation
1.
2.
3.
4.
The brain is undeveloped at
birth
The brain organizes from the
“bottom up” - brainstem to
cortex and from the inside
out
Organization and functional
capacity of neural systems is
sequential
Experiences do not have
equal significance
throughout development
7
•
•
An infant needs connection to a caregiver in order
to organize the brain’s functions in the moment,
and to allow it to develop properly over time
Failure to receive the consistent, repetitive,
positive, dependable and appropriate attention of
the primary caretaker is the premier neurological
insult
8
•
•
Caregivers of secure children respond quickly to
negative emotions that are stressful to the child,
helping to minimize exposure to the
neurotransmitters that mediate stress
The best caretakers also enhance positive
emotions through play and social interactions,
increasing the positive neurotransmitters that
enhance neuronal growth and brain maturation
9
HOW DOES CHILDHOOD TRAUMA
ALTER DEVELOPMENT?
When distress is overwhelming, or when the
caregivers themselves are the source of the
distress, children are unable to modulate
arousal. This causes a breakdown in the
capacity to process and regulate
experience. At the core of traumatic stress
is a breakdown in the capacity to regulate
internal states. (van der Kolk, 2002)

THE DISTINCTION BETWEEN
DEVELOPMENTAL TRAUMA and PTSD
◦ Causation
◦ Presentation
◦ Treatment
◦ Prognosis

WHAT ARE THE SALIENT FEATURES of
TRAUMA THAT CAUSES DEVELOPMENTAL
DAMAGE?
◦
◦
◦
◦
◦
Repetition of Trauma
More than one Kind of Trauma
Early Age
Chronicity and Persistence
Interpersonal / Intrafamilial
What we know for sure:



Child abuse is common
The consequences of early childhood abuse
can be devastating to the brain
development of the child
Although we can and do treat it, tracks of
the developmental damage from abuse can
be essentially permanent
What we know for sure:



The extended effects of early child abuse
cross the boundaries of attachment, affect,
thought, behavior, personality and health
Early abuse vastly increases the likelihood of
depression, anxiety, aggression, sleep
disturbances, delinquency and criminality
So we mistakenly call it Bipolar Affective
Disorder, Attention Deficit Hyperactivity
Disorder, Depression, Conduct Disorder and
PTSD
WHAT WE DON’T KNOW FOR SURE:
When does corporal punishment,
including routine spanking, become
abuse? And at what point does it become
damaging to the development of the
child? In other words, what is the
difference between abuse and discipline?

ADVERSE CHILDHOOD EXPERIENCES (ACE)
STUDY BY CDC AND KAISER
◦
◦
◦
◦
◦
◦
◦
◦
◦
17,337 Adult Subjects make up the Total Sample
11% Emotionally Abused
28 % Physically Abused
21 % Sexually Abused
27 % Exposed to Drug or Alcohol Abuse
19 % Exposed to Mental Illness
13 % Witnessed Violence Toward Their Mothers
23 % Lost a Parent due to Divorce or Separation
63 % Experienced at Least One Category of Negative
Childhood Experience, and 20% had Three
1.
2.
3.
4.
5.
Emotional abuse
Physical threats or physical assault
Sexual abuse (including inappropriate touch)
Emotional neglect: Often feeling unloved,
unimportant OR a sense that family didn’t
feel close or support each other.
Physical neglect: not enough to eat, had to
wear dirty clothes, and no one to protect you
OR parents too drunk/high to care for you or
seek medical help.
Centers for Disease Control & Prevention
Parents separated or divorced
7. Domestic violence toward mother or
stepmother
8. Household member a problem drinker or
used street drugs.
9. Household member depressed, mentally
ill, or attempted suicide.
10. Household member went to prison.
6.
Centers for Disease Control & Prevention

Researchers found a strong link between
adverse childhood experiences and adult
onset of chronic physical illness. Those with
ACE scores of 4 or more had significantly
higher rates of heart disease and diabetes
than those with ACE scores of zero. The
likelihood of chronic pulmonary lung disease
increased 390 percent; hepatitis, 240
percent; depression, 460 percent; suicide,
1,220 percent. Those with an ACE score of 6
had a 4,600 percent increase in the likelihood
of becoming an IV drug user.













Smoking
Chronic obstructive pulmonary disease
Hepatitis
Heart disease
Diabetes
Obesity
Alcoholism
Fifty or more sexual intercourse partners
Other substance abuse including IV drug use
Depression and attempted suicide
Teen pregnancy (including paternity)
Sexually transmitted diseases
Poor occupational health and poor job performance

The 17,337 people who participated in the
ACE study are typical, middle-class, working
Americans — 75 percent Anglo, 11 percent
Latino, 7 percent Asian, and 5 percent
African-American. They’re educated: 75%
attended college and 40% have a basic or
higher college education. Most of them had
jobs. Half were women, half were men. All of
them had good health insurance.
The Summary Conclusions:
The findings of the ACE Study suggest
that these experiences – ACEs – are the
leading causes of illness, death and
poor quality of life in the United States.

WHAT WE DON’T KNOW YET—THE FIRST CLUE
◦ According to the clear evidence of the ACE study,
adverse experiences are cumulative, and the ultimate
effects are dose dependent.
◦ This is true as much for moderately adverse
experiences like an alcoholic parent or physical
threats as more severe trauma like sexual or physical
abuse.
◦ If physical punishment is a stressor of any sort, then
the cumulative effects are dose dependent just as
they are for any other stressor.




The effects of early childhood trauma and
stress are not immediately apparent
Neurodevelopment is progressive, with later
stages depending upon earlier foundations
The changes in the brain are cumulative
and make their effects felt over the course
of the lifetime
Consequently, early stress and trauma is
initially disguised…or nearly so
1.Activation of the stress response
system
2.Under and over activation of
sensitive neurodevelopmental
processes
3.Sensitive and critical periods
4.
5.
6.
Chronic stress results in altered
function and development—eg,
changes in arousal, attachment,
reward.
Which lead to maladaptive coping
mechanisms
Which lead to disease, pathological
behaviors, and early death
 The
links between actual abuse
and corporal punishment:
◦ Differences in kind? Probably not…
◦ Differences in degree? Definitely…
◦ Differences in motivation? Variable…
◦ How is it experienced by the child?
Think about it…

23 young adults (18-25 years old) who had
experienced harsh physical punishment were
compared to 22 healthy controls. The
subjects who had experienced harsh physical
discipline had gray matter volume in the
prefrontal cortex that was reduced by 19.1 %.
Exposing children to harsh punishment has
detrimental effects on brain development.
(Tamoda et al, Neuroimage, 2009)

PHYSICAL PUNISHMENT IS NOT WHAT WE THINK
◦ Physical punishment does not promote long-term,
internalized compliance. 85 % of studies found
physical punishment to be associated with less
moral internalization (Gershoff, 2002)
◦ In fact, physical punishment is positively associated
with defiance (Eamon, 2004)
◦ As well as lack of empathy (Lopez and Bonenberger,
2001)

IT DOES NOT TEACH WHAT WE WANT…
◦ Parents often use physical punishment for either
aggression (hitting a sibling) or antisocial acts
(stealing money) in order to communicate the
seriousness of the offense. But in a meta-analysis of
27 studies, all 27 studies proved that physical
punishment was associated with more rather than
less aggression. (Pagani, International Journal of Behavioral
Development, 2004)
◦ Another study proved that 12 of 13 studies positively
linked corporal punishment and antisocial behavior.
(Gershoff, Psychological Bulletin, 2002)

IT DOES NOT HAVE THE DESIRED EFFECT
◦ It is true that many adults who were spanked as
children may be well-adjusted and caring people
today. However, research has shown that, when
compared with children who are not spanked,
children who are spanked are more likely to
become adults who are depressed, use alcohol,
have more anger, hit their own children, hit their
spouses, and engage in crime and violence.
(Discipline Your Child, American Academy of Pediatrics,
2009)

IT DOES NOT MAKE US STRONG OR HEALTHY
◦ Parents often employ physical punishment with
their children to make sure that the children have
strong social values, respect for authority and a
clear mental health status. Unfortunately, a metaanalysis indicated that in 12 of 12 studies the
frequency and intensity of corporal punishment was
associated with poor mental health measures. Every
single study saw an increase in depression,
substance abuse, and general psychological
maladjustment. (Gershoff, Psychological Bulletin, 2002)

IT DOES NOT STRENGTHEN OUR RELATIONSHIPS
◦ Parents often endorse physical punishment in the
belief that they are inculcating strong family values.
And yet, child corporal punishment also impairs the
relationship between parents and children. 13 out of
13 studies found that physical punishment was
associated with poorer quality parent-child
relationships. (Gershoff, Psychological Bulletin, 2002)

SO WHAT DOES PHYSICAL PUNISHMENT
TEACH CHILDREN?
◦ Physical punishment teaches children that violence
and coercion are acceptable ways to settle
disagreements or enforce a certain form of
behavior. Research proves consistently that the
more men and women are physically punished as
children, they more they resort to aggression with
their domestic partner. (Straus, Cross Cultural Research,
2004; Douglas and Straus, European Journal of
Criminology, 2006)


In the 80s and 90s evidence was beginning to
accumulate that showed a simple association
between physical punishment and greater
levels of aggression against parents, siblings,
peers and spouses. Virtually without
exception this association between the two
was clear and positive.
But the relationship was a simple association
and did not account for the possible
confounding factors of pre-existing
aggression.


The following studies throughout the 90s
established the actual causative nature of the
relation between corporal punishment and
later aggression and delinquency.
For example, one of the first and best
prospective studies of 807 children controlled
for the factors of socioeconomic status,
gender, pre-existing aggression and home
environment. Still there was a strong
relationship between physical punishment
and later antisocial behavior in 6-9 year olds.
(Straus, Sugarman et al, 1997)

Subsequent studies controlled for every
imaginable variable and still continued to
demonstrate the propensity of physical
punishment to cause antisocial behavior.
(Gunnoe, 1997; Grogan-Kaylor, 2005; Mulvaney, 2007)

Treatment intervention studies established
that children’s aggression and overall
behavior could be improved by reducing their
physical punishment.

Following studies starting in 2000
expanded the list of negative effects of
early corporal punishment to include mental
health, greater risk of physical injury,
conflicted interpersonal relationships,
spouse abuse, emotional delays, poor
academic performance and lower
intelligence.

MORE EVIDENCE…
◦ From the very beginning of research into child
maltreatment, studies have always indicated that
child physical abuse begins with an attempt to
correct children’s behavior or to “teach them a
lesson.”(Coontz and Martin, 1988; Gil, 1973; Kadushin,
1981; Margolin, 1990)
◦ The Canadian Incidence Study of Reported Abuse
and Neglect of 2003 confirmed that three
quarters of substantiated child abuse started with
physical discipline.



Gradually, the assumed distinction between
physical abuse and physical punishment has
been erased in the literature.
It was established that 75% of established
physical abuse happened during episodes that
started and were intended as physical
punishment. (Trocme, Fallon et al, 2005)
Another study found that children who were
physically punished were 7 times more likely
to be physically abused.(Clement and Bouchard, 2000)
“When society
condones spanking
as discipline, it has
the effect of
dramatically
increasing the
incidence of child
abuse in our
culture.”
M. Marshall, PhD

Almost never has any finding been proved so
substantially and definitively—almost against
the wishes of public opinion. Seldom has
there been more reticence within in the
scientific establishments like the American
Academy of Pediatrics and the American
Academy of Child and Adolescent Psychiatry
to weigh in on the side of overwhelming
research findings.

At long last, the American Academy of
Pediatrics has weighed in at the late date of
2011 to oppose corporal punishment for
children, noting that corporal punishment
“is harmful emotionally to both parent and
child. Not only can it result in physical
harm, but it teaches children that violence
is an acceptable way to discipline or
express anger.”

Even the Child Psychiatrists eventually took a
stand, claiming that: “Extensive research
demonstrates that although corporal
punishment may have a high rate of
immediate behavior modification, it is
ineffective over time and is associated with
increased aggression and decreased moral
internalization of appropriate behavior.” (Policy
Statement on Corporal Punishment, American Academy of
Child and Adolescent Psychiatry, July 2012)
When a child hits a child, we call it aggression
When
When
When
When
a child hits a child, we call it aggression
a child hits an adult, we call it hostility
an adult hits an adult, we call it assault
an adult hits a child, we call it discipline
Haim Ginott
all it hostility
When an adult hits an adult, we call it assault
When an adult hits a child, we call it discipline
Haim Ginott
END
Medication
 Verbal / Insight Therapies
 Cognitive / Behavioral Interventions
 Coercive Contingent Interventions
 Correctional Interventions
 Hospitalization







Relational (with another human)
Relevant (developmentally-matched)
Repetitive (patterned)
Rewarding (pleasurable)
Rhythmic (resonant with neural
patterns)
Respectful (child, family, culture)
Bruce D Perry © 2010

Since the earliest trauma
damages the more basic and
regulatory parts of the
brain, there is evidence that
non-verbal or somatic
therapies may be of more
use in the treatment of early
or pre-conscious trauma.

THE FUNDAMENTAL PRINCIPLES
◦ “Therapeutic activities will be most effective if they
are provided in the sequence that reflects normal
development—from the brainstem up.” (Perry, 2006)
◦ Begin with regulation of the most primitive
regulatory functions that are located in the
brainstem and diencephalon
 Somatic and pre-verbal
 Tapping, drumming, dance, music,
massage and movement
 Patterned, repetitive and rhythmic

THE FUNDAMENTAL PRINCIPLES
◦ After addressing the most primitive regulatory
functions of the primitive brain, the most significant
therapies are relational, social and interpersonal
 Canine and equine contact, reflective and responsive
interactions with consistent caretakers
 Strong child-centered interventions that are relational
and non-confrontational

THE FUNDAMENTAL PRINCIPLES
◦ After the most basic reflective and supportive
aspects of interpersonal interactions are
offered, the next steps toward socially
integrative and expressive activities are
encouraged
 Play and play therapy
 Drama role-play
 Narrative and story telling

THE FUNDAMENTAL PRINCIPLES
◦ In a sequential movement toward the higher cortical
functions, more verbal and cognitive behavioral
functions are introduced
 Education
 Relational / Interactional therapies like groups
 Verbal and insight therapies
END

Harsh physical punishment is associated with
increased odds of mood disorders, anxiety
disorders, alcohol and drug dependence, and
several personality disorders even after
adjusting for family dysfunction and
socioeconomic variables.

Approximately 2-5% of Axis I and 4-7 % of
Axis II disorders were attributable to harsh
physical punishment.
(Afifi, Mota et al, American Academy of Pediatrics, 2012)

1,966 children were studied to determine the
relationship between spanking before age
two and later behavior problems when
entering the school system at age six.
Children who were spanked before age two
had substantially more behavior problems at
age six. (Slade and Wissow, Journal of the
American Academy of Pediatrics, 2004)

2,461 children were studied to determine the
long term effects of spanking before 3 years
of age. The study determines that “even
minor forms of corporal punishment, such as
spanking, increase the risk for increased child
aggressive behavior. Importantly, these
findings cannot be attributed to possible
confounding effects of other maternal
parenting risk factors.” (Taylor et al, Journal of
the American Academy of Pediatrics, 2010)

The combined results of four separate
studies conclude that spanking and
other forms of corporal punishment
are associated with risky and
masochistic sexual practices.
(Strauss, Presentation at the American
Psychological Association Summit on Violence and
Abuse in Relationships, 2008, Bethesda, MD)
17,404 university students from 32
different countries were surveyed. The
analysis found a lower average IQ in
countries where spanking is more
prevalent. (Straus, 2009)
 The linkage between decreased IQ and
CP is chronic childhood stress


806 children between 2-4 and 704 children
between 5-9 were studied to determine how
spanking might influence a child’s IQ over the
course of four years. Children who were
spanked had IQs between 2.8 and 5 points
lower than children who were not. Those in
the study who were spanked more showed a
greater delay in cognitive development.
(Murray Straus, 14th International Conference on Violence,
Abuse and Trauma, San Diego, CA, 2009)

63 West African children in kindergarten and
first grade were studied to determine the
effect of school corporal punishment on
intelligence. Children in the school with
corporal punishment performed significantly
worse on tasks involving executive
functioning—such as planning, abstract
thinking and delayed gratification.
(Talwar and Lee, Social Development, 2011)

A West African study of 3-4 year old
children in two different school settings,
one of which employed corporal
punishment and the other did not, suggests
that “a punitive environment not only
fosters increased dishonesty but also
children’s abilities to lie to conceal their
transgressions.” (Talwar and Lee, Child
Development, 2011)

Different types of negative caretaker
interactions with children interact and
compound the negative effects of each
other. “Children’s behavior problems were
significantly greater when both verbal
hostility and physical punishment were
used.” (Hamai, Isbell and Ku, Encephalon, 2011)

23 young adults (18-25 years old) who had
experienced harsh physical punishment were
compared to 22 healthy controls. The
subjects who had experienced harsh physical
discipline had gray matter volume in the
prefrontal cortex that was reduced by 19.1 %.
Exposing children to harsh punishment has
detrimental effects on brain development.
(Tamoda et al, Neuroimage, 2009)

The effects of “subtle forms of infant
maltreatment” are not as well researched or
documented. “Infants who received frequent
corporal punishment (eg, spanking) showed
high hormonal reactivity to stress.” Both
corporal punishment and frequent emotional
withdrawal by the mother resulted in elevated
baseline levels of cortisol. (Bugental, Martorell, et al.
2002)

The use of violence toward children varies
widely. The prevalence of violence ranged
from 40% in Mongolia to 1% in Ukraine.
(Lansford and Deater-Deckard, 2012)

The legal prohibition of physical punishment
of children appears to have gained a foothold
in popular cultural values toward child
rearing. (Lansford and Deater-Deckard, 2012)


There is more discrepancy between beliefs and
behavior in countries where attitudes toward
children are shifting. Eg, in one study in America
54% of mothers reported that in over half the
time they used corporal punishment they
believed it was the wrong response to have
used.(Straus, 1996)
But in Ghana, 46% believe that corporal
punishment is acceptable and 50% use it. In this
case physical punishment is used more
instrumentally and with less anger and emotion.
(Lansford and Deater-Deckard, 2012)

Violence toward children is less
common in countries with a higher
index of living and more educational
opportunities, just as the same
relation proves to be true among
subgroups within the US.
(Lansford and Deater-Deckard, 2012)


Most physical abuse takes place in the
context of physical punishment (Durrant, 2004)
Fewer caregivers believed that it is necessary
to physically punish children than actually do
so. For example, only 5% of caregivers in
Montenegro believed that using physical
punishment is necessary, but 47% report that
they or someone in their household has
spanked the child in the last month (Lansford
and Deater-Deckard, 2012.) which indicates that it is
done in the heat of the moment.

8 out of 8 studies proved that the
same childhood mental health
problems that initially result from
corporal punishment persist into
adulthood and become lifetime issues.
(Turner and Muller, Journal of Family Issues, 2004)
Politics and personal choice
 The comparison to spouse abuse
 The minimizations and justifications

◦
◦
◦
◦
Open hand
Instruments
No marks were left
Parental discretion
"It is not necessary to beat the child
into submission; a little bit of pain
goes a long way for a young child.
However, the spanking should be of
sufficient magnitude to cause the child
to cry genuinely."[47]
James Dobson

LEARNING AND THE REWARD CIRCUIT
◦
◦
◦
◦
Learning and Reward
Mastery and Reward
Approval and Acceptance
The Social Aspects of Learning

NEUROLOGICALLY INFORMED
◦ What makes a healthy brain?
◦ What does the research say?

OUTCOME BASED
◦ Eventual, not immediate
◦ Character, not compliance
POSITIVE DISCIPLINE IN EVERYDAY PARENTING
Joan Durrant, PhD
1.
2.
3.
4.
Look Beyond the Immediate Behavior Toward
the Long Term Childrearing Goals
Providing Warmth and Structure
Understanding How Children Think and Feel
Problem Solving

NOTES TO CONSIDER:
◦ This is not substitution of another form of
punishment
◦ Positive Praise>Criticism
◦ The fulfillment of these Four Principles
changes with Developmental Age
Childhood
Adversity
-number
-type
Age
Genetics
Brain
Development
Domestic
Violence
Medical
Disorders
Smoking
Depression
Psychiatric
Disorders
Cognition
Addictions
Risky
Sex
Antisocial
behavior
Martin Teicher, MD