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Pediatrics International (2015) 57, 385–392
doi: 10.1111/ped.12604
Original Article
Buffering effect of parental engagement on the relationship between corporal punishment and children’s emotional/behavioral problems Lian Tong,1,2 Ryoji Shinohara,2,3 Yuka Sugisawa,2,3 Emiko Tanaka,2,3 Taeko Watanabe,2,3 Tatsuya Koeda4 and Tokie Anme2,3 1 School of Public Health, Fudan University, Shanghai, China, 2Japan Science and Technology Agency (JST)/Research Institute of Science and Technology for Society (RISTEX), Tokyo, 3Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba and 4National Center for Child Health and Development, Tokyo, Japan Abstract
Background: Previous research has established links between corporal punishment and children’s developmental problems, but few studies have investigated the moderating effect of positive parenting between corporal punishment and children’s developmental difficulties in detail. This study investigated the buffering effect of parental engagement on the association between corporal punishment and children’s emotional/behavioral problems. Methods: The main caregivers completed the Evaluation of Environmental Stimulation Scale (EES), which is an evaluation of daily parenting behaviors, and the Strengths and Difficulties Questionnaire (SDQ), which evaluates children’s developmental problems. Results: Corporal punishment was associated with worse emotional and behavioral problems in children, whereas parental engagement in games or sports was associated with fewer emotional symptoms. Similarly, parental engagement in homework or housework significantly moderated the association between corporal punishment and children’s behavioral problems. Conclusions: Parental engagement positively moderated the association between parental corporal punishment and children’s developmental difficulties. This association varied with child gender.
Key words child, corporal punishment, emotional and behavioral problem, parenting.
Symptoms of overall mental health problems are present in 8.6% of children.1 In Germany, 4.5% of children and adolescents aged 7–17 years met criteria for at least one specific mental health problem associated with impairment or had an overall mental health problem, indicated by an abnormal Strengths and Difficulties Score Questionnaire and present impairment.1 In Japan, approximately 15% of school-age children have emotional and behavioral disorders.2 Other data from the developed world show that child psychiatric disorders cause serious distress or social impairment in around 10–20% of children at any one time.3 Reasons for children’s emotional and behavioral problems have been discussed broadly. It is well documented that abusive discipline, family instability, lack of emotional support, lack of parental supervision, family isolation, violence in the home and physical neglect contribute to symptoms of conduct disorder.4–6 Parenting (and parental nurturing behavior more generally) make a child more vulnerable to social, emotional and behavioral problems.7 Negative parenting behavior, such as harsh punishment (i.e. frequent hitting, spanking, grabbing) and inconsistent discipline, is a robust predictor of child and adolescent conduct problems.8,9 In the current study, corporal punishment has been Correspondence: Lian Tong, PhD, School of Public Health, Fudan University, Dong’an Road 130, Shanghai 200032, China. Email: [email protected] Received 28 October 2013; revised 3 June 2014; accepted 18 September 2014.
© 2015 Japan Pediatric Society
defined as domestic physical punishment, mainly children being punished by parents, and is usually referred to colloquially as “spanking”, “whipping”, “smacking” or “slapping”. The effectiveness of corporal punishment and its relation to children’s emotional and behavioral outcomes is highly debated. Parental corporal punishment uniquely contributes to negative behavioral adjustment in children at both 36 months and in first grade.10 A study carried out with a sample of elementary school students in the USA found an association between the use of corporal punishment and problems in both emotional and behavioral adjustment. The associations were strongest for children who experienced high levels of corporal punishment.11 A meta-analysis conducted by Gershoff provides evidence that corporal punishment is associated with negative child behaviors, including decreased moral internalization,12 increased aggression, increased antisocial behaviors and overall mental health. A cross-cultural study also noted a link between corporal punishment and children’s antisocial behavior,13,14 and poor adjustment.15 The literature, however, also reflects opposing findings, and this makes it difficult to draw firm conclusions about the association between corporal punishment and child outcome. In a comprehensive review based on 35 peer-reviewed longitudinal studies on the relationship between customary physical punishment and child outcome, Larzelere reported that 34% of studies found detrimental outcomes, 40% found neutral outcomes and
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26% found beneficial outcomes.16 Some researchers argue that corporal punishment can be beneficial under some circumstances including (i) when it is administered by emotionally supportive parents; (ii) when it is used sparingly and non-violently; and (iii) when it is used conditionally in response to defiance.16,17 Additionally, a possible explanation for the benefit of corporal punishment may be the moderating effect of positive parenting, which effectively reduces the risk of negative child outcome. Existing studies show that parental warmth appears to moderate the association between physical discipline and child outcome.12,18 Several studies of parent training interventions have shown that a reduction in harsh discipline and increased positive parenting mediate the positive effects of the interventions on child conduct problems.19–21 Positive parenting might be a protective factor against corporal punishment in child development, but findings are few regarding the moderating influence that parental practices might have on the link between corporal punishment and children’s emotional and behavioral problems. Daily parenting practices, especially parental engagement, are considered to be important factors that explain child developmental outcomes. Studies have shown that parents’ positive engagement with children in social activities is correlated with children’s general development. For example, increased parental engagement with children in socialrelated activities has been found to decrease the occurrence of developmental problems. Research on a group-based intervention demonstrated that caregiver engagement (e.g. participation, homework completion, openness to ideas and apparent satisfaction) moderates the relationship between risk factors for children’s behavior problems and placement disruption.22 Furthermore, a longitudinal study carried out in Japan indicated that parents going shopping with their children potentially contributed to children’s gross motor development. Additionally, parent play with their children was beneficial to their child’s social competence and intelligence development, and corporal punishment was negatively correlated with children’s vocabulary and gross motor development.23 A recent study found that positive communication moderates the relationship between corporal punishment and child depressive symptoms.24 In view of the aforementioned reasons, the first hypothesis is that positive parental engagement activities have a moderating effect on the association between parental corporal punishment and children’s emotional and behavioral problems. Corporal punishment behavior may also share genetic factors with child behavior problems, such as child gender25 and child personality characteristics,26 making genetically sensitive designs imperative in the full understanding of the association. The strongest and most consistent influences on behavior and emotional problems in children originate in the home, including lower sociodemographic status, poorer maternal caregiving, parental stress/maternal mental health problems, as well as child gender (Stein et al.).27 Parent–child interaction is often considered to be the connection between the child’s own factors, parenting and rearing environment, which play a crucial role in child development.28 A model of coercive parent–child interactions, in which children respond to harsh punishment with elevated © 2015 Japan Pediatric Society
aggression and non-compliance, showed that parents become increasingly inconsistent in their parenting strategies to avoid these aversive interactions. Thus, as parents become increasingly inconsistent in their use of discipline strategies over time, they inadvertently reinforce the child’s behavior problem and exacerbate this coercive cycle.29 To clarify the effect pathway between daily parenting practices on child developmental outcomes, the psychological characteristics of parent–child interaction should be taken into consideration. The second hypothesis is that the characteristics of parent–child interaction are closely correlated with children’s developmental problems, and the association may vary with child gender.
Methods Subjects and procedure
A total of 90 dyads (children and their main caregiver) from a medium-sized city in Japan participated in this study. The sample size was calculated mainly based on the incidence of emotional and behavioral problems in children. Families meeting the following criteria were invited to participate in this study: (i) child age 7 years; (ii) child classified as normal (no diagnosed disease); (iii) agreement to attend by the main caregiver; and (iv) Japanese family, local to the environment. The subjects were limited to children 7 years old, because their cognitive and behavioral development is in progress, and because they are a homogeneous group with regard to the effect of school. Children with a doctordiagnosed physical or mental health problems were excluded from the study. The subjects were recruited at routine physical check up at a clinical child-care center. Total data were available for 90 dyads, which yielded a participation rate of 100%. The research was carried out in two steps: (i) questionnaire investigation; and (ii) laboratory observation. Measures
The parent–report version of the Strengths and Difficulties Questionnaire (SDQ)30 was used to evaluate the children’s emotional and behavioral development. The Japanese version SDQ was used in the current study, because it was shown to possess favorable psychometric properties.31 The questionnaire consists of 25 items organized into the following five subscales: hyperactivity (α = 0.80); emotional problems (α = 0.63); conduct problems (α = 0.53); peer relationships (α = 0.50); and prosocial behavior (α = 0.72). There are three levels for each item: 0, not true; 1, somewhat true; and 2, certainly true. The total score for a subscale is obtained by adding the individual scores for the five items that comprise the subscale, thus yielding a total score ranging from 0 to 10 for each subscale. A higher score indicates a higher risk of developing difficulties. Conversely, a higher score for the subscale of prosocial behavior indicates a lower risk. According to the distribution of data and the incidence in other groups, cut-offs were chosen so that approximately 80% of the children in the sample were categorized as normal, 10% as borderline and 10% as abnormal. In the present study, the main caregiver also completed the Evaluation of Environmental Stimulation (EES) scale, which is
Parent engagement and child development used to assess parenting behaviors. The scale for evaluating parenting practices was developed based on the Home Observation for Measurement of the Environment (HOME) by Anme.32,33 The correlation coefficient between HOME and EES scores is 0.80, and the internal consistency (Cronbach’s alpha) of the scale is 0.53.34,35 The EES contains 13 items that cover parental engagement activities and corporal punishment. For example, parent engagement with children in social activities consists of items on going shopping with the child, going to a park or visiting a friend and more. Punishment behavior was assessed using items such as “how often you punish your child corporally”. Response ranges were measured on a 5-point scale (1, always; 2, often; 3, sometimes; 4, rarely; 5, never). Laboratory observation
Caregiver–child interactions (89 mother–child dyads; one grandmother–child dyad) were videotaped in a laboratory setting. The technique enabled us to observe the facial expressions, eye contact and body movement for each participant, which are requirements for this assessment. Interactions were captured in a room with four video cameras mounted high on the wall at each of the four corners and one camera suspended from the ceiling in the center of the room. Only one desk and one baby chair were put in the room. The staff operated the camera through a window with a dark glass in the observation room. Staff briefly introduced the procedures to the parent before the formal observation began. The siblings of the subject child were asked to wait and play outside the observation room. No staff or other persons stayed in the observation room when the parent–child interaction started. After the parent and child were escorted into the playroom, the child was permitted to play in the room and touch the task tools freely. The task introduced involved paper folding, which is a very popular activity for children in Japan. The task procedure was considered to begin from the time the parent obtained the folding paper and a pamphlet for teaching paper folding from staff and was considered to finish upon completion of the task. With the help of an instructional pamphlet given to them, the children were asked to choose a color of the rice paper and then to create folded paper sculptures of animals that they would like to fold. Each caregiver was asked to teach her child a prescribed task that was slightly difficult for the child to accomplish by him or herself. During the process, the parent gave the same amount of necessary instruction and help as she typically did in daily life. For instance, when the child did not know what to do next, the parent would tell them immediately. The formal observation period typically lasted for 5–10 min.
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items, r = 0.98; total, r = 0.89).36 The IRS consists of five subscales pertaining to children’s competence: (i) autonomy (Cronbach alpha, α = 0.74); (ii) responsiveness (α = 0.61); (iii) empathy (α = 0.70); (iv) motor self-regulation (α = 0.43) and (v) emotional self-regulation (α = 0.66). Five items are included in each subscale for children. To assess the child items, Anme et al. observed 38 children suffering from developmental disorders (attention-deficit hyperactivity disorder/pervasive developmental disorder), mental retardation, abuse or maltreatment and classified their interaction behaviors using the IRS classification system.36 They found that low IRS score was significantly related to children’s behavior problems, confirming the reliability and validity of the scale. In addition, the IRS contains the following five subscales pertaining to caregiver behavior: (i) sensitivity to child (α = 0.43); (ii) responsiveness to child (α = 0.62); (iii) intrusiveness to child (α = 0.59); (iv) fostering of child’s social– emotional growth (α = 0.45); and (v) fostering of child’s cognitive growth (α = 0.70). Nine items are included in each subscale for parents. The Cronbach alpha of the entire scale was 0.91, with that for the child subscales being 0.88 and that for the caregiver subscales being 0.85. Inter-rater reliability
The IRS was completed by 10 research assistants (either doctoral or master’s level students) who underwent at least 1 month of training. Ten raters were divided into five pairs for double coding. The interaction video was watched twice or three times to reduce drift during coding. All raters were required to be able to correctly distinguish the cues of both child and parent during the observation period. Each coder was trained until a minimum of 80% was obtained on inter-assessor agreement on pilot tapes. To assess the reliability of coding, pairs of coders examined and recoded 25% of the tapes at the conclusion of the study. The 25% pairs were selected randomly from the database. Using this quality control check, the inter-rater reliability between assessors was >87% for both child and parent subscales. Examples of items assessing children’s autonomy include the following: “Child vocalizes while looking at the task materials” and “Child attempts to make eye contact with caregiver”. The item “Caregiver pauses when child initiates behaviors during episode” was used to evaluate parent respect for child autonomy. When the behavioral characteristic evaluated on the basis of video observation was identified during the episode, a score of 1 (yes) was given to this item; otherwise, a score of 0 (no) was given. The total score (total of all items) was used to evaluate the level of interaction for children and parents, respectively.
Laboratory observation scale and reliability
Statistical analysis
The bidirectional interaction was coded using the Interaction Rating Scale (IRS), which is widely used in both clinical practice and in research to assess the quality of caregiver–child interactions in families with young children. The IRS was developed by Anme et al. based on Nursing Child Assessment Satellite Training (NCAST) teaching scales28 for Japanese children from birth to 8 years of age.36 IRS scores have highly significant correlations with NCAST teaching scales (child items, r = 0.70; caregiver
SAS version 9.1 (Institute Inc., Cary, NC, USA) was used for data analysis. The analyses were carried out as follows. First, chi-squared test was performed to examine any gender differences in the distribution of emotional and behavioral problems. Second, multiple regression analysis was used to predict the contribution of daily parenting to children’s developmental difficulties. The five subscales of the SDQ (hyperactivity, emotional problems, conduct problems, peer relationship and prosocial © 2015 Japan Pediatric Society
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behavior) and the total SDQ score were included as independent variables in six separate models of regression analyses. The items pertaining to parenting factors were included in each model as explanatory variables. Item selection was carried out according to the following procedure: first, the significance of an assigned independent variable was determined on single regression analysis; second, stepwise multiple regression analysis was used and the independent variables were tested. All results were determined at the significance level of P < 0.05. Ethics
All participating families were required to read and sign an informed consent form before participating in this research. The students (or families) had the opportunity to decline enrollment in the study, and were allowed to withdraw at any time. Both the content and the procedure of this research were approved by the ethics committee of the Japan Science and Technology Agency (JST).
Results Of the 90 children who participated in the study, 49 (53.9%) were boys, and 41 (46.1%) were girls. At the time of the study, only nine participants (10.0%) were an only child; more than half of the children (58; 64.5%) had one sibling, 20 (22.2%) had two siblings and two (2.2%) had three siblings. Regarding the children’s parents, 61 mothers (67.8%) and 54 fathers (60.0%) were aged 35–45 years. Of the 90 children, 47 (52.2%) lived with two parents, three (3.3%) lived with a single mother, 40 (44.5%) lived in an extended family (34 [37.8%] of which included parents and grandparents), five (5.6%) lived with a single mother and grandparents, and one (1.1%) lived with a single father and grandparents. Other relevant demographic information on the children and families is presented in Table 1. With regard to gender distribution of the children’s SDQ score across categories (normal, borderline and abnormal), boys were threefold as likely to exhibit symptoms of hyperactivity/inattention compared with girls (χ2 = 8.89, P < 0.05; Table 2). On multiple regression analysis using the SDQ score of each subscale as independent variables, parents engaging with their children in physical and social activity predicted a lower likelihood of their child experiencing development problems after controlling for child gender (Table 3). Parents playing games or sports with their child often predicted a lower likelihood of their child having emotional symptoms (β = −0.32, P = 0.0378). Parents doing homework or housework with their child often predicted a lower probability of their child developing conduct problems (β = −0.44, P = 0.0185). Children who had a parent who frequently took them to museums or amusement parks had fewer peer problems (β = −0.41, P = 0.0189). The children of parents who consulted with their friends and their children’s teacher about child rearing issues had fewer peer problems (β = −1.33, P = 0.007) and fewer prosocial behavior problems (β = 1.16, P = 0.0147) than children of parents who did not engage in these activities. The findings in each independent regression model of the six aspects of the SDQ showed that parent’s engagement activities © 2015 Japan Pediatric Society
Table 1 Participant demographics Items Gender Boys Girls Siblings 0 1 2 3 NA Mother’s age (years) 25–35 35–45 45–55 NA Father’s age (years) 25–35 35–45 45–55 NA Family type Nuclear family Parents Mother only Extended family Parents, grandparents Mother, grandparents Father, grandparents Family income (USD) 100 000 NA Total
n
%
49 41
53.9 46.1
9 58 20 2 1
10.0 64.5 22.2 2.2 1.1
20 61 6 3
22.2 67.8 6.7 3.3
14 54 12 10
15.6 60.0 13.3 11.1
47 3
52.2 3.3
34 5 1
37.8 5.6 1.1
2 17 33 20 9 5 4 90
2.2 18.9 36.7 22.2 10.0 5.6 4.4 100.0
affected children’s developmental difficulties through an interaction with parent’s corporal punishment. As previously mentioned, parents playing games or sports with their child often predicted a lower likelihood of their children having emotional symptoms; conversely, corporal punishment by parents increased the risk of emotional symptoms (β = 0.77, P = 0.0031). Parents who did homework or housework with their child often predicted a lower probability of their children developing conduct problems; an inverse association was found between corporal punishment by parents and children’s conduct problems (β = 0.73, P = 0.0008). A negative association also was found between corporal punishment and children’s prosocial behavior problems (β = −0.61, P = 0.0445). Comparing the strength of the two opposite factors, we found that corporal punishment had a stronger association with children’s emotional symptoms and conduct problems, while parent’s positive engagement had a stronger association with children’s prosocial behaviors. Corporal punishment also contributed significantly to children’s total SDQ score (β = 2.41, P = 0.0064) and hyperactivity/inattention symptoms (β = 1.22, P = 0.0024). Even though parent punishment
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Table 2 Gender distribution of behavioral and emotional difficulties in children aged 7 years
n
Total (n = 90) %
n
70 10 10
77.8 11.1 11.1
35 6 8
71.5 12.2 16.3
35 4 2
85.4 9.7 4.9
3.32
71 10 9
78. 9 11.1 10.0
40 5 4
81.6 10.2 8.2
31 5 5
75.6 12.2 12.2
0.55
76 5 9
84.4 5.6 10.0
38 4 7
77.5 8.2 14.3
38 1 2
92.7 2.4 4.9
3.90
71 10 9
78.9 11.1 10.0
33 9 7
67.3 18.4 14.3
38 1 2
92.7 2.4 4.9
8.89*
72 8 10
80.0 8.9 11.1
39 5 5
79.6 10.2 10.2
33 3 5
80.5 7.3 12.2
0.29
76 6 8
84.4 6.7 8.9
39 4 6
79.6 8.2 12.2
37 2 2
90.2 4.9 4.9
2.02
SDQ score Total SDQ Normal Borderline Abnormal Emotional symptoms Normal Borderline Abnormal Conduct problems Normal Borderline Abnormal Hyperactivity/inattention Normal Borderline Abnormal Peer relationship problems Normal Borderline Abnormal Prosocial behavior Normal Borderline Abnormal
Boys (n = 49) %
n
Girls (n = 41) %
χ2
* P < 0.05. SDQ, Strengths and Difficulties Questionnaire.
negatively contributed to children’s emotional symptoms and conduct problems, parental positive engagement with children frequently moderated the negative association with children’s outcomes. Partial correlation analysis indicated an interaction between parenting, child gender and children’s individual behavior characteristics in detail. Parenting was associated with different outcomes for boys and girls and differentially affected their likelihood of suffering from developmental difficulties (Table 3). Gender differences were seen in the total SDQ score (β = 2.83, P
= 0.0081), conduct problems (β = 0.88, P = 0.006), hyperactivity/ inattention (β = 1.40, P = 0.0004) and prosocial behaviors (β = −0.98, P = 0.0266). Boys had more emotional and behavioral problems and more symptoms of hyperactivity/inattention than girls but fewer prosocial problems than girls. Partial correlation analysis between parenting behavior and children’s emotional and behavioral problems was carried out according to child gender (Table 4). Different associations were found between the characteristics of parent–child interaction and children’s developmental problems for the boys and the girls. For
Table 3 Parenting factors related to emotional and behavioral problems in children† Children’s developmental problems (dependent variables in six independent regression models) SDQ total score Emotional symptoms Conduct problems
Hyperactivity/inattention Peer problems Prosocial behavior
Parenting (independent variables)
β
P
Gender How often do you punish your child? How often do you engage in games or sports with your child? How often do you punish your child? Gender How often do you do housework or homework with child? How often do you punish your child? Gender How often do you punish your child? How often do you take your child to museums or amusement parks? How often do you consult with your friend about how to rear child? Gender How often do you punish your child? How often do you consult with your child’s teacher about how to rear child?
2.83 2.41 −0.32 0.77 0.88 −0.44 0.73 1.40 1.22 −0.41 −1.33 −0.98 −0.61 1.16
0.008 0.006 0.038 0.003 0.006 0.019 0.001 0.001 0.002 0.019 0.007 0.027 0.045 0.015
†
Controlled for child gender and family income level. SDQ, Strengths and Difficulties Questionnaire.
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Table 4 Partial correlations between child developmental problems and parent–child interaction SDQ score Boys Child domain Empathy Motor self-regulation Emotional self-regulation Autonomy Responsiveness Parent domain Sensitivity Responsiveness Respect for child’s autonomy Fostering of social emotional growth Fostering of cognitive growth Girls Child domain Empathy Motor self-regulation Emotional self-regulation Autonomy Responsiveness Parent domain Sensitivity Responsiveness Respect for child’s autonomy Fostering of social emotional growth Fostering of cognitive growth
Emotional symptoms
Conduct problems
−0.19 −0.01 0.05 −0.07 −0.22
−0.03 0.10 0.14 0.14 0.24
0.01 0.01 −0.11 0.22 −0.16
−0.26 0.07 −0.23 0.09 0.18
0.07 0.08 0.04 0.10 0.14
−0.15 −0.25 −0.45** −0.10 0.01 −0.14 −0.20 −0.18 −0.11 0.20
Hyperactivity/ inattention
Peer problems
Prosocial behavior
−0.16 −0.14 −0.05 −0.06 −0.23
−0.13 0.10 0.08 −0.17 0.15
0.09 0.07 −0.04 −0.15 −0.09
−0.20 0.08 0.09 0.10 0.07
−0.21 0.16 −0.35* 0.06 0.22
−0.17 −0.08 −0.10 −0.09 0.01
0.10 0.16 −0.11 −0.02 0.14
−0.36* −0.22 −0.06 −0.20 −0.08
0.08 0.32 0.30 0.04 −0.11
0.04 −0.11 −0.61*** 0.12 0.08
0.08 −0.12 −0.26 −0.02 0.10
−0.07 −0.04 −0.41* 0.01 −0.14
−0.17 −0.28 −0.15 0.05 0.21
−0.07 −0.01 −0.26 −0.03 0.12
−0.07 −0.19 −0.17 −0.14 0.15
0.03 0.08 0.09 −0.12 −0.10
−0.08 −0.25 0.03 −0.16 −0.10
*P < 0.05. **P < 0.01. ***P < 0.001. SDQ, Strengths and Difficulties Questionnaire.
boys, mothers respecting their children’s autonomy was found to be negatively correlated with children’s hyperactivity/inattention symptoms (r = −0.35, P < 0.05; Table 4). Moreover, individual traits such as emotional self-regulation for girls were correlated with symptoms of hyperactivity. Girls who had a high degree of emotional self-regulation had fewer symptoms of hyperactivity/ inattention and fewer developmental difficulties (r = −0.61, P < 0.001). Additionally, girls’ empathy development was found to be related to the display of emotional symptoms, and a high level of empathy development was associated with fewer emotional problems (r = −0.36, P < 0.05). Girls’ emotional self-regulation was also negatively correlated with their prosocial behavior development (r = −0.41, P < 0.05). The results are shown in Table 4.
Discussion The present findings offer strong evidence to support the hypothesis that positive parental engagement has a moderating effect on the association between parental corporal punishment and children’s developmental problems. In particular, a negative association between parental corporal punishment and children’s conduct problems was found in the present study. Meanwhile, parental engagement with children in housework and homework significantly moderated the negative association between corporal punishment and conduct problems. This might be due to parent engagement improving the parent–child relationship, and the transfer of social norms to the child during the daily activities. It has been suggested that a higher level of parental engagement © 2015 Japan Pediatric Society
and a more positive relationship with parents are associated with higher child self-rated health, and fewer child emotional and behavioral problems. Parental involvement and responsive parenting have been previously shown to be beneficial to the development of social competence in elementary school children and children’s general development.37 A recent study showed that both harsh maternal discipline and positive parenting functioned separately as mediators of the effect on child conduct problems.38 Moreover, parental engagement in games or sports with their child moderated the association between negative parenting and child’s outcomes, which is beneficial to child emotional development. Existing studies have shown that the frequency of parental engagement with their children in play activities is a critical indicator for physical and cognitive development, as well as a factor of parental responsiveness,39 because children use play as their primary medium of communication. Play is a format for transmitting children’s emotions, thoughts, values and perceptions to adults and thus for smoothing the parent–child relationship.40 It has also been suggested that domestic social interactive activities are beneficial for smoothing the parent–child relationship, potentially transferring social rules to children, and in helping children to behave in a socially acceptable way. We also found that corporal punishment can result in low prosocial development, while parental consultation behaviors regarding childrearing have a moderating effect on this association. Previous studies showed that reward and punishment clouds one’s true motives, therefore often deterring prosocial behavior.41
Parent engagement and child development Positive parental behaviors, however, have been found to be associated with positive peer outcomes and prosocial behavior in children.37 Parents’ talking with others about childrearing often was correlated with social support offered by others, which has been demonstrated to promote child general development. Talking with other persons about childrearing is also an important indicator of parental attitude, behavior and attention towards child development. In addition, to clarify the potential link between parental engagement and child developmental difficulties, synchronous parent–child interactions were recorded on video in the current study. Evidence found in this study supports the second hypothesis that the characteristics of parent–child interaction presented in both the child and parent domains are significantly correlated with child outcomes, and that the association varies with child gender. According to a previous study, underdevelopment of a child’s individual capability and the experiences of negative parenting cause children to externalize and internalize problems, leading to unsocial or disruptive behavior.42 Child characteristics such as gender and temperament appear to influence whether children are spanked and the association between spanking and subsequent behavior. Research demonstrates that gender differences characterize various aspects of conduct disorder.43 Boys tend to receive more physical punishment than girls.44,45 Child gender also moderates the association between negative parenting and childhood conduct problems.25 For boys, parents with much more respect for their autonomy predict fewer hyperactivity/inattention symptoms. It might be because children with certain characteristics may provoke certain responses. For example, boys with hyperactive symptoms might stimulate restrictive parenting. It has been suggested that parental practices restricting the autonomy of children who have symptoms of hyperactivity/inattention might exacerbate children’s poor self-regulation and poor parent–child relationships.29 Also, gender differences in cultural expectations for behavior problems should be taken into consideration, because many symptoms have different social and clinical significances in boys and girls due to the fact that it is rarer in girls and certainly far more contrary to the social mores for the female than male gender. For girls, those with good emotional self-regulation have fewer symptoms of hyperactivity/inattention, but more obvious prosocial behavior problems. And sex-differentiated treatment, regarding parental aspirations for their child’s education and expectations for the future, should be taken into consideration. Girls are frequently trained to conform to traditional gender role expectations, which include traits of calmness, politeness, selfregulation and attentiveness to the needs of others.46 Girls’ emotional and behavioral problems would be underestimated by their parent when they have high emotional self-regulation. In addition, girls’ high emotional self-regulation was negatively correlated with prosocial behavior. A potential explanation for this negative association might be gender role expectations, because high emotional self-regulation is regarded as desirable characteristics for girls in Japan’s social context. This extensively restricts their expression of emotion directly and their engagement in
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social activities. This indicates that being too self-regulated is not beneficial for young girls’ prosocial behavior development, particularly in Japanese culture. To sum up, daily parental engagement and parent–child interaction are the crucial factors in children’s emotional and behavioral problems. Community child-care practitioners should work with parents to improve positive parenting engagement and avoid physical punishment of children. The social factors surrounding child should be assessed by doctors in clinical practice. Parent–child interaction interventions should be tailored to child gender. Limitations
First, the SDQ parent-report version was used to examine children’s emotional and behavioral problems due to child age, therefore the report bias was unavoidable. Second, the data were based on the parent–child interactive behaviors during a somewhat artificial task, even though the pairs were told to play freely, so it would be very difficult to imitate the real home environment, such as the influence of siblings. Another shortcoming of this study is that all the data were collected at the same time point, meaning that the long-term effect of parenting on child outcome is unknown. A longitudinal study is required to clarify the effect pathway further.
Acknowledgment The authors thank Professor Koeda Tatsuya and his group members in the Department of Education at Tottori University for data collection.
References 1 Ravens-Sieberer U, Wille N, Erhart M et al. Prevalence of mental health problems among children and adolescents in Germany: Results of the BELLA study within the National Health Interview and Examination Survey. Eur. Child Adolesc. Psychiatry 2008; 17: 22–33. 2 Morita H, Suzuki M, Suzuki S, Kamoshita S. Psychiatric disorders in Japanese secondary school children. J. Child Psychol. Psychiatry 1993; 34: 317–32. 3 Bird HR. Epidemiology of childhood disorders in a cross-culture context. J. Child Psychol. Psychiatry 1996; 37: 35–49. 4 Burt SA, Krueger RF, McGue M, Iacono WG. Parent-child conflict and the comorbidity among childhood externalizing disorders. Arch. Gen. Psychiatry 2003; 60: 505–13. 5 Reese LE, Vera EM, Simon TR, Ikeda RM. The role of families and care givers as risk and protective factors in preventing youth violence. Clin. Child Fam. Psychol. Rev. 2000; 3: 61–77. 6 Lewis M. Child and Adolescent Psychopathology. A Comprehensive Textbook, 2nd edn. Williams & Wilkins, Hagerstown, MD, 1996. 7 Maestripieri D, McCormack K, Lindell SG, Higley JD, Sanchez MM. Influence of parenting style on the offspring’s behaviour and CSF monoamine metabolite levels in cross fostered and non cross fostered female rhesus macaques. Behav. Brain Res. 2006; 175: 90–95. 8 Burke JD, Loeber R, Birmaher B. Oppositional defiant disorder and conduct disorder: A review of the past 10 years, part II. J. Am. Acad. Child Adolesc. Psychiatry 2002; 41: 1275–93. 9 Loeber R, Burke JD, Pardini DA. Development and etiology of disruptive and delinquent behavior. Annu. Rev. Clin. Psychol. 2009; 5: 291–310.
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10 Mulvaneya MK, Meberta CJ. Parental corporal punishment predicts behavior problems in early childhood. J. Fam. Psychol. 2007; 21: 389–97. 11 Aucoin KJ, Frick PJ, Bodin SD. Corporal punishment and child adjustment. J. Appl. Dev. Psychol. 2006; 27: 527–41. 12 Gershoff ET. Corporal punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review. Psychol. Bull. 2002; 128: 539–79. 13 Simons R, Wu CI, Hsiulin K, Gordon L, Conger RD. A crosscultural study also demonstrated the link between corporal punishment and adolescent antisocial behavior. Criminology 2002; 38: 47–79. 14 Straus MA, Mouradian VE. Impulsive corporal punishment by mothers and antisocial behavior and impulsiveness of children. Behav. Sci. Law 1998; 16: 353–74. 15 Bank L, Burraston B. Abusive home environments as predictors of poor adjustment during adolescence and early childhood. J. Community Psychol. 2001; 29: 195–217. 16 Larzelere RE. A review of the outcomes of parental use of nonabusive or customary physical punishment. Pediatrics 1996; 98: 824–5. 17 Larzelere RE, Kuhn BR. Comparing child outcomes of physical punishment and alternative disciplinary tactics: A meta-analysis. Clin. Child Fam. Psychol. Rev. 2005; 81: 1–37. 18 McLoyd VC, Smith J. Physical discipline and behavior problems in African American, European American, and Hispanic children: Emotional support as a moderator. J. Marriage Fam. 2002; 64: 40–53. 19 Beauchaine TB, Webster-Stratton C, Reid MJ. Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: A latent growth curve analysis. J. Consult. Clin. Psychol. 2005; 73: 371–88. 20 Forgatch MS, Patterson GR, DeGarmo DS, Beldavs ZG. Testing the Oregon delinquency model with 9-year follow up of the Oregon Divorce Study. Dev. Psychopathol. 2009; 21: 637–60. 21 Gardner F, Burton J, Klimes I. Randomised controlled trial of a parenting intervention in the voluntary sector for reducing child conduct problems: Outcomes and mechanisms of change. J. Child Psychol. Psychiatry 2006; 47: 1123–32. 22 DeGarmo DS, Chamberlain P, Leve LD, Price J. Foster parent intervention engagement moderating child behavior problems and placement disruption. Res. Soc. Work Pract. 2009; 19: 423–33. 23 Tong L, Shinohara R, Sugisawa Y et al. Relationship of working mother’s parenting style and consistency to early childhood development: A longitudinal investigation. J. Adv. Nurs. 2009; 65: 2067– 76. 24 Wimsatt AR, Fite PJ, Grassetti NS, Rathert JL. Positive communication moderates the relationship between corporal punishment and child depressive symptoms. Child Adolesc. Ment. Health 2013, 18: 225–30. 25 Tung I, Li JJ, Lee SS. Child sex moderates the association between negative parenting and childhood conduct problems. Aggress. Behav. 2012; 38: 239–51. 26 Moffitt TE, Caspi A, Rutter M, Silva PA. Sex Differences in Antisocial Behaviour. Cambridge University Press, Cambridge, UK, 2001. 27 Stein A, Malmberg LE, Leach P, Barnes J, Sylva K, the FCCC Team. The influence of different forms of early childcare on children’s emotional and behavioural development at school entry. Child Care Health Dev. 2013; 39: 676–87.
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28 Sumner G, Spieta A. NCAST Caregiver/Parent-Child Interaction Teaching Manual. NCAST Publications, University of Washington, School of Nursing, Seattle, WA, 1994. 29 Patterson GR, Reid JB, Dishion TJ. Antisocial Boys. Castalia, Eugene, OR, 1992. 30 Goodman R. The strengths and difficulties questionnaire: A research note. J. Child Psychol. Psychiatry 1997; 38: 581–6. 31 Matsuishi T, Nagano M, Araki Y et al. Scale properties of the Japanese version of the Strengths and Difficulties Questionnaire (SDQ): A study of infant and school children in community samples. Brain Dev. 2008; 30: 410–15. 32 Caldwell BM, Bradley RH. Home Observation for Measurement of the Environment. University of Arkansas at Little Rock, Little Rock, AR, 1984. 33 Anme T. Index of child care environment. J. Natl Rehabil. Cent. Disabled 1991; 12: 29–36. 34 Anme T. Evaluation for Child Care Environment. Kawasima Publication, Tokyo, 1996. 35 Anme T. Evaluation of child care environment for 18-month child. Jpn. J. Public Health 1998; 44: 346–52. 36 Anme T, Yato Y, Shinohara R, Sugisawa Y. The reliability and validity of the assessment method for children’s social competence: Parent-child Interaction Rating Scale. Jpn. J. Health Care Welf. 2007; 14: 23–31. 37 Dekovic M, Janssens JMAM. Parent’s child-rearing style and child’s sociometric status. Dev. Psychol. 1992; 28: 925–32. 38 Bjørknes R, Kjøbli J, Manger T, Jakobsen R. Parent training among ethnic minorities: Parenting practices as mediators of change in child conduct problems. Fam. Relat. 2012; 61: 101–14. 39 Paper commissioned for the EFA Global Monitoring Report. Strong 2007 foundations: Early childhood care and education. [Cited 20 July 2009.] Available from URL: http://www .researchconnections.org/childcare/resources/1165. 40 Ray D, Bratton S, Rhine T, Jones L. The effectiveness of play therapy: Responding to the critics. Int. J. Play Ther. 2001; 10: 85–108. 41 Roland B, Tirole J. Incentives and prosocial behavior. National Bureau of Economic Research, 1-7. 2005. [Cited 20 July 2014.] Available from URL: http://www.psychwiki.com/wiki/Prosocial _Behavior. 42 Hughes C, Ensor R. Positive and protective: Associations of early theory of mind on problem behaviors in at-risk preschoolers. J. Child Psychol. Psychiatry 2007; 4: 1025–32. 43 Kazdin AE. Conduct Disorders in Childhood and Adolescence, 2nd edn. Sega, International Educational and Professional Publisher, Thousand Oaks, CA, 1995. 44 Smith JR, Brooks-Gunn J. Correlates and consequences of harsh discipline for young children. Arch. Pediatr. Adolesc. Med. 1997; 151: 777–86. 45 Straus MA, Stewart JH. Corporal punishment by American parents: National data on prevalence, chronicity, severity, and duration, in relation to child and family characteristics. Clin. Child Fam. Psychol. Rev. 1999; 2: 55–70. 46 Sugihara Y, Katsurada E. Gender role development in Japanese culture: Diminishing gender role differences in a contemporary society. Sex Roles 2002; 47: 443–52.
Pediatrics International (2015) 57, 385–392
doi: 10.1111/ped.12604
Original Article
Buffering effect of parental engagement on the relationship between corporal punishment and children’s emotional/behavioral problems Lian Tong,1,2 Ryoji Shinohara,2,3 Yuka Sugisawa,2,3 Emiko Tanaka,2,3 Taeko Watanabe,2,3 Tatsuya Koeda4 and Tokie Anme2,3 1 School of Public Health, Fudan University, Shanghai, China, 2Japan Science and Technology Agency (JST)/Research Institute of Science and Technology for Society (RISTEX), Tokyo, 3Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba and 4National Center for Child Health and Development, Tokyo, Japan Abstract
Background: Previous research has established links between corporal punishment and children’s developmental problems, but few studies have investigated the moderating effect of positive parenting between corporal punishment and children’s developmental difficulties in detail. This study investigated the buffering effect of parental engagement on the association between corporal punishment and children’s emotional/behavioral problems. Methods: The main caregivers completed the Evaluation of Environmental Stimulation Scale (EES), which is an evaluation of daily parenting behaviors, and the Strengths and Difficulties Questionnaire (SDQ), which evaluates children’s developmental problems. Results: Corporal punishment was associated with worse emotional and behavioral problems in children, whereas parental engagement in games or sports was associated with fewer emotional symptoms. Similarly, parental engagement in homework or housework significantly moderated the association between corporal punishment and children’s behavioral problems. Conclusions: Parental engagement positively moderated the association between parental corporal punishment and children’s developmental difficulties. This association varied with child gender.
Key words child, corporal punishment, emotional and behavioral problem, parenting.
Symptoms of overall mental health problems are present in 8.6% of children.1 In Germany, 4.5% of children and adolescents aged 7–17 years met criteria for at least one specific mental health problem associated with impairment or had an overall mental health problem, indicated by an abnormal Strengths and Difficulties Score Questionnaire and present impairment.1 In Japan, approximately 15% of school-age children have emotional and behavioral disorders.2 Other data from the developed world show that child psychiatric disorders cause serious distress or social impairment in around 10–20% of children at any one time.3 Reasons for children’s emotional and behavioral problems have been discussed broadly. It is well documented that abusive discipline, family instability, lack of emotional support, lack of parental supervision, family isolation, violence in the home and physical neglect contribute to symptoms of conduct disorder.4–6 Parenting (and parental nurturing behavior more generally) make a child more vulnerable to social, emotional and behavioral problems.7 Negative parenting behavior, such as harsh punishment (i.e. frequent hitting, spanking, grabbing) and inconsistent discipline, is a robust predictor of child and adolescent conduct problems.8,9 In the current study, corporal punishment has been Correspondence: Lian Tong, PhD, School of Public Health, Fudan University, Dong’an Road 130, Shanghai 200032, China. Email: [email protected] Received 28 October 2013; revised 3 June 2014; accepted 18 September 2014.
© 2015 Japan Pediatric Society
defined as domestic physical punishment, mainly children being punished by parents, and is usually referred to colloquially as “spanking”, “whipping”, “smacking” or “slapping”. The effectiveness of corporal punishment and its relation to children’s emotional and behavioral outcomes is highly debated. Parental corporal punishment uniquely contributes to negative behavioral adjustment in children at both 36 months and in first grade.10 A study carried out with a sample of elementary school students in the USA found an association between the use of corporal punishment and problems in both emotional and behavioral adjustment. The associations were strongest for children who experienced high levels of corporal punishment.11 A meta-analysis conducted by Gershoff provides evidence that corporal punishment is associated with negative child behaviors, including decreased moral internalization,12 increased aggression, increased antisocial behaviors and overall mental health. A cross-cultural study also noted a link between corporal punishment and children’s antisocial behavior,13,14 and poor adjustment.15 The literature, however, also reflects opposing findings, and this makes it difficult to draw firm conclusions about the association between corporal punishment and child outcome. In a comprehensive review based on 35 peer-reviewed longitudinal studies on the relationship between customary physical punishment and child outcome, Larzelere reported that 34% of studies found detrimental outcomes, 40% found neutral outcomes and
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26% found beneficial outcomes.16 Some researchers argue that corporal punishment can be beneficial under some circumstances including (i) when it is administered by emotionally supportive parents; (ii) when it is used sparingly and non-violently; and (iii) when it is used conditionally in response to defiance.16,17 Additionally, a possible explanation for the benefit of corporal punishment may be the moderating effect of positive parenting, which effectively reduces the risk of negative child outcome. Existing studies show that parental warmth appears to moderate the association between physical discipline and child outcome.12,18 Several studies of parent training interventions have shown that a reduction in harsh discipline and increased positive parenting mediate the positive effects of the interventions on child conduct problems.19–21 Positive parenting might be a protective factor against corporal punishment in child development, but findings are few regarding the moderating influence that parental practices might have on the link between corporal punishment and children’s emotional and behavioral problems. Daily parenting practices, especially parental engagement, are considered to be important factors that explain child developmental outcomes. Studies have shown that parents’ positive engagement with children in social activities is correlated with children’s general development. For example, increased parental engagement with children in socialrelated activities has been found to decrease the occurrence of developmental problems. Research on a group-based intervention demonstrated that caregiver engagement (e.g. participation, homework completion, openness to ideas and apparent satisfaction) moderates the relationship between risk factors for children’s behavior problems and placement disruption.22 Furthermore, a longitudinal study carried out in Japan indicated that parents going shopping with their children potentially contributed to children’s gross motor development. Additionally, parent play with their children was beneficial to their child’s social competence and intelligence development, and corporal punishment was negatively correlated with children’s vocabulary and gross motor development.23 A recent study found that positive communication moderates the relationship between corporal punishment and child depressive symptoms.24 In view of the aforementioned reasons, the first hypothesis is that positive parental engagement activities have a moderating effect on the association between parental corporal punishment and children’s emotional and behavioral problems. Corporal punishment behavior may also share genetic factors with child behavior problems, such as child gender25 and child personality characteristics,26 making genetically sensitive designs imperative in the full understanding of the association. The strongest and most consistent influences on behavior and emotional problems in children originate in the home, including lower sociodemographic status, poorer maternal caregiving, parental stress/maternal mental health problems, as well as child gender (Stein et al.).27 Parent–child interaction is often considered to be the connection between the child’s own factors, parenting and rearing environment, which play a crucial role in child development.28 A model of coercive parent–child interactions, in which children respond to harsh punishment with elevated © 2015 Japan Pediatric Society
aggression and non-compliance, showed that parents become increasingly inconsistent in their parenting strategies to avoid these aversive interactions. Thus, as parents become increasingly inconsistent in their use of discipline strategies over time, they inadvertently reinforce the child’s behavior problem and exacerbate this coercive cycle.29 To clarify the effect pathway between daily parenting practices on child developmental outcomes, the psychological characteristics of parent–child interaction should be taken into consideration. The second hypothesis is that the characteristics of parent–child interaction are closely correlated with children’s developmental problems, and the association may vary with child gender.
Methods Subjects and procedure
A total of 90 dyads (children and their main caregiver) from a medium-sized city in Japan participated in this study. The sample size was calculated mainly based on the incidence of emotional and behavioral problems in children. Families meeting the following criteria were invited to participate in this study: (i) child age 7 years; (ii) child classified as normal (no diagnosed disease); (iii) agreement to attend by the main caregiver; and (iv) Japanese family, local to the environment. The subjects were limited to children 7 years old, because their cognitive and behavioral development is in progress, and because they are a homogeneous group with regard to the effect of school. Children with a doctordiagnosed physical or mental health problems were excluded from the study. The subjects were recruited at routine physical check up at a clinical child-care center. Total data were available for 90 dyads, which yielded a participation rate of 100%. The research was carried out in two steps: (i) questionnaire investigation; and (ii) laboratory observation. Measures
The parent–report version of the Strengths and Difficulties Questionnaire (SDQ)30 was used to evaluate the children’s emotional and behavioral development. The Japanese version SDQ was used in the current study, because it was shown to possess favorable psychometric properties.31 The questionnaire consists of 25 items organized into the following five subscales: hyperactivity (α = 0.80); emotional problems (α = 0.63); conduct problems (α = 0.53); peer relationships (α = 0.50); and prosocial behavior (α = 0.72). There are three levels for each item: 0, not true; 1, somewhat true; and 2, certainly true. The total score for a subscale is obtained by adding the individual scores for the five items that comprise the subscale, thus yielding a total score ranging from 0 to 10 for each subscale. A higher score indicates a higher risk of developing difficulties. Conversely, a higher score for the subscale of prosocial behavior indicates a lower risk. According to the distribution of data and the incidence in other groups, cut-offs were chosen so that approximately 80% of the children in the sample were categorized as normal, 10% as borderline and 10% as abnormal. In the present study, the main caregiver also completed the Evaluation of Environmental Stimulation (EES) scale, which is
Parent engagement and child development used to assess parenting behaviors. The scale for evaluating parenting practices was developed based on the Home Observation for Measurement of the Environment (HOME) by Anme.32,33 The correlation coefficient between HOME and EES scores is 0.80, and the internal consistency (Cronbach’s alpha) of the scale is 0.53.34,35 The EES contains 13 items that cover parental engagement activities and corporal punishment. For example, parent engagement with children in social activities consists of items on going shopping with the child, going to a park or visiting a friend and more. Punishment behavior was assessed using items such as “how often you punish your child corporally”. Response ranges were measured on a 5-point scale (1, always; 2, often; 3, sometimes; 4, rarely; 5, never). Laboratory observation
Caregiver–child interactions (89 mother–child dyads; one grandmother–child dyad) were videotaped in a laboratory setting. The technique enabled us to observe the facial expressions, eye contact and body movement for each participant, which are requirements for this assessment. Interactions were captured in a room with four video cameras mounted high on the wall at each of the four corners and one camera suspended from the ceiling in the center of the room. Only one desk and one baby chair were put in the room. The staff operated the camera through a window with a dark glass in the observation room. Staff briefly introduced the procedures to the parent before the formal observation began. The siblings of the subject child were asked to wait and play outside the observation room. No staff or other persons stayed in the observation room when the parent–child interaction started. After the parent and child were escorted into the playroom, the child was permitted to play in the room and touch the task tools freely. The task introduced involved paper folding, which is a very popular activity for children in Japan. The task procedure was considered to begin from the time the parent obtained the folding paper and a pamphlet for teaching paper folding from staff and was considered to finish upon completion of the task. With the help of an instructional pamphlet given to them, the children were asked to choose a color of the rice paper and then to create folded paper sculptures of animals that they would like to fold. Each caregiver was asked to teach her child a prescribed task that was slightly difficult for the child to accomplish by him or herself. During the process, the parent gave the same amount of necessary instruction and help as she typically did in daily life. For instance, when the child did not know what to do next, the parent would tell them immediately. The formal observation period typically lasted for 5–10 min.
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items, r = 0.98; total, r = 0.89).36 The IRS consists of five subscales pertaining to children’s competence: (i) autonomy (Cronbach alpha, α = 0.74); (ii) responsiveness (α = 0.61); (iii) empathy (α = 0.70); (iv) motor self-regulation (α = 0.43) and (v) emotional self-regulation (α = 0.66). Five items are included in each subscale for children. To assess the child items, Anme et al. observed 38 children suffering from developmental disorders (attention-deficit hyperactivity disorder/pervasive developmental disorder), mental retardation, abuse or maltreatment and classified their interaction behaviors using the IRS classification system.36 They found that low IRS score was significantly related to children’s behavior problems, confirming the reliability and validity of the scale. In addition, the IRS contains the following five subscales pertaining to caregiver behavior: (i) sensitivity to child (α = 0.43); (ii) responsiveness to child (α = 0.62); (iii) intrusiveness to child (α = 0.59); (iv) fostering of child’s social– emotional growth (α = 0.45); and (v) fostering of child’s cognitive growth (α = 0.70). Nine items are included in each subscale for parents. The Cronbach alpha of the entire scale was 0.91, with that for the child subscales being 0.88 and that for the caregiver subscales being 0.85. Inter-rater reliability
The IRS was completed by 10 research assistants (either doctoral or master’s level students) who underwent at least 1 month of training. Ten raters were divided into five pairs for double coding. The interaction video was watched twice or three times to reduce drift during coding. All raters were required to be able to correctly distinguish the cues of both child and parent during the observation period. Each coder was trained until a minimum of 80% was obtained on inter-assessor agreement on pilot tapes. To assess the reliability of coding, pairs of coders examined and recoded 25% of the tapes at the conclusion of the study. The 25% pairs were selected randomly from the database. Using this quality control check, the inter-rater reliability between assessors was >87% for both child and parent subscales. Examples of items assessing children’s autonomy include the following: “Child vocalizes while looking at the task materials” and “Child attempts to make eye contact with caregiver”. The item “Caregiver pauses when child initiates behaviors during episode” was used to evaluate parent respect for child autonomy. When the behavioral characteristic evaluated on the basis of video observation was identified during the episode, a score of 1 (yes) was given to this item; otherwise, a score of 0 (no) was given. The total score (total of all items) was used to evaluate the level of interaction for children and parents, respectively.
Laboratory observation scale and reliability
Statistical analysis
The bidirectional interaction was coded using the Interaction Rating Scale (IRS), which is widely used in both clinical practice and in research to assess the quality of caregiver–child interactions in families with young children. The IRS was developed by Anme et al. based on Nursing Child Assessment Satellite Training (NCAST) teaching scales28 for Japanese children from birth to 8 years of age.36 IRS scores have highly significant correlations with NCAST teaching scales (child items, r = 0.70; caregiver
SAS version 9.1 (Institute Inc., Cary, NC, USA) was used for data analysis. The analyses were carried out as follows. First, chi-squared test was performed to examine any gender differences in the distribution of emotional and behavioral problems. Second, multiple regression analysis was used to predict the contribution of daily parenting to children’s developmental difficulties. The five subscales of the SDQ (hyperactivity, emotional problems, conduct problems, peer relationship and prosocial © 2015 Japan Pediatric Society
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behavior) and the total SDQ score were included as independent variables in six separate models of regression analyses. The items pertaining to parenting factors were included in each model as explanatory variables. Item selection was carried out according to the following procedure: first, the significance of an assigned independent variable was determined on single regression analysis; second, stepwise multiple regression analysis was used and the independent variables were tested. All results were determined at the significance level of P < 0.05. Ethics
All participating families were required to read and sign an informed consent form before participating in this research. The students (or families) had the opportunity to decline enrollment in the study, and were allowed to withdraw at any time. Both the content and the procedure of this research were approved by the ethics committee of the Japan Science and Technology Agency (JST).
Results Of the 90 children who participated in the study, 49 (53.9%) were boys, and 41 (46.1%) were girls. At the time of the study, only nine participants (10.0%) were an only child; more than half of the children (58; 64.5%) had one sibling, 20 (22.2%) had two siblings and two (2.2%) had three siblings. Regarding the children’s parents, 61 mothers (67.8%) and 54 fathers (60.0%) were aged 35–45 years. Of the 90 children, 47 (52.2%) lived with two parents, three (3.3%) lived with a single mother, 40 (44.5%) lived in an extended family (34 [37.8%] of which included parents and grandparents), five (5.6%) lived with a single mother and grandparents, and one (1.1%) lived with a single father and grandparents. Other relevant demographic information on the children and families is presented in Table 1. With regard to gender distribution of the children’s SDQ score across categories (normal, borderline and abnormal), boys were threefold as likely to exhibit symptoms of hyperactivity/inattention compared with girls (χ2 = 8.89, P < 0.05; Table 2). On multiple regression analysis using the SDQ score of each subscale as independent variables, parents engaging with their children in physical and social activity predicted a lower likelihood of their child experiencing development problems after controlling for child gender (Table 3). Parents playing games or sports with their child often predicted a lower likelihood of their child having emotional symptoms (β = −0.32, P = 0.0378). Parents doing homework or housework with their child often predicted a lower probability of their child developing conduct problems (β = −0.44, P = 0.0185). Children who had a parent who frequently took them to museums or amusement parks had fewer peer problems (β = −0.41, P = 0.0189). The children of parents who consulted with their friends and their children’s teacher about child rearing issues had fewer peer problems (β = −1.33, P = 0.007) and fewer prosocial behavior problems (β = 1.16, P = 0.0147) than children of parents who did not engage in these activities. The findings in each independent regression model of the six aspects of the SDQ showed that parent’s engagement activities © 2015 Japan Pediatric Society
Table 1 Participant demographics Items Gender Boys Girls Siblings 0 1 2 3 NA Mother’s age (years) 25–35 35–45 45–55 NA Father’s age (years) 25–35 35–45 45–55 NA Family type Nuclear family Parents Mother only Extended family Parents, grandparents Mother, grandparents Father, grandparents Family income (USD) 100 000 NA Total
n
%
49 41
53.9 46.1
9 58 20 2 1
10.0 64.5 22.2 2.2 1.1
20 61 6 3
22.2 67.8 6.7 3.3
14 54 12 10
15.6 60.0 13.3 11.1
47 3
52.2 3.3
34 5 1
37.8 5.6 1.1
2 17 33 20 9 5 4 90
2.2 18.9 36.7 22.2 10.0 5.6 4.4 100.0
affected children’s developmental difficulties through an interaction with parent’s corporal punishment. As previously mentioned, parents playing games or sports with their child often predicted a lower likelihood of their children having emotional symptoms; conversely, corporal punishment by parents increased the risk of emotional symptoms (β = 0.77, P = 0.0031). Parents who did homework or housework with their child often predicted a lower probability of their children developing conduct problems; an inverse association was found between corporal punishment by parents and children’s conduct problems (β = 0.73, P = 0.0008). A negative association also was found between corporal punishment and children’s prosocial behavior problems (β = −0.61, P = 0.0445). Comparing the strength of the two opposite factors, we found that corporal punishment had a stronger association with children’s emotional symptoms and conduct problems, while parent’s positive engagement had a stronger association with children’s prosocial behaviors. Corporal punishment also contributed significantly to children’s total SDQ score (β = 2.41, P = 0.0064) and hyperactivity/inattention symptoms (β = 1.22, P = 0.0024). Even though parent punishment
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Table 2 Gender distribution of behavioral and emotional difficulties in children aged 7 years
n
Total (n = 90) %
n
70 10 10
77.8 11.1 11.1
35 6 8
71.5 12.2 16.3
35 4 2
85.4 9.7 4.9
3.32
71 10 9
78. 9 11.1 10.0
40 5 4
81.6 10.2 8.2
31 5 5
75.6 12.2 12.2
0.55
76 5 9
84.4 5.6 10.0
38 4 7
77.5 8.2 14.3
38 1 2
92.7 2.4 4.9
3.90
71 10 9
78.9 11.1 10.0
33 9 7
67.3 18.4 14.3
38 1 2
92.7 2.4 4.9
8.89*
72 8 10
80.0 8.9 11.1
39 5 5
79.6 10.2 10.2
33 3 5
80.5 7.3 12.2
0.29
76 6 8
84.4 6.7 8.9
39 4 6
79.6 8.2 12.2
37 2 2
90.2 4.9 4.9
2.02
SDQ score Total SDQ Normal Borderline Abnormal Emotional symptoms Normal Borderline Abnormal Conduct problems Normal Borderline Abnormal Hyperactivity/inattention Normal Borderline Abnormal Peer relationship problems Normal Borderline Abnormal Prosocial behavior Normal Borderline Abnormal
Boys (n = 49) %
n
Girls (n = 41) %
χ2
* P < 0.05. SDQ, Strengths and Difficulties Questionnaire.
negatively contributed to children’s emotional symptoms and conduct problems, parental positive engagement with children frequently moderated the negative association with children’s outcomes. Partial correlation analysis indicated an interaction between parenting, child gender and children’s individual behavior characteristics in detail. Parenting was associated with different outcomes for boys and girls and differentially affected their likelihood of suffering from developmental difficulties (Table 3). Gender differences were seen in the total SDQ score (β = 2.83, P
= 0.0081), conduct problems (β = 0.88, P = 0.006), hyperactivity/ inattention (β = 1.40, P = 0.0004) and prosocial behaviors (β = −0.98, P = 0.0266). Boys had more emotional and behavioral problems and more symptoms of hyperactivity/inattention than girls but fewer prosocial problems than girls. Partial correlation analysis between parenting behavior and children’s emotional and behavioral problems was carried out according to child gender (Table 4). Different associations were found between the characteristics of parent–child interaction and children’s developmental problems for the boys and the girls. For
Table 3 Parenting factors related to emotional and behavioral problems in children† Children’s developmental problems (dependent variables in six independent regression models) SDQ total score Emotional symptoms Conduct problems
Hyperactivity/inattention Peer problems Prosocial behavior
Parenting (independent variables)
β
P
Gender How often do you punish your child? How often do you engage in games or sports with your child? How often do you punish your child? Gender How often do you do housework or homework with child? How often do you punish your child? Gender How often do you punish your child? How often do you take your child to museums or amusement parks? How often do you consult with your friend about how to rear child? Gender How often do you punish your child? How often do you consult with your child’s teacher about how to rear child?
2.83 2.41 −0.32 0.77 0.88 −0.44 0.73 1.40 1.22 −0.41 −1.33 −0.98 −0.61 1.16
0.008 0.006 0.038 0.003 0.006 0.019 0.001 0.001 0.002 0.019 0.007 0.027 0.045 0.015
†
Controlled for child gender and family income level. SDQ, Strengths and Difficulties Questionnaire.
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Table 4 Partial correlations between child developmental problems and parent–child interaction SDQ score Boys Child domain Empathy Motor self-regulation Emotional self-regulation Autonomy Responsiveness Parent domain Sensitivity Responsiveness Respect for child’s autonomy Fostering of social emotional growth Fostering of cognitive growth Girls Child domain Empathy Motor self-regulation Emotional self-regulation Autonomy Responsiveness Parent domain Sensitivity Responsiveness Respect for child’s autonomy Fostering of social emotional growth Fostering of cognitive growth
Emotional symptoms
Conduct problems
−0.19 −0.01 0.05 −0.07 −0.22
−0.03 0.10 0.14 0.14 0.24
0.01 0.01 −0.11 0.22 −0.16
−0.26 0.07 −0.23 0.09 0.18
0.07 0.08 0.04 0.10 0.14
−0.15 −0.25 −0.45** −0.10 0.01 −0.14 −0.20 −0.18 −0.11 0.20
Hyperactivity/ inattention
Peer problems
Prosocial behavior
−0.16 −0.14 −0.05 −0.06 −0.23
−0.13 0.10 0.08 −0.17 0.15
0.09 0.07 −0.04 −0.15 −0.09
−0.20 0.08 0.09 0.10 0.07
−0.21 0.16 −0.35* 0.06 0.22
−0.17 −0.08 −0.10 −0.09 0.01
0.10 0.16 −0.11 −0.02 0.14
−0.36* −0.22 −0.06 −0.20 −0.08
0.08 0.32 0.30 0.04 −0.11
0.04 −0.11 −0.61*** 0.12 0.08
0.08 −0.12 −0.26 −0.02 0.10
−0.07 −0.04 −0.41* 0.01 −0.14
−0.17 −0.28 −0.15 0.05 0.21
−0.07 −0.01 −0.26 −0.03 0.12
−0.07 −0.19 −0.17 −0.14 0.15
0.03 0.08 0.09 −0.12 −0.10
−0.08 −0.25 0.03 −0.16 −0.10
*P < 0.05. **P < 0.01. ***P < 0.001. SDQ, Strengths and Difficulties Questionnaire.
boys, mothers respecting their children’s autonomy was found to be negatively correlated with children’s hyperactivity/inattention symptoms (r = −0.35, P < 0.05; Table 4). Moreover, individual traits such as emotional self-regulation for girls were correlated with symptoms of hyperactivity. Girls who had a high degree of emotional self-regulation had fewer symptoms of hyperactivity/ inattention and fewer developmental difficulties (r = −0.61, P < 0.001). Additionally, girls’ empathy development was found to be related to the display of emotional symptoms, and a high level of empathy development was associated with fewer emotional problems (r = −0.36, P < 0.05). Girls’ emotional self-regulation was also negatively correlated with their prosocial behavior development (r = −0.41, P < 0.05). The results are shown in Table 4.
Discussion The present findings offer strong evidence to support the hypothesis that positive parental engagement has a moderating effect on the association between parental corporal punishment and children’s developmental problems. In particular, a negative association between parental corporal punishment and children’s conduct problems was found in the present study. Meanwhile, parental engagement with children in housework and homework significantly moderated the negative association between corporal punishment and conduct problems. This might be due to parent engagement improving the parent–child relationship, and the transfer of social norms to the child during the daily activities. It has been suggested that a higher level of parental engagement © 2015 Japan Pediatric Society
and a more positive relationship with parents are associated with higher child self-rated health, and fewer child emotional and behavioral problems. Parental involvement and responsive parenting have been previously shown to be beneficial to the development of social competence in elementary school children and children’s general development.37 A recent study showed that both harsh maternal discipline and positive parenting functioned separately as mediators of the effect on child conduct problems.38 Moreover, parental engagement in games or sports with their child moderated the association between negative parenting and child’s outcomes, which is beneficial to child emotional development. Existing studies have shown that the frequency of parental engagement with their children in play activities is a critical indicator for physical and cognitive development, as well as a factor of parental responsiveness,39 because children use play as their primary medium of communication. Play is a format for transmitting children’s emotions, thoughts, values and perceptions to adults and thus for smoothing the parent–child relationship.40 It has also been suggested that domestic social interactive activities are beneficial for smoothing the parent–child relationship, potentially transferring social rules to children, and in helping children to behave in a socially acceptable way. We also found that corporal punishment can result in low prosocial development, while parental consultation behaviors regarding childrearing have a moderating effect on this association. Previous studies showed that reward and punishment clouds one’s true motives, therefore often deterring prosocial behavior.41
Parent engagement and child development Positive parental behaviors, however, have been found to be associated with positive peer outcomes and prosocial behavior in children.37 Parents’ talking with others about childrearing often was correlated with social support offered by others, which has been demonstrated to promote child general development. Talking with other persons about childrearing is also an important indicator of parental attitude, behavior and attention towards child development. In addition, to clarify the potential link between parental engagement and child developmental difficulties, synchronous parent–child interactions were recorded on video in the current study. Evidence found in this study supports the second hypothesis that the characteristics of parent–child interaction presented in both the child and parent domains are significantly correlated with child outcomes, and that the association varies with child gender. According to a previous study, underdevelopment of a child’s individual capability and the experiences of negative parenting cause children to externalize and internalize problems, leading to unsocial or disruptive behavior.42 Child characteristics such as gender and temperament appear to influence whether children are spanked and the association between spanking and subsequent behavior. Research demonstrates that gender differences characterize various aspects of conduct disorder.43 Boys tend to receive more physical punishment than girls.44,45 Child gender also moderates the association between negative parenting and childhood conduct problems.25 For boys, parents with much more respect for their autonomy predict fewer hyperactivity/inattention symptoms. It might be because children with certain characteristics may provoke certain responses. For example, boys with hyperactive symptoms might stimulate restrictive parenting. It has been suggested that parental practices restricting the autonomy of children who have symptoms of hyperactivity/inattention might exacerbate children’s poor self-regulation and poor parent–child relationships.29 Also, gender differences in cultural expectations for behavior problems should be taken into consideration, because many symptoms have different social and clinical significances in boys and girls due to the fact that it is rarer in girls and certainly far more contrary to the social mores for the female than male gender. For girls, those with good emotional self-regulation have fewer symptoms of hyperactivity/inattention, but more obvious prosocial behavior problems. And sex-differentiated treatment, regarding parental aspirations for their child’s education and expectations for the future, should be taken into consideration. Girls are frequently trained to conform to traditional gender role expectations, which include traits of calmness, politeness, selfregulation and attentiveness to the needs of others.46 Girls’ emotional and behavioral problems would be underestimated by their parent when they have high emotional self-regulation. In addition, girls’ high emotional self-regulation was negatively correlated with prosocial behavior. A potential explanation for this negative association might be gender role expectations, because high emotional self-regulation is regarded as desirable characteristics for girls in Japan’s social context. This extensively restricts their expression of emotion directly and their engagement in
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social activities. This indicates that being too self-regulated is not beneficial for young girls’ prosocial behavior development, particularly in Japanese culture. To sum up, daily parental engagement and parent–child interaction are the crucial factors in children’s emotional and behavioral problems. Community child-care practitioners should work with parents to improve positive parenting engagement and avoid physical punishment of children. The social factors surrounding child should be assessed by doctors in clinical practice. Parent–child interaction interventions should be tailored to child gender. Limitations
First, the SDQ parent-report version was used to examine children’s emotional and behavioral problems due to child age, therefore the report bias was unavoidable. Second, the data were based on the parent–child interactive behaviors during a somewhat artificial task, even though the pairs were told to play freely, so it would be very difficult to imitate the real home environment, such as the influence of siblings. Another shortcoming of this study is that all the data were collected at the same time point, meaning that the long-term effect of parenting on child outcome is unknown. A longitudinal study is required to clarify the effect pathway further.
Acknowledgment The authors thank Professor Koeda Tatsuya and his group members in the Department of Education at Tottori University for data collection.
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