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Sunday, January 14, 2024

Traumatic bonding

From Wikipedia, the free encyclopedia

Trauma bonds (also referred to as traumatic bonds) are emotional bonds with an individual (and sometimes with a group) that arise from a cyclical pattern of abuse, perpetuated by intermittent reinforcement through rewards and punishments. The concept was developed by psychologists Donald Dutton and Susan Painter. A trauma bond usually involves a victim and a perpetrator in a unidirectional relationship wherein the victim forms an emotional bond with the perpetrator. This can also be conceptualized as a dominated-dominator or an abused-abuser dynamic.

Two main factors involved in the establishment of a trauma bond are: a power imbalance and intermittent reinforcement of good and bad treatment, or reward and punishment. Trauma bonding can occur in the realms of romantic relationships, platonic friendships, parent-child relationships, incestuous relationships, cults, hostage situations, managers versus their direct reports, sex trafficking (especially that of minors), or tours of duty among military personnel.

Trauma bonds are based on terror, dominance, and unpredictability. As the trauma bond between an abuser and a victim strengthens and deepens, it leads to conflicting feelings of alarm, numbness, and grief, which show up in a cyclical pattern. Oftentimes, victims in trauma bonds do not have agency and autonomy and do not have an individual sense of self. Their self-image is a derivative and an internalization of the abuser's conceptualization of them.

Trauma bonds have severe detrimental effects on the victim. Some long-term impacts of trauma bonding include remaining in abusive relationships, having adverse mental health outcomes like low self-esteem, negative self-image, an increased likelihood of depression and bipolar disorder, and perpetuating a generational cycle of abuse. Victims who traumatically bond with their victimizers are often unable to leave these relationships or are only able to do so under significant duress and difficulty. Even among those who do manage to leave, many go back to the abusive relationship due to the pervasiveness of the learned trauma bond.

Context

In the 1980s, Donald G. Dutton and Susan L. Painter explored the concept of the traumatic bonding theory in the context of abusive relationships and battered women. This work was then further studied in contexts of parent-child relationships, sexual exploitation, and more. Patrick Carnes described trauma bonding as "the misuse of fear, excitement, sexual feelings, and sexual physiology to entangle another person." A simpler and more encompassing definition is that traumatic bonding is: "a strong emotional attachment between an abused person and his or her abuser, formed as a result of the cycle of violence." Carnes also studied traumatic bonding theory, exploring it specifically in the context of betrayal, which involved the exploitation of the victim's trust and/or sense of power by the abuser.

Establishment

Trauma bonds are formed in abused-abuser or victim-victimizer dynamics. A victim can form a trauma bond with an abuser in the presence of a perceived threat from the abuser, the conviction that the abuser will follow through with the threat, perception of some form of kindness from the abuser, isolation from perspectives that do not serve to deepen the trauma bond, and perceived lack of ability or capacity to leave the situation.

The first incident of abuse is often perceived as an anomaly, as a one-off instance occurring at the beginning of a seemingly healthy and positive relationship that is often not very severe. Furthermore, the expression of affection and care by the abuser following the incident pacifies the victim and instills in them the belief that the abuse is not recurring. However, repeated instances of abuse and maltreatment later generate a cognitive shift in the victim's mind: that preventing the abuse is in their power. When the inescapability of the abuse becomes apparent, the emotional trauma bond is already strong.

Two main factors facilitate forming and continuing a trauma bond: a power imbalance and an intermittent reinforcement.

Power imbalance

For a trauma bond to persist, a power differential must exist between the abuser and the victim such that the abuser is in a position of power and authority whereas the victim is not. Inequity in power can produce pathologies in individuals that can fortify the trauma bond. Upon experiencing intermittent punishment from the abuser/dominator, who is in a position of high power, the victim may internalize the abuser's perception of themselves. This may result in a tendency for the victim to self-blame him/herself in situations of violence perpetrated by the abuser, which can negatively impact the victim's self-concept.

A negative self-appraisal can maximize emotional dependency on the abuser and the cyclical nature of this dependency. Negative self-concept can eventually lead to the formation of a strong emotional bond from the victim to the abuser (i.e. towards the person who is in a position of power and authority, from the person who is not). Furthermore, physical, emotional, and sexual abuse can be used to maintain the power differential. This dynamic is also maintained via the interaction of the abuser's sense of power and the victim's sense of powerlessness and subjugation.

Intermittent reinforcement

Intermittent reinforcement of rewards and punishments is crucial to establishing and maintaining a trauma bond. In trauma bonding, the abuser intermittently maltreats the victim through physical, verbal, emotional, and/or psychological abuse. This maltreatment is interspersed with positive behaviors like expressing affection and care, showing kindness, giving the victim gifts, and promising not to repeat the abuse. Alternating and sporadic periods of good and bad treatment serve to reinforce the victim intermittently.

The pervasiveness of learning something through intermittent reinforcement can be elucidated by drawing from learning theory and the behaviorist perspective. In the presence of an aversive stimulus, reinforcement through rewards in unpredictable ways is a key component of learning. When the learner is unable to predict when they will get the reward, learning is maximized. Similarly, the intermittent expressions of affection and care are unexpected, and the inability to predict them makes them more sought after. Intermittent reinforcement produces behavioral patterns that are tough to terminate. Thus, they develop incredibly strong emotional bonds.

Maintenance

A trauma bond can be maintained by keeping the power imbalance and the intermittency of abuse intact.

Trauma bonds can also be maintained if the victim is financially dependent on the abuser or has some investment in the relationship, such as a child with the abuser.

Cognitive dissonance theory can also explain the maintenance of a trauma bond, it postulates that when individuals experience a conflict between their beliefs and action, they are motivated to reduce or eliminate the incongruence to minimize the psychological discomfort. In this vein, victims may distort their cognitions about the trauma and violence of the relationship to maintain a positive view of the relationship. This can involve rationalizing the abuser's behavior, justifications, minimizing the impact of the abuser's violence, and/or self-blaming.

Furthermore, research shows that the memory of instances wherein abuse was experienced is dissociated or state-dependent, meaning that the memories of abuse only fully resurface when the situation is similar in intensity and experience to the original situation of terror.

If and when the victim finally decides to leave the abusive relationship, the immediate relief from the traumatizing violence will begin to abate and the underlying, deep attachment formed from intermittent reinforcement will begin to surface. This current period of vulnerability and emotional exhaustion will likely trigger memories of when the abuser was temporarily affectionate and caring. In the desire to receive that affection once more, the victim may try to return to the abusive relationship.

Strong social support, however, can be a protective factor in preserving the victim's functioning and providing a buffer in traumatic situations.

The role of attachment

John Bowlby maintained that a secure attachment was an evolutionarily sound human need that superseded even the need for food and reproduction. Attachment has been explored in depth in caregiver-child dynamics but recent research has shown that the principles that explain attachment between caregivers and infants can also explain attachment throughout one's lifespan, specifically in the context of intimate relationships and romantic bonds.

Attachment bonds formed during early life lay the foundation for interpersonal relationships, interactions, personality characteristics, and mental health in the future. Infants usually form attachments with their parents or immediate caregivers. Harlow's research on monkeys shows that infant monkeys formulate attachment bonds even with abusive mothers (In the experimental setup, the abusive 'mother' was a monkey made out of fabric who delivered mild shocks to the infant monkey or flung the infant monkey across the arena).

These findings also apply to human attachment bonds. Even in situations where immediate caregivers are abusive, human infants still tend to attach to them – rejection from a caregiver only enhances the efforts to increase proximity to them and establish an attachment bond with them.

Furthermore, in situations of danger, humans seek increased attachment. When ordinary pathways of attachment are unavailable, people tend to turn to their abusers. This leads to strong bonds and deep emotional connections with abusers. This attachment – both to abusive caregivers and to other abusers in the absence of a main caregiver – may be adaptive in the short run as it may aid survival. But in the long run, this attachment is maladaptive and can lay the foundation for, increase vulnerability to, and even directly lead to trauma bonding.

Stockholm syndrome

The concept of trauma bonding is often conflated with Stockholm syndrome. Although there are overarching similarities between the two, especially in the context of developing an emotional bond with one's victimizer, trauma bonding and Stockholm syndrome are distinct from one another. The main difference is the directionality of the relationship. While a trauma bond is unidirectional in that only the victim becomes emotionally attached to the victimizer, Stockholm syndrome is bi-directional.

In other words, in the case of Stockholm syndrome, the emotional connection is reciprocal such that the abuser also seems to develop an emotional connection towards the abused and harbor positive feelings for the abused, in addition to the abused developing an emotional bond with the abuser.

Realms of existence

In abusive relationships

Although the victim may disclose the abuse, the trauma bond means that the victim may wish to receive comfort from the very person who abused them.

PACE UK

Unhealthy, or traumatic, bonding occurs between people in an abusive relationship. The bond is stronger for people who have grown up in abusive households because it seems to them to be a normal part of relationships. On the psychometric scale for Stockholm syndrome the three main parts are justifying an abuser through cognitive distortions; Damage, ongoing psychological effects of abuse; and love.

Initially, the abuser is inconsistent in approach, developing it into an intensity perhaps not matched in other relationships of the victim. It is claimed the longer a relationship continues, the more difficult it is for people to leave the abusers with whom they have bonded.

There are multiple reasons why a victim would try to preserve their abusive relationship. A few of these many reasons could be fear, children, and financial constraints. These, among others, could lead a victim to accuse innocent people falsely. This could be detrimental to both individuals involved.

Battered women

Initial research about battered women held the view that a victim's return to an abusive relationship was an indicator of a flawed personality and more specifically, masochism. However, this view was perpetuated by the 'just-world hypothesis', which supports the idea that people “get what is coming for them”. In other words, the tendency to victim-blame arises from the belief that the world is a just and fair place where the victim is seen as deserving of any negative consequences. However, research on battered women and research on traumatic bonding has shown that that is not the case. In terms of battered women's decision to stay in or return to an abusive relationship, many factors are at play, ranging from family history and role expectations, to access to resources, to the dynamics of the relationship itself. A crucial part of the relationship's dynamic is the existence of a trauma bond. Maltreatment interspersed with periods of kindness aid the formation of a trauma bond that makes the victim harbor positive feelings towards the abuser.

Among battered women, a three-phase process can explain the intermittent reward-punishment cycle. During phase one, there is a gradual increase in tension, followed by an "explosive battering incident" in phase two, which is then followed by a peaceful expression of love and affection from the abuser during phase three. These phases' recurring and cyclical nature gives rise to a trauma bond.

Sex trafficking

Trauma bonds are extremely common in situations of sex trafficking, child grooming, commercial sexual exploitation of children (CSEC), and pimp-prostitute relationships.

Grooming

Child grooming involves establishing and maintaining trauma bonds between the child and the abuser. Along with the factors of power imbalance and intermittent reinforcement that contribute to trauma bonding, child grooming also necessitates gaining the trust of those around the child. Grooming also involves gaining the child's trust while simultaneously violating their boundaries. Treats and trips are used as bribes to both gain access to the child as well as ensure that they comply. Intense attachments coupled with cognitive distortions deepen the bond.

A 2019 case study explores the life of one individual who was groomed. The victim's perception of the abuser as a benefactor, a substitute parent, and a mind controller, all contributed to the development of a traumatic bond between the victim and the abuser. In terms of being a benefactor, the abuser in this case study went above and beyond to give the victim what they needed: from getting the victim a job to gifting them a plot of land for their first house, the abuser was always present as a benefactor. The abuser also acted as a substitute parent, advising and offering emotional support in times of crisis. The roles of the abuser as a benefactor and substitute parent constituted the good treatment necessary to establish a trauma bond. In contrast, the abuser's role as a mind controller involved controlling and dominating tendencies that emulated being brainwashed. This combination of perceptions established a traumatic bond that the victim found incredibly difficult to break, because rejecting the emotional connection as a whole would also involve rejecting the perks and benefits – the trips, the gifts, the treats, the confidante and the caretaker.

Child grooming can be understood from a developmental perspective as well and the relationship between the victim and the abuser evolves across the lifespan. Grooming starts when the child is extremely young – the trust of the child and the family is acquired. The child is given immense attention and is showered with gifts. As the individual matures and enters adolescence, the abuser becomes a confidante and a benefactor. In the aforementioned case study, the abuser gave the victim career advice and even picked him up and dropped him off at school. Then, at the onset of adulthood, the abuser provided the victim with land to build their home and became the person the victim brought their partner home to. As the victim's developmental needs evolved, so did the abuser's response, such that the only thing constant was the victim's need for affection. In other words, the abuser was "able to capitalize on [the victim's] relational needs" until the victim was able to meet those needs in other ways.

Commercial Sexual Exploitation of Children (CSEC)

The commercial sexual exploitation of children (CSEC) can cause debilitating physical and psychological trauma. Along with causing functional impairments, it can amplify risk-taking behaviors and increase impulse dysregulation, further compromising the child's ability to conceptualize, comprehend, establish, and maintain boundaries. This can lead to confusion regarding what safety, affection, intimacy, and kindness entail, resulting in the formation of a trauma bond with the abuser/trafficker that is based on skewed perceptions of safety and kindness. The trauma bond deepens and strengthens when isolation and threats to survival increase, forcing the victim to depend almost entirely on the abuser for survival and protection. This increased emotional dependence on the abuser normalizes the emotional violence experienced by the victim at the hands of the abuser and gradually, the victim develops a sense of trust and safety – albeit skewed – towards the abuser.

Trauma coercive bond

Trauma bonding thrives in the presence of a power imbalance and intermittent reward/punishment behavior. Trauma-coercive bonding, on the other hand, has two additional elements: social isolation and the perceived inability to escape the situation. Since these two elements are crucial to the experiences of victims of CSEC, their bonds with their abusers are better described as trauma-coercive bonds rather than simply as trauma bonds. The element of coercion concreted by social isolation and the perceived inability to escape makes the trauma bond more complex and far more deep-rooted. The use of coercive trauma bonding encapsulates the psycho-social dynamics of a relationship between a victim and a perpetrator of CSEC.

Intimate partner violence (IPV)

IPV has been defined as physical, sexual, psychological, economic, or stalking abuse, both concrete and menaced, perpetuated by current or ex-partners. Trauma bonding is used to solidify this type of relationship by, rationalizing and/or minimizing a violent partner's behavior, self-blame, and reporting love in the context of fear.

Parent-child relationships

Trauma bonds in parent-child or caregiver-child dynamics can be borne from abuse and neglect or incestuous relationships.

Abuse and/or neglect

The children of dismissive caregivers or cruel/harsh caregivers can develop insecure attachments, which can be very dysfunctional. Inconsistencies in reward and punishment (i.e. intermittent reinforcement of good and bad treatment) can highlight the affection the child receives from the parent, forcing a split between the abuse and the kindness such that the child seeks to form an overall positive view of the caregiver and thus, focuses only on the affection and kindness they receive. Overall, a trauma bond develops such that the child's sense of self is derived from their emotional dependence on the authority figure who, in this case, is the parent and/or caregiver.

Incest

Incestuous relationships between parents and children cultivate trauma bonds similar to those prevalent in victims of sex trafficking. All participants of a 1994 study on trauma in adult incest survivors demonstrated some trauma bond with their abusers. There was a positive correlation between the pervasiveness of the trauma bond and the amount of contact the victim or the victim's close family members had with the abuser: those who self-reported less pervasive trauma also reported sustained contact with their abuser, while those who self-reported more pervasive trauma demonstrated an active avoidance of maintaining a relationship with their abuser. In incestuous parent-child dynamics, the study found that maintaining an unhealthy relationship with the abuser contributes to trauma and sustains the trauma bond.

This aligns with the idea that trauma bonds are toxic and difficult to leave due to the inherent power imbalance, which, in parent-child relationships, is even more pervasive than in other situations. Incestuous relationships also have an added layer of betrayal trauma, which arises from the exploitation of the victim's trust, resulting in a feeling of betrayal.

Military (tours of duty)

Trauma bonds can develop in military settings. The literature demonstrates this specifically in the context of tours of duty, wherein military personnel are deployed in hostile environments or areas of combat. A 2019 study exploring this specific phenomenon sought to understand the traumatic bond developed between Japanese soldiers and Korean 'comfort women' in the midst of World War II. The trauma, in this case, was two-fold: not only did the trauma bond develop in an abused-abuser dynamic, but the trauma itself was also a result of and was perpetuated by the war. While the relationships provided the Japanese soldiers with emotional relief and an escape from the violence of the war and the tyranny of the higher-ranking officers, they provided the Korean 'comfort women' with much-desired protection and kindness from the soldiers.

Soldiers would behave aggressively and violently towards the 'comfort women' and often sexually exploit them. They would use intimidation tactics to assert dominance and foster coercion. However, this abuse would be interspersed with kindness and empathy from the soldiers, whose moods – and subsequent behavior and interactions – were highly contingent on the time and context in terms of the ongoing war. Nonetheless, the intermittent kindness allowed the formation and maintenance of a trauma bond. Intermittent rewards were sometimes also more tangible, in the form of food, outings, and physical protection. However, protection and emotional support were pivotal in maintaining the trauma bonds, and far more important than food and outings. The Korean 'comfort women' eventually came to be emotionally dependent on the Japanese soldiers and began to relate this dependence with their own sense of power, thereby establishing a trauma bond that, for some, persisted even after the war was over.

Outcomes

Trauma bonding has several short-term and long-term impacts on the abused. It can force people to stay in abusive relationships, negatively affect self-image and self-esteem, perpetuate transgenerational cycles of abuse, and result in adverse mental health outcomes like the increased likelihood of developing depression and/or bipolar disorder.

Staying in abusive relationships

Owing to the debilitating psychological manipulation involved in the development of a trauma bond, abused people tend to stay in abusive relationships mainly because the perceived consequences of leaving the relationship seem far more negative than the consequences of staying in the abusive relationship.

In such relationships, maltreatment is often interspersed with fragments of solace and peace that involve the expression of love, kindness, affection, and/or general friendliness from the abuser towards the abused. This intermittent reinforcement of a reward (here, the abuser's love and kindness) amidst all the abuse becomes what the victim begins to hold on to. Thus, victims tend to become emotionally dependent on the abuser and construct the belief that their survival is contingent upon receiving the abuser's love. Victims thereby begin to formulate their sense of identity, (a form of and their sense of self around receiving the abuser's affection, points to what could be gaslighting. Kindness and affection from the abuser amidst the abuse becomes a focal point for the victim's emotional dependence. This dependency is characterized by the belief that their survival is contingent on the abuser's love and affection, leading victims to construct their sense of identity and self-worth around this dynamic Additionally, the provision of intermittent love and affection makes the victim cling to the hope that things can change. Furthermore, self-blame, the fear of social stigma and embarrassment, the fear of loneliness in the absence of a partner, and the lack of or poor social support from other family and friends also contribute to individuals remaining in abusive relationships.

Perpetuation of transgenerational cycles of abuse

People who have experienced trauma and traumatic bonds can – knowingly or unknowingly – repeat the cycle of abuse. In other words, victims who were traumatically bonded with abusers may grow to become abusers themselves. The abuse that victims inflict may or may not involve trauma bonding.

For instance, in a 2018 study on convicted child murderers, researchers found that caregivers who committed child homicide (murdered their child/care-receiver) had experienced traumatic experiences and had trauma bonds with abusers in their early lives. Individuals with cruel and/or dismissive caregivers are likely to develop insecure attachments that result in a host of problems, including emotion dysregulation and an attitude of confusion towards the caregiver, who becomes a source of comfort as well as fear. These adverse attachments can manifest in the individual's relationship with their own children as well. Attachment issues and painful memories of trauma bonds with their own caregivers can be triggered and individuals may demonstrate heightened and disproportionate aggression toward their child, some culminating in homicide. In this study, participants had experienced physical abuse, sexual abuse, lack of protection from external dangers, abandonment, emotional rejection, and more from their caregivers. Nonetheless, participants expressed unconditional love towards their caregivers, justified by wanting to maintain an overall positive view of them. In their continued efforts to form an emotional connection, a trauma bond was fostered. These experiences had a severe negative impact on their relationship and bonding with their own children, contributing to "affectionless, unempathetic interpersonal behavior" that inflated aggressive and violent tendencies triggered by vulnerabilities.

Neurophysiological outcomes

The experience of being in a trauma bond can have adverse neurobiological and neurophysiological outcomes. The body of the victim of a trauma bond is in a perpetual 'fight-or-flight' response state, which can increase cortisol levels that can have a cascading effect and trigger other hormones.

Persistent, chronic stress can also hamper the cellular response in the body, thereby negatively impacting immunity, organ health, mood, energy levels, and more. In the long run, this can cause epigenetic changes as well. Furthermore, a study conducted in 2015 found that establishing a trauma bond in infancy is also linked with amygdala dysfunction, neurobehavioral deficits, and increased vulnerability to psychiatric disorders later on in life.``Psychological abuse is correlated to sleep-related impairments. Disruption in sleep patterns leads to adverse neurophysiological problems, such as an increase in anxiety, and irritability. For victims of psychological abuse, the increase in cortisol affects the brain in such a manner that it allows the trauma bonding to be strengthened.

Adverse mental health outcomes

Trauma bonding is linked to several adverse mental health and well-being outcomes. As a result of the abuse itself and of their emotional dependence on their abusers, victims tend to develop an incredibly negative self-image. "controlling, restricting, degrading, isolating, or dominating" abuse has a crippling effect on the self-image and self-esteem of the abused, and this psychological abuse is far more dangerous than physical abuse. In a 2010 study on battered women labeling themselves as "stupid", researchers found that victims who felt like they allowed themselves to be mistreated and victims who stayed in abusive relationships labeled themselves as "stupid" for doing so. This further contributes to a negative self-image and maintenance of low self-esteem, both of which foster a poor self-concept, which, in turn, adversely impacts mental well-being. The same was observed in the aforementioned case study on grooming.

Trauma bonding can also lead to dissociative symptoms that could be a self-preservation and/or coping mechanism. Neurobiological changes can also affect brain development and hamper learning. The internalization of the psychological manipulation and trauma can give rise to anxiety and increase the likelihood of engagement in risk-taking behaviors. Furthermore, the isolation involved in trauma bonding can foster a generally skewed sense of trust, making victims vulnerable to situations that may retraumatize or revictimize them. Victims may also tend to either completely dismiss or minimize dangerous, damaging behaviors and violence around them.

Trauma bonds in parent-child relationships (wherein the child is the victim, and the parent is the abuser) can also lead to depressive symptoms later on in life. In a 2017 study exploring this, it was found that an "affectionless control" parenting style, characterized by high protection and low care from parents, was a major predictor of depressive symptomology for the victim. In other words, the presence of poor parental bonding coupled with childhood trauma bonds increased the likelihood of the child developing depressive symptoms in the future. A negative self-image is formed when feelings of inadequacy and hopelessness persist and are reinforced by caregivers. Perpetual efforts to seek secure emotional attachments reap no rewards and a trauma bond facilitates a negative core schema that influences perceptions and interactions throughout one's life. This can give rise to mental health issues such as depression, bipolar disorder, mania, suicidality, and substance abuse that can be pervasive and lifelong.

Oppositional defiant disorder

From Wikipedia, the free encyclopedia
 
Oppositional defiant disorder
SpecialtyPediatrics, Psychology
SymptomsRecurrent patterns of negative, hostile, or defiant behavior towards authority figures
ComplicationsEnforcement action
Usual onsetChildhood or adolescence (can become evident before 8 years of age)
DurationIs diagnosed until 18 years of age
CausesInsufficient care for the affected child during early development
Risk factorsADHD
Differential diagnosisConduct disorder, disruptive mood dysregulation disorder, attention-deficit hyperactivity disorder, bipolar disorder, autism spectrum disorder, a psychotic disorder, borderline personality disorder, major depressive disorder, antisocial personality disorder
TreatmentMedication, Cognitive behavioral therapy, family therapy, intervention (counseling)
Medication
PrognosisPoor unless professionally treated
Frequency~3%

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is usually targeted toward peers, parents, teachers, and other authority figures, including law enforcement officials. Unlike conduct disorder (CD), those with ODD do not generally show patterns of aggression towards random people, violence against animals, destruction of property, theft, or deceit. One half of children with ODD also fulfill the diagnostic criteria for ADHD.

History

Oppositional defiant disorder was first defined in the DSM-III (1980). Since the introduction of ODD as an independent disorder, the field trials to inform its definition have included predominantly male subjects. Some clinicians have debated whether the diagnostic criteria would be clinically relevant for use with women, and furthermore, some have questioned whether gender-specific criteria and thresholds should be included. Additionally, some clinicians have questioned the preclusion of ODD when conduct disorder is present. According to Dickstein, the DSM-5 attempts to:

"redefine ODD by emphasizing a 'persistent pattern of angry and irritable mood along with vindictive behavior,' rather than DSM-IV's focus exclusively on negativistic, hostile, and defiant behavior.' Although DSM-IV implied, but did not mention, irritability, DSM-5 now includes three symptom clusters, one of which is 'angry/irritable mood'—defined as 'loses temper, is touchy/easily annoyed by others, and is angry/resentful.' This suggests that the process of clinically relevant research driving nosology, and vice versa, has ensured that the future will bring greater understanding of ODD."

Epidemiology

ODD is a pattern of negative, defiant, disobedient, and hostile behavior, and it is one of the most prevalent disorders from preschool age to adulthood. This can include frequent temper tantrums, excessive arguing with adults, refusing to follow rules, purposefully upsetting others, getting easily irked, having an angry attitude, and vindictive acts. Children with ODD usually begin showing symptoms around age 6 to 8, although the disorder can emerge in younger children too. Symptoms can last throughout teenage years. The pooled prevalence is 3.6% up to age 18.

Oppositional defiant disorder has a prevalence of 1–11%. The average prevalence is approximately 3%. Gender and age play an important role in the rate of the disorder. ODD gradually develops and becomes apparent in preschool years, often before the age of eight years old. However, it is very unlikely to emerge following early adolescence.

There is a difference in prevalence between boys and girls, with a ratio of 1.4 to 1 before adolescence. Other research suggests a 2:1 ratio. Prevalence in girls tends to increase after puberty. Researchers have found that the general prevalence of ODD throughout cultures remains constant. However, the gendered disparities in diagnoses is only seen in Western cultures. It is unknown whether this reflects underlying differences in incidence or under-diagnosis of girls. Physical abuse at home is a significant predictor of diagnosis for girls only, and emotional responsiveness of parents is a significant predictor of diagnosis for boys only, which may have implications for how gendered socialization and received gender roles affect ODD symptoms and outcomes.

Children from lower-income backgrounds are more likely to be diagnosed with ODD. The correlative link between low income and ODD diagnosis is direct in boys, but in girls, the link is more complex; the diagnosis is associated with specific parental techniques such as corporal punishment which are in turn linked to lower income households. This disparity may be linked to a more general tendency of boys and men to display more externalized psychiatric symptoms, and girls to display more internalized ones (such as self-harm or anorexia nervosa).

African Americans and Latinos are more likely to receive diagnoses of ODD or other conduct disorders compared to non-Hispanic White youth with the same symptoms, who are more likely to be diagnosed with ADHD. This has wide-ranging implications about the role of racial bias in how certain behaviors are perceived and categorized as either defiant or inattentive/hyperactive.

Prevalence of ODD and conduct disorder are significantly higher among children in foster care. One survey in Norway found that 14 percent met the criteria, and other studies have found a prevalence of up to 17 or even 29 percent. Low parental attachment and parenting style are strong predictors of ODD symptoms.

Earlier conceptions of ODD had higher rates of diagnosis. When the disorder was first included in the DSM-III, the prevalence was 25% higher than when the DSM-IV revised the criteria of diagnosis. The DSM-V made more changes to the criteria, grouping certain characteristics together in order to demonstrate that people with ODD display both emotional and behavioral symptoms. In addition, criteria were added to help guide clinicians in diagnosis because of the difficulty found in identifying whether the behaviors or other symptoms are directly related to the disorder or simply a phase in a child's life. Consequently, future studies may find that there was also a decline in prevalence between the DSM-IV and the DSM-V.

Signs and symptoms

The fourth revision of the Diagnostic and Statistical Manual (DSM-IV-TR) (now replaced by DSM-5) states that a person must exhibit four out of the eight signs and symptoms to meet the diagnostic threshold for ODD. These symptoms include:

  • Often loses temper
  • Is often touchy or easily annoyed
  • Is often angry and resentful
  • Often argues with authority figures or, for children and adolescents, with adults
  • Often actively defies or refuses to comply with requests from authority figures or with rules
  • Often deliberately annoys others
  • Often blames others for their mistakes or misbehavior
  • Has been spiteful or vindictive at least twice within the past six months

These behaviors are mostly directed towards an authority figure such as a teacher or a parent. Although these behaviors can be typical among siblings, they must be observed with individuals other than siblings for an ODD diagnosis. Children with ODD can be verbally aggressive. However, they do not display physical aggressiveness, a behavior observed in conduct disorder. Furthermore, they must be perpetuated for longer than six months and must be considered beyond a normal child's age, gender and culture to fit the diagnosis. For children under five years of age, they must occur on most days over a period of six months. For children over five years of age, they must occur at least once a week for at least six months. If symptoms are confined to only one setting, most commonly home, it is considered mild in severity. If it is observed in two settings, it is characterized as moderate, and if the symptoms are observed in three or more settings, it is considered severe.

These patterns of behavior result in impairment at school or other social venues.

Etiology

There is no specific element that has yet been identified as directly causing ODD. Research looking precisely at the etiological factors linked with ODD is limited. The literature often examines common risk factors linked with all disruptive behaviors, rather than ODD specifically. Symptoms of ODD are also often believed to be the same as CD, even though the disorders have their own respective set of symptoms. When looking at disruptive behaviors such as ODD, research has shown that the causes of behaviors are multi-factorial. However, disruptive behaviors have been identified as being mostly due either to biological or environmental factors.

Genetic influences

Research indicates that parents pass on a tendency for externalizing disorders to their children that may be displayed in multiple ways, such as inattention, hyperactivity, or oppositional and conduct problems. Research has also shown that there is a genetic overlap between ODD and other externalizing disorders. Heritability can vary by age, age of onset, and other factors. Adoption and twin studies indicate that 50% or more of the variance causing antisocial behavior is attributable to heredity for both males and females. ODD also tends to occur in families with a history of ADHD, substance use disorders, or mood disorders, suggesting that a vulnerability to develop ODD may be inherited. A difficult temperament, impulsivity, and a tendency to seek rewards can also increase the risk of developing ODD. New studies into gene variants have also identified possible gene-environment (G x E) interactions, specifically in the development of conduct problems. A variant of the gene that encodes the neurotransmitter metabolizing enzyme monoamine oxidase-A (MAOA), which relates to neural systems involved in aggression, plays a key role in regulating behavior following threatening events. Brain imaging studies show patterns of arousal in areas of the brain that are associated with aggression in response to emotion-provoking stimuli.

Prenatal factors and birth complications

Many pregnancy and birth problems are related to the development of conduct problems. Malnutrition, specifically protein deficiency, lead poisoning or exposure to lead, and mother's use of alcohol or other substances during pregnancy may increase the risk of developing ODD. In numerous research, substance use prior to birth has also been associated with developing disruptive behaviors such as ODD. Although pregnancy and birth factors are correlated with ODD, strong evidence of direct biological causation is lacking.

Neurobiological factors

Deficits and injuries to certain areas of the brain can lead to serious behavioral problems in children. Brain imaging studies have suggested that children with ODD may have hypofunction in the part of the brain responsible for reasoning, judgment, and impulse control. Children with ODD are thought to have an overactive behavioral activation system (BAS), and an underactive behavioral inhibition system (BIS). The BAS stimulates behavior in response to signals of reward or non-punishment. The BIS produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of non-reward or punishment. Neuroimaging studies have also identified structural and functional brain abnormalities in several brain regions in youths with conduct disorders. These brain regions are the amygdala, prefrontal cortex, anterior cingulate, and insula, as well as interconnected regions.

Social-cognitive factors

As many as 40 percent of boys and 25 percent of girls with persistent conduct problems display significant social-cognitive impairments. Some of these deficits include immature forms of thinking (such as egocentrism), failure to use verbal mediators to regulate his or her behavior, and cognitive distortions, such as interpreting a neutral event as an intentional hostile act. Children with ODD have difficulty controlling their emotions or behaviors. In fact, students with ODD have limited social knowledge that is based only on individual experiences, which shapes how they process information and solve problems cognitively. This information can be linked with the social information processing model (SIP) that describes how children process information to respond appropriately or inappropriately in social settings. This model explains that children will go through five stages before displaying behaviors: encoding, mental representations, response accessing, evaluation, and enactment. However, children with ODD have cognitive distortions and impaired cognitive processes. This will therefore directly impact their interactions and relationship negatively. It has been shown that social and cognitive impairments result in negative peer relationships, loss of friendship, and an interruption in socially engaging in activities. Children learn through observational learning and social learning. Therefore, observations of models have a direct impact and greatly influence children's behaviors and decision-making processes. Children often learn through modeling behavior. Modeling can act as a powerful tool to modify children's cognition and behaviors.

Environmental factors

Negative parenting practices and parent–child conflict may lead to antisocial behavior, but they may also be a reaction to the oppositional and aggressive behaviors of children. Factors such as a family history of mental illnesses and/or substance use disorders as well as a dysfunctional family and inconsistent discipline by a parent or guardian can lead to the development of behavior disorders. Parenting practices not providing adequate or appropriate adjustment to situations as well as a high ratio of conflicting events within a family are causal factors of risk for developing ODD.

Insecure parent–child attachments can also contribute to ODD. Often little internalization of parent and societal standards exists in children with conduct problems. These weak bonds with their parents may lead children to associate with delinquency and substance use. Family instability and stress can also contribute to the development of ODD. Although the association between family factors and conduct problems is well established, the nature of this association and the possible causal role of family factors continues to be debated.

School is also a significant environmental context besides family that strongly influences a child's maladaptive behaviors. Studies indicate that child and adolescent externalizing disorders like ODD are strongly linked to peer network and teacher response. Children with ODD present hostile and defiant behavior toward authority including teachers which makes teachers less tolerant toward deviant children. The way in which a teacher handles disruptive behavior has a significant influence on the behavior of children with ODD. Negative relationships from the socializing influences and support network of teachers and peers increases the risk of deviant behavior. This is because the child consequently gets affiliated with deviant peers that reinforce antisocial behavior and delinquency. Due to the significant influence of teachers in managing disruptive behaviors, teacher training is a recommended intervention to change the disruptive behavior of ODD children.

In a number of studies, low socioeconomic status has also been associated with disruptive behaviors such as ODD.

Other social factors such as neglect, abuse, parents that are not involved, and lack of supervision can also contribute to ODD.

Externalizing problems are reported to be more frequent among minority-status youth, a finding that is likely related to economic hardship, limited employment opportunities, and living in high-risk urban neighborhoods. Studies have also found that the state of being exposed to violence was a contribution factor for externalizing behaviors to occur.

Diagnosis

For a child or adolescent to qualify for a diagnosis of ODD, behaviors must cause considerable distress for the family or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD. Other common comorbid disorders include depression and substance use disorders. Adults who were diagnosed with ODD as children tend to have a higher chance of being diagnosed with other mental illness in their lifetime, as well as being at higher risk of developing social and emotional problems.

Management

Approaches to the treatment of ODD include parent management training, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training. According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents.

Children with oppositional defiant disorder tend to exhibit problematic behavior that can be very difficult to control. An occupational therapist can recommend family based education referred to as parent management training (PMT) in order to encourage positive parents and child relationships and reduce the child's tantrums and other disruptive behaviors. Since ODD is a neurological disorder that has biological correlates, an occupational therapist can also provide problem solving training to encourage positive coping skills when difficult situations arise, as well as offer cognitive behavioral therapy.

Psychopharmacological treatment

Psychopharmacological treatment is the use of prescribed medication in managing oppositional defiant disorder. Prescribed medications to control ODD include mood stabilizers, anti-psychotics, and stimulants. In two controlled randomized trials, it was found that between administered lithium and the placebo group, administering lithium decreased aggression in children with conduct disorder in a safe manner. However, a third study found the treatment of lithium over a period of two weeks invalid. Other drugs seen in studies include haloperidol, thioridazine, and methylphenidate which also is effective in treating ADHD, as it is a common comorbidity.

The effectiveness of drug and medication treatment is not well established. Effects that can result from taking these medications include hypotension, extrapyramidal symptoms, tardive dyskinesia, obesity, and increase in weight. Psychopharmacological treatment is found to be most effective when paired with another treatment plan, such as individual intervention or multimodal intervention.

Individual interventions

Individual interventions are focused on child-specific individualized plans. These interventions include anger control/stress inoculation, assertiveness training, a child-focused problem-solving skills training program, and self-monitoring skills.

Anger control and stress inoculation help prepare the child for possible upsetting situations or events that may cause anger and stress. They include a process of steps the child may go through.

Assertiveness training educates individuals in keeping a balance between passivity and aggression. It aims to help the child respond in a controlled and fair manner.

A child-focused problem-solving skills training program aims to teach the child new skills and cognitive processes that teach how to deal with negative thoughts, feelings, and actions.

Parent and family treatment

According to randomized trials, evidence shows that parent management training is most effective. It has strong influences over a long period of time and in various environments.

Parent-child interaction training is intended to coach the parents while involving the child. This training has two phases; the first phase is child-directed interaction, where the focus is to teach the child non-directive play skills. The second phase is parent-directed interaction, where the parents are coached on aspects including clear instruction, praise for compliance, and time-out for noncompliance. The parent-child interaction training is best suited for elementary-aged children.

Parent and family treatment has a low financial cost, which can yield an increase in beneficial results.

Multimodal intervention

Multimodal intervention is an effective treatment that looks at different levels including family, peers, school, and neighborhood. It is an intervention that concentrates on multiple risk factors. The focus is on parent training, classroom social skills, and playground behavior programs. The intervention is intensive and addresses barriers to individuals' improvement such as parental substance use or parental marital conflict.

An impediment to treatment includes the nature of the disorder itself, whereby treatment is often not complied with and is not continued or adhered to for adequate periods of time.

Comorbidity

Oppositional defiant disorder can be described as a term or disorder with a variety of pathways in regard to comorbidity. High importance must be given to the representation of ODD as a distinct psychiatric disorder independent of conduct disorder.

In the context of oppositional defiant disorder and comorbidity with other disorders, researchers often conclude that ODD co-occurs with an attention deficit hyperactivity disorder (ADHD), anxiety disorders, emotional disorders as well as mood disorders. Those mood disorders can be linked to major depression or bipolar disorder. Indirect consequences of ODD can also be related or associated with a later mental disorder. For instance, conduct disorder is often studied in connection with ODD. Strong comorbidity can be observed within those two disorders, but an even higher connection with ADHD in relation to ODD can be seen. For instance, children or adolescents who have ODD with coexisting ADHD will usually be more aggressive and have more of the negative behavioral symptoms of ODD, which can inhibit them from having a successful academic life. This will be reflected in their academic path as students.

Other conditions that can be predicted in children or people with ODD are learning disorders in which the person has significant impairments with academics and language disorders, in which problems can be observed related to language production and/or comprehension.

Criticism

Oppositional defiant disorder's validity as a diagnosis has been criticized since its inclusion in the DSM III in 1980. ODD was considered to produce minor impairment insufficient to qualify as a medical diagnosis, and was difficult to separate from conduct disorder, with some estimates that over 50% of those diagnosed with conduct disorder would also meet criteria for ODD. The diagnosis of ODD was also criticized for medicalizing normal developmental behavior. To address these problems, the DSM-III-R dropped the criterion of swearing and changed the cutoff from five of nine criteria, to four of eight. Most evidence indicated a dose–response relationship between the severity of symptoms and level of functional impairment, suggesting that the diagnostic threshold was arbitrary. Early field trials of ODD used subjects who were over 75% male.

Recent criticisms of ODD suggest that the use of ODD as a diagnosis exacerbates the stigma surrounding reactive behavior and frames normal reactions to trauma as personal issues of self-control. Anti-psychiatry scholars have extensively criticized this diagnosis through a Foucauldian framework, characterizing it as a tool of the psy apparatus which pathologizes resistance to injustice. Oppositional defiant disorder has been compared to drapetomania, a now-obsolete disorder proposed by Samuel A. Cartwright which characterized slaves in the Antebellum South who repeatedly tried to escape as being mentally ill.

Race and gender bias

Research has shown that African Americans and Latinos are disproportionately likely to be diagnosed with ODD compared to White counterparts displaying the same symptoms, who are more likely to be diagnosed with ADHD. Assessment, diagnosis and treatment of ODD may not account for contextual problems experienced by the patient, and can be influenced by cultural and personal racial bias on the part of counselors and therapists. Many children diagnosed with ODD were, upon reassessment, found to better fit diagnoses of obsessive–compulsive disorder, bipolar disorder, attention deficit hyperactivity disorder, or anxiety disorder. Diagnoses of ODD or conduct disorder are not eligible for disability accommodation at school under the Individuals with Disabilities Education Act. When parents request accommodation for a diagnosed disorder which is eligible, such as ADHD, the request can be denied on the basis that such conditions are co-morbid with ODD. This bias in perception and diagnosis leads to defiant behaviors being medicalized and rehabilitated in White children, but criminalized for Latino and African American ones. Counselors working with children diagnosed with ODD reported that it was common for them to face stigma around the diagnosis in educational and justice systems, and that the diagnosis affected patients' self image. In one study over a quarter of children placed in the foster care system in the United States were found to have been diagnosed with ODD. Over half of children in the juvenile justice system have been diagnosed with ODD.

Latina women may be disproportionately impacted by the diagnosis of ODD because of the difference between Latino and White conceptions of femininity and appropriate feminine behavior.

African American males are known to be more likely to be suspended or expelled from school, receive harsher sentences for the same offenses as defendants of different races, or be searched, assaulted or killed by police officers. The disproportionately high diagnosis of ODD in AA males may be used to rationalize these outcomes. In this manner, ODD diagnoses can serve as a mechanism of the school-to-prison pipeline. From this viewpoint, the ODD diagnosis frames expected reactions to injustice or trauma as defiant or criminal.

Child discipline

From Wikipedia, the free encyclopedia

Child discipline is the methods used to prevent future unwanted behaviour in children. The word discipline is defined as imparting knowledge and skill, in other words, to teach. In its most general sense, discipline refers to systematic instruction given to a disciple. To discipline means to instruct a person to follow a particular code of conduct.

Discipline is used by parents to teach their children about expectations, guidelines and principles. Child discipline can involve rewards and punishments to teach self-control, increase desirable behaviors and decrease undesirable behaviors. While the purpose of child discipline is to develop and entrench desirable social habits in children, the ultimate goal is to foster particular judgement and morals so the child develops and maintains self-discipline throughout the rest of their life.

Because the values, beliefs, education, customs and cultures of people vary so widely, along with the age and temperament of the child, methods of child discipline also vary widely. Child discipline is a topic that draws from a wide range of interested fields, such as parenting, the professional practice of behavior analysis, developmental psychology, social work, and various religious perspectives. In recent years, advances in the understanding of attachment parenting have provided a new background of theoretical understanding and advanced clinical and practical understanding of the effectiveness and outcome of parenting methods.

There has been debate in recent years over the use of corporal punishment for children in general, and increased attention to the concept of "positive parenting" where desirable behavior is encouraged and rewarded. The goal of positive discipline is to teach, train and guide children so that they learn, practice self-control and develop the ability to manage their emotions, and make desired choices regarding their personal behavior.

Cultural differences exist among many forms of child discipline. Shaming is a form of discipline and behavior modification. Children raised in different cultures experience discipline and shame in various ways. This generally depends on whether the society values individualism or collectivism.

History

Historical research suggests that there has been a great deal of individual variation in methods of discipline over time.

Medieval times

Nicholas Orme of the University of Exeter argues that children in medieval times were treated differently from adults in legal matters, and the authorities were as troubled about violence to children as they were to adults. In his article, Childhood in Medieval England, he states, "Corporal punishment was in use throughout society and probably also in homes, although social commentators criticized parents for indulgence towards children rather than for harsh discipline." Salvation was the main goal of discipline, and parents were driven to ensure their children a place in heaven. In one incident in early 14th-century London, neighbors intervened when a cook and clerk were beating a boy carrying water. A scuffle ensued and the child's tormentors were subdued. The neighbors did not even know the boy, but they firmly stood up for him even when they were physically attacked, and they stood by their actions when the cook and clerk later sued for damages.

Colonial times

During colonial times in the United States, parents were able to provide enjoyments for their children in the form of toys, according to David Robinson, writer for the Colonial Williamsburg Journal. Robinson notes that even the Puritans permitted their young children to play freely. Older children were expected to swiftly adopt adult chores and accountabilities, to meet the strict necessities of daily life. Harsh punishments for minor infractions were common. Beatings and other forms of corporal punishment occurred regularly; one legislator even suggested capital punishment for children's misbehavior.

Pre-Civil War and Post-Civil War times

According to Stacey Patton, corporal punishment in African American families has its roots in punishment meted out by parents and family members during the era of slavery in the United States. Europeans would use physical discipline on their children, whereas she states that it was uncommon in West African and Indigenous North American societies and only became more prevalent as their lives grew more difficult due to slavery and genocide. As such, Patton argues that traditional parenting styles were not preserved due to the "violent suppression of West African cultural practices". Parents were expected and pressured to teach their children to behave in a certain way in front of white people, as well as to expect the physical, sexual, and emotional violence and dehumanizing actions that typically came with slavery. While the Emancipation Proclamation ended the institution of slavery, in the south many expected former slaves to conform to the prior expectations of deference and demeanor. Patton states that black parents continued to use corporal punishment with their children out of fear that doing otherwise would put them and their family at risk of violence and discrimination, a form of parenting that she argues is still common today.

Biblical views

The Book of Proverbs mentions the importance of disciplining children, as opposed to leaving them neglected or unruly, in several verses. Interpretation of these verses varies, as do many passages from the Bible, from literal to metaphorical. The most often paraphrased is from Proverbs 13:24, "He that spareth his rod hateth his son: but he that loveth him chasteneth him betimes." (King James Version.) Other passages that mention the 'rod' are Proverbs 23:14, "Thou shalt beat him with the rod, and shalt deliver his soul from hell," and Proverbs 29:15, "The rod and reproof give wisdom: but a child left to himself bringeth his mother to shame."

Although the Bible's lessons have been paraphrased for hundreds of years, the modern phrase, "Spare the rod and spoil the child," was coined by Samuel Butler, in Hudibras, a mock heroic narrative poem published in 1663. The Contemporary English Version of Proverbs 13:24 is: 'If you love your children you will correct them; if you don't love them, you won't correct them'.

Medieval views

Medieval schoolboy birched on the bare buttocks

The primary guidelines followed by medieval parents in training their children were from the Bible. Scolding was considered ineffectual, and cursing a child was a terrible thing. In general, the use of corporal punishment was as a disciplinary action taken to shape behavior, not a pervasive dispensing of beatings for no reason. Corporal punishment was undoubtedly the norm. The medieval world was a dangerous place, and it could take harsh measures to prepare a child to live in it. Pain was the medieval way of illustrating that actions had consequences.

Influence of John Locke

In his 1690 Essay Concerning Human Understanding English physician and philosopher John Locke argued that the child resembled a blank tablet (tabula rasa) at birth, and was not inherently full of sin. In his 1693 Some Thoughts Concerning Education he suggested that the task of the parent was to build in the child the strong body and habits of mind that would allow the capacity of reason to develop, and that parents could reward good behavior with their esteem and punish bad behavior with disgrace – the withdrawal of parental approval and affection - as opposed to beatings.

The twentieth century

In the early twentieth century, child-rearing experts abandoned a romantic view of childhood and advocated formation of proper habits to discipline children. A 1914 U.S. Children's Bureau pamphlet, Infant Care, urged a strict schedule and admonished parents not to play with their babies. John B. Watson's 1924 Behaviorism argued that parents could train malleable children by rewarding good behavior and punishing bad, and by following precise schedules for food, sleep, and other bodily functions.

Although such principles began to be rejected as early as the 1930s, they were firmly renounced in the 1946 best-seller Baby and Child Care, by pediatrician Benjamin Spock, which told parents to trust their own instincts and to view the child as a reasonable, friendly human being. Dr. Spock revised his first edition to urge more parent-centered discipline in 1957, but critics blamed his popular book for its permissive attitude during the youth rebellions of the 1960s and 1970s.

In the last half of the century, Parent Management Training was developed and found to be effective in reducing child disruptive behavior in randomized controlled trials.

Conservative backlash

Following the permissive trend of the 1960s and early 1970s, American evangelical Christian James Dobson sought the return of a more conservative society and advocated spanking of children up to age eight. Dobson's position is controversial. As early as 1985, The New York Times stated that "most child-care experts today disapprove of physical punishment."

Corporal punishment

School corporal punishment in the United States
Corporal punishment of minors in the United States
  Corporal punishment prohibited in schools only
  Corporal punishment not prohibited
 
Legality of corporal punishment in Europe
  Corporal punishment prohibited in schools and the home
  Corporal punishment prohibited in schools only
  Corporal punishment not prohibited in schools or in the home

In many cultures, parents have historically had the right to spank their children. A 2006 retrospective study in New Zealand, showed that physical punishment of children remained quite common in the 1970s and 1980s, with 80% of the sample reporting some kind of corporal punishment from parents, at some time during childhood. Among this sample, 29% reported being hit with an empty hand. However 45% were hit with an object, and 6% were subjected to serious physical abuse. The study noted that abusive physical punishment tended to be given by fathers and often involved striking the child's head or torso instead of the buttocks or limbs.

Attitudes have changed in recent years, and legislation in some countries, particularly in continental Europe, reflect an increased skepticism toward corporal punishment. As of December 2017, domestic corporal punishment has been outlawed in 56 countries around the world, most of them in Europe and Latin America, beginning with Sweden in 1966. Official figures show that just 10 percent of Swedish children had been spanked or otherwise struck by their parents by 2010, compared to more than 90 percent in the 1960s. The Swedish law does not actually lay down any legal punishment for smacking but requires social workers to support families with problems.

A 2013 study by Murray A. Straus at the University of New Hampshire found that children across numerous cultures who were spanked committed more crimes as adults than children who were not spanked, regardless of the quality of their relationship to their parents.

Even as corporal punishment became increasingly controversial in North America, Britain, Australia and much of the rest of the English-speaking world, limited corporal punishment of children by their parents remained lawful in all 50 states of the United States. It was not until 2012 that Delaware became the first state to pass a statute defining "physical injury" to a child to include "any impairment of physical condition or pain."

Cultural differences

A number of authors have emphasized the importance of cultural differences in assessing disciplinary methods. Clinical psychologist Diana Baumrind argues that "The cultural context critically determines the meaning and therefore the consequences of physical discipline...".

Child discipline is often affected by cultural differences. Many Eastern countries typically emphasize beliefs of collectivism in which social conformity and the interests of the group are valued above the individual. Families that promote collectivism will frequently employ tactics of shaming in the form of social comparisons and guilt induction in order to modify behavior. A child may have their behavior compared to that of a peer by an authority figure in order to guide their moral development and social awareness. Many Western countries place an emphasis on individualism. These societies often value independent growth and self esteem. Disciplining a child by contrasting them to better-behaved children is contrary to the individualistic societies value of nurturing children's self-esteem. These children of individualistic societies are more likely to feel a sense of guilt when shame is used as a form of behavior correction. For the collectivist societies, shaming corresponds with the value of promoting self improvement without negatively affecting self esteem.

Parenting styles

There are different parenting styles which parents use to discipline their children. Four types have been identified: authoritative parents, authoritarian parents, indulgent parents, and indifferent parents.

Authoritative parents are parents who use warmth, firm control, and rational, issue-oriented discipline, in which emphasis is placed on the development of self-direction. They place a high value on the development of autonomy and self-direction, but assume the ultimate responsibility for their child's behavior.

Authoritarian parents are parents who use punitive, absolute, and forceful discipline, and who place a premium on obedience and conformity. These parents believe it is their responsibility to provide for their children and that their children have little to no right to tell the parent how best to do this. Adults are expected to know from experience what is really in the child's best interest and so adult views are allowed to take precedence over child desires. Children are perceived to know what they want but not necessarily what is best for them.

Indulgent parents are parents who are characterized by responsiveness but low demandingness, and who are mainly concerned with the child's happiness. They behave in an accepting, benign, and somewhat more passive way in matters of discipline.

Indifferent parents are parents who are characterized by low levels of both responsiveness and demandingness. They try to do whatever is necessary to minimize the time and energy they must devote to interacting with their child. In extreme cases, indifferent parents may be neglectful. They ask very little of their children. For instance, they rarely assign their children chores. They tend to be relatively uninvolved in their children's lives. They believe their children should live their own lives, as free of parental control as possible.

Connected parents are parents who want to improve the way in which they connect with their children using an empathetic approach to challenging or even tumultuous relationships. Using the 'CALM' technique, by Jennifer Kolari, parents recognize the importance of empathy and aspire to build capacity in their children in hopes of them becoming confident and emotionally resilient. The CALM acronym stands for: Connect emotionally, match the Affect of the child, Listen to what your child is saying and Mirror their emotion back to show understanding.

Non-physical discipline

Non-physical discipline consists of both punitive and non-punitive methods but does not include any forms of corporal punishment such as hitting or spanking. Thus, no single method is considered to be for exclusive use. Non-Physical discipline is used in the concerted cultivation style of parenting that comes from the middle and upper class. Concerted cultivation is the method of parenting that includes heavy parental involvement, and use reasoning and bargaining as disciplinary methods.

Time-outs

A common method of child discipline is sending the child away from the family or group after misbehavior. Children may be told to stand in the corner ("corner time") or may be sent to their rooms for a period of time (room time). A time-out involves isolating or separating a child for a few minutes and is intended to give an over-excited child time to calm down.

Time-out, painting by Carl Larsson

Alternatively, time-outs have been recommended as a time for parents to separate feelings of anger toward the child for their behavior and to develop a plan for discipline.

If an individual decides to use the time-out with a child as a discipline strategy, the individual must be unemotional and consistent with the undesired behavior. Along with taking into consideration the child's temperament, professionals have recommended that the length of the time-out also should depend on the age of the child. For example, the time-out should last one minute per year of the child's age, so if the child is five years old, the time-out should go no longer than five minutes. However, research results have suggested that this does not improve its effectiveness.

Time-outs have been recommended by researchers and professional organizations on the basis of a large body of research. However, several anti-discipline experts do not recommend the use of any form of punishment, including time-outs. These authors include Thomas Gordon, Alfie Kohn, and Aletha Solter.

Grounding

Another common method of discipline used for, usually, preteens and teenagers, is restricting the child's freedom of movement, optionally compounded by restricting activities. Examples of restriction of movement would be confinement to the yard, to the house, or to just the bedroom and restroom, excepting for required activities, such as attending school or religious services, going to work, obtaining healthcare, performing chores, etc. Examples of restriction of activities would be disallowing visits by friends, forbidding use of a telephone and other means of communications, prohibiting games and electronic entertainment, taking away books and toys, and forbidding watching television and listening to music.

Hotsaucing

"Hotsaucing", or "Hot saucing", is the practice of putting hot sauce in the child's mouth, which can be considered a form of child abuse. Some pediatricians, psychologists and experts on childcare strongly recommend against this practice.

Former child star Lisa Whelchel advocates hot saucing in her parenting book Creative Correction. In the book, Whelchel claims the practice is more effective and humane than traditional corporal punishments, such as spanking; she repeated this opinion when promoting her book on Good Morning America, where she said in raising her own child she found the technique successful where other measures had failed. Whelchel's book recommends using only "tiny" amounts of hot sauce, and lists alternatives such as lemon juice or vinegar.

The practice had also been suggested in a 2001 article in Today's Christian Woman magazine, where only "a drop" is suggested, and alternative substances are listed.

While these publications are credited with popularizing hot saucing, the practice is believed by some to come from Southern United States culture. It is well known among pediatricians, psychologists and child welfare professionals. If a child is allergic to any of the ingredients in a hot sauce, it can cause swelling of the child's tongue and esophagus, presenting a choking hazard.

Scolding

Scolding involves reproving or criticizing a child's negative behavior and/or actions.

Some research suggests that scolding is counter-productive because parental attention (including negative attention) tends to reinforce behavior.

Non-punitive discipline

While punishments may be of limited value in consistently influencing rule-related behavior, non-punitive discipline techniques have been found to have greater impact on children who have begun to master their native language. Non-punitive discipline (also known as empathic discipline and positive discipline) is an approach to child-rearing that does not use any form of punishment. It is about loving guidance, and requires parents to have a strong relationship with their child so that the child responds to gentle guidance as opposed to threats and punishment. According to Dr. Laura Markham, the most effective discipline strategy is to make sure your child wants to please you.

Non-punitive discipline also excludes systems of "manipulative" rewards. Instead, a child's behavior is shaped by "democratic interaction" and by deepening parent-child communication. The reasoning behind it is that while punitive measures may stop the problem behavior in the short term, by themselves they do not provide a learning opportunity that allows children the autonomy to change their own behavior. Punishments such as time-outs may be seen as banishment and humiliation. Consequences as a form of punishment are not recommended, but natural consequences are considered to be possibly worthwhile learning experiences provided there is no risk of lasting harm.

Positive discipline is both non-violent discipline and non-punitive discipline. Criticizing, discouraging, creating obstacles and barriers, blaming, shaming, using sarcastic or cruel humor, or using physical punishment are some negative disciplinary methods used with young children. Any parent may occasionally do any of these things, but doing them more than once in a while may lead to low self-esteem becoming a permanent part of the child's personality.

Authors in this field include Aletha Solter, Alfie Kohn, Pam Leo, Haim Ginott, Thomas Gordon, Lawrence J. Cohen, and John Gottman.

Essential aspects

In the past, harsh discipline was the norm for families in society. However, research by psychologists has brought about new forms of effective discipline. Positive discipline is based on minimizing the child's frustrations and misbehavior rather than giving punishments. The main focus in this method is the "Golden Rule", treat others the way you want to be treated. Parents follow this when disciplining their children because they believe that their point will reach the children more effectively rather than traditional discipline. The foundation of this style of discipline is encouraging children to feel good about themselves and building the parent's relationship with the child so the child wants to please the parent. In traditional discipline, parents would instill fear in their child by using shame and humiliation to get their point across. In positive discipline the parents avoid negative treatment and focus on the importance of communication and showing unconditional love. Feeling loved, important and well liked has positive and negative effects on how a child perceives themselves. The child will feel important if the child feels well liked and loved by a person. Other important aspects are reasonable and age-appropriate expectations, feeding healthy foods and providing enough rest, giving clear instructions which may need to be repeated, looking for the causes of any misbehavior and making adjustments, and building routines. Children are helped by knowing what is happening in their lives. Having some predictability about their day without necessarily being regimental may help reduce frustration and misbehavior.

Methods

Praise and rewards

B. F. Skinner argued that simply giving the child spontaneous expressions of appreciation or acknowledgement when they are not misbehaving will act as a reinforcer for good behavior. Focusing on good behavior versus bad behavior will encourage appropriate behavior in the given situation. According to Skinner, past behavior that is reinforced with praise is likely to repeat in the same or similar situation.

In operant conditioning, schedules of reinforcement are an important component of the learning process. When and how often we reinforce a behavior can have a dramatic impact on the strength and rate of the response. A schedule of reinforcement is basically a rule stating which instances of a behavior will be reinforced. In some case, a behavior might be reinforced every time it occurs. Sometimes, a behavior might not be reinforced at all. Either positive reinforcement or negative reinforcement might be used, depending on the situation. In both cases, the goal of reinforcement is always to strengthen the behavior and increase the likelihood that it will occur again in the future. In real-world settings, behaviors are probably not going to be reinforced each and every time they occur. For situations where you are purposely trying to train and reinforce an action, such as in the classroom, in sports or in animal training, you might opt to follow a specific reinforcement schedule. As you'll see below, some schedules are best suited to certain types of training situations. In some cases, training might call for starting out with one schedule and switching to another once the desired behavior has been taught.

Example of operant conditioning

Positive reinforcement: Whenever they are being cooperative, solves things non-aggressively, immediately reward those behaviors with praise, attention, goodies.

Punishment: If acting aggressively, give immediate, undesired consequence (send to corner; say "NO!" and couple with response cost).

Response cost: Most common would be "time-out". Removing sources of attention by placing in an environment without other people.

Negative reinforcement: One example would be to couple negative reinforcement with response cost—after some period of time in which he has acted cooperatively or calmly while in the absence of others, can bring him back with others. Thus, taking away the isolation should reinforce the desired behavior (being cooperative).

Extinction: Simply ignoring behaviors should lead to extinction. Note: that initially when ignored, can expect an initial increase in the behavior—a very trying time in situations such as a child that is acting out.

It is common for children who are otherwise ignored by their parents to turn to disruptive behaviour as a way of seeking attention. An example is a child screaming for attention. Parents often inadvertently reward the bad behavior by immediately giving them the attention, thereby reinforcing it. On the other hand, parents may wait until the child calms down and speaks politely, then reward the more polite behavior with the attention.

Natural consequences

Natural consequences involve children learning from their own mistakes. In this method, the parent's job is to teach the child which behaviors are inappropriate. In order to do this, parents should allow the child to make a mistake and let them experience the natural results from their behavior. For instance, if a child forgets to bring his lunch to school, he will find himself hungry later. Using natural consequences would be indicative of the theory of accomplishment of natural growth, which is the parenting style of the working class and poor. The accomplishment of natural growth focuses on separation between children and family. Children are given directives and expected to carry them out without complaint or delay. Children are responsible for themselves during their free time, and the parent's main concern is caring for the children's physical needs.

Research

Non-violent discipline options

A systematic overview of evidence on non-violent discipline options conducted by Karen Quail and Catherine Ward was published in 2020.This meta study reviewed 223 systematic reviews covering data from 3,921 primary studies, and available research evidence was summarized for over 50 discipline tools.

Non-violent parenting tools were defined as any skills "which can be used to address a child's resistance, lack of cooperation, problem behavior or dysregulation, or to teach and support appropriate behavior". This is distinguished from a coercive approach, "in which the adult tries to force a certain reaction from the child using threats, intimidation and punishment." Coercive approaches have been found to increase child aggression and conduct problems.

Quail and Ward observed that information on discipline skills on the internet and in parenting books is limited and often inaccurate and misleading. "There is advice against time-outs or praise and rewards, when in fact these are evidence-supported skills which, used appropriately, have positive effects on behavior.". They highlight the need for an evidence-based toolkit of individual skills from which parents and teachers can choose techniques that best suit the situation and fit with their cultural norms. The meta-study found a wide range of evidence-supported nonviolent discipline tools, many of which have been found effective with severe problem behavior. Quail organized these into a Peace Discipline model supported by a toolkit of techniques.

A few of the specific tools showing positive effects include the following.

  • Good, warm, open communication between parent and child, especially the kind that encourages child disclosure. This could imply the use of skills such as active listening and open-ended questions, and the absence of judgment, criticism or other reactions on the part of the parent that would shut child disclosure down.
  • Time-in. Time with parents during which there is physical touch and ample expressions of care, compassion and praise.
  • Parental monitoring. It has been shown that aside from supervision or surveillance, child disclosure is an important part of monitoring. This underlines the importance of a good parent-child relationship, with warm, open communication and good listening skills.
  • Setting expectations (rules).
  • Distracting a child with an acceptable toy, object, or activity.
  • Modelling the behavior parents wish to see.
  • Prompting or reminding a child to do something.
  • Feedback on behavior.
  • Praise.
  • Rewards.
  • Goal-setting with the child.
  • Promoting self-management.
  • Promoting problem-solving skills. This can be done by collaborating with children to find solutions for discipline problems e.g. having a meeting with children to discuss the problem of them getting to school late every morning, brainstorming possible solutions with them, and together choosing the solution that would work best
  • Giving appropriate choices.
  • Time-out. There are two kinds, exclusionary (e.g. the child must stay in their room for a few minutes if they lash out and hurt someone) and non-exclusionary (e.g. a time-out from a toy or cell phone if they are fighting over the toy or abusing phone privileges). Time-outs are most often used for aggression or non-compliance. Exclusionary timeouts may be necessary in the case of aggression, but in other situations either kind has been shown to work. The wide variation in timeouts that work suggests that parents can tailor timeouts according to what feels right for them and what best suits their child's needs. Some examples are: time-out in a room, timeout from a toy, screen time, attention, or from playing in a game they are disrupting. Timeouts in the studies reviewed were implemented calmly, not in a harsh or rejecting manner, and work better in a context where interaction between parent and child is usually of good quality (see time-in).
  • Emotion Coaching or teaching children emotional communication skills. This involves the parents developing an emotional vocabulary for themselves and their children, and learning to become comfortable using emotional experiences as teaching and connection opportunities.

Other, more technical tools include behavior contracts, utilizing cost, group contingencies, and restorative justice interventions.

Quail and Ward suggest that parental attunement is a key parent-skill to effectively use positive parenting tools. Attunement involves giving focused attention to the child's needs behavioral signals, and matching an appropriate choice of discipline tool. They use this example as an illustration: "rewards undermined intrinsic motivation for children who were already motivated, but had positive effects where motivation was low, and were found to be particularly important for children with ADHD." From this perspective, reward should not be considered a good or bad tool in itself, but rather evaluated according to its fit with the needs and signals of the child.

Beyond their effectiveness and usefulness as alternatives to corporal punishment, reviewed skills also showed important and often long-term positive effects. Examples included "improved school engagement, academic achievement, participation, communication and social relationships, better self-regulation, higher self-esteem and independence, and lower rates of depression, suicide, substance abuse, sexual risk behavior, conduct disorders, aggression and crime.". Quail and Ward concluded that the "important positive outcomes shown suggest that use of these tools should be promoted not only for prevention of violence, but for optimum child development."

Cycle of abuse

From Wikipedia, the free encyclopedia
The four phases of the cycle of abuse

The cycle of abuse is a social cycle theory developed in 1979 by Lenore E. Walker to explain patterns of behavior in an abusive relationship. The phrase is also used more generally to describe any set of conditions which perpetuate abusive and dysfunctional relationships, such as abusive child rearing practices which tend to get passed down. Walker used the term more narrowly, to describe the cycling patterns of calm, violence, and reconciliation within an abusive relationship. Critics suggest the theory was based on inadequate research criteria, and cannot therefore be generalized upon.

Overview

Lenore E. Walker interviewed 1,500 women who had been subject to domestic violence and found that there was a similar pattern of abuse, called the "cycle of abuse". Initially, Walker proposed that the cycle of abuse described the controlling patriarchal behavior of men who felt entitled to abuse their wives to maintain control over them. She used the terms "the battering cycle" and "battered woman syndrome". Terms like "cycle of abuse" have been used instead for different reasons: to maintain objectivity; because the cycle of abuse doesn't always lead to physical abuse; because symptoms of the syndrome have been observed in men and women, and are not confined to marriage and dating. Similarly, Dutton (1994) writes, "The prevalence of violence in homosexual relationships, which also appear to go through abuse cycles is hard to explain in terms of men dominating women."

The cycle of abuse concept is widely used in domestic violence programs, particularly in the United States. Critics have argued the theory is flawed as it does not apply as universally as Walker suggested, does not accurately or completely describe all abusive relationships, and may emphasize ideological presumptions rather than empirical data.s

The cycle usually goes in the following order, and will repeat until the conflict is stopped, usually by the survivor entirely abandoning the relationship or some form of intervention. The cycle can occur hundreds of times in an abusive relationship, the total cycle taking anywhere from a few hours to a year or more to complete. However, the length of the cycle usually diminishes over time so that the "reconciliation" and "calm" stages may disappear, violence becomes more intense and the cycles become more frequent.

1: Tension building

Stress builds from the pressures of daily life, like conflict over children, marital issues, misunderstandings, or other family conflicts. It also builds as the result of illness, legal or financial problems, unemployment, or catastrophic events, like floods, rape or war. During this period, the abuser feels ignored, threatened, annoyed or wronged. The feeling lasts on average several minutes to hours, although it may last as long as several months.

To prevent violence, the victim may try to reduce the tension by becoming compliant and nurturing. Alternatively, the victim may provoke the abuser to get the abuse over with, prepare for the violence or lessen the degree of injury. However, the abuser is never justified in engaging in violent or abusive behavior.

2: Incident

During this stage, the abuser attempts to dominate their victim. Outbursts of violence and abuse occur which may include verbal abuse and psychological abuse.

In intimate partner violence, children are negatively affected by having witnessed the violence, and the partner's relationship degrades as well. The release of energy reduces the tension, and the abuser may feel or express that the victim "had it coming" to them.

3: Reconciliation

The perpetrator may begin to feel remorse, guilty feelings, or fear that their partner will leave or call the police. The victim feels pain, fear, humiliation, disrespect, confusion, and may mistakenly feel responsible.

Characterized by affection, apology, or, alternatively, ignoring the incident, this phase marks an apparent end of violence, with assurances that it will never happen again, or that the abuser will do their best to change. During this stage the abuser may feel or claim to feel overwhelming remorse and sadness. Some abusers walk away from the situation with little comment, but most will eventually shower the survivor with love and affection. The abuser may use self-harm or threats of suicide to gain sympathy and/or prevent the survivor from leaving the relationship. Abusers are frequently so convincing, and survivors so eager for the relationship to improve, that survivors (who are often worn down and confused by longstanding abuse) stay in the relationship.

4: Calm

During this phase (which is often considered an element of the honeymoon/reconciliation phase), the relationship is relatively calm and peaceful. During this period the abuser may agree to engage in counselling, ask for forgiveness, and create a normal atmosphere. In intimate partner relationships, the perpetrator may buy presents or the couple may engage in passionate sex. Over time, the abuser's apologies and requests for forgiveness become less sincere and are generally stated to prevent separation or intervention. However, interpersonal difficulties will inevitably arise, leading again to the tension building phase. The effect of the continual cycle may include loss of love, contempt, distress, and/or physical disability. Intimate partners may separate, divorce or, at the extreme, someone may be killed.

Critiques

Walker's cycle of abuse theory was regarded as a revolutionary and important concept in the study of abuse and interpersonal violence, which is a useful model, but may be simplistic. For instance, Scott Allen Johnson developed a 14-stage cycle that broke down the tension-building, acting-out and calm stages further. For instance, there are six stages in the "escalation" or tension building stage. These lead up to the assault by acting out the revenge plan, self-destructive behavior, victim grooming and the actual physical and/or sexual assault. This is followed by a sense of relief, fear of consequences, distraction, and rationalization of abuse.

Donald Dutton and Susan Golant agree that Walker's cycle of abuse accurately describes all cyclically abusive relationships they studied. Nonetheless, they also note that her initial research was based almost entirely on anecdotal data from a rather small set of women who were in violent relationships. Walker herself wrote, "These women were not randomly selected and they cannot be considered a legitimate data base from which to make specific generalizations."

Inequality (mathematics)

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Inequality...