Screening for harsh punishment in a pediatric primary care clinic

ObjectivesTo determine: (1) the prevalence of harsh punishment among parents in a pediatric clinic, and (2) the sensitivity, specificity, predictive values, and stability of a brief screening measure.MethodsA subset of families involved in a study of child maltreatment prevention were recruited for this study. Two items in a parent screening questionnaire (PSQ) were related to child punishment. Comparisons were made between parents’ responses on the PSQ and on the Parent-Child Conflict Tactic Scale (CTSPC).ResultsOn the PSQ, 7% of parents of infants and 32% of parents of toddlers/preschoolers reported that their child was difficult to take care of or needed to be hit or spanked. On the CTSPC, 14% of the infants had experienced physical assault and 21% psychological aggression. For older children, subscales were modified to exclude common discipline measures, resulting in 20% experiencing physical assault and 19% psychological aggression. Sensitivities for the PSQ were relatively poor for infants, but moderate for older children. Specificities were good. Stability was adequate.ConclusionsHarsh punishment experienced by older children was similar to that in published studies. Punishment of infants is concerning. The PSQ can be used to screen out parents who are not using harsh discipline measures.Practice implicationsThe PSQ has variable utility in determining which families are using harsh punishment. Until the measure can be further refined, universal counseling is needed.