Should the primary-care physician advise parents to be strict or permissive? Is it harmful or beneficial to spank children? What are the common types of child-rearing styles found in this country? How do the child-training practices of Americans compare with those of other cultures? Can parents be trained to raise socially and cognitively competent children just as they can be trained to cook or sew? When should a pediatrician try to change a parent's child-rearing style? Such questions as these lead to heated debates among professionals as well as among lay persons over the virtues of different approaches to child rearing, with each defending vigorously his favorite ideology and methods.
The purpose of this article is to review some of the information we have on child-rearing styles and their effects on child behavior in terms of these questions and to discuss what implications these findings have for the advice given by pediatricians to new mothers.
COMMON CHILD-REARING STYLES IN UNITED STATES
In a review of the child-rearing literature some years ago, two main ideologies about family life and child rearing were identified; these are still prominent in the lay literature today.1 They are outlined in Table 1.
In general, the "authoritarian," "strict," or "directive" approach emphasizes a sharp dichotomy of parental roles and unquestioning obethence to parental authority by the children. The parents see the child as having a tendency to develop bad habits that will get out of control unless they suppress them and keep the child headed in the right direction.
The "egalitarian," "accommodative," or "permissive" ideology emphasizes overlapping parental roles and a child-rearing approach whose goal is to help each child "develop his full potential." The child is seen as having the basic capacity to learn and mature without excessive pressure or protection, and the parents see their main role as one of guidance and encouragement.
These ideologies become translated into different child-rearing styles according to how the parents respond to common behavioral situations arising with their young children. The "authoritarian" or "strict" parent usually has more rules defining what is and what is not acceptable behavior and is more liable to respond to rule violations with some kind of physical or psychologic punishment (the scold, spank, yell approach). The "accommodative" or "permissive" parent tends to ignore more behavior and is more likely to respond to transgressions by trying to reason with the child about why the behavior is unacceptable or by finding mutually acceptable alternatives - i.e., making an accommodation.
COMPARISON OF "AUTHORITARIAN" AND "EGALITARIAN" IDEOLOGIES CONCERNING FAMILY STRUCTURE AND ROLES
From reading the lay press, one gets the impression that Americans are becoming more and more "permissive," with permissiveness defined as setting few or no limits on unacceptable behavior. This increasing "permissiveness" is said to be leading to increasing problems of crime on the streets, corruption in government, drug abuse, sexual promiscuity, and any other type of undesirable behavior that is currently receiving attention.
However, when one goes out in the community to ascertain what child-rearing practices are actually being used, the picture that emerges is quite different. First of all, very few of the parents interviewed or observed fall into the clearly defined patterns that we have just described. Differences are a matter of degree rather than kind. None of the parents encountered set no limits at all, and it is only a rare parent who has never spanked or yelled at his child. It is equally difficult to find parents who have never used reasoning or made some accommodation to their child's demands. Second, it seems clear that the predominant child-rearing style in this country is more or less "authoritarian." Parents using primarily a "democratic" or "permissive" approach are much harder to find. For instance, Watson had this experience in trying to identify a group of "permissive" parents in a suburb of New York City during his study of child rearing in 1957:
We had been led to believe, however, that in certain subcultures of the United States the ideal of respecting the child and of permitting him great freedom to mature in his own way and at his own good time had taken root. We knew that psychoanalytic concepts were commonly heard in upper-middle class Westchester child-study groups and that "mental hygiene" was looked upon as favorably as Divine Grace once had been. Some teachers complained that children were being given too much freedom at home and writers in popular journals freely listed lack of firm parental discipline as a major cause of juvenile delinquency. It was easy to find citizens who thought that some of their neighbors were overly-permissive parents.
We set the modest goal of 50 cases - 25 boys and 25 girls - from child-centered, permissive homes. After strenuous search, with the cooperation of the Guidance Center, the Child Study Association, the Mental Hygiene Association, social workers, clergymen, teachers, pediatricians and P.T.A.'s; and after extending our quest for an extra year and modifying our qualifying scores a step or two downward toward the middle; we eventually located 38 permissively brought-up children. . . . With much less effort, we found three times as many "strict" as "permissive" homes in the most "Uberai" section of an upper-middle class suburban. community.2
Ten years later, in the highly educated middle-class population of suburban Rochester, we encountered the same problem in trying to study longitudinally the effects of "authoritarian" and "accommodative" childrearing styles on the early home and school behavior of young children.3 Soon after the start of the study, it became apparent that most of the families were more or less authoritarian in their style of rearing and that a special effort would be needed to find a large enough sample of "accommodative" parents to serve as a contrast group. In this study, as with others, the best predictor of the mother's style was her educational level, with the more "accommodative" mothers coming largely from a highly selected subgroup of middleclass families having a four-year college degree. Recent census figures indicate that only about 10 per cent of the general population have this much education, and fewer than half of these are women. With these figures in mind, it is difficult to contemplate that there ever was, is, or will be a massive shift toward "permissive child-rearing styles" in this country.
Of interest in this regard is how physicians form opinions about a mother's child-rearing style. In our study, at the time of the twoyear-old well-child visit, we asked each physician to rate the mothers' style in terms of being "overpermissive" or "overstrict." Three times as many mothers (10 per cent) were rated as moderately or markedly overpermissive as those rated as overstrict (3 per cent).4 Inquiry about what criteria the physicians were using to make these judgments about the mothers' style revealed that most of these impressions are gained from the office behavior of the mother. Physicians tend to identify a mother as "overpermissive" if her child misbehaves in the office and she has difficulty setting limits. Mothers were labeled "overstrict" if they responded to the usual exploratory behavior of the two-year-old with frequent "no's," threats, or hand slaps. That this limited view of the mother may be misleading is suggested by the fact that some of the mothers identified by the physicians as "overpermissive" reported much use of scolding, yelling, and spanking in the home interview. Social-class differences. Other evidence for the nonpermissive nature of our general child-rearing population comes from studies comparing the child-rearing styles across social classes. There is general agreement that as the educational level and social status of the parents go down, the use of "authoritarian" methods increases.5 This is generally true until one reaches some of the disorganized families in social class five,* where there is often an inconsistent combination of styles - with behavior being ignored until it annoys the parent, who then responds with harsh verbal or physical punishment.6 Since many more people reside in social classes three and four than in one, two, and five, "authoritarian" methods clearly predominate in the population at large.
Cross-cultural studies. Cross-cultural studies add further evidence. Whiting and Child compared the child-rearing practices of a group of middle-class Chicago families with those of more primitive cultures in terms of the initial indulgence and later severity of socialization methods used for weaning from the breast, control of elimination, and the expression of sexual, aggressive, and dependent feelings.6 They found that the Chicago families were "extremely low in average indulgence of these five initial tendencies in their children" and that the American middle class is "rather extreme in the severity of its socialization practices, but it does not fall outside the range of the primitive societies."
We would conclude from these studies that the predominant mode of raising children in this country is still more or less "authoritarian" and that there seems to be little danger of our becoming "overpermissive." Is this good or bad?
EFFECTS OF PARENTING STYLES ON CHILDREN'S BEHAVIOR
When one observes groups of nurseryschool and kindergarten children, certain types of behavior patterns can be readily identified. Some children are more aggressive than others in terms of more frequent temper outbursts, hitting or taking things from others, being bossy in play situations, and resisting the teacher's directives. Others display more inhibited patterns, with greater dependence on adults, fear of new situations, shyness with other children, and a tendency to get upset easily. Finally there is a group of friendly, outgoing children who participate readily in all activities, demonstrate leadership ability in free play situations, and maintain friendly relationships with teachers and peers. One hypothesis is that these patterns result from the child's rearing experience in the home and that if the pediatrician could only help parents adopt the "right" childrearing methods, he could increase the yield of friendly, outgoing children. Another hypothesis is that these patterns result from basic temperament traits within the child and are relatively independent of child-rearing methods used by parents and teachers. A third hypothesis is that these ways of behaving result from an interaction of the child's basic biologic characteristics, the rearing pattern used in the home, and the characteristics of the school environment in which the behavior occurs. What evidence is there to support these various explanations of why children behave the way they do?
Psychoanalytic theories implicated spécifie child-rearing practices, such as early weaning or coercive toilet training, as having pervasive long-term effects on personality development, but reviews of research by Orlansky and Sears have found little objective evidence to support this hypothesis.8,9
Investigators then shifted their attention to such pervasive attitudes as "acceptance" or "rejection," but after a decade of research reviewers concluded that measures of attitudes do not predict very much very well.10
More recent studies have shifted to looking at the effect of various patterns of actual parent behavior as observed m the home or described in detail in an interview. At best, only modest relationships are found when measures of both parental behavior and the child's behavior are made at the same time.11,12 However, even these tenuous relationships become weaker if the children are followed longitudinally and measures made in settings other than the home. For example, in our study contrasting the behavior of children being reared by "authoritarian" and "accommodative" styles, there were significant relationships between "authoritarian" styles and aggressive-resistant behavior in both boys and girls at age two when both measures were made at the same time. However, this relationship disappeared as the children were followed longitudinally.13 At age four, repeat measures did show that "accommodatively" raised boys were described as more friendly and outgoing and less active in the home than boys raised by "authoritarian" styles, but there was no difference in their behavior at school. For girls there was no difference in their reported home behavior, but "accommodatively" raised girls were described as functioning somewhat more positively in school. There was no significant difference in the amount of aggressive or inhibited behavior shown by either group of children in either setting. Also, in spite of these few statistical differences, it was clear that most children from both types of homes were doing reasonably well in both settings. Certainly there was no evidence to suggest that the more "permissive styles of child rearing" were turning out large numbers of "spoiled brats," nor is there much evidence to indicate that the more "authoritarian" styles are producing large numbers of overly compliant children or children filled with repressed hostility waiting to be unleashed on unsuspecting teachers or peers. There were some children from each type of rearing situation who had problems either at home or at school and occasionally in both settings, but these did not follow any consistent pattern.
These largely negative studies indicate that parental attitudes and "strict" or "permissive" child-rearing practices, by themselves, do not explain much of the variation in behavior that we observe from child to child.
Similar conclusions have come from reviews of other studies trying to explain the origin of behavioral problems of children by examining only one aspect of the child or his environment (central nervous system dysfunction,14 broken homes,15 etc.). A study of each variable adds something to our knowledge of why a child is behaving the way he is but, by itself, is a poor predictor of future behavior. In addition, there must be a large situational component to a child's behavior because behavior in school often differs markedly from that at home and vice versa.16,17
We would conclude, then, that the way a child is behaving at any one time results from an interaction of a number of different biologic and environmental factors (Figure 1). There is no simple cause-and-effect relationship between a parent's particular style of rearing and the behavior of his child.
Does this mean that it makes no difference how parents rear their children? Not at all. There is ample evidence that longstanding patterns of neglect and abuse produce lasting emotional as well as physical scars on child development.18'19 What it does mean is that most children can adapt to a relatively wide range of child-rearing practices without developing symptoms of malfunctioning. It is also worth repeating that even in the nonextreme range of practices we are discussing, some children will develop difficulties unless the practices are modified to better "fit" the type of child. A good example of this is the child with temperament traits making up the "difficult child" described by Thomas, Chess, and Birch.20 Such a child will encounter trouble with either a "strict" or a "permissive" approach unless it is modified enough to take these characteristics into account.
The discussion so far has been concerned largely with only one aspect of child rearing. Another aspect that seems considerably more important to the child's development is the amount and quality of "positive contact" received by the child. This term refers to the amount of praise, reassurance, affection, companionship, and intellectual stimulation that occurs between parent and child. There is considerable evidence that children who have been talked to, read to, and otherwise stimulated in the home do better in school than children not receiving this kind of attention.21 This relationship has been demonstrated retrospectively, prospectively, and experimentally and holds for middle-class children as well as for those brought up in poverty environments. In the longitudinal study of the children of Kauai, the best predictor of favorable outcome both at home and at school for children at age 10 was the amount of emotional support and intellectual stimulation received in the home during the early years.22
Whether or not parents can be taught how to provide more of this kind of support in ways that will influence the long-term development of the child is still an open question. That short-term gains can be produced for both parent and child is clear; but unless the support is continued in both the home and the school, the effects are transitory.21 Perhaps we need to spend as much time trying to make schools more responsive to the individual needs of children as we do with parents.
Figure 1. Diagram indicating how a child's current behavior is made up of a number of interacting factors.
IMPLICATIONS FOR PEDIATRICIANS
Since "strictness" or "permissiveness" by itself does not have much influence on the development of most children as long as extremes are avoided, the pediatrician should avoid inflicting his favorite ideology of child rearing on the parents and support what they are doing as long as the child is adapting well to the approach being used. Also, the pediatrician should avoid being dogmatic about specific practices (for example, use of pacifiers or age of weaning from the bottle), since there is no evidence whatsoever that these by themselves have any long-term effects on the social and cognitive development of the child.
Similarly, the pediatrician should avoid trying to explain all of a child's behavior in terms of only one factor, such as "brain damage" or a "broken home," while ignoring equally important contributors, such as temperament, parent response patterns, or some aspect of the school environment.
When there is an obvious "lack of fit" between a particular child and the style adopted by the parents (or teacher), the pediatrician can help them modify their response pattern to better fit the type of child.23 Also, helping the parents understand that child behavior is affected by such things as age, sex, temperament, and the school setting, as well as by what is going on at home, will relieve guilt feelings that they alone are responsible for how their child behaves.
Since the quality and quantity of "positive contact" between parent and child do seem to have some influence on later development, the physician should make some effort to screen for how much of this is occurring and should encourage parents who are providing low levels to increase this kind of support for their children. Children who seem particularly at risk for low levels of "positive contact" are the later-born children of large families24 and children spending large amounts of time in institutional settings that provide only physical care, such as hospitals, premature nurseries, or custodial types of day-care settings, as well as the proverbial "orphanages" of the past.25,26 Others at risk are infants of young, inexperienced mothers or those whose mothers received little affection and attention in their own upbringing.27
By educating parents and institutions about the importance of "positive contact" and through the use of judicious referrals for families in difficulty, the physician can do much to promote the cognitive and social development of the child and the well-being of the family.
1. Chamberlin, R. W. Approaches to child rearing: Their identificatori and classification. Clin. Pediatr. 4 (1965), 150-159.
2. Watson. G. Some personality differences in children related to strict or permissive parental discipline. J. Psychol. 44 (1957). 227-249.
3. Chambertin. R. W. Authoritarian and accommodative childrearing styles: Their relationships with tf>e behavior patterns of 2-year-old children and with other variables- J. Pediatr. 84 (1974), 287-293.
4. Chamberlin, R. W. Behavioral problems of preschoolers, tn Haggerty, R., Roghmann, K., and Pless. I. (eos.). Child Health and the Community. New York: John Wiley and Sons, 1975, pp. 95-101.
5. Bayley, N., and Schaefer, E. Relationships between socioeconomic variables and the behavior of mothers toward young children. J. Genet. Psychol. 96 (1960), 61-77.
6. Chuman, C. Child rearing and family relationship patterns of the very poor. Welfare in Review 3 (1965). 9-14.
7. Whiting, J., and Child, I. Child Training and Personality. New Haven, Conn.: Yale University Press, 1953.
8. Orlansky, H. Infant care and personality. Psychol. Bull. 46 (1949), 1-48.
9. Sears, R. Survey of Objective Studies of Psychoanalytic Concepts. New York: Social Science Research Council, 1943.
10. Becker. W., and King, R, The parent attitude research instrument - A research review. Chad Dev. 36 (1965), 329-365.
11. Baumrind. D. Current patterns of parental authority, Dev. Psychol. 4 (1971), 1-103.
12. Yarrow. M. R,, Campbell, J., and Burton. R. Child Rearing: An Inquiry into Research and Methods. San Francisco: Jossey-Bass, 1968.
13. Chamberlin, R. W. Can we identify "high risk" child rearing patterns with two year old children that predict later home and school behavioral or emotional problems? Am. J. Dis. Child, (in press).
14. Shulman, J. L.. Kaspar. J, C., and Throne, F. M. Brain Damage and Behavior. Springfield, III.: Charles C Thomas. Publisher, 1965.
15. Douglas. J., and Btoomfield, J. Children under Five. London: George Alien and Unwin, 195T.
16. Chamberlin, R. W. The use of teacher checklists to identify children at risk for later behavioral and emotional problems. Am. J. Dis. Child, 130 (1976), 141-145.
17. Chamberlin, R. W. Can we identify a group of children at age two who are at risk for the development of behavior , ot emotional problems in kindergarten and first grade? Pediatrics 59 (Suppl., 1977) 971-981.
18. Matene, C., et al. (ed.). The Drifters. Boston: Little. Brown and Company, 1967.
19. Elmer, E. Children in Jeopardy. Pittsburgh: University of Pittsburgh Press. 1967.
20. Thomas, A., Chess, S., and Birch, H. G. Temperament and Behavior Disorders in Children. New York: New York University Press, 1968.
21. Schaefer, E. Parents as educators: Evidence from crosssectional longitudinal and intervention research. Young Children 27 (1972), 227-239.
22. Werner, E.. Bierman, J" and French, F. The Children of Kauai, Honolulu. Honolulu: University of Hawaii Press, 1971.
23. Chamberlin. R. W. Management of preschool behavior problems. Pediatr. CUn. North Am. 21 (1974), 33-47.
24. Chamberlin, R. W. Parental use of "positive contact" in child rearing: Its relationship to child behavior patterns and other variables. Pediatrics 56 (1975), 768-773.
25. Provence, S., and Lipton. R. Infants in Institutions. New York: International Universities Press. 1962.
26. Scarr-Salapatek, S.. and Williams, M. L The effects of early stimulation on low-birth-weight infants. Child Dev. 44 (1 973), 94-101.
27. Kempe, H.. and Heifer, R. Helping the Battered Child and His Family. Philadelphia: J. B. Lippincott Company, 1972.
COMPARISON OF "AUTHORITARIAN" AND "EGALITARIAN" IDEOLOGIES CONCERNING FAMILY STRUCTURE AND ROLES