Spank Less, Praise More

Spanking is an extremely common form of corporal punishment, generally used against a child in response to a perceived bad behavior. It is an old-fashioned form of punishment that has the potential to cause more harm than good. It is clear that spanking may be effective in causing immediate obedience, but this effect is short-lived.

Corporal punishment has been associated with adverse effects in childhood, such as causing the child to believe that he or she is bad, increased aggression, behavioral problems, delinquent and antisocial behavior, and decreased quality of the parent-child relationship. Additionally, corporal punishment has been associated with long-term consequences in adulthood, such as criminal and antisocial behavior, aggression, and abuse of one’s own children and spouse.  

It is also concerning that spanking is associated with an increased risk of physical abuse. If a child is spanked often, spanking will become less effective as a form of punishment and less likely to modify the undesired negative behavior. This may lead a parent to spank more or harder or use an object to spank with.

As a mother of two wild toddlers, I understand very well the temptation to spank your children and the feeling of desperation when you have exhausted your parenting bag of tricks. I have even been frightened by my own drive to spank my children due to rage and frustration when they are at their peaks of unruliness. The only times I believe that I made the right choice by spanking are situations in which I have spanked my child to prevent some greater immediate harm, such as slapping her hand away from something extremely hot or trying to prevent her from running into the middle of a busy street.

Some states have mandatory reporting laws that require health care workers to report parents who engage in corporal punishment. While I do believe these laws help identify and prevent child abuse, they may have also created a situation in which parents are afraid of or uncomfortable with discussing corporal punishment with their healthcare providers.  

If parents are not comfortable discussing spanking with their healthcare providers, I think it’s important for parents to ask themselves questions about their discipline techniques, including the following: What does my child do that makes it necessary to spank him/her? Does spanking work? If so, for how long? What am I trying to accomplish by spanking my child? What am I feeling when I spank my child? How do I feel afterward? Does my child understand what I am trying to teach him/her? Do I sometimes find it necessary to spank harder or more often to teach him/her a lesson? What else have I tried to teach my child?

Alternatives to corporal punishment include the following strategies:

  • Praise your children and give them increased attention when they are behaving well to promote desired behaviors
  • Use “time outs” to take a break from escalating behaviors
  • Use positive reinforcements such as giving rewards for good behaviors
  • Use other forms of negative reinforcement such as expressing disappointment or taking away a privilege
  • Ignore small misbehaviors that are not a priority for improving behavior and may be a part of normal development
  • Take a break from your children when you are angry
  • Ask a partner, friend, or family member for emotional and practical support

If you choose to spank your children, consider the following recommendations:

  • Try to use other discipline techniques more often to decrease the frequency of spanking
  • Avoid the use of any objects (such as a belt or switch)
  • Avoid spanking while angry
  • Avoid spanking very young children (less than 3 years old)

Although I firmly believe that most parents who spank their children are not doing so in a way that would be considered child abuse, I think there are more effective and better options than spanking, with less potential for harm.

Because spanking is such a pervasive and common practice in our society, I don’t think telling parents to never spank is realistic, and this advice can have the unwanted effect of making a parent tune out or feel judged. It is more important to have a dialogue about the effects of spanking and try to make the shift away from this form of punishment.

Originally published in The Hill (http://thehill.com/blogs/pundits-blog/healthcare/300820-spank-less-praise-more)

Learn more about Dr. Trotta

Project Semicolon: Helping People Continue Their Story

Suicide is the second leading cause of death for ages 10-34, according to 2014 statistics from the Centers for Disease Control and Prevention (CDC).*  Millions of people every year suffer from mental illnesses such as depression, bipolar disorder, psychotic disorders and borderline personality disorder, that can cause or worsen suicidal and self-injurious thoughts and behaviors. 

Project Semicolon is a global non-profit movement dedicated to presenting hope and love for those who are struggling with mental illness, suicide, addiction and self-injury.  This movement uses the power of sharing struggles and providing emotional support through peers who have had similar difficulties.  Peer support is mutually offered and reciprocal, which allows peers to benefit from support whether they are giving or receiving it. Recovery groups such as alcoholics anonymous, narcotics anonymous, over-eaters anonymous and eating disorder support groups also function through peer support.

According to the founder, Amy Bleuel: “This movement has impacted people by creating a conversation point. Through a simple yet elegant symbol many have found the strength to carry on. Many now know that they are not alone in their fight anymore.”

We support and applaud the efforts of Project Semicolon.  Increased awareness and support are necessary for individuals contemplating harming themselves and for their loved ones.  If you are having thoughts of harming yourself, please seek help by calling 911 or contacting a mental health care professional.  The National Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255.

http://www.projectsemicolon.org/

*http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2014_1050w760h.gif

Adult Coloring Books: The New Art Therapy

Art therapy is a therapeutic process in which art is either created or analyzed to help treat various mental and emotional issues.  It is a widely accepted form of therapy in hospitals, clinics, schools and with private practice therapists. With the guidance of trained art therapists, people can increase awareness of self, learn to cope with symptoms of stress and trauma, and enjoy the pleasure of making art.  We like adult coloring books because they are easily accessible and affordable.  Although you may not have the help of a trained art therapist with you while you color, you can still benefit greatly from taking the time to create art for the purposes of self-expression, stress reduction and increased emotional awareness.

Our tips to increase the therapeutic benefits of your coloring book experience:

  • Choose a calming location, such as a quiet room or your favorite café.
  • Before coloring, think about your current mood and what you want to accomplish by coloring.  Are you angry and want to feel calmer?  Are you happy and just want to enjoy the moment?  Are you stressed and need something relaxing to reduce the tension?
  • Think about the colors you decide and why you want to use that color.  Does the color blue make you feel calm?  Does the color red remind you of a favorite moment?
  • Consider adding music to the environment.  Art therapists often choose relaxing music, like classical music or jazz, but you can choose your favorite genre.  Consider making a “coloring time" playlist.
  • Don’t let the lines on the paper limit your creativity.  Don’t just color, add to the design on the page.
  • Put your cell phone and other distracting electronic devices away.

Some coloring books we like:

Adult Coloring Book: Stress Relieving Patterns, by Blue Star Coloring

ColorIt – Colorful Flowers: Adult Coloring Book with Relaxing Zentangle Flowers and Patterns, by ColorIt

Color Therapy: An Anti-Stress Coloring Book, by Richard Merritt, Cindy Wilde and Laura-Kate Chapman

Top 5 Reasons Your Doctor Chooses Your Medications

Although most doctors choose medications based on a combination of factors, below are some of the most common reasons a doctor might choose one particular medication over another.

1. Insurance coverage: Access to medications is highly dependent on decisions made by health insurance companies.  Each insurance company has a panel of medications that are pre-approved for a doctor to prescribe.  Other medications require prior authorization, which means your health care provider has to contact the insurance company directly to ask the insurance company to cover the cost of the medication.  Even though your doctor might request prior authorization, sometimes the insurance company will deny approval or require that you take other medications (usually less expensive ones) that they have approved for coverage.  This can be a timely and very frustrating process for both the patient and the doctor.  As high deductible health plans (HDHP) are becoming more common, more people are faced with high out-of-pocket costs. An example of this is the current controversy over the exorbitant cost of the EpiPen, produced by Mylan pharmaceuticals.

2. Side effect profile: All medications have effects on the body.  The wanted effects are called “treatments” and the additional, unwanted effects are called “adverse effects” or “side effects.” A doctor might choose to stay away from certain medications because of their general side effects or because they have knowledge that a medication will affect you adversely due to your particular health status or life circumstances.

Some examples:

  • Serotonin reuptake inhibitors (SSRIs), such as Prozac, can cause sexual dysfunction.  A couple that is actively trying to have a baby might prefer a different medication.
  • Benzodiazepines (such as Ativan, Xanax, or Valium) may not be good choices for someone who drives a taxi because these medications can cause drowsiness and impairment while driving.
  • Lithium, which is used to treat bipolar disorder, can cause renal dysfunction.  If a patient has known kidney disease, a doctor may not want to prescribe this medication due to concerns of worsening kidney problems.

3. Doctor preference: After years of experience treating the same disorders, doctors can start to develop a preference or bias about which medications work better than others.  The time period in which a doctor was trained can also affect his/her preferences because of the level of exposure a doctor has to learning about and using different medications.  More recently trained psychiatrists have less experience using monoamine oxidase inhibitors (MAOIs), because serotonin reuptake inhibitors (SSRIs) are used more frequently now, due to fewer side effects.

4. Patient preference: Patients also have preferences or biases about medications.  Some patients ask their doctor for a medication they saw in a commercial or a medication that was recommended by a friend or family member.  Sometimes a patient will have heard a story about someone who had a bad reaction to a medication and will be afraid to take it, even if it is highly recommended by the doctor.

5. Availability of generic medications: When a new medication comes to market, the pharmaceutical companies have a patent, that allows only the brand version to be sold.  A patent is valid for 20 years after the date it is filed, but it can take many years before a medication gets FDA approval to be used by the general population.  The cost of the branded version of a medication is usually much higher than the cost of the generic. When the generic version becomes available, it is more likely that individuals and institutions will have access to these medications.  Some examples of newer psychiatric medications include: Aristada, Rexulti, Vraylar, and Probuphine.