In the present study, we found significant associations of the parental attitudes towards CP, parental expected outcomes of CP, and parental disciplinary practices, with the academic, developmental and psychological child dysfunctions reported by parents.
The most common reported child dysfunction among the participants was the academic dysfunction, reported in every fourth parent (27.2%). To our knowledge, there are no studies that report the prevalence of academic dysfunctions of children based on the parental report. Owing to the fact that there was no analogue data in the current literature, the direct comparison of the results was not possible. However, other studies in this area that researched the behavioral dysfunctions in school-aged children report that the prevalence of behavioral difficulties in school-aged children range roughly from 23.5% in preschool children 28, 36.4% in children in elementary school 29.
The second highest reported problem in children in our sample was developmental dysfunction which was reported by every fifth parent (20%). The reported data from the studies conducted in other countries, that based the prevalence of developmental dysfunctions on a parental report, range from 11.36% in Taiwan 30 to 18% in the United States 13. A review done in 2007 in low- and middle-income countries reports child disability prevalence from 0.4–12.7% depending on the study and assessment tool 31. However, the authors state that the rates can be higher due to the problems in identifying the disabilities and the lack of adequate instruments. The most prevalent developmental dysfunctions in our study were the problems with vision, followed by speech problems and motoric problems. Similar results were found in a recent study done by Chen et al 30.
The percentage of parents that reported that their child has psychological-emotional dysfunctions was the lowest (3.9%). In our country, the psychological-emotional dysfunctions among children and adolescents are largely unrecognized and stigmatized. This is especially the case in rural areas 32. This lack of knowledge with high rates of stigma is probably due to the lack of experts, services, education and systemic support in the field of Child and adolescent psychiatry 32. This can also be the possible explanation for a high percentage of reported academic dysfunctions, and in contrast, a low percentage of reported psychological-emotional dysfunctions. The occurrence of NSSI reported by parents in our study was 1.5% of parents, while suicidal attempts were reported in 0.4%. This finding is in concordance with the Bella study performed by Resch et al. that reported the prevalence rates of 1.4% for self-mutilation and/or suicidal attempts, also reported by parents 33. However, the data in the literature is mainly based on the child reports, and those studies report higher rates of suicidal behavior 34,35, and higher rates of suicide attempts in youth with a lifetime prevalence of 6% 36.
In the present study, our results indicate that parents of children with any reported dysfunction, as well as with any dysfunction separately (developmental, psychological-emotional and academic), more often believe that the outcomes of CP on children are positive in comparison with the parents of children without reported dysfunctions. In other words, former parents believe that CP will benefit their child’s personality and behavior and lead to a behavioral correction, better family relations and learning self-control 18. One of the first studies that assessed the perceived parental outcomes of CP was done in 2003 by Durrant et al. This study reported that the two samples of mothers in two countries (Sweden and Canada) expected that the outcomes of CP are mainly negative (increased child aggression, long-term emotional upset and parental guilt). A similar finding was also shown among professionals that work with children, where the professionals also believed that the outcomes of CP were primarily negative 18. This is in line with the findings performed in our country17 where we analyzed the differences between the expected outcomes of mothers and fathers17.
These studies didn’t include the perceptions of parents that care for the child with certain dysfunctions. To our knowledge, there is no previous literature on expected outcomes of parents of a child with a dysfunction. From the qualitative study done by Whittingham et al.37 the responses of parents outlined some possible factors that shape their opinions on this matter. Some of these factors included difficulties to determine which behaviors are out of the child’s control versus which are amenable to change 37. Parents that have children with dysfunctions can have a problem in applying alternative and non-violent discipline since these children can have a problem in understanding them, communicating, or hearing them 38. Moreover, an increased pressure of caring for a child with dysfunctions, additional parenting tasks and behavior management difficulties can, in turn, lead to the increase of parental stress, and the likelihood of believing that CP will be an efficient short- or long-term disciplining method 39.
Our results also indicate that the attitudes of parents of children with reported dysfunctions towards the use of CP are positive. When we analyzed each group of dysfunctions we have found that parents of children with psychological and academic dysfunctions have positive attitudes towards CP, while the attitudes of parents of children with developmental dysfunctions don’t differ from the attitudes of parents with children without dysfunctions. In a recent study in Taiwan7, it has been shown that isolated parental attitudes don’t predict the negative outcomes in children. However, when the positive attitudes are combined with the actual use of CP significantly predicts later dysfunctions in children such as depression and violent behavior 7.
This leads us to the final aspects of the parental discipline that we analyzed which are the actual parental practices. From the results presented in our study, it can be concluded that the children with any reported problem are significantly more often subjected to all forms of discipline. This is not a surprising result, since the children with difficulties usually require more parental attention, support and guidance in order to achieve their full potential. However, it should be noted that the children with dysfunctions are not only disciplined more by nonviolent practices, but they are also more often exposed to almost all types of violent parental practices. In the past, the researchers constantly report that children with disabilities and behavioral disturbances are constantly more frequently exposed to all forms of violence (physical, emotional) and neglect 40–45.
When analyzing parental expectations of CP outcomes, parental attitudes and parental practices as predictors of the reported child dysfunctions among the participants, we found significant effects. The significant predictors for the reported developmental dysfunctions in children were the parental positive expectations of CP (i.e. positive outcomes) as well as the parental use of physical assault. In the past, researchers have reported that children with certain developmental difficulties are constantly more often exposed to abuse. According to the authors, this is mainly due to their common cognitive immaturity and social invisibility 46. There is an increasing body of evidence that abuse (especially severe forms of abuse) alters brain development 43. It needs to be highlighted that these children are already more vulnerable to all types of adverse external factors, and even with sufficient support often struggle to reach their full potential and to adequately follow their peers. We can conclude that the effects of abuse in this group of children can be even more devastating in terms of their further development.
The significant predictors of academic dysfunctions in children were psychological aggression, minor physical assault and neglect. The significant predictors for psychological-emotional dysfunctions in children were all forms of physical abuse (minor to extreme). Considering the fact that this is a cross-sectional study, the associations between the examined variables can be bidirectional. The use of CP and other harsh disciplining measures can lead to many negative mental health outcomes for a child such as internalizing (depression, NSSI, suicidal behavior) 47,48 and externalizing problems (increased impulsivity, temper outbursts, and aggression) 49. This is why parents need to bear in mind the fact that not only these violent measures are not going to resolve the child’s dysfunctions, but they can cause and/or worsen them. On the other hand, the challenging behaviors that are often expressed by children with dysfunctions can lead to a decrease in parental capacity to handle their demanding parental role and to deal with stress, which can worsen their unfavorable discipline practices. These factors can form a virtuous circle that can be dangerous for the whole family.
The main limitation of this study is its cross-sectional structure and its inability to form a causal relationship between the measured variables. The use of self-report and the retrospective nature of some parts of the study instrument may have caused a recall bias among the participants. In addition, this study was based on parental reports of child dysfunctions, which could have led to false negative and false positive identification of certain dysfunctions in their children. The participants were approached by the interviewer in their household and the interview was conducted face-to-face. Some questions could have been sensitive and possibly incriminating for certain parents, which is why they might have been reluctant to provide truthful answers.