Background
In many countries worldwide, children are frequently exposed to harsh discipline such as spanking or being beaten with objects like sticks or belts [
1,
2]. We define harsh discipline as the use of any physical or psychological force with the intention of causing physical or emotional pain for the purpose of correction or control of the child’s behavior. As physical and psychological discipline occasionally harms the child but poses at least a continuous threat or stressor to the child, harsh discipline is commonly defined as physical or emotional abuse [
3]. In Tanzania, a national survey with a representative sample of more than 3,700 youths between the ages of 13 and 24 revealed that almost three quarters of both girls and boys had experienced physical discipline (e.g., being punched, whipped, or kicked) and more than one quarter faced emotional violence (e.g., being insulted, humiliated, threat of abandonment) prior to the age of 18 [
4]. More than half of the girls and boys aged 13–17 years reported that they had experienced physical violence by either a relative or an authority figure during the past year. Concordantly, in a recent study with primary school students aged 6 to 15, it was found that nearly all children had experienced corporal punishment at some point during their lifetime in both family and school contexts [
5]. Half of the respondents reported having experienced corporal punishment within the last year. Furthermore, a study conducted at secondary schools showed that 40 % of the teachers reported the frequent use (defined as more than ten times a week) of physical discipline (e.g., beating with a stick) in school [
6]. Interviews with teachers and students confirmed that caning (i.e., being beaten with a stick) was the most frequently used disciplinary method in schools. Harsh discipline seems to be a very common phenomenon in Tanzania. However, little is known about the impact of harsh discipline on the children’s mental health, cognitive functioning and school performance in societies in which these disciplinary methods are commonly utilized.
Relation between harsh discipline, child abuse and mental health problems
Prior research, mostly from Western countries, showed that in addition to physical injury, child maltreatment is associated with a number of emotional and behavioral problems that begin in childhood but may last through adolescence and adulthood [
7]. Adverse effects of child abuse include depression, anxiety disorders, substance abuse, and aggressive or delinquent behavior [
8‐
10]. Physical abuse, for example, contributed significantly to other risk factors in accounting for lifetime diagnoses of major depression, conduct disorder, and drug abuse [
11,
12]. Corporal punishment also shows an association with psychopathology. Individuals who had experienced corporal punishment were at increased odds of psychopathology compared to those who had not experienced corporal punishment [
13]. Both cross-sectional and longitudinal studies suggested that corporal punishment is associated with increased externalizing and internalizing problems in childhood, adolescence and adulthood [
14‐
18].
Psychological or emotional maltreatment also seems to be a potent form of maltreatment that has been linked with attachment disorders, developmental problems, aggression, and later psychopathology [
19,
20]. For example, emotional abuse was associated with later symptoms of anxiety and depression [
21] and parental verbal aggression with depression, anxiety and anger-hostility [
22].
Harsh discipline, child abuse and its impact on cognitive functioning
Yet, child maltreatment is not only risk factors for mental health problems, it may also affect the cognitive functioning [
23]. For example, child abuse is related to delayed language and cognitive development, lower IQ and poorer school performance [
24]. A systematic review showed that teenagers exposed to child maltreatment performed more poorly than nonmaltreated controls on tasks assessing working memory, attention and executive functions [
25]. Augusti and Melinder [
26] replicated this negative association between child maltreatment and working memory capacity. A number of studies reported not only an association of parental verbal abuse and emotional abuse with impaired spatial working memory performance but also with an alteration in the integrity of neural pathways, which seem to have implications for language development [
27,
28].
Most studies investigating the link between child maltreatment and cognitive functioning have been conducted in children or adolescents who also reported mental health problems. Therefore, it is difficult to disentangle whether child maltreatment has a direct impact on cognitive functioning or whether it is mediated through mental health disorders [
24]. Deficits in executive functions and working memory seem to mediate the relationship between child abuse and lowered school performance [
29]. For example, physically abused children displayed an overwhelming set of problems on nearly all dimensions of school performance [
30]. However, less is known about the association between harsh punishment and cognitive functioning.
Internalizing problems seem to contribute to the prediction of school performance and cognitive functioning over and above the effects of intelligence [
31]. Overall, prior research findings indicated an association between child abuse and internalizing problems as well as between internalizing problems and cognitive dysfunctions. Therefore, internalizing problems may provide one route through which abused children are at heightened risk for impaired cognitive functioning and thus lowered school performance.
Objectives
In Tanzania and other countries children are frequently exposed to harsh discipline, which may have detrimental consequences for their mental health and cognitive functioning. We have already demonstrated that corporal punishment was linked to children’s externalizing problems in Tanzanian children [
5]. Yet, in our work at Tanzanian schools and child care institutions it became obvious that mainly children with externalizing problem behavior were regarded as “
problem children”, whereas caregiver and teachers did not notice or report internalizing problems of children. Therefore, in the present study we aimed at investigating more closely children’s internalizing problems and its association with harsh discipline, children’s working memory capacity and school performance in a sample of Tanzanian primary school students. We hypothesized that (a) exposure to harsh discipline would be related to internalizing problems, and cognitive dysfunctioning (i.e., lower school performance and working memory). We also predicted that (b) internalizing problems would be negatively associated with cognitive dysfunctioning. Furthermore, we expected (c) that internalizing problems would mediate the association between harsh discipline and cognitive dysfunctioning.
Discussion
Our results indicated that 14 % of the participating students reported clinically relevant symptoms of depression in a common screening instrument (CDI). Using the SDQ 8 % respectively 9 % reported clinically relevant levels of peer problems (e.g., social withdrawal) and emotional problems. These numbers indicate that internalizing problems are also of relevance in Tanzanian primary school students though neither teachers nor caregivers reported internalizing problem behavior of children during the preparatory phase of our study. These findings may explain why so many parents, caregivers and teachers in Tanzania and elsewhere are convinced that harsh discipline does no harm to the children: Often the children suffer in silence and neither their parents, their caregivers nor their teachers notice the children’s suffering.
Harsh discipline may impair mental health across the entire lifespan [
13]. In line with this, we found a strong relationship between harsh discipline and internalizing problems. In turn, internalizing problems were related to lower working memory capacity and lower school performance. However, in contrast to our hypothesis the extent of harsh discipline was not directly linked to impaired working memory capacity and poor school performance. Our findings indicate that harsh discipline may not only be related to poor mental health but may also be associated with reduced cognitive functioning via internalizing mental health problems. Our results are in concordance with prior studies mostly from Western countries suggesting a relationship between exposure to child abuse, including harsh discipline, and internalizing problems [
9,
22] and cognitive functions [
27,
28]. However, it is not yet clear whether harsh discipline directly impacts cognitive functions or whether mental health problems mediate this relationship [
24]. The results of the present study suggest that internalizing problems may provide one route through which harshly disciplined children are at risk for both impaired memory functions and for lowered school performance.
The effect size of this association implies a small but marked influence. These results are congruent with previous research indicating a cumulative effect of harsh discipline on the children’s mental health problems [
5,
14,
22]. Considering the high prevalence of harsh discipline in the current sample and other reports with representative samples [
1,
2,
4], the consequences of harsh discipline may manifest into a considerable cause for concern at the societal level [
1]. Yet, further research is needed to thoroughly understand the causal mechanisms that may underlie the relationship between harsh discipline, mental health problems and cognitive deficits. Particularly, further studies that examine these relations across countries and societies in which harsh disciplinary methods are legal and highly prevalent using scientific rigorous designs are essential.
The findings of the present study emphasize the need to inform parents, caregivers, governmental organizations, and the population at large, especially in countries with a high prevalence rate of harsh discipline, about the potentially adverse consequences associated with harsh discipline. Thereby, it is important to raise awareness that children also suffer from internalizing problems (e.g., depressive symptoms, social withdrawal, etc.) helping parents, caregivers and teachers to be able to notice also a quiet child that suffers from mental health problems in order to break the vicious cycle that our results may indicate: Children suffer in silence, their suffering is not noticed but as a result of poor school performance these children may be even more likely to experience further harsh punishment.
Furthermore, our findings suggest that effective prevention of harsh discipline may be required to help to prevent children from developing mental health problems. Beside economic and environmental factors (e.g., poverty, high stress level, societal beliefs), reasons for using harsh disciplinary methods that parents and caregivers reported to researchers were, among others, a lack of non-violent caregiving skills, excessive demands, and helplessness [
51]. Lansford et al. [
52] showed that parents’ positive evaluations of aggressive responses to hypothetical childrearing vignettes predicted parents’ self-reported harsh discipline in a study in nine countries. Thus, efforts to eliminate harsh discipline toward children could target parents’ beliefs about the acceptability of using harsh discipline. Hermenau et al. [
51] successfully tested the feasibility of a preventative approach with caregivers in Tanzania that focused on caregivers’ beliefs, self-reflection of own experiences of harsh discipline, positive parenting skills, and nonviolent caregiving strategies. We recommend more research efforts that focus on developing and testing culturally appropriate prevention programs that effectively replace harsh discipline by forms of educational measures that do not harm the children.
There are some limitations of the study that should be noted: first, the cross-sectional study design does not allow for the establishment of causality. We cannot, for example, completely rule out the possibility that children who perform poorly at school experienced more harsh discipline and thus develop mental health issues. However, in our models we did not find a direct association between poor school performance and harsh discipline. The recruitment of study participants at one primary school limits the generalizability of our findings. In the school context of our data assessment we were unable to include parents’ reports for logistical reasons. Therefore, we could not gather information regarding the socio-economic status (SES) of our sample. It remains to be tested whether SES may impact cognitive functioning through other pathways than harsh discipline. Generally, the children talked very openly about their experiences and feelings. However, potential biases, such as social desirability, can never be completely ruled out for subjective reports. However, a recent study strengthened the credibility of children’s self-report by comparing epigenetic and self-report data and supported the conclusion that children are capable of accurately reporting their exposure to abuse [
53]. Furthermore, we did not assess the exposure to harsh discipline by teachers systematically. The exposure to harsh discipline in school may have further added to the impact of harsh discipline at home.
Conclusions
The present study suggests that harsh discipline is closely linked to children’s internalizing problems, which are in turn associated with lower cognitive functioning and school performance. Given the high rates of harsh discipline experienced by children in East African homes and elsewhere, the findings of the present study emphasize the need to inform the population at large about the potentially adverse consequences associated with harsh discipline. Further, our findings underscore the need to implement preventative measures against the use of these forms of discipline. Through these efforts, reducing harsh discipline in their home environments combined with the fostering of positive caregiving skills we would enable children to grow up in a respectful and supportive atmosphere, thereby strengthening their development.
Acknowledgements
We are grateful to all of the children who participated in this study. We also wish to thank all of the teachers, the head teacher and the director of the school for their support while conducting this study. We are very grateful to our highly motivated and reliable research team, including: Manswab Geho, Dorothea Isele, Huruma Kipagile, Getrude Mkinga, Andrew Mtitu, Zephania Ngowi, Lulu Nziku, Astrid Pabst, and Leila Samson. We are grateful to Anna Radkovsky for her statistical advice, Katharina Zepf and Justin Preston who critically reviewed the manuscript.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
TH participated in the conception and design of the study, collected data, performed the statistical analyses and interpretation of findings, and drafted the manuscript. KH participated in the conception and design of the study, collected data, performed the statistical analyses and interpretation of findings, and helped to draft the manuscript. CS collected data, supported the statistical analyses, and revised the manuscript. MT made substantial contributions to the interpretation of findings and revised the manuscript. TE participated in the conception and design of the study, made substantial contributions to the statistical analyses and interpretation of findings, and revised the manuscript. All authors read and approved the final manuscript.