One View: A Spanking Might Beat Ritalin

Pediatrician Lawrence Diller finds that many kids who appear to have ADHD need discipline, not drugs.


Over the years I've talked with Lawrence Diller, a behavioral pediatrician in Walnut Creek, Calif., about how society deals with children with attention deficit hyperactivity disorder. He often prescribes Ritalin for children with ADHD, but he also thinks that Ritalin is prescribed too often. He seems like a thoughtful, reasonable guy. So imagine my surprise when I saw an article by Diller in which he asked: "Could it be that America would rather give unruly kids a pill than a swat?" Spanking instead of Ritalin? Wow. So I called him and asked what's up. Excerpts:

Spanking is probably the most controversial issue in child rearing. You treat children with ADHD. What on earth compelled you to write that spanking may not be so bad?

I was provoked. About a year ago, a California assemblywoman from the South Bay put out a proposal to make the spanking of children 3 years old and under criminal. I thought, please, please! The reason it gets to me is that in 30 years of practice as a developmental pediatrician, issues of discipline cause 80 percent of the problems that I see. The families that are struggling with children's behavior are also struggling with spanking. Often, they've taken a vow of abstinence. They figure if spanking is bad, then all forms of conflict are bad, and they hesitate to discipline their children. They wait too long before taking effective action. This doesn't have to be spanking; it could be removal of a toy or imposition of a timeout. I am talking about middle-class, upper-middle-class families that love their kids, that have the resources for their kids. What gets children into trouble early on are qualities of temperament—qualities of persistence and intensity. These kids have determination, stubbornness—a simple no doesn't work. Even a "Boo!" doesn't faze these guys. The other quality of temperament that comes into play is intensity. When the child is happy they're very happy, but when they're angry they're very angry.

What form of discipline do you recommend to parents?

I keep copies of the book 1-2-3 Magic [a top-selling book by clinical psychologist Thomas Phelan] in my office. I like it a lot. [The book provides a simple system for disciplining that involves counting to three and then putting the child in timeout.] I give parents of 4-, 5- and 6-year-olds a guarantee that in 72 hours their child will be better if they follow these methods. The component I added to Phelan's program that makes it 80 to 90 percent successful in the 6-and-under group is spanking or other physical intervention. There's good solid evidence that when you give parents permission to give one or two smacks on the child's bottom if the child defies the rules of the timeout procedure, the family is more often successful with the approach. For parents still uneasy about a spank, they can use a specific restraint technique I call "the hold" [holding a child against the parent's chest]. But kids actually prefer a spank because it's over with right away.

But spanking's not recommended in 1-2-3 Magic.

No. Phelan says if they don't go to timeout, start the timer again, and add another consequence. I think that's extremely hard for small children to use to make the right decision. I prepare the parents for the likely initial very intense negative reaction from the child, and I feel that if I send them out with the 72-hour guarantee, they're strong enough to handle it. This is very important to tell the parents because otherwise many would give up.With their understanding that they are not hurting their child long term and this is what's called for to demonstrate their consistent strength and steadiness, they are ready to persevere. When children are out of control, you may be sparing this kid and family months of treatment and the risk of being labeled mentally ill. If you don't deal with the bad behavior, it takes you to ADHD-land; it takes you oppositional-defiant-disorder-land, to generalized anxiety-land, and obsessive-compulsive-disorder-land.

One of the big concerns is that spanking will increase the physical abuse of children. Are there parents who shouldn't spank?

Parents shouldn't spank if they have major depression, major marital problems, or substance abuse problems. They shouldn't spank in desperation or in anger—that's what leads to the negative outcomes, like increased violence, associated with corporal punishment. Aren't you worried that parents will say: Larry Diller says if I spank my kid, he won't get ADHD?

That is my big worry. And that's why my friends tell me to keep my mouth shut. To say that all ADHD kids should be spanked is a misreading of my position. But I expect parents and schools to do something before we give out pills. And I give out pills.

What we overlook is that in mild ADHD, which is the majority of the ADHD that is diagnosed in the community, a more organized and coherent system of discipline can make the difference in whether your kid will be on Ritalin or not. You don't have to spank. But if you're using spanking as one of an array of tools to get control of your kid, you're not hurting them in the long term. Lively, impulsive, spontaneous kids who know when to shut up don't get medicine.

Nobody wants to be pro-spanking. I just got asked to be on a website called Opposing Views, where they asked me to take the pro-spanking position. I declined. I'm not pro-spanking. I just think a well-thought-out spank ain't so bad and shouldn't be banned.