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Advising parents on discipline: what works.

Discipline for children is one of the most common behavioral issues encountered when providing health care for children, and 90% of pediatricians report that they include advice about discipline most of the time when providing anticipatory guidance to families.1 Although we should provide advice for discipline strategies that have evidence of being effective, this goal is quite complex because of the broad scope of what constitutes discipline and the multifactorial etiology of behavior problems.
 THE BROAD SCOPE OF DISCIPLINE
 Discipline refers to systems of teaching, learning, and nurturing that are used in child rearing. These systems include procedures that encourage appropriate behavior and deter misbehavior according to the child's developmental abilities. The systems' ultimate goals are for the child to achieve competence, self-control, and self-direction.2 Some children make these teaching tasks more difficult than others, often due to differences in temperament.3 Children who have aspects of their personality defined as "difficult" are both more likely to have behavior problems and to present a challenge for caregivers trying to be consistent and positive in their discipline teaching. Children with diagnosable mental health problems or developmental disabilities, including attention deficit hyperactivity disorder, often have their own additional special difficulties with socialization and learning. Conversely, children with higher intelligence and better language skills are more resilient to stress, have fewer behavior problems, and respond better to parent-mediated behavior training and therefore are easier to discipline.
 Many other factors affect a caregiver's ability to conceive of, establish, and maintain a system of discipline. Many of the same parental factors that interfere with establishing optimal discipline and responding to parent intervention programs are the ones that make it more likely that the child will have problematic behaviors.