An Empirical Investigation of Time-Out With and Without Escape Extinction to Treat Escape-Maintained Noncompliance

A systematic review of the correspondence between descriptive assessment and functional analysis

Clinicians report that they often rely on descriptive assessments when developing behavior-reduction plans despite literature suggesting that functional analysis is the most rigorous assessment method. Further, research comparing the outcomes of descriptive assessments and functional analyses is mixed, with some studies showing low correspondence and others showing high correspondence. Such persistent use of descriptive assessments suggests that they may yield useful information despite inconsistent correspondence with functional analyses. A more fine-grained analysis of the relation between descriptive assessments and functional analyses may elucidate variables affecting their utility. We conducted a review of 48 studies that included descriptive assessments and functional analyses and evaluated several measures of correspondence between each pair of assessments. Results indicated that descriptive assessments had exact correspondence with functional analyses in 50% of comparisons. Results also suggested that descriptive assessments were more likely to accurately identify and predict the absence of a function relative to the presence of a function and that structured descriptive assessments were more likely to accurately predict functions.

Time-Out with Young Children: A Parent-Child Interaction Therapy (PCIT) Practitioner Review

Time-out is a component of many evidence-based parent training programmes for the treatment of childhood conduct problems. Existing comprehensive reviews suggest that time-out is both safe and effective when used predictably, infrequently, calmly and as one component of a collection of parenting strategies-i.e., when utilised in the manner advocated by most parent training programmes. However, this research evidence has been largely oriented towards the academic community and is often in conflict with the widespread misinformation about time-out within communities of parents, and within groups of treatment practitioners. This dissonance has the potential to undermine the dissemination and implementation of an effective suite of treatments for common and disabling childhood conditions. The parent-practitioner relationship is integral to the success of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment which involves live coaching of parent(s) with their young child(ren). Yet this relationship, and practitioner perspectives, attitudes and values as they relate to time-out, are often overlooked. This practitioner review explores the dynamics of the parent-practitioner relationship as they apply to the teaching and coaching of time-out to parents. It also acknowledges factors within the clinical setting that impact on time-out's use, such as the views of administrators and professional colleagues. The paper is oriented toward practitioners of PCIT but is of relevance to all providers of parent training interventions for young children.

Longitudinal Relationship Between Time-Out and Child Emotional and Behavioral Functioning

OBJECTIVE

Time-out is a widely used child discipline strategy and one of the only strategies currently recommended by the American Academy of Pediatrics. Despite its widespread use and significant evidence to support its effectiveness in decreasing problem behavior, time-out is often suggested to be harmful or ineffective by the popular media and select professional organizations. Empirical evidence regarding possible side effects of time-out is limited. The present study examined the relationship between reported use of time-out and child emotional and behavioral functioning and parent-child relationships using longitudinal, archival data.

METHODS

The study used archival, longitudinal data from the Early Head Start Research and Evaluation study. This study tracked families with children in Early Head Start at 3 different time points as follows: baseline (aged 0-3 years), pre-kindergarten, and fifth grade. Parent interviews, including questions on the use of time-out, were conducted when the children were 36 months old. Indicators of child emotional and behavioral health were measured at 36 months, pre-K, and fifth grade. Statistical analyses were completed to assess for potential side effects of time-out on child behavioral and emotional functioning and parent-child relationships.

RESULTS

Analyses for all outcome variables suggest no significant difference for children whose parents reported using time-out versus those who did not.

CONCLUSION

Parental reported use of time-out was not associated with long-term negative outcomes. Further research in this area is necessary to continue to address the multitude of concerns related to time-out that are presented by the media.

Effects of delayed time-out on problem behavior of preschool children

Time-out is a common negative punishment procedure in home and school settings. Although prior studies have shown time-out is effective, more research is needed on its effects when implementation is imperfect. We evaluated delays to time-out with 4 preschool children who engaged in some combination of aggression, property destruction, and rule breaking. Target behavior decreased for all subjects exposed to delayed time-out, with 3 of 4 subjects displaying low levels of target behavior even when time-out was delayed by 90-120 s. These data suggest delayed time-out might be effective in situations in which a caregiver or teacher cannot implement time-out immediately.

A Survey of Parents' Perceptions and Use of Time-out Compared to Empirical Evidence

OBJECTIVE

To assess parents' perceptions and use of time-out (TO) in contrast to empirical indications and examine the relationship between reported implementation procedures and perceived effectiveness.

METHODS

We surveyed parents of preschool and school-age children (n = 401, aged 15 months to 10 years) at well-child visits with regard to their awareness, perception, and usage of TO. Parents were specifically surveyed regarding TO components that have been empirically evaluated or pertain directly to its underlying behavioral principles. Descriptive analyses, group comparisons, and correlational analyses were used to characterize responses and evaluate the relationship between TO administration variation and perceived effectiveness.

RESULTS

Most parents (76.8%) reported using TO in response to misbehavior, but a large majority of these parents (84.9%) reported implementing TO in a manner counter to empirical evidence. Parents who endorsed TO as effective varied significantly from those who did not on key implementation components (eg, use of a single warning). Further, several reported implementation practices were correlated with perceived effectiveness and challenging child behavior. For example, requiring a child to be calm before ending TO was positively correlated with perceived effectiveness.

CONCLUSIONS

These results cement TO as a widely disseminated practice but cast doubt on the fidelity with which it is typically implemented. Better methods of educating parents on evidence-based discipline are needed.

Internet guidance on time out: inaccuracies, omissions, and what to tell parents instead

OBJECTIVE

Pediatricians are frequently asked to address parents' behavioral concerns. Time out (TO) is one of the few discipline strategies with empirical support and is recommended by the American Academy of Pediatrics. However, correctly performed, TO can be a complex procedure requiring training difficult to provide in clinic due to time and cost constraints. The Internet may be a resource for parents to supplement information provided by pediatricians. The present study included evaluation of information on TO contained in websites frequently accessed by parents. It was hypothesized that significant differences exist between the empirically supported parameters of TO and website-based information.

METHODS

Predefined search terms were entered into commonly used search engines. The information contained in each webpage (n = 102) was evaluated for completeness and accuracy based on research on TO. Data were also collected on the consistency of information about TO on the Internet.

RESULTS

None of the pages reviewed included accurate information about all empirically supported TO parameters. Only 1 parameter was accurately recommended by a majority of webpages. Inconsistent information was found within 29% of the pages. The use of TO to decrease problem behavior was inaccurately portrayed as possibly or wholly ineffective on 30% of webpages.

CONCLUSIONS

A parent searching for information about TO on the Internet will find largely incomplete, inaccurate, and inconsistent information. Since nonadherence to any 1 parameter will decrease the efficacy of TO, it is not recommended that pediatricians suggest the Internet as a resource for supplemental information on TO. Alternative recommendations for pediatricians are provided.