Time-Out in Child Behavior Management E-Book

Corey C. Lieneman

• Herausgeber: Hogrefe Publishing
• Kategorie: Geisteswissenschaft
• Serie: Advances in Psychotherapy - Evidence-Based Practice
• Sprache: Englisch
• Veröffentlichungsjahr: 2023

Seitenzahl: 278

Beschreibung

Practical, evidence-based guide to using time-out safely and effectively Written by leading experts Highlights applied research Reviews parent training programs Details parent–child interaction therapy Addresses controversial issues Includes downloadable tools This book is essential reading for psychologists, therapists, students, and anyone who works with children and their families. It is a compact, comprehensive guide to understanding, administering, and teaching caregivers to implement time-out effectively for child behavior management. Readers will learn about time-out's history and scientific research base, particularly with respect to child age, cultural groups, and presenting concerns. Practitioners will appreciate the focus on applied research highlighting the efficacy of specific time-out parameters, such as duration, location, and handling escape. Overviews of behavioral parent training programs that include time-out are also provided. The authors then share their expertise in the use of time-out in parent–child interaction therapy (PCIT), both conceptually and by using an in-depth case study. They also thoroughly examine controversial issues related to time-out, from theoretical and practical standpoints. The appendix provides the clinician with hands-on tools: step-by-step diagrams for administering time-out and managing escape, handouts for parents about issuing effective instructions, and a list of further resources.

Leseprobe

Advances in Psychotherapy – Evidence-Based Practice, Volume 48

Time-Out in Child Behavior Management

Corey C. Lieneman

Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE

Cheryl B. McNeil

Department of Psychiatry, University of Florida, Gainesville, FL

About the Authors

Corey C. Lieneman, PhD, is a clinical child psychologist and assistant professor in the Department of Psychiatry at the University of Nebraska Medical Center. Her research and clinical interests lie in disruptive behavior disorders, autism spectrum disorder, and behavioral parent training for young children. She is level one trainer for Parent–Child Interaction Therapy (PCIT) International.

Cheryl B. McNeil, PhD, is a professor in the Department of Psychiatry at the University of Florida. She spent the previous 28 years of her career at West Virginia University. Dr. McNeil has coauthored many books, chapters, and over 150 research articles related to the importance of intervening early with young children displaying disruptive behaviors. Dr. McNeil is a global trainer for PCIT International and has disseminated PCIT to agencies and therapists in many states and countries, including Norway, New Zealand, Australia, Taiwan, Hong Kong, and South Korea.

Advances in Psychotherapy – Evidence-Based Practice

Series Editor

Danny Wedding, PhD, MPH, Professor Emeritus, University of Missouri–Saint Louis, MO

Associate Editors

Jonathan S. Comer, PhD, Professor of Psychology and Psychiatry, Director of Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL

J. Kim Penberthy, PhD, ABPP, Professor of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, VA

Kenneth E. Freedland, PhD, Professor of Psychiatry and Psychology, Washington University School of Medicine, St. Louis, MO

Linda C. Sobell, PhD, ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a reader-friendly manner. Each book in the series is both a compact “how-to” reference on a particular disorder for use by professional clinicians in their daily work and an ideal educational resource for students as well as for practice-oriented continuing education.

The most important feature of the books is that they are practical and easy to use: All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls,” marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

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Psychologists and other healthcare providers may earn five continuing education credits for reading the books in the Advances in Psychotherapy series and taking a multiple-choice exam. This continuing education program is a partnership of Hogrefe Publishing and the National Register of Health Service Psychologists. Details are available at https://www.hogrefe.com/us/cenatreg

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

Library of Congress of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2022950048

Library and Archives Canada Cataloguing in Publication

Title: Time-out in child behavior management / Corey C. Lieneman (Department of Psychiatry,

University of Nebraska Medical Center, Omaha, NE), Cheryl B. McNeil (Department of Psychiatry,

University of Florida, Gainesville, FL).

Names: Lieneman, Corey C., author. | McNeil, Cheryl Bodiford, author.

Series: Advances in psychotherapy--evidence-based practice ; v. 48.

Description: Series statement: Advances in psychotherapy--evidence-based practice ; volume 48 |

Includes bibliographical references and index.

Identifiers: Canadiana (print) 20220475490 | Canadiana (ebook) 20220475601 | ISBN 9780889375093

(softcover) | ISBN 9781613345092 (EPUB) | ISBN 9781616765095 (PDF)

Subjects: LCSH: Timeout method. | LCSH: Discipline of children. | LCSH: Behavior modification.

Classification: LCC HQ770.4 .L54 2023 | DDC 649/.64—dc23

© 2023 by Hogrefe Publishing

www.hogrefe.com

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|v|Acknowledgments

I am incredibly grateful to my coauthor and the best mentor I have ever known, Dr. Cheryl McNeil, for her support and belief in me during the writing of this book and always. I am forever indebted to Cheryl for her expert training and professional guidance. Thank you to my husband, Casey, for his patience with this book project, as well as his unwavering encouragement as we navigated raising two young children during my graduate education. To my boys, Malachi and Benny, thank you for giving up your mom on Saturdays to make this book possible. Finally, I am thankful to my parents, Bill and Jody, for instilling in me the importance of hard work and education.

C.C.L.

Here is a loud shout out to all of the graduate and undergraduate students who have supported my work in the parent–child interaction therapy research lab over the years, as well as Dr. Sheila Eyberg who provided me with the gift of PCIT. I especially appreciate Erinn Victory who provided editorial comments on the first draft of this manuscript. I also want to thank my supportive husband, Dan, who held down the fort and provided moral support during the long absences needed for several book projects over the years. I also want to thank my sons, Danny and Will, who were willing to give up some “Mom time” so that I could pursue my academic dreams. Finally, hugs and thanks to my father, Otis, who encouraged me to excel in school and be the first in our family to attend college, as well as Jack and Debbie who have diligently helped our family through thick and thin.

C.B.M.

|vi|Preface

The concept of using time-out for child discipline has been a topic of attention for both researchers and the lay public for many decades. Sarah Vander Schaaff summarized the issues well in her 2019 Washington Post article about time-out researcher Dr. Arthur Staats entitled, “The Man Who Developed Timeouts for Kids Stands by His Now Hotly-Debated Idea” (Vander Schaaff, 2019). In the article, Vander Schaaf points out the controversies associated with this evidence-based approach for managing child disruptive behavior:

Today, the merits of timeout are hotly debated. Some argue it is harmful, provoking feelings of isolation, abandonment and anxiety while doing little to teach self-regulation. Others maintain the discipline is effective and not only helps a child acquire self-control but also gives parents the opportunity to cool off and reduces yelling or physical abuse. Staats, now 95 and with two adult children, five grandchildren and two great-grandchildren, stands by his work from the early 1960s. ‘TYM-OUT’ proclaims his license plate. (Vander Schaaff, 2019)

Dr. Cheryl McNeil, one of the authors of this text, added to this Washington Post article by stating,

When families and children are trained in the proper techniques for timeout – learning a system that involves creating a positive ‘time-in’ environment of parent–child interaction, explaining the rules of timeout in advance, using warning statements and consistent follow-through – children show great success… And it’s a big flop if it’s done without training and ineffectively. (Vander Schaaff, 2019)

In this book, we strive to flesh out the issues discussed in the Washington Post article, providing an overview of the research, as well as clinical details regarding time-out techniques. Our goal is to provide an even-handed description of the pros and the cons of time-out, with particular attention to empirical evidence and behavioral theory.

Contents

Acknowledgments

Preface

1  Description

1.1  History of Time-Out

1.2  Defining Time-Out: Extinction or Punishment?

2  Review of Time-Out Research

2.1  Children With Attention-Deficit/Hyperactivity Disorder (ADHD)

2.2  Children With Autism Spectrum Disorder (ASD)

2.3   Children With Intellectual Disability/Cognitive Delay

2.4  Children With Internalizing Disorders

2.5  Child Trauma

2.6  Changing Caregiver Behavior

2.7  Child Compliance Training

2.8  Long-Term Outcomes of Child Behavior Management

2.9  Summary

3  Using Time-Out: Developmental Age-Based Considerations

3.1  Children Younger Than 24 Months

3.1.1  Managing Problem Behavior

3.1.2  Training Emotion Regulation and Self-Control

3.1.3  Compliance Training

3.2  Children Ages 2–10 Years

3.2.1  Cognitive Factors

3.2.2  Physical Factors

3.2.3  Social Factors

3.3  Children Ages 8–10 Years and Older

3.3.1  Managing Time-Out Refusal and Escape

3.3.2  Increasing Buy-In

3.3.3  Alternative Forms of Time-Out

4  Diversity Issues

4.1  Ethnic, Racial, and National Considerations

4.1.1  Minority Groups in the United States

4.1.2  International Views

4.1.3  Summary

4.2  Time-Out in Relation to Other Socioeconomic Factors

5  Evidence-Based Programs Including Time-Out

5.1  The Defiant Children Program

5.2  Family Interaction Training Program (FIT)

5.3  The Helping the Noncompliant Child Program

5.4  The Incredible Years Program

5.5  Parent–Child Interaction Therapy (PCIT)

5.6  The Kazdin Method (Formerly Parent Management Training)

5.7  Triple P – Positive Parenting Program

5.8  Summer Treatment Program

5.9  Parent Management Training – Oregon/Generation PMT–O

5.10  Summary

6  Parameters of Time-Out

6.1  Verbalized Reason

6.2  Warning

6.3  Administration

6.4  Location/Type

6.4.1  Isolation Time-Outs

6.4.2  Exclusionary Time-Outs

6.4.3  Nonexclusionary Time-Outs

6.5  Duration

6.5.1  Brief Time-Outs

6.5.2  Longer Time-Outs

6.5.3  Contrast or Sequencing Effects

6.6  Schedule

6.7  Release From Time-Out

6.7.1  Time-Based Release

6.7.2  Behavior-Based Release

6.7.3  Time- and Behavior-Based Release

6.7.4  Comparing Release Contingencies

6.8  Escape

6.8.1  Escape From Time-Out

6.8.2  Escape Through Time-Out

7  Controversial Issues Related to Time-Out

7.1  Behavioral Parenting Approaches

7.2  Punishment

7.2.1  What Is Punishment?

7.2.2  Concerns With Punishment

7.3  Controversies Around Time-Out

7.3.1  Does Time-Out Cause Trauma and Physiological Harm?

7.3.2  Are There Other Negative Outcomes Associated With Time-Out?

7.3.3  Time-Out is Efficacious in Research, but Is It Effective in the “Real World”?

7.3.4  Does Time-Out Only Affect Immediate Behavior Problems?

7.3.5  Is Exclusively Positive Parenting Preferable to Time-Out?

7.3.6  Is Time-Out Widely Unacceptable?

7.4  Legal Issues

7.4.1  Modifications of Time-Out Procedures

7.4.2  Conclusion

7.5  Ethical Issues

7.6  Conclusion

8  Parent–Child Interaction Therapy (PCIT) Time-Out as an Exemplar

8.1  Introducing Time-Out

8.2  PDI Teach Session

8.2.1  Effective Commands

8.2.2  Effective Follow-Through

8.2.3  Return to Child-Directed Interaction

8.2.4  Planning for At-Home Practice

8.2.5  Planning for the First Discipline Coaching Session

8.3  First PDI Coaching Session

8.3.1  Preparing the Room

8.3.2  Preparing the Back-Up Space

8.3.3  Beginning the First Discipline Coaching Session

8.3.4  Teaching PDI to the Child

8.3.5  Coaching PDI

8.4  Gradual Roll-Out Approach

8.4.1  Time-Out for Other Behavior

8.5  Alternatives to Chairs, Back-Up Spaces, and Carrying Children

8.6  Conclusion

9  Case Vignette

9.1  Case Background

9.2  Treatment Plan and Goals

9.2.1  Treatment Session 1 (Relationship-Building Didactic & Coaching)

9.2.2  Treatment Session 2 (Relationship-Building Coaching & Differential Attention)

9.2.3  Treatment Session 3 (Relationship-Building Coaching & Discipline Didactic)

9.2.4  Treatment Session 4 (Compliance Training & Time-Out Coaching)

9.2.5  Treatment Session 5 (Compliance Training & Time-Out Coaching)

9.2.6  Treatment Session 6 (Compliance Coaching, House Rule, & Public Behavior Planning)

9.2.7  Treatment Session 7 (Follow-Up & Future Planning)

10  Further Reading

11  References

12  Appendix: Tools and Resources

|1|1Description

Time-out is short for time-out from positive reinforcement. In its most basic definition, time-out refers to “a period of time in a less reinforcing environment made contingent on a behavior” (Brantner & Doherty, 1983, p. 87). In other words, following a specific behavior, an individual is either moved to a less reinforcing environment or somehow limited in accessing reinforcement in the current environment. Time-out is typically used as a punishment procedure to discourage undesirable behavior. Although principles of time-out have been used in other arenas, for the purposes of this book we discuss time-out as it relates to child behavior management, predominantly in the United States.

1.1  History of Time-Out

Some of the earliest discussions of time-out in the literature appear in studies of animal behavior from the 1950s (Ferster, 1958; Ferster & Skinner, 1957; Skinner, 1950). This research centered on training animals, such as pigeons and chimpanzees, to peck keys or press switches in order to access reinforcement in the form of food. When time-out from reinforcement was employed – animals no longer received food for responding (e.g., pressing keys or switches) – behavioral researchers discovered that rates of responding were impacted. This literature began to establish the study of time-out as a procedure in which animals’ behavior mirrored behavior under conditions of other known forms of punishment. Most fundamentally, animals’ responding for food decreased during periods of time-out. Relatedly, animals either responded more or less frequently before and after periods of time-out depending on how the experimenters arranged the contingencies (Ferster & Skinner, 1957).

Later, in the 1960s and 1970s, researchers began to generalize time-out procedures to applied settings. Children with disabilities demonstrating dangerous or destructive behavior were some of the first subjects to appear in the time-out literature. For example, Risley (1968) attempted to use time-out from social attention to decrease dangerous behavior (e.g., climbing bookshelves, hitting others) in a child diagnosed with autism. Similar time-out studies targeted self-injurious behavior, aggression, tantrums, elopement, and problems related to eating, sleeping, and toileting (Harris & Ersner-Hershfield, 1978). Subjects were often individuals with cognitive deficits, neurodevelopmental disabilities, or serious mental health diagnoses, especially those who were institutionalized. Time-out was employed as a less aversive alternative to |2|popular methods of severe behavior management of the day, including corporal punishment, pharmacotherapy, and electric shock.

During this same period, time-out became broadly appealing as a practice for typically developing children. Behavioral learning theorists such as Gerald Patterson and Arthur Staats have been credited with introducing the concept of time-out as a component of childrearing (Patterson & White, 1969; Staats, 1971). However, the practice may have predated formal naming and study. Constance Hanf was another influential figure in the popularization of time-out as a parenting technique. Hanf developed a treatment program for improving parent–child interactions, which included time-out as a component of discipline (Hanf, 1969). Hanf’s two-stage model went on to serve as a blueprint for many of the most evidence-based behavioral parent training programs in use today, including parent–child interaction therapy (PCIT; McNeil & Hembree-Kigin, 2010), Helping the Noncompliant Child (McMahon & Forehand, 2003), The Incredible Years (Webster-Stratton & Reid, 2017), Parent Management Training – Oregon (Dishion et al., 2016), and Triple P – Positive Parenting Program (Reitman & McMahon, 2013; Sanders, 1999). These programs, discussed further in Chapter 5, continue to support the effectiveness of time-out as a disciplinary strategy for children with disruptive behavior problems.

Along the same vein, various forms of time-out for child behavior management found their way into classroom settings in the 1970s. It was around this time that individual states began banning corporal punishment in schools (Forehand & McKinney, 1993). Student behavior such as tantrums, physical aggression, out-of-seat behavior, and general disruptiveness served as the first targets of classroom time-outs in the literature (Foxx & Shapiro, 1978; Porterfield et al., 1976). Researchers pioneered creative variants of time-out principles in public schools, daycare centers, camps, and special education settings for children aged 1–18 years.

Before the advent of time-out as a common disciplinary measure for children, other disciplinary methods like corporal punishment, defined as the intentional infliction of physical pain contingent upon target behavior, were more popular than they are today. Arthur Staats cited concerns with damaging the parent–child relationship through spanking as his motivation for creating time-out, a new technique he used with his own children in the 1960s (Vander Schaaff, 2019). In addition, the popularization of time-out was overlaid on historical changes in mainstream American parenting as outlined by Forehand and McKinney (1993): (1) Disciplinary standards became less strict and punishments less severe; (2) Parents shifted away from reliance on religious guidance and toward guidance from professionals (e.g., psychologists); (3) Focus on ethical and legal standards aimed at improving children’s rights increased; and (4) Fathers became more involved in the social development of children.

Changes in discipline practices have occurred worldwide as well. Corporal punishment of children is currently unlawful in more than 75 countries around the world, areas encompassing 77% of the world’s child population (Global Initiative to End All Corporal Punishment of Children, 2020a). In contrast, corporal punishment by parents remains legal in the United States with at least 15 states still also allowing corporal punishment in public schools (|3|Global Initiative to End All Corporal Punishment of Children, 2020b). Still, the popularity and use of corporal punishment across demographics is declining. In one large longitudinal study, researchers found that American mothers across socioeconomic groups reported significant decreases in their use of spanking and significant increases in their use of time-out as disciplinary strategies from 1988 to 2011 (Ryan et al., 2016).

A key development during this time period was a policy statement from the American Academy of Pediatrics (AAP, 1998). Physical discipline has been associated with many negative outcomes such as poorer caregiver–child relationships, mental health problems, antisocial behavior, future abuse perpetration and victimization (Kazdin & Benjet, 2003). In turn, time-out has received strong empirical support (Kaminski et al., 2008). Based on this growing body of research, the AAP released their official position as discouraging corporal punishment and recommending nonphysical discipline, specifically naming time-out. More evidence behind the efficacy of time-out in comparison to other forms of discipline can be found in Chapter 2.

From its origins in animal research 70 years ago, to its place as one of the most popular parenting strategies in use today, time-out has come a long way. As it originates from the field of behavior analysis, most time-out research and implementation has been conducted by behavior analysts or behavioral psychologists. As such, in the next section, we briefly define the behavioral underpinnings of time-out.

1.2  Defining Time-Out: Extinction or Punishment?

Researchers and behavioral learning theorists have disagreed as to whether time-out from positive reinforcement constitutes extinction, punishment, or both (Brantner & Doherty, 1983). Extinction, defined as the removal of a specific behavior’s reinforcer, results in the decrease of a target behavior (Skinner, 1953). For instance, imagine a scenario in which a child’s hitting behavior is maintained by escape. Each time a teacher assigns academic work, a student hits her and is sent to the principal’s office, escaping the task. To implement extinction, the teacher would discontinue sending the child to the office (the reinforcer) immediately following the hitting behavior, insisting that the child complete the academic task. Hitting, in this scenario, should decrease because it is no longer being reinforced by escape.

In addition to extinction, punishment is also a relevant concept. In behavioral terms, punishment is defined as a procedure in which some positive reinforcement is removed or an aversive stimulus is introduced following a target behavior; this procedure results in a reduction of a given behavior (Skinner, 1953). For example, caregivers may wish to reduce their children’s hitting behavior toward siblings at home. A parent could remove access to a positive reinforcer (e.g., a favorite toy) or introduce an aversive stimulus (e.g., criticism) after the child hits to reduce the hitting behavior. The punishment procedure works because hitting is followed by the loss of reinforcement or exposure to an aversive stimulus. Given these definitions, the following arguments related to time-out can be posed.

|4|Time-out is an extinction procedure. Let’s say that a caregiver identifies the function of a child’s screaming in the following scenario: A parent is busy working on the computer. Each time her child screams, the parent stops working, comes close to the child, and talks to them about the behavior. In this case, the screaming is reinforced or maintained by parental attention. After identifying this connection, the parent decides to extinguish the child’s screaming by using time-out instead. With minimal attention from the mother, the child is sent to their room for 5 minutes each time they scream. If the screaming decreases because screaming is no longer being reinforced by parental attention, time-out can be considered an extinction procedure.

Applied or at least analyzed in a different way, time-out can be conceptualized as punishment. Using the same example, one could argue that the act of sending a child to their room is aversive. Similarly, being sent to one’s room effectively removes the positive reinforcement of the original environment from the child. For example, in addition to social attention, the child may not be able to access food, television, or toys during the 5 minutes in their room alone. This removal of positive reinforcement is also considered punishment if it is followed by less screaming.

Taken together, it might be argued that time-out can be both punishment and extinction, depending somewhat on circumstances. In our example, time-out functions as both. While it is possible to carry out a time-out procedure that can be considered purely punishment and not extinction or purely extinction and not punishment, the two are not typically mutually exclusive. Using the example of the child screaming to access parental attention, the mother may use time-out from her attention alone as a pure extinction procedure (and not punishment). In this scenario, she would continue to work on her computer, ignoring the screaming. The child would not be sent to their room, and therefore would not experience punishment through the imposition of a nonpreferred activity or removal of access to other privileges. This procedure is often referred to as planned ignoring or time-out from caregiver attention. Planned ignoring is effective at extinguishing problem behavior as long as the target behavior is not maintained by other factors. If, however, the child’s screaming was simultaneously being reinforced by the mother’s and sibling’s attention, for example, then attempting to extinguish the behavior through a time-out from the mother’s contingent attention alone would be less effective.

The same issues may apply to time-out procedures which employ only principles of punishment and not extinction. In our example, given the goal of decreasing screaming, the mother might carry the child to a time-out chair each time he screams. If the child gets up from the chair, she may scold him and carry him back to the chair repeatedly. In this case, the child is experiencing an aversive stimulus (e.g., criticism) and has been removed from other reinforcement (e.g., access to preferred activities, social attention from other family members). However, this time-out is not considered an extinction procedure because the stimulus reinforcing the screaming behavior, maternal attention, is not being removed.

Why does it matter if time-out works by punishment, extinction, or both? In short, understanding the behavioral underpinnings of time-out can help professionals and caregivers better harness the power of time-out under different circumstances. For instance, time-outs operating at least in part as punishment |5|may be more effective in situations where the function of the behavior is unknown. Removing several sources of reinforcement (e.g., access to television and peer attention) by having a child leave the room, may decrease the problem behavior whether or not its function is related to TV or attention. This is particularly relevant when working with children for whom the reinforcing value of social attention may be decreased or unknown, for example children with autism spectrum disorder. In addition to social attention, sitting in a time-out chair for a few minutes effectively removes tangible reinforcement, increasing effectiveness of the procedure. On the contrary, when the function of problem behavior is known, time-outs operating purely through extinction may be less restrictive but still effective. For example, a child whose swearing is maintained by social attention alone can be allowed to remain in the original environment with access to other reinforcers as long as the swearing behavior itself is put on extinction (i.e., ignored) by surrounding peers and adults. The level of restriction used also has ethical implications, discussed further in Chapter 7.

Because components of extinction and punishment so often overlap, and both have utility in decreasing different cases of problem behavior, many time-out procedures employ both. Later in this book, we discuss specific parameters of time-out in general (Chapter 6), as well as unique formulations of time-out procedures within evidence-based treatment programs (Chapter 5 and Chapter 8). Time-out has been the topic of much research and debate over the past 70 years. Next, we provide a broad overview of the resulting literature.

|6|2Review of Time-Out Research

Time-out is considered a highly effective, evidence-based practice for child behavior management across the fields of child psychology and pediatrics. The American Academy of Pediatrics began recommending time-out as an effective disciplinary strategy in 1998 and continues to do so (AAP, 1998, 2018). The use of time-out for child behavior management has also been recognized by the American Psychological Association (APA; Novotney, 2012; Society of Clinical Child and Adolescent Psychology [SCCAP], 2017). These recommendations are built on scientific evidence. The time-out literature can be organized into two categories: (1) studies investigating the efficacy or effectiveness of time-out itself and (2) investigations of time-out as part of larger treatment packages. Although not an exhaustive review, this chapter describes much of the evidence around time-out in these two areas.

How has time-out been studied? The foundation of research investigating the efficacy and effectiveness of time-out as a tool for improving human behavior is made up of single-subject designs in applied behavioral research. In the 1960s, researchers found time-out to be useful in reducing a variety of child behavior problems (e.g., temper tantrums, thumb sucking, self-harm, undesirable mealtime behavior, disruptive classroom behavior, aggression, and even problematic consumption of alcohol; see Brantner & Doherty, 1983, for a review). More recently, researchers have continued to study the effects of time-out in both single-subject and group designs. The majority of the evidence clusters around the use of time-out to treat externalizing child behavior problems, most frequently aggression and noncompliance. Studies specifically investigating the effects of time-out often target populations of children at risk for or diagnosed with disruptive behavior disorders, conduct problems, attention-deficit/hyperactivity disorder (ADHD), and/or other disabilities. Regarding setting, time-out has demonstrated effectiveness in correctional programs, psychiatric treatment facilities, day-treatment programs, preschool and elementary school classrooms, summer camps, and the family home (Morawska & Sanders, 2011).

The largest arena for studying time-out has been within behavioral parent training (BPT) research. Fittingly, the most effective, well-studied BPT programs all prescribe time-out. Of these, parent–child interaction therapy (PCIT; McNeil & Hembree-Kigin, 2010), Helping the Noncompliant Child (McMahon & Forehand, 2003), The Incredible Years (Webster-Stratton & Reid, 2017), Parent Management Training–Oregon (Dishion et al., 2016), and Triple P – Positive Parenting Program (Sanders, 1999) are some of the best supported. These treatments, and therefore time-out, are recognized as first-line treatments for disruptive behavior problems by a number of the most trusted |7|leaders in mental health: the Substance Abuse and Mental Health Services Administration (SAMHSA, 2011), the American Psychological Association’s Division 53: Society of Clinical Child and Adolescent Psychology (SCCAP, 2017), in the book Evidence-Based Psychotherapies for Children and Adolescents (considered to be the premier book on the topic; Kazdin, 2017), and in several large scale literature reviews of evidence-based psychosocial treatments for child and adolescent behavior problems (e.g., Kaminski & Claussen, 2017). The Centers for Disease Control and Prevention (CDC) also included time-out in their nationally disseminated program, Essentials for Parenting Toddlers and Preschoolers (CDC, 2019).

BPT programs use time-out in combination with other positive parenting strategies. Conceptually and empirically, time-out, without a contrast between conditions in and out of time-out, is less effective (e.g., Willoughby, 1970). Therefore, the treatment programs listed, and many others, incorporate components aimed at increasing positive caregiver–child interactions and desirable child behavior in addition to components aimed at decreasing undesirable child behavior, like time-out.

In what ways do time-out and treatments that include it help children and families? Research supporting time-out has focused on several specific clinical topics. Most commonly, time-out independent of BPT has demonstrated effectiveness at reducing externalizing behavior problems (Kaminski et al., 2008). These problems can include physical aggression (e.g., hitting, biting, throwing objects), verbal aggression (e.g., yelling, name-calling), noncompliance (e.g., arguing, refusing to follow directions), and generally disruptive behavior (e.g., tantrums, interrupting). For example, Adams and Kelley (1992) found that time-out was effective at reducing sibling aggression. Donaldson and Vollmer (2011) demonstrated that time-out reduced screaming, persisting at a task when told to stop, and disrupting classroom activities in young children.

Similarly, BPT programs which include the use of time-out as a discipline strategy have also demonstrated effectiveness at reducing a variety of externalizing behavior problems, for instance, hyperactivity, aggression, and noncompliance (Comer et al., 2013; Eyberg et al., 2008). While BPT programs as a whole are important, time-out is a vital component. As an example, a study of the relative effectiveness of the two phases of PCIT (child-directed interaction and parent-directed interaction) demonstrated that the time-out component resulted in improvements in behavior problems from outside of normal limits to within normal limits (Eisenstadt et al., 1993). A meta-analysis of 77 parent training studies found that those treatments which included time-out were significantly more effective at reducing externalizing behavior problems than those programs that did not teach time-out (standardized mean difference effect sizes of 0.52 and 0.36, respectively; Kaminski et al., 2008).

If left untreated, children’s externalizing behavior problems are likely to maintain or escalate over time (Broidy et al., 2003). For this reason, several treatment packages relying on time-out for discipline have been studied as prevention programs for future behavior problems. An adaptation of the Incredible Years program was found to be effective in preventing future conduct problems in Head Start students (Webster-Stratton, 2001). A Triple P prevention program administered through 12 television episodes, which advocated for the |8|use of time-out, also demonstrated efficacy in preventing and decreasing child disruptive behavior (Sanders et al., 2000).