Is time-out appropriate and effective for children with trauma histories?

Is time-out appropriate and effective for children with trauma histories?

26 November 2019
Back view of dad sit on couch with son talking sharing thoughts or problems,  support him showing care and understanding

This short article reviews research on whether time-out is an appropriate and effective discipline strategy for children with trauma histories.

Time-out from positive reinforcement (‘time-out’) is a widely used parental discipline strategy for children aged 2–8 years old. However, there is sometimes confusion about what it is and how it should be applied, particularly whether it should be used for children with trauma histories.

As we discuss in this article, time-out is used within a number of evidence-based interventions for children with behavioural problems. Evidence-based parenting programs that include time-out have also been found to be effective for children with histories of trauma.1 But we are also aware that some caregivers and practitioners have concerns about whether time-out is appropriate and effective for children with trauma histories.

In this short article, we describe what time-out is and draw from our recent review article to briefly summarise evidence for its effectiveness and discuss whether it is appropriate for children with trauma histories.

What is time-out?

Time-out is an abbreviation of ‘time-out from positive reinforcement’.

It has two aspects:

  1. a positive reinforcing environment (i.e. high rates of caregiver attention, praise and affection – also known as ‘time-in’)
    and
  2. the removal of positive reinforcement for a brief period of time for misbehaviour (e.g. placing a child who has misbehaved in a boring/neutral space and requiring them to be calm and quiet for a set period of time, before returning to ‘time-in’).

Time-out is one part of a set of practices of which increasing warm, positive and responsive parenting is the critical first step.2 The strategy is most commonly used for misbehaviours, such as noncompliance, tantrums and aggression. To apply the strategy effectively, caregivers should follow a number of evidence-based practices.23

Is time-out an effective parenting strategy?

There is a large body of research demonstrating the effectiveness of time-out.2 Time-out is a component of several evidence-based parenting programs, with substantial research showing improvements in behavioural adjustment in children.4 Time-out is also associated with larger program effects in improving child adjustment.5 Importantly, we are not aware of any scientific evidence to show that time-out is associated with harmful effects on children’s well-being.26

Is it appropriate and effective for children with trauma histories?

Exposure to traumatic events is common in childhood and is associated with the onset of a broad range of mental health difficulties,7 as well as behavioural symptoms of trauma.

Anecdotally, we are aware that some practitioners may have concerns about whether time-out could serve as a reminder of a previous traumatic event and, in turn, cause children to feel fear or distress, leading to re-traumatisation.

While these are understandable concerns, we would highlight that not only are children's behaviours improved in parenting programs that include time-out strategies, but there is currently no scientific evidence of its harmful effects. Moreover, we would suggest – as others have also argued – that gradual exposure to time-out may serve to reduce distress and fear when used as part of a calm, predictable approach to discipline that maintains secure attachment.89

We also note that time-out is a component in parenting programs found to be effective for improving behaviour adjustment in children who have experienced abuse and neglect1 and for children in out-of-home care.1011 For example, one study on Parent Child Interaction Therapy that included time-out found significant reductions in child trauma symptoms, as well as behavioural problems.12 These findings suggest that parenting programs involving time-out may reduce behavioural problems and even trauma symptoms. However, since this has been the only study conducted on trauma symptoms to date, further research on trauma symptoms is needed.

Along with other parenting strategies, time-out is also a component of evidence-based interventions specifically for child trauma symptoms, such as Trauma Focussed Cognitive Behaviour Therapy (TF-CBT).13 However, as we discuss below, it is important to caution that time-out should not be used as a discipline strategy for trauma symptoms themselves. Instead, where trauma symptoms are present, time-out should only be used as part of a parenting program focused on child misbehaviour.13

What should be considered if using time-out for children with trauma histories?

Use of time-out should be carefully considered by practitioners (e.g. psychologists, social workers) and caregivers with each child’s trauma history in mind.6 A thorough child and family assessment by practitioners is critical to determine what child behaviours and parenting strategies should be focused on during treatment.1314

When working with children who have trauma histories, some parenting strategies may need to be modified or given an increased emphasis, such as a more intense focus on strengthening the caregiver–child relationship prior to introducing time-out.2 Practitioners should closely monitor how time-out is being implemented to ensure caregivers adhere to evidence-based practices,3 and to assess changes in child behaviour.2 Effective use of time-out should result in a decrease in child behaviour problems over time and, as a result, a decrease in how often caregivers use it.

Conclusion

There is a large body of research to support the effectiveness of time-out from positive reinforcement in improving children’s behavioural adjustment. When implemented as part of a broad parenting intervention, current evidence suggests it is effective and appropriate for improving child outcomes.

Based on our review, we found no evidence of harmful effects for children, including children with trauma histories – though, more research is needed to confirm its effectiveness. We would emphasise it is key that time-out from positive reinforcement is implemented appropriately. We would also stress that time-out procedures may need to be modified for children with trauma histories, and practitioners must closely monitor implementation to ensure that it is effective and appropriate.

Related resources

Developmental differences in children who have experienced adversity
This series of CFCA practice guides and accompanying webinar are intended for professionals (psychologists, mental-health social workers, therapeutic specialists) supporting vulnerable children and families who may have developmental differences.

The effect of trauma on the brain development of children: Evidence-based principles for supporting the recovery of children in care
This CFCA practitioner resource provides an overview of what we know from research about cognitive development in children who have experienced trauma, and provides principles to support effective practice responses to those children's trauma.

Children’s attachment needs in the context of out-of-home care
This CFCA resource sheet is intended to provide an overview of what we know, and what needs to be better understood, about children’s attachment needs in the context of out-of-home care.

References

1. Batzer, S., Berg, T., Godinet, M. T., & Stotzer, R. L. (2018). Efficacy or chaos? Parent-child interaction therapy in maltreating populations: A review of research. Trauma, Violence, & Abuse, 19, 3–19. Retrieved from http://dx.doi.org/10.1177/1524838015620819

2. Dadds, M. R., & Tully, L. A. (2019). What is it to discipline a child: What should it be? A reanalysis of time-out from the perspective of child mental health, attachment, and trauma. American Psychologist. Advance online publication. Retrieved from http://dx.doi.org/10.1037/amp0000449

3. Corralejo, S. M., Jensen, S. A., Greathouse, A. D., & Ward, L. E. (2018). Parameters of time-out: Research update and comparison to parenting programs, books, and online recommendations. Behavior Therapy, 49, 99–112. Retrieved from http://dx.doi.org/10.1016/j.beth.2017.09.005

4. Kaminski, J. W., & Claussen, A. H. (2017). Evidence base update for psychosocial treatments for disruptive behaviors in children. Journal of Clinical Child and Adolescent Psychology, 46, 477–499. Retrieved from http://dx.doi.org/10.1080/15374416.2017.1310044

5. Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36, 567–589. Retrieved from http://dx.doi.org/10.1007/s10802-007-9201-9

6. Quetsch, L., Wallace, N., Herschell, A., & McNeil, C. (2015). Weighing in on the time-out controversy: An empirical perspective. Clinical Psychologist, 68, 4–19.

7. McLaughlin, K. A., Greif Green, J., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2012). Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. JAMA Psychiatry, 69, 1151–1160. Retrieved from http://dx.doi.org/10.1001/archgenpsychiatry.2011.2277

8. McNeil, C. B., Costello, A., Travers, R., & Norman, M. (2013). Parent child interaction therapy for children traumatized by physical abuse and neglect. In S. Kimura & A. Miyazaki (Eds.), Physical and emotional abuse: Triggers, short and long-term, consequences and prevention methods (pp. 53–86). Hauppage, NY: Nova.

9. Quetsch, L., Lieneman, C., & McNeil, C. (2017). The role of time-out in trauma-informed treatment for young children. Society for the Advancement of Psychotherapy. Retrieved from http://societyforpsychotherapy.org/role-time-trauma-informed-treatment-young-children/

10. Mersky, J. P., Topitzes, J., Grant-Savela, S. D., Brondino, M. J., & McNeil, C. B. (2016). Adapting parent–child interaction therapy to foster care: Outcomes from a randomized trial. Research on Social Work Practice, 26, 157–167. Retrieved from http://dx.doi.org/10.1177/1049731514543023

11. Price, J. M., Roesch, S., Walsh, N. E., & Landsverk, J. (2015). Effects of the KEEP Foster Parent Intervention on child and sibling behavior problems and parental stress during a randomized implementation trial. Prevention Science, 16, 685–695. Retrieved from http://dx.doi.org/10.1007/s11121-014-0532-9

12. Pearl, E., Thieken, L., Olafson, E., Boat, B., Connelly, L., Barnes, J., & Putnam, F. (2012). Effectiveness of community dissemination of parent–child interaction therapy. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 204–213. Retrieved from http://dx.doi.org/10.1037/a0022948

13. Cohen, J. A., Berliner, L., & Mannarino, A. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems. Child Abuse & Neglect, 34, 215–224. Retrieved from http://dx.doi.org/10.1016/j.chiabu.2009.12.003

14. Cohen, J. A., Bukstein, O., Walter, H., Benson, S. R., Chrisman, A., & Farchione, T. R. (2010). Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 414–430.


Featured image: © GettyImages/fizkes

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Authors

Lucy Tully

Dr Lucy Tully is Project Manager and Senior Supervising Psychologist at the Child Behaviour Research Clinic at the University of Sydney.

Mark Dadds

Prof. Mark Dadds is Professor of Psychology in the School of Psychology at the University of Sydney and Co-director of the Child Behaviour Research Clinic.

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