Dr Lucy Tully is Project Manager and Senior Supervising Psychologist at the Child Behaviour Research Clinic at the University of Sydney.
Is time-out appropriate and effective for children with trauma histories?
Is time-out appropriate and effective for children with trauma histories?
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.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:
- a positive reinforcing environment (i.e. high rates of caregiver attention, praise and affection – also known as ‘time-in’)
- 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.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.
Is time-out an effective parenting strategy?
There is a large body of research demonstrating the effectiveness of time-out.Time-out is a component of several evidence-based parenting programs, with substantial research showing improvements in behavioural adjustment in children. Time-out is also associated with larger program effects in improving child adjustment. Importantly, we are not aware of any scientific evidence to show that time-out is associated with harmful effects on children’s well-being. ,
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,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.,
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 neglectand for children in out-of-home care. , 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. 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).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.
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.A thorough child and family assessment by practitioners is critical to determine what child behaviours and parenting strategies should be focused on during treatment. ,
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.Practitioners should closely monitor how time-out is being implemented to ensure caregivers adhere to evidence-based practices, and to assess changes in child behaviour. 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.
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.
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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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