Parental Use of Time Out Revisited: A Useful or Harmful Parenting Strategy?
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- Morawska, A. & Sanders, M. J Child Fam Stud (2011) 20: 1. doi:10.1007/s10826-010-9371-x
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Time out has been widely advocated as an effective parental discipline practice to reduce disruptive and oppositional child behaviour in young children. Despite evidence showing that the procedure is effective when used as part of a comprehensive positive parenting strategy it has not been uniformly accepted and critics have questioned its effectiveness and potentially adverse effects on the parent–child relationship. This paper examines the controversy surrounding the use of time out, discusses the criticisms levelled against it, and concludes that its judicious use in parent training programs is justified and is of benefit to many children with conduct problems. Factors that influence the effectiveness of time out and some contraindications are also discussed.
KeywordsTime outParentingChild behaviourDisciplineParenting strategies
Continuing concern about the prevalence of child abuse and neglect and the long term adverse consequences of inadequate parenting has renewed the focus on the role of parenting in the prevention of mental health problems in children and the promotion of children’s well being. Time out has been used in behavioural programs since the 1960s and its judicious use is recommended in most evidence- based programs targeting parents of children with conduct problems including the Triple P-Positive Parenting Program (Sanders 1999; Sanders 2008), the Incredible Years Program (Webster-Stratton 1998), Parent–Child Interaction Therapy (Eyberg 1988) and, Parent-Management Training Oregon (Patterson 2005). Despite strong evidence and the support of various professional societies such as the American Academy of Pediatrics (1998, 2004), and best practice guides for the management of conduct problems (Grant and Evans 1994; Kazdin and Rotella 2008; Martin and Pear 2007; Sarafino 1996) criticism of the procedure continues and some practitioners and program developers condemn the use of time out as a harmful strategy (e.g., Clewett 1988; Gartrell 2001, 2002; Schreiber 1999). Wells (1997) argues that “there is a current trend against the use of confrontive discipline (i.e., punishment), including time-out, with children” (p. 340). Critics of time out have argued that the United Nations Convention on the Rights of the Child prohibits the use of the strategy by parents, however, this is not the case, and in fact numerous international organisations specifically recommend the implementation of parenting programs which include time out in the set of strategies taught to parents (O’Connell et al. 2009; UNDOC 2009).
We argue that this criticism is largely misplaced or at least exaggerated and that a balanced appraisal of the evidence and currently recommended use of the procedure shows that it can be safely and effectively used by parents to reduce problem behaviour. We begin by providing a description of the time out routine and principles of effective usage. We then review the existing evidence concerning its efficacy and acceptability. Finally, we review the specific criticisms that have been put forward and discuss evidence either supporting or refuting the criticism.
Definition and Description of Time Out
Time out is the contingent withholding of the opportunity to earn reinforcement (MacDonough and Forehand 1973). It is defined as time away, usually for 1-5 min, from rewarding stimuli including attention from the parent, as a consequence of some form of misbehaviour (Brantner and Doherty 1983; Jones and Downing 1991). It is not defined by sending children to a specific place (e.g., chair, another room) although it may involve both or neither. It is defined by the contrast between what is referred to as “time in” and time out environments (Everett et al. 2007). When used properly its use is self limiting, which means that children’s behaviour changes in response to time out, and hence the strategy needs to be in place for only short periods of time (Eyberg 1988; Sanders et al. 2001; Webster-Stratton 1981).
Time out is used as one of a suite of strategies in many well established and internationally recognised parenting programs for parents of young children (e.g., Triple P, Incredible Years, Parent–Child Interactional Therapy; Eyberg 1988; Sanders et al. 2001; Webster-Stratton 1981). A distinction is usefully drawn between non exclusionary time out or quiet time where the child remains in the same environment when the problem occurs and exclusionary time out where the child is removed to another place or area for more serious or continuing misbehaviour (Harris 1985; Scarboro and Forehand 1975). Both procedures require the parent to remain calm; not to raise their voice, escalate their emotion, or use any other behaviour that humiliates, embarrasses, threatens the child, or rewards misbehaviour. Parents learn a simple routine that requires the child to have calmed or settled before being allowed to rejoin the rewarding activity that they have been removed from. There are numerous variations on the use of time out in various settings, but the fundamental principles remain the same (Turner and Watson 1999).
It is important to differentiate discipline situations, from those which are either emotionally upsetting for the child or ones that activate the attachment system. Attachment has been conceptualised in terms of self-regulation (Cummings and Davies 1996) where attachment behaviours represent strategies for maximising proximity to the caregiver, for facilitating comforting, and as a way to regulate distress (Vallance 2004). Attachment behaviours are not the same as misbehaviour, and the parent needs to respond differently to these. Time out is used for child behaviours which are inappropriate, and when the child has not complied with a parental instruction. For example, if the child is throwing objects around in a manner judged to be unsafe and refuses to stop when instructed by the parent, time out could be initiated. Similarly, if the child is aggressive towards others, and does not stop when instructed by the parent time out may be used. It is not used for situations when the child is feeling scared, frightened, or distressed due to an accident. Anderson and King (1974) characterises three situations in which the use of time out is appropriate: (1) high rate inappropriate behaviour e.g., physical aggression; (2) safety e.g., child persistently running out onto street, and; (3) when the use of parental reinforcers is ineffective, such as when the child’s behaviour is reinforced by a sibling or another adult.
Another potential advantage of time out is that it provides an upset or angry child with an opportunity to calm themselves down with minimal parental assistance or involvement. However, to provide the child with a practice opportunity to self calm requires that the parent avoids providing additional attention or prompts to calm (either verbal or physical) while the child is in time out. If children learn to calm by relying on parental help they may become dependent or overly reliant on such assistance.
How is Time Out Used Effectively?
Effective use of time out involves a number of steps. Time out is always used in combination with other strategies, in the context of a positive parent–child relationship. It is not recommended to use time out in isolation, as a stand alone strategy (Anderson and King 1974), with evidence suggesting that it is less effective alone than when used in combination (Everett et al. 2007; Ford et al. 2001; Lucas 2000; Olmi et al. 1997; Willoughby 1969, 1970). The more positive the “time in” environment, the less uninteresting the time out environment has to be to for time out to be effective (Hobbs and Forehand 1977; Solnick et al. 1977). Parents need to use a range of strategies to promote children’s development, teach new skills, encourage appropriate behaviour, prevent problems and manage any difficulties (Sanders 1999). This means that the more effort the parent devotes to creating an interesting, loving time in environment, the less need there will be for the use of time out. Equally, the parent can use other appropriate consequences or use non exclusionary time out (Scarboro and Forehand 1975). Most importantly the parent needs to monitor the child in time out (Anderson and King 1974).
MacDonough and Forehand (1973) characterised eight parameters which need to be considered when implementing time out: verbalised reason, warning, administration, location, duration, time out stimulus, schedule, and release. A verbalised reason involves providing an explanation to the child as to why they are going to time out (e.g., “you haven’t done as I asked so now you are going to time out”). The evidence suggests that the addition of this reason does not add to the effectiveness of time out (Gardener et al. 1976; MacDonough and Forehand 1973), although it is commonly included in time out routines. The use of warnings or threats (e.g., “if you don’t stop hitting your brother you will go to time out”) also generally does not add to the effectiveness of time out (Jones et al. 1992; Roberts 1982, 1984). There is no evidence as to the administration procedure i.e. physical versus instructional, however, in general the least restrictive method of getting the child to time out is recommended. In terms of location, comparisons have been made between exclusionary versus non-exclusionary time out, and the evidence suggests that while both are equally effective, non-exclusionary time out requires more trials for the child to learn appropriate behaviour (Scarboro and Forehand 1975).
There is no evidence that longer periods of time out are any more effective than shorter periods (Benjamin et al. 1983; Freeman et al. 1976; Hobbs et al. 1978; McGuffin 1991; Pendergrass 1971), and short periods of time out are generally recommended. There is no specific research providing recommendations relation to the time out stimulus or the schedule. In terms of release from time out, contingent release (i.e., child needs to be quiet for specified time) leads to better outcomes (Erford 1999; Hobbs and Forehand 1975). In particular, release from time out that’s initiated by the child (Bean and Roberts 1981), or situations where a parent holds the child in time out (Roberts and Powers 1990) are less effective.
What is the Evidence for the Use of Time Out?
Many studies have shown time out, when used in combination with other positive parenting methods can be an effective strategy for reducing child uncooperative and aggressive behaviour. There is evidence that the addition of time out, in the context of a comprehensive behaviour management plan, adds to reductions in aggression, destructive behaviour and non-compliance, over and above components such as rewards, praise, social reinforcement, use of effective instructions, response cost and social skills training (Fabiano et al. 2004; Ford et al. 2001; Hobbs et al. 1984; Kaminski et al. 2008; Roberts et al. 1981). It has been used successfully with 1-year old infants to reduce the occurrence of dangerous behaviour (Mathews et al. 1987), with preschoolers to reduce aggression (Firestone 1976), and to reduce sibling aggression (Olson and Roberts 1987), for children and youth in psychiatric settings (Crespi 1988; Joshi et al. 1988), and for children diagnosed with ADHD participating in a summer camp (Fabiano et al. 2004). Research has shown that time out in combination with other strategies is effective for parents of toddlers (Larzelere et al. 1996; Morawska and Sanders 2006), preschoolers (Sanders et al. 2000; Webster-Stratton 1990), and primary schoolers (Webster-Stratton 1993).
Acceptability of Time Out to Parents
Time out is widely used by parents, and over 80% of parents report using time out to deal with misbehaviour (Sanders et al. 1999). Consumer research shows that parents report it to be acceptable and effective (Calvert and McMahon 1987). Studies of community samples indicate that time out is seen as an acceptable behaviour management technique (Blampied and Kahan 1992), as do studies of university students (Kazdin 1980; Rodgers 1992), and paediatricians (Arndorfer et al. 1999). Parents who have been trained in the use of time-out rate it as an acceptable strategy, comparative to social reinforcement (Hobbs et al. 1984; Matsumoto et al. 2007), and more acceptable than humanistic parenting, which involved spending more time following misbehaviour and reassurance of love (Singh and Katz 1985). Children also rate time out as an appropriate strategy for parents to use (Dadds et al. 1987).
What are the Concerns About the Use of Time Out?
Some practitioners and organisations have expressed concerns about the use of time out, and the negative effects time out may have on children and families (e.g., Clewett 1988; Gartrell 2001, 2002; Schreiber 1999). Currently, there is to the authors’ knowledge, no evidence to suggest that the use of time out, as described here, impacts negatively on children. The authors have carried out a review of the evidence in relation to the various concerns, which have been raised by those troubled about the use of time out, and these are discussed below.
Some of the concerns raised about the use of time out include that it does not work for some children, that children simply become more defiant after use of time out, and that there may be negative side effects to the use of time out for the child. There is considerable evidence that time out is effective as a strategy for the vast majority of children, over and above the effects of social rewards and other behaviour management strategies (Fabiano et al. 2004; Ford et al. 2001; Hobbs et al. 1984). Time out has been applied effectively to children across age groups, including in adolescence (Crespi 1988; Jones and Downing 1991), however, strategies do need to be tailored to the age and developmental stage of the child. In relation to misbehaviour following time out, the literature suggests that if children are let out of time out before they have calmed down, then they are likely to become disruptive following time out. If their exit out of time out is contingent on them being calm for a set time, there is no evidence of additional disruptive behaviour (Hobbs and Forehand 1975). Furthermore, a practice of the time out strategy with the child when there are no behaviour problems to clarify what is expected and how the strategy works can also facilitate the use of time out. A positive side effect of the use of time out is reduction in not only the target behaviour (e.g., physical aggression), but also other negative behaviours (e.g., verbal aggression) (Firestone 1976). Furthermore, time out also has the additional benefit of assisting children to regulate their emotions, by providing an opportunity for the child to calm down, and to learn to manage difficult and frustrating situations. In addition, as a side effect of improved child behaviour, the parent–child relationship often improves (Kazdin 2005). Time out has been used in combination with other strategies for over three decades in a range of parenting programs, and there is no evidence that such programs create subsequent childhood behaviour problems. To the contrary there is good evidence that such programs prevent the development of further problems (Cunningham et al. 1995; Webster-Stratton 1998; Zubrick et al. 2005).
Concerns have also been raised that time out is an authoritarian approach, that labels children, and requires the child to excessively focus on their misbehaviour. Time out is consistent with the principles of authoritative parenting, when it is used within the context of a positive relationship, and in combination with other strategies (Baumrind 1967). In fact, a positive, loving time in environment is essential for ensuring the effectiveness of time out (Hobbs and Forehand 1977). Time out works by establishing a contrast between the time in environment, and the time out environment. The more positive the time in environment, the less effort needs to be put into make the time out environment uninteresting (Hobbs and Forehand 1977). A careful functional analysis of the problem behaviour is a recommended part of a behaviour management program (Hanley, Iwata, and McCord 2003), to determine the reason for the child’s inappropriate behaviour. The child’s needs have to be addressed; the child needs to understand what is expected of them and the expectations should be developmentally appropriate; and the child’s emotions need to be suitably addressed. However, if the family environment and parenting strategies contribute to the child’s problem behaviour, parents requires appropriate, evidence based strategies, including time out, to manage the behaviour more effectively.
Reviews have concluded that the effects of consequences such as time out have more positive side effects than negative ones (Newsom et al. 1983). Like any parenting strategy it can be used in an authoritarian manner, however, this implies that parents need to be taught effective use of the strategy to ensure they are following recommended practices. The recommended procedure for time out, does not include labelling the child as naughty. The child is simply told that their behaviour is inappropriate, and that the consequence is time out. Furthermore, correct implementation of time out does not include a component asking the child to think about their behaviour. In fact, it is recommended that the parent determines when the child exits time out on the basis of the child’s behaviour and specific time limits, as these are observable and objective. Allowing the child to determine when they come out of time out, based on having ‘thought’ about their behaviour or being ‘ready’ to behave is not supported by research (Bean and Roberts 1981).
Other concerns relate to the expression of emotion, in particular the notion that children may bottle up their feelings, may have difficulty in being aware of feelings, and learn that negative emotions are not acceptable. Time out is designed as a consequence for inappropriate behaviour, and to help children learn to self-regulate their emotions (Joshi et al. 1988). It is important to recognise the kinds of behaviours time out is recommended for; including aggression, tantrums, and non-compliance and not a strategy to be used for when the child is sad or anxious. Parenting programs that include time out as a strategy have not shown that children’s anxiety or other problems increase following implementation (Cunningham et al. 1995; Webster-Stratton 1998; Zubrick et al. 2005), and there are no studies demonstrating that children exposed to time out repress their feelings, or have difficulties with awareness of feelings. However, there is good longitudinal evidence that behaviour problems evidenced in early childhood continue if parents do not have access to effective, evidence-based strategies for managing behaviour (Greenberg et al. 1993). In fact, children of parents who participate in parenting intervention which include the use of time out, show positive outcomes for periods up to 3 years later (Sanders et al. 2007; Webster-Stratton et al. 2004).
What are the Alternatives to Time Out?
Are there appropriate alternatives to the use of time out? Fundamentally, if the parent implements time out in combination with other strategies they are less likely to need to use time out. However, time out is a legitimate consequence for children, following inappropriate behaviour, as long as it is used in the context of a warm, loving, and supportive family environment. Two alternatives commonly suggested include smacking and the use of holding or physical restraint by the parent. A further alternative is to use approaches which focus on family relationships and limit the use of consequences for misbehaviour entirely (Mooney 1995).
In terms of smacking, the research literature clearly demonstrates that this strategy is not effective in managing misbehaviour and it is not recommended for children of any age (Kazdin and Benjet 2003). Similarly, research demonstrates that holding a child following non-compliance is associated with less future compliance, and thus a higher likelihood of further aggressive behavior. In addition, holding the child has been associated with more escape efforts compared to the use of time out (Roberts and Powers 1990). Holding therapy, based on attachment principles is controversial, and there are currently no established guidelines for its use (Simmonds 2007). Data indicate that defiant children can often take 20 min or more to calm, and parents have difficulty maintaining a hold that is safe and effective (McNeil et al. 1994). The use of restraint with children is generally not recommended (Masters et al. 2001).
The use of approaches which de-emphasise discipline has limited empirical support, and by and large the use of parenting strategies without a set of back up consequences for child misbehaviour has not shown to be effective (Mooney 1995; Roberts et al. 1981). Parenting programs which focus on strategies to encourage appropriate behaviour, without providing tools for managing difficult behaviour generally show limited effects on children’s behaviour (Cedar and Levant 1990), and the use of positive attention alone in the absence of back-up consequences is less effective (Jones et al. 1992; Olson and Roberts 1987; Roberts et al. 1981; Yeager and McLaughlin 1994).
A number of authors (e.g., Clewett 1988; Gartrell 2001, 2002; Schreiber 1999) and in our experience in disseminating Triple P, various practitioners and clinicians have argued against the use of time out, suggesting that other strategies such as a preventive approach to misbehaviour, the use of guidance, understanding the child’s behaviour, and encouraging appropriate behaviour are more appropriate for children of all ages. While the research evidence most certainly supports the idea that such strategies are useful, and that all parents should be encouraged to use them, the evidence does not support the notion that time out should not be a recommended strategy. Critics often argue against the use of time out based on the assumption that the strategy is used in isolation. However, the use of time out in isolation is not recommended in evidence-based parenting programs, and it needs to be placed within the context of a warm, caring, supportive environment. The research evidence clearly points to the effectiveness of time out, and there is little empirical support for the notion that time out is damaging.
However, like all parenting strategies, time out can be misused (Anderson and King 1974). Appropriate education and training has been associated with more effective use of time out (Turner and Watson 1999). Parents need to be aware of how to use time out most successfully and how to avoid the pitfalls of time out (e.g., specifying the behaviour, getting a baseline, avoiding reinforcing the inappropriate behaviour, escalation bursts, and reinforcing the appropriate alternative behaviour) (Drabman and Jarvie 1977). This points to the need for parents to have access to quality evidence-based parenting information, and support as necessary to assist them in effective use of time out, in the context of a range of other parenting strategies.
A number of clinical implications arise from our review of time out. There is sufficient evidence concerning the efficacy of time out that the promulgation of misinformation about time out and its adverse effects on children is doing a disservice to families. As a result, parents may be denied access to potentially effective treatment and alternative interventions or procedures with limited evidence base for managing problem behaviour are advocated (e.g., holding, calming, and soothing). A potentially important source of confusion regarding the use of time out is that the broader relationship context within which the strategy is typically advocated is not clearly highlighted. Some variant of time out is often used in a variety of popular reality television shows on parenting such as Nanny 911, Supernanny, Little Angels and Driving Mum and Dad Mad. These programs rarely provide parents with sufficient information to enable parents to implement the procedure properly, leading to failed attempts and parental disillusionment. Hence, it is critical that parents are able to obtain evidence-based information from service providers that provide clear guidelines as to the effective use of time out, within an appropriate context.