By Brett Enneking, PsyD, HSPP Assistant Professor of Clinical Pediatrics Department of Pediatrics, Division of Child Development
For decades, time-out has been promoted as an effective and safe parenting strategy to manage challenging behaviors exhibited by young children. Currently, both the American Academy of Pediatrics and Centers for Disease Control encourage the use of time-out as a best practice behavior management strategy within the context of a strong, positive parent-child relationship. Many decades of research have shown that time-out is associated with a reduction in aggressive behavior, improved child compliance, and increased generalization of appropriate behavior across environments.
Despite this strong body of literature, controversy continues to swirl around time-out. In recent years, multiple articles have been written in popular magazines and newspapers calling into question whether time-out may be harmful for children and whether other strategies may be superior. Common criticisms of time-out include that time-outs increase emotional dysregulation, fail to teach children distress tolerance skills, isolate them when they need support, and may re-traumatize children who have experienced abuse. Moreover, there is concern that time-outs may not be properly implemented by parents and lead to inappropriate and coercive use of time-out.
Critical to an understanding of time-out is first establishing a clear definition of what is meant by the term, “time-out.” A well-implemented time-out occurs in the context of a warm and supportive parenting relationship that includes a high level of positive parental attention, including specific or labeled praises for appropriate child behavior (e.g., “Great job listening”), high fives, hugs, etc. This positive parental attention increases the likelihood of the positive child behavior occurring again while also showing parental approval and increasing the child’s self-esteem. Across the existing time-out literature, 86% of studies utilized positive reinforcement strategies like these in conjunction with the time-out process (Everett, Hupp, & Olmi, 2010).
A review of the time-out literature spanning nearly 30 years examined the best practice time-out procedures (Everett, Hupp & Olmi, 2010). Best practice time-outs include a verbalized warning, verbalized reason, placement in a safe location, removal from environmental reinforcement (e.g., toys, siblings), location in a chair, short duration (e.g., typically around 3 minutes for children between ages 3 and 7), returns to the chair following escape, and follow-through with original request if the time-out was due to noncompliance. Additionally, evidence suggests that other management principles, including remaining calm, using the intervention consistently, and having realistic, developmentally appropriate expectations were also critical to the success of the time-out.
Overall, time-out is designed to be a consistent, structured discipline strategy that allows the parent to remain calm and controlled throughout the process. Once the time-out has been completed, the parent should quickly return to warmth and positive attention toward their child to help the child regain emotional control. Ideally, time-out is utilized in conjunction with other methods of discipline (e.g., removal of privileges, token economies) to support behavior change.
What about those criticisms?
When implemented appropriately, the common criticisms of time-out become less valid. With regard to concern for child isolation and removal of warmth, sticking to a short duration provides a brief respite from a difficult interaction for both the parent and child. This allows the parent to regain emotional composure in order to provide genuine warmth once the time out has been completed. Additionally, a well-implemented time-out provides a reliable structure wherein both parent and child know what to expect during the discipline process. In this way, time-out can even provide a corrective experience for children who have a history of exposure to abusive or coercive disciplinary practices. However, there may be situations where re-traumatization is possible given the nature of the child’s trauma; in those situations, ongoing consultation and guidance from a trained behavioral health provider is critical to the success of the intervention.
While concern for parental misuse of time-out is valid, it is essential for parents to have a variety of behavioral skills and techniques that they may utilize when their young child exhibits challenging behaviors. Teaching an evidence-based time-out procedure has a low risk for harm; the risk becomes much greater if parents are not given adequate support in the use of time-out and other discipline strategies. Adequate support varies from family to family. Some may only need brief, informal consultation while others may need the ongoing support of a structured parent training program. With the right match, parents can have a more successful and positive experience using time-out.
When confronted with criticisms of time-out, providers should emphasize the benefits, provide guidance regarding proper implementation, and highlight evidence-based behavioral strategies that should occur in conjunction with time-out. If the parent continues to be challenged by managing their child’s behavior, a referral to a behavioral health professional specializing in parent training is strongly recommended.
Everett, G., Hupp, S., & Olmi, D. (2010). Time-out with Parents: A Descriptive Analysis of 30 Years of Research. Education and Treatment of Children, 33(2), 235-259. Retrieved from http://www.jstor.org/stable/42900065
American Academy of Pediatrics: Bring out the best in your children (2014). Retrieved from https://www.aap.org/en-us/Documents/ttb_bring_out_best.pdf
Centers for Disease Control and Prevention: Steps for Using Time-Out. Retrieved from https://www.cdc.gov/parents/essentials/timeout/steps.htmlBourduin
Quetsch, L., Wallace, N. M., Herschell, A. D., & McNeil, C. B. (2015). Weighing in on the time-out controversy: An empirical perspective. The Clinical Psychologist, 68(2), 1-19.
Brett Enneking, PsyD, HSPP, is a licensed Clinical Psychologist and Assistant Professor of Clinical Pediatrics at the Riley Child Development Center and Indiana University School of Medicine. Dr. Enneking provides diagnostic consultation and psychological evaluations for children with neurodevelopmental and related disabilities. She is also certified in Parent-Child Interaction Therapy (PCIT), a short-term behavioral intervention for young children and their parents. Dr. Enneking’s clinical interests include disruptive behaviors, early childhood mental health, parent-child relationships, autism spectrum disorder, and intellectual disabilities.
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Cristina James is the Data Coordinator, Associate Training Director, and Family Discipline Coordinator in the Department of Pediatrics, Division of Child Development at Indiana University School of Medicine. She has over 10 years of professional experience and a life-long lived experience in neurodevelopmental disorders which, combined with her analytical skills, allow her to effectively span across functions to help provide and improve many LEND outcomes.