Time-Outs for Students with Emotional and Behavioral Disorders
Time-Outs for Students with Emotional and Behavioral Disorders
On the second page of a 2010 report published by the National Disabilities Rights Network (NDRN) called School is Not Supposed to Hurt is a picture of a 7-year-old girl who died while being restrained and secluded in a Wisconsin school. This report went on to describe the wide-spread used of restraints and seclusion by schools in the United States and its publication triggered a congressional investigation. The Government Accountability Office (GAO, 2009) published its own report a few months later, which examined 10 court cases resulting in criminal convictions, civil adjudications, or settlements. These 10 cases formed the basis for judging the veracity of hundreds of allegations of mistreatment, injuries, and death resulting from children being restrained or secluded by school personnel. Even more troubling was the finding that no federal law regulates the use of restraints and seclusion on children, while state statutes vary widely in terms of existence, content, and effectiveness.
The GAO defined a restraint as "… any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of an individual to move his or her arms, legs, body, or head freely" (2009, p. 1). The definition for seclusion was "… involuntary confinement of an individual alone in a room or area from which the individual is physically prevented from leaving" (GAO, 2009, p. 1). The 10th case examined by the GAO (2009) involved a 9-year-old boy with a learning disability who was secluded several times in a 'time-out' room by school staff in New York. The parent-approved individualized education plan (IEP) for this child included the use of a time-out room as a last resort, but school records revealed the room had been used 75 times during a six-month period. Some of the behaviors the teachers felt justified the use of the time-out room was whistling, slouching, and waving hands. Each time the child was escorted out of the classroom in from of his peers and when placed into the time-out room a staff member would physically hold the door closed. On at least one occasion the child's hands were blistered from trying repeatedly to open the 'unlocked' door. The size of the room was no more than a broom closet and lined with torn padding. Once the mother became aware of what was occurring she requested that her child be transferred to a different school and a jury awarded the parents $1,000 for each seclusion event, plus attorney fees.
The NDRN (2010) report described an IEP including time-outs in response to aggressive behavior for an autistic child. This child's parents eventually become aware of the fact that their child was spending about 75% of each school day in a time-out room (2010, p. 25, 38-39). A 9-year-old girl with ADHD, mild intellectual disability, and an anxiety disorder had tried to run away from school, so the teacher responded by placing the student in time-out under the teacher's desk. Often parents realize something is wrong when their child returns from school traumatized or injured and is unwilling to return to school voluntarily. Although the use of restraints, seclusions, and time-outs were originally intended to be therapeutic for children, the GAO (2009) discovered that teachers and staff untrained in the use of these methods were often relying on them to control non-aggressive behavioral problems exhibited by disabled children.
Unfortunately, the examples of maltreatment of disabled children by teachers and staff described in the GAO (2009) and NDRN (2010) reports are representative rather than exceptional. The response at the federal and state levels has been slow and limited, although many legislative bodies in the United States seem to agree that the use of restraints and seclusion should be banned outright or severely restricted. The use of time-outs, however, is still a widely accepted method of behavioral control. According to Kerr and Nelson (2009) there are three levels of time-outs used in a primary school setting: (1) planned ignoring, (2) contingent observation, and (3) exclusionary/seclusionary time-out (p. 82-83). These three levels represent a continuum from the least to most restrictive, with the latter triggering the most serious ethical and legal concerns. To better understand the use of time-outs as a classroom management tool for children suffering from emotional and behavioral disorders (EBD), this essay will examine what is known about this topic and review the findings of several relevant research studies.
The first topic to be discussed will be the theoretical justifications for the use of time-outs in the classroom, with a focus on EBD children. Textbooks dealing with managing student behavior will provide a foundation for this discussion. This is followed by an examination of empirical research studies that have investigated the efficacy and utility of time-outs in the school setting and which variables control outcomes. The theoretical foundations and empirical findings will then be discussed and conclusions drawn.
Behavioral psychology, the most common approach to classroom behavioral management, provides the theoretical framework within which time-outs can be justified (Goldstein & Brooks, 2007). At its most basic level, behavioral psychologists believe that consequences determine future behavioral choices. In other words, if a behavior is perceived to be rewarded then the chances of it recurring increases, but if a behavior is punished future occurrences are discouraged. The factors that influence this relationship are: (1) time, (2) relevance, and (3) number. Time is important because temporal proximity between the behavior and consequence(s) will determine the strength of influence on future behavioral choices. The consequence must be perceived as relevant to the behavior or it will lack influential power. Finally, as the number of consequences increase the stronger the influence on future behavioral choices. Time-outs fall squarely within the punishment category of behavioral consequences, because reinforcement (e.g., teacher approval/attention) is withheld.
Reinforcers can be broken down into positive and negative (Goldstein & Brooks, 2007). Positive reinforcement can come in many forms in the classroom, including self-reinforcement, positive social interactions, tokens, awards, edible treats, and tactile/sensory reinforcement (Kerr & Nelson, 2009, p. 75-79). Negative reinforcement, on the other hand, encourages behaviors through the removal of an aversive stimulus (Goldstein & Brooks, 2007, p. 236). An example of a negative reinforcer would be the delay or termination of classroom demands when a child is placed in time-out, which tends to reward behaviors that elicit time-outs. In the absence of negative or positive reinforcement, behaviors may be extinguished if they are not inherently rewarding to the child. For example, completing math homework in the absence of reinforcement could eventually lead to extinction of this behavior.
Punishment, on the other hand, is the presentation of an aversive stimulus or the loss of a positive stimulus following an undesirable behavior (Goldstein & Brooks, 2007, p. 240-252). For example, if being engaged in classroom learning activities is enjoyable to the student then a time-out would be aversive. If, however, the student is seeking to escape classroom activities for whatever reason then a time-out could be reinforcing for problem behaviors. Punishment is most effective in the short-term and at best, punishment will suppress behaviors, not extinguish them. In addition, the effectiveness of punishment can be reinforcing for the teacher and result in an overreliance on punishment for managing classroom behavior. The contexts within which time-outs are administered are also important. For example, time-outs administered without providing instruction on acceptable alternative behaviors, or rewards for engaging in these behaviors, tend to reduce time-out efficacy and behavioral flexibility, increased avoidance behaviors, and model poor behavioral management strategies to the classroom. When used properly, however, time-outs can be an effective behavioral suppression tool.
The effectiveness of time-outs for reducing the incidence of intentional aggression, destruction of property, and non-compliance was examined by Fabiano and colleagues (2004). The results were compared to a no time-out, response cost only, control group. Seventy one children (14% girls), ranging in age from 6 to 12 years, diagnosed with ADHD, and enrolled in an intensive behavioral treatment program in Buffalo, New York or Cleveland, Ohio, participated in the study. When compared to response cost alone, 5-minute, 15 minute, and variable length time-outs (5-15 minutes) were significantly (p < .002) more effective for reducing problem behavior incidence. No difference in efficacy between the different time-out strategies could be quantified, suggesting time-outs per se are effective regardless of the length of the time-out. The main limitation of this study is the lack of control for carryover effects from one time-out condition to the next, since the children were exposed to each condition for only a week before transitioning into the next condition. This could explain the lack of difference based on time spent in time-out. Given the relatively large sample size, however, time-outs are effective in reducing the incidence of problem behaviors in children with ADHD.
Most studies into time-out efficacy have relied on small sample sizes, except when non-EBD children are involved in…