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Time-out effective in children with trauma

A recent study found that parent management training programs which incorporated time-out as a behavioral response are just as effective in children with history of adverse child experiences (ACE) as those without ACE history.

Parenting programs including time-out (TO) are equally effective in children who have experienced trauma as those who haven’t, according to a recent study.

Childhood trauma, referred to as adverse childhood experiences (ACE), can lead to alarming physical and mental health problems. ACEs have been observed as common, and can include experiences of maltreatment, household dysfunction, minority adversities, and stressful life events. Nearly 30% of childhood mental health disorders can be attributed to ACEs.

While hostile family dynamics, violent discipline techniques, and the absence of stable, nurturing primary attachment can all lead to ACEs, they can be mitigated by effective parenting measures, such as parent management training (PMT). This involves improving parental behavior and reducing instances of coercive cycles, creating a responsive, affirming, and consistent environment for children.

TO is a core PMT strategy that has received criticism in recent years, with concerns that it can lead to feelings of abandonment in children with a history of ACE. This could rupture attachment bonds, disrupt developing nervous systems, and retraumatize children.

In PMT, TO is used to set healthy boundaries and reduce risk of physical punishment. In TO, children are put in an environment with little reinforcement as a response to poor behavior. Evidence has shown that parents who use TO have reduced abusive behavior.

To fill the gap in knowledge on the effects of PO in children with a history of ACE, investigators conducted a study with a nonrandomized intervention group, a waiting list-controlled group, and groups with high or low adversity exposure.

Participants were gathered from self-referrals to the Child Behavior Research Clinic from February 14, 2018, to February 1, 2021. There were 205 children, 206 mothers, 177 fathers, and 2 other caregivers participating in the study. Children were aged 2 to 9 years and had presented with oppositional defiant disorder or conduct disorder.

Data was collected from interviews and online surveys which parents and caregivers participated in. Preliminary assessments were completed by treating clinicians pretreatment and independent clinicians posttreatment.

The Integrated Family Intervention for Child Conduct Problems was given to parents, which they followed during the testing period. This PMT included TO among its strategies for reducing child conduct problems.

A Strengths and Difficulties Questionnaire (SDQ) was used to determine results, with higher scores showing that a greater number of characteristics apply to the child. Treatment dose, comorbid attention-deficit/hyperactivity disorder, and caregiver stress and anxiety were variables associated with treatment outcomes.

While both groups had similar baseline scores, children in the intervention group had a lower posttreatment SDQ score than children in the waiting list group. Children with high ACE exposure had a greater baseline score than children with low ACE exposure, but both groups had similar posttreatment scores.

These results indicate that therapeutic benefit from PMT-TO programs is equal, if not greater, in children with high ACE exposure compared to children with low ACE exposure. This supports prior evidence that PMT programs which incorporate TO are effective at treating ACE exposure.

Reference

Roach AC, Lechowicz M, Yiu Y, Mendoza Diaz A, Hawes D, Dadds MR. Using time-out for child conduct problems in the context of trauma and adversity: anonrandomized controlled trial. JAMA Netw Open. 2022;5(9):e2229726. doi:10.1001/jamanetworkopen.2022.29726