Monday, July 19, 2010

Does Time-Out really work for behaviour problems? Especially for children with ADHD, autism, Aspergers or bipolar disorder?

Another parent comes by with tales of woe from attempting to use "Time-Out" to change behaviour. Well, this doesn't surprise me at all. Time Out is a very difficult procedure, and it really isn't designed to do what most people expect: get a new behaviour started. It is especially difficult to use with children with ADHD, autism, Asperger's and other disorders that have a high percentage of problems with executive function.

Time Out is designed to reduce the frequency of a behaviour by reducing the reinforcement it gets. If a behaviour isn't reinforced, eventually it will fade away. The problem with this is that often times we don't do Time Out well, and because we argue, occasionally give in, and sometimes the child simply wins or gets other reinforcement (like attention) Time Out is very hard to do. This is especially true with children with attention deficit hyperactivity disorder, autism or those kids we think of having paediatric bipolar disorder. Even if we do it wrong one time out of five, we are providing what we call "intermittent reinforcement" and the child will become even more difficult to change. Intermittent reinforcement is what keeps people going back to gamble, in spite of the fact they only win occasionally. Face it, if you've watched "Super Nanny" you know she uses Time Out a lot, calling it the "naughty circle." And in every episode she needs to return and retrain the parents.

But eventually things do improve, and that's often because other behaviour techniques are being used that work better for ADHD, autism and bipolar disorder. These include setting up a family visual schedule, which helps reduce anxiety and depersonalizes the parent-child interactions, and there is always a positive reinforcement system (sometimes a token system) being used.

Whatever the inappropriate and unwanted behaviour is, somehow it works for the child. Somehow it is reinforcing. It may not have been at first, but sooner or later something about the behaviour and the response to it is reinforcing. Otherwise the behaviour would have stopped. It's our job to find out what is reinforcing the behaviour, what its "function" is, and teach our children new, more appropriate and functional "replacement behaviours." Behaviours that serve the same function as the original one, but are appropriate. We call this behaviour the FERB or Functionally Equivalent Replacement Behaviour. Every behaviour plan worth it's salt has a FERB. The replacement behaviour is taught, reinforced, and at the same time the inappropriate behaviour is ignored (as much as humanly possible ....we aren't all Super Nanny!). In this way we are teaching a new skill, and ignoring something we want to go away. We also make environmental changes to decrease the need to engage in the inappropriate behaviour (that's the purpose of that visual family schedule).

Notice, we are ignoring, and teaching, but what are we not doing? We aren't punishing. It isn't really a "naughty circle." It's a Time Out space where what your doing doesn't get reinforcement. Punishment is seldom an important component of successful parenting!

A really good book to learn interaction techniques to deal with children who have frequent and excessive temper tantrums is Dr. Ross Green's "The Explosive Child." It teaches you the skill and philosophy behind providing positive behaviour support to your child rather than trying to use punishment, which, you may have noticed, might stop a particular behaviour, but fails in one big way: It doesn't teach new skills!

For more information about child and adolescent parenting you can visit my web page at www.relatedminds.com, or www.adhdhelp.ca or my Psychology Today Website. You can also call my office at 778.998-7975 to make an appointment for a consultation.

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