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Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question actually comes from a list serve rather than an actual email to me directly.

A number of parents have been discussing the issue of scream rooms or seclusion timeout rooms. If you are interested in reading about this more, please check out our previous posts on the topic here, here, here, and here.

As part of the discussion about these rooms, a number of people mentioned the importance of having a functional behavioral assessment (FBA) done combined with developing an appropriate behavior plan. Other people then posted about the importance of a functional analysis. That is when a parent asked,

“Could you please explain the difference between an FBA (functional behavior assessment) and a Functional Analysis?” “Also, please explain who can do a functional analysis and why it’s important you get a qualified person to do it.”

We have written about FBAs on this blog before. We described an FBA here, we described when to do an FBA here, and we reviewed some legal cases on FBA here.

So, for a recap, remember:

The FBA is a multi-step process that may include some or all of the following:
A good FBA will include a graph summarizing the observations and/or functional analysis.
The FBA should result in a statement or statements that tell you WHY the child is engaging in the behavior.
Additionally, according to federal special education law, an FBA must be completed under these conditions:
  • If, during the IEP meeting, the team determines that the child has a behavior that is impeding his/her learning (or that of others)
  • If the child’s placement needs to become more restrictive because of the challenging behaviors
  • If the child’s behavior has resulted in an emergency change of placement
  • As part of the initial and full evaluation if necessary
What is a Functional Analysis?
 The functional analysis is one step or possible component of the FBA. The functional analysis is a manipulation of events to PROVE why the behavior is happening. For example, if the assessment data suggests that a child may be attention seeking with his/her behavior, then the functional analysis will be implemented so that in one condition, the child is given a toy immediately following the challenging behavior but in the comparison condition, the child is given attention immediately following the challenging behavior. Then, the behavior analyst will count and graph the number of times the child engaged in challenging behavior in each condition. If the child is truly attention seeking, the rates of challenging behavior will be higher when the child receives attention for his/her behavior when compared to rates when the child received a toy following his/her behavior.
I have simplified the description of the analysis in order to show readers the difference between an FBA and a functional analysis. Many functional analysis conditions can be completed and they may be quite complicated depending on the child’s behavior and other relevant information.
By definition, a functional analysis results in an increase in challenging behavior in some or all conditions. Thus, only appropriately trained people should oversee the design and implementation of such conditions. Additionally, the functional analysis results may be influenced by the implementor, the setting, the language in which the instructions are given, and other variables. Thus, the functional analysis should be completed in conditions that are as close to the natural setting as possible (including people, materials, and location).
Finally, the functional analysis ALWAYS results in a graph depicting the results of the analysis.
I hope this helps clarify the difference between the two procedures.
If you have questions about behavior be sure to email Missy at askmissy at appliedbehavioralstrategies dot com.

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Here at Applied Behavioral Strategies, we try to review a research article on a hot topic for our readers. Because a timeout room procedure in Connecticut has received quite a bit of attention lately, it seems timely to review another study about timeout.

Christine Readdick and Paula Chapman authored the article called, Young Children’s Perceptions of Timeout. The Journal of Research in Childhood Education in 2000. If you want to read the article yourself, you may find it here.

Purpose

Because timeout has been such a widely used procedures in both homes and classrooms, and because researchers have never paused to ask children how they felt about being placed in timeout, the authors hoped to learn how children understood timeout. They stated that the specific study purpose was to learn how young children felt about being placed in timeout and if they understood why they were placed in timeout.

Participants

The authors studied 42 young children ages 2, 3, and 4 years old who attended child care centers that were willing to be included in the study. Parents consented in writing for their children to participate in the study.

Methods

Immediately following a timeout, the researchers interviewed the child asking a series of 17 pre-determined questions. These questions included things like:

  • do you like school?
  • when you are in timeout do you feel lonely?
  • when you are in timeout do you feel sad?
  • when you are in timeout do you feel that the teacher disliked you?
  • when you are in timeout do you feel that you dislike timeout?
  • do you think you need to be in timeout?
Results

More children reported feeling alone, yet safe while in timeout. More children also reported that they disliked (rather than liking) timeout. Sadly, more children also reported feeling that their peers did not like them when they were in timeout.

More children than not could identify what they were doing that led to timeout (e.g., I wasn’t playing the right way). More children reported being in timeout “a little” rather than “a lot”. Most children reported that an adult told them why they were in timeout. Interestingly, most children also indicated that they deserved to be in timeout.

Teachers placed most children in timeout for being non-compliant (N=27). Sixteen children were placed in timeout for aggression.

When the authors compared the answers between children who were placed in timeout “a little” to those of children who were placed in timeout “a lot”, the authors noticed that their negative feelings were more intensified (e.g., more alone, more sad, more disliked by friends).

Interestingly, only about 50% of the children correctly identified the reason for being placed in timeout. Observers recorded behaviors prior to timeout and those records were used to verify if children’s responses were correct.

Summary

The authors noted that timeout, in this study, was being used for minor offenses (e.g., non-compliance in most cases) and that timeout should be reserved for the most severe and dangerous behaviors.

We want to hear from readers. For those of you that have verbal children, have they shared their thoughts about timeout? Are your children being placed in timeout for minor offenses?

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Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases.

Our intent is to show readers how successful ABA can be. Today’s success story is not about a clinical case but rather a personal case.

As some of our readers may know, Missy has a brother with autism and intellectual disabilities. Mac is also non-verbal which complicates the intervention process.

When Mac was in his early 20s, he moved in to a group home with 5 other men. Mac engaged in inappropriate touching during mealtimes. He touched their plates, he pushed their drinks, and he touched his roommates. When he did this, staff put Mac in timeout until the end of the meal and then Mac was allowed to eat his meal alone.

After several weeks, the staff called Missy to report that the inappropriate mealtime behavior had become a serious problem and that state rules required roommates to eat together. Thus, they needed an intervention so that Mac could eat with his roommates. They had concern that their timeout technique was not working.

Missy provided them with some important background information. When Mac was very young, like many children with autism, he engaged in challenging behaviors during mealtime. To decrease family stress, their mother fed Mac separately from the rest of the family. Thus, Mac had developed a strong preference for eating in isolation with abundant space on either side of him.

Missy explained to them how to develop an appropriate behavior intervention plan: a) modify antecedents to prevent challenging behavior; b) teach appropriate/replacement behaviors; and c1) modify consequences to stop reinforcing challenging behaviors; and c2) begin or increase reinforcement for appropriate behaviors.

Modify Antecedents to Prevent Challenging Behaviors

Staff planned to do a variety of things to prevent Mac from touching his roommates, their food, and their drinks.

  1. At the beginning of the meal, they asked Mac where he would like to sit. He often chose to eat at the bar adjacent to where the rest of the roommates were eating.
  2. Chips (a highly preferred food for Mac) were offered at the table. Mac could only have chips when he sat at the table with everyone else.

Teach Appropriate/Replacement Behaviors

The staff also taught Mac to communicate instead of using challenging behavior to get his needs met.

  1. They taught Mac to ask (using gestures) to sit in a different place.
  2. They taught Mac to ask for additional space (using gestures) when he felt crowded.

Reinforce Appropriate Behaviors

Staff also focused on reinforcing Mac for engaging in good mealtime behaviors.

  1. They provided him with attention (praise and high fives) when he was eating appropriately.
  2. They provided him with chips when he sat at the table with everyone else.

Staff stopped reinforcing Mac’s challenging behaviors.

  1. When Mac touched other people, their food, or their beverages, staff did not allow Mac to eat alone.
  2. Staff did not allow Mac to leave the area when he touched other people or their food and drink.
  3.  Staff only allowed Mac to leave the table when he asked to move or when he asked to sit somewhere else.

Follow-Up

Mac now lives in a home with 2 other roommates. He eats at the table with his roommates. The table is large so that Mac has ample space. When Mac comes to visit Missy and her family, he eats at the table with the children but he asks them to make extra space for him. When Mac eats out in restaurants with Missy and her family, they always ask him where he would like to sit before the meal begins. If the table is large enough, he asks to sit at the end. If the table is small and he feels crowded, he asks to sit at an adjacent table so that he can interact with his family but still have ample space to feel comfortable.

Summary

Staff originally tried to use a timeout procedure to address Mac’s inappropriate mealtime behavior. Staff failed to notice that Mac wanted to eat alone. When they used the timeout procedure it actually had a reinforcing effect: Mac’s inappropriate mealtime behavior increased because they gave him what he wanted when he misbehaved. Additionally, the timeout intervention did not teach Mac any new skills. He still prefers to eat alone or with ample space around him but now he has learned how to communicate his preferences so that he does not have to engage in challenging behavior to get his way.

Thus, when addressing challenging behavior, we must first understand why the behavior is happening. It is then, that an appropriate intervention may be developed to effectively address the behavior.

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Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question comes from two reporters who interviewed me for follow-up articles they were writing about the Scream Rooms (also known as Timeout Rooms) here in Connecticut.

One reporter asked, “Is there any research to support the use of timeout rooms?”

Sadly, I was not able to cite any research supporting the use of timeout rooms so I told the reporter that I would look in to it and get back to him.

Exclusionary Versus Non-Exclusionary Timeout

We have already discussed the research on the timeout procedure, as well as one alternative that may be used instead of timeout (there are many others). Most of the recent research on timeout involves non-exclusionary uses of the method. Specifically, rather than excluding a child and isolating her in a room alone, other ways of implementing a time out include:

  • Having the child sit and watch recess rather than participate in it
  • Preventing a child from earning tokens when the rest of the class is earning tokens
  • Briefly turning your back to the child to remove adult attention

Published Studies

I conducted a cursory review of the literature in search of research to support the use of timeout rooms and I will briefly review what I found.

Timeout for Inappropriate Mealtime Behavior

In 1970, Barton, Guess, Garcia, and Baer published a study about the use of timeout rooms for various inappropriate mealtime behavior of individuals with intellectual disabilities. Inappropriate mealtime behaviors included eating with fingers, stealing food, and “pigging” (e.g., eating off the floor). The authors noted that some participants were called to an isolated room whereas others experienced non-exclusionary timeout in that their tray was removed for 15 seconds. The authors noted that the 15-second non-exclusionary timeout was just as effective as the more lengthy timeout room.

Length of Timeout

By 1972, substantial research on timeout had been conducted such that researchers had already learned that the use of timeout for challenging behaviors combined with the use of reinforcement for appropriate behaviors was superior to either of the interventions alone. Also by 1972, researchers knew that timeout was effective but they were interested in learning the effects of varying lengths of timeout. Thus, White, Neilsen, and Johnson (1972) sought to compare the effects of 1-minute timeouts, 15-minute timeouts, and 30-minute timeouts for “deviant children”. The authors found that 1-minute timeouts were effective when they were presented first. Thus, longer periods of timeout were not required.

Timeout for Selective Mutism

In 1973, Wulbert, Nyman,  Snow, and Owen published a study on an intervention package for a young girl with selective mutism. The authors provided the young girl with candy when she spoke. They slowly faded new people in to the treatment room and continued to reinforce the girl when she spoke in front of strangers. After a few weeks of treatment, the authors added a 1-minute timeout in a timeout room. The young girl learned to talk with new peers, a new teacher, and the researchers. However, this was not achieved unless novel people were carefully faded in to the treatment.

Timeout for Aggression

In 1973, Clark, Rowbury, Baer, and Baer published a study showing the effectiveness of a 3-minute timeout room immediately following aggressive behavior. The timeout procedure worked, but note that it was very brief in duration.

Timeout Not Always Effective

White and colleagues (1972) pointed out that timeout was not always effective. They noted that the timeout procedure must match the reason or purpose (also known as function) of the behavior. Specifically, if a child engaged in challenging behavior to obtain attention, then timeout from attention or people would be effective. If a child engaged in challenging behavior to gain access to a preferred item or activity, then timeout from that item or activity would also be effective. However, if a child engaged in challenging behavior to avoid a person or to avoid work, then the use of timeout from a person or work would be ineffective for that child.

In 1977, Solnick, Rincover, and Peterson described the results of a timeout procedure for a little girl with autism who was learning her colors. If the child engaged in challenging behavior, the teacher picked up the candy (reinforcer for learning) and briefly left the room. (Note, the timeout room was not used here.) The authors noted that this procedure actually resulted in an increase in challenging behaviors rather than a decrease. Essentially, the little girl did not want to work and when the teacher left the room (i.e., removed attention), work stopped briefly. They replicated the study with a little boy diagnosed with intellectual disability. Again, when the child did not want to work, the timeout procedure was ineffective. However, when the researchers improved the quality of the instructional time (e.g., made it more fun), then the timeout procedure became effective. In summary, if instruction is of high quality, children will want to participate. If children enjoy the instructional time, the timeout procedure will be effective.

Move from Exclusionary to Non-Exclusionary

By the late 1970’s researchers learned that exlusionary timeout was not the only way of effectively addressing behavior. Researchers also began recognizing that timeout rooms required additional space, highly trained staff, and that timeout was not always effective. Thus, researchers sought to demonstrate that non-exclusionary timeout procedures could be used effectively.

In 1978 Foxx and Shaprio published a study describing the effects of a non-exlusionary timeout wherein the child wore a timeout ribbon and was not allowed to receive reinforcers that other children in the classroom were receiving.

In 1980, Wahler and Fox published a study describing the results of teaching parents to use timeout at home with their children. Children spent 5 minutes alone in their rooms when they misbehaved. Please note that in 1980 children did not have televisions, gameboys, and computers in their rooms. Thus, 5 minutes in the room with no adult or sibling attention proved effective.

Summary

In summary, a number of research studies exist demonstrating the effectiveness of timeout rooms. It should be noted that these studies were published in the late 1960’s and early 1970’s and are now considered out-of-date. While those studies helped better our understanding of behavioral techniques, research since then has shown us that:

  1. Timeout is only effective when used for attention-seeking behavior
  2. Timeout is most effective when used in combination with reinforcement for appropriate behavior
  3. Non-exclusionary timeout is equally effective at reducing behaviors
  4. Timeout should be part of a carefully monitored plan

Finally, timeout does not teach children new, appropriate or replacement behaviors. Thus, the child is not learning what to do, instead they are only learning what not to do. As teachers, we must teach children and that includes teaching them what to do instead of acting out.

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One of our goals for improving the quality of lives through effective intervention is to share with our readers research on effective treatments. We do this by summarizing peer-reviewed research articles. Yesterday, in response to our post on Scream Rooms (also known as Time Out Rooms), a twitter follower asked, “what else can teachers do?” Thus, it seems appropriate that we should review a study that demonstrates one effective alternative to time out.

Mark Durand and Ted Carr authored the article in 1992. The Journal of Applied Behavior Analysis published the article and you may read it yourself here.

Study Purposes

The purpose of the study was to determine which of two interventions would be effective at reducing attention-maintained challenging behavior (when children act out in order to get reactions from their teachers).

The authors also set out to determine which effects of the two interventions would generalize to untrained teachers. For example, a teacher could implement a behavior plan in her class but when the substitute teacher is present, he may not implement the intervention. If the child’s good behavior happens with the trained teacher and with the new/untrained teacher, it is said to generalize. If the child’s good behavior does not happen with the new/untrained teacher, the effects failed to generalize. Obviously, teachers would want interventions that work with them as well as with their substitutes.

Participants

Twelve children participated in the study. Children ranged in ages between 3.5 years and 5 years of age.  The children were diagnosed with a variety of conditions including attention deficit disorder, language delay, autism, or developmental delay. The children engaged in a variety of inappropriate behaviors including aggression, opposition, tantrums, and property destruction. Six children were assigned to one treatment group and six children were assigned to the other treatment group.

Assessment

The authors completed a functional behavioral assessment (FBA) for all 12 students. As part of the FBA, the authors completed a functional analysis to demonstrate that all 12 children engaged in various challenging behaviors in order to gain attention from their teachers (The authors referred to this as Study 1). This type of behavior is known as attention-maintained behavior.

Baseline

Before treatment, the researchers observed children during regular school work activities. The work was considered easy work but the teachers did not provide a high rate of attention for appropriate behaviors.

Intervention

The researchers compared the results of two interventions. (The authors called this Study 2). One intervention was time out. We discussed time out and its variations here yesterday. The second intervention the authors studied was called Functional Communication Training (FCT). You may read more about it here (You will find other evidence-based strategies on that website if you are interested). FCT has a substantial research base to support its use. With FCT, teachers simply teach children to communicate instead of acting out to get what they want. Often we teach children to talk but sometimes we teach children to use pictures to communicate if they cannot speak very well.

In this study, teachers implemented time out by simply removing all instructional materials and turning their backs to the children for 10 seconds each time the child engaged in challenging behavior.

During FCT, teachers taught the children to ask for teacher attention by saying things like, “Am I doing good work?”

Once the researchers demonstrated that the intervention was working, a new/substitute teacher was brought in to see if the intervention effects would generalize. (The authors called this Study 3).

Results

Time out effectively reduced the rates of challenging behavior for all 6 children in the treatment group. Similarly, FCT effectively reduced the rates of challenging behavior for all 6 children in the treatment group.

However, when the new teacher worked with the children, the results were remarkably different. Specifically, children who received the time out intervention, failed to generalize their good behavior to the new teacher. Essentially, their challenging behavior returned to pre-treatment levels with the new teacher.

On the other hand, children in the FCT group, generalized their good behavior to the new teacher. Not only did they maintain good behavior, they used their new communication with the new teacher.

Thus, while brief time out from teacher attention may be effective at reducing attention-maintained behavior, the improved behavior will not generalize to new, untrained teachers. However, FCT teaches children to use communication instead of challenging behavior. This results in improved behavior and the improvement carries over to new, untrained teachers.

So, if you find yourself wondering what to do instead of time out, try teaching the child to communicate instead of acting out.

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An elementary school has come under fire in Connecticut for using “Scream Rooms” as a method of discipline. If you haven’t heard, you may learn more about it here, here, and here.

What is a Scream Room

According to reports, parents described the rooms as 6-by-4-foot spaces with concrete walls used to isolate students with special needs who are disruptive in the classroom. As best as we can tell, Scream Rooms is simply another name for a Time Out Room or more specifically, a Seclusionary Time Out Room.

So what is a time out room? Let us first define time out.

  • A time out is a period of time when opportunities to access reinforcement are prevented.
  • Most people think of a time out as sitting in a chair and not being able to play.
  • Time out may also be missing recess for 5 minutes.
  • Time out may also include losing TV time after dinner.

Time out may be administered within a classroom so that the student does not lose instructional time. For example, the child may be asked to sit at the back of the class where she can still hear instruction but where she may not interact with others. This type of time out is called inclusionary time out.

Seclusionary time out is when the student is removed from the instructional setting and placed in isolation so that minimal or no interaction with others is allowed.

Thus, a time out room or a seclusionary time out room is a room where someone might go so that no other forms of reinforcement may be accessed (e.g., no social interaction, no music, no toys).

What is the Purpose of a Scream Room or Time Out Room?

Historically, time out has been used as a consequence to challenging or disruptive behavior as a type of punishment. The underlying philosophy is that if the child is engaging in behavior to gain attention, placing the child in isolation for brief periods of time immediately after the challenging or disruptive behavior will teach the child that acting out will not result in attention.

While this method has been supported with substantial research, the technique is often used incorrectly. Before a time out may be planned as part of an intervention for a student, a behavior analyst must first assess the behavior and determine why the child is mis-behaving. This is called a Functional Behavioral Assessment (FBA) and we have talked about it here, here, and here.

Once the assessment is completed, an intervention is developed based on the assessment results. If the child engaged in challenging behavior to gain attention, a time out from attention following challenging behavior may be part of the behavior plan. If the child engaged in the challenging behavior to gain access to preferred items such as computer time or television time, then a time out from computers or television following challenging behavior may be part of the plan. If a child is engaging in challenging behavior as a way to get out of non-preferred activities such as school work or home work, time out from school work would be inappropriate and ineffective.

When time out is used as part of a treatment plan, its use must be carefully monitored with data collection and ongoing analysis to verify if the intervention is working as planned. All staff who use time out as part of a treatment plan must be trained to use the procedure. Additionally, the time out procedure must be supervised to ensure that staff are implementing it correctly.

Sadly, it does not appear that time out is being used in this way in this particular school. Based on the reports we have read, it seems as if staff sent children to these rooms to “calm down”. Based on the reports we have read, staff were not following carefully developed behavior plans. Instead, teachers appeared to be sending children to these rooms when teachers became frustrated with student behavior.

Rules for Restraint and Time Out

Currently, no federal legislation exists preventing schools from using seclusionary time out or time out rooms. However, federal legislation has been proposed. We used Wright’s Law(a helpful website for parents and teachers alike) to find additional information about seclusionary time out rules in each state. Many states have specific rules so parents, teachers, and behavior analysts should become familiar with the rules in their states. These states include: California, Colorado, Connecticut, Iowa, Illinois, Massachusetts, Maryland, Maine, Minnesota, Montana, North Carolina, New Hampshire, Nevada, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, and Washington.

Connecticut has specific rules regarding the use of seclusionary time out. You may read the rules here.

The rule states that “no provider shall involuntarily place a person at risk in seclusion (there are two exceptions). This means that a child may not be placed there against his/her will (with those exceptions).

The state went on to define seclusion as the confinement of a person in a room, whether alone or with staff supervision, in a manner that prevents the person from leaving.

Seclusion may be used in an emergency. But remember, an emergency does not happen daily as described in these news reports. The rules also state that if seclusion is used, “it must be part of the IEP of that person AND that other less restrictive, positive behavior interventions appropriate to the behavior exhibited by the person at risk have been implemented but were ineffective.”

The rules also state that if seclusion as a behavior intervention is repeated more than two times in any school quarter, the IEP team must meet to review the use of seclusion, consider additional evaluations or assessments, and may even revise the child’s IEP.

Most importantly, when a student is placed in seclusion, school staff must attempt to notify the parents on the same day or within 24 hours. They may use phone, email, or a note home. Parents must receive a copy of the incident report within 2 days. The state even provides a sample of the incident report form that could be used.

And finally, the rule states that any staff who uses seclusion must be trained in that technique.

Please note that this rule applies only to students who have an IEP. Students who do not have identified disabilities do not have the same rights.

What Should Parents Do to Prevent the Use of Scream Rooms/Time Out Rooms?

If your child does not have a disability, then you should meet with your principal to discuss the use of such procedures. Again, your child does not have the same rights as children with IEPs.

If your child has an IEP, then you should:

  1. Learn your state’s rules about seclusionary time out
  2. Review your child’s IEP to be certain that it does not include seclusionary time out
  3. If you have concerns about your child’s behavior, you should request the IEP team to complete a Functional Behavioral Assessment (FBA)

We hope that none of your children have experienced these rooms. We also hope that we have helped you prevent the use of these rooms on your child.

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