Monday, August 28, 2006

Clinic Notes: Time out and Autism

Time out is an often used and misused procedure. If done properly, time out is a very effective, humane procedure. Find a place in your house where a time out chair, preferably a chair with arms and not a bench, can be left. The chair should face a blank wall and not be close to a window, shelves, glass, electrical outlets, or storage cabinets containing chemicals. Hallways and alcoves often work. Do not use bathrooms or closets. The time out chair should be close to the play area so the child can be placed in time out quickly. Think safety, especially for small children. (If the child is very young, then the baby bed will do, and no, the child will not develop an aversion to the baby bed and have sleep problems. An alternative time out procedure for a young toddler is to sit him/her down on the floor with his/her back to you and hold them there for thirty seconds. Do not talk to the child except to tell him or her at the beginning and end of time out why he or she is in time out.) For young toddlers you can just count to thirty in your head. For older children, use an egg timer and teach the child that he or she cannot get out of time out until the egg timer goes off. The child has to stay in time out for three minutes plus one minute of good behavior. In other words, the child has to be quiet and cannot be arguing, complaining, or tantruming for one full minute before he or she can get out of time out. Do not be surprised if the child comes up with a whole bag of new inappropriate behaviors in order to get out of time out. Kids have been known to gag, vomit, and one of my own kids even hit herself in the face several times. Do not respond and thereby reinforce these new inappropriate behaviors or they will increase in their frequency. Only good behavior gets the child out of time out. (Initially, some kids have to be held in time out. Gradually, decrease the restraint you have on the child and make sure he/she is sitting there quietly for one minute before he/she gets out. If the child is too large to safely hold in time out, then use a response cost procedure instead. In response cost something the child values is taken away temporarily. Examples include watching TV, going outside, videos, the opportunity to play games with caregivers, favorite foods or beverages, a favorite toy, etc.) In the beginning of this procedure, it is not unusual for a child to be in time out for fifteen to twenty minutes before he/she quiets down, and to go to time out as often as twenty times a day. After a few days the child learns the requirements of the time out procedure and he/she gets out in the minimum four minutes. The number of times the child goes to time out each day also drops dramatically. When the child gets out of time out, remind your child of why he or she had to go to time out in a firm tone. Do not be timid with your voice or body language. (Excerpted from my ABA eBook available at www.aba4autism) In my next blog I will discuss why time out does not always work with children with autism

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