Adjusting chair timeout enforcement procedures for oppositional children

SErlAVlOR TrlERAPY 21, 257-271, 1990

Adjusting Chair Timeout Enforcement Procedures for Oppositional Children MARK W. ROBERTS SCOTT W . POWERS

Idaho State Untverstty Mothers of noncompliant, clinic-referred preschool children were randomly assigned to 1 of 4 chair timeout (TO) enforcement procedures" Spank, Hold, Barrier, or Child Release. Standardized Forehand compliance training was implemented. Hold procedures were associated with less compliance criterion performance and excessive TO escape efforts. Child Release procedures were associated with excessive TOs. Neither Hold nor Child Release procedures are recommended. Barrier and Spank procedures appeared equally effective, replicating prior studies. The importance of monitoring and adjusting initial clinic TO enforcement procedures was documented. Noncompliant children who resisted TO displayed significantly less improvement In compliance than noncompliant children who accepted TO Group data were obtained in the home setting across a four-week period. Most children displayed near-zero levels of TO resistance within 3 weeks in the home.

There is little doubt about the importance of remediating noncompliance in clinic-referred children (e.g., Barkley, 1987, pp. 9-22; Patterson, 1982). Further, a good case has been repeatedly made for the necessity of constructive discipline in teaching oppositional children to obey adult requests (e.g., Roberts, Hatzenbuehler, & Bean, 1981; Wahler, 1969). Unfortunately, as our laboratory has demonstrated, noncompliant preschoolers often resist chair timeouts (TO) (Roberts, 1982), despite our best efforts to prepare them for changed contingencies (Roberts, 1984). Fortunately, at least two viable procedures have been found to suppress child escape efforts from TO chairs: spanking and brief room TOs (i.e., "barrier enforcement") (Roberts, 1982; 1988). The purposes of the present study were several. First, a large sample of noncompliant child referrals was used to replicate prior data (Roberts, 1982, 1988)

The authors gratefully acknowledge the role of many students in the collection of data and training of parents. Appreciation is extended to Le Matthews for his continued assistance with statistical analyses. A subset of these data was previously presented by the senior author in a Poster Session at the Annual Meeting of the Association for Advancement of Behavior Therapy, New York, November, 1988. Requests for reprints should be addressed to Mark Roberts, Psychology Department, Box 8112, Idaho State University, Pocatello, ID 83209. 25 7 0005-7894/90/0257-0271 $1.00/0 Copyright 1990 by Association for Advancementof Behavior Therapy All rights of reproduction m any form reserved

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on the effects of spanking and barrier procedures to enforce chair TOs; a replication of the ineffectiveness of child-determined TO release procedures (Bean & Roberts, 1981) was also sought. Second, the current project systematically tested parental use of a brief physical restraint to enforce chair TOs. Major theorists (Barkley, 1987, p. 118; Forehand & McMahon, 1981, p. 80) have suggested restraint as a back-up system if spanking fails to quickly inhibit TO resistance. Restraint to maintain TO condiUons has been described in the clinical literature (Barrett, 1969; Carlson, Arnold, Becker, & Madsen, 1968; Henriksen & Doughty, 1967; Luiselli, Suskin, & Slocumb, 1984; Patterson & Brodsky, 1966) and can be used to suppress all motion/vocalizations in TO (Rolider & Van Houten, 1985a, 1985b). Third, normative data definmg excessive resistance to TO (Roberts, 1982) were applied to the clinical decisionmaking process. Specifically, if a child displayed excessive escape efforts or noise during TO, or an excessive number of TOs, alternative procedures were immediately implemented. Fourth, home data were collected to establish typical levels of child resistance to TO in home settings.

METHOD Subjects

Clinic-referred, preschool children and their mothers participated. Subjects (n = 36) were selected for low baseline compliance ratios. Mothers of all subjects reported problems of child conduct in the home setting (e.g., noncompliance, aggression, tantrums). Child age ranged from 2 to 6 years (X = 4.0 years, S D = 1.0); 27 males and 9 females participated. Familial social economic status (SES) ranged from 1 to 5 on the Meyers and Bean (1968) index, where 1 represents professional class standing and 5 represents welfare class standing (X = 3.6, S D = 0.8). Most mothers perceived their children as oppositional as measured by the Eyberg Child Behavior Inventory (Eyberg & Ross, 1978). t Procedures

A clinic analog study of alternative enforcement procedures for chair TOs was performed, followed by a four-week assessment of TO resistance in the home setting. To qualify for the study, all children displayed compliance ratios of 60070 or less on The Compliance Test (Roberts & Powers, 1988) during the first clinic session. 2 The Compliance Test consists of 30 pairs of "pick up" ' The mean Problem Score was 19.7 and the mean Intensity Score was 154.3 Using the recommended cutoff scores, 91.7%0 of the mothers perce)ved excesswe behavior problems and 88.9% also perceived excessive frequency of those problems. 2 Roberts and Powers (1988) analyses of Comphance Test subject rehabdlty data indicated a slgmficant decrease from test to retest Gwen th~s reformation, chmc participants were routinely gwen a second Comphance Test during the second chmc session. This procedure affected the last six participants m this project. Two were assigned to Child Release and Barrier, one each to Spank and Hold. Actual test-retest data for the six subjects were: 3% and 20/0, 3% and 0%, 35 % and 2%, 2% and 0%, 52% and 55%, and 65 % and 17%. Since these subjects were balanced across conditions and since test-retest dtfferences were small m four of s~x subjects, retest data were used for analysis.

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and "put" tasks (60 instructions) given to the child in a clinic playroom by the mother who receives prompts and feedback from an experimenter in an observation room via a bug-in-the-ear device. Compliance Test procedures and psychometric properties have been thoroughly discussed by Roberts and Powers (1988) and will not be detailed here. Qualified children were randomly assigned to 1 of 4 experimental conditions: Spank, Hold, Barrier, or Child Release. Randomization was qualified, however, to balance the groups for child age and baseline compliance ratios. If a new subject matched a previously assigned subject for age (within 6 months) and compliance ratio (within 10%), he/she was randomly assigned to one of the remaining conditions. The assignment procedure yielded four groups of nine children. Child age (F (3, 32) = 0.06) and baseline compliance ratios (F(3, 32) = 0.31) were not systematically different. Further, group membership was not associated with familial SES (F (3, 32) = 0.25) nor maternal perceptions of child deviance on the two Eyberg scales (both F-values less than 2.0). The assignment process did skew the groups for child sex. The 9 females were distributed as follows: Hold 4, Spank 2, Child Release 2, and Barrier 1. During the second clinic session mothers were trained in responsive play skills. See Forehand and McMahon (1981, pp. 61-72) for a discussion of these skills and Roberts (1985) for a discussion of the limitations of responsive play training. During the third clinic session experimental procedures were administered and completed. All mothers signed an approved consent form. All parents and children then participated in a "standard treatment phase" designed to improve compliance with maternal chore-like instructions, based on the Forehand and McMahon (1981, pp. 72-88) procedures. Only the experimentally manipulated enforcement procedure for maintaining chair TOs differentiated the child experience during the standard treatment phase. The following procedures were common to all subjects in all conditions during the standard treatment phase: 1) All parents were trained to give explicit instructions, to praise child compliance, to warn children for noncompliance, and to use TO contingent on noncompliance to warnings. 2) Chair TO parameters, other than the enforcement routine, were a 2 minute minimum duration and a 15-second quiet release rule. Parents ignored all child vocal behavior in TO. The quiet contingency duration was reduced to 5 sec if a TO exceeded 10 min. Time occupied by enforcement procedures was disregarded. 3) Parent training (in the absence of the child) included discussion, handouts, m-vivo modeling, and role-playing. 4) Children were trained in all contingencies prior to initial use by the parent. Specifically, children were informed of the noncompliance - TO contingency, the TO quiet rule, and the TO escape effort - enforcement contingency via discussion, modeling, and verbal rehearsal procedures. (See Roberts (1984) for more details about step 4.) 5) Standardized guided practice with the mother and child was then initiated. All parents represented the 30 two-step Compliance Test tasks, incorporating the praise, warning, and TO contingencies. Therapist guidance was provided to the mother via a bug-in-the-ear. Training was continued until the compliance criterion (defined below) was met. 6) Step 5 was discontinued if the child displayed excessive resistance to TO (7 escape efforts during a single TO episode) or exces-

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ROBERTS AND POWERS

sive TOs (7) prior to meeting the compliance criterion. Adjustment procedures (described below) were then implemented. 7) Finally, all parents were trained to record the frequency of TOs and enforcement procedures used in the home setting. The experimental conditions were utilized if a child made an escape effort from chair TO conditions. The four conditions were as follows:

1. Spank: Mothers firmly said, "Since you left the chair, you must be spanked!" She then spanked the child twice on the buttocks with an open hand, replaced the child on the TO chair and said, "Now stay there and be quiet!" 2. Hold: Mothers firmly said, "Since you left the chair, I will have to hold you." She then replaced the child on the chair, crossed his/her arms, and held the chdd by the wrists from behind while squatting behind the chair. She counted from 1 to 10 and then said, "Now stay there and be quiet!". Next she released her hold on the child's wrists. 3. Barrier: Mothers firmly said, "Since you left the chair, you wall have to stay by yourself." She then guided the child into an adjacent, small (4 × 5 feet), empty, carpeted room. The light was turned on, the door left open, and a 4-feet-high plywood sheet ("barrier") was slid into the door slot. The mother, in the playroom, leaned against the barrier to prevent the child from knocking it down and to provide visual assurance she had not left. All child behavior was ignored. Mothers were encouraged to briefly visually "check" the child if they had any concern for the child's safety. After 60 sec, the mother slid back the barrier, guided the child to the TO chair, and said, "Now stay there and be quiet!" 4. Child Release: When children in the Chdd Release group were sent to TO, mothers always said, "You may leave the chair when you decide to do as you're told." In contrast, children in Conditions 1 through 3 were told, "Now stay there and be quiet." When a Child Release subject left the chair (see escape effort definition below), mothers stud, "Since you left the chair, that means you have decided to do as you're told." She then resumed the standardized guided practice. If a Child Release subject remained in TO for 10 min, the chdd was reminded that he/she could leave TO when she/he wished to obey. This verbal prompt was given once every minute (beginning on minute 10) until the child left the chair. The standard treatment phase was discontinued and an "adjustment treatment phase" initiated for any child who displayed excessive resistance to TO or excessive TOs. The new enforcement contingency was modeled for the child by the experimenter before standardized guided practice with the mother and child was resumed. The adjusted procedure for children in the Hold, Barrier, or Child Release conditions was the Spank routine. The Barrier routine served as the adjustment procedure for resistant Spank condition subjects. Adjustment procedures were contmued until the child obeyed 10 successive instructions or associated warnings. Following initial compliance training, individualized parent training was

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initiated, with clinic sessions typically occurring on a weekly basis. Generally, additional sessions included procedures to manage aggression (Olson & Roberts, 1987), negative verbalizations, and public situation problems. Consequently, home record data of TO frequency included TOs for disobeyed warnings and for additional coercive behaviors. Weekly parent training continued until all problems were considered manageable by both parent and therapist or until the client discontinued treatment, whichever came first. Subjects averaged 8.1 weeks in active therapy. Follow-up periods varied by client need.

Dependent Variables (1) Compliance: Given a "pick-up" instruction, compliance was defined as a continuous motor response initiated within the 5 sec post-instruction or post-warning interval that terminated in grasping the instructiondesignated toy. Given a "put" instruction, compliance was defined as a continuous motor response initiated within the 5-sec post-instruction or post-warning interval that terminated in object release in or on the designated container. Compliance ratios were derived by dividing the number of compliant responses per assessment by the number of instructions issued during that assessment. Compliance criterion responding was defined as compliant reactions to 10 successive instructions or associated warnings beginning with Instruction 51 or any higher numbered instruction o f the standard treatment phase. Children who disobeyed a warning following any of the last 10 instructions were always given additional instructions until the compliance criterion was met or the criteria for excessive resistance or excessive TOs was met. (2) Timeout Duration: the number o f seconds (in 5-second units) between the onset and termination of chair timeouts. These data were analyzed only for Child Release subjects. (3) Escape Effort: a movement away from the timeout chair such that a child's thighs and buttocks no longer contacted the timeout chair seat. (4) Child VerbalRehearsalSkill: During pretraining to maximize child awareness o f all contingencies, questions were asked to facilitate memory, e.g., "Why was (actor) sent to TO?" (See Roberts, 1984, for an exact list of questions and the feedback format). Child Accuracy Percentage was recorded for all questions presented and Recall Mastery was coded as present if the child correctly verbalized all four contingencies (i.e., noncomply - TO, quiet in TO - release, stay in TO - release, escape from TO - enforcement procedure). (5) Home RecordData (HRC). A 5" × 8" tally sheet was posted in the home to record daily occurrences of chair TOs and any escape efforts (i.e., use of the TO enforcement procedure). Parents were trained to use the HRC via discussion, brief modeling, and weekly feedback during clinic visits. One tally mark was to be made for each chair TO and each use of the enforcement procedure. A weekly (daily) escape/TO ratio was derived by dividing all escape efforts by all TOs for a given week (day).

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ROBERTS AND POWERS

Observer Reliabdity Data Eighteen students and the two authors coded mother-child behavior in the clinic analogs. Two observers independently coded compliance ratios during 8907o of all baseline sessions. The agreement ratio was 97.607o. Two observers independently coded compliance ratios during 97 07oof the standard treatment phases, yielding a 96.2070 agreement ratio. Only 3307o of the adjusted treatment phases were independently coded, but did yield a 90.4°7o agreement ratio for compliant behavior. Two observers independently coded 87.9070 of the 99 TOs during the standard phase of treatment and 4507o of the 31 TOs during the adjustment phase. Correlations of each observer's recorded total escape efforts per TO were r = .98 (standard phase) and r = .99 (adjustment phase). Timeout duration was linked to the quiet release rule. Consequently, the observer reliability of TO duration was estimated by comparing each 5-sec interval of TO for child vocalizations (quiet vs. disruptive). Agreement ratios of 91.907o and 90.7 °7o were achieved during the two treatment phases. Although no independent coding of home TOs and escape efforts was attempted, parentcollected data were evaluated for evidence of subject reliability. Daily esc a p e / T o ratios were summed across alternate days in which one or more TOs were recorded. At least three "odd" and three "even" days were required for a subject to be included in the analysis. The uncorrected "odd-even" split-half reliability coefficient was r (27) = .762.

RESULTS Criterion performance and TO resistance data during the standard treatment phase are summarized in Table 1. TABLE 1 ENFORCEMENT EFFECTS ON TIMEOUT (TO) DATA DURING STANDARD TREATMENT Condmona Measurement Subjects attaining criterion performance Subjects with excessive TO's Escape efforts/TO b Subjects with excessive escape efforts/TO e Number of subjects requiring adjustment

.'K SO

Spank

Hold

Bamer

Child release

Effect

Dxrect~on

6707o

33%

8907o

44070

.025

H < B

0% 3.0 (3.0)

22°70 5.1 (2.7)

0°70 26 (2.7)

56°70 -

.015 n.s.

B < CR; S < CR

33070

5607o

1707o

-

n,s.

3

6

1

5

-

a Spank = S, Hold = H, Barrier = B, Child Release = CR. b Subjects with no TO's (3 m Barrier) were excluded, subjects with excessive escape efforts were assigned 7 escape efforts/TO. e Subjects with no TO's were again excluded.

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Compliance criterion performance was less likely under Hold conditions than Barrier conditions when contrasted with Fisher's Exact Test (Hays, 1973, pp. 738-740). Subjects with excessive TOs (7) were much more likely to be in the Child Release group than either Barrier or Spank conditions (Fisher's Exact Test). Mean escape efforts per TO and the number of children with excessive escape efforts during any given TO were contrasted across the three enforcement conditions, excluding Child Release subjects. No significant condition effects were detected. Large sample (n = 76) data presented by Roberts and Powers (1988) were assessed to calculate the population probability of a noncompliant child displaying excessive escape efforts, given a TO. For noncompliant preschool children exposed to Spank conditions, that probability was 1207o. The obtained sample probabilities of excessive escape (Table 1) were 3307o for Spank, 56070 for Hold, and 17070 for Barrier. The binomial probabilities of these sample data being selected at random from the defined population were .067 for Spank, .002 for Hold, and .380 for Barrier subjects. Therefore, only Hold subjects displayed significantly more excessive escape efforts than would be expected by chance. Timeout duration data were analyzed for Child Release subjects. Duration data for children in other conditions were rendered uninterpretable. Some TOs were terminated because of excessive escape efforts, while other TOs were discontinued because the child met the 15-sec quiet release criterion. The median TO duration of Child Release subjects who had at least one TO was 17 sec (n = 8). For these eight Child Release subjects, the correlation between mean TO duration and compliance criterion performance was r (6) = .755, p < .05. Compliance ratios were compared across the four experimental conditions and two assessments: baseline and standard treatment phase. For the 15 children who required adjustment procedures, compliance ratios during the standard treatment phase were based on the number of instructions given prior to termination of the standard treatment. Group means and standard deviations are presented in Table 2. A 4 × 2 analysis of variance (ANOVA) (Groups by Assessments) yielded a significant Assessment effect (F (1,32) = 60.68, p < .001) but no evidence of Group (F(3,32) = 0.80) or Interaction effects (F (3,32) = 1.26). Therefore, mean compliance ratios (collapsed across groups) significantly increased from baseline (,~ = 19.3070) to standard treatment (X = 64.0070). Fifteen subjects (42070) required adjustment procedures as a result of excessive TOs (7 subjects) or excessive escapes per TO (9 subjects) during the standard treatment phase. 3 See Table 1 for group distributions. An analysis of compliance ratios across phases was performed, contrasting adjusted v e r s u s non-adjusted subjects. Non-adjusted subjects always received at least 60 instructional trials (i.e., 30, 2-step tasks); adjusted subjects averaged only 14.5 instructional trials prior to termination of standard treatment. Adjusted subjects received additional trials (a minimum of 10) during the adjustment treat-

3 One subject had 7 TOs and made 7 escape efforts during the seventh TO, qualifying him under both categories of TO resistance.

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ROBERTS AND POWERS TABLE 2 COMPLIANCE RATIOS ACROSS ENbORCEldENT CONDITIONS

Condiuon Spank Hold Barrier Child release

~a SD X SD X SD X SD

Baseline

Standard treatment

18.0 (15.6) 18.3 (13.6) 16.8 (17.7) 23.9 (20 7)

56.9 (42.9) 51 6 (40.2) 79.8 (30.8) 67 9 (22.9)

a All data are percentages.

ment phase. The proportion of trials completed by adjusted subjects during the standard treatment phase was 39%. Consequently, compliance ratios for non-adjusted subjects were calculated separately for the first 39% and the last 61%o of all instructional trials. Similarly, compliance ratios for adjusted subjects were calculated separately for standard treatment and adjustment treatment phases. Mean compliance ratios for the Adjusted (n= 15) and Nonadjusted (n= 21) groups are displayed in Figure 1 across three assessments: baseline and two treatment phases (first 39% v s . last 61% for non-adjusted subjects; standard v s . adjustment phases for adjusted subjects). A 2 × 3 ANOVA revealed significant Group (F(1,34) = 33.68, p<.001), Assessment (F (2,68) = 166.4, p<.001), and Interaction effects (F (2,68) -- 24.4, p<.001). Tests of simple effects indicated significant differences between adjusted and non-adjusted subjects at the first treatment phase (F (2,93) = 80.66, p<.001) and at the second treatment phase (F (2,93) = 5.29, p<.05), but not at baseline. Using tests of simple effects and subsequent Newman Keuls comparisons, it was found that adjusted subjects improved significantly from baseline to the first treatment phase (q (2,68) = 3.02, p<.05) and from the first to the second treatment phase (q (2,68) = 10.27, p<.01). In contrast, nonadjusted subjects improved significantly from baseline to the first treatment phase (q (2,68) = 18.59, p<.01), but not from the first to the second treatment phase (q (2,68) = 2.63). Prior to guided practice with the mother and child, all children were pretrained in the various contingencies. Child Accuracy Percentage and Recall Mastery were collected during the pretraining. Mean Accuracy Percentages across the four conditions (Spank, Hold, Barrier, and Child Release) were 54%, 34%, 48%, and 34°70, respectively. Mean Recall Mastery data were 56%, 44%, 33%, and 44o70, respectively. Both measures were significantly correlated with child age: Accuracy Percentage v s . Age, r (34) = .543, p<.001; Recall Mastery v s . Age, r (34) = .528, p<.001. Neither cognitive measure, however, discriminated group membership, both F (3,32)-values less than 1.0. Moreover, neither measure was associated with criterion performance: Ac-

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100-

~O

/ / / / / / I

O

75-

m

I--

< iv

LU

~J Z <

50-

m

,--I

:E o U

25-

C)-- - - "C) N o n - a d j u s t e d ~)

I

BASELINE

I

FIRST TREATMENT PHASE

~) Adjusted

I

SECOND TREATMENT PHASE

FIG. l. Mean compliance ratios across basehne and two treatment phases for children requiring adjustments in TO enforcement procedures (n = 15) and those not requiring adjustments (n=21) during initial clinic comphance training.

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ROBERTS AND POWERS

curacy Percentage v s . Criterion performance, r (34) = .040; Recall Mastery v s . Criterion performance, r (34) = -.151. Age also failed to correlate with Criterion performance, r (34) = -.092. Given treatment phase data, maternal preferences, and therapist input, the 36 mothers selected the following distribution of TO enforcement procedures for home use: Spank - 23, Hold - 3, Barrier - 5, Child Release - 0, and Combination 4 - 5. In the home setting, the "barrier" was a door to a room. All other home enforcement procedures were identical to the laboratory procedures. During the four-week home assessment, four children (11°70) required further adjustments: two shifted from Spank to Barrier; two shifted from Combination to Spank. Decisions to shift enforcement procedures were based on single episodes of intense resistance, increasing escape/TO ratios, and/or parental preferences. Four subjects prematurely discontinued therapy during the four-week period. Using an arbitrary criterion of a 0.1 escape/TO ratio during a one-week period in which at least one TO was recorded, 69.407o of the children met the criterion during the four-week assessment. Mean weekly escape/TO ratios in the home setting are displayed in Table 3. For any child to receive a score for a given week, an HRC must have been returned by the parents. Moreover, the HRC had to include designated columns to record TOs and escape efforts (occasionally neglected by the therapist) and at least one recorded TO episode by the parent. Using these criteria, 74.3070 of the possible weekly data points were available for analysis. If a child met the minimal e s c a p e / T o ratio criterion (0.1 or less), recording of enforcement use was discontinued and a 0.0 escape/TO ratio was inferred thereafter. This latter rule was applied during 11.8070 of the weekly escape/TO ratios. Analyses of group trends were performed on the weekly escape/TO ratios. Only those subjects who possessed a score for each week of the analysis were eligible, rendering variable sample sizes. Analyses revealed a s~gnificant decline in the escape/TO ratio from Week 1 to all remaining weeks. The F-ratios

TABLE 3 MEAN WEEKLY ESCAPE/TO RATIOS IN HOME SETTINGS Weeks Index

1

2

3

4

Mdn (SD) n

0.7 0.5 (0.8) 32

0.3 0.1 (0.5) 30

0.1 0.0 (0.3) 23

0.2 0.0 (0 4) 16

4 An example of a "combination" is as follows: One mother whose child resisted spanking procedures was reluctant to use a "room TO" at home, although it was successful in the cllmc. We negotiated a combination procedure, consistmg of using the room backup only if the boy displayed three successive escape efforts (spankings) during a single TO

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267

derived from one-way repeated ANOVAs across four weeks (F(3,24) -- 12.43), three weeks (F (2,36) -- 19.90), and two weeks (F (1,27) = 14.79) were all significant (p < .001). Newman Keuls indicated that only the decline from Week 1 to all other weeks was significant. For the Four-Week sample (n = 9), the escape/TO ratio at Week 1 was greater than at Week 2 (q (3,24) = 6.95), at Week 3 (q (4,24) = 7.63), and at Week 4 (q (2,24) = 6.41), all p-values less than .01. For the Three-Week sample (n = 19), the escape/TO ratio at Week 1 was greater than at Week 2 (q (2,36) = 7.05) and at Week 3 (q (3,36) = 8.21), both p-values less than .01. The Two-Week sample (n = 28) did not require further analysis.

DISCUSSION The effects of alternative TO enforcement procedures were compared on child compliance and TO resistance behaviors. All procedures were effective for some children. From a nomethetic perspective, however, Barrier and Spank procedures appeared to be the treatments of choice. Barrier enforcement was associated with an increased likelihood of criterion performance, relative to Hold procedures; fewer subjects with excessive TOs were in Barrier and Spank conditions than the Child Release condition; no systematic differences between Spank and Barrier conditions were detected. These data replicate the effectiveness of Spank and Barrier procedures (Roberts, 1982, 1988) and the relative ineffectiveness of Child Release procedures (Bean & Roberts, 1981). Hold condition data represent the first systematic test o f a brief restraint procedure to inhibit escape from chair TOs in noncompliant preschoolers. It seems to be a poor procedure. The probability of a Hold subject displaying excessive escape efforts during TO was very high, relative to the population estimate. Perhaps if restraints are to be effective, they need to be sustained, released only upon the absence o f child struggling, and faded gradually. The senior author has successfully used such procedures in residential settings. We do not believe, however, that such restraint procedures are easily taught to, or used by, parents. Since Spank and Barrier options are now firmly established, there is little to support the use of restraints with this population. The Child Release procedure partially replicated Bean and Roberts (1981). Short TO durations were associated with poor compliance acquisition. Unlike the original sample, however, compliance acquisition data did not differ between Spank and Child Release conditions. Within-cell compliance ratio variance was pronounced in both conditions during standard treatment. Intriguingly, two Child Release subjects remained in TO without any external enforcement, and they stayed a long time! Both had to be prompted off the chair after 10 min; both displayed compliance criterion behavior after a single, long TO, producing the significant within-group correlation between TO duration and criterion behavior. Nevertheless, considering the 1981 and current samples, using a child-determined TO duration for defiant preschoolers seems unwise. The children are likely to experience several brief TOs and are less likely to improve in compliance than children who are required to remain in TO for a minimum period.

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ROBERTS A N D P O W E R S

Child foreknowledge of changed contingencies failed to be associated with criterion performance. These data are consistent with our earlier efforts to attenuate TO resistance (Roberts, 1984) via pre-treatment contingency awareness training. Stubborn young children seem to insist upon a behavioral experience. Modeling, verbal information, and verbal rehearsal seem insufficient. Most mothers (64°70) selected the Spank procedure to enforce chair TOs at home. These data probably reflect the procedural decision to use Spank as the adjustment procedure for resistant children from the Hold, Barrier, and Child Release conditions. Powers (1987) found different preference data. When Spank and Barrier procedures were presented to mothers (n = 22) as equally effective options prior to actual use with children, 41070 selected Spank, while 59070 chose to use Barrier. It is not yet clear what variables influence maternal preferences between the two basic TO enforcement options. Procedural effectiveness and style of clinical presentation seem to be important. Group mean compliance ratios improved similarly regardless of condition. Such improvements are very unlikely to be associated with temporal or measurement effects (Peed, Roberts, & Forehand, 1977; Roberts, Hatzenbuehler, & Bean, 1981; Roberts & Powers, 1988) or placebo effects (Roberts, McMahon, Forehand, & Humphreys, 1978). These data replicate several prior studies at Idaho State University (cf. Roberts & Powers, 1988) and at the University of Georgia (cf. Forehand & McMahon, 1981), demonstrating the robust nature of the compliance training package. Compliance ratio data, however, must be carefully qualified. First, compliance ratios during standard treatment were based on an unequal number of instructional trials. Adjusted subjects typically experienced only 15 instructions prior to termination of standard procedures. Were an identical 60 instructions given to all subjects, compliance ratio data might have varied across groups (cf., Bean & Roberts, 1981). Second, by terminating standard procedures upon excessive TO resistance, large within cell compliance ratio variance was virtually guaranteed during the standard treatment phase (see Table 2). Consequently, detecting a group effect on compliance ratio data was unlikely. Third, the apparent importance of the adjustment phase of treatment must be highlighted. Some children in each condition displayed excessive escape efforts or excessive TOs. Excessive was defined empirically from an earlier data set (Roberts, 1982). Switching TO enforcement procedures at the moment of excessive resistance appeared to be a good clinical decision. At that point compliance had improved only marginally for adjusted subjects, but dramatically for non-adjusted subjects. Therefore, TO resistance was associated with attenuated treatment effects. Following adjustments in TO enforcement procedures, adjusted subjects displayed a clinically significant increment in compliance, almost "catching up" with the quasicontrol group of non-adjusted children. Unfortunately, it is not possible to conclude that adjustment procedures were functionally related to improved compliance. Resistant children (i.e., adjusted subjects) were not randomly assigned into alternative conditions of an experiment. It is possible, for example, that TO resistant children would have improved eventually if we had simply persevered with assigned conditions. A no-adjustment control procedure for TO resistant preschoolers would be scientifically desirable. It is our position,

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however, that monitoring and adjustment is the clinically correct decision. Our position is supported by the observational technology to measure and define excessive resistance to TO (Roberts, 1982) and the empirical demonstration that TO resistance attenuates treatment effects (Figure 1). Why a child resists a specific TO enforcement procedure is currently unknown and cannot be predicted from baseline compliance levels or child age. Presumably, each unique parent-child discipline history plays a central role. If, for example, spanking has been discriminatory for intense coercion that eventually or even occasionally inhibits parental discipline efforts, spanking would not have the typical suppression effect on escape efforts from chair TOs. Similarly, if being sent to one's room or being restrained has been discriminatory for successful termination of parental discipline via escalated coercion (scream, kick, struggle loose, force the door open, etc.), then these procedures would fail. Therefore, information gained from systematic interviews of discipline practices might predict child acceptance of specific TO enforcement procedures. Intriguingly, one of the two basic procedures (Spank or Barrier) worked well for all subjects in this sample. Children who violently resisted Spank accepted the Barrier and vice versa: Home collected data revealed subject reliability and temporal trends in chair TO resistance data. The reliability coefficient for escape/TO ratio data was acceptable, indicating consistency of inter-individual variation across time. Although no observer reliability data were available, surely HRC data reflect a conservative lower-limit of what actually happened at home. Specifically, it is unlikely that a parent would record a TO or enforcement procedure that did not occur; errors of omission seem more likely. Therefore, the data in Table 3 should be viewed as a lower limit of typical reactions of noncompliant preschoolers experiencing a functional chair TO enforcement procedure in the home setting. A child client could be judged as making "normal" progress if his/her HRC weekly escape/TO ratio were at or below one standard deviation above the mean for any given week. Further, normally progressing children should display a significant decline in escape efforts from week 1 to week 2. Finally, a clinician could indicate to parents that two o f three oppositional children display minimal escape efforts (0.1/TO or less) within four weeks. Relatively few adjustments in TO enforcement were necessary during the home follow-up period, once adjustments (if any) were made in the clinic during initial training. This does not mean HRC monitoring is unimportant. Four children required shifts in TO enforcement procedures. H o m e data not only served to monitor progress, but quickly indicated any escalating escape/TO ratios, flagging the need for careful interviewing, parent retraining, child retraining, a n d / o r procedural alteration (e.g., Spank to Barrier). s The worstpossiblecase should also be noted. Occasionally,a child resists Spank and Barrier procedures.In these rare cases(none in the current sample)a modifiedBarrierprocedureis recommended. After an escape effort from a TO chair, the child is placed behind the Barrier and left behind the Barrieruntil he/she meetstemporaland quiet contingencies.This, of course, is similar to a traditional room TO procedure.See Roberts(1988,pp. 365-367)for a discussionof problems with seclusion TOs with preschoolers.

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Specific ethical issues are raised by this report. First, clinicians should disclose the data presented herein (e.g., Tables 1 and 3) to provide parents a fully informed choice regarding program participation. Although excessive TO escape efforts are unlikely, they do happen. Parents should be made aware of the probabilities and options. Second, initial TO use should be directly monitored in the clinic to allow adjustments, followed by continuous parent-collected data from the home setting. Inadequate monitoring may lead to the sustained use of a coercive, ineffective procedure. Third, parents should be carefully trained (i.e., discussions, written materials, modeling, role-plays, and guided practice with the child) in TO enforcement procedures to prevent misuse. Fourth, parents should be repeatedly reminded that TO enforcement procedures only teach the child to remain on a TO chair. Compliance and other pro-social behaviors (e.g., sharing toys) must be taught v t a other program components. Fifth, defiant children should be made as fully aware of changed contingencies as possible, prior to use. Although this has not demonstrably altered group data, an individual child might benefit. Finally, referred parents who have previously abused their children should be taught the Barrier procedure. No matter how carefully one might train the Spank procedure, it could be discriminative of more intense physical punishment. Since the Barrier procedure is usually effective, it is recommended for parents from such populations.

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Patterson, G.R., & Brodsky, G. (1966) A behavior modification program for a child with multiple behavior problems. Journal of Chdd Psychology and Psychiatry, 7, 277-295 Peed, S., Roberts, M., & Forehand, R. (1977). Evaluation of the effectiveness of standardized parent training program in altering the interactions of mothers and their children. Behavior Modification, 18, 323-350. Powers, S.W. (1987). The use of multiple examplars to enhance the acquisition and setting generamy of parental skdls Unpubhshed master's thesis, Idaho State University, Pocatello, ID. Roberts, M.W. (1982). Resistance to timeout: Some normative data. Behavioral Assessment,4, 239-248. Roberts, M.W. (1984). An attempt to reduce timeout resistance in young children. Behavior Therapy, 15, 210-216. Roberts, M.W. (1985). Praising child compliance: Reinforcement or ritual? Journal of Abnormal Chdd Psychology, 13, 611-629. Roberts, M.W. (1988). Enforcing chair timeouts with room timeouts. Behavior Modification, 12, 353-370. Roberts, M.W., Hatzenbuehler, L.C., & Bean, A.W. (1981). The effects of differential attention and timeout on child noncompliance. Behawor Therapy, 12, 93-99 Roberts, M.W., McMahon, R.J., Forehand, R , & Humphreys, L. (1978). The effect of parental instruction-gwmg on child compliance. Behavior Therapy, 9, 793-798. Roberts, MW., & Powers, S.W. (1988) The compliance test BehavtoralAssessment, 10, 375-398. Rohder, A , & Van Houten, R. (1985a). Movement suppression time-out for undesirable behavior in psychotic and severely developmentally delayed children. Journal of Apphed Behavior Analysts, 18, 275-288. Rohder, A., & Van Houten, R. (1985b). Suppressing tantrum behavior in pubhc places through the use of delayed punishment mediated by audio recordings. Behavior Therapy, 16, 181-194. Wahler, R.G. (1969). Opposltional children: A quest for parental reinforcement control. Journal of Apphed Behavior Analysts, 2, 159-170. RECEIVED. July 5, 1989 FINAL ACCEPTANCE: April 5, 1990