Parameters of Time-out: Research Update and Comparison to Parenting Programs, Books, and Online Recommendations.

In reviews published more than 30 years ago, eight parameters important to the use of time-out were identified and available research was summarized. The purpose of the current paper is to provide an updated summary of existing research for each parameter of time-out. Within each parameter, we conducted a thorough review of the published literature and identified all peer-reviewed articles addressing each parameter. We identified and summarized a total of 46 articles across the eight parameters, including 32 not cited in previous reviews. Sufficient findings were available to draw conclusions regarding time-out warning, schedule of time-out, contingent versus noncontingent release, and duration. Tentative conclusions based on only a few studies could be drawn in regard to instructional versus physical administration and verbalized reason for time-out. No conclusions could be drawn regarding time-out signal and specific time-out location. While we know much more today regarding effective implementation of time-out, there is a clear need for further exploration within these identified parameters. In addition to summarizing the literature, we reviewed recommendations made by behavioral parent training programs, parenting books, and parenting Web sites, and compared how well their recommendations matched current research based on the conclusions drawn from our review. We found that parenting sources made strong and specific recommendations on several of the parameters that were either not consistent with available research or simply lacked a sufficient research base.

Structured Feedback Training for Time-Out: Efficacy and Efficiency in Comparison to a Didactic Method.

Although time-out has been demonstrated to be effective across multiple settings, little research exists on effective methods for training others to implement time-out. The present set of studies is an exploratory analysis of a structured feedback method for training time-out using repeated role-plays. The three studies examined (a) a between-subjects comparison to more a traditional didactic/video modeling method of time-out training, (b) a within-subjects comparison to traditional didactic/video modeling training for another skill, and (c) the impact of structured feedback training on in-home time-out implementation. Though findings are only preliminary and more research is needed, the structured feedback method appears across studies to be an efficient, effective method that demonstrates good maintenance of skill up to 3 months post training. Findings suggest, though do not confirm, a benefit of the structured feedback method over a more traditional didactic/video training model. Implications and further research on the method are discussed.

Measurement Issues: Large effect sizes do not mean most people get better - clinical significance and the importance of individual results.

BACKGROUND: This paper seeks to compare group statistical analysis with effect size, group measures of clinical significance (Reliable Change Index and normative comparison), and individual analysis of clinical significance. METHOD: Measures of variables important to parenting and child behavior improvement (Parenting Scale, Eyberg Child Behavior Inventory, and Parenting Stress Index [PSI]) were administered pre and post for a 9- to 10-week group Behavioral Parent Training Intervention. Analysis compares traditional group statistical significance testing with group measure of clinical significance and individual analysis of clinical significance. RESULTS: All three measures demonstrated statistically significant differences from pre to post, with large effect sizes. Group measures of clinical significance, however, demonstrated meaningful change only on the PSI, while individual analysis showed improvements of 54% of participants at best and 0% at worst. CONCLUSIONS: Individual analysis of clinical significance provides valuable information in treatment outcomes and should be included as a standard practice in outcomes research.

Engagement in Behavioral Parent Training: Review of the Literature and Implications for Practice.

Engagement in behavioral parent training (BPT), including enrollment, attrition, attendance, within-session engagement, and homework completion, has long been a critical issue in the literature. Several estimates of various aspects of engagement have been suggested in the literature, but a systematic review of the available literature has never been accomplished. This review examines engagement data across 262 studies of BPT. Recruitment attrition, program attrition, attendance, and within-session engagement are examined across studies, with particular emphasis on the impact that SES, study purpose (efficacy vs. effectiveness), treatment format (individual vs. group), and age of child may have on those rates. Results of this review suggest that the significant amount of attrition occurs prior to enrollment in BPT, with at least 25 % of those identified as appropriate for BPT not enrolling in such programs. An additional 26 % begin, but drop out before completing treatment. Still the combined dropout rate of at least 51 % leaves at best half of identified parents completing treatment. While SES status had a small effect on attrition, other variables were not found to meaningfully impact engagement. Information on within-session engagement (homework and ratings of participation) was not often reported in studies. Key issues in this literature (e.g., varying definitions of engagement, limited attention to reporting key aspects of engagement) are discussed, and recommendations are made to further improve this important area of research and clinical practice.

Payment schedules do not affect attendance/completion of group behavioral parent training.

Though previous research suggests that attendance at individual therapy is not impacted by amount or source of payment for services, such research is relatively sparse and clinician concerns remain. The present study explores the connection between payment of fees and attendance at group treatments--a previously unexplored area. Participants in a 10-week behavioral parent training (BPT) program varied in timing of payment of fees as well as amount of fees based on income. The varying payment schedules did not affect attendance to sessions at which payments were due nor did payment schedules affect completion of the program. A small relationship was found between income group and attendance. The results are discussed in their relation to the larger literature on fees and attendance at psychotherapy.

Cleft lip and palate: association with other congenital malformations.

UNLABELLED: Orofacial clefts are frequently associated with other congenital malformations. Studies vary in incidence and types of anomalies. OBJECTIVE: To evaluate associated malformations in orofacial cleft patients at a major research hospital. STUDY DESIGN: Medical records of 1127 patients, in the Cleft Palate/Craniofacial Clinic, Boys Town National Research Hospital, from January 1980 through February 2000 were reviewed. Patients were divided into two categories: 1) cleft palate only (CP), and 2) cleft lip, with or without cleft palate (CL +/- P). Further categorization included location and type, if any, of other congenital malformations. RESULTS: 47.2% of patients had CP and 52.8% had CL +/- P. 32.2% of all cleft patients had associated congenital malformations. The orofacial region was the most common site, followed by cardiovascular central nervous, and skeletal systems. Congenital malformations were more common in CP (38.7%), than CL +/- P (26.4%). Of malformations diagnosed, 63.1% were chromosomal/syndromic anomalies while 36.9% were non-chromosomal/syndromic. CONCLUSIONS: Recognition of the spectrum of congenital malformations, associated with orofacial clefting, is essential for further diagnostic testing and in some cases genetic counseling.

College students' attitudes toward their ADHD peers.

OBJECTIVE: The attitudes of college students with and without ADHD toward peers with ADHD were examined. METHOD: A total of 196 college students (30 diagnosed with ADHD) anonymously completed four attitude measures. General analyses of attitudes toward peers with ADHD as well as comparisons between those with and without ADHD are made. RESULTS: For all participants, but especially for those with ADHD, more frequent contact with peers with ADHD was associated with more positive attitudes toward individuals with ADHD. Only half of individuals with ADHD report receiving adequate accommodations, and only half of those report actually using the available accommodations. Overall, more negative than positive adjectives were endorsed as describing individuals with ADHD, and this was especially true for individuals with ADHD in comparison to those without ADHD. CONCLUSION: Contact with other individuals with ADHD may be especially important for college students with ADHD.

Religiosity and coping in mothers of children diagnosed with cancer: an exploratory analysis.

Although several factors related to coping in parents of children diagnosed with cancer have been explored, little is known about their religious beliefs and behavior and its relationship to coping. The purpose of this study was to provide preliminary data on the religious beliefs and behaviors of mothers of children with cancer and the relation to their psychological adjustment. Twenty-seven mothers of children diagnosed with cancer completed several measures of religious beliefs and behaviors as well as the Beck Depression Inventory-II. The sample was highly religious and specifically Christian. Thirty percent of the mothers reported elevated levels of depressive symptoms, and these mothers reported lower levels of religious belief and behavior than the mothers who denied depressive symptoms. These data suggest a relationship between religiosity and positive coping behavior that should continue to be explored.

The reading grade level of common measures in child and adolescent clinical psychology.

The purpose of this article is to provide easily accessible readability information for 49 parent- and 35 child- and adolescent-report measures commonly used by clinicians and researchers. There is a great deal of variability in reading ability required across measures. The majority of parent-report measures (65%) required reading ability above the 8th grade level. The average child-/adolescent-report measure required reading ability above the 6th grade level. Given the potential contribution of readability to a measure's reliability, validity, and overall utility, examining and accounting for readability should be a more common practice in test construction and administration.