Using Time-out for Child Conduct Problems in the Context of Trauma and Adversity: A Nonrandomized Controlled Trial.

Importance: Exposure to adverse childhood experiences substantially increases the risk of chronic health problems. Originally designed to treat child conduct problems, parent management training programs have been shown to be effective in preventing children from being exposed to further adversity and supporting children's recovery from adversity; however, there are increasing concerns that a core component of these programs, the discipline strategy time-out, may be harmful for children with a history of exposure to adversity. Objective: To investigate the comparative benefits and potential harms to children exposed to adversity that are associated with parenting programs that include time-out. Design, Setting, and Participants: This nonrandomized waiting list-controlled clinical study was conducted at a specialist clinic for the treatment of conduct problems in Sydney, Australia. The self-referred sample included children with conduct problems and their caregivers. Eligibility was confirmed through clinician-administered interviews. Data were collected between February 14, 2018, and February 1, 2021. Interventions: Caregivers participated in a 10-session, social learning-based parent management training program. Caregivers were provided with parenting strategies aimed at encouraging desired behaviors through effective reinforcement and managing misbehavior through consistent limit setting, including the use of time-outs. Main Outcomes and Measures: The primary outcome was the parent-reported Strengths and Difficulties Questionnaire score, and secondary outcomes included subscale scores from the clinician-administered Diagnostic Interview Schedule for Children, Adolescents, and Parents. Multi-informant measures of child adversity were collected using the parent-reported Adverse Life Experiences Scale and the clinician-rated Maltreatment Index. Results: A total of 205 children were included in analysis (156 in the full intervention and 49 in the control condition; 158 boys [77.1%]; mean [SD] age, 5.6 [1.8] years [range, 2-9 years]). Compared with children with low adversity exposure, children with high adversity exposure showed greater reductions in the Strengths and Difficulties Questionnaire score from baseline (mean difference, 3.46 [95% CI, 1.51-5.41]; P < .001) to after treatment (mean difference, 1.49 [95% CI, -0.46 to 3.44]; P = .13) and in the internalizing symptom subscale score (baseline mean difference, 1.00 [95% CI, -2,00 to 0.00]; P = .50; posttreatment mean difference, 0.06 [95% CI, -0.82 to 0.94]; P = .90). No significant differences in the externalizing symptom subscale score were found. Conclusions and Relevance: In this nonrandomized clinical study, children with high exposure to adversity experienced equivalent, if not greater, benefits associated with parenting programs that include time-out compared with children with low exposure to adversity. Results suggest that time-out was an effective component of parenting programs for children exposed to adversity. Trial Registration: anzctr.org.au Identifier: ACTRN12617001472369.

The linearity of the El Niño teleconnection to the Amundsen Sea region.

El Niño Southern Oscillation (ENSO) drives interannual variability in West Antarctic climate through altering atmospheric circulation in the Amundsen Sea region (ASR). The El Niño-ASR teleconnection is known to be strongest in austral winter and spring, but its variation with El Niño amplitude is underexplored. This study uses experiments from the HadGEM3-A climate model to investigate the El Niño-ASR teleconnection for a range of imposed SST perturbations spanning weak (0.75 K) to strong (3 K) amplitudes. In austral winter, the El Niño-ASR teleconnection behaves linearly for El Niño amplitudes up to 2.25 K, but is found to weaken for stronger forcing (3 K). The anomalous Rossby wave source in the subtropical South Pacific increases monotonically with El Niño amplitude. However, a Rossby wave reflection surface originally located in the western South Pacific sector extends progressively eastward with increasing El Niño amplitude, reducing wave propagation into the ASR. The wave reflection surface is associated with curvature in the upper tropospheric zonal winds which intensifies as the subtropical jet strengthens under El Niño forcing. In contrast, the El Niño-ASR teleconnection in austral summer, which more closely resembles the Southern Annular Mode, is found to increase linearly for El Niño amplitudes up to 3 K. The results explicitly demonstrate that a linear approximation of the El Niño teleconnection to the ASR is reasonable based on the range of El Niño amplitudes observed in recent history.