3-hour timeout in school raises discipline doubts
An autistic child's parents want to curb the use of timeout rooms after watching a video of the incident in a Waukee elementary school
By JENNIFER JACOBS
REGISTER STAFF WRITER
August 5, 2007
144 Comments
Doug and Eva Loeffler stared at the videotape of their daughter.
It showed 8-year-old Isabel, who has autism, in a timeout room in her Waukee elementary school for more than three hours, even after she'd wet her pants and struggled to obey the rules so that she could be let out.
The teachers, who watched Isabel continuously through a window, placed her in the secluded, empty room because she didn't want to complete a reading assignment.
"It was more than shock. It was pure mortification," her father later testified during a legal proceeding. "We saw her hitting herself in the head. We saw her just looking like a wild animal, essentially, for well over an hour, someone who had just lost all control of herself and all hope."
The Loefflers immediately decided to pull Isabel out of school. Then they called a lawyer.
The Loefflers and the Waukee Community School District engaged in a 10-day hearing that focused on whether the school district failed to provide Isabel with public education in the least restrictive environment possible.
The administrative law judge ruled in favor of the Loefflers earlier this year, sparking attention from advocates in the autism field who hope it will persuade other educators in Iowa and across the country to curb use of seclusion and restraint.
The Waukee district and the Heartland Area Education Agency, which helped prepare the learning plan for Isabel, are adamant that they did nothing wrong and are appealing the decision.
The Iowa Department of Education offers guidelines for timeouts, but schools are not required to follow the suggestions. The Loefflers hope the department will use its rule-making powers to create legally required time limits on restraint and seclusion.
Timeout rooms common, often prove effective
Many experts - and the Loefflers - agree that timeout rooms can be effective for children with aggressive behavior, but only as a last resort, only for short periods, and only as a way to calm a child, not as punishment for not completing a task.
"We are not opposing timeouts as a concept in and of itself," the Loefflers' lawyer, Curt Sytsma, said during the administrative law hearing in the winter of 2006. "We are no more opposing them than we oppose salt in a recipe, but if you add a whole cup of salt, it's an entirely different matter."
School records used as evidence in the hearing show Isabel was aggressive at times - she kicked, spit, hit students and teachers, jumped on tables, and overturned desks.
But the Loefflers argued that Isabel's disruptive behavior was triggered and worsened because educators used restraints and seclusion to an extreme, with methods not based on peer-reviewed research. Records show Isabel was in timeout for 100 sessions between September and December 2005, for as many as five sessions in a single school day, and sometimes for an hour or more.
The educators believed they were working cooperatively with the Loefflers to provide an appropriate education for Isabel in the least restrictive environment appropriate, said Roxanne Cumings, Waukee's director of student services. The strategies they used were supported by education research, she said.
School, parents decide to videotape Isabel
Isabel enrolled at Waukee Elementary for the 2004-05 school year. Her teacher at her previous school in Colorado said Isabel was a pleasant child who made good progress in second grade.
She was never restrained by her teachers and was never placed in a timeout room, but she did have a hard time keeping her hands to herself.
Waukee educators placed Isabel in a classroom with nondisabled children for about 35 percent of her day. She'd spent about 75 percent of her school day with nondisabled students in Colorado.
For the 2005-06 school year, Isabel was switched to Walnut Hills Elementary with the same teacher and same one-on-one aide. After a few months, her behavior became "more intense," and the district and Heartland began working with the Loefflers to develop a new plan, Cumings said.
"It is difficult to find a balance that satisfies everyone, especially when a child's conduct can be disruptive to other students," she said.
Isabel's educators and parents agreed to videotape more than three hours of Isabel's day at Walnut Hills Elementary School on Dec. 7, 2005. Everyone wanted to analyze what was happening just before the girl's outbursts.
When the video begins, Isabel is seated at a desk in the timeout room, a concrete-block room formerly used for storage. Because the room serves as punishment, it's deliberately neutral in decoration and is sparsely furnished.
Teacher Patti Brinkmeyer asks Isabel to choose her own assignments. Isabel seems cheerful and eager to please. As the girl completes worksheets, the teacher encourages her with comments like "Good job!"
After about 20 minutes, school psychologist Monica McKevitt comes to help with reading. She calmly tells Isabel three times she needs to keep working. Isabel loudly says no. McKevitt tells Isabel she has chosen a timeout.
Isabel climbs up on her desk, then jumps down and flops on the floor. Two teachers whisk all the furniture out of the room.
Almost immediately after the door is shut, Isabel folds her legs and sits quietly. She clearly knows from past timeouts that she has to prove she is ready to focus on her next activity by sitting cross-legged on the floor. Her learning plan calls for five minutes.
Isabel says she has to go to the bathroom. A teacher, watching through a small window, says no. School staff later testified that students sometimes use the bathroom as an excuse to escape punishment.
Before the required five minutes are up, Isabel gets restless and crawls across the floor. The teacher starts the timeout all over again.
Isabel returns to the proper sitting position, called "body basics," at least 10 times for two to four minutes.
Whenever she fidgets, the clock stops and she has to sit for another five minutes straight.
At times, Isabel looks like she's playing. At times, she looks uncomfortable. She struggles to open the door. She pounds on her head with her fist. There are sounds of children going about their school day outside her concrete room.
By the end of the day, she has wet her pants, has lost her temper and has gone ballistic, her father said.
That night, the teacher, the school psychologist and Principal Deb Snider watched the video together, brainstorming what to do better the next day, including shortening the length of time Isabel had to sit to prove she was ready to go back to her studies.
The Loefflers watched the video later and decided to pull Isabel out of the school.
"What kind of killed us is that she tried so hard to get out of it," Doug Loeffler said in an interview. "She's sitting on the linoleum and then they say, 'Oh, you moved,' and you can hear her sigh. She was literally physically incapable of getting out of that. It became counterproductive."
Timeouts can be helpful, some experts testify
Autism experts watched the video before testifying at the hearing.
Keith Allen, a professor of pediatrics and psychology at the University of Nebraska Medical Center, testified that the preferable duration for a timeout is between 30 seconds and four minutes. Timeouts beyond 30 minutes are not effective as a behavior-changing technique, he said.
Vincent Carbone, a New York-based behavior analyst who has designed learning environments for autistic children for more than 30 years, testified that school timeouts can be appropriate at times.
But if the procedure isn't used effectively, it's predictable that a child will respond negatively. Isabel's reaction didn't surprise him, he said.
Kevin Took, a psychiatrist at Blank Children's Hospital in Des Moines, said he deals with children who have been severely traumatized.
Took testified that he did not see anything traumatic about Isabel's videotaped timeout, even though she wet her pants. Urination and defecation are fairly common issues with children with autism spectrum disorders, he said.
"I will say it made me uncomfortable watching it," he testified. "I think sometimes that the timeout process seemed to go - I kept wanting to say, 'Gosh, let her out. Why is it, you know, taking so long?' "
Isabel's behavior becomes aggressive
The Waukee and Heartland educators testified that they kept the Loefflers updated on Isabel's progress and punishment. They sent a notebook home each day. Eva Loeffler, who walked her two daughters to school, spoke with the teachers regularly. The teachers e-mailed Doug Loeffler.
The teachers tried all sorts of strategies, including giving Isabel "sensory breaks" where she could skip in the hallways, listen to music, jump on a trampoline, or have Junie B. Jones books read out loud to her.
But in an effort to help her become a functioning member of society, they also set high standards for her.
Sue Seitz, a lawyer for Heartland, which serves 1,300 students with characteristics of autism, said during the hearing that the educators did their best to keep Isabel in her neighborhood school.
"In most cases, this child would have been removed and put in a special school," Seitz said.
The teachers, at times, dealt with Isabel's aggression by using hand-over-hand, a strategy the administrative law judge called controversial.
Hand-over-hand is a prompting technique in which a teacher guides a student's hand until she understands, for example, how puzzle pieces fit together or how to write a letter of the alphabet.
At first, if Isabel refused to complete a worksheet, her teachers would help her do it using hand-over-hand.
But as time passed, they used the technique if Isabel refused to do any task.
Isabel resisted, and it became a physical battle.
The teachers' notes show they used up to three staff members to hold her in her chair while a fourth teacher forced her hand to color. In at least four episodes in November 2005, hand-over-hand continued for more than an hour while Isabel insisted throughout that she could color by herself, records show.
"Even if this worked and produced some sort of good for the child, we would have opposed it," Sytsma said during the hearing. "The girl is being exposed to aggression. She is learning aggression and she is reacting to what is happening to her."
Isabel's behavior disintegrated during the first few months of the school year.
One September day after she was aggressive with students in gym class, she was placed in timeout in a conference room. She threw chairs and climbed on tables.
She spit at the teachers restraining her. The judge noted that she hit passing students as she was walking to timeout.
During two days in December, the teachers logged nine incidents of aggression, "the likes of which had never, ever appeared in this young lady's history at any point in time," Sytsma said during the hearing.
On one day, Isabel hit the girl who was assigned to sit next to her. That girl later approached her desk to get something, but was to scared to be near Isabel. The girl was shaking and "absolutely terrified," a one-on-one aide testified.
What's next for state, Waukee and Isabel
Barb Rankin, who heads Heartland's challenging behavior and autism team, said she thinks all the educators did what they thought was in the best interest of Isabel - and the other children.
"In hindsight, are there things we might change? Absolutely," Rankin said. "After her first day, some things were changed."
Meanwhile, many school districts in Iowa have timeout rooms, she said.
"I can't say exactly what percentage, but it's a very high percentage," Rankin said. "In some they're being used appropriately - and some of them less appropriately - to keep the child safe and other children safe and staff safe."
Timeout rooms sound archaic, but they are an acceptable practice, according to Sue Baker, autism services consultant for the Iowa Department of Education.
However, educators must carefully monitor whether the technique is actually benefiting a child, she said. They should ask: Does seclusion calm the child so that afterward he or she can come up with the right answer? Strategies, and success, vary with each child, Baker said.
"That's why you can't go, 'Oh yes, that's our state rule on timeout,' " Baker said. "It's so individual."
The judge's ruling would have forced the district to educate Isabel differently, but Doug Loeffler recently left his job as an investment consultant with Principal Financial Group and moved his family to California.
As a result, Waukee is not bound to change the way it uses timeout rooms.
Because it was an administrative hearing, the Loefflers cannot seek damages, although they could seek reimbursement for their $80,000 in legal fees. They also have the right to sue for damages in civil court.
There was no penalty for the school district.
Isabel's experience in Waukee has left her unable to tackle a full day of school, her father said.
This fall, Eva Loeffler will homeschool Isabel, now 11, and she'll go to school for short sessions. Isabel's parents hope to gradually add hours as she becomes comfortable with the staff and the environment.
