MCQ Psychiatry Solution 42

The correct answer is D.


The purpose of the time out is to remove the girl from stimuli to facilitate the extinction of unwanted behavior. To be effective, time out must be used consistently and predictably. If the child protests during a time out, as in this case, additional time is added to the period to extinguish the protest behaviors. The goal is to convey the clear message that the time out will be ended only when unacceptable behaviors are ended.

To impact behavior, the intervention must be closely associated with the behavior. To delay in responding to the girl's protests (choice A) makes it harder for her to realize that the additional time is a direct consequence of her behavior.

At age 3, reasoned, rational explanations (choice B) are unlikely to have any impact on the child's behavior. The child probably lacks the cognitive capacity to grasp the abstract rationale for why she is being disciplined.

Paddling (choice C) is a type of attention, and can actually reinforce the behavior the parents are trying to extinguish. The child learns that protestation will bring the parents and their attention, even if it is negative attention. In addition, as a general rule, any response option on the USMLE exam that has someone hitting a child will almost certainly be scored as a wrong answer!

This option encourages the child to cry and then demand a treat to become quiet (choice E), a kind of juvenile blackmail. Avoiding bad behavior is a baseline and need not be specially rewarded.

Category: Psychiatry MCQs