Tag: fear

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behaviorally inhibited temperament exposure ladder

My struggle with balancing anxiety treatment and life

Sometimes dealing with anxiety (or a behaviorally inhibited temperament) can feel like a losing battle. You finally address one fear and five more pop up. There are many days when I wonder, “how much fear-facing is too much?” How should I weigh “encouraging bravery and working on fears” with “accepting my child as-is and building a positive, loving relationship”? Experts would say those two goals are the same and do not need to be balanced, especially when you look at the big picture of a person’s life. But every parent of an inhibited child knows that those two goals come into conflict daily. Crying, tantrums, resistance, and abject terror on your child’s face are just some of the possible outcomes of facing fears, even in controlled environments. These behaviours are physically and emotionally exhausting for both the caretaker and the child.

Facing fears is extremely hard. I often wonder how many psychologists and therapists have used cognitive behavioural therapy and exposure therapy to face their own worst fears? I first learned about this treatment when I used both therapies for a medical condition and associated phobia in my twenties. I spent 2 hours per day on meditation, mindfulness and thought records, and then worked on the exposure ladder. I chose each step and set the timeline and rewards. It was incredibly difficult and time-consuming. For the specific phobia, working through the exposure ladder was one of the hardest things I have ever done. I know the physical and emotional toll it takes to face a fear using these methods. This is one of the reasons why I balk at the idea of continuous and constant exposure for inhibited children.

I mentioned my daughter’s tendency to avoid busy play-gyms to the psychologist and she told me, “oh no, you can’t avoid play gyms. You need to go to them.” And I thought, why? I hate them too! They are loud and over-stimulating. Many of the children are poorly behaved with caregivers sitting on the sidelines with their faces in phones ignoring their child who is grabbing toys from anyone within reach. As the gym filled up with more and more children, my daughter stopped moving, looked at the door and walked towards it. I would have had to physically restrain her and have her cry to keep her in the gym (or reward her a lot!). Then, would I have to decide how long before we were “exposed” enough? I could set up an exposure ladder with rewards to achieve a cry-free extended play-gym experience. But is this worth it? I don’t know. I know that I do not like big groups of my peers at busy bars and pubs (the adult equivalent to play-gym?). I do not want to go to a party and make small talk for hours. I am happy and content with my life. I love being a mom and I am a good scientist. I like getting together with close friends. I like being with bigger groups of friends and family on special occasions. I got to “work” my friend’s wedding and I had a blast. I felt useful while still being in the hustle and bustle celebrating my friend’s big day without having to make small talk continuously. I help others and get a lot of joy out of my interests like baking and sewing. So why does my 22-month-old need to survive play gym?

The psychologist would probably agree that there needs to be balance, but when I read information about anxiety, there never seems to be a balance: the recommendation is exposure, exposure, exposure. And the research seems to support this. Researchers have shown that anxious rat pups (baby rats) exposed to novelty early in life became less anxious adult rats compared with control (unexposed) pups. A human child might be less inhibited as an adult with forced, continuous exposure therapy in early life, but at what cost? I do not think science and research has an answer for me. Those mother rats never had to endure tantrums from their exposed pups, and those rat pups did not cry when the researchers picked them up and removed them from their mom (or maybe they did!). And when they were adult rats, we have no idea if they still “loved” their mom and had a positive attachment to their mom. Unlike mother rats, human parents weigh the benefits and consequences to find a solution that works for their family. This might mean exposure, exposure, exposure. But it also might mean some exposure and some avoidance to make space for other non-fear related positive child-parent interactions because there are only so many hours in the day.

The bias underlying anxiety treatment (and the associated research) is that uninhibited, social traits are preferred over all other personality traits [more info]. As an introverted, inhibited, shy person, that slant feels wrong to me. Our strange existence in the pandemic has given me pause to reflect on anxiety treatment and exposure and I am still working towards finding a balance for my daughter and me. I found great success with the elevator exposure ladder, but would I want to do this every day for every fear? No. I am taking a page from Ross Greene’s book Raising Human Beings, and prioritizing my daughter’s fears. I do not need to tackle them all. She does not need to tackle them all.

In my next post I discuss behaviour modification and my mostly hate relationship with this ubiquitous parenting strategy.

The Good in Inhibited Children

After I wrote this post, I started reading an evidence-based book, The Orchid and the Dandelion by W. Thomas Boyce. The author weaves his personal family history with research findings related to inhibited (orchid) and uninhibited (dandelion) children. He creates a story that describes the challenges of having an inhibited temperament and the unique opportunities to nurture great beauty in the child. It is the first writing that I have come across that explicitly states research-backed positive traits of an “orchid” child. I will provide an update when I finish the book.

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behaviorally inhibited temperament play-it-out re-enactment

Play-it-out

Image by Bruno /Germany from Pixabay

In my previous post, I discussed some of the strategies that my partner and I used to help our daughter with specific aspects of her anxiety that were exhibited before 2 years of age. Most of those strategies were developed in response to her actions and were not based on any treatment or specific anxiety knowledge – just our best guess of how to cope in the moment! In this post, I will discuss one of our earliest “informed” strategies that is broadly applicable to general anxieties from the past, present and future and continues to have great impact in our daily life. I titled this strategy “play-it-out” and it is the manifestation of my husband’s and my interpretation of a few sections from the book The Whole Brain Child by Daniel Siegel and Tina Bryson.

The Whole Brain Child has wonderful information. The brain science is fascinating, and the “comic” descriptions of the various strategies were very useful. Of interest to my husband were the sections on storytelling to integrate the left and right sides of the brain (Chapter 2, Strategy 2) and on memory integration with events (Chapter 4, Strategies 6 and 7). Integrating the left and right sides of the brain works to link facts and details (left) with feelings and emotions (right). Through storytelling, the child names the event and is then better able to move towards taming the feelings for future related events. This strategy conveniently involves memory integration, in which we remember the event and associated feelings such that the feelings are explicitly connected to the event instead of floating around disconnected. Floating feelings can become attached to unrelated events, causing phobias and fears that, from an outsider’s perspective, appear to have no origin.

For example, a young child is bitten by a dog. The child cries and eventually recovers and the days and weeks (maybe months) pass. Eventually, the child fears cats, birds, dogs, and various animals. You might reassure her that the animals are friendly, safe, and more afraid of her than she is of them, but nothing you say seems to change her fear. What happened? The dog-biting event created a feeling of fear in the child. By effectively ignoring the event (i.e. allowing “time to heal all wounds” and “memory to fade”), the disconnected, floating fearful feelings attached themselves more broadly to many animals. No reassurances will fix the problem because the reassurance does not address the original dog-biting event. At this stage, a brave story and exposure ladder could be used to help the child face the fear. What could the parent have done differently to possibly prevent this phobia from developing in the first place? After the dog-biting event, the parent can talk to the child by describing the event and naming her feelings and experience. In the days and weeks that follow, the parent can help the child tell the story (if the child is verbal) and even re-enact it with stuffed animals. This creates a connection between the fear and hurt with that specific dog-biting event. If the dog was unfamiliar, then your child will probably never see the dog again and that will be that. If the dog was familiar, the child will still probably have some lingering fear about that dog in future situations because that dog really did bite her! She will need many positive interactions before she can “trust” the dog again. And of course, she may need more explicit instruction on how to safely interact with that dog (and all dogs). That is normal. But, hopefully, she will not develop a phobia of all dogs from the single dog-biting incident.

As you probably guessed, my daughter was that child that was bitten by a strange dog (without teeth!) when she was 12 months old. After the bite, she did not cry, there was no blood or cut and I did not think it hurt. I ignored the situation since she appeared to be fine and thought, “oh well, her memory will fade”. But I was wrong! She was terrified of dogs for the next 8 months and at 3 years old rarely pets a dog and has a look of terror on her face if a dog comes towards her. As soon as I read The Whole Brain Child, I knew I hadn’t handled the dog-biting event well! The problem is that I did wait long enough for the memory to fade so now I am not sure if there is any point in describing the original event as it would be completely unknown to my daughter. Just as predicted in the book, the feelings attached themselves to all dogs (luckily, they did not attach themselves to cats or birds – look out Goose, my daughter is coming for you!). Now I am faced with a phobia treatment with a story and exposure ladder. However, her dog fear is low on my fear-conquering priorities, so it is on the back burner for now.

After discussing the left-right brain integration and memory integration, my husband implemented our new “play-it-out” strategy to link our daughter’s emotion with an event. For example, our very active daughter liked to spin in our small living room with hardwood flooring and various pieces of furniture. Inevitably, she would fall and impact something and burst into hysterical crying. I held her and witnessed the tears and provided words for the experience, “ouch, you had a tumble. That hurt. You are sad. It’s ok to be sad and cry.” Eventually, she stopped crying and my husband used her large stuffed penguin (which was about her size!) to re-enact the event. He showed her with the penguin how she fell (trip, face-plant, etc.), what she hit (foot stool) and where on her body she hit (head). He repeated the process as many times as she asked. She was enthralled after the first time! Often, my husband re-enacted the event himself and then our daughter re-enacted the re-enactment at slow speed, complete with a fake fall! We did this repeatedly. Sometimes, we did not see the event and could not re-enact it accurately. Instead, we first asked her what part on her body hurt. She might point to her knee and then we guessed what she impacted “might this have happened? Or maybe you hit this?” She might grunt (which was her sound for yes). And then we re-enacted what we thought happened. Now that she is 3, she often points or describes which part on her body is hurt and then she will sob into my chest and mumble “show [me] what happened”. The re-enactment is now part of her healing process! She stops crying almost immediately when Daddy re-enacts the event. Not only are we integrating events, feelings, facts and memories, we are also changing the unknown into the known, the exact root fear of people with anxiety! So much of what is scary about falling is not knowing how or why it happened and then not knowing how to prevent it in the future!

The next aspect of the play-it-out method is performing oral stories and plays to address previous anxiety-inducing incidents (like a dog-biting event!). After nap time, I used her stuffed animals to ask her about her morning. Usually, she did not describe anything, so the animals asked me, and I provided a few details. The animals continued to probe but, unfortunately, my daughter’s language is a little delayed and she just did not have the words, so I typically recounted the incident in as factual language as possible. The animals asked questions and expressed feelings and concerns. For the first storytelling, the animals acted as an interested audience to the story and then transitioned into play. For retellings of the story, the animals acted out an analogous story and showed the expected/desired behaviour with possible ideas and solutions that my daughter could use the next time she found herself in that situation.

For example, during one of our first days at a parent and tot forest school when my daughter was 2 years old, another child walked up to my daughter and pushed her over. It happened fast. My daughter and I were both shocked. I was so busy trying to assess the group of kids and help my daughter stand near the group without freezing that I was not anticipating a direct knock-out! My daughter burst into tears and I provided comfort and eventually we carried on with the class. That day after nap, I began my storytelling. My daughter was visibly upset about the situation. We talked about how the other child was having a hard time that day and she was feeling mad. It was wrong of her to push. It was surprising and unexpected. We moved on to play as I did not want her to dwell on the event and I hadn’t actually thought of what the best strategy was moving forward! Even Mommies need time to think. In subsequent retellings, the animals suggested that my daughter say, “no” or “ouch! That hurt! Don’t push!” (I would have been lucky to have her make any sound directed towards another child, so it was a bit of stretch to suggest speaking. I was hoping for the “no”). For my part, I decided that I needed to be more upfront with the other child. A week later, we attended the next class and as the other child made another beeline to my daughter, I stepped forward and said (in the most enthusiastic, cheerful voice I could muster), “Hello, Jill, I like your whistle.” This preemptive invitation to a friendly interaction paid off. The child stopped moving towards us and looked at her whistle. Then I pointed out my daughter’s whistle. Then, the teacher started talking and we avoided a negative interaction. After a few more classes with forced Mommy-induced positive interactions, the other child had settled into forest school and I no longer needed to head her off at the pass! We retold the pushing story almost daily for weeks (usually from my daughter’s prompt). But by the end of forest school, my daughter talked about this other child in a positive way and included her in our “forest school play” at home. The other child was now referred to as a friend who rolled down hills and was a highlight of our forest school experience. The play-it-out method not only integrated her memory and feelings with the single pushing event but eventually, allowed my daughter to think more fondly of this child as we talked about her many positive attributes in our stories.

Another example is when my daughter was afraid of her little cousin who had learned to crawl! From an adult’s perspective, it was a funny scene: my 18 month old 80th percentile-size toddler slowly backing away and saying “no” with a sheer look of terror on her face from an army-crawling 10 month old 10th percentile-size baby. The little Crawler was desperate to get closer and touch my daughter and my daughter would repeatedly say “no” and fall into my lap and scramble up my body to get away from the little Crawler. My daughter could not focus on any activity if the Crawler was in the room. The only time she appeared to feel safe was in the highchair where the Crawler could not reach her. I used the animals to re-create the situation, and the animals came up with different ideas to cope with the little Crawler, like climbing onto the couch, giving the Crawler a toy, or having a snuggle with Mommy. After performing this play many times, my daughter started giving the Crawler toys, unprompted! It was amazing. My daughter still had great fears and concern about her little cousin. But, as we talked about more ideas (like Mommy will make sure everyone has food, since my daughter would be in a panic that the Crawler would eat all her food) and helped each of them have positive interactions, their relationship has grown to have more and more positive interactions. Now that they are 3 and 2.25 years old, they both speak in their own limited language (which does not overlap that much!) and “argue” about everything like whether it is raining. Whatever choice one makes the other makes the opposite, regardless of the weather or the truth. The little cousin always offers help when my daughter is upset and although my daughter still refuses that help, she occasionally offers hugs to her cousin when she is hurt!

In my next post I will discuss my struggle with balancing anxiety treatment and fears with life enjoyment.

Categories
behaviorally inhibited temperament

Seven strategies to use with young fearful children

As I witnessed the various atypical behaviours from my daughter (a selection of which are listed in the previous post), my partner and I started developing solutions. We fine-tuned our strategies as we read more articles and books. Here are some of the most successful solutions that we used from when our daughter was 7 months to the present time. 

  1. Our basic “discipline” guidelines and strategies came from reading Peaceful Parent, Happy Kids by Dr. Laura Markham. This positive parenting method has nothing to do with anxiety, but we found it a useful approach for coping with the regular trials of parenting (conflicts!). Markham describes an approach to discipline called “Empathic Limits”. In brief, discipline starts from a place of connection or attachment between parent and child [more info]. Then, the parent sets and enforces empathic limits using these steps:
    • Get down to the child’s level (with eye contact or physical touch)
    • Join with the child, “It looks like you’re having fun throwing sand”
    • State your concern, “I’m concerned someone is going to get hurt”
    • Use calm, kind, empathetic words as you set the limit, “I do not want other people getting hurt with sand, so let’s find a different way for you to use the sand now.”
    • Acknowledge her point of view as you set the limit, “It’s hard to stop what you are doing. But it’s time to find something else to do.”
    • Whenever possible, offer a choice, “Do you want to drive the truck through the sand or play on the slide now?”
    • If needed, calmly enforce an action, “I see you’re having difficulty safely playing in the sand where our friends are playing too. We are leaving the park now. We can try again tomorrow.” (aka “bring on the crying!”)
  2. For the long period of time when my daughter would “freeze” on the sidewalk and stare at another person until she burst out crying, I tried to “catch” her before the freeze by touching, talking and picking her up to comfort. Some people might think that this is rescuing behaviour which can actually make anxiety worse in the long run, but I thought it was more important to prevent the “freeze” response. My goal was to stop her brain from entering the freeze/fight/flight state, in which her brain and body would be overwhelmed by stress. I wanted my touch, words and voice to still have some influence before her automatic primitive brain took control. In hindsight, this “catching before the freeze” could be an early rung of an exposure ladder for an eventual goal of greeting our neighbours. Each step of an exposure ladder requires the anxious person to control their behaviour and commit to the step. If their brain is overwhelmed by stress and in a fight/flight/freeze, they are not in control. At 3 years old (and under pandemic conditions), my daughter rarely enters the freeze/fight/flight response. She will say, “no” and be resistant to novelty but she typically will not become paralyzed with fear anymore.
  3. A second strategy we employed for passing people on the sidewalk was to hold my daughter’s hand while we passed someone and label the person as a “kind neighbour out for a walk like us”. Usually, she did not like holding hands but when passing another person, holding my hand gave her the safety and comfort she needed to keep moving forward. The more times she walked by people without stopping (and freezing), the more times she experienced nothing bad happening! Although holding her hand does not directly address her fear of other people, the act of walking past people reinforces the tangential idea that there is no threat on the sidewalk. In addition, by labeling the person as a kind neighbour out for a walk, I created a familiar connection of someone being kind. This was a concept we had already celebrated when we first met a “kind doctor” when my daughter had a potential UTI. As well, it was a commonality between my daughter and the neighbour: they both like walking! At 3 years old, we still talk about neighbours walking in the neighbourhood and we practice brave talking.
  4. Bring a comfort toy (lovey) to all outings. I used this strategy based on our sleep consultant’s suggestion to provide an object that can be used to self-sooth for independent sleep and I was trying to create an attachment between my daughter and the object. It was so successful for sleep, comfort and soothing that I kept using it for general comfort for anxiety behaviours that typically occurred in social settings. Many people envision Charlie Brown’s Linus and his seemingly disgusting blanket being dragged around in perpetuity when they think of a child and her “lovey”. And in some respect, that’s true! (It’s good to have multiple loveys so they can be washed!) The lovey was one of the only things that allowed my daughter to calm when she escalated to fearful crying after freezing. Due to her sensory processing differences, my daughter dislikes being held, touched, hugged, etc., except on her terms, so having a lovey gave her comfort when hugging an adult was not helpful. At 3 years old, she brings a favourite toy outside and rarely uses it for comfort, but it is there if she wants it. She has loveys inside that still provide lots of comfort and joy. Maybe she will always have something soft to snuggle as she gets older. She may always need a lucky “rabbit’s foot” for comfort and I would rather she have a comfort object than to seek out food, cigarettes, drugs and alcohol to fill that need. Is Linus really so bad?
  5. Use a “brave” phrase to encourage my daughter to physically move forward: “1, 2, 3, go”. She would say this phrase at the top of a slide and then push herself forward, at the edge of a field to start running, and to continuing walking on the sidewalk before entering a “freeze” state. This was surprisingly successful. My partner and I would say the phrase and smile and encourage her to come forward and eventually she started saying it. I would even hear her whisper it and I could see her using it as a self-motivation tool. We have just recently returned to using mostly empty playgrounds since the pandemic and for the first few slides, I heard her counting to herself before pushing off! She no longer uses it for walking or running – she just walks and runs!
    • Note: Many inhibited children are also physically timid. When I described my daughter at almost 3 years old to the public health nurse, the nurse was shocked that she jumps, climbs, runs, rides a scooter, and rides a push bike. She was surprised my daughter was so physical. Since she was 7 months old, I have spent a lot of time at local parks and playgrounds every day. We were often the only ones there in the morning rain or shine. This allowed me to encourage physical bravery and physical movement without the inhibiting social factors of other children in busy playgrounds. She built confidence and had a natural interest in going fast, moving her body, and getting from one place to another. When we would go to busy playgrounds, she moved less, observed more and I had to “hover” much more because if she froze, she might suddenly let go of a ladder or swing or walk off a platform. But, as time went on and her confidence built, she was able to physically move past other people because she had enough muscle memory and confidence to keep her body moving even when her mind was in a state of stress.
  6. Lisa went through a few phases of being afraid of various slides and of sliding too fast. We showed her strategies of slowing herself down by using her hands and feet or by sliding on her tummy. As she went down the slide with a strategy, we would describe what she was doing and how she was controlling her speed. This gave her confidence that she was in control and she was safe. Eventually, she started sailing down the slides at full speed again!
  7. Modelling expected behaviour for child-to-child interactions. At busy play gyms or play spaces, I try to intervene with other children just prior to a physical altercation (which would then put my daughter in freeze mode). I spoke the words for my daughter saying things like, “No, my turn” or “I want to get out”, and I would describe to the other child what was happening, “She is using this toy. She is having a turn. You can have a turn when she is finished” or, “She is trying to get out of the house”. My daughter still has trouble speaking to others, but she is able to say these types of phrases to her cousin and she started turning her back to show kids at play gym that she was still using a toy. It’s not the ultimate behaviour I want, but they are steps in the right direction: remaining in control of her brain (staying out of the freeze state), using her body in a coordinated manner to express possession/turn-taking through body language, and starting to use appropriate phrases with another child in a low-anxiety setting.

You might notice that the outcome from some of these strategies does not meet your expectations for your child. You may feel strongly that they should not carry a stuffed animal when they are school-aged. And I completely understand why! Kids who are different are more likely to be teased and bullied at school. Unfortunately, your kid is who they are. You can try to change them into something else, but somewhere along the line that will probably backfire through rebellion or a poor parent-child relationship. However, you could prioritize weaning from a lovey at social settings like school and develop a story to help your child willingly leave the lovey at home. There are a few ideas to keep in mind when you think about your child’s behaviour and your expectations: are your expectations reasonable for your child’s age and developmental stage (i.e. make sure you are expecting typical or normal behaviour at the most, not advanced behaviour)? Are your expectations reasonable for your child’s inherent personality (given you may have an inhibited child, should you adjust your expectations)? If your child is not meeting many expectations, what are the priorities? Answering these questions may help you decide which goals are important and which ones you will let go of, for now.

In my next post, I will describe our play-it-out strategy that has evolved into a useful multi-purpose tool to help us process past events and prepare for the future.

Secure attachment and attachment parenting

Secure attachment between child and parent is now recognized as one of the most (if not the most) powerful and important influencing factor on a child’s wellbeing. Attachment has been tested by researchers using the “Strange Situation” experiment. The results of the experiment indicate whether the child is attached and how they are attached to the parent. In fact, the first thing our child psychologist did when she met my daughter and me was to conduct a version of the “Strange Situation” to confirm that we were attached. The psychologist said that there was no intervention for anxiety or any other problems that could be administered without attachment. Attachment appears to be generated through responsive parenting during infancy and babyhood. It is not simple to define exactly what behaviours the parent needs to exhibit to create attachment. There are many roads to having an attached child.

Attachment parenting is a parenting philosophy first proposed by Dr. William Sears with basic advice about how to parent with the goal of creating a secure attachment between parent and child. The problem is that the specific strategies are not all supported by research as necessarily creating secure attachment. Unfortunately, much of the advice can end up creating unnecessary stress on the parent-child relationship when the parent, for any reason, doesn’t follow the advice (i.e. vaginal delivery, breastfeeding, baby-wearing) and instead feels guilt, shame, and anxiety about not doing what Dr. Sears recommends. For some reason, this parenting philosophy seems to have created a militant following, such that there can be associated parent- (usually mother-) shaming if you don’t do attachment parenting. If you strongly support Dr. Sears’ attachment parenting philosophy and it has worked for you, that’s wonderful, but it is not the only way of creating a secure attachment with a child and for many parents and children, other strategies are more successful at creating a secure attachment and maintaining the parent’s mental health.

This article is a great summary of the differences between secure attachment and Attachment Parenting by developmental psychologist Dr. Divecha. This article is a summary of how a parent can create a secure attachment with their child and provides an interesting comparison between “secure attachment” and “bonding” (terms that are often incorrectly used interchangeably).

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brave story exposure ladder

Brave stories and exposure ladders for anxiety: a fear of the bike trailer

After great success conquering my daughter’s elevator fear, I was eager to try this method again. Conveniently, when you are around two 2-year-olds, there is always a fear that can be addressed. This is the story of how I put my 2-year-old niece in a bike trailer and thought everything was going great until an extremely fearful tantrum showed me it was not going great at all and I needed to slow waaaaaay down.

The weather was getting better and better and I wanted to start biking my daughter to the beach and forest. My husband and I decided to take my niece with us on our forest adventure. My husband rode his bike and I rode our e-bike pulling a double bike trailer to my sister’s house. I picked up my niece and started talking enthusiastically about going to “Turtle Pond” (a forested park with a pond that is a 5-minute bike ride from our house). My daughter has always loved the bike trailer and bike seat and she was sitting patiently in the trailer when I popped my niece in and away we rode. We had a great time playing in the forest. After dealing with my daughter’s meltdown right before we needed to leave Turtle Pond, I was trying to get the kids buckled in as quickly as possible so as not to be late for nap time. My niece was having none of it. She physically resisted (which is hard because she is tiny and slight with minimal muscle strength). I could have physically forced her into the trailer, but that is a parenting method I try to use very rarely. I stopped, pulled back, and talked to her about going to see her mommy. She said she wanted to drive back. I explained there was no car; this was the only way home. She continued to resist. Eventually, I think she misunderstood what I said and was somehow convinced to get into the trailer, but as soon as I secured the buckles she started screaming. The look of desperation and fear on her face was unmistakable. She screamed to be let out. And of course, just our luck, it was also raining so I zipped up the rain cover on the trailer making it even more of a constrained box. Thankfully, my daughter did not break down through all of this and sat their quietly (her meltdown came later!). Anyway, I looked at my husband with pleading eyes, thoughts whirling around: I do not want to bike this scared child; she is terrified; it is almost nap time, she’s probably tired and I have no other way of getting her home in a timely fashion. My husband convinced me to start biking and immediately she calmed down. Ok, I thought, maybe she did not know what the bike trailer was all about. This is fine. My husband played “peek-a-boo” with her during the ride home and got some smiles. I dropped her off and explained what happened to my sister in case my niece needed to “release her emotional backpack” in the form of a good cry again.

You can guess what happened the next time my husband and I tried to take my niece on an adventure. No dice. I had already told my husband there is no way I was going to strap a screaming Niece into the bike trailer. When there is so much fear going on, that fear needs to be addressed on her timeline, not mine. I do not agree with “sink or swim” methods as I think this can lead to phobias and I think it is disrespectful of the child as a human being [more info]. Instead, I took a step back and realized I needed to make a Brave Bike Trailer Story and exposure ladder. I also needed to figure out what exactly was fearful about the bike trailer from a limited-vocabulary, minimalist speaking 2 year old. Luckily, these things became evident one day during a walk. My niece said to my sister “tight” and “bump”. In a bit of context, we discovered that my niece was afraid of bumps in the bike trailer and the tightness/constraint of the straps. I included these two specific issues in the brave story (at the time, I knew the straps were an issue but I didn’t realize the word “tight” was related which is why it is not included in the story).

We read the story and started the exposure ladder:

  1. Read personalized story (reward: none)
  2. Bring bike trailer to front door for investigative play (reward: verbal encouragement)
  3. Bring bike trailer on walk to park for investigative play (reward: verbal encouragement)
  4. Offer ride in bike trailer used as a stroller (no buckles) (reward: book in trailer)
  5. Go over bumps in stroller-mode (no buckles) (reward: verbal encouragement)
  6. Ride in bike trailer for adventure with Mommy (reward: book in trailer)
  7. Goal: Ride in bike trailer for adventure with Auntie A (reward: book in trailer)

We stalled on step 2! Unlike my daughter, my niece had absolutely no interest in investigating the bike trailer and playing with the zippers and buckles. My daughter still spends many minutes sitting in the trailer buckling in her stuffed animal and zipping the zippers and asks to play in the trailer every time we use it. My niece could not have cared less about the trailer. I tried step 3 and there was minimal interest from my niece. She did not care about this trailer coming with us to the local park; she cared more about looking for bugs than zipping zippers. The next idea I had was to encourage her to sit in the bike trailer for a snack and I rewarded her with a chocolate chip. This worked, but I did not want to make this a habit since I do not allow my daughter to eat in the bike trailer. From this non-step, I discovered that my niece would get in the trailer under the right circumstances and she feels proud of herself for accomplishing brave tasks. Her smile was huge, and she clapped when I stated how brave she was for sitting in the bike trailer even when she felt scared.

My next idea was to use books as an enticement into the trailer. Unlike my daughter, my niece LOVES books. All she wants to do is have someone read books to her and she is also thrilled to flip through books alone. So, I collected a few small board books and put them into the trailer on our next walk. My niece walked along without so much as a glance towards the trailer. My daughter saw the new books and jumped into the trailer. This was finally the scenario that convinced my niece to get into the trailer. I decided not to secure the straps and just slowly pushed the trailer with the kids looking at the books. At the end of the walk, I specifically pushed it over some small “off-road” grassy bumps. I ended up combining steps 4 and 5 and we had success. I found new books for step 6, and with a beach destination my niece was excited. We set up the bike trailer, showed her the books, explained where we were going, and she jumped right in! We finished off the exposure ladder by leaving Mommy at home and now my daughter and niece happily ride in the bike trailer together reading books and singing songs.

I am relieved I did not force a screaming Niece into the bike trailer. Taking a step back and seeing the situation through her eyes and addressing her fears allowed us to move forward in a positive way that ended up right where I wanted her (able to ride in the bike trailer) and, more importantly, gave her a sense of bravery and accomplishment that we can now reference for future fears. The whole process took about 2 weeks with no tears and was not intensive (i.e. I did not read the story or implement the exposure ladder steps daily). This is an example of why you do not have to write the perfect story or make the perfect exposure ladder to get positive results. Give it your best first shot and then adapt as you learn new information from your child. However, developing a plan with thoughtful steps is important to prevent you from jumping too far ahead and going faster than the child’s pace.

In my next post, I will describe the behaviorally inhibited temperament, anxiety and the numerous behaviours I noticed in my daughter that were “different”.

Sink or Swim

I do not agree with using sink-or-swim methods on children for fears. I think the messages to children from sink or swim methods are negative and include:

  • The adult’s needs are most important.
  • The adult doesn’t care about my needs.
  • The adult does not know my concerns.
  • The adult is not going to take time to find out about my concerns.
  • The adult is bigger than me and can physically control me.
  • There is nothing I can do to stop the adult.

So even with a successful sink or swim method (i.e. the child eventually gets into the bike trailer without screaming/crying), the messages that the adult is sending are negative, aggressive, and controlling. Whereas, in a thoughtful, planned gradual exposure method based on the child’s fears and concerns, the messages are much more positive

  • The adult hears me.
  • The adult wants to help me.
  • I am scared and it’s okay to be scared.
  • I am brave.
  • I can do things all by myself.

We are all such capable adults that it can be hard to slow our life down and move at a child’s pace. But whenever we can take time, the results are so rewarding and go far beyond just conquering one fear. The child will develop greater confidence as their bravery increases as they face more fears when they feel in control of the progress.

The researcher in me is also curious if a person implementing a sink or swim method would find “success” any sooner than using a gradual exposure “planned” method. When you look at the grand scheme of life, two weeks is quite fast to go from fear of a bike trailer to happily riding for adventures!

Categories
brave story exposure ladder

Brave stories and exposure ladders for anxiety: a fear of elevators

Photo by Arisa Chattasa on Unsplash

I discussed explanatory stories in my previous post. Now, I will present the more common type of story used for anxiety: brave stories. A brave story is about a situation, person, object, or activity about which a specific child is frightened. I will use the word “situation” in the rest of the post in place of person, object, and activity for simplicity. A brave story is used in combination with an achievable goal that allows the child to better cope with the anxiety or decrease the severity of anxiety associated with the situation. This differs from the explanatory story, which does not have a child-led goal. The explanatory story is about a situation that exists over which a child has little or no control and may be inherently scary (sibling behaviour, COVID-19) but could also be mundane (wedding). The brave story involves the child taking control, taking action and feeling brave and confident, despite feelings of anxiety. The situation is not inherently scary.

Brave stories supplement direct action. The direct action is defined as rungs on an exposure ladder. Exposure ladders are an exercise in cognitive behavioural therapy. Each rung is defined explicitly, and the child is encouraged and supported by caregivers to reach that rung. Rewards may be used after reaching particularly challenging rungs, just as you might reward yourself with drink, food, clothing, or vacations for reaching a goal. Rewarding is not bribing. Bribes are used to convince a child to do something that you want them to do (on your timeline) and may have nothing to do with feelings of anxiety (i.e. a child is tired and does not want to get into their car seat. Offering a treat for getting in the car seat is a bribe). Rewards are for a child doing something (on their timeline) that elicits a sense of pride, despite feelings of fear (i.e. a child is afraid of the car seat and after explicit steps of exposure to the car seat is rewarded with a treat for getting in the car seat, despite feelings of anxiety). The distinction between bribes and rewards can feel fuzzy but it becomes clear when you work through an exposure ladder with your child. I can see the fear written on my child’s face when she does something scary and afterwards, she is beaming and proud of herself and asks for a special treat and is motivated to try again. Alternatively, I can see that there is no fear but just tiredness, hunger, or discomfort about getting in the car seat quickly on my timeline so giving a treat is a bribe.

One of my first brave stories was inspired by my daughter’s increasing hyper-vigilance about the elevator doors closing. Months ago, my daughter, niece, sister and I got trapped in my condo building’s elevator. We were trapped for about 30 minutes while we waited for the fire department to rescue us. My sister and I maintained calm speaking voices, video chatted with grandparents and sang songs. But my daughter was clearly terrified. She reverted into her non-verbal, limp rag-doll state. After the event, we got her running around outside and she seemed okay. She also played “elevator rescue” with my husband for weeks afterwards in our home. A few weeks ago, as I was trying to maneuver a bike into the elevator, the bike fell, and the doors started closing with my daughter inside the elevator and me outside. I was able to press the call button and the doors opened before they completely closed, but I could see my daughter’s terrified face. The following weeks, I noticed that my daughter became hyper-vigilant about making sure everyone got on/off the elevator without the doors starting to close. I thought her anxious behaviour would lesson over time, but it seemed to get worse, so I decided to write a Brave Elevator Story. I also created an Elevator Exposure Ladder that my daughter and I worked on over the following weeks. Before each step, I talked about what we would do.

  1. Read story
  2. Show Lisa how I can get the doors to open by pressing buttons (outside elevator)
  3. Show Lisa how I can get the doors to open by pressing buttons (inside elevator)
  4. Put Rabbit (stuffed animal) on the elevator alone and watch the doors close. Talk about how Rabbit is safe. Mommy pushes call button and we give Rabbit a hug. Repeat.
  5. Mommy goes on elevator alone while Lisa waits outside the elevator. Lisa watches the doors close and Mommy opens the doors again by pushing the buttons (Lisa is praised for bravery and receives a sticker). Repeat.
  6. Mommy goes on elevator alone while Lisa waits outside the elevator and Mommy rides the elevator one floor down. When the doors open, Mommy calls out to Lisa that Mommy is still on the elevator. Mommy rides back up to the floor where Lisa is waiting. (Lisa is praised for bravery and receives a sticker). Repeat.
  7. Lisa goes on the elevator alone and watches the doors close and Mommy pushes the buttons outside to open the doors. (Lisa is praised for bravery and receives a sticker).
  8. Final Goal: Lisa goes on the elevator alone and watches the doors close and Daddy pushes the elevator call button on another floor. Lisa is alone on the elevator when it moves to the next floor. The doors open and Lisa sees Daddy at the new floor. (Lisa is praised for bravery and receives a sticker). Repeat.

I did not think my daughter would reach the goal. This is not the best way to start an exposure ladder. It would be much better to have confidence that your child will succeed. I created the exposure ladder based on my own idea of logical, sequential steps but without a lot of thought of my daughter’s age (2.5 years old) and developmental stage. In hindsight, I should have given this greater consideration and with a different child, I might have stopped the ladder at a lower point. Ultimately, I thought there was so much fear around the elevator that my daughter would never ride the elevator alone (at this age). But isn’t the point to alleviate some of those fears? Anyway, without more thought, I blazed ahead with the plan.

The story intrigued my daughter and we talked about the elevator a few times after reading the story, reinforcing that the elevator was safe and that Mommy can always open the doors (ok, except the freak time when it stalls and you have to wait for the fire department but that’s pretty rare and I decided I was not going to address that in this round of story-exposure-ladder action). I waited for a week or so of reading the story before starting the ladder. Each step was refused by my daughter. I would smile and say, ok, maybe next time we’ll try that. EVERY time, my daughter would wait a couple of seconds and then say, “ok [let’s try it]” and we would try the step. My daughter is one of those kids that loves to please (me). She wants to do what I suggest and has a rule-follower type personality, so this often works to my advantage. I stay enthusiastic, upbeat, and encouraging and eventually my daughter usually complies. Not everyone is so easy (as we will see in another example with my niece in my next post). But her reactions in steps 2-5 gave me more and more confidence that we could achieve the next step. That all stopped at step 7 though. I still hesitated to push her to step 8. Was this step really necessary? Does a 2.5-year-old need to ride the elevator alone? I decided I wasn’t going to push it, but one day I accidentally pressed the wrong floor button. As we were going to the wrong floor, I said, “I could jump out and you could ride the elevator all by yourself to our floor and I’ll meet you up there”. She said, “ok”, without much thought and everything happened too fast to change our minds. Away she went in the elevator while I ran like never before up the stairs to get there before the doors had fully opened. She came out grinning and gave me a hug. She was so proud of herself. She now asks to ride the elevator alone, so I purposely push the wrong floor button and jump out and take the stairs to meet her. Her bravery surprised me! Interestingly, through all the steps, the first few times of each step were clearly causing feelings of anxiety. Her fear was written all over her face as the doors would close, but she would always come out grinning and excited that she had done it “all by myself!”

I learned some valuable lessons from this experience.

  • My daughter is more capable than I thought!
  • When creating exposure ladders, it is important to consider age and developmental stage and to remember that every 2.5-year-old does NOT need to ride the elevator alone. My daughter experienced so many feelings of bravery from steps 4-7 and she stopped being hypervigilant about the elevator doors by step 7, so that is where I should have stopped the ladder. Step 8 was just a bonus.
  • It is okay to take breaks during the exposure ladder and regroup (I took a long break between steps 7 and 8).

Older children can participate in creating the Final Goal and the Rungs (steps) of the ladder, but for very young children, the caregiver will create the goal and ladder. If you have never worked with an exposure ladder for anxiety treatment, try it first on yourself. Pick something that truly gives you feelings of anxiety and fear. If you don’t have an anxious temperament or many fears, this may not be feasible for you. I have done an exposure ladder on my own phobia which helps me understand what my daughter will face at each step. This gives me a sense of empathy that is truly authentic! It is helpful to have an adult describe the feelings and thoughts for their own personal ladder rungs so you know what your child might be going through even though they may not be able to articulate those thoughts and feelings.

Before I started writing brave stories, I created a Dentist Exposure Ladder with the help of the child psychologist. One of the rungs on the ladder was to read a dentist story. I used Daniel Goes to the Dentist (the book based on the story from Daniel Tiger’s Neighborhood TV show) adapted by Alexandra Schwartz because it was one of the only stories that showed a simple cleaning visit (no x-rays, surgeries, teeth pulling, etc.). I saw how much this story helped my daughter think about the dentist and realized that a personal story (with specific language and images) would have been even better. The combination of Exposure Ladder and personalized Brave Story is more likely to succeed in reducing anxiety, converting an unknown situation into a known situation, and creating positive feelings of bravery in a child than either strategy in isolation.

In my next post, I will describe a Brave Story and Exposure Ladder for a bike trailer fear with a child less eager to please me!

Categories
explanatory story

Coping with a sibling’s unexpected behaviours

Some stories explain a situation that has happened, is currently happening, or is going to happen. An example of an explanatory story is the COVID-19 story. The goals of these stories are to explain in simple, factual language the “who, what, when, where, how” of an event without using judgement or fearful/threatening statements. One of the main goals of an explanatory story is to shift an event from the unknown realm into the known realm. Adults and children tend to fear what is unknown because they don’t know what to expect. Of course, you could expect chocolate, sunshine and rainbows from an unknown event. But, if you have an anxious temperament, the unexpected is always linked to scary thoughts. I don’t know the brain science of why the unknown is more frequently associated with negative emotions and thoughts than positive, but I do know that this is the way it is for people who experience anxiety. In addition, many topics for explanatory stories are inherently scary, such as: COVID-19 (global health problems), war, oppression, -isms (sexism, racism, classism, etc.), fearful/violent religious stories, news stories, illness, aggressive behaviour. These are all topics that tend to occur in real-time (and sometimes over long periods of time) and may or may not have direct impact on your child (from your child’s perspective). These topics may be sources of fear for young children if left in the unknown realm for three main reasons: 1) the topic directly impacts your child and is scary, 2) the environment changes due to the topic (i.e. the topic has indirect impact) or 3) the child is exposed to incomplete or inaccurate information on the topic and their anxious mind catastrophizes the information while shifting the unknown topic into a false known realm.

Besides the COVID-19 story, I wrote explanatory stories for a friend’s 2-year-old child and my almost 3-year-old daughter to acknowledge the unexpected (scary) behaviours exhibited by my friend’s 9-year-old autistic child. I have posted the “sibling” story on the Brave Tools page and changed the original family photos to freely available stock images to protect the identity of the individuals in the story. The words are original. The goals of the story include:

  • State the child is loved
  • State what are the possible behaviours of the autistic child
  • Explain how the child is kept safe
  • Explain who helps the autistic child calm down
  • Explain how the child resumes in family life (i.e. mommy comes back for a snuggle and autistic child cares for child)

After reading the story, you may feel as my husband did: why is there only one page dedicated to describing the scary behaviours? Shouldn’t there be a greater focus on the behaviours since that is what is scary? This will make more sense once you compare an “explanatory” story with a “brave” story, but my answer is, “No”. There should not be additional focus on the scary behaviours. Simple, clear language should be used to describe the behaviours. I write facts about a situation to achieve the goal of changing the unknown into the known by answering who, what, when, where, and how. Focusing on the scary behaviours with multiple pages does not change it more into the known and will likely increase fear because these are situations that are inherently scary. They will never become not scary no matter how many pages you use to describe them. Violence is scary, but you can still use explanatory stories to help make the unknown parts known (Where will I go when the scary behaviours happen? Who will help me? Who will help the violent child? What happens after?), thus alleviating some of the associated fear with a situation [more info].

Alternatively, a popping balloon is not inherently scary which is why you can use a brave story and exposure ladder to help move towards it not being as scary (although you may always have some fear about balloons). I differentiate between two types of stories: explanatory and brave. I will describe brave stories in my next post with an example of the fear of elevators and companion exposure ladder. [Comments are closed on this post. If you have a comment, concern, suggestion or want to tell me your story please contact me.]

Explosive Children

Many families are in crisis, especially during COVID-19 restrictions. An explosive child creates a threatening situation for all people in the household. Many caregivers rely on school to provide some unofficial respite from the child since most families are not receiving official respite care from any health organizations or social programs. You probably know a family coping with an explosive child, but you may not realize that the child is explosive! These parents often suffer in silence and isolation from their families and friends due to shame and embarrassment about their child’s behaviours. No matter how often the parents are reassured that they did not cause these explosions, they feel ashamed because there are still lots of people and professionals who imply that if they only parented the right way, their child would be fixed or cured. Although parenting can affect children, there are a lot of other factors at play (genetics being a big one!). Non-violent, peaceful, non-punitive, responsive parents can still end up with an explosive child. The parents are often sleep-deprived, fear being harmed by their own child, and become anxious and/or depressed. They have tried countless parenting and “expert” philosophies with no long-lasting benefit. They may be silently wading through the world of medication side-effects, dosing, and stigma. These families need a village to raise their most difficult child. Everyone can be part of someone’s village. Take a step back from the news cycles and ask yourself what act can you do today to help someone in crisis? Deliver a meal, clean a toilet, send sweets, offer a sliver of time.

Categories
explanatory story

COVID-19 story for young children

covid-19 virus drawing

A few weeks into isolation recommendations amidst the coronavirus pandemic I noticed some changes in my 2.5-year-old’s behaviour: more tantrums, constantly asking to eat, and more stuttering. I know her behaviourally inhibited (anxious) temperament causes her to have strong reactions to changes in routines, so I was not surprised. However, I thought the routine changes would reduce her social anxiety since she was no longer having to confront situations like music class, forest school or play gyms. I wasn’t too concerned with the changes, but I was having a hard time understanding her through the stutter and my husband was definitely worried. I made a virtual appointment with a child psychologist that specializes in anxiety. I had seen her weekly for a couple of months the previous autumn to get a better handle on behaviourally inhibited temperament, childhood anxiety and treatments. I wanted her to weigh in on whether my daughter’s “new” pandemic behaviours were normal. She made three recommendations: 1) stuttering is out of her wheelhouse and I should get referred to a speech and language pathologist (SLP), 2) make a simple routine chart showing our daily routine and meal times, and 3) talk to my daughter about COVID-19.

I diligently checked off the recommendations. We are on a waitlist for an SLP. I made a simple chart showing our daily activities including meal times and within a few days of posting it, my daughter stopped asking for food constantly. I felt uneasy about recommendation 3. I know it’s important to talk about the pandemic with children to help alleviate anxiety and I had already seen plenty of stories and articles about how to talk to your kids about COVID-19, but I hadn’t seen any stories appropriate for a 2 year old. The stories I read had a detailed description of COVID-19 and viruses and often described school being closed. The stories also seemed to assume the child had already heard words like pandemic, virus, coronavirus, COVID-19, etc. My daughter had never heard the word virus, let alone coronavirus, and did not relate to school closures. We don’t use screens, other than for video chats with extended family, so she wasn’t being exposed to information from the news. My husband was working fulltime from home and I was a busy mom and aunt; he and I did not discuss the pandemic in front of her. I assumed she didn’t have any idea what was going on. I was seriously thinking about ignoring recommendation 3. How could I explain this pandemic in a helpful way to my 2-year-old and how was talking about a virus really going to help with her tantrums? But, as a rule-follower, I find it hard to go against expert advice, so I gave it more thought and decided to write my ideas because I don’t do well trying to speak off the cuff (thank you, INTJ personality and behaviourally inhibited temperament!).

After some brainstorming, I concluded that the best format to deliver COVID-19 information would be a short, personalized story. Prior to this point, I had written a couple of Social Stories for a friend with an autistic child. I had written them in a rush and took some basic pointers from my friend about how they should be written. I decided to write a “social story” for my daughter about COVID-19. But I did not adhere to any specific principles of official Social Stories, per se. I focused on how to address anxiety for a very young child. For content ideas, I read articles from anxietycanada.com and Psychology Today. My goals for the story were as follows:

  1. The story is understandable
    1. Use age-appropriate (simple) language
    1. Use words that I know my child understands
  2. The story is relatable
    1. Use lots of personal pictures
    1. Describe the current unknown situation in relation to known situations
    1. Describe how we help
  3. The story is factual (not fearful)
    1. Highlight both positive and negative changes to my daughter’s routine
    1. Explicitly state positive and negative feelings

I wrote the story and was amazed at how much my daughter enjoyed it. Weeks after reading it she still talks about the “new cold” in relation to activities in our lives. If I say, “no” about something she will ask, “because of the new cold?” I was able to refer to the story when she resisted washing her hands after coming inside and avoided a few (not all!) meltdowns. The story provided us with a platform to talk about the changes we continue to notice when we go out for walks. It also provides my husband and I (and my parents and sister) the same language to consistently reinforce the story concepts.

Now that you have read the story, you might feel that it is not right for your family. That’s good! A story like this should not be right for anyone else’s family. It is critical to personalize these stories when you are using them for very young children. As children age, they gain life experience such that there is a greater chance that a generalized story is applicable to that child. However, for young children with very short memories and limited experience, it is important to adjust the story to fit the child such that it is understandable, relatable, and factual, from that specific child’s perspective.

I will review a few aspects of the story and how they relate to the three goals. Then, I will analyze some statements from a generalized COVID-19 Social Story to see why those statements are not useful in a story for my child and probably most 2-year-olds.

  • I call the coronavirus (COVID-19) the “New Cold” and people who have the new cold are referred to as “Sickly Sues”. This might seem like strange language to you, but I considered exactly what words I had used since my daughter’s birth to describe when we got sick (with anything – common cold, flu, food poisoning, headache, roseola, etc.). I most commonly used the words “cold” and “Sickly Sue” (That is a family thing – thanks, Mom!). Your family might use “Sniffles” or illness. The point is that I knew my daughter had feelings associated with those words. She used those words to describe herself when she was sick. Using this vocabulary supports goals one and two: understandable (language) and relatable (feeling of sickness).
  • I explain that some people wear masks like dentists and Mommy makes masks for our family and I have a photo of my daughter wearing her mask. Luckily, we had talked about masks prior to COVID-19 because of the dentist. We had already started our anxiety exposure ladder leading up to visiting the dentist and covered our faces with scarves while playing dentist. If you have not talked about the dentist in your family, try to think of another positive mask association that your child has. Maybe you have seen people cover their faces in the winter when skiing or playing in the snow. Maybe your child likes construction and they have seen a welder’s mask. Doctors, nurses, welders, carpenters, etc. The discussion of masks supports goals two and three: relatable (dentists wear masks) and factual (stating that masks are being worn without adding judgement or fear like relating the masks to robbers or “bad guys”).
  • I talk about “helpers” (i.e. doctors help, [Name] helps) because toddlers and young children love to be helpers! My daughter turns on the washing machine and dishwasher and we have talked about how to help someone who is hurt (ask if they are okay, get an adult). Being a helper is something she understands from other activities in life. So, instead of being burdened by having to wash hands, use sanitizer and give others space, it is empowering that this little person is helping with the “new cold”. Describing “helpers” supports goal two: relatable (helpers existed before the pandemic, exist during the pandemic and will exist after the pandemic).

Here are a few statements from a typical COVID-19 social story and why they don’t work for my daughter. Although I am reprinting statements from this story, most other stories had these same kinds of statements:

  1. The Coronavirus is a virus that can make people feel unwell. The coronavirus can also be called COVID-19. My daughter doesn’t know the word virus, Coronavirus or COVID-19. It’s too much detail and would have been superfluous to include a statement with synonyms of coronavirus.
  2. People who have the coronavirus may have fever, sore throat/dry cough, shortness of breath. This is too much detail for a young child; they likely won’t stay engaged for a long list of symptoms. I chose a single symptom (cough) in my story; I also selected a symptom that I knew my daughter understood (cough, not dry cough). I like the symptom “cough” because it is something we can easily play/pretend and she can see it (body tensing, hand/elbow covering face) and hear it.
  3. I know that I will be safe… I like the idea of stating that a child is safe, although I didn’t include that message in my story since there was no focus on the danger/threat/safety aspect of the pandemic; I didn’t discuss family members getting sick or dying because it was low risk for us. If I lived in a different place, that might be more relevant. Instead, I included a phrase from Daniel Tiger’s Neighborhood that we learned about in our Daniel Tiger Goes to the Dentist book, “When we do something new, let’s talk about what we’ll do.” I sing this phrase constantly for anything we do that is “new” and scary. Although the phrase is not correct for this situation, the feelings behind it are empowering to my daughter. This is one more personalized aspect of the story to keep my daughter engaged and feeling confident. I also included the phrase, “mommy, daddy and [Name] will always be a family.” This phrase is more powerful than the “safety” concept because even if mommy or daddy die, we are still a family. Relationships and family transcend death.
  4. …and I don’t have to feel afraid. I would not include this kind of statement in any story. No one has to feel afraid, but they do! I prefer to phrase feelings as simple statements like “I feel sad. I feel scared. I feel happy.” Negative commands are confusing and try to control how a child feels. Statements such as “I don’t have to feel happy. I don’t have to feel sad. I shouldn’t feel mad” may be confusing for a young child if they are experiencing a feeling that the story has told them not to feel. If you incorrectly guess a child’s feeling by writing, “I feel happy” when they actually feel sad, the child can say, “no” and then you can correct it. But if you write, “I don’t have to feel sad”, the child cannot easily respond “yes/no” because a statement written in the negative is more confusing for a young child to understand and then relate it back to what they are actually feeling.

It is June now and the city is starting to open up again, but I am resisting diving back into old patterns, as I expect a second wave of the virus and I’d rather try to hold steady instead of implementing more routine changes, suddenly. The story and routine chart helped to reduce some anxiety. In addition, enough time has passed such that our new isolation routine has now become our routine, and my daughter is surrounded by people with whom she feels comfortable and she isn’t having to confront anxiety-producing social situations. I believe my daughter’s stutter is caused by anxiety and her temperament and not by a developmental issue. Therefore, my hypothesis is that if we address the anxiety, improvement in stutter will follow. COVID-19 caused the elimination of most of my daughter’s anxiety sources. I’m not saying elimination (avoidance) is the best way to deal with anxiety (more info) and without COVID-19 I wouldn’t have self-selected this isolation just to see what happens, but now that it has happened, it’s amazing to see my daughter flourish! The stutter (more info) has improved to better than pre-COVID levels and tantrums are down. I hope that in this state of low anxiety, my daughter will be able to practice and solidify stutter-free speaking patterns. I am curious if, by eliminating most social situations and allowing her language to develop in a low anxiety COVID-19 isolation bubble, she will maintain that language and speech pattern when we eventually face new social situations. We may still need to employ exposure ladders for those social situations, but will her speech patterns be affected? Only time will tell! (And we have the SLP waitlist in our back pocket.)

Anxiety

Avoidance is precisely the wrong way to deal with anxiety because it does not help a person learn skills to cope with anxiety. It just pushes it out of the way until later. A person who avoids the fearful event/object will still experience anxiety when confronted with it in the future. Find out more about anxiety at anxietycanada.com. However, for extremely young children, there is also a developmental component to consider. Separation anxiety is normal in babies and toddlers and there is a large “normal” range of behaviour. As a scientist, I like to follow evidence-based parenting practices, which support non-avoidance exposure ladders for treating anxiety in children. However, most research is based on older children (school-age+) and adults with diagnosed anxiety disorders and it is often just assumed to work for young children (when it is still thought of as a temperament and not a disorder).

Stutter

My daughter has stuttered since she started talking at 2 years old. Usually I understood what she was saying through context and I even thought her stuttering was improving before the isolation rules came into effect. Prior to the pandemic, she exhibited whole word stuttering (5-20 times repetition of a word); for example, during snack time after music class she said, “got got got got got got got got got got got got… JAM!” which was an exclamation about the sandwich containing real jam instead of apple butter. During isolation, whole word stuttering continued as well as being “stuck” (no sound comes out and she was stuck on a word with her mouth open and muscles visibly straining to get the sound out) and sound holding, like “I want to go hoooooooooooooome”.

In the next post I will further discuss explanatory stories for young children with an example of coping with an autistic sibling.