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