Now that we’ve seen a few tools in action (explanatory stories, brave stories, exposure ladders, routine chart), I am going to circle back around to talk about what motivated me to start investigating temperament and anxiety: my daughter’s behaviours in infancy. This ultimately led me to the brave tools that I am currently using.
From my daughter’s 3rd month of life, I knew her reactions to the environment were atypical. As time went on, I also knew she was not meeting social expectations/milestones for age-matched peers. There are plenty of books that advise parents not to worry about meeting milestones. Child development varies widely across children and a child who does not speak at two years might speak in full sentences by three without any intervention. On the other hand, delays in achieving milestones can indicate developmental issues that are best treated early or at least monitored by a healthcare professional. But how does a parent know when to wait and see and when to act? I started making a list of behaviours that were “different” when my daughter was around 18 months. There are too many behaviours to list all of them, but this is a representative sample. Each behaviour is not necessarily remarkable but taken together they paint a picture of a fearful child.
- At 3 months Lisa was held by my friend. One week later, the same friend came over and upon seeing her, Lisa burst into tears; from that point forward, Lisa exhibited fear (crying) for all people other than mom and dad.
- Lisa tracks/monitors every person in the room and is clearly concerned if someone “disappears” from view. Once she could make sounds, she called a person back when they left the room.
- If a “stranger” (friend/acquaintance with child) comes into our house, Lisa sits in my lap, unable to do any activity.
- At 5 months, Dad went on a five-day work trip. When he returned, Lisa cried and would not go to him. It took approximately 24-48 hours for her to warm to him again.
- From 11-16 months, when we would walk down the street Lisa would fixedly stare at a stranger. After a couple minutes, she would burst into tears. She seemed paralyzed prior to crying.
- At play gym if another child approaches or takes her toy, Lisa appears stunned and does not respond. If another child blocks her way out of an enclosed space or end of a tunnel, she will become afraid, panicky and eventually burst into tears.
- Around 13-14 months, Lisa ran into the bathroom and saw the bathmat moved off the floor. She ran out of the room crying.
- By 18 months, Lisa “freezes” and then bursts into tears if I talk to another mom at play gym or the park.
- When Lisa is alone at the park, she makes sounds, sings, says words, and smiles; if another child approaches, she stops moving and making sounds. Her facial expression is blank. She stares at the child and is unable to continue with her activities.
- Lisa stands off the sidewalk if she sees another person or dog walking, up to a block away (in either direction – behind or ahead of us). She waits for them to pass us (or turn a corner) before continuing.
- By 21 months, Lisa smiles when she sees someone she likes arrive at a park (Grandpa, Gammie, Daddy), but when the person approaches, she shies away and hides behind my legs or indicates she wants to be held.
- Lisa cried and hid when she observed Auntie letting out her hair from a ponytail.
- At 2 years old, Lisa refused to get into the swimming pool when the music for aquacise was playing (although she was already in her bathing suit and showered). She said “no, stop” when the announcements played over the PA system at Science World and wanted to leave the Aquarium.
- Lisa asks to sing songs outside music class and seems to express interest in going to class, but she will not participate in the class and “melts” into me if the teacher tries to touch her or speak to her directly.
- Lisa is unable to go down the slide when another child is near the bottom or the side or is looking in her direction.
- When staying at other places (grandparents’ house), Lisa reduces her food and liquid intake and appears distracted and unable to be calm.
- Most recently, at almost 3 years old, Lisa reacted negatively upon seeing Daddy after he had trimmed his beard (no eye contact, avoidance). The next time Daddy trimmed his beard, we asked her to watch. After she watched and received a brave sticker, she was almost in tears and wanted to snuggle with Mommy.
If you met my 3-year-old daughter today, you would probably label her as shy and quiet. You might think she is timid and sedentary, and she may even seem a little dull! She probably wouldn’t speak to you and she might try to pull me away from you and eventually she might start crying from a seemingly miniscule event like falling down or eye contact! But she is a completely different child in her comfort zones at home, with select family members or outside alone. She sings, dances, runs, jumps, talks, builds, tells stories and moves constantly. This dual personality is typical of children with behaviorally inhibited temperaments [more info] and often only their parents and a few chosen people are privy to all the amazing parts of their personality. When my daughter was just under 2-years-old, I tried to record her different behaviours but unfortunately, she is also influenced by the camera such that she becomes more inhibited. I was not coordinated enough nor had the forethought to set up the camera unobtrusively. As a result, the differences that I captured are minimized on camera: the inhibited behaviour is more mild than typical because I couldn’t step back and film during extreme inhibition behaviours and she altered her behaviours, due to the camera, for the comfortable/uninhibited situations! Nevertheless, these videos provide a small glimpse into the range of behaviours exhibited by my behaviourally inhibited child.
As I tracked my daughter’s behaviours, I came across the description of a childhood anxiety disorder called selective mutism [more info]. When I read about the behaviours associated with selective mutism, it described my daughter perfectly. She was too young for us to determine if she was “mute” around other people, but everything else aligned well. I found a child psychologist in the city that specialized in childhood anxiety, selective mutism, and worked with very young children. While on the wait list, the psychologist recommended I start reading about the behaviourally inhibited temperament, since a 2-year-old would never be diagnosed with an anxiety disorder like selective mutism.
From what I have read, the behaviours of a child with either an anxiety disorder like selective mutism or a behaviourally inhibited temperament can be identical. Researchers have found that a behaviourally inhibited temperament in infancy is predictive of future social anxiety disorders, but not all people with an inhibited temperament will end up with an anxiety diagnosis (Kagan et al., 1992 and Degnan and Fox, 2007). Most children with anxiety disorders are diagnosed during school years, while temperaments can be detected by 3 months of age in infants. As I was writing this blog, I came across this article that proposes exactly what I have wondered: is an inhibited temperament different than an anxiety disorder or is it just an anxiety disorder that is observable in infants? The article does not answer the question as the research is not there yet. Ultimately, does it matter if your very young child (less than 3 years old) has an inhibited temperament or an anxiety disorder? If you’re looking at ways to help your child with behaviours and fears, then probably not; if you’re looking at how to understand your child and how to describe your child to other people, then it might make a big difference.
Mental health has a stigma associated with it. When someone hears that a young child has an anxiety disorder, they may have unhelpful thoughts:
- the parent caused that (judgement)
- the child is damaged (hopelessness)
- the child should be fixed (judgement and power)
- we need to make that child behave like this other “normal” child (control)
But if a person hears that a child has an inhibited temperament that is a stable part of personality, they will likely have different thoughts:
- What is an inhibited temperament? (curiosity and learning)
- I wonder what temperament I have and what I was like as a baby (curiosity and learning and possible recognition of genetic influence)
- I guess that’s just who the child is (acceptance)
- So that’s why that child is different than this one (understanding)
- It looks like that child needs extra help with that task (empathy)
Many parents do not consider temperament when they have babies (and why should they? Not many people talk about it!), nor do they know how temperament is defined. Medical professionals do not educate new parents on this topic. Instead, they say the baby has “colic”, the toddler is “shy” or “slow to warm” (aka cold). Other parents can provide unhelpful advice such as expose the child and “socialize” them to fix their behaviours (aka cure them), leave the child to cry because this is the “real world” and the kid needs to adapt. But these words and ideas do not define temperament, they do not encourage respect of the child, nor do they validate that temperament is normal and stable. Children with different temperaments behave differently and that is okay.
One of my concerns as I read about behavioural inhibition, anxiety and treatments and prepared for my first appointment with the psychologist was that she would try to make me convert or change my daughter into the opposite of who she is. However, I was relieved when the psychologist confirmed that:
- Inhibited temperaments are stable through life.
- There is no cure for anxiety since the brain (amygdala) is designed to experience anxiety with fight/flight/freeze responses to threats.
- Bravery is not about eliminating fear but about accomplishing things that have meaning to us to lead a healthy and happy life, despite fear.
I often consider these points as I reflect on my daughter’s latest fears or most severe ongoing fears (talking and interacting socially). She is who she is. My job is to facilitate her interests and support her in finding contentment in her life. Hopefully, I will achieve this by providing a secure, loving foundation with tools she can wield to meet and overcome challenges. I want her to know that she can feel fear and still be brave and move forward towards her goals. She does not need to reach my potential or achieve my goals or become the person I am. Parents often talk about wanting their child to reach their full potential, but that is almost always code for wanting the child to reach the parent’s idea of potential. Ross Greene has a wonderful discussion in his book Raising Human Beings about accepting the cards you are dealt in life and moving forward together: parent and child. Will my daughter ever be the charismatic life of the party type? Probably not. Will she find a creative way to make her mark on the world? I think that is a very real possibility.
In my next post, I will describe seven useful strategies that we used to help our anxious daughter when she was less than 2 years old.
behaviorally inhibited temperament
The developmental psychologist Jerome Kagan studied temperament in infants and defined two temperaments: inhibited and uninhibited. Kagan described these temperament profiles as shy, timid, and fearful for the inhibited child and bold, sociable, and outgoing for the uninhibited child. Inhibited infants reacted more strongly to novel objects compared to uninhibited infants. Kagan and others also found that inhibited temperaments in infancy are associated with anxiety disorders in adolescence and adulthood. Researchers have suggested that parenting styles and cognitive behavioral strategies can positively affect an inhibited child’s response to novel stimuli, especially social situations, and reduce their fear response to prevent the onset of future anxiety disorders.
Selective Mutism is a childhood anxiety disorder characterized by a child’s fear of speaking in specific social situations (typically school). Children with selective mutism often have a genetic predisposition to anxiety and exhibit extremely inhibited temperaments as infants and toddlers. Like any anxiety disorder, the person’s brain has an over-active amygdala that is triggered into fight/flight/freeze by typically non-threatening events (like social situations). Many children with selective mutism also have sensory processing difficulties such that their brain may be over-reacting to smell, sight, touch, sound and/or taste stimuli causing inflexibility, frustration, and feelings of anxiety. A few typical behaviours include inability to speak in select social settings, blank facial expressions, lack of smiling, awkward body language, physical symptoms and negative behaviours prior to social activities.