Getting therapy early can be critical for helping children with these anxiety disorders tolerate their anxiety and regain their voices. We know that children whose anxiety is significant enough to meet a diagnosis for SM or social anxiety disorder do not tend to just outgrow these struggles, and that each day they practice not talking or not participating their worry links with those behaviors get even stronger. Parents can use the same ideas and strategies the therapist will use to help their child with their brave talking and participating outside the home.
The ideas discussed here are drawn from Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM) developed by Dr. Steven Kurtz and the behavioral theories on which it is based. PCIT-SM uses positive reinforcement in the form of verbal and tangible reinforcement and has been used to successfully treat both SM and social anxiety disorder. Verbal reinforcement is given through specific paise for the child’s brave talking or participating and reflecting or repeating what the child says. Tangible reinforcement is given in the form of stickers for each brave statement or action and a prize for earning enough stickers. But “how do we get them talking and participating in order to be able to reinforce them for it?” you might ask.
Two important and connected strategies for helping children face their fears that both come from behavioral theory are rehearsal and shaping. So, what do these mean and how do you use them?
Rehearsal means practice! If you want your child with SM to order their own donut, they will need to practice first. If you want your child with social anxiety disorder to wave at their friend as they walk up to the school building, they will need to practice first. They will likely need to practice many times. Do not underestimate the power of practice in getting your child ready to face a new challenge with their brave talking or participating. Rehearsal could mean practicing with you multiple times, it could mean practicing with a bunch of different people, it could mean practicing in a bunch of different places. You might be wondering “what is the best way to approach this rehearsal?” That is where shaping comes in.
Shaping is used to establish a behavior that does not currently get performed. It involves breaking the ultimate goal down into smaller steps to take toward that goal. Shaping is a process of taking small steps starting with a lower difficulty action and gradually increasing the difficulty working progressively toward the ultimate goal. You want to wait until your child has more confidence with the step they are working on before increasing the difficulty. If you take things a step harder and your child is completely unable to do it then you probably need to break the steps down into smaller steps toward their goal. There are many different ways to use rehearsal and shaping. Here are examples that walk through possible steps for the donut and waving situations referenced above.
SM example- ordering a donut
- Start by finding out what flavor donut your child would like to order. In this situation getting the donut itself could be the larger reward, however long that takes. Have your child practice ordering with you acting as the person at the donut counter. Have your child practice with other adults they are already comfortable speaking to. If your child does not speak to anyone else, have them practice ordering from you in gradually closer proximity to people they know and are comfortable with. Then practice in gradually closer proximity to less known people or strangers. Then practice ordering from you on the way to the store, in front of the store, and maybe that’s it for that day. When your child is ready to speak inside the store practice right inside the door to the store, practice in line, and practice in front of the person at the counter. It may take several trips to the store before they get that donut. They can earn other small prizes for their hard work on days they are not ready to order the donut themselves but save that donut for when (not if) your child is able to order that donut!!
Social Anxiety example- waving hello to a friend walking up to the school building.
- Select the friend your child wants to work on waving to. Have your child pretend you are the friend and at home practice walking up to school with their backpack on and waving at you as the friend. If even with you they need to work up to raising their hand to shoulder height, then having them start by waving their hand with their arm still long by their side, then with their elbow bent a tiny bit, then gradually raising their hand higher and higher. If you are using stickers, you can put a sticker on your finger and raise the sticker as high as you want their hand to go each time. Practice outside of school with other people – kids and adults they are comfortable with. Go to the school building on the weekend and practice in multiples spots out front when no one else is around. Practice in the car on eh way to school or on the walk to school. If needed, practice waving directly to the friend starting with just moving the outstretched hand with the arm still by their side and over a few days or however long is needed gradually lift their arm higher until finally the friend is able to see the wave.
I use the word “when” not “if” because with enough practice and small enough steps, they will get there!! If this ends up feeling to daunting or overwhelming to try on your own reach out to an child anxiety therapist to assist you. There is help for childhood anxiety. Your kids can learn to be brave and you can learn to be there coach to help get them there!