“Alana has never been to the dentist before. She is sensitive to strange noises and tastes, and she sometimes experiences anxiety around new people and settings. At times, when she feels very overwhelmed, she has ‘meltdowns’ in public. Her mother plans to take her to the dentist in two weeks. Is there a way to support Alana through the appointment, reduce her stress, and increase her compliance during the visit?”
In our previous article, we discussed the use of social stories as a tool for preparing children for changes in routine. In addition to helping to anticipate a deviation from a typical schedule, social stories can be used to help teach a child about a new experience or tough situation: be it a trip to the dentist, a first haircut, or a visit with relatives.
As explained previously, “Social Story ™” is a term coined by Carol Gray, who developed the concept as a way to help students on the autism spectrum, as well as typical children or those with a range of social/communication needs, to better understand challenging concepts or situations (http://www.thegraycenter.org/social-stories/what-are-social-stories). A social story consists of short sentences that break down facts about the situation in a simple, meaningful way while balancing new or difficult ideas with familiar, positive ones.
When children encounter unfamiliar situations, some experience anxiety due to what can feel like a bombardment of new people, sounds, tastes, and sensations. There also may be a social communication component that places new demands on a child. Sometimes, a child faces recurring experiences which, though not entirely novel, continue to present challenging aspects. If a child is not adequately prepared for such encounters, we set him up to fail. With a social story, we can start to teach a child ahead of time about what to expect (and what is expected of him) in words that are familiar and unintimidating, while sending him positive messages about himself. This way, we are more likely to provide him with the support that will make the experience smoother. Below are a few examples of social stories for new or difficult situations:
Situation: Alana (above)’s first trip to the dentist
“My name is Alana and I am five years old. I am a healthy kid! I know how to keep my teeth healthy at home. I eat healthy foods. I brush my teeth. My mom and dad help me floss my teeth.
Sometimes, people go to a special teeth-doctor called a dentist. My mom will take me to the dentist in two weeks. The dentist and her helpers are nice people who will help me keep my teeth healthy!
There will be some new sounds and tastes when I visit the dentist. When Mom and I get to the dentist’s office, we will wait in the waiting room until my name is called. Then I will go with Mom to a little room with a big chair. I will sit in the big chair and the dentist’s helper will show me how the chair can move up and down, or lay back like a bed! It may sound or feel funny to lie back in the chair. Mom can stay next to me while I am in the chair.
The dentist’s helper will ask me to open my mouth. I know how to open my mouth wide, just like when I brush my teeth! She will use tools to check my teeth. The tools might feel cold or a little prickly in my mouth. I can hold Mom’s hand. If I need a break, I can squeeze Mom’s hand and we will take a break.
The helper might also use tools that make noises in my mouth, like humming or squirting. I might feel some sticky toothpaste on my teeth, or feel water or air squirt in my mouth. These may be new, funny feelings. Mom and I can ask the helper to tell us before she uses these tools so I am ready. I can close my ears if I do not like the sounds. When I am done, I can drink some water if I do not like the new tastes. The sounds and tastes may be new, but I will be okay. These things help keep my teeth clean.
Then the dentist will come in to check my teeth. I will open my mouth again and the dentist might use tools like the helper. Then the dentist will talk to Mom and me about my teeth. Then, I will be all done at the dentist’s office! I will leave with Mom and we will come home and play my favorite game together. I will be very proud that I went to the dentist for the first time!
Situation: Large family gatherings are difficult for Dylan. He does not like being hugged by everyone or answering the same questions over and over. He is going to his grandparents’ home for a visit.
“My name is Dylan and I am nine years old. I live at home with my mom, my dad, and two sisters. I like being home with my family. I also have relatives, which means other people who are in my bigger family but who don’t live with me. My grandparents, aunts and uncles are all relatives. I like my relatives, but sometimes I don’t like when they hug me and say silly things.
When I go to my grandparents’ house, I see my relatives. I am a nice kid so my relatives are happy to see me! Sometimes, it seems like everyone wants to give me a hug. I do not have to go hug my relatives. If a relative tries to hug me, it is polite to let them hug me for a few seconds. A hug will not last for a long time. I can tell myself, “This hug will only last for a few seconds,” or I can count to ten and then the hug will probably be over.
Sometimes, my relatives say things that I think are dumb like, “You’ve gotten so tall!” or “You look like your dad!” If my relatives say something that I think is dumb, I should not tell them that it is dumb. If I say, “That is dumb,” or “You already told me that,” it may make them feel bad. Instead, I can say, “Thank you,” or I can just try to smile or nod my head and not say anything. This is a polite thing to do if relatives talk to me, even if I think it is dumb.
After I have spent time with my relatives, I can ask my mom and dad if I can take a break. When my mom and dad say it is okay, I can go in the backyard or I can go to another room and listen to my music for a bit. My music helps me to feel calm and happy. It is important to be polite to my relatives, but it is also okay to take breaks while I am at my grandparents’ house. I am a nice kid. I can be polite to my relatives and also take breaks when I need to.”
(Note: In both of these examples, there are a number of factors at work that make the situation difficult, including social demands, sensory sensitivities, and physical or emotional discomfort. Social stories address one aspect of preparations for such experiences, to be complemented by others, e.g. desensitization measures or environmental accommodations.)
Whenever possible, it is a good idea to provide opportunities for repetition of the social story beforehand so that it becomes familiar by the time of the actual encounter. Such stories can also be simplified greatly for children with more basic language comprehension skills. Whether the challenging situation is a brand-new experience or a recurring one, a properly-developed social story can be key to improving a child’s perception of the experience and his ability to handle it in an acceptable way.
Anna Fredman is a licensed, certified Speech Language Pathologist. She received her Master of Science in speech language pathology from the MGH Institute of Health Professions in Boston, MA and previously worked at the Monarch Center for Autism. She currently sees school-aged children and has also worked with toddlers through students 21 years old. Anna has specialized in therapy for individuals on the autism spectrum, with a special interest in high-functioning students focusing on social pragmatics and young children learning basic communication and social skills. She also addresses reading, expressive language skills, written expression, and articulation with her students.