Brave Talking Exposure
Brave talking exposure is used for children struggling to speak due to selective mutism. Please click on the following link to learn about selective mutism. However, even if your child does not have a formal diagnosis of selective mutism but is reluctant to talk outside of the home to new or familiar adults and children, the following steps can be used. It is important to practice ‘brave talking’ daily. In order to help your child to be successful at talking, follow these 3 steps daily:
Step 1: Warm-up activities
- Set aside anywhere from 5 to 15 minutes to play with your child. The goal of warm-up activities is for your child to become comfortable and engaged, and thus this may take as little as a few minutes or as much as 15 minutes or more. Choose toys that lead to creative play (for example, drawing, food, animals, lego). Give your child a couple of options and let him/her pick what to do. Skip games with pre-set rules, like board games, during warm-up.
- Follow your child’s lead in the play. Describe what they are doing. Act like an announcer at a sporting event – give the play by play. Just say what you see. “You picked up the yellow marker, you are drawing a yellow circle at the top of the page, you are drawing lines out of the yellow circle – 1, 2, 3, 4, 5 lines”.
- Give your child lots of “labeled praise.” Labeled praise is specific praise that tells your child not just that you like something, but what that something is, and why you like it. For example, instead of saying “good job”, try, "What a fantastic job of cleaning up all your toys. Now we have time to sit and colour!". Other examples include, “I love the way you are sitting in your chair”, or “Great job working so hard at drawing that picture”, or “Wow you are being really creative with your art!” Think about behaviours you would like to see more of and praise them.
- If your child does say something (and at home this will happen often, while at other times it might be less frequent), reflect what they say. Reflecting is like being a parrot. Repeat exactly what you heard. You can do this by making a statement, but becareful not to put it in the form of a question. This means says this, “Sun, it is a sun!” but not this, "Sun? Really, thats a sun?" Follow that up with a labeled praise, “Thank you for telling me it is a sun!” Reflecting and providing specific praise for verbal behaviours will increase the likelihood that they will occur again.
- Don’t ask any questions during warming-up periods. This is not easy and requires lots of practice. Instead of questions, go back to providing descriptions and praises to connect with your child.
- Lastly, stay positive and enthusiastic at all times. Try to not say anything negative, even subtly, as it will only serve to increase anxiety (for example, "Why aren’t you talking today? You were talking great last time.").
- Use warm-up activities in all anxiety provoking situations, whenever your child seems stuck, and before each exposure (see below).
Remember: The warm-up activity may seem a bit awkward the first several times you try it. The more you practice these skills, the more readily available they will be when you need them.
Step 2: Prompt brave talking
When you have completed the warm-up activities, start prompting brave talking in a way that is more likely to get a verbal response (see below). First, practice these skills in a comfortable place and then use them during exposure exercises in public (see Step 3).
- Ask forced-choice questions: “Would you like chocolate or vanilla ice cream?” “Do you want the blue paper or a different colour?”
- Ask open-ended questions: “What is your favourite type of ice cream?" “What colour paper would you like?”
- Don’t ask Yes/No questions: Yes/No questions usually encourage a nonverbal response, such as head shaking/nodding, followed by silence. We are breaking the nonverbal responding habit by encouraging verbal responding instead.
- Wait 5 seconds: Children with selective mutism often take longer to respond to a question because it’s hard to think quickly when you feel anxious. Also, these children have learned if they wait long enough they won’t have to answer the question because someone else will do it for them. So it can feel really uncomfortable in those very long 5 seconds – get comfortable being uncomfortable! It is important to send the message that you are expecting a verbal response and believe in your child's ability to do this.
- Reflect verbal responses: Once your child has responded, repeat what s/he said in a non-question format. “Chocolate!” Reflecting or echoing what your child says provides support for him/her to learn to take risks with speaking. This allows him/her the experience of being heard even if s/he speaks quietly. It reinforces the experience making it even more likely s/he will respond verbally again.
- Praise verbal responding: When your child does respond, immediately speak up with a specific praise, telling him/her exactly what you liked. This will help your child know exactly what s/he is being praised for and increase the motivation to do that behavior again. So instead of just “good job”, try saying things like:
- “That was great brave talking!”
- “Thank you for telling me what you want.”
- “I love the way you shared that with me.”
- “That is a great way of explaining that game.”
Troubleshooting: What if the child provides no response or a nonverbal response?
- Repeat or rephrase the question. For example, change the question to a forced-choice, if it was open-ended. Kids with selective mutism often have difficulty make choices, which may contribute to non-responding. Adding an option like “or something different” or “or you are not sure” to a forced-choice question can help. For example, "Do you want vanilla or something different?"
- Wait an additional 5 seconds.
- If still no response, try an easier situation or go back to the last place you were successful (e.g. instead of ordering ice cream at the counter, take your child to a quieter corner of the store).
- Go back to using the warm-up skills, which help to decrease anxiety and increase confidence. Then, try prompting your child to speak a little later. Don’t reinforce avoidance by allowing escape all together - in otherwords, make sure to come back to the hard situation at a later time, rather than giving up completely.
- If your child responds nonverbally (by pointing or nodding), acknowledge that they are trying to communicate with you and prompt for the verbal response. For example, say: “I see that you are pointing, do you want the blue or the red paper?”
Step 3: Daily exposures
After you have practiced the warm-up activities and prompting brave talking in every day situations, you are ready for planned exposures. Planned exposures are daily practices in specific situations. The best way to overcome a fear is to face it, which is easier said than done. That’s why exposures are done gradually, like climbing a ladder. Speaking goals are broken down into smaller feared situations. For each exposure, you will only try to change one element to make it slightly harder, choosing from three elements: – either person, place or the activity. As your child overcomes fears that are lower on his/her ladder, s/he becomes more confident and brave and is better able to attempt harder things. Success breeds success.
Examples of exposures:
- Playing easy, familiar games with a clear speech demand like Spot it, Guess Who, or Go Fish.
- Create interview games like, the Favourites game, where children ask different people about their favourite things (e.g. ice cream, fruit, toy, etc.).
- Ordering food in restaurants (ice cream is always a favourite!).
How to do exposures:
- Pick 1 or 2 exposures to do every day. These should be planned in advanced – remember to vary the people (e.g. 1 new person), the activity (e.g. changing the game) or the location where you are doing the exposure (e.g. home versus school). Remember to change just one thing at a time.
- Exposure 1: For example, start by playing “Spot it” at home, together (here the challenge is the activity)
- Exposure 2: Play “Spot it” at school with no one around (once your child is feeling more brave about the activity, you can introduce doing the activity in a more challenging location as the next challenge)
- Exposure 3: Playing “Spot it” at school with a teacher, and then at school with a teacher and a friend… etc. (once your child is feeling more brave about the activity and location, you can introduce new people as the next challenge, introducing one new person at a time)
- Practice each and every exposure ahead of time. For example, if you are going to order ice cream, first practice at home by acting it out.
- Have your child choose a reward. Rewards play an important role in fighting anxiety. We want to change the association between talking and anxiety to talking and a good outcome (at first this might be a candy or a small prize). With time, being able to talk in situations becomes rewarding and the "prize" become less important. Sit down with your child and come up with some small, medium and bigger rewards to choose from, depending on the practice task.
- Use your “warm-up” skills prior to the exposure in the new situations (see Step 1 above).
- When your child is ready, prompt his/her brave talking during each and every exposure (see Step 2 above).
- Praise your child's verbal responding and provide his/her reward as previously discussed.
- Plan your next exposure – remember you are climbing a ladder that becomes a little harder each time. Remember to involve your child in the plans.
- If you get stuck, go back to the warm-up activities and then try again. Remember, the goal is to avoid reinforcing the habit of not responding. If the plan doesn’t work, go back to the last place that was successful.
Adapted from the copyrighted work of Steven Kurtz 2007 - 2014.