A few thoughts & ideas for coping with exposure anxiety:

Facilitating LearningThe concept of exposure anxiety challenges many common assumptions such as:• The child is rejecting. Although the child’s actions may indicate this, they do not necessarily relate to his real feelings.• Stereotyped behaviours should be discouraged. Stereotyped behaviours can often be positive acting as a gateway to learning, a reward, or a pressure valve helping the child to unwind when he is particularly stressed.• Bad behaviour should be ignored and good behaviour should be praised.   Although this strategy may work for some children, it may be counter-productive for the child who cannot cope with direct attention. 

Indirect approachesThere are many different aspects to this approach all of which aim to avoid triggering anxiety. While the following ideas may seem a little strange to start with, they can prove extremely effective with some children: 

• Indirect communicationThere are times when he may want to do something, but is unable to pose the question to ask. Help him out by making statements but do not address them directly at him. Some simple examples are shown as follows:

Ask him to do things for another person.If you think he wants to go to the toilet, suggest he takes a sibling to the toilet or get him to go to see if something has been left in the bathroom.     He may then use the toilet while he is there.

If you wish to discuss a particular situation with the child, talk quietly to  yourself about the subject so he can hear. Alternatively, take advantage of his supersensitive hearing by talking to someone else about it or by talking to a nonexistent person on the phone. 

You can use a similar approach for mealtimes. Suggest (to someone else) that he should eat separately until he can cope with mealtimes. If he then decides to join you at the table, accept this without comment and do not expects it to happen every time. 

• Play hard to getIf he is actually enjoying you playing with him, take a break, so that you leave him wanting to return to the activity. Also, try to avoid making eye contact with him by looking away each time he looks at you. This may intrigue him and will also let him know that you realize he finds eye contact difficult. 

• ModelingShow the child how to use things by using them yourself first while he is in the room. For example, switch on the tape recorder and play a relaxation tape. Make sure it looks as though you are doing this for yourself. Do not show him how to use things directly as he may then reject them altogether. 

• Discovery learningThis simply means introducing new toys or equipment by abandoning them in his room or leaving them around the house for him to find. The type of items could include: a tape recorder, a talking parrot, a video, a computer, a relaxation tape, games, crayons, paper, a dictionary or some books. When the child becomes interested in or begins to use these items continue to ignore him.   Full length mirrors are also useful to enable the child to explore his own sense of identity, although some children dislike them intensely.

A similar technique can also be used when the child has to make a transition, for example, from home to school or to a new house. Familiarity lessens fear, so decrease his stress in the new situation by introducing him to a few of the things that he will find when he gets to the new place. The type of item will depend on the transition being made but a few suggestions follow:

Situation                                                   Object

Starting nursery school                    Toys

Primary school/moving class            Chair, chalks, books, etc.

Respite care/hospital                      A cushion, a pillowcase, etc.

Moving house                                A piece of curtain, wallpaper, a rug, etc.

These items should be left around the house so that he can look at them in his own time. The objects can then disappear again, only to turn up in the new and unfamiliar surroundings where the instant familiarity will offer some security.  Similarly, you can use a particular aroma which he likes and is used to before he first visits the new house.  

Conversely, it may also help if he takes something from the old situation into the new one. If he is going into a new school situation, this will need to be done in an age-appropriate way. It could involve taking a familiar toy with him or, for example, a pocket sized object like a key ring, if he is older.