We are working on so many therapy targets right now I honestly struggled a bit to decide which one to lead in with this week. I decided that what made the most inherent sense to discuss is the work we are doing towards helping Tony gain increased tolerance for wearing a mask, as our ability to return to public therapy work hinges in part on his ability to correctly wear one for any period of time.
And ideally, for safety reasons, I would love for our son to be able to wear a mask for the entirety of each and every one of his in-home therapy sessions, but we are nowhere near achieving that level of acceptance at this time. I don’t believe “down playing” health and safety risks is ever the correct choice when interacting with loved ones, much less for a person having any sort of responsibility to lead and protect. When hurricanes come, concerned leaders don’t tell citizens in the storm’s path that it will all just “blow over” and they’ll be just fine. No, typically we tell people in the storm’s path to evacuate or take whatever other steps are necessary to protect themselves. I recall a rather blunt statement being issued over a recent hurricane headed towards one of our coastal states directing anyone who chose not to evacuate to write their names on a piece of paper and put it in their pockets so that rescuers could identify their bodies.
And I never once considered telling our daughter as she headed into her teen years that experimenting with certain drugs was likely to end well for her. Nope. I told her exactly what happened to my brother on his path of addiction prior to his death, including the part about his teeth rotting out from freebasing. No, a leader of any kind who genuinely cares about the lives and safety of those that are served doesn’t sugar coat dangers or play things down.
As a parent, I am not going to downplay what I see happening with this pandemic for either of my children. My opinion very clearly is that Dr. Redfield was correct in his recent statement that a mask is likely to be a more effective protection for our citizens than any initial vaccine, which likely won’t guarantee immunity. And the companies producing the current vaccine candidates (none of which have fully established meeting safety yet via clinical trials) are pretty clear distribution for the entire public would be several months to nearly a year from now. Certain manufacturing logistics can’t be gotten around with wishful thinking or assurances meant to calm rather than accurately inform. Until all of those pieces fall into place, our communities must adopt a higher rate of wearing masks if we really want to slow down infections rates and deaths.
As I write this, nearly 200,000 Americans have already died from COVID. What we need more than political division is a national sense of mourning for those whose loved ones are lost, and to develop a unified desire to protect the lives of as many of our citizens as possible. Never for a second would I say to any person in our communities that our son’s continued progress in gaining public safety skills is more important than their lives, and so we have been at home focusing on building up as many skills as we can in other areas until he gains adequate mask tolerance.
We have, of course, explained to our little man why we are all wearing the masks and why he will need to as well when we resume work anywhere but our community sidewalks. However, a repeated explanation alone simply would never be enough to help him create the necessary acceptance or tolerance for the sensation of wearing a mask.
Our son has a history of pretty intense tactile defensiveness. What that means is that his skin nerves are overly sensitive. Gentle touches can feel much stronger and even more painful for him and he will try to avoid or push things away that are more uncomfortable. As a toddler, his reactions made it clear that he experienced certain sensations most people wouldn’t be bothered by as extremely painful. We have been doing years of sensory integration therapies with Tony to help him cope with the world around him, and what we are doing with the mask is based on desensitization that follows a painstaking and methodical process towards increasing tolerance.
The first step was just to put the mask on him and let him take it right off. We then began adding individual seconds to how long we were asking him to keep the mask on. Right now we have also added use of a timer so that he can see exactly how long he is expected to keep it on. This helps him to visualize the “end,” or in this case when he can take the mask off and still receive a reward. He usually likes to watch TV or a video on a tablet while we are working on mask tolerance because it helps distract him from whatever sensory discomforts he is experiencing. I have also done a bit of shopping so that I could find the softest 3 layer mask possible (our son does better with soft cloth textures), and the last set I purchased from an Etsy vendor seems to have pleased him the most.
We have begun pairing all of this with practice during certain outside activities in our community, and I will be discussing those more in an upcoming post. For right now, we’re at 47 seconds tolerance per trial with 100% of trial targets being successful in home. I vary the number of trials I run per session, anywhere from 3 to 10 depending on what his emotional regulation looks like on any given day. I stay aware of what his non-verbal cues are about this so that I can try to make sure we always end on a successful trial because I don’t want him to associate the ending of mask work for the day with an outburst or taking it off too soon.
Tomorrow, I will be advancing him to 50 seconds and we will continue to work from there. I understate nothing when I said this work is painstaking. Some children with sensory differences may be able to progress more quickly, some not even at this pace. But this is the basic backbone of one way to help a kiddo with tactile differences adjust to mask wearing. Masks may not be comfortable for any of us, but as I look at the people around me, I can’t imagine thinking the safety of any one of them wasn’t worth the effort.
