Addressing fears of children with Williams syndrome: therapist and child behavior in the context of a novel play-and humor-infused exposure therapy approach.
Play-and-humor exposure turns dreaded sounds into games that kids with Williams syndrome later ask to play again.
01Research in Context
What this study did
Young et al. (2023) worked with four children who have Williams syndrome.
Each child had a strong fear of everyday sounds like vacuum cleaners or hand dryers.
Therapists used a new play-and-humor exposure plan.
They turned scary sounds into silly games and laughed with the kids while the sound got louder step by step.
Sessions were short and ended only when the child felt safe.
What they found
All four kids could stay in the room with the feared sound by the end.
Two children simply stopped crying or running away.
The other two started to smile and ask to play the sound game again.
No child showed more fear after the playful exposure.
How this fits with other research
Ahlborn et al. (2008) first showed that most kids with Williams syndrome jump at mild sounds.
That study explained why we need exposure plans like the one Young tested.
Uljarević et al. (2018) added that these kids hate not knowing what comes next.
Young’s playful steps gave clear, fun cues so uncertainty dropped.
Fahmie et al. (2013) used plain exposure for repetitive behaviors in autism.
Young’s team kept the step-by-step idea but added jokes and toys.
The change fits the social, music-loving style seen in Williams syndrome.
Why it matters
If you serve a child with Williams syndrome, try turning feared stimuli into a short, funny routine.
Start tiny, laugh together, and end on the child’s cue.
You may see faster calm and even new play requests.
Track minutes of tolerance and note any smiles or initiations to repeat the game.
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02At a glance
03Original abstract
Many children with Williams syndrome struggle with fears and phobias that significantly impact their daily lives. Yet, there is sparse literature about the impact of behavioral interventions to treat anxiety and phobias among children with Williams syndrome. Using observational coding of intervention videos, the current study examines patterns of the therapist's use of play and humor and relations to child behavioral responses for four children with Williams syndrome who were identified as treatment responders to humor- and play-infused exposure therapy for fears and anxieties. Sessions were coded for therapist behaviors (exposure with or without play/humor, stimulus type used during exposure, passive or invited attention to feared stimulus, and spontaneous parent participation in exposure) as well as positive, negative, and neutral child behaviors (verbalizations and behaviors). Temporal patterns between therapist and child behaviors were analyzed using lag sequential analyses. The results showed that tolerance of feared stimuli improved for two of the four children following this play- and humor-infused exposure therapy approach, and the remaining two participants demonstrated progress beyond tolerating the feared stimulus and showed increased positive behaviors with the feared stimulus across sessions. Findings also showed patterns of therapist attunement to the child's anxiety level demonstrated through efforts to flexibly adjust the degrees of exposure. Therapist-initiated invited attention behaviors, indicative of the therapist's use of narration and priming, were associated with child tolerance and positive behaviors during exposure to the feared stimulus. Limitations of this study include a very small sample size, short duration of intervention, and a single-subject research design, which limit the generalizability of findings. Implications and future directions of this research are discussed.
Frontiers in Psychology, 2023 · doi:10.3389/fpsyg.2023.1098449