By Claudia M. Gold, MD, November 30, 2021
In the months that followed the brief moment of hope in the spring of 2021-before the surge of the delta variant of COVID-19-in my behavioral pediatrics practice pervasive anxiety of in-person visits felt even more acute in contrast to that small, glorious taste of freedom. As I see children under four with their family for hourlong sessions, the benefits of the mask-free Zoom space soon brought me back to the virtual world. But in the interim I learned a new technique. I asked parents to videotape a moment of their child’s distress so that we might watch it together on the screen. By using the screen share option, parents could stop and start, as we took time to explore the full range of feelings that came up.
My work with Alex’s family offers an example. When they first came to see me with the question of what was “wrong” with their three- year-old son, they focused exclusively on his behavior. They described years of worry that he was “too aggressive” or maybe had “bipolar disorder.” His intense reactivity dated back to birth: they described a baby who “noticed everything.” Consultation with pediatricians and other specialists hadn’t made a dent in the problem. Now things were getting worse; there was a fear he might get kicked out of preschool. Behavior management plans failed to shift the downward spiral of distress into which the whole family, including 8-year-old sister Elena, descended multiple times a day.
It the video clip of one of Alex’s typical meltdowns which we watched together on the second visit, we got right up to the burning flame of the family’s pain. Brian described a sense of helplessness as he listened to his son’s cries of despair in the grip of complete disorganization. We saw the deep sadness on Sondra’s face, strained from the exhaustion of efforts to reach her son. She appeared to succeed for a fleeting moment as Alex tried to catch his breath before her words seemed to set him off into total loss of control. As we spoke about the stress this intense child put on their marriage and their relationship with their daughter, Sondra quietly wept tears of acknowledgement.
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