“Distraction ABC”

The distraction ABC is one of the most effective distraction techniques available for children with pain. It may be adapted to the abilities and preferences of every child and combined with nearly every other pain reduction technique. With increasing expertise, older children develop unique variants of this technique tailored to their specific skills and habits of distraction. Hence, teaching this method is complex and requires a very creative therapist. He/she should not focus too much on a fixed plan but should rather explore the individual abilities, resources, and spontaneous suggestions of the patient. The exploration of ­failures will offer valuable hints for the development of more individual and effective variants. As a rule of thumb, a distraction score of 7 and up (scale 0–10 (0, no distraction at all; 10, totally absorbed by the exercise, I don’t take notice of my environment at all)) indicates that the exercise is perceived as helpful. A distraction score of 5–6 refers to a pain reduction of about 1 score (NRS, 0–10); a distraction score of 7–8 refers to a pain reduction of about 2 scores (NRS, 0–10); a distraction score of 9–10 refers to a pain reduction of about 3 scores (NRS, 0–10). By no means should one query the effect on pain directly, because this bears the risk of classical conditioning.

After the technique has been presented by the therapist, the child and therapist develop suitable variants. These are tested together once. The homework then is to perform and document the distraction ABC at least four times. For documentation, a sheet of paper with the columns (1) time, (2) type of ABC, and (3) distraction score (0–10) is used. If the exercise is complex enough, the technique may be suitable for controlling flashbacks, stopping thoughts, and reducing fear in children with high fear sensitivity.

Step 1

In the first and simplest step, the child is instructed to find any item matching a chosen topic for each letter of the alphabet from A to Z.

Step 2

In the second step, a sensory channel (visual, auditory, haptic, olfactory, gustatory) is added to verbalization. This will result in a higher degree of distraction in most children. This can only be done successfully if the child is able to sufficiently imagine that channel. A child with difficulties in figurative imagination should, for example, avoid the visual channel.

Step 3

In the third step, two or more sensory channels (visual, auditory, haptic, olfactory, gustatory) are added to verbalization. Techniques of step 3 are rarely applied right away. Usually they emerge while doing exercises from the previous steps, for instance if the degree of distraction is too low or if the children unleash their creativity.

Step 4

In step 4, the techniques proven helpful during steps 1–3 are combined with another technique (e.g., the Safe Place). That step is especially helpful for children with a comorbid trauma disorder who need both a higher degree of distraction and emotional stabilization and who have an excellent figurative imagination. The techniques of step 4 are very complex and require a lot of creativity and figurative imagination. The exercises need to be presented very clearly. The best way is to describe the examples from below as one possible way to perform this exercise. Most children will react spontaneously and unambiguously (“That sounds tiring,” or “Great, I’ve already got an idea”). Different examples for this step are listed below.