The Subjective Units of Distress Scale (SUDS) was developed by Joseph Wolpe in 1969 to assist clients in rating their level of disturbance or distress during treatment for anxiety disorders. It is an 11-point scale starting at 0 (calm, no distress) and increasing by 10 until it reaches 100 (the worst possible anxiety one could experience) (Wolpe, 1969).
Since its inception, the SUDS scale has been adopted and adapted by mental health professionals in many settings. It can be particularly useful when working with children, especially those who are prone to escalations and/ or have difficulty identifying their emotions. In this post, we will review different ways to adapt the SUDS scale to fit your child’s needs, and how you can use the scale to intervene during escalations.
When creating your child’s SUDS scale, we recommend you use 0-10, 0-5, or even 0-3 instead of 0-100. Young children especially will have difficulty identifying 11 different levels of emotional escalation. For each number, work with your child to identify the following information:
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What do they feel when they are at this number? This can refer to emotions, thoughts they may have, and/ or physical sensations. Young children might have difficulty identifying their exact emotions, but physical sensations may be easier for them to describe.
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Are there certain behaviors that they display when they are at this number?
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How can an adult help them calm down at this number? Are there any coping skills that may assist them? Do they need alone time, or direct support from someone?
If a numbered scale is too difficult for your child to use, you may instead try emoji-like figures or a temperature scale. If your child has a special interest or favorite tv show, you may choose to use symbols or characters relating to this interest to represent each emotional level. Regardless of how you label the scale, it is still important that you answer the 3 questions above. It is helpful to write out the answers, either directly on the scale or in an easily accessible location.
Once you’ve created the scale, display it somewhere for your child to see. If there is a place in the house where escalations often occur, consider displaying it in that room.
When you notice your child becoming distressed, ask them to identify what level they are at on the scale. If they are having trouble giving an answer, you can suggest what level you think they are on and ask if they agree. For young children, it may work better to have them point to the level rather than say it out loud. From there, assist them in utilizing the coping skills that you’ve pre-determined as appropriate for that emotional level. If they’ve identified they need alone time at that level, encourage them to take space in their room or another “safe space”.
Children can bounce between levels very quickly during an escalation. If your child continues to escalate, it may be best for you as the caregiver to implement the pre-determined calming measures without discussing the levels in the moment. When the escalation is over, you can then circle back with your child to see if they can identify the different emotional levels they were experiencing. This conversation should be approached through a lens of caring and curiosity, not frustration. The goal is to help your child increase their emotional awareness, not make them feel guilty about the emotions they experienced.
With practice, your child may be able to utilize their SUDS scale and designated calming measures with minimal prompting from an adult. Positive reinforcement and praise throughout the process is essential. If you are having difficulty creating or implementing the SUDS scale, ask a mental health professional in your child’s life for assistance. If your child’s escalations include behaviors that are harmful to themselves or others, it may be time to seek regular support from a therapist.
How PWC Can Help
At PWC, many of our clients include children and adolescents who display externalized behaviors at home. Your child’s therapist can help you identify the coping skills and calming strategies that work best for your child. They can also assist your child in developing their self-awareness and emotional identification skills. For clients with high-risk behaviors, your therapist can review proactive and reactive safety measures to implement in the home to reduce the potential harm during escalations.
Interested in getting your child started with one of our therapists? Fill out the “Appointment Request” form on our website, and a staff member will reach out to you to discuss your options.
References
Wolpe, J. (1969). Subjective units of distress scale (SUDS) [Database Record]. APA PsychTests. https://doi.org/10.1037/t05183-000