do you have any treatment for selective mutism

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The literature on selective mutism provides little information on the child's own perspective. Six adults who had been selectively mute were interviewed about their childhood and adolescence. Data analysis led to identification of five themes, each of which has potentially important implications for teachers. (1) Origins of selective mutism: all interviewees reported withdrawal from social interaction at an early age. There was evidence from three respondents that onset of selective mutism was associated with events they had found traumatic. (2) Maintenance of selective mutism: all interviewees reported being strong willed, with a conscious determination not to speak. Selective mutism became a clearly understood and well-defined social role. (3) Determination, social anxiety and loneliness, only two respondents (twins) reported feelings related to social anxiety in childhood, but other symptoms were reported. (4) In the recovery process four respondents reported their own conscious decision to change their current lifestyle as a precursor to starting to speak. (5) Concerning current psychosocial adjustment, four respondents had obtained therapy as adults, though not for selective mutism; five interviewees felt confident in formal, professional settings, but still experienced anxiety in informal, social situations. The data are discussed in light of previous work on selective mutism. In spite of inherent limitations, interviews with adults who have recovered may help teachers to understand both the development of the problem and their own role in helping students to recover from it. [CLICK ATTACHED PDF FILE]


Selective mutism is a disorder which can cause severe social and academic impairment, and for which a wide variety of treatment approaches have been used, with varying degrees of success. Selective mutism can be conceptualized as the lack of generalization of a class of operant responses (e.g. audible and comprehensible verbalizations) across environmental contexts. The rehabilitation hospital setting, in which the patient is seen daily by multiple people in multiple settings, is particularly well-suited for implementing a systematic behavioural intervention to establish verbal behaviour and simultaneously reinforce its generalization. Data are presented on a 7-year-old female admitted to a rehabilitation hospital following orthopaedic surgery, whomet the DSM-IV diagnostic criterionfor selective mutism. Additional medical diagnoses included cerebral palsy, microcephaly, and mild mental retardation. A behavioural programme was developed and implemented to reinforce differentially first any communication, then verbal communication across staff and settings. Results were evaluated using a modified multiple baseline across settings design, and demonstrate that verbal, written, and tangible reinforcement effectively increased verbal behaviour where it previously rarely occurred. Results are discussed in terms of the relationship between selective mutism, social phobia and related disorders. The theoretical roles of behavioural phenomena (discriminative stimuli, stimulus generalization) in the development and treatment of these disorders are discussed. [CLICK ATTACHED FILE]

Selective Mutism (SM) in children and adolescents is characterized by a persistent failure to speak in certain social situations including at school or with friends despite the ability to speak and comprehend language. Not due to a specific communication disorder, SM is actually a pervasive psychological problem that lies along the continuum of anxiety disorders, and therefore, requires expertise in determining how the problem is supported and maintained by a child's history, family, and environment (Giddan, Ross, Sechler & Becker, 1997). This article represents a case study of a selectively mute child and a successful comprehensive treatment plan that was developed by a multidisciplinary team in consultation with the child. [CLICK ATTACHED FILE]


Selective mutism is disorder where your child does not speak in public even though he can speak and understand spoken language. It used to be called elective mutism.

The disorder occurs in about 1 in every 1,000 children. It is more common in girls than boys.

What are the symptoms?

You may notice your child is very shy when she enters school and seems unable to talk to other children.

Many parents are confused by this behavior because their child is often very outgoing at home. Some children will talk easily on the phone to people, but cannot talk to them face-to-face.

Your child may have selective mutism if:

Your child does not speak in social situations where talking is expected (such as school, play groups), but can talk at home to family members.

The problem starts to cause problems at school and with social development.
The problem lasts longer than a month.

Your child has no other problems with language, such as understanding language or stuttering.
Your child often seems shy, afraid, or anxious.

What is the cause?

The cause of selective mutism is not known. It tends to run in families. A child is more likely to have this disorder if other family members have had problems with selective mutism, social anxiety, or other anxiety disorders. It is not caused by abuse or trauma.

Children with this disorder do not choose to be silent. They are afraid. Most children with selective mutism also have social phobia or social anxiety. Social phobia is an anxiety disorder in which people fear situations where they might say or do something embarrassing. People with this disorder often fear speaking in public or to strangers.

How is it diagnosed?

Your healthcare provider or therapist will ask about your child's symptoms and any drug or alcohol use. Your child may have some lab tests to rule out medical problems.

You may want to contact a mental health therapist who specializes in working with children and teens. The therapist will ask questions, observe the child, and may give some special tests. Parents and teachers will also be asked about the child's behavior. It is important to get a very thorough medical, social, and psychological history from the child and family. The mental health specialist will assess:

how severe the child's symptoms are
how much they interfere with the child's daily activities
if the anxiety seems appropriate for the child's age.

How is it treated?

Children do not just grow out of this disorder. Treatment at an early age is important. It helps if the child and parents learn about the disorder.

The main goal with treatment is to lower anxiety and to increase self-esteem and confidence in social settings. Cognitive behavior therapy (CBT) helps children learn what causes them to feel anxious and how to control it. CBT might also include social skills training, role-playing, and learning relaxation skills. A speech language pathologist (SLP) may be helpful. Medicine may be used along with behavioral therapy to help with anxiety. Medicine should be prescribed by a child psychiatrist familiar with this disorder.

How can I help my child?

Let your child watch you talking in a relaxed way in a lot of different situations such as in the neighborhood with friends, at school events, and while ordering at restaurants.

Always reinforce any attempt your child makes to speak in a public place by gently patting his or her shoulder or providing verbal praise in a soft voice.

Don't force your child to talk or ridicule your child for not speaking. This does not work and often makes the child more anxious.

Don't talk about your child's problem to relatives or friends when the child is present. This also may make the child more anxious.

Help your child to speak where she is comfortable. Usually that means in small groups of people that your child knows. If your child is more comfortable at home, it may be helpful to invite friends over often to give your child more chances to talk with others.

Many children who are shy begin to speak in new places after they have become familiar with the teacher, new children, or the place. If this does not happen and the shyness begins to affect a child's ability to progress in school and socially, it is time to seek help.

Resources
Selective Mutism Foundation

http://www.selectivemutismfoundation.org

Published by RelayHealth.

Written by Patty Purvis, PhD.

© 2008 RelayHealth and/or one of its affiliates. All Rights Reserved.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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