psychology

Selective Mutism

Selective Mutism: Although this is not classified as a child anxiety disorder, selective mutism is often seen around the time that children enter school for the first time, and can be accompanied by anxiety. The essential feature of selective mutism is the persistent failure to speak in specific social situations (e.g., school, with playmates) where speaking is expected, despite speaking in other situations. In order to be diagnosed with selective mutism, the person’s speech refusal must interfere with educational or occupational achievement or with social communication, and must be going on for at least one month. Selective mutism is not diagnosed if the individual’s failure to speak is due solely to lack of knowledge of the language. Primary Symptoms: Primary symptoms of selective mutism include persistent failure to speak in specific social situations where there is an expectation for speech. The child should be able to speak in other situations. This disorder is usually first seen in childhood, and is treatable with cognitive-behavioral techniques. Treatment: One of the most important first steps in the treatment of selective mutism is conducting a thorough evaluation, including getting a good social history of the child, and a history of the onset, duration, precipitants, and consequences of the child’s non-speech behavior. Also, it is important for the clinician to get a good understanding of the child’s speech behavior in different settings. A detailed history of the child’s motor, language, and social development should also be obtained. In addition, it is important for the clinician to assess how the child’s failure to speak is perceived and reacted to by the family. Through processes of shaping, therapists’ goals are typically to increase the child’s verbalizations first within the therapy framework, while building a good therapeutic alliance. The child is encouraged and praised when he or she even approximate speech behaviors (e.g., whispering). The next phase of treatment typically involves generalization of verbal mastery to the school setting, which often requires teacher involvement. Other skills used in treatment include role playing, changing anxious thoughts about speaking, and using relaxation training to assist children in meeting therapy goals. <<<< BACK