Selective Mutism Strategies and Causes: What Research Suggests?

Research-Based Causes of Selective Mutism

In terms of the factors associated with selective mutism, based on the findings of three studies, the majority of children with selective mutism suffer from the problem due to social phobia (social anxiety), avoidance disorder, and additional anxiety disorder, but not other psychiatric disorders. By investigating the family background of children with selective mutism, the results also address that its development is not due to physical or psychologically traumatic experience. In addition, selective mutism does not have more external behavioral problems compared to other normal children.    

Strategies for Selective Mutism

In terms of strategies to help children with selective mutism, based on the results of one study,

Cognitive behavioral approaches that include thinking processing, relaxation training, management of anxiety, and focus on communication skills in social situations are effective in treating children with selective mutism. (Cohan et al., 2006)

Below are some tips:


  1. A slow and progressive process that achieves the targeted behavior first in a less socially-complex interaction and then proceeds to the next targeted behavior and in a more socially-complex interaction.

  2. The initial attempt can be made by enhancing nonverbal  communication skills  by making appropriate eye contact and nonverbal participation in group activities.

  3. Next, the management of anxiety by relaxation training, thinking process, and exposure exercise.

  4. Next, “A hierarchy of feared speaking situations may also be developed for the child during individual therapy sessions. The therapist helps the child practice speaking in these situations until the child feels comfortable at each step of the hierarchy. When comfort is reached in individual sessions, the hierarchy is transferred to the school setting. If needed, stimulus fading techniques by gradually increasing exposure to a fear-evoking stimulus can also be used to help the child to initially become comfortable with the therapist. These same techniques can later be used in the school setting to help generalize speech to different individuals and areas of the school. This may involve inviting peers to play-dates in a location the child is comfortable speaking in and later moving these play dates to the school grounds, and finally inside the child's classroom.” (p.10, Cohen et al., 2006).  

Created on November 21 2015 at 08: 00 AM


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Details of Scientific Answers: Click on each bullet to Read References

References:

1: "Practitioner review: Psychosocial interventions for children with selective mutism: A critical evaluation of the literature from 1990–2005," Journal of Child Psychology and Psychiatry, 2006, by Cohan, S. L., Chavira, D. A., & Stein, M. B.. (Citations: 108).

Background:  There have been several reports of successful psychosocial interventions for children with selective mutism (SM), a disorder in which a child consistently fails to speak in one or more social settings (e.g., school) despite speaking normally in other settings (e.g., home). The present literature review was undertaken in order to provide an up-to-date summary and critique of the SM treatment literature published in the past fifteen years. Methods:  PubMed, PsycINFO, and Web of Science databases were searched to identify SM treatment studies published in peer-reviewed journals between 1990 and 2005. Results:  A total of 23 studies were included in the present review. Of these, ten used a behavioral/cognitive behavioral approach, one used a behavioral language training approach, one used a family systems approach, five used a psychodynamic approach, and six used multimodal approaches to SM treatment. Conclusions:  Although much of this literature is limited by methodological weaknesses, the existing research provides support for the use of behavioral and cognitive-behavioral interventions. Multimodal treatments also appear promising, but the essential components of these interventions have yet to be established. An outline of a cognitive-behavioral treatment package for a typical SM child is provided and the review concludes with suggestions for future research.


References:

1: "Psychiatric characteristics of children with selective mutism: a pilot study," Journal of the American Academy of Child & Adolescent Psychiatry, 1995, by Black, B., & Uhde, T. W. . (Citations: 270).

Objective To ascertain characteristics of children with selective mutism. Method Subjects with selective mutism were evaluated by means of parent and teacher rating scales and structured diagnostic interviews. Results Thirty children were evaluated. Mutism severity varied markedly in different environmental settings. Ninety-seven percent of the subjects were diagnosed with social phobia or avoidant disorder of childhood or adolescence or both and 30% with simple phobia. No other psychiatric disorders were common. Parent and teacher rating scales showed high levels of anxiety symptoms, especially social anxiety, and low levels of all other psychiatric symptoms. Anxiety and social anxiety severity correlated with mutism severity. First-degree family history of social phobia and of selective mutism, obtained by family history method, was present in 70% and 37% of families, respectively. There was no evidence of a causal relationship between psychologically or physically traumatic experiences and development of selective mutism. Conclusions Selective mutism may be a symptom of social anxiety, rather than a distinct diagnostic syndrome. Further study of the characteristics of children with selective mutism and their families is warranted. J. Am. Acad. Child Adolesc. Psychiatry, 1995, 34, 7:847–856.


2: "Systematic assessment of 50 children with selective mutism," Journal of the American Academy of Child & Adolescent Psychiatry, 1997, by Dummit, E. S., Klein, R. G., Tancer, N. K., Asche, B., Martin, J., & Fairbanks, J. A.. (Citations: 186).

Objective To clarify the diagnostic significance of selective mutism (elective mutism in DSM-III-R). Method Fifty children with selective mutism were evaluated systematically by means of semistructured clinical interviews and rating scales to obtain detailed diagnostic information. Results All 50 children met DSM-III-R criteria for social phobia or avoidant disorder and 24 (48%) had additional anxiety disorders. Clinical measures of anxiety and behavioral symptoms supported the presence of anxiety disorders as a characteristic of selectively mute children. Only one case each of oppositional defiant disorder and attention-deficit hyperactivity disorder was found. Conclusions Persistent selective mutism typically presents in the context of anxiety disorders.


3: "Selective mutism in children: Comparison to youths with and without anxiety disorders," Journal of Psychopathology and Behavioral Assessment, 2005, by Vecchio, J. L., & Kearney, C. A. . (Citations: 62).

Fifteen children with selective mutism (SM), 15 children with anxiety disorders (AD) without selective mutism, and 15 children without anxiety disorders or selective mutism (CN) were compared to examine the relationship between selective mutism and anxiety. Data were collected from children (age 4–10 years), parents, teachers, and clinicians. Results indicated that children with SM closely resemble children with AD. All children with SM received a diagnosis of social anxiety disorder and 53% received a diagnosis for an additional anxiety disorder. In addition, the SM and AD groups differed substantially from controls with respect to parent- and teacher-rated internalizing behavior problems. No differences among the groups were found with respect to parent-and teacher-reported externalizing behavior problems. The results are consistent with prior research emphasizing the association between selective mutism and anxiety disorders, and suggest that selective mutism may be conceptualized, assessed, and treated as an anxiety-related problem.


References:

1: "Psychiatric characteristics of children with selective mutism: a pilot study," Journal of the American Academy of Child & Adolescent Psychiatry, 1995, by Black, B., & Uhde, T. W. . (Citations: 270).

Objective To ascertain characteristics of children with selective mutism. Method Subjects with selective mutism were evaluated by means of parent and teacher rating scales and structured diagnostic interviews. Results Thirty children were evaluated. Mutism severity varied markedly in different environmental settings. Ninety-seven percent of the subjects were diagnosed with social phobia or avoidant disorder of childhood or adolescence or both and 30% with simple phobia. No other psychiatric disorders were common. Parent and teacher rating scales showed high levels of anxiety symptoms, especially social anxiety, and low levels of all other psychiatric symptoms. Anxiety and social anxiety severity correlated with mutism severity. First-degree family history of social phobia and of selective mutism, obtained by family history method, was present in 70% and 37% of families, respectively. There was no evidence of a causal relationship between psychologically or physically traumatic experiences and development of selective mutism. Conclusions Selective mutism may be a symptom of social anxiety, rather than a distinct diagnostic syndrome. Further study of the characteristics of children with selective mutism and their families is warranted. J. Am. Acad. Child Adolesc. Psychiatry, 1995, 34, 7:847–856.



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