When to intervene in selective mutism: The multimodal treatment of a case of persistent selective mutism

Children Who are Anxious in Silence: A Review on Selective Mutism, the New Anxiety Disorder in DSM-5

Selective mutism (SM) is a relatively rare childhood disorder characterized by a consistent failure to speak in specific settings (e.g., school, social situations) despite speaking normally in other settings (e.g., at home). The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists SM among the anxiety disorders. This makes sense as the current review of the literature confirms that anxiety is a prominent symptom in many children suffering from this condition. Further, research on the etiology and treatment of SM also corroborates the conceptualization of SM as an anxiety disorder. At the same time, critical points can be raised regarding the classification of SM as an anxiety disorder. We explore a number of such issues in this review. Recommendations for dealing with this diagnostic conundrum are made for psychologists, psychiatrists, and other mental health workers who face children with SM in clinical practice, and directions for future research are highlighted.

[Treatment of selective mutism]

Selective mutism is a communication disorder of childhood in which the child does not speak in specific social situations despite the ability to speak in other situations. A literature review was completed in order to provide practical guidelines for the assessment and treatment of children with selective mutism. There are many different behavioral approaches in the treatment of this disorder, e.g. contingency management, shaping, stimulus fading, escape-avoidance, self-modeling, learning theory approaches. A clearer diagnostic understanding of the disorder as part of anxiety or oppositional disorders needs to be realized prior to generalize an effective treatment for this disorder.

Practitioner review: Psychosocial interventions for children with selective mutism: a critical evaluation of the literature from 1990-2005

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.

A brief review of selective mutism literature

Selective mutism is a disorder characterized by a persistent failure to speak in certain social situations. It is typically diagnosed in childhood, and the disorder can last from just a few months to several years in some individuals. Debate surrounds the origins and causes of this disorder. Recent literature suggests that selective mutism may be a form of social phobia. The present article is a brief review of the literature on the etiology, assessment, comorbid diagnoses, and treatment perspectives from several theoretical orientations, including behavioral, family systems, and psychopharmacological.

The successful treatment of long-term selective mutism: a case study

This study describes the successful treatment of a seventh grade boy who had selective mutism in school since kindergarten. Treatment consisted of systematic desensitization, consultation with school personnel, and training in social speaking skills. The student made significant gains with respect to frequency of verbalizations to teachers and peers, number of individuals spoken to, anxiety related to speaking, school attendance, and involvement in school-based extracurricular activities. At one year follow-up, the student's rate of speech was indistinguishable from his classmates'. Special issues concerning the treatment of long-term selective mutism are discussed.

Treating selective mutism in a paediatric rehabilitation patient by altering environmental reinforcement contingencies

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, who met the DSM-IV diagnostic criterion for 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.