Elective mutism: learning from the analysis of a successful case history

Innovative Analyses and Interventions in the Treatment of Selective Mutism

The authors present a successful, 25-session, multidimensional intervention for the treatment of selectivemutismin a 6-year-old male with a 1-year observational follow-up. They also include an evaluative review of the extant literature of the treatment of selective mutism from 1950 to the present. Their assessment approach utilized behavioral, cognitive, systems, and psychodynamic components. Treatment efficacy was assessed through videotaped observation of behavioral time-samples of the client during therapeutic interaction, self-report, parental report, and real-time behavioral observations at school. Results indicated a significant increase in verbal behaviors during therapy sessions, paired t(17) = 2.31, p= .033. In addition, the client was observed to be verbally interacting with peers and teachers at school at 1-year follow-up. These results suggest that the authors’ multidimensional approach to the treatment of selectivemutismmay offer a successful, brief intervention for those families in which parents decline use of pharmacotherapy in a child.

Could Selective Mutism be Re-conceptualised as a Specific Phobia of Expressive Speech? An Exploratory Post-hoc Study

BACKGROUND

  Selective mutism (SM) is now widely seen as a symptom of social anxiety. However, observations of children's interactions in the natural contexts of home and school/kindergarten suggest that this may be in need of review.

METHOD

  Data were available from two sources: first, interviews with six adults who had recovered from SM in childhood and adolescence; second, informal observations of five SM children in home and school/kindergarten, and semi-structured interviews with their parents and teachers. The research had three stages: (i) Data were examined for the presence of social anxiety and/or determined or stubborn behaviour, but neither provided a satisfactory explanation for the SM. (ii) The data suggested that SM could be reconceptualised as a specific phobia of their own speech. It is argued that if this is the case, SM should respond to intervention at school based broadly on a cognitive behaviour therapy methodology. (iii) A post hoc examination of observation and interview transcripts was used to test this hypothesis.

RESULTS

  (i) Apart from two adults, no evidence was found of social anxiety. Determined and stubborn behaviour was observed but was inadequate as an explanation of SM. (ii) Two children recovered when exposed to classroom interactions that could be seen as consistent with the principles of graded in vivo flooding. Three children who were not exposed to similar interactions did not improve.

CONCLUSIONS

  SM may be understood and treated successfully at school/kindergarten as a specific phobia of expressive speech.

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.

A guided bibliography of the selective mutism (elective mutism) literature

This guided bibliography of 122 articles on selective mutism covers nearly all of the English language publications on the topic. Index Medicus and Psychological Abstracts were the major source documents for the citations.