[Selective mutism]

Selective mutism was first described in the medical literature 140 years ago. The diagnosis came into the focus of adult psychiatry with the appearance of DSM-5. Henceforth, selective mutism during infancy, adolescence and also adulthood is specified as an independent anxiety disorder. It often begins in early childhood with a kind of speechlessness in certain situations. A diagnostic clarification often only takes place after school enrolment. Very often comorbid anxiety disorders, especially social phobia and depression also occur. The course is very variable and with some affected persons regression of the pathology occurs suddenly and completely and with others there is a slow regression of the symptoms. Equally the disorder can persist until adulthood. Whilst formerly a traumatic genesis was assumed, a multifactorial etiology with genetic, psychological and language-associated effects is nowadays presumed. The therapy is supported through psychotherapy, speech therapy and psychopharmacology.

Social Communication Anxiety Treatment (S-CAT) for children and families with selective mutism: A pilot study

This research assessed the feasibility of Social Communication Anxiety Treatment (S-CAT) developed by Elisa Shipon-Blum, a brief multimodal approach, to increase social communication in 40 children aged 5-12 years with selective mutism (SM). SM is a disorder in which children consistently fail to speak in specific situations although they have the ability to do so. Key features of this approach are the SM-Social Communication Comfort Scale (SCCS), transfer of control (ToC), a nonchalant therapeutic style, and cognitive-behavioral strategies over a brief time frame. Following 9 weeks of treatment, children showed significant gains in speaking frequency on all 17 items from the Selective Mutism Questionnaire (SMQ), a standardized measure of SM severity. Children also showed decreased levels of anxiety and withdrawal as reported by parents on the Child Behavior Checklist (CBCL). SM initial symptom severity and family therapy compliance, but not duration of SM, contributed to treatment outcomes.

Personalized Individual and Group Therapy for Multifaceted Selective Mutism

Selective mutism refers to a persistent and debilitating condition in which a child fails or refuses to speak in public situations. Research on treatment for selective mutism has progressed in recent years toward a more personalized model based on clinical profiles unique to a given child. Such profiles may include aspects of anxiety, oppositional behaviors, and communication problems as well as operant factors that maintain selective mutism. The present case represents a 6-year-old child with selective mutism with a multifaceted clinical profile that included internalizing and externalizing behavior problems with multiple operant factors. Initial personalized individual therapy focused on anxiety and contingency management procedures to address school refusal behavior and to lay the groundwork for later treatment of selective mutism. Group therapy with parent and child components focused on these procedures in more detail in addition to social skills development. Each component included detailed hierarchies for increasing frequency and audibility of speech in a clinic setting as well as in community and school settings.

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.

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.