WHAT IS SELECTIVE MUTISM?
Selective mutism (SM) is debilitating anxiety disorder upon which a child consistently fails to speak in social situations where they are expected to speak. Simply put, SM is the fear of speaking! A child with SM will selectively engage with his or her environment, speaking only to those with whom they feel most comfortable; a child with SM may only use non-verbal communication (i.e., pointing or head-nodding), if at all, to convey wants and needs. While some children with SM struggle to speak to his or her parents at home, it is more common that the child is quite talkative with parents. When required to speak outside the home setting or others besides his or her parents, a child with SM may experience a reluctance to speak to extended family members, adults and children in the community, and in the school setting. Despite the age of onset being in early childhood, SM can be identified as late as 7-years-old; later identification of this anxiety disorder is typically related to school attendance and the teacher informing parents that the child is unable to verbally participate in class and / or communicate and socialize with peers. It is not uncommon for a parent to comment during the interview process that they were aghast by the teacher’s report that their child isn’t speaking, as the SM behavior is in stark contrast to the child’s “chatty” behaviors at home.
WHAT ELSE MIGHT I OBSERVE ALONG WITH SM SYMPTOMS?
SM is a distinct anxiety disorder that is independent of other anxiety disorders; however, SM frequently co-occurs with social anxiety disorder at a rate of 98%. Social anxiety disorder is an anxiety disorder where a child is fearful of and avoids social interactions with peers; being around unfamiliar adults and peers can be painfully uncomfortable. Children with social anxiety disorder may also avoid, or fear being involved in situations where they are observed eating, drinking, or playing; some children with social anxiety refuse to use school restrooms. The child may experience fear and avoidance when participating in performance activities, such as reading aloud, giving a speech, singing in a holiday program along with peers, playing team sports, or going up to the whiteboard / smartboard to engage in classwork. Children may manifest their anxiety in a variety of ways, such clinging to parents or freezing, crying or engaging in temper-tantrums, demonstrating physical or verbal aggression, or becoming reluctant to speak.
HOW DO I HELP MY CHILD?
Although SM is impairing, there is hope! Exposure therapy is a behavioral therapy technique that is frequently used to treat many different types of anxiety disorders. For the treatment of SM, exposure therapy requires both parent and child to engage in a series of contacts, or exposures, to what the child fears. In this case, speaking exposures are facilitated in gradual manner; as speaking behaviors are shaped, a child confidence grows and learns that speaking is less fearful and easier to do! Dr. Steven Kurtz’s Parent Child Interaction Therapy-Adapted for Selective Mutism (PCIT-SM) is a type of behavioral therapy that teaches parents how to prompt and reinforce his or her child’s speaking behaviors, in various settings, to increase the ease of and confidence in speaking, while decreasing non-verbal communication behaviors (i.e., pointing and nodding).
WHERE CAN I RECEIVE SM TREATMENT FOR MY CHILD?
Weekly Sessions
Chidthrive offers PCIT-SM! Dr. Andrea Brandon has received training in PCIT-SM from Dr. Steven Kurtz, developer of PCIT-SM and of Brave Buddies, and has also received SM training by Dr. Carmen M. T. Lynas of Advanced Therapeutic Solutions, developer of Adventure Camp. Parent training and the child’s speaking exposures typically begin in the office setting, and eventually moves into the child’s eco-system (i.e., school and / or community) to foster speaking generalization.
Intensive Treatment
For a more concentrated dose of SM treatment services, childthrive includes half or full-day intensive exposures, ranging from 3 to 8 hours. Intensive treatment can pack 3 to 8 sessions into one day, that would typically take 3 to 8 weeks. Intensive treatment typically begins in the office setting; as a child has made enough speaking progress, he or she can begin to transfer speaking behaviors into the community setting within the same day.
Pre and Post SM Treatment
Psychological services for SM also include identifying and addressing symptoms and behaviors that interfere with beginning effective SM treatment, and that interfere with successful SM recovery. Interfering factors may include disruptive behaviors, other compromising anxiety disorders, social skill or identity development. Treatments include Parent Child Interaction Therapy (PCIT), Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and more.
