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Behavioral Techniques in the Treatment of Selective Mutism

Behavioral Techniques in the Treatment of Selective Mutism. Aimee Kotrba, Ph.D. Can you identify the child with selective mutism?. DSM-IV Criteria. Consistent, ongoing failure to speak in specific social situations Interferes with education or social communication

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Behavioral Techniques in the Treatment of Selective Mutism

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  1. Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

  2. Can you identify the child with selective mutism?

  3. DSM-IV Criteria • Consistent, ongoing failure to speak in specific social situations • Interferes with education or social communication • Not due to lack of language skills • Other disorders (e.g., stuttering, PDD) have been ruled out • A relatively rare childhood disorder, affecting approximately 1% of children in elementary school settings

  4. Assessment of Selective Mutism • History • Behavioral observations • Cognitive functioning • Language functioning

  5. Psychological Treatment of Selective Mutism • Education • Medication • Desensitization • Hierarchical exposure • Relaxation techniques • Shaping speech • Generalization

  6. Psycho-education of Child • Bibliotherapy • Cat’s Got Your Tongue: A Story for Children Afraid to Speak • Written by Charles Schaefer • Published by Magination Press in 1992 • Treatment is explained in age-appropriate language to child • Child is assured that the therapist will practice with them in becoming braver and stronger.

  7. Psycho-education of Parents • Selective mutism is conceptualized as a social anxiety disorder • Behavioral techniques are explained • Describe ways parents could prevent inadvertently reinforcing mutism • Pediatrician discusses role of medication • Anti-depressants have been found to produce beneficial effects for children with selective mutism. • However, research demonstrates that the most effective treatment is cognitive-behavioral therapy.

  8. Treatment Package Implementation Flowchart Individual work with child Work with parent present Training parents Collaboration with other professionals

  9. Fear Hierarchies Example Fear Hierarchy • Expanding stimulus & response classes • Expand hierarchy to include other adults and children • Increase volume requirements for speech • Decrease latencies to responding • Utilizing shaping and fading principles

  10. Self Modeling

  11. Case Example 1Alone with Mother • 6 year old (Annie) diagnosed with selective mutism • 2nd session of treatment • Early treatment on her fear hierarchy

  12. Escape Contingency • Required to nod head Yes or No as a response to the question posed by the therapist • Posture, facial expression, and demeanor changes when therapist enters the room

  13. Relaxation Techniques • Deep breathing exercises • Positive self-statements • Visualization

  14. Shaping Techniques • One word spoken simultaneously with therapist • One word spoken alone • Repeated a short sentence • Answered questions • Gradually increased voice volume

  15. Generalizing Behavior to School • Teachers are given information concerning the present step on the heirarchy. • Importance of practicing heirarchy in the school setting • Steps are only added when they were “cleanly” demonstrated in the therapy session

  16. Generalizing Behavior to Public • Gradually increasing proximity to peers • Working with peer dyad in the clinical setting • Parents asked child questions in public • Parents arranged play dates

  17. Post treatment with Therapist • Hierarchical steps have been accomplished with the therapist • Future goals will include expanding the response class to include additional adults and children in a variety of settings

  18. Termination • Achieving spontaneous speech across multiple settings • Booster sessions will likely be necessary

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