What is Selective Mutism and How is it Treated?
What is Selective Mutism?
Selective Mutism is a social anxiety disorder that inhibits one's ability to speak in certain situations. For example, a person may have difficulty speaking in work, school, or community settings, but speak freely in home or family settings.
If you know someone who can speak freely in certain situations, but in others does not speak or is restricted in who they can speak to, they may have selective mutism (SM). Many SM children struggle to effectively participate in peer relationships, school, or adult relationships with teachers. This difficulty in speaking is not caused directly by any external circumstances or trauma – rather, it is an anxiety disorder that results in avoidant behavior which may be reinforced over time.
Symptoms are typically present beginning between age 2 and 4 and diagnosis can be given into adulthood. The defining factors of SM are the presence of symptoms in childhood and the variation in people, places, and actives in which a person is able to use their voice when they can speak in other places. Approximately 1 in 140 children are diagnosed with SM with about a 2:1 ratio female to male. Unsurprisingly, 75% of children diagnosed with SM also meet the criteria for social anxiety disorder.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, in order to be diagnosed with selective mutism, an individual must meet the following criteria:
Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.
The disturbance interferes with educational or occupational achievement or with social communication.
The duration of the disturbance is at least one month (not limited to the first month of school).
The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
The disturbance is not better explained by a communication disorder (e.g., stuttering) and does not occur exclusively during the course of autism spectrum disorder disorder, schizophrenia, or another psychotic disorder.
For more information on SM, the SMA website has many resources for parents that are free of charge.
How is Selective Mutism Treated?
There are several different options to effectively treat sm. However, Parent-Child Interaction Therapy (PCIT) is the only one that is evidence-based (as of writing this post, 2022). PCIT-SM, PCIT for selective mutism, treatment is rooted in Parent Child Interaction Therapy developed by Sheila Eyberg and adapted for those with SM. Treatment is systematic and planned with use of earned rewards for verbal engagement (sometimes we need a boost to do hard things!).. When ready, the patient approaches planned exposure and response prevention to practice the target behavior of talking to new people in new places.
At Child and Family Therapy Collective, we offer weekly mini-intensive, as well as week-long intensive, treatment programs – please keep in mind, this is a general structure, and specifics will be discussed with you and your treatment provider. If you’d like to learn more about our sm treatment options and the details of working with us, please visit this page.
An important part of effective sm treatment is also parent, teacher, and school collaboration. Once clinical treatment is initiated, the collective group of individuals needs can be brought together to develop an appropriate plan for the patient targeting areas of impairment. Just as with many other disorders impacting children, IEPs and 504 plans can be very helpful in the school environment.
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