Although this is not classified as a child anxiety disorder, selective mutism
is often seen around the time that children enter school for the first time,
and can be accompanied by anxiety. The essential feature of selective mutism
is the persistent failure to speak in specific social situations (e.g., school,
with playmates) where speaking is expected, despite speaking in other situations.
In order to be diagnosed with selective mutism, the person’s speech refusal
must interfere with educational or occupational achievement or with social
communication, and must be going on for at least one month. Selective mutism
is not diagnosed if the individual’s failure to speak is due solely to lack
of knowledge of the language.
Primary symptoms of selective mutism include persistent failure to speak in
specific social situations where there is an expectation for speech. The child
should be able to speak in other situations. This disorder is usually first
seen in childhood, and is treatable with cognitive-behavioral techniques.
One of the most important first steps in the treatment of selective mutism
is conducting a thorough evaluation, including getting a good social history
of the child, and a history of the onset, duration, precipitants, and
consequences of the child’s non-speech behavior. Also, it is important
for the clinician to get a good understanding of the child’s speech behavior
in different settings. A detailed history of the child’s motor, language,
and social development should also be obtained. In addition, it is important
for the clinician to assess how the child’s failure to speak is perceived
and reacted to by the family. Through processes of shaping, therapists’
goals are typically to increase the child’s verbalizations first within
the therapy framework, while building a good therapeutic alliance. The
child is encouraged and praised when he or she even approximate speech
behaviors (e.g., whispering). The next phase of treatment typically involves
generalization of verbal mastery to the school setting, which often requires
teacher involvement. Other skills used in treatment include role playing,
changing anxious thoughts about speaking, and using relaxation training
to assist children in meeting therapy goals.
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Anxiety Network. All Rights Reserved.
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