Selective Moutism In Preschool Children

Sam is an adopted child. Quite early on his adoptive parents had concerns about his speech and language. They noticed he uses very few single words and is very reluctant to communicate with anyone. Initially they thought he is feeling shy or taking time to adjust to new environment but Sam started having more tantrums. They were worried about his communication and ability to cope at nursery school. He was referred to the Speech and Language Therapy Service when he was two years old.

This study was a quantitative study using and exploratory, descriptive design to explore the role of the school psychologists, their involvement, knowledge and training regarding the Selective Mutism child. The study’s purpose was to measure how much knowledge the school psychologists had regarding intervention used when an SM child was identified. The research questions developed (Ellis, 2015):

Most parents fail to recognize their child’s disorder until early kindergarten years and contribute the lack of speech prior to entering school as shyness or fear. The average age of onset for selective mutism occurs between three and five years (Beidel & Turner,

Sample population: The diagnosis was that the children had to have CAS. The eligibility criteria were that they were between the ages of 5 years, 5 months to 11 years, 2 months. They also had to pass a pure tone audiometry test, have normal receptive vocabulary, and have a normal oral structure. They seemed to consent to the study, which appears to be a convenience sampling technique. Originally 11 children were selected, but six of them did not meet the criteria listed. Furthermore, one of the children used in this study did receive speech therapy during the posttreatment period.

However there is good news and that is that with the right help and the right amount of time and effort kids with selective mutism get better.

My proposed area of study for my dissertation is to look at and explore the phenomenon of Selective Mutism as it appears in children. I will specifically be examining the symptoms of this behavior utilizing a variety of cognitive and behavioral theories. Contemporary forms of treatment for SM will also be researched in my dissertation. Through the totality of my research I will be able to draw conclusions and report my findings to the psychological community. These findings will provide insight on how to detect, diagnose, and treat this rare, but serious condition.

To ensure that criterion E has been satisfied an understanding the differential diagnoses is imperative. Differential diagnosis can be understood as, “the distinguishing of a disease or condition from others presenting with similar signs or symptoms” (“Differential Diagnosis”). Selective Mutism has differential diagnoses under three domains, communication disorders; neurodevelopment disorders (including schizophrenia and similar disorders) and social anxiety disorder (American Psychiatric Association, 2013a). Understanding the differences in these diagnoses versus selective mutism benefits the client and ensures that they receive the correct treatment and care. Communication disorders are commonly misunderstood as both at face value deal with communication. However, it is important to recognize that communication disorders, such as social pragmatic disorders, language disorder, speech and sound disorders and childhood onset fluency disorder are characterized by an in ability to communicate, regardless of setting. This differs from selective mutism due to the disorder not presenting itself in all settings. Arguably if there were systemic difficulties with communication, such as vocabulary, syntax or stuttering were present these disabilities would be noticed prior to entering grade school and would be present in situations where selective mutism children are present speaking.

Selective Mutism, a disorder that is complex and differentiated by an individual’s failure to communicate effectively and speak in social settings. Although adults also have this disorder, this study is related to children only with this disorder and how to support them in a regular classroom setting (Harwood, & Bork, 2011).

This can be even more problematic if it is not treated early on because then it can develop into social anxiety and/or avoidant personality disorder in the future. Selective mutism is a poorly understood childhood condition that affects approximately 1% of the population (Cohan et al., 2008). Helping to make the child see that it is okay to speak and that we want to hear what the client has to say is important. Starting by using non-verbals is an important bridge and the use of play therapy for these children is the key to building a relationship and rapport with them. As we learned in class play is the language for children so this is exactly how we can get them to express themselves, especially for younger children.

6). Approval was obtained from the research ethics boards of the academic centers of Toronto, Vancouver, and Montreal. The sample was recruited through specialized anxiety disorders clinics in three urban areas. Forty-four children with 32 SM girls and 12 SM boys, and 28 children with Axis I anxiety disorders. Also, included in the group 13 girls and 15 boys with Anxiety disorders, along with 17 with generalized anxiety disorder, 7 with social phobia, 4 with separation anxiety disorder, and 14 females and, 5 males diagnosed as normal made up the participants. To validate their data, the researchers used some test such as The Peabody Picture Vocabulary Test-III (PPVT-III; Dunn and Dunn, 1997) is an extensively norm-based measure that estimates children's receptive vocabulary skills. The ADIS (Silverman and Albano, 1996) is a semistructured diagnostic interview focusing on childhood anxiety disorders in addition to The Selective Mutism Questionnaire (SMQ; Bergman et al., 2001) was also included. This is a specific parent- and teacher-report measure of mutism severity. Strengths of the study were it was the only study so far to examine the three factors of oral language, working memory and social, clinical impairment and intervention within the same sample. The weaknesses were The availability of questionnaires in English only eliminated a large segment of the SM population from this study. Also,

Diagnosis of selective mutism is mostly on the basis of the patient’s clinical history. A speech-language pathologist (SLP) plays a key role in the diagnosis of the condition. A child who shows signs of selective mutism should be taken to an SLP, apart from a pediatrician and a child psychologist. All of these health care professionals need to come together and work as a team with parents, teachers, and the affected child.

As the makeup of students in classrooms change and general education teachers are educating a range of students with diverse needs, new learning barriers are becoming prominent in American classrooms. One of these learning disabilities that is emerging is a language disorder called selective mutism. Selective mutism is defined as a language disorder in which individuals who exhibit normal language skills with no delays in daily home situations are unwilling or unable to speak when confronted with novel situations or people. This disorder, when presented in classrooms, can affect both the social and the academic progress of the student. When considering students who exhibit symptoms of selective mutism,

There are several ramifications of the problem for development in terms of the biological, psychological, and social domain. Biological consequences are genetic and neurologically based. Selective mutism and related anxiety conditions (e.g. social anxiety) can be passed through generations. For example, one longitudinal study found that amongst 45 children diagnosed with SM, between the years of 1964 and 1979, 9%, 18%, and 18% of their fathers, mothers, and siblings, had similar histories of selective mutism (Remschmidt, 2001). Some neuro-developmental delays as a result of selective mutism can include a later onset of communication disorders. In one sample of children with SM, it was found that 30.3% developed speech and language disorders (Steinhausen, 2006). Though these neurological delays were found to be not as severe as expected. Another biological result of selective mutism are auditory processing deficits. One study looked at issues in the ability

Thus, Melinda’s inability to speak allowed for her secondary diagnosis of selective mutism. The defining criteria of selective mutism is a “consistent failure to speak in specific social situations in which there is an expectation for speaking, such as at school, despite speaking in other situations” (DSM-V 195). While selective mutism involves a ‘failure’ to speak, the mutism is anxiety-driven and is therefore not a conscious choice by the sufferer, hence Melinda’s frustration: “it is getting harder to talk. My throat is always sore, my lips raw. Sometimes my mouth relaxes around Heather, if we’re alone. Every time I try to talk to my parents or a teacher, I sputter or freeze. What is wrong with me?” (Anderson 50). Melinda could hardly speak at school or home, but she spoke more freely around those she felt comfortable with. Additionally, selective mutism is not the result of another psychotic disorder or inadequate knowledge of the language, and symptoms must be present for at least one month (DSM-V 195). Like PTSD, selective mutism interferes with academic and social

There are many treatments for Selective Mutism, such as psychodynamic, family systems, and pharmacological approaches, however the most commonly used techniques are behavioral interventions (stimulus fading, contingency management, shaping, learning theory approaches, escape-avoidance, and self-modeling techniques) (Mitchell & Kratochwill, 2013). It is very important that children who begin to display signs of Selective Mutism get treated right away to avoid further impairment in their academic success and social interactions.