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Selective Mutism: Coordinated Behavioral Approaches for Therapists, Parents, and Schools

Presenter: Brian C. Chu, Ph.D
Download this webinar by clicking here
Download this webinar’s corresponding slides here.
Dr. Chu explained this impairing behavioral disorder, to help us understand how the problem presents and how it can best be addressed. He provided descriptions of how selective mutism presents in children, its associated impairment, and provided guidance for parents, schools, and therapists for addressing this problem.

For additional resources on selective mutism and its treatment, please visit the following sites:

Our own Rutgers University Youth Anxiety and Depression Clinic (YAD-C):
http://yadc.rutgers.edu/

American Psychological Association Division 53 (Child Clinical) website on Evidence-base Treatments for Children and Adolescents:
http://www.effectivechildtherapy.com/

Association for Behavioral and Cognitive Therapies, Child and Adolescent Anxiety SIG:
http://www.childanxietysig.com/

The Selective Mustim Group: A Family Advocacy Organization
http://www.selectivemutism.org/

Comments(7)

  1. kerry.harvey says

    Hi

    not sure if this is the area for questions. I am interesting in knowing how to deal with professionals when I am trying to get help who have little or no experience with SM, what should be my approach in education and also while respecting their knowledge and experience.

    Kerry in Western Australia.

    • Dr. Chu says

      I think it’s important to approach others as active collaborators. For example, my talk did not highlight as much as it should have the important roles that Speech and Language Pathologists can play in addressing SM. Why? Simply because the school districts I’ve worked in haven’t had as ready access to SLP, so I have had less experience with them. Should I have the opportunity to work with the SLP, that would be a good occasion to schedule a collaborative meeting (school, family, SLP, psychologist) and discuss (a) what expertise/knowledge we each had, (b) what roles we could each play to help the child, and (c) develop a feedback loop/communication system so that we were keeping each other informed. That would ideally maximize the strengths/knowledge of each member of the team but also minimize redundancies in effort or stepping on each others’ toes. There’s no magic to this – it’s the same as working in any system. Ongoing communication is best. But given how busy everyone is, having a solid plan ahead of time helps simplify things and gets everyone going in the same direction.

  2. Pearl says

    Dr. Chu,
    Enjoyed the webinar, but have one question…
    With regard to the “ice cream parlor” example. How long do we wait for our sm daughter to order, and what do we do when she doesn’t? Do we walk away and not let her get the ice cream? And isn’t that punishing her for her sm?
    Thanks,
    Pearl

    • Dr. Chu says

      Good question about the ice cream parlor example. And this will be difficult to describe in a blog post. We don’t want to punish kids or embarrass them or impart hopelessness. We use two separate, parallel, processes. First is the planful one. This is more akin to what I was describing in the talk. Here, we devise a fear hierarchy, we practice going up to the counter at home and in safe environments, and when we’re ready, we plan to go to the ice cream parlor. And in THAT context, we planfully tell the child, “Okay, I think we’re ready to try going to the ice cream parlor. When we get there, though, I want you to go up to the counter and ask for the ice cream yourself. I know this is still a challenge, so if you make it up to the counter without hiding behind me, you’ll get one point/sticker; if you say, “hello,” you’ll get two stickers; if you point at the ice cream you want, you get three stickers; if you reply to him when the attendant identifies the flavor, you get four stickers; if you actually verbally ask for the ice cream, you get a special bonus.”

      Now, the decision on whether the child should get the ice cream that day depends on where you are in the “treatment” and how much practice the child’s had. If she’s at the beginning stages, you might want to encourage all that behavior leading up to asking, then, you might say, “If you do steps x, y, z, then you ALSO get the ice cream.” If you have been practicing this for days/weeks, and the child has been demonstrating increased skill, then, I would draw the line in the sand and say, “This is it. Today, we’re going there to practice asking for ice cream. I think you can do it. You will still get points for the other actions, but you will only get ice cream if you ask for it. It’s okay by me. I won’t think badly about you; I just want to help you get ice cream when you want it. Okay?” And then, you hold to your bargain.

      All the while you are doing this, there’s the second process is: while you’re planfully doing this, you may find yourself in an ice cream parlor with a bunch of your child’s friends. In this case, continue to use empathize and encourage and expect them to behave up to the level that they have achieved on the fear hierarchy. But here, if they haven’t already gotten to asking for ice cream by themselves, I wouldn’t expect it here. Here, I would encourage them up to the level they can achieve and then help them with the rest (including buying the ice cream). I don’t think drawing a line in the sand in front of other kids helps too much.

  3. kerry.harvey says

    Hi there

    sorry another question, do you have any advice for Speech Therapists. My son has a moderate to severe language delay is there any advice you can give for them?

    Kerry in Western Australia

    • Dr. Chu says

      As you can tell from my first response, I think I would allow the Speech Therapist to give you guidance about what they can offer. They have a lot of skills in helping address motor and expression problems that can be contributing to a child’s anxiety. However, if there are additional anxiety issues associated with the child’s SM (which we find to be common), then, that’s when you want to suggest collaboration, potentially with a psychologist. I wouldn’t expect a speech therapist to be able, or willing, to conduct exposure exercises. Division of labor here can be helpful so that each professional can bring their own expertise to the situation.

  4. Brian Chu, Ph.D. says

    Thank you all for your interest. I will try to answer some of your questions shortly, but I also wanted to post some helpful links. These all will provide information on child anxiety, including SM, and help you identify professionals in your area:

    Our clinic, the Youth Anxiety and Depression Clinic (YAD-C): http:yadc.rutgers.edu

    APA Div 53 site for evidence-based treatments: http://www.effectivechildtherapy.com

    ABCT Child Anxiety SIG: http://www.childanxietysig.com

    Child Anxiety Network: http://www.childanxiety.net

    Selective Mutism Group: http://www.selectivemutism.org

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