Areas of Specialization - Children and Adolescents
Selective Mutism Treatment
Several cognitive behavioral techniques
can be utilized to help selectively
mute children and their parents.
Treatment plans are based on the
principle that the selectively mute
child is not talking as a result
of anxiety in social situations
or to gain attention or rewards.
The focus of therapy is to reinforce
speaking, or anything that approximates
speaking, and not to reinforce the
mute behavior. Thus comprehensive
treatment for selective mutism concentrates
on the child's social anxiety, the
lack of practice and experience
the child has obtained speaking
outside the home, and the reinforcing
factors that maintain the child's
nonverbal communication. Treatment
typically begins with teaching the
child, with their parents present,
relaxation techniques to decrease
their anxiety. At this point the
child is only expected to listen
in session, but the child is instructed
to practice the relaxation at home
with their parents. Children are
notified that they will be expected
to gradually speak with people in
their family in front of unfamiliar
people and eventually talk with
these unfamiliar people. The concept
of rewards and consequences are
explained to the child and used
as motivation for the child to talk.
A hierarchy is created that ranks
the child's least anxiety provoking
to most fear inducing talking situations.
The child is gradually exposed to
situations that create anxiety and
once the child is speaking comfortably
in that situation, the child works
on the next challenging situation.
Additionally the exposures are progressively
conducted within the classroom with
the child's teacher and peers to
encourage communication and lessen
anxiety about speaking. Throughout
the exposures, parents are instructed
to provide consistent praise for
talking, reward social behavior
according to a reinforcement plan,
and provide consequences for refusals
to make efforts to speak.
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