1st half Flashcards
selective mutism
● Definition: persistent failure to speak in specific social situations despite speaking in other situations.
● Disturbance must interfere with achievement or social communication & last for more than a month
● Impairment: Achievement & Socialization
Comorbid Problems
● Elimination problems ● School and social phobia ● Obsessive compulsive features ● Depression ● Speech and language problems
Prevalence
● Fewer than 1% of school children
● More common in females
Prognosis
Prognosis problematic with respect to social development as opposed to academic difficulties
● Even after cessation of disorder, child may still have difficulties with respect to being uncomfortable in social situations & experiencing social anxiety
● Longer child left untreated, more likely they experience difficulties later on in adolescence & adulthood with respect to socialization, peer relations, & managing conflict in interpersonal exchanges
Etiology
● Genetic predisposition
● Psychoanalytic perspective: results from trauma, insecure environment, or conflictual family relationships
● Response to family neurosis (overprotective mothers, strict fathers, history of anxiety disorders, parenting style)
● Develop as a reaction to trauma (e.g., hospitalization, abuse), but not necessarily
● Temperament, behavioral inhibition
● Learning perspective: SM is a learned pattern of behavior that is maintained by the consequences being mute.
● SM results from a way to reduce fear or an unfamiliar environment
● Student freezes up ® people leave them alone (adaptive)
Prognosis and family environment
● Longer problem exists poor prognosis /resistant to intervention
● Environment associated with Selective Mutism:
● Social isolation
● Disharmony
● Absent / distant father
● Overprotective / depressed mother
Assessment
● Longer problem exists poor prognosis /resistant to intervention
● Environment associated with Selective Mutism:
● Social isolation
● Disharmony
● Absent / distant father
● Overprotective / depressed mother
Structure Parent Interview
Structured parent interview because child may not speak to therapist
● Get info on onset (sudden or insidious) to rule out ASD or language delay
● Degree to which child is verbally or nonverbally inhibited (e.g., does he speak at home?)
● Academic ability?
● Does the child exhibit behaviors that are not characteristic of SM?
● Obtain a neurological & developmental history to rule out neurological injury, developmental delays, etc
Evaluation & testing
● Evaluation of speech and language ability
● Auditory testing since hearing difficulties can affect speech & language development
● Physical examination
● Exposure to English language
● Cognitive testing rule out LD
● Academic testing both standardized & informal
Interview the child
● Allows clinician to directly observe the severity & nature of child’s mutism
● Observe temperament, quality of interaction, ability to communicate verbally & nonverbally, play, etc
School plan for SM
● Goal: reduce anxiety associated with speaking while encouraging the child to interact & communicate
● Interventions conducted in classroom:
● Separate class into smaller groups
● Identify supportive peers
● Alternate means of communication
● Reward child for behaviors that they already mastered until child has gained confidence (difficulty of desired behavior can be increased)
● Once child begins speaking, generalize to other environments using techniques such as stimulus fading
● Speech therapist
Behavioral interventions
1. Contingency Management
involves both reinforcement of the child’s verbal behavior (reinforcement) & ignoring of nonverbal attempts at communication (extinction). Both reinforcement & extinction used together are more effective than either alone
Behavioral interventions
Stimulus fading
transfer of stimulus control by reducing the strength of or fading, the stimulus that causes the SM
● similar to desensitization where therapist sets simple goals & gradually increase difficulty of task
○ Example: playing game with people child feels comfortable speaking with in school class room. Successive introduction of other students until SM is attenuated
Behavioral interventions
Shaping
systematic reinforcement of successive approximations toward normal speech
● therapist reinforces mouth movement (approximate speech) until true speech is achieved
Behavioral interventions
Self-modeling
involves child’s repeated & spaced viewings of edited videotapes depicting child performing exemplary behaviors
● Some view as most efficacious though rarely used
● Tape the teacher delivering the questions & tape the child responding to parent & edit the film so it looks like child is responding to teacher
● Have child repeatedly view taping
