Selective Mutism

Question 1

selective mustism is a deep-seated and complex emotional disorder which manifests behaviourally as an absence of speech in some situations despite the ability to speak in others

Answer 1

Cline & Baldwin (2004); Kotrba (2015)

Question 2

children with SM show signs of social anxiety but not always to the extend of a Social Anxiety Disorder diagnosis

Answer 2

Johnson (2012)

Question 3

SM is believed to stem from “a pattern of avoidance of anxiety-provoking situations accidentally strengthened by negative reinforcement”

Answer 3

Kotrba (2015)

Question 4

DSM-V diagnostic criteria

Answer 4

APA (2013)

Question 5

what are the DSM-V diagnostic criteria

Answer 5

• consistent inability to speak in some social situations
• persists for longer then one month (or six months if it’s the first year of school)
• impacts social and educational functioning
• cannot be accounted for by another condition

Question 6

SM is not diagnosed in children who are simply uncomortable with a language such as recent immigrants unless the mutism persists for longer than six months or is present in both languages

Answer 6

Toppelberg et al. (2005)

Question 7

“selective” mutism is the preferred term over “elective” as it correctly refers to the anxiety-driven nature of the condition whereas the latter falsely implies blame or choice

Answer 7

Johnson (2017)

Question 8

1 in 140 young children are affected by SM

Answer 8

NHS

Question 9

study which found that 0.18% of nearly 11,000 Irish Primary School children fit the diagnostic criteria for SM

Answer 9

Sharkey & McNichols (2014)

Question 10

SM is 3 times more common in immigrant children from minority language backgrounds

Answer 10

Toppelberg et al. (2005)

Question 11

contributing factors to the development of SM include temperamental traits (shyness and fearfullness), a family history of anxiety-related behaviours and a significant environmental change (moving house or starting school)

Answer 11

Cline & Baldwin (2004)

Question 12

SM is distinguished from PTSD by the difference in mutism course

Answer 12

Kotrba (2015)

Question 13

course of mutism arising from PTDS

Kotrba (2015)

Answer 13

typical development -> traumatic event occurs -> child stops speaking -> child tends to start speaking again very quickly

Question 14

course of mutism in SM

Kotrba (2015)

Answer 14

child displays shy or inhibited termperament -> child displays other anxiety behaviours -> may have mutism in some social settings (e.g., church) which is dimissed -> onset of pervasive mutism on entering school

Question 15

SM is distinguished from shyness. Children with SM display a persistent lack of ability to speak, unlike shy children they do not “warm up to a situation”. The absence of verbal communication causes functional impairment. A child with SM may go years speaking to nobody or only to a few trusted individuals. Shy children may be initially hesitent but will engage eventually.

Answer 15

Kovac & Furr (2019)

Question 16

38% of children with SM have a premorbid SLCN

Answer 16

Steinhausen & Juzi (1996)

Question 17

theory that fear of teasing due to SLCN (e.g., speech errors) may contriute to the development of SM

Answer 17

Kryzanski (2003)

Question 18

children with SM may demonstrate subtle underlying expressive language deficits, e.g., shorter, less detailed narratives even when social anxiety is not a factor

Answer 18

McInnes et al. (2004)

Question 19

60-75% of children with SM have a comorbid SLCN

Answer 19

Sharkey & McNichols (2008)

Question 20

study which found that 75% (n=28) of children with SM had a comorbid SLCN and a further 33% had additional learning difficulties

Answer 20

Carmody (2000)

Question 21

prognosis of SM is worse if there is a family history of SM

Answer 21

Steinhausen et al. (2006)

Question 22

emphasises necessitation of MDT involvement for SM intervention

Answer 22

Hungerford et al. (2017)

Question 23

assessment components include diagnostic interviews with parents and teachers, standardised questionnaires and unobtrustive observation across a rang of social contexts and environments

Answer 23

Kotrba (2015)

Question 24

it may take 2-3 sessions before the child is comfortable enough to engage

Answer 24

Kotrba (2015)

Question 25

parents can be trained to admisiter simple formal assessments (e.g., RAPT) at home or in clinic

Answer 25

Johnson & Wintgrens (2001; 2016)

Question 26

study which investigated the feasibility and effectiveness of parent-administered formal assessments and found 42% of children had underlying expressive narrative impairments (n=33)

Answer 26

Kliem et al. (2013)

Question 27

communication rating scale (CRS) is a 17-item self-report scale which measures how easy it is to speak in different contexts (0=easy) (5=difficult)

Answer 27

Johnson & Wintgrens (2001; 2016)

Question 28

video recordings of the child speaking in a comfortable environment can be used to assess their communication skills if necessary

Answer 28

Kotrba (2015)

Question 29

preschool-aged children intervention focuses on reducing anxiety and discomfort ("nasty feeling")

Answer 29

Johnson (2017)

Question 30

behavioural interventions are the first-line approach for SM

Answer 30

Zakzseski & DuPaul (2016)

Question 31

shaping is a behavioural method in which sucessive approximations of the desired speech behaviour are reinforced

Answer 31

Kotrba (2015); Zakzseski & DuPaul (2016)

Question 32

key components of shaping are gradual exposure, reinforcing success and maintaining momentum

Answer 32

Kotrba (2015)

Question 33

collaboration between schools and SLTs us crucial to ensure consistency across settings and to embed interventions in the environment where mustism occurs

Answer 33

Keem et al. (2008)

Question 34

SLTs are responsible for delivering psychoeducation and training to educational staff to integrate cross-setting strategies to support the child's communication development

Answer 34

Sakzseski & DuPaul (2016)

Question 35

SLTs take on a consultancy role to share rationale and guidance on intervention plans. These plans help integrate interventions such as shaping and stimulus fading in routine classroom practice

Answer 35

Stuckin & Smith (2014)

Question 36

creating an anxiety-free environment is key as reducing anxiety is often a prerequisite for communication

Answer 36

O'Neill (2005)

Question 37

understanding that SM is an anxiety disorder and not a result of trauma or stuborness is key

Answer 37

Kovac & Furr (2019)

Question 38

study investigating feasibility and efficacy of group therapy for children and parents with SM (5 children)

Answer 38

Sharkey et al. (2008)