behavioral techniques in the treatment of selective mutism l.
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Behavioral Techniques in the Treatment of Selective Mutism. Aimee Kotrba, Ph.D. Can you identify the child with selective mutism?. DSM-IV Criteria. Consistent, ongoing failure to speak in specific social situations Interferes with education or social communication

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dsm iv criteria
DSM-IV Criteria
  • Consistent, ongoing failure to speak in specific social situations
  • Interferes with education or social communication
  • Not due to lack of language skills
  • Other disorders (e.g., stuttering, PDD) have been ruled out
  • A relatively rare childhood disorder, affecting approximately 1% of children in elementary school settings
assessment of selective mutism
Assessment of Selective Mutism
  • History
  • Behavioral observations
  • Cognitive functioning
  • Language functioning
psychological treatment of selective mutism
Psychological Treatment of Selective Mutism
  • Education
  • Medication
  • Desensitization
  • Hierarchical exposure
  • Relaxation techniques
  • Shaping speech
  • Generalization
psycho education of child
Psycho-education of Child
  • Bibliotherapy
  • Cat’s Got Your Tongue: A Story for Children Afraid to Speak
    • Written by Charles Schaefer
    • Published by Magination Press in 1992
  • Treatment is explained in age-appropriate language to child
  • Child is assured that the therapist will practice with them in becoming braver and stronger.
psycho education of parents
Psycho-education of Parents
  • Selective mutism is conceptualized as a social anxiety disorder
  • Behavioral techniques are explained
  • Describe ways parents could prevent inadvertently reinforcing mutism
  • Pediatrician discusses role of medication
    • Anti-depressants have been found to produce beneficial effects for children with selective mutism.
    • However, research demonstrates that the most effective treatment is cognitive-behavioral therapy.
treatment package
Treatment Package

Implementation Flowchart

Individual work with child

Work with parent present

Training parents

Collaboration with other


fear hierarchies
Fear Hierarchies

Example Fear Hierarchy

  • Expanding stimulus & response classes
    • Expand hierarchy to include other adults and children
    • Increase volume requirements for speech
    • Decrease latencies to responding
    • Utilizing shaping and fading principles
case example 1 alone with mother
Case Example 1Alone with Mother
  • 6 year old (Annie) diagnosed with selective mutism
  • 2nd session of treatment
  • Early treatment on her fear hierarchy
escape contingency
Escape Contingency
  • Required to nod head Yes or No as a response to the question posed by the therapist
  • Posture, facial expression, and demeanor changes when therapist enters the room
relaxation techniques
Relaxation Techniques
  • Deep breathing exercises
  • Positive self-statements
  • Visualization
shaping techniques
Shaping Techniques
  • One word spoken simultaneously with therapist
  • One word spoken alone
  • Repeated a short sentence
  • Answered questions
  • Gradually increased voice volume
generalizing behavior to school
Generalizing Behavior to School
  • Teachers are given information concerning the present step on the heirarchy.
  • Importance of practicing heirarchy in the school setting
  • Steps are only added when they were “cleanly” demonstrated in the therapy session
generalizing behavior to public
Generalizing Behavior to Public
  • Gradually increasing proximity to peers
  • Working with peer dyad in the clinical setting
  • Parents asked child questions in public
  • Parents arranged play dates
post treatment with therapist
Post treatment with Therapist
  • Hierarchical steps have been accomplished with the therapist
  • Future goals will include expanding the response class to include additional adults and children in a variety of settings
  • Achieving spontaneous speech across multiple settings
  • Booster sessions will likely be necessary