In addition to systematic desensitization, the therapist may use audio or videotapes to help the youngster. In one scenario, the therapist may ask the parents to bring in an audiotape or videotape of the child at home when she is speaking. The therapist then provides ample reinforcement for the child’s speech by praising the child for having a beautiful voice and for making the tape. Audio and videotapes may also be used to help the child speak louder or work on her articulation.
Reinforce the positive, avoid “shaming”
Parent-based practices include reinforcing the child’s speech in different settings, developing new and independent exposures to generalize speech, and consulting with school officials on an ongoing basis to address social and academic problems from poor use of speech.
The therapist is likely to remind the parent that positive reinforcement is key, while punishing or “shaming” the child is ineffective.11 Some therapists will make use of a technique called “token economy,” where the child’s progress earns her colored chips that can be redeemed for a trip to a video game center, or a special treat, such as a sleep-over with a trusted friend.11
With the therapist’s help, parents can also model appropriate social interactions for a child with selective mutism because social skills may not be sufficiently developed. For example, the parent might encourage the child to answer the door or telephone. The parent might also monitor the child’s interactions with friends and provide feedback. In addition, the therapist may encourage the parents to ignore inappropriate compensatory behaviors as treatment progresses. Instead, a child with selective mutism may be increasingly challenged to provide audible speech to make requests or otherwise communicate.21
Drug therapy may include MAOIs and SSRIs
Medical treatment for selective mutism may include monoamine oxidase inhibitors (MAOIs) such as phenelzine (30–60 mg/day) or selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (10–60 mg/day), sertraline (100 mg/day), fluvoxamine (50–100 mg/day), citalopram (20–40 mg/day), or paroxetine (5 mg/day).22 However, no large-scale studies of pharmacotherapy for selective mutism have been conducted and medication effects are quite variable. The literature in this area has consisted largely of case studies.
After 9 months of treatment, Lucy speaks up at school
Lucy’s therapist (JLV) utilized many of the behavioral procedures described in this article. Treatment included exposure-based practices at home, in a clinic, in various community settings, and at school. By the end of her 9 months of treatment, Lucy was speaking independently to her classmates and teachers, though ongoing praise by her teachers was needed to encourage her to maintain an appropriate speech volume.
The literature on selective mutism suggests Lucy’s case was not unusual; it typically takes several months for these young patients to improve. Ongoing communication issues, though, often linger.9
8 questions to ask when you suspect selective mutism
- What specific settings involve failure to speak?
- Has the mutism lasted at least one month?
- Does the child speak well at home with people she knows well?
- Is failure to speak significantly interfering with the child’s academic or social development?
- What circumstances surround each episode of mutism?
- Can the child be encouraged to speak audibly in any way in certain public settings?
- How do others respond to, or compensate for, the child’s mutism?
- Does the child appear anxious or depressed in situations involving mutism?
Correspondence
Christopher A. Kearney, PhD, Department of Psychology, University of Nevada, Las Vegas, 4505 maryland Parkway, Las Vegas, Nv 89154-5030; chris.kearney@unlv.edu