Wednesday, September 18, 2013

Understanding Katie and Selective Mutism

I have a student on my caseload this year with selective mutism. Knowing virtually nothing about this disorder, I immediately began looking up information. One of the things I came across was the SMART center. I read and then ordered books. The first is a short one called the Supplement Treatment Guide to "Understanding Katie": For Parents, Teachers and Treating Professional: Understanding Selective Mutism and Social Anxiety by Elisa Shipon-Blum. The book could accompany a picture book called Understanding Katie, which I did not get. The guide both describes the picture book and gives lots of commentary and information about the disorder.

My takeaways:
Mental health aspects:  The anxiety is clearly overwhelming and needs to be treated. Medication may enable people to address the concerns. Desensitization to the phobic areas with a trained psychologist/psychiatrist is important. Focusing on getting the child to "talk" or "speak" may be counterproductive because it increases anxiety. Anxiety may be so severe that facial and vocal muscles are frozen. Treatment should include normalizing anxiety and the desire to be right/perfect while acknowledging how dysfunctional the mutism is and presenting strategies to deal with anxiety through other means. Professionals who wrap around different environments may be helpful with transitions. While some cases are caused by trauma, many cases do not involve any known trigger.

Behavioral aspects: Effort at communication and attempting hard things needs to be rewarded. Because of the anxiety, maladaptive behaviors may have been learned and these need to be changed. The idea that the silence becomes a habit needs to be addressed. Rewarding appropriate attempts rather than punishing inappropriate ones is helpful.

Educational aspects: These children are usually of average intelligence and want to learn and socialize. Reducing anxiety is important. Working with the family is essential. What the child may be able to do in one environment, he or she may not be able to do in another. Creative ways to assess learning may be required. Using the phrase, "has trouble getting the words out in school," rather than "doesn't talk" or "can't talk" is less anxiety producing.

Social aspects: The child needs to have structured opportunities to develop and maintain friendships, even if they are silent. Parallel play. Perhaps video games where individuals do not need to respond to each other but to the screen. Playgrounds where the expectation that talking is not essential. Comfortable adults or friends need to be available to facilitate transitions.

Stages of Communication Comfort Scale: This can be assessed in different environments with different people. Stages may change based on the surrounding circumstances.
  • 0- non-communicative- nonverbal and verbal
    • no response or initiation
    • motionless, frozen, expressionless
  • 1- nonverbal communication
    • responding- pointing, nodding, writing, sign language,...
    • initiating- get someone's attention, speak first, handing a note to someone
  • 2- verbal communication
    • responding- includes using a verbal intermediary, perhaps whispering to another who speaks on the child's behalf
    • initiating- speaking, getting attention, making sounds

I am curious if anyone has any advice on strategies that have been successful with such individuals.

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