Sunday, November 24, 2013

The Source for Selective Mutism

Gail J. Richard's book, The Source for Selective Mutism, is a comprehensive book for addressing selective mutism but has a heavy focus on young children. It has six main points of evidence based practice that it builds on are as follows:
  • Early intervention is critical- provide therapy as soon as possible
  • Therapy is more successful with young children than older ones
  • The majority of approaches are behavioral using desensitization and shaping verbalizations across settings and people
  • Many select mutes have comorbid speech and language issues
  • The research leans toward it most often being an outreach of anxiety
  • A close relationship exists between selective mutism and expressive language issues

The author defines the disorder, provides characteristics and assessment suggestions for the disorder. This is one of the first places I have seen links between social behaviors such as eating and laughing and selective mutism emphasized. The individual that I work with will not smile or open her mouth at all. In twelve weeks I have seen her teeth precisely once.

The book does include some nice handouts for parents and teachers. These could be very useful since the disorder is so rare. The author does speculate that more people have the disorder but are either not diagnosed (ie. she is just shy) or diagnosed with a different disorder, most often autism spectrum ones. Having materials to share helps people deal with child.

The graphs in the text are difficult to read. A reliance of 3-D graphics dose not allow easy comparisons of information. Other graphics, however, are clear and readable.

My concern is that I have an adolescent who will not speak at all. She did once, two years ago. She has comorbid anxiety and OCD which seem to be related. Getting her to participate is a challenge, even one on one. The desensitization issue is problematic because she does not have a speaking environment to draw upon. Familial coping patterns are well established. There is some acceptance that she may never speak or communicate with outsiders.

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