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Innovative Treatments for Selective Mutism - featured September 24, 2010

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Innovative Treatments for Selective Mutism

All material Copyright © 2010 Aimee Kotrba, SelectiveMutismTreatment.com

By: Aimee Kotrba, Ph.D., Pediatric Psychologist


Research clearly demonstrates that Cognitive Behavioral Therapy is the most effective treatment for Selective Mutism, a childhood anxiety disorder characterized by a fear of and hesitancy/refusal to speak to individuals outside of the immediate family (Kratochwill, 1981; Krohn et al, 1992; Leonard & Topol, 1993; Tancer, 2002). Cognitive Behavioral Therapy conceptualizes Selective Mutism as a set of behaviors that have been, in part, learned and can therefore be “unlearned.” Treatment consists of modifying the child’s environment, systematically practicing new behaviors, and identifying factors that maintain the avoidance of communication. Additionally, children are taught to change thoughts and perceptions of their environment that might inhibit communication with others.

With this in mind, researchers and practitioners have searched for ways to utilize technology and different treatment modalities in alignment with Cognitive Behavioral Therapy to assist children with Selective Mutism. Dr. Steven Kurtz currently runs Brave Buddies, a one-week intensive summer program designed to prepare children with Selective Mutism (SM) for school. Using a simulated classroom setting, the program offers opportunity for the practice of verbal participation. The daily schedule is modeled after a typical school day, including morning meetings, activity centers, meals, and field trips. Each “camper” is paired with an adult “counselor” who facilitates their participation during the week. Children benefit not only from the daily experience of a classroom setting focusing only on practicing new, “brave” behaviors, but also from interacting with other “campers.” Brave Buddies has demonstrated success in helping children with SM. Results thus far demonstrate that six months after treatment children who were involved in individual Cognitive Behavioral Therapy plus Brave Buddies camp did significantly better than those in individual Cognitive Behavioral Therapy alone.

Video and Audio Feedforward is also occasionally used in conjunction with Cognitive Behavioral Therapies. This technique uses audio or videotaping spliced to depict the child speaking in situations in which he/she is not currently speaking. For example, the practitioner may videotape the teacher take part in a one-sided conversation about a topic, pretending to ask questions to the SM child (who is not in the room). Next, the child is videotaped (without the teacher present) answering these questions. Finally, the tape is spliced together to depict the teacher asking the questions and the student answering them. This technique is useful for multiple reasons. First, it models for the child what they would look like if they could speak directly to the teacher (e.g., self-modeling appropriate behavior). Second, it could be considered one step in the exposure process, prior to the child actually speaking to the teacher. Third, it could be shown (with the child’s permission) to the class, correcting any assumptions peers might have about the child’s ability to speak.

Finally, Dr. Daniel Fung has adapted a web-based Cognitive Behavioral Therapy program for children with SM. This treatment includes a web-based child workbook and downloadable parent/teacher manual focusing on educating the child and parents on Selective Mutism and anxiety, teaching the child to recognize anxious arousal, and instructing the child on helpful coping strategies. Furthermore, homework, in the form of graded exposures to feared situations, is given and results are submitted by email. Treatment consists of 14 sessions estimated at 90 minutes in length. Although an initial case study demonstrated improvements, further studies haven’t suggested significant effectiveness.

As rates of Selective Mutism increase, researchers and practitioners strive to find more inventive, effective modes of assisting children. Group therapy, Audio/Video Feedforward, and web-based therapy may provide some additional options for parents and children in their quest to increase communication and decrease anxiety.


Featured Author and Organization: Aimee Kotrba, Ph.D., Pediatric Psychologist and SelectiveMutismTreatment.com

We thank Aimee Kotrba, Ph.D. for contributing this article for the PediaStaff website and newsletter.

Dr. Aimee Kotrba is a pediatric psychologist in Plymouth, MI offering expert consultation, diagnosis, and treatment for Selective Mutism. Dr. Kotrba currently conducts regular workshops on the identification and treatment of Selective Mutism for parents, professionals, and educators. In therapy, Dr. Kotrba integrates behavioral techniques with cognitive strategies, parent coaching, and school intervention to provide a well-rounded and complete treatment plan. She serves on the board of the Selective Mutism Group. Information about Dr. Kotrba and her practice can be found at http://www.selectivemutismtreatment.com.

Tags: Newsletter 24 September 2010 Selective Mutism SLP School Based Psychology