play therapy for selective mutismplay therapy for selective mutism

Look directly at the child without focusing on a prop. Treating older kids with SM is more complicated because they have lived with the disorder for longer, but there is still excellent help available for them. It involves gradually exposing a child to increasingly difficult speaking tasks. While an increasing amount of literature on selective mutism has been published during the last fifteen years, studies involving school personnel are virtually nonexistent. This is the only known case study where a single intervention was isolated and its effectiveness examined. Additionally, the safe nature of this type of treatment along with its high success rates, make it popular. Clinical Case Studies, 4(1), 81112. Geelong clinic: 2/142 Little Ryrie Street Geelong (1997) found no evidence of trauma among their case study participants. Tel: +658189 3820Email: appointments@akids.sg, Dr Annabelle ChowChristine KwekHaanusia Prithivi RajJemie WangKimberly Chew Kirsty PngJiayong LinStephanie Chan, Careers | Community | Terms | Payment All rights reserved 2022Annabelle Kids Pte Ltd, ADHD - Attention-Deficit/Hyperactivity Disorder, Avoidant/Restrictive Food Intake Disorder, Childhood-onset Fluency Disorder (Stuttering), Social (Pragmatic) Communication Disorder, Baby Developmental Milestone Guide (0-5 yrs). Journal of Child Psychology and Psychiatry, 47(11), 10851097. It is important to mention that a childs cognitive development dictates how well this intervention may work. Playing becomes the childs way to communicate and make sense of his or her experiences. They can work through their concerns and never utter a word! Cohan, S. L., Chavira, D. A., & Stein, M. B. Many factors play a part in selective mutism, such as. June 2023 4344). Treatment plans may include any combination of the following selective mutism therapy: The top 10 therapies are: Behavioral Therapy. Parents often feel confused Recognizing body symptoms of anxiety (e.g., heart beating fast, shortness of breath, flushed cheeks), Identifying and challenging maladaptive beliefs (e.g., Everyone will laugh at me if I speak due to the sound of my voice), Developing a coping plan to deal with distress (e.g., generating calm thoughts, and problem solving how to cope), Communicate by pointing, gesturing, or nodding (use games, toys, and age-appropriate projects), Communicate by drawing or writing (use games requiring these modalities), Talk through a recording device that is played when out of the room and then when in the room (as comfort increases), Talk to another person who speaks for the child (in front of others with increasing distance from the persons ear), Talk to others using sounds (may be blended to form words), Talk to others using rehearsed or scripted language with and without visual prompts (develop charts to play guessing games), Talks spontaneously using words or phrases. This type of therapy helps children to express themselves more easily by using toys and games. (2006). A medical doctor such as a psychiatrist or pediatrician may prescribe medications to address the underlying cause of the child being nonverbal in certain situations: anxiety. Play Therapy. The use of self-modeling as an intervention in school psychology: A case study of an elective mute. As described above, SLPs may also use augmented self-modeling, the video-based technique, with promise for reducing anxiety when speaking (Kehle, Bray, Byer-Alcorace, Theodore, & Kovac, 2011). Cline and Baldwin (1994) noted that art therapy provides a springboard for verbal communication (p. 80). Perhaps its most significant drawback is the amount of time and patience required of the counselor. Social communication bridge for selective mutism. While psychotherapy is rarely utilized as a primary mode of treatment for selective mutism today, psychodynamic projective interventions such as play, music, and art therapy are commonly utilized by counselors in conjunction with other treatment approaches. Improving Communication Ability of a Child with Selective Mutism Kehle, T. J., & Owen, S. V. (1990). Lo sentimos, la pgina que usted busca no se ha podido encontrar. For a treatment program to be effective, kids need to learn how to speak in everyday situations not just in the doctors office. Play therapy for children with selective mutism. It is important to note that the short- and long-term effects of pharmacotherapy remain unclear. American Psychiatric Association (2000). Elective mutism: Origins in stranger anxiety and selective attention. Within school settings, labels such as autistic, language delayed, defiant, or learning disabled saddle such children with inappropriate or ineffective interventions. Typically, kids with SM are mild mannered and polite in classroom settings, so their silence can be misinterpreted as shyness and never addressed as a possible barrier to their learning. The effectiveness of pharmacological interventions is perhaps one of the most widely debated issues related to this disorder. Excessive shyness, social isolation, school refusal and non-compliance may be present. (2006). In addition to the recommendations pertaining to research and the counseling profession, it is important that counselor education provide training for treating this disorder. Definition of Selective Mutism and Prevalence. Journal of Emotional and Behavioral Disorders, 16(4), 248255. Additionally, several small-scale studies have shown these types of medications to effectively treat SM. They may eventually develop poor self-esteem or suffer from social isolation. Sharkey, L., McNicholas, F., Barry, E., Begley, M., & Ahern, S. (2007). Selective mutism can cause significant impairment in a childs life. Furthermore, Amir claims that a trained music therapist can interpret music created by the child in order to establish a bridge to the childs inner world (p. 76). Selective mutism is more common among children who speak a second language. When children play with a therapist alongside, the therapists job is to help the child deepen their play and to aid their awareness of the psychological and emotional content that arises through their play. This . Tatem, D. W., & DelCampo, R. L. (1995). This type of treatment provides a step-by-step approach that can be easily modified to fit the changing needs of the child. A third group remains completely withdrawn in social settings (Amir, 2005). . Interventions aimed at achieving this goal include relaxation skills, meditation, and breathing techniques. Please click on link at bottom of this page to register or to get more information. (2016). Starting the medication at a very low dosage and increasing it very gradually has been effective in keeping side effects to a minimum and usually avoiding them altogether. Finally, selective mutism has been described by some as oppositional; however this assumption implies that mutism is a conscious choice. If a child isnt improving after a month, parents should consult with a child and adolescent psychiatrist who can prescribe medication. The counselor would subsequently aim to help family members remove conditions that are causing the childs anxiety and maintaining the mutism (Cohan et al., 2006). wanting to be alone and not talk to friends or other people. These researchers exclusively utilized positive reinforcement to successfully increase verbalizations in three different settings. These professionals will work as a team with teachers, family, and your child. Please enable it in order to use the full functionality of our website. However, switching classes doesnt always work, particularly if that is the only changethat you make. Treatment for selective mutism (SM) can include psychotherapy and medication to address the anxiety that underlies the persons inability to speak in certain situations. The expectation to talk to certain people triggers a freeze response with feelings of panic, like a bad case of stage fright. In other words, they have inherited a tendency to be anxious from one or more family members. Parent-Child Interaction Therapy Adapted for Selective Mutism (PCIT-SM) Training for Professionals | Kurtz Psychology The next training will start October 26-27, 2023 9am-5:30pm and is SOLD OUT. Cognitive strategies should be added to behavioral strategies at a point in time determined by the treatment provider. where the relative can ask direct/choice questions regarding the prop shown, Games: board games, card games (Go Fish, War), complete back/forth interview games. Journal of Child Psychology and Psychiatry 47:11, 10851097. Nordic Journal of Music Therapy, 14 (1), 6777. Selective Mutism | Psychology Today Clinical Case Studies, 6(1), 3443. Kumpulainen, K. (2002). However, according to more recent studies, children who have experienced trauma are not more likely to develop selective mutism, and early childhood trauma is rarely associated with the development of the disorder (Gray et al., 2002; Steinhausen & Juzi, 1996). Omdal, H. (2007). Psychodynamic play therapy: A case of selective mutism. Shy children, phobic adults: Nature and treatment of social phobia. Play therapy can offer a safe environment in which the counseling relationship is established without placing pressure on the child to speak (Hultquist, 1995). Selective mutism: Causes and interventions. Explore gradual exposure techniques, communication alternatives, and the therapeutic benefits of Play Therapy, empowering your child to . Systematic assessment of 50 children with selective mutism. Other Neurodevelopmental Disorders Global Developmental Delay (GDD) Cerebral Palsy Down Syndrome Dyspraxia Intellectual Disability Specific Learning Disorder (Dyslexia, Dysgraphia, Dyscalculia), Behavioural and Emotional Disorders Bipolar Disorder Conduct Disorder Depression Oppositional Defiant Disorder Separation Anxiety Disorder, Feeding Disorders Paediatric Feeding Disorder Avoidant/Restrictive Food Intake Disorder Dysphagia Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Pica), Communication Disorders Childhood-onset Fluency Disorder (Stuttering) Social (Pragmatic) Communication Disorder Language Disorder Dyslexia Aphasia Childhood Apraxia of Speech Receptive Language Expressive Language Cleft Lip and Cleft Palate Childhood Speech Delay, Vocal Disorders Speech Sound Disorders Voice Disorder Transgender and Gender Diverse Populations, Hearing Disorders Childhood Hearing Loss, Psychological Disorders Obsessive-Compulsive Disorder (OCD) Selective Mutism, Psychometric Testing and Assessments Cognitive Assessments Neurodevelopmental Assessments Learning & Academic Performance, Therapy Psychotherapy Speech Therapy Occupational Therapy Art Therapy. Children with SM can get accustomed to not speaking and thereby assume the self-image of a child who does not talk (Omdal, 2007). Research has shown that teachers involvement in the treatment process is vital to positive treatment outcomes (e.g., Kumpulainen, 2002; Lescano, 2008), yet their role in the treatment process is rarely described in the research. Too often, these children are misdiagnosed or labeled as just shy. Schwartz, Freedy, and Sheridan (2006) surveyed 27 parents having a total of 33 children with selective mutism. Psychodynamic theorists describe mutism as a defense mechanism which the child utilizes rather than expressing feelings directly towards a parent, most commonly the mother (Cline & Baldwin, 1994). Coming, We added footcups to provide passive exercise to her legs while using the trike and built a backrest to attach, Fine Motor Skills for Children Aged 6-9 Months Fine Motor Skills for Children Aged 9-12 Months, Im sure youre asking what are you talking about?. Selective Mutism Treatment: The Top 10 Options To Treat It - MantraCare B., Francis, G., Miller, L. M., & Leonard, H. L. (2004). Since levels of anxiety are likely to elevate during behavioral interventions, particularly systematic desensitization and stimulus fading, children are taught relaxation skills in order to manage anxiety before applying such techniques (Cohan et al., 2006). Treating Selective Mutism with Play Therapy - Wonders Counseling Services, LLC Treating Selective Mutism with Play Therapy Wednesday July 29 11:00 - 1:00 EASTERN time zone Description: Cunningham, C. E., McHolm, A. E., & Boyle, M. H. (2006). Selective mutism appeared in the news again the following year when it was revealed that Seung-Hui Cho, the shooter in the Virginia Tech massacre, was diagnosed with selective mutism as an adolescent (Kearney & Vecchio, 2007). Get down on the childs level and focus on a prop. Behavioral strategies, such as stimulus fading and systematic desensitization, that are implemented before healthy coping skills are established will likely increase a childs anxiety and delay further treatment. McNicholas, F., Barry, E., Begley, M., & Ahern, S. (2007). The purpose of this article is to highlight current issues related to this disorder as well as describe various treatment approaches including behavioral, cognitive-behavioral, psychodynamic, family, and pharmacological interventions. Use reflective listening and encouragement when they do speak voluntarily e.g., You explained how to play that game really clearly or you used a strong voice to ask for lunch. The more she is used to not talking in a particular setting, the more ingrained it will be. Selective mutism often starts before a child is 5 years old. However, for some families, that experience can be diminished by the fact that in some situations, their child seems completely unable to speak. In such cases, researchers may initially utilize pharmacological interventions to assist the child in overcoming anxiety associated with the disorder so that other treatments can subsequently occur. Selective mutism in children. International Journal of Play Therapy, 25(4), 203-209. https://doi.org . Finally, the results of the follow-up will be reported. Additionally, praise the childs efforts and acknowledge the difficulties. Experts dont know how many children with selective mutism will grow out of thedisorder. Most seek to increase a childs self-esteem, strengthening them emotionally by reinforcing areas of competence, belonging, and acceptance as they complete the difficult work involved in these behavioral and cognitive-behavioral therapies. According to their study, parents of selectively mute children were significantly more likely to have a history of shyness or social anxiety as compared to a control group. Creative use of feeling faces, drawings, and play materials can provide the therapist with a wealth of information. Ask open-ended questions, which require the child to think in order to formulate an answer. Vecchio, J., & Kearney, C. A. Participants will be required to complete the online quiz immediately upon conclusion of the webinar presentation in order to receive credit for contact hours. She appeared enthusiastic and interested in drawing and toys. Meyers, S. V. (1984). In order to better understand selective mutism and the treatment approaches that best minimize its associated symptoms, it is imperative that large-scale studies are conducted with a focus on the efficacy of isolated techniques. Selective Mutism Association. Ask, bribe, or beg the child to talk to you. The key with selective mutism, is that children with this disorder will speak where they feel the most safe, such as at home, among direct family members or with a close friend. 1:10 Lisa introduces the Lessons from the Playroom Series and asks for topic suggestions, 2:50 Episode 18 Lessons from the Playroom podcast, 3:25 Selective mutism as an anxiety disorder, 4:10 Mutism shows up in specific situations or around certain people, 4:45 The correlation with shyness and social anxiety, 5:30 Children may stay mute despite shame or repercussions. Only one item endorsed as very true was wets the bed. A behavioural intervention for selective mutism in an eight-year-old boy. Beare, Torgerson, and Creviston (2008) described interventions used to increase the verbal behavior of a 12-year-old boy with selective mutism. This difficulty talking lasts for at least 1 month. This allows the child to feel in control and safe from the start. Selective mutism has gained considerable national and global attention, particularly due to several magazine and professional articles recently published about this disorder. Belmont, CA: Thomson. Cognitive therapy teaches the child to understand that those thoughts are the product of worryand therefore are not real threatsand teaches them to self-coach by thinking positive thoughts instead. If you continue to use this site we will assume that you are happy with it. Evidence for effective treatment has been predominantly presented in the form of single-case studies using a variety of techniques. Using an audio or video recorder, the child speaks and answers questions within a comfortable environment. She concluded that the therapy sessions encouraged feelings of safety and served as a container and foundation where heavy feelings and emotions [could] be explored (p. 75). Elective mutism in children: A family systems approach. A child can instead express themselves through play. In general, the goal of family intervention in relation to selective mutism is to identify faulty family relationships and communication patterns that may have contributed to the development of the childs anxiety. . Follow-up was conducted with the parents 30 months after the end of treatment. A Qualitative Investigation of Guyanese American Perceptions of Mental Health, Understanding Racial Trauma: Implications for Professional Counselors, Im so #OCD: A Content Analysis of How Women Portray OCD on TikTok. Different rates apply to family or other services. Once rapport is established, anxiety reduction is a vital component of any treatment plan for selective mutism. These professionals may aid the counselor by providing regular monitoring of progress and implementation of behavioral interventions. Shipon-Blum (2007) warns that if selective mutism is left untreated, the academic, social, and emotional repercussions may include depression, social isolation, poor academic performance, self-medication with drugs and alcohol, and suicide. Shipon-Blum (2007) explains that psychological approaches are effective only when all pressure for verbalization is removed and emphasis is [placed] on helping the child relax and open up (p. 6). BIC (SWIFT- Code): BCITITMM, Chrissys mutism was indirectly treated through two main avenues: the. There is little consensus regarding the etiology of selective mutism. While a communication disorder will be apparentin all situations, symptoms of selective mutism are only noticeable in specific socialsituations. The teacher also may help to minimize anxiety while the child is in school. There will be a maximum of 40 participants and all participants must have their camera on and name clearly displayed the entire 2 hours. This may be a combination of strategies including; A behavioral treatment program may include the following: For specific speech and language problems our therapist can: Working with the childs teachers includes: Working with your child, our therapist, and teachers to generalise learned communication behaviours into other speaking situations is essential for the success of intervention. However, CBT is different from behavioral approaches because it has an additional dimension that stresses anxiety management education (Chansky, 2004). Medication is most effective when combined with behavioral and/or other psychological strategies above, especially to help the child maintain improvement over time. During these games and activities, relatives, friends, or school staff should ask the child questions. Practical guidelines for the assessment and treatment of selective mutism. For example, many selectively mute children have anxious thoughts revolving around people making fun of their voice or what they wish to say. Thus, voiceless speech sounds such as /h/ (similar to breathing), /k/ (similar to a cough), /s/, /t/, /p/, etc. Dear SM Community, This disorder remained relatively obscure until 2006 when Newsday published an article entitled Behind a Wall of Silence that described an eight year-old girls struggle with speaking at school. Check out the Selective Mutism Group/Childhood Anxiety Network on the Internet. Understanding and Treating Selective Mutism | Psychology Today Diagnostic and statistical manual of mental disorders. If left untreated the long-term impact can include complex, debilitating mental health conditions. Useful Information Baby Developmental Milestone Guide (0-5 yrs) What does a Child Psychologist Do? In a survey conducted by Schwartz et al. Other studies have cited higher rates of marital conflict and divorce among families of children with selective mutism when compared to controls (Viana, Beidel, & Rabian, 2009). Accordingly, they will feel more comfortable in being a part of situations and interacting in conversations. Most treatments, in fact, are characterized by a gradual and supportive progression from nonverbal to verbal play. Some children interact easily with peers in and outside of the home. In other settings where they dont feel as safe, like school or among adults they dont know well, they will be unable to talk. The repetition of what the individual said, if done in a very subtle way, helps him or her know that they were heard and it was not a big deal. Therefore, when repeating, eye contact should be minimized and a very nonchalant, no-big-deal attitude should be adopted. Treating Selective Mutism - Selective Mutism Association Children feel air move in and out of their mouths as they breathe, blow, and cough. Lastly, it is important that a counselor take into consideration the amount of time and patience required to implement a treatment program for selective mutism. Whileyour intention is to lessen her anxiety, this pattern of rescuing only reinforces thelikelihood that she will continue being quiet around waiters. SLPs may first work on nonverbal skills of social engagement and later include communication skills in joint activity routines. Its important that everyone in a childs life be involved with treatment because SM is adisorder that other people tend to adapt to, which can actually make it harder to treat. New York, NY: Norton. In many circumstances, parents simply wait for the child to outgrow this disorder, not realizing that the absence of proper treatment can lead to lifelong psychological problems (Shipon-Blum, 2007). Children with selective mutism typically have an extreme fear of speaking in social situations and feel paralysed by this fear. American Speech-Language-Hearing Association. Blum, N. J., Kell R. S., & Starr, H. L. (1998). Treatment of selective mutism: A best-evidence synthesis. It is logical to expect some level of social maladjustment regarding development of social relationships with peers given that children with selective mutism have limited social interactions. As the individual responds by telling his or her Verbal Intermediary, the relative should repeat what was said. American Speech-Language-Hearing Association 23:50 Howare selective mutism and fear related? Selective mutism may also continue into adulthood. If the counselor is unwilling or unable to devote such a level of time and dedication, a referral to another counseling professional with knowledge of this disorder should be provided to the client. The therapist did not want to communicate to Chrissy that she would be expected to talk. Silent children: Assessment and treatment of selective mutism. Selective mutism is described as persistent failure to speak in specific social situations (e.g., school, with playmates) where speaking is expected, despite speaking in other situations (American Psychiatric Association, 2000, p. 125). Chansky, T. E. (2004). Appear upset if the child does not respond to you. This helps children bring the speaking skills they are developing with them when they return to their real classroom. The world of the counselor: An introduction to the counseling profession (3rd ed.). Case study: Audio feedforward treatment of selective mutism. (4th ed., text rev.). Early, accurate diagnosis and intervention are crucial to overcoming selective mutism regardless of the type of treatment program. Behavioral strategies refer to coming up with a step-by-step plan where the child gradually performs increasingly difficult speaking-type behaviors coupled with positive reinforcement whenever the child accomplishes those behaviors. The author also thanks the Sciscente family (with permission) for the inspiration to write this article. Bilingual children also typically begin developing language slower. A variation of this strategy may include family members who are recorded while asking questions such as those the child might hear in school (Cline & Baldwin, 1994). In fact, the only items endorsed as somewhat or sometimes true were connected to: acts too young for her age; fears certain animals (dogs) and refuse to talk. In a case study by Sharkey et al. Explain the variance of symptom severity with SM with regard to demonstrated social skills. McHolm et al. This 2 hour live interactive online training webinar teaches a prescriptive play therapy approach to treating selective mutism based on what the research says is most effective in treating young children including a combination of child centered play therapy, lightly structured play therapy and more directive cognitive behavioral play therapy and behavioral play-based interventions based upon the symptom severity measured by observations and reports using behavioral rating scales and interview consultations. Developmental difficulties, particularly in the area of language. Diagnosing children who use a second language should be done carefully. Depending on the severity of the condition, medications may be considered to help reduce the symptoms of selective mutism. Through this approach, the primary goal of the counselor is not to directly address the mutism, but rather understand its origin (Cohen et al., 2006). In the few large-scale studies done, experts report that these medications have been very helpful and are largely safe. Teachers may assist in reinforcing behavioral treatment techniques as well. Selective Mutism is an anxiety disorder (DSM-5) and is manifested by the inability of children to talk in one or more major social situations, despite an ability to understand and speak. Selective Mutism | Vision Psychology Brisbane Aside from verbal communication, many children with selective mutism are inhibited in other ways as well (McHolm, Cunningham, & Vanier, 2005). Between the thirteenth and seventeenth sessions she began talking to her teacher and gradually to other adults. As a result, awareness is increasing while quality research on this serious disorder is scarce. As a pediatrician, several times a week, I see a patient in the office that has been flagged by their school as having some concerns, but with no clear direction in what to do next. Your childs clinician shouldprovide good strategies and advice for doing this.