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An electronic communication device for selective mutism
... Nach dem gleichen Prinzip funktioniert auch das visuelle Feedforward, bei dem die Szenen per Video aufgenommen werden (Holmbeck & Lavigne, 1992;Kehle, Owen, & Cressy, 1990;Pigott & Gonzales, 1987). Beim elektronischen Feedforward benötigt das betroffene Kind eine elektronische Kommunikationshilfe. Auf Tastendruck antwortet dann seine eigene Stimme mit einer Begrüßung, Zustimmung, Ablehnung oder etwas Ähnlichem (Kee, Fung, & Ang, 2001). ...
... If the child is mute, the therapist offers the parents two alternatives: to record the messages at home on the home computer and bring it on a memory device, or to record the messages on an audiotape, which can be transferred to the computer in the clinic. This is a treatment procedure adapted from a report using an augmentative communication device [26]. The idea is to allow the child to hear his or her own voice and thus be desensitized to speaking in various situations. ...
Introduction: Cognitive behavioral therapy (CBT) approaches have shown promise for some children with Selective Mutism (SM), but to date there are limited published randomized controlled trials (RCT) of CBT interventions for SM. We present findings from a pilot RCT of the Meeky Mouse program, a 14-week web-based CBT program for children with SM. Method: A total of 21 children (6-12 years old) with a primary diagnosis of SM from a child psychiatric outpatient clinic were included in this study. They were randomly assigned to either 14 weeks of the Meeky Mouse program (n=10) or to a control condition in which they interacted with the therapist while playing computer games (n=11). Results: No significant group differences were found on anxiety symptoms. The control group showed significant improvements from pre- to post-treatment on total frequency of speech. Children in the Meeky Mouse group showed greater improvements in clinician-rated severity of mental illness and had higher clinician-rated improvement scores relative to those in the control group. Conclusions: Findings from our pilot RCT study suggest that the web-based CBT using anxiety management strategies may be no different from an intervention that involves regular monitoring of child’s engagement in socializing activities for improving SM symptoms. Further study is needed to determine optimal strategies for treating children with SM with the use of web-based applications.
... In session 8, a personal computer program called the "Meeky Soundpad" is introduced. This is based on an earlier idea (Kee et al., 2001) which allows the child to record short messages that can be replayed during the session, allowing the child to hear his or her voice and be desensitized to speaking in various situations. B.P.H. initially hesitated in performing simple tasks, but he became more enthusiastic as his typing speed improved. ...
There is little research on inclusion of children with selective mutism in school/kindergarten. Moreover, few studies have tried to understand selectively mute children’s interactions in the natural surroundings of their home and school/kindergarten. Five children meeting the DSM‐IV criteria for selective mutism were video‐observed in social interactions in kindergarten/school and at home. Their parents and the staff in kindergarten/school took part in semi‐structured interviews. Themes arising from the data were: (1) assessment by the school/kindergarten; (2) interactions in the classroom/kindergarten: inadvertent maintenance of mute behaviour; (3) interactions in the classroom/kindergarten: overcoming selective mutism; (4) school/kindergarten contacts with parents; and (5) tensions in cooperation between home and kindergarten/school. Kindergartens/schools that succeeded in including children with selective mutism found that the child started to speak after a year with encouragement and gentle support from adults and other children. In those cases where the children maintained their selectively mute behaviour, teachers and other children either accepted their refusal to speak and their exclusion of themselves, or selectively reinforced the maladaptive behaviour.
Im vorliegenden Fallbericht wird die erfolgreiche Behandlung eines 17-jährigen Jugendlichen mit einem seit 10 Jahren bestehendem elektiven Mutismus dargestellt. Nach einer zusammenfassenden Darstellung der in der neueren Literatur berichteten Therapieansätze bei elektivem Mutismus werden das in diesem Fall verfolgte Behandlungskonzept mit sorgfältiger Diagnostik der komorbiden Störungen, der Motivationsarbeit zur Therapie, der kognitiv-verhaltenstherapeutischen Maßnahmen mit unterstützender medikamentöser Intervention sowie der intensiven Zusammenarbeit mit den pädagogischen Bezugspersonen und Einbezug der Eltern berichtet.
Selective mutism is an unusual but intriguing condition with a reputation for being particularly intractable to intervention. Originally described as ‘elective mutism’, selective mutism is a heterogeneous disorder associated with a number of individual and family factors including developmental disorders/delay; particular temperamental and personality characteristics; and other co-morbid symptoms and psychiatric disorders. Considered by some in the past as an oppositional disorder, it is the proposal that SM might be a childhood manifestation of an anxiety disorder such as social phobia that has influenced recent developments in the use of behavioural and drug interventions.
Background:
Selective mutism (SM) is now widely seen as a symptom of social anxiety. However, observations of children's interactions in the natural contexts of home and school/kindergarten suggest that this may be in need of review.
Method:
Data were available from two sources: first, interviews with six adults who had recovered from SM in childhood and adolescence; second, informal observations of five SM children in home and school/kindergarten, and semi-structured interviews with their parents and teachers. The research had three stages: (i) Data were examined for the presence of social anxiety and/or determined or stubborn behaviour, but neither provided a satisfactory explanation for the SM. (ii) The data suggested that SM could be reconceptualised as a specific phobia of their own speech. It is argued that if this is the case, SM should respond to intervention at school based broadly on a cognitive behaviour therapy methodology. (iii) A post hoc examination of observation and interview transcripts was used to test this hypothesis.
Results:
(i) Apart from two adults, no evidence was found of social anxiety. Determined and stubborn behaviour was observed but was inadequate as an explanation of SM. (ii) Two children recovered when exposed to classroom interactions that could be seen as consistent with the principles of graded in vivo flooding. Three children who were not exposed to similar interactions did not improve.
Conclusions:
SM may be understood and treated successfully at school/kindergarten as a specific phobia of expressive speech.
De huidige stand van zaken omtrent selectief mutisme wordt beschreven. Uit het grote aantal publicaties blijkt dat er evenveel
uiteenlopende verklaringen als behandelvormen zijn. Recente onderzoeken wijzen echter steeds meer op het verband tussen selectief
mutisme en angststoornissen bij kinderen. Deze ontwikkeling biedt de mogelijkheid om in de behandeling van selectief mutisme
aan te sluiten bij die behandelingsstrategieën die effectief zijn gebleken bij angststoornissen. Dit wordt toegelicht aan
de hand van de overwegingen en uitgangspunten die aan een door de auteurs ontwikkeld behandelprotocol ten grondslag liggen.
selective mutism-childhood anxiety disorders-treatment protocol
The present case report describes the successful treatment of a 17 year old male adolescent suffering for 10 years from selective mutism. Following a summary review of recent publications on therapy approaches, the report describes the treatment concept in the present case, including detailed assessment of co-morbid disorders, motivation for change, behaviour therapy with supporting drug intervention, and intensive co-operation with parents and other caretakers.
Selective mutism is the persistent failure of a child to speak in a
specific social situation where speaking is expected, despite normal
or near-normal speech in other situations. Selective mutism is
not a rare disorder, with an estimated prevalence of between 2/
10,000 and 70/10,000 school-age children. Until recently,
selective mutism was considered difficult to treat and even
``intractable'' , requiring a variety of treatments such as
behavioral techniques, psychodynamic approaches and combina-
tions of family, art and speech therapies. However, the
conceptual basis of selective mutism has changed, the consensus
being that social phobia and anxiety components are the major, or
at least important, etiologic factors. This concept bears
important pharmacotherapy implications. Since only
one article has been published in the general English-language
literature on the etiologic and therapeutic issues of selective
mutism, we would like to draw particular attention to the
pharmacotherapy ± of major importance in the management of
selective mutism.
Elective mutism is a rare disorder of communication, where the child speaks fluently in familiar situations, such as home, despite lack of speech in less familiar settings, for example school. A variety of temperamental and behaviour characteristics, co-morbid psychiatric conditions, neurodevelopmental delay and family factors have been associated with the disorder. EM children are described as excessively shy, withdrawn, 'slow to warm up', inhibited, often avoid eye contact, fear social embarrassment and experience significant separation anxiety, on separation from their attachment figures. Their behaviour is often perceived by others as controlling and oppositional. Onset of EM is typically in early childhood years. A number of constitutional and environmental factors have been considered in its onset, progression and response to intervention. Treatment is generally considered to be multimodal, and occurs in a variety of settings, including home and school. Longterm studies suggest that communication difficulties may extend into adulthood. In addition, outcome studies showing a high rate of phobic disorders suggest that EM may be a developmental precursor of adult social phobia. This article reviews the literature on EM, its presentation, aetiology, epidemiology and the various evidence based biopsychosocial treatments.
To examine the relationship between the syndromes of elective mutism and social phobia, a case of elective mutism associated with social phobia in a 12-year-old girl is presented, and the clinical literature regarding the syndrome of elective mutism is reviewed. Elective mutism or reluctance to speak in unfamiliar social situations may be a symptom of social phobia. Social anxiety is a nearly universal characteristic of children manifesting the syndrome of elective mutism. Elective mutism may respond to treatment with medications that also are effective in the treatment of social phobia. Elective mutism may be a manifestation of social phobia rather than a separate diagnostic syndrome. Pharmacologic treatment may be effective.
To examine the relationship between the syndromes of elective mutism and social phobia, a case of elective mutism associated with social phobia in a 12-year-old girl is presented, and the clinical literature regarding the syndrome of elective mutism is reviewed. Elective mutism or reluctance to speak in unfamiliar social situations may be a symptom of social phobia. Social anxiety is a nearly universal characteristic of children manifesting the syndrome of elective mutism. Elective mutism may respond to treatment with medications that also are effective in the treatment of social phobia. Elective mutism may be a manifestation of social phobia rather than a separate diagnostic syndrome. Pharmacologic treatment may be effective.
Elective mutism represents a relatively rare clinical syndrome in which children with normal verbal capabilities totally refuse to speak in select settings for prolonged periods of time. It is often described as particularly treatment resistant. This study describes 20 strictly diagnosed elective mutes treated, using the Hawthorn Center approach. As found in other studies, most of the elective mutes in this sample (90%) were described as controlling, negative, or oppositional, and a high rate (50%) of maternal-child overenmeshment was found. Treatment outcome using the Hawthorn Center approach was found to be at least fair for all cases and excellent for 85%.
The relationship between selective mutism (SM) and childhood anxiety disorders is illustrated through an examination of their temperamental, environmental, and biological etiologies. SM is also explored as a symptom of the specific anxiety disorders of social phobia, separation anxiety, and posttraumatic stress disorder. The etiology and symptom overlap demonstrates SM as being an anxiety disorder or a variant of a specific anxiety disorder. The conceptualization of SM as an anxiety disorder is helpful in effectively treating afflicted children. There is enough evidence in the current literature to challenge the current classification, from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders of SM as an Other Disorder of Infancy, Childhood, and Adolescence.
To assess the comorbidity of developmental disorder/delay in children with selective mutism (SM) and to assess other comorbid symptoms such as anxiety, enuresis, and encopresis.
Subjects with SM and their matched controls were evaluated by a comprehensive assessment of the child and by means of a parental structured diagnostic interview with focus on developmental history. Diagnoses were made according to DSM-IV.
A total of 54 children with SM and 108 control children were evaluated. Of the children with SM, 68.5% met the criteria for a diagnosis reflecting developmental disorder/delay compared with 13.0% in the control group. The criteria for any anxiety diagnosis were met by 74.1% in the SM group and for an elimination disorder by 31.5% versus 7.4% and 9.3%, respectively, in the control group. In the SM group, 46.3% of the children met the criteria for both an anxiety diagnosis and a diagnosis reflecting developmental disorder/delay versus 0.9% in the controls.
SM is associated with developmental disorder/delay nearly as frequently as with anxiety disorders. The mutism may conceal developmental problems in children with SM. Children with SM often meet diagnostic criteria for both a developmental and an anxiety disorder.
Selective mutism and comorbidity with developmental disorder, anxiety disorder, and elimination disorder Historically, drug treatment of Tourette's syndrome (TS) had limited or nonexistent results, until the advent of the neurolep-tics, which had a distinctly higher range of effectiveness
- Quetiapine For Tourette 's Syndrome To
- Editor
H (2000), Selective mutism and comorbidity with developmental disorder, anxiety disorder, and elimination disorder. J Am Acad Child Adolesc Psychiatry 39:249–256 QUETIAPINE FOR TOURETTE'S SYNDROME To the Editor: Historically, drug treatment of Tourette's syndrome (TS) had limited or nonexistent results, until the advent of the neurolep-tics, which had a distinctly higher range of effectiveness. Even LETTERS TO THE EDITOR J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 40:4, APRIL 2001