Selective Mutism: Effective Treatment Options And Interventions For The Silently Suffering

Selective Mutism is an extremely rare psychological disorder that is characterized by a refusal or inability to produce speech in certain situations, where verbal interaction is expected, while functioning normally in others. The etiology of this disorder is often a subject of debate, as researchers have not been able to point to a single cause for its development. Selective mutism is oftenperpetuated when others begin to compensate, in various ways, for the child’s lack of speech; in doing so, they allow the child to rationalize his behaviors and become more comfortable with his choice not to speak in public situations. Children whose psychological disorders are unidentified or untreated are often subject to more adverse short- and long-term outcomes than those who are identified andtreated. It is clear, then, why treatment for selective mutism is so imperative for the well being of those children who struggle with the challenges it brings. This paper attempts to elucidate the viability of certain treatment options, while keeping in mind how vulnerable children with this diagnosis may actually be.
Selective mutism (SM) impacts between .18% and 1.0% of the generalpopulation (Yeganeh, Beidel, & Turner, 2006). More specific prevalence rates are extremely difficult to establish due to the difficulty of diagnosis and the rarity of the disorder itself. SM is categorized as a disorder of early childhood, as age of onset is usually somewhere between 2.7 and 4.1 years of age (Viana, Beidel, & Rabian, 2008). SM appears to affect boys and girls equally (Kearney &Vecchio, 2007). Many children who come to be diagnosed with SM remain silent in school and community settings, but speak freely and fluently in the confines of their own homes. For the diagnosis of selective mutism to meet DSM-IV criteria, the ability to comprehend and produce spoken language is present, and mutism symptoms must persist for a minimum of one month (Omdal, 2007). Other issues, such ascommunication disorders, language acquisition delays and pervasive developmental disorders, must be ruled out before steps can be taken to address the SM diagnosis (Viana, et al., 2008). Interventions and treatment efforts for this disorder are particularly vital due to the unremitting nature of its associated symptoms. Selective mutism is not a disorder that children seem to “grow out of” ontheir own accord; therefore, it is essential that appropriate treatment options and intervention plans be identified, studied, assessed and supported (Harris, 1996).
Selective mutism is commonly associated with anxiety disorders, specifically social anxiety and social phobia. It has been theorized that SM is an extreme form of social phobia that manifests itself in early childhood as a result ofboth genetic and environmental factors. The majority of children who are diagnosed with the disorder also meet the DSM-IV criteria for social phobia, including avoidance of social and performance situations, social inhibition, sadness and/or loneliness: a fact that has caused much speculation about the etiology of selective mutism. The high rates of comorbidity between selectively mute andsocially phobic disorders has led many researchers to hypothesize that intense social distress is the fundamental cause of mute behavior (Yeganeh et al., 2006). It is important that research provide us with a more comprehensive understanding of the relationship between these two disorders, to avoid erroneously grouping them together. Many psychologists have launched interventions for their SMpatients that closely resemble those appropriate for social phobia; the issue with that practice, however, is that treatments for social phobia may not adequately address symptoms of selective mutism. Studies have shown that blind judges commonly rate selectively mute children as much less socially competent and much more anxious in social situations than those diagnosed with social phobia (Yeganeh...