Selective Mutism: A Three-Tiered Approach to Prevention and Intervention
Busse, R. T., Downey, Jenna, Contemporary School Psychology
Selective mutism is a rare anxiety disorder that prevents a child from speaking at school or other community settings, and can be detrimental to a child's social development. School psychologists can play an important role in the prevention and treatment of selective mutism. As an advocate for students, school psychologists can work with teachers, parent caregivers, speech pathologists, and other support staff toward helping children who may develop or have selective mutism. The purpose of this article is to present school-based prevention and intervention approaches within a three-tiered approach that may reduce the incidence and severity of selective mutism. We present theories and research on the etiology and prevalence of the disorder, followed by a review of intervention methods and research at each tier. Based on the theoretical and research literature base, we conclude that early intervention may result in the prevention and amelioration of many occurrences of selective mutism.
KEYWORDS: Selective Mutism, Childhood Anxiety Disorders, Social Phobia, Prevention, Treatment
The purpose of this article is to present school-based prevention and intervention approaches within a three-tiered approach that may reduce the prevalence and severity of selective mutism. Children with selective mutism (SM) experience a "consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations" (American Psychiatric Association [APA], 2000, p. 78). To be diagnosed with SM, a child's lack of speech: a) must last for at least one month, excluding the first month of school; b) must interfere with educational or occupational achievement or with social communication; c) cannot be due to any lack of knowledge or discomfort with the spoken language; and d) cannot solely be due to a communication disorder, pervasive developmental disorder, schizophrenia, or any other psychotic disorder (APA, 2000).
Selective mutism is widely characterized as a disorder primarily linked with social anxiety (Bergman, Piacentini, & McCracken, 2002; Chavira, Shipon-Blum, Hitchcock, Cohan, & Stein, 2007; Ford, Sladeczek, Carlson, & Kratochwill, 1998; Kratochwill, 1981; Stone, Kratochwill, Sladeczek, & Serlin, 2002). SM often can be confused with other speech issues, such as the silent period some children experience when learning a second language, the absence of speech due to aphasia or deafness, or the absence of speech sometimes associated with autism (Cline & Baldwin, 2004). The primary characteristic that differentiates this disorder from related conditions is that children who experience SM usually speak freely in other environments, and their failure to speak usually occurs at school (Leonard & Dow, 1995).
Not speaking in school may hinder a child's academic performance and social development in particular, although more research needs to be conducted on the short and long term negative consequences of SM. Not surprisingly, the short-term effects have been found to include heightened anxiety and social skills deficits (e.g., Bergman, et al., 2002; Cunningham, McColm, & Boyle, 2006; Ford, et al., 1998). The long-term effects of SM have been infrequently studied, with two well-controlled studies indicating that the majority of cases remitted without intervention, however young adults with former selective mutism described themselves as less independent and having more social problems than controls (Rcmschmidt, Poller, Herpetz-Dahlmann, Hennighausen, & Gutcnbrunncr, 2001; Steinhausen, Wächter, Laimbock, & Mctzkc, 2006). Furthermore, many cases of SM persist if not treated (Crundwell, 2006; Ford, et al. 1998; Stone, et al., 2002), which indicates the need for intervention. Interventions with SM are especially important in elementary schools, because the majority of cases are first identified in preschool or kindergarten (Leonard & Dow, 1995; Stone, et al, 2002). …