Treatment for Children with Selective Mutism: An Integrative Behavioral Approach
Selective Mutism (SM) is an impairing behavioral condition in which a child fails to speak in certain social situations despite speaking regularly and normally in other situations. SM presents a significant mental and public health problem due to impact on the social, emotional, and academic functioning of young children at a critical point in their development. SM is closely related to childhood social phobia, but it cannot be treated in the same way because of the young age of the children affected, their lack of speech in the treatment setting, and the need for significant school involvement in treatment. Treatment for Children with Selective Mutism outlines the sequence and essential elements to guide clinicians through a comprehensive, integrated program for young children who display symptoms of SM. This approach utilizes behavioral interventions targeting gradual increases in speaking across settings in which the child initially has difficulty. The integrated nature of the therapy refers to the goal of incorporating input from the clinician with that from the parents and teacher, as well as others impacted by the lack of speech. Exposure exercises are based on behavioral techniques such as stimulus fading, shaping, and systematic desensitization that also allow for a less intense or gradual exposure to the speaking situation. These techniques are combined and used flexibly with a behavioral reward system for participation in treatment. The approach was developed by Dr. R. Lindsey Bergman as part of the UCLA Childhood OCD, Anxiety, and Tic Disorders Program. The treatment protocol consists of 20 sessions, 60 minutes each, delivered over the course of 24 weeks. Treatment for Children with Selective Mutism is an invaluable guide for mental health professionals who deliver CBT-based treatment to children and want to help those with SM.
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Chapter 1 Introductory Information for Therapists
Chapter 2 Pretreatment Assessment and Psychoeducation ParentOnly Session
Introduction to Treatment and Rapport Building
Rapport Building Reward System Feelings Chart
Class Chart Talking Ladder Exposure Practice
Initial Exposure Sessions
Treatment Midpoint Session
Intermediate Exposure Sessions
Continued Exposure and Introduction of Transfer of Control
Continued Exposure With Additional Focus on Transfer of Control
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____________________________M/F ___________________________M/F ____________________________M/F ___________________________M/F ____________________________M/F ___________________________M/F activities appropriate assignments with parents attempt avoid speech binder or notebook Category fill-in child and write child speaks children with SM classroom comorbid decided in session develop difficult Discuss assignments disorder Exposure Assignment Form exposure exercises exposure hierarchy Form Assignment binder functioning in home Homework Form photocopy in-session behavioral exposures in-session exposures interventions involve lack of speech Manassis manual Materials Needed Outline medication ment Name:________________________M/F Name:________________________M/F Name:________________________M/F parents and child participation Past Week Review peers photocopy from Appendix play positive occurrence Review general events Review homework Review of Homework reward system Seldom Never Selective Mutism significant environmental events Situation Rating Form SM symptoms social anxiety social phobia speaking behaviors speaking in situations specific SSRI systematic desensitization teacher Therapist Note therapy room transfer of control treatment of SM treatment program Weekly Homework Form