When to intervene in selective mutism: The multimodal treatment of a case of persistent selective mutism

Abstract

An identification and treatment model differentiating Transient from Persistent Selective Mutism is proposed. The model incorporates treatment recommendations for Persistent Selective Mutism and suggests that interventions are not usually warranted for Transient Selective Mutism. The case study of a 6-year-old female manifesting Persistent Selective Mutism is presented. A multimodal treatment approach combining behavioral techniques with play therapy and family involvement was applied to improve her verbal interactions. Pre-and posttreatment evaluations were conducted. During pretreatment evaluations the child was manifesting Persistent Selective Mutism, immaturity, and withdrawal behaviors. At posttreatment evaluations she was talking in a manner consistent with her peers without problematic behaviors displayed. Results of a &month follow-up completed after the child had entered first grade showed that she was continuing to speak in a manner consistent with her peers without behavioral concerns.

Practitioner Review: Psychosocial interventions for children with selective mutism: a critical evaluation of the literature from 1990–2005

“…Moldan (2005) developed a multimodal treatment that includes stimulus fading, play therapy, parent training, and a socialization group based on her conceptualization that SM results from a child's ‘attempt to self‐regulate internal anxiety and other emotional states’ (p. 292). Powell and Dalley (1995) used a variety of behavioral techniques (contingency management, shaping, self‐modeling, stimulus fading) in addition to ongoing play therapy sessions with the school psychologist to treat a six‐year‐old girl with persistent SM. After six months of treatment and at six‐month follow‐up the child was speaking in school in a manner consistent with her peers.…”

“…(1998) cautioned that several SM children in their study were unwilling to record an audiotape. In some cases listening to edited audiotapes actually increases the child's anxiety about speaking, making this intervention unsuitable for a certain segment of the SM population (Powell & Dalley, 1995). Since self‐modeling has often been combined with other behavioral techniques like positive reinforcement and stimulus fading, the extent to which it can be considered a stand‐alone intervention remains unknown.…”

Selective Mutism The implications of current research for the practice of educational psychologists

“…The concern expressed by Lumb and Wolff (1988) was that most studies did not give a justification for interventions, but were merely implemented because the child's behaviour was difficult to understand and was frustrating adults. As Powell and Dalley (1995) point out, one needs to balance the impact of the non-speaking behaviour with the child's overall development, such as factors like social adjustment and the inability to interact fully in various aspects of home or school. Gravell and France (1991) found that it is extremely rare for children above the age of 10 years to be identified as having selective mutism.…”

The use of play for assessment and therapy: the case of a child with selective mutism

“…Moldan (2005) developed a multimodal treatment that includes stimulus fading, play therapy, parent training, and a socialisation group based on her conceptualisation that SM results from a child's 'attempt to self-regulate internal anxiety and other emotional states ' (p. 292). Powell and Dalley (1995) used a variety of behavioural techniques (contingency management, shaping, self-modelling, and stimulus fading) in addition to ongoing play therapy sessions with the school psychologist to treat a six-year-old girl with persistent SM. Jackson, Allen, Boothe, Nava, and Coates (2005) used a combination of systematic desensitisation, shaping, relaxation training, parent journaling, and play therapy to treat a six-year-old boy with SM.…”