A marathon behaviour modification of a selectively mute child

Anxiety in Children with Selective Mutism: A Meta-analysis

This study evaluates the current conceptualization of selective mutism (SM) as an anxiety disorder in the DSM-5 using a meta-analytic approach. In the absence of any systematic assessment of anxiety in the field of SM, we pooled prevalence data of comorbid anxiety disorders in a random-effects meta-analysis. On the basis of 22 eligible studies (N = 837), we found that 80% of the children with SM were diagnosed with an additional anxiety disorder, notably social phobia (69%). However, considerable heterogeneity was present, which remained unexplained by a priori specified moderators. The finding that SM is often diagnosed in combination with anxiety disorders, indicates that these disorders are not discrete, separable categories. Moreover, this finding does not help to elucidate the relation between SM and anxiety as an etiological mechanism or symptomatic feature. Broadening our research strategies regarding the assessment of anxiety is paramount to clarify the role of anxiety in SM, and allow for proper classification.

Interdisciplinary Treatment of a Case of Elective Mutism

Following a literature review, a severe case of elective mutism is described. A concurrent programme of individual and family therapy is then presented in detail. The treatment programme is an example of effective interdisciplinary work involving an occupational therapist and a psychologist. Behavioural and psychometric data are presented to illustrate the dramatic improvement which the electively mute child showed over the course of treatment. Finally, the probable mechanisms underpinning the child's improvement are discussed.

Innovative Analyses and Interventions in the Treatment of Selective Mutism

The authors present a successful, 25-session, multidimensional intervention for the treatment of selectivemutismin a 6-year-old male with a 1-year observational follow-up. They also include an evaluative review of the extant literature of the treatment of selective mutism from 1950 to the present. Their assessment approach utilized behavioral, cognitive, systems, and psychodynamic components. Treatment efficacy was assessed through videotaped observation of behavioral time-samples of the client during therapeutic interaction, self-report, parental report, and real-time behavioral observations at school. Results indicated a significant increase in verbal behaviors during therapy sessions, paired t(17) = 2.31, p= .033. In addition, the client was observed to be verbally interacting with peers and teachers at school at 1-year follow-up. These results suggest that the authors’ multidimensional approach to the treatment of selectivemutismmay offer a successful, brief intervention for those families in which parents decline use of pharmacotherapy in a child.

The efficacy of stimulus fading and contingency management in the treatment of elective mutism: a case study

Stimulus fading techniques were compared to those of contingency management in the treatment of a 6-yr-old, electively mute girl. Experimental periods consisted of the mother rewarding the child for verbal and motor responses to scheduled tasks, while a stranger slowly entered the room and then gradually administered the task items as mother left the room. A timeout contingency for non-response to task items was also employed. Control periods consisted of a stranger administering the same tasks to the child under the same contingencies but without the presence of the mother or the use of stimulus fading. Experimental and control periods were alternated during each treatment hour. The stimulus fading procedure was found to be a necessary component of the treatment process. While the timeout contingency for non-response was found to facilitate treatment if combined with stimulus fading, it was completely ineffective without the stimulus fading.

Elective mutism and mental retardation

The association of elective mutism and mental retardation is noted. Two cases of elective mutism associated with mental retardation are presented. Both individuals had long-standing patterns of inhibition, shyness, and anxiety manifested by general refusal to talk outside the home, particularly at school. The importance of assessment of intellectual functioning and linguistic skills for the establishment of intervention priorities and clinical management is discussed. The possibility of the presence of mental retardation in individuals with elective mutism should be considered.

Research on parent training: shortcomings and remedies

This paper reviews the research on parent training, identifies shortcomings, and recommends various remedies. We review parent training research along three general dimensions: (1) overall effectiveness, (2) differences in effectiveness attributable to certain features of the program, and (3) durability and generalization. Recommendations include using a model of human behavior that focuses on the functional behavioral repertoire, assessing additional family variables that include the child's role and participation, utilizing control and experimental groups, documenting the process of change and the family's use of community services, and using longitudinal designs that enable investigators to monitor the family's use of training materials and knowledge over a longer period of time.

Elective mutism in a first grader: the remediation of a complex behavioral problem

Teachers frequently deal with unusual and perplexing behavioral problems in their classes. This study demonstrates how spontaneous and prompted speech were produced in a six-year-old mute by a first-grade teacher and her aide. A reinforcement system for peer-prompted speech and spontaneous speech was employed in three separate school classes in a multiple-baseline fashion. The reinforcement system produced prompted and spontaneous speech in each situation. Postchecks in the second grade indicated the child was still speaking and conversing spontaneously with his peers. This study suggests a method that teachers can use in the classroom to deal with this severely handicapping condition.

Volume feedback and generalization techniques in shaping speech of an electively mute boy: a case study

An “electively mute” 12-yr.-old boy was successfully treated using positive reinforcement procedures. Visual feedback from the volume-level meter of a tape recorder was used to help in inducing sounds and to aid in raising speech volume. Various other techniques were employed to increase the rate of speech and to generalize it to a variety of environmental situations.