Study Notes on Selective Mutism (SM)

Selective Mutism (SM)

  • Definition and Classification

    • Selective mutism is classified under anxiety disorders in DSM-5.
    • It is defined as a rare childhood disorder characterized by a lack of speech in one or more social settings where speaking is expected.
    • The lack of speech is not due to:
    • A lack of knowledge of spoken language.
    • Physical difficulties affecting speech.
    • Another disorder, such as autism spectrum disorder, that impairs communication.

  • Characteristics of Selective Mutism

    • The term "selective" indicates that children may speak in certain environments (e.g., home) but not in others (e.g., school).
    • For a diagnosis of SM, the lack of speech must occur for more than one month and should not be limited to the first month of school.

  • Association with Social Anxiety

    • Evidence suggests a strong correlation between SM and social anxiety disorder (SAD):
    • High rates of comorbidity exist between the two conditions.
    • A study by Dummit et al. (1997) found that nearly 100% of 50 examined children with selective mutism also met criteria for SAD.
    • Buzzella, Ehrenreich-May, & Pincus (2011) found more significant social anxiety levels in children with SM compared to a matched control group without SM.

  • Prevalence

    • Approximately 0.5% of children are estimated to have SM.
    • The condition tends to affect girls more than boys (Kumpulainen, 2002; Viana, Beidal, & Rabian, 2009).

  • Emergence of Symptoms

    • The specific symptom of lack of speech in certain situations is not entirely understood.
    • Research suggests that parents may unintentionally enable this behavior by intervening and speaking on behalf of their children (Buzzella et al., 2011).

  • Treatment Approaches

    • Treatment employs cognitive behavioral principles that are effective in addressing social anxiety in children, with a greater focus on speech development (Carpenter et al., 2014).
    • An example of a specialized treatment program is the "Boston University Brave Buddies Camp," designed for children aged four to eight diagnosed with SM or those who have difficulty speaking in social or school situations:
    • The program lasts one week and involves guided interaction with peers and adults, classroom-like activities, field trips, and socialization games promoting verbal participation, termed "brave talking."
    • Behavioral interventions used in the program include:
      • Modeling: Demonstrating appropriate behaviors.
      • Stimulus fading: Gradually introducing speaking situations.
      • Shaping: Reinforcing closer approximations to the desired behavior.
    • A behavioral reward system is implemented to encourage treatment participation (Sacks et al., 2011; Furr et al., 2012).

  • Results and Accessibility

    • Positive outcomes have been observed from this program, with 80% of 15 participating children successfully initiating speech and maintaining productivity at a two-year follow-up.
    • Unfortunately, such specialized programs are currently not widely available.