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

Abstract

Although much of this literature is limited by methodological weaknesses, the existing research provides support for the use of behavioral and cognitive-behavioral interventions. Multimodal treatments also appear promising, but the essential components of these interventions have yet to be established. An outline of a cognitive-behavioral treatment package for a typical SM child is provided and the review concludes with suggestions for future research.

Assessment and Treatment of Anxiety Disorders in Children and Adolescents

“…Until evidence from comparative studies is Cognitive restructuring of anxious thoughts when away from caregivers Parents and school work together to address school refusal Behavioral strategies to shape and extinguish tantrums, irritability, physical resistance Parent training to increase child's independent functioning GAD [44] Relaxation techniques to target physical symptoms of anxiety Cognitive restructuring to challenge persistent and general worries Practice problem solving to prepare for worry in real life situations Social phobia [45,46] Social skills training and practicing in group setting Live exposure sessions in social situations Increased social opportunities Peer generalization component with nonanxious peers Specific phobia [47] Induction of muscle relaxation Development of fear-producing stimulus hierarchy Systematic, graduated pairing of items on hierarchy with relaxation Panic disorder [48] Psychoeducation about physiologic processes that result in physical symptoms Progressive muscle relaxation, breathing retraining, cue-controlled relaxation Cognitive coping Gradual exposure to agoraphobic situations Interoceptive exposures (exposure to physical sensations of panic) for anxiety about future panic attacks Selective mutism with social phobia [49,50] Behavioral interventions in multimodal approach Positive reinforcement of nonverbal (pointing and participation) and verbal behaviors and communication (mouthing words, whispering, speaking in soft voice) Anxiety reduction Social skills training available to inform clinical practice, treatment of children with anxiety disorders of mild severity and associated with minimal impairment can begin with psychotherapy. Combination treatment with medication and psychotherapy may be necessary in children with moderate to severe anxiety for acute symptom reduction, concurrent treatment of a comorbid disorder, partial response to psychotherapy alone, and potential for improved outcome with combined treatment [30].…”

Social anxiety disorder: questions and answers for the DSM-V

“…Based on the outcome of single-case experimental studies, behavioral interventions in the form of contingency management, shaping, stimulus fading, systematic desensitization, and self-modeling appear efficacious (e.g., [114,116,117] ). The efficacy of cognitive interventions for SM is less clear, [114] perhaps due to the young age of the sample.…”

“…Four excellent reviews [93,103,114,115] indicate that (a) methodological weaknesses in study designs limit the confidence that can be placed in the extant intervention outcome data, and (b) most investigations are limited to case studies. Based on the outcome of single-case experimental studies, behavioral interventions in the form of contingency management, shaping, stimulus fading, systematic desensitization, and self-modeling appear efficacious (e.g., [114,116,117] ). The efficacy of cognitive interventions for SM is less clear, [114] perhaps due to the young age of the sample.…”

Selektiver Mutismus bei mehrsprachigen Kindern

“…Konsequenterweise lässt sich ebenso nicht die eine Ursache für das Schweigen benennen, sondern es wird von einer multifaktoriellen Ätiologie ausgegangen (Cohan, Price et al, 2006). Kristensen (2000) Kinder mit SM (n = 54) Kontrollkinder (n = 108) Zur Erklärung des SM ziehen einige Autoren ein Diathese-Stress-Modell heran (Bahr, 2006;Cohan, Chavira et al, 2006;Cohan, Price et al, 2006;Elizur & Perednik, 2003;Hartmann, 1997). Diathese-Stress-Modelle nehmen eine Prädisposition oder Vulnerabilität für eine bestimmte Störung an-die so genannte Diathese (Ingram & Luxton, 2005 (Ingram & Luxton, 2005).…”

“…Mehrsprachig schweigend: n Eltern = 11, n Geschwister = 6; einsprachig schweigend: n Mutter = 7, n Vater = 6, n Geschwister = 3; mehrsprachig sprechend: n Eltern = 3, n Geschwister = 2; einsprachig sprechend: n Eltern = 8, n Geschwister = 5 (Cohan, Chavira et al, 2006). Der…”