W4 - Selective Mutism

Question 1

What is selective mutism?

Answer 1

Selective mutism is periods of no speech through choice, rather than physical inability.

It is typically setting dependent.

ICD-10:

> Elective mutism is characterised by emotionally selective speaking, whereby the child competently communicates in some situations but not in others. It is typically associated with social anxiety, withdrawal or resistance.

Question 2

What is the DSM-5 definition of selective mutism?

Answer 2

Classes selective mutism as an anxiety disorder.

1. A consistent failure to speak in specific social situations despite speaking in other situations.
2. The disturbance interferes with educational and social functioning.
3. The duration is at least 1 month (not limited to the 1st month of school)
4. Not due to a lack of knowledge of, or comfort with the spoken language required in the social situation.
5. Not better accounted for by another condition, eg: dysfluency, and is not occurring as part of a pervasive communication disorder.

Question 3

What are the symptoms of anxiety particularly associated with selective mutism?

Answer 3

• Lack of eye-contact/facial expression
• ‘naughty’
• Fidgety
• Displays avoidance strategies
• Physical tension present in the body and face
• Appears helpless
• No self-help strategies for new/difficult situations

Question 4

What are the predisposing factors for selective mutism?

Answer 4

• Family history of shyness
• Family history of SM
• Family history of psychiatic conditions
• Pre-existing anxiety

Question 5

What are the precipitating factors (external) for selective mutism?

Answer 5

• Frequent moves/migration
• Self-awareness of S&L difficulties
• Bullying/teasing

Question 6

What are the perpetuating factors (preventing resolution) of selective mutism?

Answer 6

• Inappropriate management
• Over acceptance (not doing anything)
• Negative models of communication

Question 7

What are the (potential) impacts of selective mutism?

Answer 7

Academic:

underachieving * misinterpretation of cognitive abilities * misplacement within schools

Social Development:

school refusal * social isolation * social withdrawal

Emotional Development:

impacted self-esteem and confidence * anxiety * impact on family and other relationships

Question 8

What is the role of an SLT in cases of selective mutism?

Answer 8

Aim to:

• Minimise the negative impact for the child
• Prevent the situation worsening
• Prevent the behaviour becoming an inherent part of their being
• Preventing repetitive ineffective attempts to elicit speech
• Prevent the child developing a non-speaking role
• Minimise the emotional and physical drain on the adults around the child
• Offer opportunities to speak that aren’t demands