Understanding Selective MutismAbbie M. Hartwick Cayuga Secondary School Abstract About 5% of children have selective mutism that’s just the ones who have been diagnosed what about the ones that are often misdiagnosed or labeled as “just shy. Selective Mutism is where one’s inability to speak in certain social situations such as school, strangers, even family members, yet they speak freely in situations where they are comfortable and relaxed. Selective Mutism is a complex anxiety disorder which is unique to each person because there’s no one same cause or signs or even treatment that occurs in people. Making it difficult to understand the subject with it being so broad and open.Cause There is little information about the cause of Selective Mutism. Early research suggested that a traumatic event was the cause of SM, this theory isn’t always right being not very one with SM had a traumatic event and if they did it’s hard to pinpoint the exact event that caused it. Another theory to the cause is the anxiety is hereditary. Thou parents aren’t directly related to the cause they are what maintains the anxiety of speaking. The best explanation is The Behavioral Conceptualization Cycles figure 1 which often occurs on a daily base with people who have SM. Whenever an adult rescues the child from their anxieties of speaking, they end up giving the child short-term relief. However, it just ends up reinforcing the negative behavior the child is exhibiting ie. Anxious and avoid the situation. showing the child whenever they feel anxious that someone will rescue them creating anxiety habit which over time will become harder to break the cycle.(add more) Signs & SymptomsOften SM goes unnoticed or is just labeled as shy because of the common traits that SM shares with shyness. However, there’s a difference between the two someone who is shy will generally respond to the question asked just in a quiet voice or in few spoken words. Yet someone who has SM are normally not able to respond to the question asked. The most common sign of SM is the mutism the inability to speak in different situations like strangers, teachers, authorities, family members yet talk freely in situations where s/he is comfortable in like their home and with parents (for me I find it a little easier to talk to women than men and people my age) To communicant in anxious situations s/he will use gestures like pulling, pushing, pointing, and nodding or s/he will cling to parent or hide. However, it’s not just mutism being exhibited often people with SM will present a stiff or frozen look (similar animal in the wild when they stand motionless with fear!) or expressionless/ blank face and nerves fidgeting is exhibit when doubt by strangers or when s/he experiences distressing. People with selective mutism are more sensitive to things going around and a harder time self-regulation (defiant, disobedient, easily frustrated, stubborn, inflexible, etc) then others would be. The behavioral characteristics of SM are moody, exhibits mood swings, crying spells. They also have a hard time with following a series of direction or staying on task, they have a need for inner control, order, and structure, and have difficulty with transitions or change. Treatment OptionsThere are a number of different ways to treat Selective Mutism and each one works differently in every situation. With SM often being timid and cautious in new situations the first step to any treatment is to lower their anxiety levels. Most therapists do this by making the atmosphere as relaxing as possible for the child usually by using toys, friends, or animals (ie. Dogs because some people say that dogs have a calming/ relaxing effect on people (Dr. Pam Struiksma, personal communication, 2012) Each different treatment focuses on a certain area of s/he’s anxiety. The most common therapy for SM is Behavioral Therapy where they focus on the problems and how to change them. To achieve this therapist, use different techniques to teach how you can change problem. An example is a rating scale (Dr. Pam Struiksma, personal communication, 2012) ie. The ladder Figure 2. Once the scale is all figured out there them able to start to reduce the anxiety and change their behaviors usually by setting up goals for s/he to achieve ie. The ladder figure 2 or stair steps figure 3 (Dr. Pam Struiksma, personal communication, 2013) Play therapy is usually a therapy for children because they focus on using the aspect of play to help the child communicate with them. Another commonly used treatment is desensitization is where they are taught a replace their fear response to a relax response ie. Nothing bad will happen this is used whenever you feel anxious about something in a selective mutism situation it’s the fear of speaking. So, you ask yourself will anything bad happen if you were to speak. (Dr. Pam Struiksma, personal communication, 2014) Cognitive behavioral therapy is centered around how your thought, feeling, and behaviors influence the situation figure 5 and how you can change the situation by changing your thoughts, feelings, and behaviors. Take the Spotlight effect its where s/he feels that everyone is watching you ever move and ridiculed, or harshly evaluated them. However, the reality is most people don’t care what’s going on around them but themselves Commonly medication is used for the last way of dealing with SM, or in dealing with adolescents because you can’t just rely on medication to help s/he anxiety. Medication is a good way to help lower the anxiety level by using Serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, Celexa, Luvox. When starting out on an (SSRIs) medication its best not to underdose, once the anxiety good level they slowly wean off of the (SSRIs). However, medication is not a permanent solution to selective mutism and there are still known things about the long-term effects it has someone. A therapist will sometimes use a mixture of therapy’s depending on the anxiety level ie. Medication, Cognitive behavioral therapy, and Behavioral Therapy. Also depending on the level of anxiety presented decide the schedule of therapy and how often s/he goes ex. Once a week, every two weeks, three weeks, four weeks and so on. However, the efficacy of the treatment depends on s/he and the parent. Impact Selective Mutism has a big impact on one’s life in some way or another, and the impact will only increase as s/he ages. The most common impact SM has on one’s life is the effect it has on their social skills ie. engaging/ interacting with others (peers, adults) and the isolation from the socialization effect the forming and maintaining friendships. Not only does it impact s/he socially, yet also effects them academically ie. Talking in front of the class, answering questions, reading aloud. As s/he ages the impact has more of an effect on them ie. Socially like relationships (dating etc.) and becomes more noticeable to others around them. (add more)Current Research & SupportThe Selective Mutism Association is a non-profit organization that is committed to offering information, research, and support to those that are affected. Another non-profit organization is the Selective Mutism Research Institute (SMRI) where their task is to help support current research, promote awareness and educate/ teach the public about Selective Mutism. There’s a number of support provide for someone with SM being a group therapy, consoling, or Psychological Services. However, there is also support educationally like The Individualized Educational Plan or known as an IEP, which is a plan that helps those with disabilities ie. certain accommodations (ex. preferential seating, assistive technology, resource room etc.) and adapted the curriculum to the certain individual. An alternative educational support is the 504 which is like a blueprint on how the school will arrange for support/ remove obstacles for the student with a disability. Unlike the IEP the 504 offer support thru accommodations (ex. the ability to leave the classroom for short amount of time, extended time on tests, homework. (add more)Conclusion ReferencesShipon-Blum, E., Dr. (n.d.). What Is Selective Mutism. Retrieved December 19, 2017, from https://selectivemutismcenter.org/whatisselectivemutism/Camposano, L. (2011). Silent Suffering: Children with Selective Mutism. The Professional Counselor: Research and Practice, 1(1), 46-56. Retrieved from http://tpcjournal.nbcc.org/wp-content/uploads/Camposano-Article.pdfSchum, R., Ph.D. (2006). Clinical Perspectives on the Treatment of Selective Mutism. The Journal of Speech and Language Pathology – Applied Behavior Analysis,, 1(2). Retrieved from http://psycnet.apa.org/fulltext/2014-51875-006.pdf Downey, J., & Busse, R. (2011 ). Selective Mutism: A Three-Tiered Approach to Prevention and Intervention. Contemporary School Psychology, 15. Retrieved from http://www.casponline.org/pdfs/pdfs/2011_journal_individual/2011_selective-mutism_53-63-b.pdf (2007). Selective Mutism. Retrieved December 19, 2017, from https://www.anxietybc.com/parenting/selective-mutism Shipon-Blum, E., Dr. (n.d.). What Is Selective Mutism. Retrieved December 19, 2017, from https://selectivemutismcenter.org/whatisselectivemutism/ C. (n.d.). ISpeak. Retrieved December 19, 2017, from http://www.ispeak.org.uk/Overview.aspx Chansky, T., Ph.D. (2004). Chapter 8: From shyness to social anxiety and selective mutism. In Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries, and Phobias (pp. 146-163). HarmonyMcCurry, C., PH.D. (2009). Chapter 1. Clinical Diagnosis and the Form of Childhood Anxiety. In Parenting Your Anxious Child with Mindfulness and Acceptance (pp. 11-33). New Harbinger. McHolm, A., Ph.D., Cunningham, C., Ph.D., & Vanier, M. (2005). Helping your child with selective mutism. New Harbinger. Smith, B. R., & Sluckin, A. (2015). Tackling selective mutism: a guide for professionals and parents. London: Jessica Kingsley.Watson, C. (2014). The girl without a voice: the true story of a terrified child whose silence spoke volumes. London: Harper Element.Kearney, C. A., Ph.D. (2011). Silence is not golden: Strategies for helping the shy child. Oxford: Oxford University Press.