Selective Mutism
Practical Guidelines for the Assessment and Treatment of Selective Mutism
SARA P. DOW, B.A., BARBARA. C. SONIES, PH_D.. DONNA SCHEIB, M.S_C.CC.lS.P-, SHARON E. MOSS, PH.D" AND HENRlETT A L. LgONARD, M.D.
ABSTRACT Objective: To provide practical guidelines for the assessment and treatment of children with selective mutism, in light of the recent hypotnesis that selective mutism might be best conceptualized as a childhood anxiety disorder. Method: An extensive literature review was completed on the phenomenology, evaluation, and treatment of children with selective mutism. Additional recommendations were based on clinical experience from the authors' selective mutism clinic. Results: No systematic studies of the phenomenology of children with selective mutism were found. Reports described diverse and primarily noncontrolled treatment approaches with minimal follow-up information. Assessment and treatment options for selective mutism are presented, based on new hypotheses that focus on the anxiety component of this disorder. Ongoing research suggests a role for behavior modification and pharmacotherapy similar to the approaches used for adults with social phobia. Conclusion: Selectively mute children deserve a comprehensive evaluation to identify primary and comorbid problems that might require treatment. A school-based multidisciplinary individualized treatment plan is recommended, involving the combined effort of teachers, clinicians, and parents with home- and clinic- based interventions (individual and family psychotherapy, pharmacotherapy) as required. J. Am. Acad. Child Ado/esc. Psychiatry, 1995, 34, 7:836-846. Key Words: selective (or
SARA P. DOW, B.A., BARBARA. C. SONIES, PH_D.. DONNA SCHEIB, M.S_C.CC.lS.P-, SHARON E. MOSS, PH.D" AND HENRlETT A L. LgONARD, M.D.
ABSTRACT Objective: To provide practical guidelines for the assessment and treatment of children with selective mutism, in light of the recent hypotnesis that selective mutism might be best conceptualized as a childhood anxiety disorder. Method: An extensive literature review was completed on the phenomenology, evaluation, and treatment of children with selective mutism. Additional recommendations were based on clinical experience from the authors' selective mutism clinic. Results: No systematic studies of the phenomenology of children with selective mutism were found. Reports described diverse and primarily noncontrolled treatment approaches with minimal follow-up information. Assessment and treatment options for selective mutism are presented, based on new hypotheses that focus on the anxiety component of this disorder. Ongoing research suggests a role for behavior modification and pharmacotherapy similar to the approaches used for adults with social phobia. Conclusion: Selectively mute children deserve a comprehensive evaluation to identify primary and comorbid problems that might require treatment. A school-based multidisciplinary individualized treatment plan is recommended, involving the combined effort of teachers, clinicians, and parents with home- and clinic- based interventions (individual and family psychotherapy, pharmacotherapy) as required. J. Am. Acad. Child Ado/esc. Psychiatry, 1995, 34, 7:836-846. Key Words: selective (or