Selective mutism

2949
Philip Kelley
Selective mutism

Selective mutism is characterized by an important selectivity in the occasions in which he speaks, despite a normal development in both comprehensive and expressive language.

The child speaks in circumstances that are definite and predictable. For example, it is typical for the child to talk at home or with close friends, but remain silent at school or in front of strangers..

Contents

  • Disorders and symptoms associated with selective mutism
  • Prevalence of the disorder
  • Onset and course of mutism
  • Differential Diagnosis
  • Evaluation of mutism
    • Appearance and development
    • Maintenance of silence
  • Treatment of selective mutism
    • When he does not speak to anyone in any situation
    • When you speak to someone in a situation

Disorders and symptoms associated with selective mutism

It is usually accompanied by excessive shyness, fear of social pregnancy, social isolation, "sticking" with others, compulsive traits, negativism, tantrums, or controlling behavior. The existence of some Communication Disorder is frequent. Anxiety Disorder can also be associated.

Prevalence of the disorder

It is quite rare and is found in less than 1% of clinical subjects. It is somewhat more common in women than in men.

Onset and course of mutism

It usually starts before 5 years of age but may not be diagnosed until the child enters school. Usually lasts only a few months but can sometimes last for years.

Differential Diagnosis

It differs from the Communication Disorders and the lack of knowledge of the language in which the people around them speak, because in these the lack of verbal behavior is not limited to specific situations.

Evaluation of mutism

Appearance and development

Organismic variables

  • Biological (sex, age, brain damage, neurobiochemical problems, etc.)
  • Psychological (anxiety about separation from loved ones and normal fears in certain evolutionary periods, excessive shyness, little or no experience in oral interactions with strangers, insufficient mastery of the use of language skills, other problems such as toilet training, IQ, et. )

Environmental variables. Family context

  • Modeling and transmission of information (presence of models who avoid talking with people outside the intimate environment, give instructions to avoid talking to strangers, or tell events in this behavior has had very negative consequences.
  • Educational style that reinforces avoidance or escape behaviors from situations in which the child is forced to talk to strangers, or negative stimuli are provided to the child when they do so.
  • Other variables (social isolation from the family, behavior and personality disorders in the father or mother, bilingualism, family arguments and fights, abuse, etc..

Educational context

  • Deficit or inadequate training of professionals
  • Educational style

Other contexts (immigration, hospitalization, general environmental stress).

Maintenance of silence

  • Social isolation
  • Use of alternative communication systems
  • Reinforcement of avoidance or escape behaviors (attention from adults, exemption from unpleasant tasks, facilities in the execution of others, guessing of needs)
  • Cognitive variables (evaluation of oral interaction situations, memories of past situations, etc.)
  • Psychophysiological variables (repeated association of physical feelings of anxiety with situations of oral interaction with / before strangers)

Treatment of selective mutism

When he does not speak to anyone in any situation

  • Behavior shaping until speaking to someone in the child's intimate environment begins
  • Behavior modeling
  • Response cost
  • Reinforcement sampling

When you speak to someone in a situation

  • Fainting stimulate before new people and / or new situations
  • Fainting stimulate before new people in different situations
  • Contingency control
  • Gradual exposure
  • Self-modeling filmed
  • Self-modeling filmed "tricked"
  • Reinforcement programs, up to maintenance by natural reinforcement.

All Psychological Therapies


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