SELECTIVE MUTISM
Selective mutism is a complex anxiety disorder that affects pragmatic language. This diagnosis is made when:
• The child shows consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school), despite speaking in other situations.
• The lack of verbal communication interferes with educational or occupational achievement or with social communication.
• The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
The onset of selective mutism typically occurs between 3 and 6 years of age.
• The child is generally able to speak to familiar people who they are comfortable with in familiar settings.
• With the same familiar person, the child may be verbal in one setting but mute in another setting.
• Within the same setting, the child may be verbal with some people but mute with others or may be mute during specific anxiety-producing activities (e.g., reading out loud, music class).
• Performance is most difficult when there is an expectation for speaking (mostly at school).
Early intervention for selective mutism is key to remediation. Structured interventions are useful such as:
Exposure based practice
Systematic desensitisation
Stimulus fading
Contingency management
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